Open Dialogue in the Therapeutic Relationship
The Importance of the Therapeutic Alliance
Individuals attending therapy commit to a professional relationship as a means of reflection and growth. This means the client-therapist relationship itself is instrumental in the therapeutic process. In order for a client to engage, they need to trust that their communication partner will work in a non-judgmental, compassionate, and collaborative way. In fact, research poses that progress in therapy can be attributed to qualities of the therapeutic relationship — rather than participating in one specific “best” treatment modality (Browne et al., 2021). Browne and colleagues review contributing factors such as the relational bond, agreement and collaboration on treatment goals, and therapist empathy.
Ruptures or Challenges in the Alliance
Therapists do their best to be mindful of clients’ communication styles, establish & navigate boundaries respectfully, and recognize social positionality & identity differences. And yet we expect that clients will experience ruptures or uncomfortable feelings towards the therapist while working together. This might happen if a client feels misunderstood by the therapist’s interpretation, disappointed about how their experiences or identity were (un)addressed, or dissatisfied by a logistical arrangement. As a result, clients might experience mistrust or anxiety about therapy, withdraw, or avoid discussing certain topics.
Given the importance of the therapeutic alliance, clients benefit by addressing any issues and seeing them as growth opportunities. While it may feel uncomfortable, doing so is considered an effective tool across treatment modalities.
Opportunities to Repair and Grow
– Throughout the course of therapy, an attachment develops within the partnership; naturally, this means clients engage with their therapist in patterns that parallel past and present relationships. Therapists intend to work with these unconscious occurrences, or enactments, by bringing them into awareness and discussion. For example, people who experienced an insecure parent-child attachment growing up have the opportunity to learn new patterns in a therapeutic relationship that aims to establish security. If they were shamed for expressing difficult feelings as children, they may avoid telling others when they feel hurt or misunderstood. In therapy, they have the opportunity to experience new relational patterns by sharing a possible rupture or feeling and having it met with compassion; you may have heard this described more simply as corrective emotional experiences (Castonguay & Hill, 2012).
– Therapists are trained to develop professional self-awareness and implement feedback, both of which reduce self-defensiveness that often occurs in non-therapeutic relationships. When a therapist can offer validation, provide an apology, or discuss their perspective and intentions, the client might then reflect upon how it felt practicing vulnerability and direct communication. The therapist and client can also discuss ways to navigate future ruptures or client discomfort in the future.
– Clients generally seek to be liked by their therapist — an intuitive reaction to pursuing trust and support from another. Preoccupying oneself with likability at the expense of insight development, however, poses barriers for authentic discussions. This may in fact be an enactment playing out. Discussing fear of judgment, disconnect, or offending the therapist would be a productive way to work towards therapy goals.
– Clients and therapists join each other with unique identities—including gender and sexuality, race, class, ability, and family constellation. These unique constellations of similarities and differences, or intersectional identities (Crenshaw, 1989), may be more or less apparent depending on disclosure or visibility/expression. They also come with unique privileges and oppression. Therapists aim to recognize how social identities impact clients’ lived experiences as well as the nature of the therapeutic relationship itself. And while they may set boundaries on personal disclosures, this doesn’t mean identity differences shouldn’t be discussed. It’s important that clients feel affirmed in their identities and empowered to address social dynamics of the therapeutic relationship.
Blog by Sarah Berlin, MA, LICSW, MEd
Photo by Annie Wiegers