Partnership within Therapy

How a Coaching Approach Can Promote Faster Change

Lynn Grodzki

Imagine you’re learning to ride a bike and you’ve asked two people to help: a therapist and a coach. The therapist might stand off to the side, closely observing your attempt to stay upright. She’d be empathic, compassionate when you fall, and give you useful insights about why you’re a little unstable and wobbly. She’d help you express your feelings or frustration about your struggle to move forward on two wheels, and maybe explore why you waited so long to try. Over time, your riding skills would improve as you developed more confidence, armed with new insight and awareness.

The coach, however, would climb on the seat right behind you and ask, “Where do you want to go today?”

This is an exaggeration, of course, but the difference in role is clear. Having a coach right behind you, an ally guiding you and the bike as you both pedal along together, is an example of coaching collaboration. The coach and client work together through intense partnership. Rather than observing from a neutral distance, a coach is at your back, keeping you motivated to continue riding until you can do it on your own, like a pro. You’re in the steering position, and her only agenda is to get you where you wish to go, in the fastest, most focused manner possible.

At its best, this collaborative position can reduce the friction of hierarchy and promote faster behavioral change. You may have experienced it with a fitness coach who’s run alongside you as you’ve jogged around a track. Or perhaps you had a tutor who sat right next to you, shoulder to shoulder, sharing calculations, as you tried to work through an algebra problem. Having a coach at your side, or at your back, can help you go faster and try harder than if you’re being observed by a distant expert.

Partnership within Therapy

When I began to develop the Therapy with a Coaching Edge model, I found that some coaching elements fit into therapy easily, while others challenged therapeutic norms and needed modification. So I spent a few years defining a set of distinctly adapted coaching skills for use within therapy sessions, then I thought hard about who was “coachable” within therapy.

Bringing in a coaching style required identifying the therapy clients who could accept and benefit from a directive, action-oriented, short-term method, versus vulnerable clients who’d find this approach too exacting. For clients who seemed to be a fit for this approach, I experimented with formatting sessions to make them more strategic, with a distinct beginning, middle, and end that ensured there was time to both set goals and consolidate gains.

The coaching strategy of commenting openly on progress as it occurs translated well into therapy. I slowed down and paused a session to highlight client results—a new insight, cognition, expression of affect, demonstrated strength, or moment of honest self-reflection. Rather than merely observing signs of their development, I prompted clients to give their session takeaways, and if they came up blank, I asked if I could share what I’d be putting in my notes. Soon clients began to recognize and verbalize their own markers of forward movement in therapy, session by session.

Yet the success of these strategies hinged on incorporating the coaching element of collaborative partnership, which also presented the biggest complication. Therapy is traditionally hierarchical for many good reasons. Could the power of a nonhierarchical partnership—being on the back seat of the bike—be adapted for a therapeutic relationship without compromising its integrity? Would working more transparently and directly with a client help or hurt the goal of therapy?

The more I considered it, the more I saw how a reduction in hierarchy and working “close in” could grease the wheels of motivation. I longed to replicate some of that leverage or ability to boost action within therapy, but wondered how to translate partnership ethically for therapy professionals. Was it possible? I concluded that with enough careful attention to respecting the distinctive boundaries of a therapeutic relationship, enhancing collaboration between client and therapist can add an important dimension to the therapy. In many cases, I saw that it could result in helping clients take action faster, with more behavioral compliance.

Taking the Lead

In my early training as a psychodynamic therapist and a social worker, I was taught that my primary role was to follow, not lead. I let the client begin a session. That meant I’d start a session in silence, so as not to influence or bias the client in any way. My client could talk or not talk; I wouldn’t influence or interrupt. I let a client take the lead and watched as the session unfolded, sometimes in confusion if a client wasn’t sure how therapy worked or what to do.

Unlike the blank demeanor that I was taught, Therapy with a Coaching Edge encourages therapists to take some leadership, at certain times, as a way to offer collaboration. Don’t stay neutral and force a client to flounder. Help out the process; ensure that it goes well. Use skills to shape a session agenda, to give it structure and a dynamic flow that promotes more results. Rather than allow a client to devolve into long narratives off topic, help them follow a plan. Ask effective, pointed, even powerful questions when it would help to pick up the pace. Take responsibility to keep the session organized and relevant.

Upholding Boundaries

Shifting to a less hierarchical, more collaborative relationship as a therapist might worry those who’ve been trained in models that are intentionally neutral to protect therapeutic and ethical boundaries. I’ve sat through many ethics workshops during 30 years of practice as a clinical social worker, and I respect the rationale for keeping clear boundaries between therapist and client. But discussions of boundaries aren’t always black and white, or exacting in their application. If you want to adopt a coaching approach and a partnership position but don’t find it natural to the way you currently work, it’s important to proceed slowly and, of course, adhere to all the ethical requirements of your licensure.

To better understand the shades of gray in situational ethics, when applying a new persona to your practice, I like the distinction psychologist Ofer Zur makes between boundary crossings—clinically effective interventions such as self-disclosure, home visits, client touch in the form of handshakes, or a nonsexual pat on the back—and boundary violations—when therapists cross the line of decency, violate or exploit their clients sexually, financially, or in other unethical ways, including misusing dual relationships.

Some therapists wonder whether the two roles—that of therapist and coach—can be combined with a single client. Is it possible to switch roles and be a client’s therapist and then, later on, her coach? If it’s sequential, or there’s a break between the contracts, is it permitted? I’m of the firm belief that the roles of therapist and coach for a client are distinct and need to be kept separate. Even though I use a model of therapy with adapted coaching skills, when I practice as a therapist, I stay in that role.

Both coaching and therapeutic work have the potential to be profoundly helpful to different kinds of clients with different issues, at different stages in their journey. But professionals with training in both modalities must be aware of the strengths and limitations of each and not imagine that it’s possible to seamlessly shift back and forth between defining themselves as a coach or a therapist without confusing their clients and giving into the illusion that they can be all things to all people who come to them for help.

***

This blog is excerpted from the article, "Translating Coaching Into Therapy," by Lynn Grodzki. The full version is available in the July/August 2018 issue, "When Depression Comes Back: Going Beyond the Limits of Therapy."

Read more FREE articles like this on Professional Development.

Or, find articles just like this one in our Archives on the new, enhanced Networker mobile app! Click here for more details

Want to read more articles like this? Subscribe to Psychotherapy Networker Today!  >>

Illustration © Brian Jensen

Topic: Professional Development

Tags: 2018 | Alliances | boundaries | boundary issues | coaching | ethical boundaries | healthy boundaries | Lynn Grodzki | partners | partnerships | Personal & Professional Development | personal boundaries | professional boundaries | professional coaching | Professional Development | rapport | therapeutic alliance | therapists as coaches | therapy coaching

Comments - (existing users please login first)
Your email address will not be published. Required fields are marked *

*
*
*