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TALKING THE WALK AND WALKING THE TALK (PART 2)

In my last post I discussed the idea that a good therapist has two jobs: first, to create a functional, connected relationship, and second, to gradually address and resolve the client’s problems. In this post I’ll attempt to identify some of the relationship skills that a therapist uses to builds and maintains an effective therapeutic relationship. To be clear, this is an enormous issue - a gazillion books are written on the subject. The following ideas are clearly subjective and personal - different therapists work in different ways, and what I’ll describe here emerges from my own ways of working.

, the founder of client-centered therapy, proposed that three core conditions were needed for good therapy: unconditional positive regard, congruence, and empathy. At this point in my career (13 years of work), I’d honor that list and propose the following five: a) Non-judgmental assessment; b) Validating; c) being Optimistic and Empowering; d) being Realistic; and e) being Congruent/Funny. NON-JUDGMENT: The therapeutic relationship depends on an absence of judgement. When we judge someone, what we’re doing is assessing them moralistically (e.g. (a parent berating a teenager for cutting herself; an anxious person hating herself for avoiding a doctor’s appointment), and by doing so, we become a threat to their identity. Judgements are generally toxic in healthy relationships; they distort the power dynamic, and generate despair, anxiety, shame, and resentment. [NOTE: Non-judgement is not the same as acceptance. I once saw a client who told me she’d hit her boyfriend then called the police and told them he’d hit her, which led to his getting arrested. I said “You must really feel guilty.” She said that she’d seen other therapists who tried to make her feel better by offering understanding of her behavior, but that she really liked I had been realistic (and confrontational). What I said wasn’t a judgement: she had betrayed her boyfriend and her own values, and thus naturally felt guilt. She didn’t like the emotion, but she had earned it, and she was wiling (for awhile) to try to fix the situation.] VALIDATING: Validation is the expression of empathy - communicating understanding to that person. It’s telling a person that their present function (thoughts, feelings, behaviors) make sense given their history, and that what they’re doing is fundamentally normal/human (the underlying message being: “you’re not crazy”). Validation helps to create a soothing effect by decreasing hidden feelings of panic and shame that serve to drive problematic behavior, and, get in the way of feeling liked, or loved. (for more on validation see for “Six Levels of Validation” ). OPTIMISM/EMPOWERMENT: A good therapist maintains an optimistic attitude towards the client’s ability to find ways to create change, either internally or externally (see the next section for how to respond when change is not possible). The balancing act is to maintain optimism about change AND validate the reality that a person might have limited options/means. Helping a person create change means helping them identify and activate their own sense of power, no matter how small it might be. By taking the client seriously - and being affected by them - a good therapist shows them their relational power, their ability to impact others. I also believe that a good therapist can teach the client about reinforcement, especially when the client has a tendency to only see their failures, and never their successes. BEING REALISTIC: A good therapist realistically recognizes that change is not always possible, and that in many situations, the client is going to suffer. I believe - and there is considerable evidence for this - that life IS often unfair, cruel, confusing, etc, and there’s nothing we can do to change it. When I teach the idea of “Distress Tolerance,” I often tell people that no matter what they do, they’re going to suffer - their decision is whether to suffer well (by accepting suffering) or suffer badly (by not accepting suffering, and lashing out at self and others in unhelpful ways). Just about everyone has heard of the Serenity Prayer: “God, grant me the serenity to accept the things I cannot change/ The courage to change the things I can / And the wisdom to know the difference.” What a good therapist does, therefore, is try to help the client find wisdom. IRREVERENT/FUNNY: The therapeutic process is often very serious, given the high stakes of what’s discussed - suicidality, depression, family and love problems, trauma, addiction etc. Having said that, I believe that a vibrant therapeutic relationship often features some healthy irreverence (defined as "showing a lack of respect for people or things that are generally taken seriously”). It’s good for the client to see the therapist as a fellow human - with faults and foibles, imperfect and in ways, like them. Irreverence is a crucial way in which the relationship itself can reduce the shame that so many people come to therapy with - seeing themselves - tragically and incorrectly - as terrible, or crazy, or bad.

 

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