What produces progress for one client may rupture the relationship with another. If you don't have the habit of carefully studying your clients' facial expressions and physical posture so that you can adjust the depth and pace of therapeutic exploration, you run the risk of being in the position of the therapists described in the previous examples, who acted as if they were completely unaware of their clients' internal reactions to therapy.
Connecting by Staying in the Present
The question of what the client is showing at the moment and how to use it to form a connection covers a broad set of dynamics. When developing a new relationship, people naturally seek out those who seem capable of understanding and accepting them. This validation can occur at the level of thoughts, feelings, or actions. If this validation doesn't occur on at least one level, then seemingly "helpful" interventions can harm the therapeutic alliance.
For instance, at the level of thoughts, if a client believes he's unworthy of love and the new therapist argues that this belief is incorrect, the client isn't likely to feel greater self-acceptance, but rather, misunderstood, as if his thoughts don't matter. Instead, the therapist should be willing to listen quietly and convey openness to whatever the client is saying, without starting a discourse about "dysfunctional cognitions." At the affective level, if a client feels utterly depressed about a particular event and the new therapist responds with a positive emotional tone, the client may feel uncomfortable with his own emotion and more reluctant to express it. At the behavioral level, if the client shares a great deal of personal information and the new therapist responds to questions about him- or herself by refusing to disclose anything, the client may feel that he's in an unfair, hierarchical relationship with an aloof, unbending therapist. He may even feel subtly humiliated by the interaction.
Rather than assuming that there's one correct way to greet all new clients, I try to determine what I can do to make the first visit less stressful for each individual. I've responded to adolescents who said they didn't want to talk by doing all of the talking myself—at least during the first visit. I've responded to others who didn't want to talk and were tired of listening too, by suggesting that they close their eyes and silently collect their thoughts as we sat quietly. When clients experience the therapeutic relationship as a good fit, more energy is available for personal problem-solving and collaborative involvement. In addition to being the primary vehicle for the delivery of care, the strength of the therapeutic relationship—from the very first session—is the best predictor of outcome success. Or as experts in impression management have noted, "As it begins, so shall it end."
Dan Short, Ph.D., a clinical psychologist and trainer in Ericksonian hypnosis, specializes in brief treatment of recalcitrant problems. He's the lead author of Hope & Resiliency: Understanding the Therapeutic Strategies of Milton Erickson. Contact: firstname.lastname@example.org; website: www.iamdrshort.com.
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