“What’s the nature of the therapeutic relationship? It’s complicated!”
Everyone Wants To Know (Or Do They?)
The therapeutic relationship is complicated. I have been on both sides of the counselling scenario (as both a client and psychotherapist). These are two entirely different points of view. As challenging as the task might be, I want to address both perspectives in this, “tell all” confessional.
I have to admit, as a client many years back, I remember often being curious about what my therapist thought about me. A bit self-absorbed, eh? Moreover, I wanted to know how they acted in their personal life. Was there congruence between the persona they portrayed in the session, compared to their engagement in real life?
Flashing forward many years, I came to understand that working as a therapists is a bit like walking through a vast field, desperately attempting to not disturb the tall grass as you gently move forward. Clients ask personal questions. Knowing how to respond requires thoughtfulness; your answer must always be to their benefit and not your own.
On the rare occasion when I have chosen to answer a personal question (with measure), the response from clients is always the same – They listen, pause for a moment to ponder, and quickly move on. I have come to believe that clients are curious, but actually do not want to know.
But, why? My theory is that it messes with the scheme they have built up around you as a therapist, a schema that is functionally helpful to the client.
Enter The Therapist’s Confessional
Clients should know more about the mysterious internal mechanisms driving the therapeutic relationship, even though it might create discomfort. I believe that it is important to pull the veil back in order to provide insight into the nature of the work. Relationships are complicated and bidirectional, even between the counsellor and the individual seeking help.
Psychotherapy is a service offered to anyone willing and able to engage. Entering a session for the first time is the initial step in a unique relationship guided by ethics and rules of conduct that most do not understand. While this article does not attempt to tackle every nuance of the work we do as mental health professionals, it does attempt to provide a basic framework of how therapists conceptualize their work and the clients they work with.
The Definition Of, “Client”
There is no braver soul than the individual seeking support through psychotherapy. Becoming a client requires that you have accepted the status quo is no longer adaptive. You feel a mysterious tug towards something better, deeper, with clarity. You enter with an understanding that sharing is required, and that you might feel compelled to reveal the never spoken. Becoming a client means entering a relationship, even though you tell yourself initially that you are only seeking information.
The Therapeutic Journey
Whether you are seeking help for depression, or want to learn techniques for improving anxiety symptoms, the counselling process is a journey created by engaging with a trained therapist. The journey is often described as a, “…joint process of exploration and reflection” (Thorne, 2007). Carl Rogers (1957), in his person-centred approach, identified seven stages in the counselling process:
- Rigidity: Client’s present with calculated intellectual expression and a low rate of emotional disclosure.
- Other Person Focus – Opening Up: Client begins to disclose their situation in greater detail, mostly with a focus on other people.
- Intellectualizing: Client becomes deeply expressive but intellectualizes difficult personal experience.
- Emerging Feelings From Past: Client now talks openly about personal emotions, but centred in the past.
- Free Emotional Expression: Client is now able to talk about present emotions in the session while seeing connections to past experience.
- Acceptance and Pivot: Client sees a path for change and is now action oriented.
- Independence: Client is less reliant on therapist and individuates.
*Note that in Carl Rogers’ original work, he does not distinctly label the above stages. Consider the labels here as suggestions to the broader context.
Whether you subscribe to the work by Rogers, or another theory identifying the unique process, the therapeutic experience has a specific order. Oftentimes, individuals initiate therapy seeking advice and information. Clients quickly learn that counselling is a dynamic experience designed to elicit a future path informed by personal experience and wisdom.
As of mid-2018, I have been a clinician for almost 21 years. My career is varied with a wide range of experiences, each enhancing my professional development. Over the years, I have gained a few personal insights about psychotherapy and the counseling process, insights that most clinicians might agree with:
- Psychotherapy is spiritual work. We engage in an interpersonal dance designed to help the client deep dive into their own intra-personal dynamics. This journey sees every individual as engaging in that process, one way or another, leading to improved life satisfaction and happiness.
- The process cannot be rushed. Time is the client’s best friend. It is a gift if you are able to work in an environment allowing for unlimited sessions and return clients. With the advent of HMOs, limits are tightly set. If you work in the public sector, caseloads are so high that it is challenging to not set some sort of session limit.
- Be absolutely absorbed into your own personal development. Insight is gained through experience. As a clinician, you quickly learn how little you know about other people and yourself. Growth in this area never ends.
- Pain is universal. Your clients initially have a difficult time articulating the similarity between their pain and that experienced by others. It is easily intellectualize, but poorly understood or acknowledged.
- Difficult clients become our teachers. We all enjoy a caseload of clients eager to dive into self-exploration. Challenging cases are those with clients who are externally fixated and resist feedback. Moreover, they keep coming back, even though you perceive the sessions as going horribly. There is a wealth of information and learning to be had with clients you dread seeing.
Perfectionists Never Last
Early in counsellor education, two types of clinicians emerge – Those that are not encumbered, and those who fret the details. Both are eager to perform and seek approval from their supervisors. However, the later gets caught up in perfectionism.
The problem is that perfectionism in psychotherapists leads to anxious psychotherapist. Clients seek and find every nuance in our verbal and non-verbal communication. It is important to reduce perfectionistic tendencies in order to be fully present with the client. Your session is not time to work through agenda items. They are an opportunity to meet the client in their place if pain, and joy.
My Four (4) Driving Principles
Over time, every therapist develops a personalized set of core understandings and beliefs driving their work. In the following list, I describe four principles that I have acquired over time, both as part of my clinical practice, and working in administration. All four inform my decision making and the conversations I have with fellow therapists, especially as part of supervision.
1- Interpersonal Process: The theories guiding practice are vast. During my internship in graduate school, I adopted Interpersonal Process Psychotherapy (IPP) theory as a way to understand the clinical relationship, especially as it relates to early patterns and intra-personal congruence.
In short, IPP promotes the understanding that clients are reacting to you in ways informed by their own childhood and early adult experiences. Your response to their reactions is critical in breaking old patters of interpersonal interactions with others that become particularly maladaptive in adulthood.
2- Reducing Harm: The goal of every interaction with clients, especially as it relates to the field of substance misuse, is to reduce the harms associated with their behaviour. It is critical to approach clients from the perspective that their behaviour is unlikely to change regardless of my personal opinion. Simply put, “Let go of control.” Your role is to be present, not change their behaviour. Only the client can accomplish that.
3- Readiness Is King: Meet clients where they are at. Remember that water is nature’s greatest solvent. Gently suggest and guide within the parameters of the client’s readiness for change. Be equipped with the research by Miller and Rollnick in their book, “Motivational Interviewing.”
Know the difference between the pre-contemplative client, and those ready for action. Never get caught into the trap of believing that you can only do meaningful work when clients are ready. Everything leading to this point is groundwork for reducing harm and relationship building.
4- Understand Type: Acknowledge that over time there will be many personality types presenting to your office. There is no such reality as a therapist that likes every client walking through the door. Instead, equip yourself with a firm understanding in the Myers-Briggs Type Indicator (MBTI).
The MBTI provides a pathway to understanding and respect. You are not a blank slate. We react to the differences sitting in front of us. Understanding type means that you see the other personality as valid and with meaning. You start to look for their contributions, regardless of their difference to you.
Your Willingness To Grow
We hope that you have found some useful content in this telling confessional. The above insights were designed to talk directly to the client, and fellow therapists on their own professional journey. Both client and therapists present to the therapeutic scene with an eagerness to engage. The greater our openness to engage, the better the outcome. It is the client’s responsibility to physically show-up. It is the clinicians responsibility to emotionally, and spiritually, do the same.
There is an overwhelming lack of available content designed to reveal the internal mechanisms of the psychotherapeutic process. If you are an avid podcasted, check-out, “Other Peoples Problems,” produced by the CBC. Also, don’t forget about the Finding My Psych Podcast associated with this site!