In Consultation Jan/Feb - Page 3


I used these reactions as a cue to search for a different way of relating, hoping to connect with a less defensive aspect of his character. Given his low tolerance for emotional experience, I turned down the heat on anything remotely emotional and changed my language from comments about "my concerns" and "his potential" to concrete remarks about keeping a "productive focus" and "meeting established goals"—less like therapy and more like a motivational business meeting.

I noted a reduction in tension and resistance almost immediately. The less effort I made to connect personally, the more Joseph relaxed and allowed connection. By going slower, we arrived faster. Eventually, Joseph became comfortable enough that I could gently confront him with the need to make a choice between "having fun"—engaging me in argumentative banter—or actually meeting his goals for therapy.

3. Closely monitor your clients' anxiety level.

The best barometer of therapeutic responsiveness is clients' anxiety level. Anxiety is like the tip of an iceberg. We may not know what lies below the surface, but sensitively monitoring clients' discomfort will provide a guide for how to proceed. Alter your approach as needed to keep anxiety in an optimal range: too little and clients aren't motivated; too much and they get overwhelmed and defensive.

Sue, a middle-aged woman with a long history of self-defeating behavior, suffered from severe depression and feelings of inadequacy. As a child, she'd been physically abused and devalued. My personality and training led me to maintain a more distant relationship, offering little of my personal self. Thus, when Sue would sink into helplessness and hopelessness, I'd explore, dispassionately, the related internal dynamics and conflicts. These explorations proved fruitless, and I noticed an increasing anxiety, frustration, and even confusion on her part. As I experimented by offering more personal reactions, I noted a reduction in anxiety and a deepening of rapport. Expressions of compassion for her suffering and admiration for her courage in addressing such difficult childhood experiences seemed to compensate for her inability to offer these feelings to herself. Unlike Joseph, who needed less therapeutic emotion, Sue needed more emotional connection than I'd been giving. She didn't need to hide or guard herself: she needed to be understood explicitly and validated in a deeply emotional way.

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