Therapeutic change is due more to factors outwith therapy than any one aspect of therapy. Factors outwith the session are at least as important as our rapport with our clients…and much more important than our years of experience or the technique we’re using.
The myth of therapy is that it is done by therapists to patients and that the outcome is a measure of the therapist or of the technique employed, not of the client (unless, of course, the client is “resistant†or “non-compliantâ€, in which case the outcome is very definitely attributed to them!).
The myth of therapy is perpetuated by research focusing upon the outcome of a given intervention on a given condition, where the therapist is merely a vessel for delivery of the treatment and the client is an interchangeable recipent of said treatment.
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Solution oriented Therapists ask clients how they will know when they are better. Therapists often wish to be better in their role, but few ask the Miracle Question of themselves.
Solution-Oriented Therapists often ask clients the Miracle Question:
Suppose that one night, while you were asleep, there was a miracle and this problem was solved. How would you know? What would be different? (de Shazer, 1988)
Stressed therapists might be asked a similar question:
Suppose that tonight, while you are asleep, there is a miracle and you become a better therapist. How will you know that this has happened? What will you notice has changed about the way you’re working?
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Giving clients permission “not to speak†encourages disclosure. Explicitly granting the freedom to subvert our power frees the client to tell us what they need.
The first time is to check out the therapist, the second is to tell you the real problem.
I was given this advice in training and for years it seemed to be true. Now, in my practice at least, it is the exception rather than the rule.
The balance of power in therapy lies with the therapist. We decide when, where and for how long is each appointment. We set the boundaries and grant exceptions. The client must work within our framework.
Clients can exercise control by withholding information or themselves. Failure to attend is the ultimate means of regaining control of therapy. More subtly, the client can, without overtly challenging the therapist, keep back important facts for as long as they choose.
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Steady eye contact from a client is your prompt to speak. Attending to eye contact helps us to minimise interruptions of the client’s train of thought and to be more comfortable with silences.
In 1:1 conversation we spend 50% of our time looking at the other person. It is important to remember that this is an average across two distinct roles: speaker and listener.
When listening, we look for 50-90% of the time. We can see expressions and gestures, the non verbal modulators of the spoken word. More importantly, we can see if the other person shows signs of finishing, so that we can have our turn.
When speaking, we look from 10-50% of the time. We need to know that the other person is listening, but we can reassure ourselves of this with a quick glance. When we have the floor, it is more useful to look away from the other person, minimising distractions from our train of thought.
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Relaxation improves our performance, benefitting us and our clients. We promote relaxation in our clients but we rarely apply our approaches and techniques to ourselves.
Both physical and psychological therapists promote relaxation as a way of decreasing disease and distress. Relaxation improves balance, coordination, digestion & sleep. Relaxation also improves concentration, memory, decision making & self control.
Sports coaches and life coaches recommend relaxation as a way of improving performance. A colleague once said that he knew his clients were getting better when their golf game improved. I know my clients are recovering when they don’t need me to repeat the date of their next appointment.
Physiotherapists are usually fit and speech therapists enunciate clearly, but relaxed therapists are rare. Therapists are typically pressured by excessive demand, inadequate resources, wide responsibilities and the need to balance personal & professional life. Not only do we need to practice what we preach, any gains will be experienced both by us and by our clients.
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