The success or failure of therapy can be often come down to one thing, the therapeutic relationship. Although, you shouldn’t always expect therapy to meet all your ideal mental health recovery goals, as often that is unrealistic. Instead, therapy is there to help you improve your quality of life by helping you learn how to help yourself. Or at least that’s the idea of therapy that I subscribe to.
There are two types of counselling practitioners, the purest and the multimodal. A purest will stick rigidly to one theory or model of counselling, whereas a multimodal practitioner will take an eclectic approach, borrowing from different theories and models to best meet the client’s needs (Colledge, 2002). Both can be useful, depending on the context, and the theory or model.
Unless you want support for something specific and you’ve looked into different forms of counselling and believe you’ve found one that will work best for you as an individual, then a multimodal therapist is probably going to be better. The success of either approach, however, may be down to the therapeutic relationship, especially for a multimodal approach.
The therapeutic relationship begins with how you start your sessions and even how you first meet each other. Starting each session by greeting the client and asking how they are, is important for several reasons. It’s friendly, helps build rapport, and it can help identify any immediate issues that need to be discussed. It can also be used to show the client they’re doing better than they’ve realised.
It gives you the opportunity to reflect back on previous examples about the client at the start of the session to correct their thinking errors, if appropriate. It also allows you to do the same at the end of a session. You might be able to reflect on how the client said they weren’t doing to well at the beginning of the session and point out they’d made a lot of progress by point out stuff from that session, especially if they’ve discounted the progress they’ve made between sessions due to thinking errors.
For example, a client may feel they’ve not achieved anything since the last session when you ask how they are. But as the session progresses, the client might share achievements they’ve made, counselling homework they’ve completed, etc, which they’ve not appreciated, that you can then present to them at the end of the sessions to show they have in fact achieved quite a bit. You’d be surprised how common this comes up.
More importantly, counselling is very much is a collaborative relationship (Frank and Davidson, 2014), and the effectiveness of that collaboration is down to the rapport and the quality of the therapeutic relationship. A good therapeutic relationship can recover from mistakes and making a faux pas.
The more comfortable the relationship is in the therapeutic setting, the more likely you are to feel comfortable with making yourself vulnerable so you can be properly supported with your needs. Think about it, would you share your inner demons with someone you can barely have a conversation with if you both felt awkward?
Evidence suggests that the type of treatment used in counselling doesn’t matter, the results are the same (Beutler, et al., 1991; and Baer, Kivlahan, and Donovan, 1999); a multiple model approach might be best (Ramanathan and Reischl, 1999). The personality traits of the client could be the main factor in which treatments will work best (Beutler, et al., 1991). If you’re solution-focused then something like CBT might work be best, but if you just want to talk about your problems, then Humanistic could fit the bill. Creating the right recovery environment to promote change in the addict is important; the regularity of substance use was reduced by 70% due to quality of care creating positive changes, Brown and Riley (2005).
If you feel that you lack rapport with your counsellor, then the first thing you should do is talk to your counsellor about it. They might be feeling the same thing you are, and talking about it could lead to the therapeutic relationship improving. But if that doesn’t work, don’t be scared to request working with another counsellor.
Even though therapy should be a collaborative effort to improve your mental wellbeing, at the end of the day, your wellbeing is more important than staying in a therapeutic relationship that isn’t working for you. Your counsellor will understand, especially if you first gave yourselves the change to work on the therapeutic relationship.
As always, leave your feedback in the comments section below. Did you have more success with therapists you liked? Also, feel free to share your experiences of rapport and the therapeutic relationship in the comments section below as well. If you want to stay up-to-date with my blog, then sign up to my newsletter below. Alternatively, get push notifications of new posts by clicking the red bell icon in the bottom left corner.
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Unwanted Life readers.
Baer, J., Kivlahan, D., and Donovan, D. (1999). Integrating Skills Training and Motivational Therapies Implications for the Treatment of Substance Dependence. Journal of Substance Abuse Treatment, 17(1–2), 15–23. Retrieved from https://www.journalofsubstanceabusetreatment.com/article/S0740-5472(98)00072-5/fulltext
Beutler, L. E., Engle, D., Mohr, D., Daldrup, R. J., Bergan, J., Meredith, K., & Merry, W. (1991). Predictors of Differential Response to Cognitive, Experiential, and Self-directed Psychotherapeutic Procedures. Journal of Consulting and Clinical Psychology, 59(2), 333-340. Retrieved from https://doi.org/10.1037/0022-006X.59.2.333
Brown, V. L., & Riley, M. A. (2005). Social Support, Drug Use, and Employment Among Low-Income Women. The American Journal of Drug and Alcohol Abuse, 31(2), 203-223. Retrieved from https://www.researchgate.net/publication/7828430_Social_Support_Drug_Use_and_Employment_Among_Low-Income_Women
Colledge, R. (2002). Mastering Counselling Theory. Basingstoke: Palgrave Macmillan.
Frank, R. I., & Davidson, J. (2014). The Transdiagnostic Road Map to Case Formulation and Treatment Planning: Practical Guidance for Clinical Decision Making. Oakland: New Harbinger Publications.
Ramanathan, C. S., & Reischl, T. M. (1999). Innovative approaches to predicting and preventing addiction relapse. Employee Assistance Quarterly, 15(2), 45-61. Retrieved from https://doi.org/10.1300/J022v15n02_04FollowFollow Unwanted Life on WordPress.com