Saturday, April 16, 2011

The Therapy Relationship {{ Guest Post }}

Hi, I’m Sally, your guest blogger for this Saturday.  Today I’m going to write about what I have found makes a good therapeutic relationship, understanding that people have different needs in some areas and have to consider what truly works best for them.  I want to acknowledge all the people who contributed to this thread on WeBiteBack {{ EDITOR'S NOTE by Kat: WeBiteBack is a recovery based forum that Sally is a member of }}, and that I am not so much the writer, as the compiler of this information.  Nonetheless, I’d like to dedicate my blog entry to C., who was the first person who helped me learn what a therapeutic relationship was like.

A good relationship with a therapist can be critical to your recovery efforts, if you have access to one. A mediocre therapist or relationship will take you nowhere, except to their office every week or two. Below are some of the things that have been important to me and to others.

One caveat: this post won’t help you at all with finding a therapist; it is intended just to give you some things to think about when you are selecting a therapist.

Trust. I can’t emphasize enough that you need to feel a sense of trust which allows you to be honest with your therapist.  After a series of bad experiences with therapists (not always their faults, either), I had serious trust issues when I was assigned to C.  When we decided to work together, I told her that I needed to talk about trust, and we spent three sessions just doing that, how to build it, her commitments to me about how she would behave in our relationship, how we would work together to set goals, and her limits.  She listened to me, and remained professional but empathetic about some of my earlier therapists and made commitments to me that would avoid similar situations arising again. 

Respect. This goes hand in hand with trust: that you respect your therapist and that she or he respects you.  This is manifested by many things, including, being on time for appointments, being prepared, acknowledging that you are your own expert while challenging you when appropriate.

A friendly relationship. After my bad experiences with other therapists, I wanted to be liked. I did not want to be the seemingly nasty person who couldn’t seem to make therapy work. C. told me that she likes me and she likes working with me.  She shows that she cares about me, and that makes me feel good.  Some people are less interested in this, and don’t really want to know much about their therapist, or prefer to keep a really clear delineation between the professional, therapeutic, and the personal.  It’s really about your needs, although I would say stay open to all options in this area.

Your therapist is on your side. C. fights for me with other treatment professionals I may be seeing, to the extent that it has been mentioned how committed she is to me.  That’s not to say that she is blindly following me down a rabbit hole, but that when we agree that I need or would benefit from something, she chases it down until she gets it.

Your therapist reads the client.  A good therapist knows your "tells" - when you’re feeling uncomfortable or nervous or having a hard time with something.  My therapist reminds me about my body. When I talk to her in high emotion, she slows me down and gets me to tell me what I am feeling in my body. I am realising that the body also has part of the story to tell. 

Non-judgmentalism. A therapist should listen without judgment and respond without judgment.  At the same time, a therapist should not be afraid to push the client when appropriate, and to ask tough questions. A good therapist may make you feel uncomfortable when necessary to deal with tough issues, but never makes you feel unsafe.

Validation. This goes with being non-judgmental.  There are no right or wrong feelings, and a therapist should validate all feelings, even while allowing space to challenge them.

Involvement. This issue goes two ways.  Some people find that they are more comfortable with a therapist who is emotionally detached and doesn’t get involved in what you’re experiencing or feel your pain for you.  Other people want their therapist to empathise and feel their pain.  And you may have to experiment to see what works for you.  I always thought that I didn't want a therapist to feel my pain with or for me, one reason why I stuck with a specific therapist for two years, because he was never “touched” by anything I told him.  I am now with a therapist who wholeheartedly acknowledges my pain, and sometimes her own pain for me, and we have done more in a few months that I did in two years with my other therapist.

Assess situations as they are happening.  A therapist should recognize your limits, know when to let a highly emotive issue be, know when to engage and respond, and when to listen.  A therapist should know when to raise issues from the past, and when to deal with the here and now, and even when to be talking about the future.

Challenge.  Therapists should challenge clients when necessary, even while remaining respectful, validating and non-judgmental.  But they need to have the skills to challenge effectively and conversely, you need to have enough trust in your therapist to be challenged and respond honestly and openly about hard issues.

Goal-setting.  It helps when you work with your therapist to set short, medium and long-term goals, and to revisit those goals periodically to make sure that they are still valid or to adjust them for changes in circumstance.

Listening and believing.  Your therapist is there to hear your story and to believe you and believe in you.  It’s hard to develop trust if you feel your therapist isn’t hearing or believing you.

You are unique.  Your therapist shouldn’t assume that you are going to need what other people have needed, even in similar circumstances. 

Your therapist is an active participant in your treatment team, and may even be the one who pulls it all together.  She or he is respectful of everyone on your treatment team, and is willing to help with problem resolution in a positive and helpful way.

Readiness.  It should go without saying that your therapist should be on time and prepared for your appointments, have your file at the ready and be ready to get to work.  It feels very invalidating to be sitting in a waiting room, often surrounded by people you find triggering, and to finally get in to you appointment only to find that your therapist has not prepared for the appointment and is “winging” it.  In this circumstance, use your voice.  Say how it affects you.

A lot of this comes across as therapist-focused.  But it’s not really.  You need to approach your therapist with trust, honesty, respect, and be willing to use your voice to describe your issues and your needs.  You need to also learn non-judgmentalism, particularly concerning yourself, and to go to appointments in a state of readiness and open to being challenged.

In closing, I liked this quote from one of the wonderful contributors to this thread on WBB:

“They were down to earth, and didn't expect miracles. But they still reminded me of my potential and focussed on the positive and the good work I was doing.”

{{ EDITOR'S NOTE by Kat: What are your thoughts on what the Therapy Relationship should be like?? }}

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