As a former therapist I know just how satisfying it feels to guide a client to an insight. I used to think "Now they understand how their current behaviour relates to their childhood experiences of emotional neglect, so they will now find it easy to change!" But, you know what, those long conversations didn't actually lead to a whole lot of change. I think they were based on a misunderstanding of what needs to happen in therapy.
William Miller (founder of an approach called Motivational Interviewing) discovered that some therapists do a much better job at helping their clients
to change than others. Miller studied the differences between effective
and ineffective therapists and found that the highly effective therapists:
- Were good at empathic listening and were genuinely interested in understanding the client’s perspective
- Coached the client to explore the pros and cons of change and helped them to make their own decision about whether they wanted to change
- When the client resisted the idea of change, the effective therapists ‘rolled with that resistance’ rather than arguing with the client.
- Had a respectful stance
- Honoring the client’s autonomy – the client gets to choose whether they change or not, and as adults, they take responsibility for the consequences of their choice.
- Viewing the client as the expert in their life. They didn’t talk down to the client but took a collaborative approach where they worked together to figure out what to do next.
So, here is my advice, if you want good therapy:
- Look for a therapist who treats you and your perspective with respect
- Avoid therapists who argue with you; make you wrong or talk down to you
- Avoid therapists who want to spend hours working out how your parents/childhood messed you up
- Ask for the research evidence that supports the approach they are taking.
Great post Rachel. Miller’s approach and your recommendations align with the recovery model of psychiatric rehabilitation like the Boston Recovery Model (there are other versions of similar theme). Having had 18 months of this after 23 years of the maintenance model (top-down, practitioner/clinician driven traditional model found in Australia and its mental health facilities, Medicare and PBS supported) I found it to be exactly what I needed. Statistics are great generalities but my ‘anecdotal’ experiences are reality for me. My insights and understandings acquired over a lifetime of illness have to count for something.
ReplyDeleteThe comment about the client having to want to change is very important. If the client is forced to attend counselling without agreeing that there is a need for change (and perhaps there isn’t) resentment and more than likely, regression, will result. Enough of this and eventually the client may become very difficult to assist due to persistent negative experiences with unsuitable models of counselling.
ACT and RFT seem to fit in nicely with the recovery model I experienced and benefited most from.
Regards
Charlie