The Improbable Therapeutic Relationship

Jordache Williams | Therapy | Fields of Knowledge

How does a therapist appear inviting, even friendly, when they don’t know who you are?  When you don’t know them?  How do they encourage you to tell them every single deep, dark secret in your life?  How can you tell them things you have never told anyone else?

MYTH: If I see a therapist, I will have to tell them things I don’t want to share with anyone.

TRUTH: Effective therapy does not always consist of digging into your past.  If this is something you are worried about, it’s simply not a valid excuse for avoiding counseling services.  However, since this is a common practice in several models of therapy, it is best to share your concerns with any potential therapist early in the process.  This allows the clinician to determine if they are skilled to work within your comfort zone.

For more myths, take a look at Margaria Tartakovsky’s Therapists Spill: 11 Myths About Therapy.

What things effect you prior to your first therapeutic encounter with a particular therapist?

Past experiences with therapy.  “I’ve tried this before and it didn’t work.”  Whether you have bad, or even good, recollections of past therapeutic encounters, these expectations may prove to be obstacles in your current effort.

Baggage being brought to therapy.  The intensity of the presenting problem(s) at the time you arrive is likely heightened.  The final straw has landed on the camel’s back, so to speak.

Starting over.  You may feel like you already know your problems and having to relay information about them requires starting back at step one.

The journey to the office.  Most people experience anxiety in some form or fashion—bad traffic, you’re running late, or the simple fact you’re missing work (i.e. “Things are going to pile up before I get back” or “I need that money”).

Paperwork.  The amount of paperwork you fill out beforehand and how much or what type of information is requested may leave an impression.

Fees.  You are anticipating paying for a service in some form or fashion, which you are not entirely sure is worth it.

So what happens when you see the therapist for the first time?

You’re looking to be wowed.  You’re evaluating the environment, the therapist’s clothes, and the way they present themselves.  You expect their presentation to be on point, and you expect to see several framed degrees perfectly positioned on the wall.  In a way, you want to feel better by simply being in their presence.

You’re looking for them to be relatable.  You make judgements based on things you perceive: race, ethnicity, mannerisms, and level of attractiveness.  You’re looking for any religious symbology in the office, a golf bag in the corner, maybe photos of their family.

Ultimately how do you know if you and a particular therapist are a match?

The therapist’s experience.  It is your right to ask the clinician if they have experience working with clients of your race, gender, and general perspective.  It’s a good idea to ask if they have experience assisting others with issues similar to yours.

Observation.  Evaluate whether the therapist appears to show genuine concern and a willingness to be present in the moment.  Understand that therapists must inform you of their experience and credentials but they are not required to pontificate.

Are they “working?”  Oftentimes, therapist don’t work by doing all of the talking.  In most settings, if therapy is going well, you are the one doing the majority of the work.  Therapist work may include: enabling you to express yourself openly, asking questions you can’t answer with one word, using words you have introduced into the session, and asking how you feel about certain things you describe.

You leave with a shopping bag.  When you walk away you may leave some things behind, but you should also exit understanding what you should be doing prior to your next appointment.  Whether or not the counselor has specifically told you to do something (i.e. homework) or you’ve gained a certain clarity, you should feel like you have work to do.

Here are a few things you may have to get over—they may not mean what you perceive them to mean.

The therapist doesn’t stand to greet you, they don’t walk you out, they don’t shake your hand or hug you, they don’t open doors for you, they sit beside you, they don’t sit beside you, they offer you drinks or snacks, they look at you over the top of their glasses, they write notes while you talk, or they type on a computer during the session or intake process.

The point is, that it’s okay to not like everything about a therapist.  While most clinicians have been trained in some form or fashion on cultural competence, you must understand that each client is different and most of the time a counselor is just being themselves.  Many times, if you ask about a particular nuance which bothers you, the clinician may be able to make accommodations for you.  If things aren’t adding up for you as the client, express yourself, and make a determination on whether you would like to continue seeking the services of that particular therapist.

The more important point is that you should not write-off the mental health industry because of one bad experience (or several for that matter).  For more information on how therapists may differ, take a look at Therapists Differ and so do Their Approaches.

Finally…

It is an expectation of therapists to establish trust.  Many do this well which creates an unrealistic view of the splendor of its accomplishment.  Factors exist outside of the control of the clinician, but others they do direct: the physical environment, the way they dress, talk, act, and present themselves, and sometimes the administrative processes.  As interaction increases, the use of “I” statements, being present in the moment, active listening, rapport building, joining, and even the manner they orchestrate therapeutic transitions can all affect trust.  It’s difficult in itself to build someone’s trust in you, because trust is a personal process—they’ve just met you.  Trust is more probable over time and through shared experiences.  If there are barriers to trust based on superficial things such as gender and race, these barriers can only be overcome through conversation—conversation which is relatable.  Finding common ground may be an effective way, in the early stages of counseling, to achieve trust.  This can be done through acknowledging similarities and the clinician proving motivational.  Establishing individualized and agreeable goals as well as serving as a beacon of hope, also assist the formation of a therapeutic alliance.  When you land across the room from a therapist for the first time, understand the number one objective may very well be the establishment of a relationship between the two of you.  Engaging this process with an open mind is one of the best things you can do to get the most from the experience.

Additional resources:

Rosen, D. C., Nakash, O., & Alegría, M. (2016). The impact of computer use on therapeutic alliance and continuance in care during the mental health intake. Psychotherapy, 53(1), 117-123. doi:10.1037/pst0000022

Smith-Hansen, L. (2016). The therapeutic alliance: From correlational studies to training models. Journal of Psychotherapy Integration, 26(3), 217-229. doi:10.1037/int0000012

Wiarda, N. R., McMinn, M. R., Peterson, M. A., & Gregor, J. A. (2014). Use of technology for note taking and therapeutic alliance. Psychotherapy, 51(3), 443-446. doi:10.1037/a0035075


Jordache Williams

Jordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

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