Is it just me or does finding a good therapist feel a bit like the search for finding a compatible partner? Although there isn’t an app to swipe through all of the available therapists within a 10km radius (yet), it feels just as tedious to find a good match. It can be challenging, expensive, and at times, downright frustrating.
It often feels rather mystical—the reasons we “click” with one therapist and not another. Is it the shared values or interests? Is it the techniques and theories that they use to guide their practice? It could be, but studies show it is more likely the relationship between client and therapist, or the therapeutic alliance—this is the most consistent predictor of positive clinical outcomes.
What about the type of therapeutic relationship? If you think about the friends in your life you may be able to see how different friendships have a different feel to them. Some may be built on emotional intimacy and closeness, others may involve shared adventure, and some may be rooted in common interests.
No two relationships are alike and the same can be said with the relationships we form with our therapists.
Alexandra Bachelor’s research on Clients’ Perception of the Therapeutic Alliance is both fascinating and may be useful to those of us seeking counselling or who are in counselling. Bachelor examined the therapeutic relationship from the client perspective, and ended up identifying 3 categories of perceived therapeutic relationships.
Below are the three client-perceived types of therapeutic relationships:
Nurturant
The nurturant alliance is just as it sounds—attentive, empathetic, and nonjudgmental. It is the kind of relationship where you feel seen and heard, and that may elicit feelings of warmth and comfort that make it comfortable to open up. Other important characteristics for those who preferred a nurturant alliance were friendliness and trust.
For folks that prefer this kind of relationship, having a therapist create a safe and open space is crucial to permitting their self-disclosure. All of these attributes can be referred to as facilitative conditions, which are rooted in the work of Carl Rogers, an American psychologist who emphasized the person-to-person relationship in a counselling relationship. The three conditions that Rogers proposed are widely taught in counselling training programs, they are: unconditional positive regard, genuineness, and empathy.
In addition to facilitative attributes, the dimensions of competency, and activity or directiveness, were also important in the nurturant alliance. This means that although comfort is important in the nurturant alliance, there is also a recognition that therapy can be, and probably needs to be, uncomfortable at times. We want someone who is going to ask hard questions, direct us towards change, and help us get to the root of our problems.
Bachelor included an appendix with some excerpts from the individuals who participated in the study. This is what one of the participants said about their preferred alliance type that was categorized as nurturant:
“…A good therapist represents for me first and foremost someone who shows quality listening and passes no judgment. It is a relationship that should have a climate of trust and where the client feels as much at ease as possible to express everything. She/he should…intervene at the right moment and in an appropriate way so that the client finds out himself what is not functioning right…”
Insight-Oriented
Are you hoping that therapy will help you to reach a deeper level of self-understanding? For some of us, the “aha” moments that can happen in counselling are the ones that are the most profound and impactful. Sometimes it is hard to see our own stories objectively, and it’s not uncommon to have the unconscious parts of ourselves running the show with little or no understanding of what those parts are or why we are falling into patterns of thought or behaviour.
Perhaps you have heard the famous words of Carl Jung before:
“Until you make the unconscious conscious, it will direct your life and you will call it fate.”
For these clients, the therapist is there to shine light on the unconscious parts of ourselves that we may not be able to reach ourselves.
The participants who fit in this particular group are interested in the underlying causes and dynamics of their ways of being in the world. For example, someone who is insight-oriented not only wants to know how to change their behaviour, but is also going to be interested in why they have been displaying that behaviour in the first place. An important component of this alliance is that of “client self-revelation,” which is the “free, uninhibited self-expression and disclosure of intimate feelings in the working relationship” (p. 327).
Below is another quote from Bachelor’s appendix from a participant who was part of the insight-oriented group:
“What I ask of the therapist is to help me advance, help me understand and see clearly what is going on inside during different situations, try to find out what these situations stir in me. To explore, with his help, different problems or difficulties, which come up again particularly in relation to others, in order to then find out by myself the best solutions,to achieve a sense of well-being… a relationship that would enable me to make links between events, situations, emotions, etc. that I would not have come up by myself… “
Collaborative
For clients who prefer the collaborative approach, therapy is seen as a joint venture, one where the client is an active participant in the course of therapy. Whereas it is common for many of us to see the therapist as responsible for guiding the change process, these clients see their own participation as a necessary component to change.
If this is you, you are most likely going into therapy with ready to participate in the process and committed to ‘doing the work’ involved in the therapeutic process, including “exploration of material, self-analysis, self-discovery, identifying issues, finding and applying solutions, open and frank self-disclosure, and, particularly in therapy, participation in the evaluation of strategies, solutions, or its conduct” (p. 328).
For these clients, it was observed that the therapist’s receptivity to client’s feedback or criticism of the therapist was a key to success. These therapists were able to discuss any sources of client dissatisfaction that may have arisen during the therapeutic process. Finally, trust and respect were two ingredients of this particular relationship that were identified as crucial to the working relationship for these clients.
Below is a quote from Bachelor’s appendix from a participant in the collaborative group:
“A climate of trust must be established from the onset between client and therapist… comes from good attentive listening on the side of the therapist… the therapist must adapt to the style and personality of the client, a good client-therapist relationship will also come from the readiness of the client to open up and to participate actively in therapy…”
Not all clients are the same when it comes to viewing the quality of the working relationship between their therapist. A positive relationship for some clients may focus on the quality of the relationship, and for others it might be based on the self-understanding gained in therapy. For a minority of clients, it is going to be the collaboration and participation in the process that is most important.
Whether or not you were able to clearly identify with one of the above groups, this kind of research might encourage you to think about your own views of therapy. As the client — what is your preferred role in the therapeutic process? What are you looking for in the therapeutic relationship? We might think that the answer would be relatively the same across the board, but Bachelor has shown us that that is not the case.
This can become painfully clear when a friend refers us to their therapist—someone that they swear by. We may even skip the consultation call, feeling assured that if this person helped our friend, they are bound to be able to help us. Our friend might very well know us, but they could also have different views and expectations of therapy, and might be looking for a therapeutic relationship that looks different from the one that is going to be most beneficial to us.
