keiranbissell

Does Client + Therapist Fit Matter?

Wed, 26 Feb 2020 19:27:57 GMT

Client + Therapist Fit: does it really matter that much?

Client+ Therapist Fit.... the "working alliance," the "therapeutic alliance," or "interpersonal synergy." It's probably come up for you in your search for a therapist or in the course of your therapy (I know it has for me!). Client+therapist fit is incredibly important. This is why I offer a no-cost, in-person meeting for us to determine fit. Client+therapist fit is something I try to talk about in therapy and I hope you're able to talk about with therapist(s) as well.

There's almost fifty years worth of research on this topic, so I wanted to write this article to break down some of that research for you, as the client. I want you to have the information you need about how to find a therapist who is a good fit and the importance of fit for your therapy. According to this almost 50 years of research, Client+therapist fit is the most important factor of good therapy . Or as the researchers write, "it is well established that the therapeutic alliance is the best predictor of therapeutic outcome" (Negri et al, 2019).

5 Questions About Client + Therapist

1. Is the client + therapist fit more important than the therapist's treatment method?
I often hear from clients and friends that they searching for therapists by treatment method. Folks tell me things like, "I want to do EMDR" or "Somatic therapy just feels right" or "CBT appeals to how my mind works." Searching for a therapist by method or modality is a great way to get started. It can create a smaller list of potential therapists, and when you consider who is drawn to train in methods like art therapy, somatics, or CBT you may find yourself sitting across from someone who is similarly minded in their creativity, holistic approach, or logic.
That said, research shows.. A treatment method's effectiveness is not as strong of an indicator of good therapy as a good fit with the therapist . Or according to researchers who reviewed over 70 studies, "the results showed a significant relationship between total therapeutic alliance ratings and treatment outcome across modalities, with more of the variance in outcome attributed to alliance than to treatment method" (Krupnick et al, 1996).

2. What if I can only go for a few sessions of therapy.. is client+therapist fit important if I'm not doing therapy for a long time?
Yes . Whether you're seeking long-term therapy or short-term therapy, if you think someone is a good fit, that tends to continue and whether short-term or long-term, your sense of getting 'good therapy' will still depend on feeling connected to the therapist. According to over twenty studies on therapeutic fit, "the length of treatment does not appear to influence the relation between the quality of the alliance and therapy outcome" (Horvath & Symonds, 1991).

3. Does the importance of therapist + client fit matter regardless of my diagnosis or issue?
Another common method of searching for a therapist is searching for therapists who specialize in a particular disorder, diagnosis, or issue. This is another way to shorten your list of potential therapists and insure you may be sitting across from someone capable. For instance, many of my LGBTQ clients expressing wanting to find therapists who specialize in assisting the LGBTQ population to insure their identities are understood in therapy. Finding someone who specializes in your diagnosis or issue is important, again, it gets you in front of a smaller list of people and similarly-minded therapists. And just because someone is a specialist doesn't mean you should disregard client+therapist fit; still see a couple people to make sure the person you're sitting down with feels good for you.
Regardless of your diagnosis or issue, the therapist + client fit is an important factor for good therapy. Research shows it can be even more important for individuals struggling with symptoms or diagnosis from previous trauma (Cronin, 2014). As the researchers note, "The working (therapeutic) alliance is of general clinical importance irrespective of the disorder group and should be a central target in all therapies" (Mander et al, 2017)

4. What if I really like the therapist but I'm not sure how they feel about me?
Okay, so maybe you found a therapist (or a few!) that you feel a good fit with. As is often the case when we're getting to know people, you're just not sure what they're thinking and if the therapist is also feeling the fit. Add to that, the fact that your therapist will likely choose to share their personal selves less than an average conversation, because therapy is your space. Your feeling of fit matters more than the therapist's. Researchers on the topic are clear, "The client's opinion of this fit is a better indicator of a future positive outcome than the therapist's" (Horvath and Luborsky, 1993).

5. What if I feel like it's a good fit but then something happens? Is that fixable? Is it still a good fit?
As in our other relationships, there can be moments of feeling like something was missed in therapy. Perhaps the therapist misunderstood something or they thought one piece of your story was important but it was actually the other piece... or all kinds of other moments of disconnection. In therapy lingo, we call this a rupture. Ideally, you should feel comfortable talking with your therapist when this happens and open an opportunity for repair. These conversations are a normal part of therapy and a good therapist should welcome them as a way to better understand you. Even with therapists who are a good fit there may be some moments of disconnection; repairing those is important. " In therapy with good outcomes, the studies show there may be rupture and repair in the alliance with repair being most important" (Horvath 1991).

Links to research!
Cronin, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946510/
Negri et al, 2019. https://researchinpsychotherapy.org/index.php/rpsy/article/download/374/317
Horvath & Symonds, 1991. Relation between working alliance and outcome in psychotherapy: a meta-analysis.
Horvath and Luborsky, 1993
https://www.researchgate.net/profile/Adam_Horvath7/publication/14828157_The_role_of_the_therapeutic_alliance_in_Psychotherapy/links/54bc62a30cf24e50e9404dbf.pdf
Krupnick et al, 1996 https://www.researchgate.net/profile/Paul_Pilkonis/publication/14503250_The_Role_of_the_Therapeutic_Alliance_in_Psychotherapy_and_Pharmacotherapy_Outcome_Findings_in_the_National_Institute_of_Mental_Health_Treatment_of_Depression_Collaborative_Research_Program/links/53d1048c0cf25dc05cfe7e19/The-Role-of-the-Therapeutic-Alliance-in-Psychotherapy-and-Pharmacotherapy-Outcome-Findings-in-the-National-Institute-of-Mental-Health-Treatment-of-Depression-Collaborative-Research-Program.pdf
Mander et al, 2017. https://www.ncbi.nlm.nih.gov/pubmed/28497909

So it's your first time doing therapy... what to expect.

Thu, 15 Aug 2019 15:29:14 GMT

A short guide on first appointments and therapy for newcomers

So you're new to therapy and you're wondering what to expect.... How do you navigate a first appointment? What are they going to ask? What does therapy even look like? What if I'm not ready to talk but I still want therapy?

I hope you are able to give yourself some credit and validation on choosing to try therapy. Whether you're pursuing growth or change, working on a relationship, contemplating your identity, or planning on addressing some difficult past experiences- your choice to work with a therapist is an important, and for many folks an intimidating, first step. The information below is a short guide to beginning this process.

How do I get started?

Utilize a therapist directory such as psychologytoday.com or goodtherapy.org to check out therapists in your area or in your insurance network.
Ask a friend for a referral.
- I'd recommend asking a friend who struggles with similar issues or who thinks, feels, and processes similarly to you.
Ask the therapist to schedule an abbreviated session to determine "fit."
- I offer individuals a no-charge, 30 minute consult, in-person so you and I can get a sense of if we're a good fit. Most therapists offer between 15 and 30 minutes usually via phone, no-charge, for individuals to check fit. While their websites may say these are generally phone consultations, it's worth asking if they're willing to do this in-person. It can be hard to get a sense of someone over the phone.
Schedule more than one consult.
- While this might feel nerve-wracking, it's so important. Even just sitting down with two people you'll get a sense of their different styles, whether they feel like someone you could trust, and different therapeutic methods or tools that might work for you.

Okay..... two first sessions/consults are scheduled. Now...

What will happen in a first session/consult?
I can share exactly what to expect during a consult with me, and I'll add some general ideas of a first session with others. Different therapists may do first sessions in different ways. If you're nervous about what will happen or what may be asked in the first session, send the therapist an email and ask! It's normal to be nervous when you're new to therapy and a good therapist will be happy to answer any questions you have prior to meeting.

In most first sessions/consults, the therapist will likely:

Ask about and get a sense of why you are pursuing therapy at this time.
Ask about how you currently cope with whatever you're bringing to therapy maybe asking about your support network, coping mechanisms, personal approach to difficulties, or fulfilling hobbies/activities.
Discuss confidentiality and the therapeutic relationship.
Provide some information on their own style or techniques they offer that may help you in therapy.
Offer time and space to answer any questions you may have about therapy.

In my first sessions/consults, I will likely:

Ask about what's bringing you to therapy.
Ask if you've been to therapy in the past and how you felt about it.
Discuss confidentiality and therapy in general.
Explain what techniques I use in therapy, including somatic awareness and mindfulness (check my other blog posts for what this looks like!).
Give you time and space to ask any questions you may have about me, my therapeutic approach, or therapy in general.
If there's time, I may guide you through a somatic awareness or mindfulness practice so you can get a sense of what it's like and ask if you feel like this might be helpful.

What should I ask in a first session/consult?
Below are some ideas for what you might ask in a first session/consult. It might be good to prepare some questions ahead of time, especially if the consult is only 15 minutes, so you can get a good sense of if a therapist might be helpful for you.

Ask the therapist about their therapeutic style and what a session might look like.
Give some information about what's bringing you to therapy and ask the therapist how they might approach this issue/situation with you.
Offer some information about how you process such a verbally or non-verbally, quickly or slowly, tearfully or stoic, and ask the therapist about their approach to your style.
Ask the therapist to tell you about him/her/their-self.
Ask about the therapist's knowledge of a particular issue or marginalized identity; this may be especially relevant for individuals seeking therapy to work with their gender identity, sexuality, or racial battle fatigue.

Good therapy includes all the elements of a healthy, supportive relationship such as trust, mutual respect/appreciation, healthy boundaries, and a sense of being understood. You may find after one or more sessions that a therapist isn't a good fit for you; it's totally okay to voice that and find someone who is. As therapists, we get a lot of practice in not taking things personally, and perhaps the therapist you're working with can provide you with good referrals (I'm happy to do this for my clients!). Check the links below for more info about beginning therapy and searching for a therapist:

https://www.bustle.com/p/8-things-to-know-before-seeing-a-therapist-for-the-first-time-9784855
https://www.self.com/story/first-therapy-appointment
https://www.buzzfeed.com/annaborges/how-does-that-make-you-feel
https://psychcentral.com/lib/what-to-expect-in-your-first-counseling-session/

Body-Oriented Psychotherapy: An Example

Mon, 08 Apr 2019 16:26:36 GMT

What IS body-oriented psychotherapy?

I imagine at least some of the readers of this website are searching for a therapist, reading my description and wondering, "What does body-oriented psychotherapy actually look like?" This article is an experiential example of how you might use body-oriented psychotherapy techniques to better understand yourself and a particular pattern. In therapy, we might do this body-focused exploration together.

Worry/Anxiety is a great emotion to work with. It's an emotion many people experience regularly, one clients often seek support for, and anxiety is also one emotion in which most folks can notice a mind/body disconnect. One pattern of anxiety is a situation comes up during which we feel uncertain or worried, the anxiety follows while we're still in the situation or some time afterward, and generally we try to rationalize why we don't "need" or "have to" be anxious. We try our best to soothe our anxiety with our mind: explaining the situation to ourselves, trying to reassure our anxiety why we don't have to be anxious about something we said or did or didn't say or do. Like when we're at a party with new people and say something 'cringey' or 'awkward.' While at the party or afterwards, we're thinking about this moment trying to tell ourselves how it's not a big deal, people will understand, and besides this isn't something we should be focusing on at 2am.... Sometimes this talking ourselves down works. But often we try to use the rationalization, our mind, to make the anxiety "go away" and instead we create a cycle. Anxiety, rationalization, and continued anxiety. Rinse and repeat.

Anxiety, like all our feelings, has a mental, emotional, and physical aspect. We can try to soothe our mental worry via logic. But when we want our emotions to go away, and succeed, we lose our chance to learn more about them and potentially have different options for when they arise in the future. By noticing how our physical experience interacts with our mental and emotional experience, we can better understand how we get caught in the circles of anxiety, and perhaps even calm or soothe our anxiety more deeply.

The steps below are a way to try this technique yourself.

Consider a situation which you recently felt anxiety about or are currently experiencing anxiety about. (If you struggle with anxiety, choose a situation that brought up smaller anxiety, maybe a 3 or 4 out of 10).
If this was in the past, bring the feeling of that situation up now. It may help to imagine it more specifically. What space you were in, who were the people or animals nearby, and at what moment did the anxiety arise?
Now, notice your body. Some things you may ask yourself are: What part of your body do you notice most easily? Is it the anxiety or some other part or feeling? Where is the anxious feeling in your body? Is it small, medium, large? Does it have a shape, color, or temperature? Is there an image associated with it?
As you explore these questions, notice how your mind or thinking interacts with the feeling. (In therapy, I might make additional comments to help you notice more about what you are labeling). Some questions you may wonder about are: Are you surprised that some other feeling was more noticeable than the anxiety? Do you have an opinion about how big or small the anxiety is? Is there a second emotion or reaction you notice to the anxiety, such as disappointment or overwhelm or anger?
Get to know the feeling.
Now, as you finish this exercise, notice where in your body or outside yourself you notice calm. Is that calm big, medium, or small? Where is it? How do you know that the thing you're noticing is calm?

Being human is difficult; certain emotions are innately painful like anxiety, grief, or fear. Sometimes our patterns can expand these feelings and sometimes we have patterns that soothe these feelings that we may not even be aware of. When we deal with these emotions merely from a logical aspect, we don't learn about other important pieces of our experience.

When I do this work with clients, they sometimes comment on that their anxiety was bigger or smaller than they thought or that the anxiety was a medium size but the disappointment or sadness that followed was big and actually the tougher emotion to cope with. Others comment on their surprise that the anxiety is a small part of their physical experience, and some other emotion like happiness or calm is actually more noticeable. Doing this process with a therapist or friend is one way to share ourselves and get to know ourselves better.

I hope y'all find this to be a helpful example of some body-oriented psychotherapy. Message me for more information or if you're interested in trying this in-person. Or check out the books recommended below if you'd like to research this more:

The Body Keeps the Score by Bessel Van der Kolk
https://www.amazon.com/gp/product/0143127748/ref=ppx_yo_dt_b_asin_title_o00_s00?ie=UTF8&psc=1

Waking the Tiger by Peter Levine
https://www.amazon.com/Waking-Tiger-Healing-Peter-Levine/dp/155643233X/ref=sr_1_3?crid=THM867S7QCFD&keywords=waking+the+tiger+peter+levine&qid=1555608309&s=books&sprefix=waking+the+tiger%2Cstripbooks%2C190&sr=1-3

Healing Developmental Trauma by Laurence Heller and Aline Lapierre
https://www.amazon.com/Healing-Developmental-Trauma-Self-Regulation-Relationship/dp/1583944893/ref=sr_1_3?crid=JCJMN69Z3Z30&keywords=healing+developmental+trauma+heller&qid=1555608341&s=books&sprefix=healing+devel%2Cstripbooks%2C175&sr=1-3

Nurturing Resilience: Helping Clients Move Forward from Developmental Trauma-- An Integrative Somatic Approach
https://www.amazon.com/gp/product/1623172039/ref=ppx_yo_dt_b_asin_title_o08_s00?ie=UTF8&psc=1

Some Thoughtful Quotes

Mon, 01 Apr 2019 19:01:37 GMT

Some of the thoughtful quotes I decided not to use on the website but still love.

While deciding on content for this website, I ran in to some great quotes that I wanted to share, but decided not to feature on the site. I hope you enjoy them too.

“I'm not sure if there's one right place I'm supposed to be, he said, but I know a couple of wrong places I'd give a second try in a heartbeat. ” – Brian Andreas

“What I'm mostly good at is sleeping, he once told me in confidence, but he added, I don't see much future in it.” -Brian Andreas

“Trapped mainly by wanting things to be exactly as they are, only better.” -Brian Andreas

“My grandma used to plant tomato seedlings in tin cans from tomato sauce & puree & crushed tomatoes she got from the Italian restaurant by her house, but she always soaked the labels off first. I don't want them to be anxious about the future, she said. It's not healthy. ” -Brian Andreas.

“Is willing to accept that she creates her own reality except for some of the parts where she can't help but wonder what the hell she was thinking” - Brian Andreas

“Remember to use positive affirmations. I am not a dork is not one of them.” -Brian Andreas

“That is to say I am not going to get a single speed bike if I can’t make it up the hill
I know exactly how many gears I’m going to need to love you well
And none of them look hip at the coffee shop
They all have God saying ‘good job you’re finally not full of bullshit’ “ -Andrea/Andrew Gibson

“A further sign of health is that we don't become undone by fear and trembling, but we take it as a message that it's time to stop struggling and look directly at what's threatening us. ” – Pema Chodron

"The fundamental question is not whether there is or isn’t suffering. It is how we work with suffering so that it leads to awakening the heart and going beyond the habitual views and actions that perpetuate suffering. How do we actually use suffering so that it transforms our being and that of those that we come in contact with?" – Pema Chodron

"I give up both the hope that something is going to change and the fear that it isn’t. We may long to end suffering but somehow it paralyzes us if we’re too goal-oriented." -Pema Chodron

Check out these folks Instagrams for more great quotes (and Brian Andreas's is an illustrator as well).
https://www.instagram.com/brianandreas/
https://www.instagram.com/andrewgibby/?hl=en
https://www.instagram.com/anipemachodron/?hl=en