Let me have it therapy client…it will be fun, and you will get more out of your therapy

I am reading in Barry Duncan’s book, On Becoming a Better Therapist, that two factors that are predictive of better client outcomes in psychotherapy are confident collaboration and the expression of negative feelings (Hatcher and Brands, 1996). Confident collaboration speaks of the level of confidence that the client has that the therapy and the therapist will be helpful. Now, I administer a scale called the SRS (session rating scale)  (www.heartandsoulofchange.com) that helps to measure these factors. I find that clients experience a certain tension when they fill out the scale that has to do with a natural tension between feeling confident and feeling negative. Clients tend to have trouble giving negative feedback on the SRS or verbally. I used to think it was because they want to be polite or protect my feelings. In light of this research, I wonder if it has more to do with their wanting to maintain their confident collaboration with you. So it is important to support them in this, but at the same time help them feel free to express negative feelings.  How? Feeling both and expressing that latter predicts better client outcomes.   As a therapist , how can I help facilitate both?

How about this hypothetical response to a client who just gave a high SRS score and doesn’t have anything negative to say about the session:

“Seems like you are feeling good about this session. I am too. I like the way you ( fill in the blank). I also want you to know that sharing a negative feeling about the therapy at any time will in know way diminish my confidence that you are going to get what you want from this therapy. I think it will actually help you get what you want from it faster. To use the analogy of driver and passenger in a care,  if I am driving and you see I am turning left, and you know it is the wrong way, the sooner you tell me I went the wrong way, the sooner I can correct my mistake and get back on track. You may have been confident up until then, and maybe you assume that I knew another way to the destination so you stay quiet and don’t mention that you think I made a mistake. What I am saying is that I really need you to speak up. I make mistakes, even if I am a good driver and usually get people where they want to go.

In therapy, the sign that I am making a mistake is any negative feeling you may have, no matter how small. ”

Clients who express even low levels of disagreement with their therapists report better progress (Hatcher and Barends, 1996)

Debono’s 6 hats thinking method outlined in a recent post might also be a way to help clients navigate this seeming contradiction between confident collaboration and expression of negative feelings.



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