Who Cares for the Therapist

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Who Cares for the Therapist who care for Others?

Most therapists feel deflated if the therapy they have provided has not resulted in the success they were expecting for their client.

We know that when a client has reached the point of success in any therapeutic work, we often let them know they were the ones who had done the work and we were the instrument to assist and support them achieving the outcome they needed. We give them most of the accolades for their work. We then take most all responsibility when the client does not reach the result they or we want. We often blame ourselves, reflect on our technique, go over sessions and conversations and discuss the therapeutic work with our supervisor in the hope they may have some wise or insightful words and suggestions.

Are we too hard on ourselves or is this feeling of regret something we should carry? Clients have a life outside of the therapy room where considerable influences can affect them and this can have an effect on the work done within the therapy room. The results we are usually after in therapy is to assist and support the client in dealing with these influences so they can remain focused on their desired outcome.

According to Lambert (1992), there are four primary factors that research has shown are shared in all forms of therapy

1. Extratherapeutic (40%)
This means that external events that exist outside the therapy room affect clients. There are 168 hours in a week; approximately 56 hours spent sleeping meaning there are another 112 hours the client is operating for each week and only 1 hour spent in the therapy room. These extra therapeutic events can, therefore, have an impact on how the client responds. The client’s life experiences, their strengths, capability and willingness to transform themselves. Their family relationships, work and connections also affect their thoughts or behaviours in these other 111 hours.

2. Therapeutic Relationship (30%)
This is the quality of the relationship and rapport developed between the therapist and their client. The therapist ensures the client feels comfortable, safe, heard and understood without judgement. The therapist must be able to display empathy, honesty and unconditional positive regard for the client and their goal?

3. Therapeutic Technique (15%)
What type of therapy is used, or what combination of therapy, such as CBT, Solution Focused, Gestalt, CT, or whatever the client requires to ensure they reach their desired outcome with positive results.

4. Placebo or Expectancy (15%)
The positive expectation of what the client expects to receive from the therapist. The confidence they feel in their therapist. The results they have heard or seen from the therapist. According to Miller, Duncan and Hubble (1997), 40% of people on waiting lists for therapy improve prior to attending.

We all should take some credit for the positive result we assist clients to achieve yet we so often hand it back to them. We do this because we want to empower them and to inflate their feeling of self-confidence and self-ability. If we place this back to the client for the work they have done, do we also need to hand back to the client their inability for not reaching their optimum result? Of course not, we would never do that.

Research shows when clients take credit for their success they can maintain their achievements, while those clients who believe their success is because of their therapist are less likely to maintain their gains (Liberman,1978). We, therefore, understand the absolute necessity for clients to believe they were instrumental in their achievements.

Of course, we must all reflect on the therapy we use; the questions we asked, the response we provided and the rapport developed. What we need to remember is, we can not resolve all matters for everyone nor does everyone want to be ‘fixed’.

Many therapists after working a few years may begin to start questioning their own therapeutic model, many wanting to expand and do more for their clients. They often wish to step outside their current preferred modality and use more, different or newly developed therapeutic processes. How then do we discover learn these new modalities? Certainly, Ongoing Professional Development can assist, and we all need to ensure we choose the OPD’s that benefit us and widen our modality base.

Many OPD’s are not relevant to individual therapists’ field. Sometimes OPD’s are provided within the group where the presenter is not so thoroughly experienced in the field as necessary to present. This seems to be an ongoing problem that I have heard from a number of group participants. I, therefore, suggest that professional therapists search out the relevant areas of training and OPD in the area of choice and from an experienced and qualified presenter. It may cost a little more, but surely this is worth it, to enable your clients to progress faster with a new or sometimes improved modality. It can also ensure the therapist is reminded of some of these previously learned modalities to reignite their trust and use again.

To enable us to work with a range of different clients and client needs, therapists need a ‘bag of tricks’ to draw from when a client attends. The abundance of therapeutic modalities available are plentiful yet as a supervisor I find many of my supervisees use their main one or two only and neglect the others. All therapists should learn and use a broad range of therapeutic tools. When we can use all the standard therapeutic modalities such as Gestalt, CBT, Solution Focused, Person Centred; I ask why not also learn and use EFT, EMDR, Hypnotherapy and the list continues.

We undertake our training and either open our practice doors or work for an organisation, and this is often where we remain. We use the same therapies with the occasional additional modality we learnt in an Ongoing Professional Development session. Perhaps we all need to increase our ‘tool box’ of modalities to become truly competent and beneficial for clients. If we do have a client who seems to remain stagnant? What are we able to offer them to expedite their progress?

Depending on the client, the rapport, and the issue; we can use a range of beneficial modalities if we know how to use them and what they are their beneficial use is. Naturally, we do not need to be fully proficient with absolutely all types of therapeutic modalities however surely it is advantageous to our clients and us, to ensure we continue to expand our knowledge base and learn a wider range of therapeutic tools. Many of these modalities can be learned over a weekend or two before being practised at supervision or with fellow therapists. Practice after all helps us improve, become more skillful and more confident in our ability.

We also need to be aware of any bias we hold, and we all have some bias, this is human. As noted by Sommers-Flanagan, (2004) ‘It is impossible to be objective or neutral’. Do we ask ourselves if we are preventing the therapeutic progression due to any bias? These are the struggles therapists can also experience. Bias or misunderstanding is not uncommon to experience as a therapist. The need for all therapists to undertake their self-improvement work is ongoing, hence why supervision is essential for all.

As a Supervisor I do see therapists struggling with some clients and often with their own buried bias or misunderstanding of the issue. Asking questions, paraphrasing back, creating curiosity, while being mindful, is essential to develop a full understanding, rapport and ease with your client. It seems once we are really able to connect with our client, understand what they are trying to say and to be where they are, can we start to develop the rapport and appreciation of what they require.

We all need an experienced supervisor to review and discuss our methods and advise us on a full range of modalities we can offer and recommend to use for our clients. We then have a responsibility to seek out, learn or become qualified to use them. A supervisor helps protect clients by involving themselves as an impartial third party in the work of the counsellor and client The supervisor can help the therapist reduce the risk of therapeutic oversights to reflect on their own feelings, thoughts, beliefs and approach with their therapeutic work. A supervisor assists us to continue to grow as a therapist because if we remain where we are, we can become stale and stuck.

We advise our clients the best way forward is to remove themselves from their stuck state. This is great advice for therapists as well. Get into a group and obtain a supervisor that is able to expand your learning, provide a broad range of ideas and support your development.

This way you can be confident that you are doing everything to support, enable and empower your client for the result they want and need. The responsibility is then on the client to continue on the path that you and they have decided upon. If they chose to run, walk or sit, then it is on them, not you.

As a therapist, you do all you can and sometimes the results are not as good as we hope. If you have done your best, obtained support from your supervisor or group then be assured, you did well. We must then accept sometimes we can’t do all we want to do. Refer your client and remain confident you did your best. Take time for yourself every week to renew and regenerate and know your clients are fortunate to have you supporting them.

References:
Lambert, M. J. (1992) Psychotherapy Outcome Research: Implications for Integrative and Eclectic Therapists in Norcoss, C. and Goldfried, M. (Eds) and book of Psychotherapy Integration, Basic Books, United States
Liberman, B.L. (1978) ‘The maintenance and persistence of change: Long-term follow-up investigations of psychotherapy’, New York: Brunner/Mazel
Miller, S.D., Duncan, B.L. and Hubble, M.A. (1997) Escape from Babel: Toward a Unifying Language for Psychotherapy Practice. New York: W.W.Norton & Co
Sommers-Flanagan, J., Sommers-Flanagan R. (2004), Counselling and Psychotherapy Theories in Context and Practice. John Wiley & Sons. Inc. New Jersey