Navigating the Complexities of a Therapeutic Relationship

Kimberly Morrow

Providing evidence-based treatment to clients with anxiety and OCD is not only ethical, but it is essential.  However, learning these treatments doesn’t help you navigate the complexities of a therapeutic relationship. It seems important to have a conversation regarding what our clients need that is not in the manuals.

At the ADAA conference this year, Elizabeth and I joined two colleagues to present on a difficult topic. How to help someone recover from a traumatic therapy experience so they can fully benefit from the therapeutic relationship you will develop with them. As we well know, clients are vulnerable in therapy. If not respected, this vulnerability can lead to difficult experiences including poor boundaries, mismanagement of power, and lack of attention to what our clients need, versus what the manuals tell us to provide them.

Understanding Their History of Therapeutic Relationships

Clients may come with specific expectations of therapy. Maybe they were used to telling their worry stories to their therapist. Maybe they received what they thought was evidence-based therapy and they didn’t see improvement. Or maybe they didn’t feel safe in their prior experience with therapy. All of these issues will need your attention before you can move forward with evidence-based treatments.

Unfortunately, I have had many clients have poor therapy experiences before they come to my office. It is important to attend to their experience and process it if they are willing because it can affect their ability to work with you.

I had one client whose experience in a specialized residential treatment center was complicated and hurtful. I asked him what he would want therapists to know as he was healing. He told me that he believed therapists have good intentions but that he thought they might rely too much on manualized treatment and not enough on being with their client, listening to what they need, and providing that even if it goes against the treatment plan. He wondered out loud about our work on psychological flexibility and said he wondered if therapists also need to practice this.

Attending to Your Clients Needs to Bolster Your Therapeutic Relationship

If they have had previous experiences that were poor or traumatic, get a good history and really listen. Consider treating their trauma before treating their anxiety or OCD but include them in this decision. Provide your client information about the treatment and let them ask questions. End each session by asking them to summarize what they will take from the session. Ask them if their needs are getting met and be willing to be flexible if you need to take a detour for a while. Be willing to educate them on how to report a therapist to the board or find ways to support them if they decide to sue as this can be a lengthy and challenging experience.

Self-Care & Therapeutic Relationships

While attending to your client’s needs is important, it is equally important to attend to your own. When we are tired at the end of the day or burnt out from too many clients, it’s difficult to truly be present. Pay attention to self-care and practice it. Also, stay on top of the latest treatments by taking trainings or going to yearly conferences with ADAA or IOCDF . You will feel reenergized, be able to bring back the latest treatment approaches to your clients, and benefit from connecting with like-minded colleagues.

By listening to your clients and engaging in self-care, you will be in a better place to navigate the complexities of a therapeutic relationship.

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