When it comes to making progress in therapy, the most important agent of change is the relationship between therapist and client. This is stunning really–that when a client is faced with the serious nature of depression or anxiety or another illness that it may not be medication or an evidence-based model of therapy that best determines the outcome of their treatment, but rather the quality of the relationship in the therapy room.
Occasionally I have clients who come to me after trying out other therapists in our community, and typically the client seeks out a new relationship not because of ethical disagreements or doubts about their therapist’s competence, but because the fit just isn’t right. Some common complaints from clients during their search for the right therapist: “she didn’t talk much and she just nodded her head as I spoke; he was just too academic and determined to talk to me about the science of treatment and I just wanted to feel understood; it just felt too uncomfortable because the therapist was writing while I was talking—I couldn’t tell if he was really listening”.
Scott Miller, Ph.D. has focused his career researching the power of the relationship between therapist and client. In his studies, the client’s rating of the therapeutic alliance is the best predictor of success in therapy (www.scottdmiller.com). As insurance companies seek to limit payment to only those clinicians providing evidence-based models of therapy, the successful therapist is careful to determine what works best with each client as an individual.
My friend and colleague Melissa Elliott has told me that she believes, quite simply, that therapy is about keeping a good conversation going. Part of this might be asking the client “Are we talking about what we need to be talking about today?” or “Do you feel like we are on the right track when we are talking about this?” Every time I slow down enough to ask these questions I feel a tangible, positive shift in the room. Perhaps the client is reminded that she is the expert, and that although I will be a part of the conversation–ultimately she will find the answers to her own therapy goals. Maybe the shift happens because these questions evoke respect and confidence in the client. Or maybe there is a change in the room because the client is surprised I want to know how they feel about our work right then as the session is unfolding. Regardless, I feel like I can’t go wrong when these questions are asked with genuine curiosity AND a willingness to actually change the conversation with the client’s guidance.
I am not the best therapist for everyone. In fact, I feel I am the right therapist for only a small amount of clients who call me seeking therapy. An important part of my work is to have a careful consultation with the client before he or she ever arrives at my office to assure we are both hopeful of a good match. Part of the client’s work during the first session (and thereafter) is assessing how our conversation feels. I rely heavily on my instincts both in my personal and professional life, and I encourage my clients to trust and listen to theirs as well. If I am not a good fit for a client, I want to know and I want them to find the right person for them.
If you are looking to start therapy or if you are already in therapy and looking to make a change, be sure to consider first and foremost the foundation of change: that relationship with your therapist could just change your life.
For more about Scott Miller:
For more about Melissa Elliott:
Griffith, James L. and Griffith, Melissa Elliott. (1994). The Body Speaks: Therapeutic Dialogues for Mind-Body Problems.
Griffith, James L. and Griffith, Melissa Elliott (2001). Encountering the Sacred in Psychotherapy: How to Talk with People about Their Spiritual Lives.