How to build a therapeutic relationship with a client?
In the context of mental health practice, the therapeutic relationship has been called a “foundation”, without which any progress is impossible. It forms a vital part of the treatment process. In fact, it is also said that the therapeutic relationship or alliance is more valuable than the specific techniques or interventions in a psychotherapeutic setting. Hence, its importance cannot be overlooked.
What does a therapeutic relationship mean?
The therapeutic relationship is a collaborative alliance between the mental health professional and the client to effect beneficial change within the client. For many clients, therapy is the first time they experiment with vulnerability. Successful therapy depends on the client’s honest sharing of events, thoughts, feelings and behaviors. Sharing these with a stranger for the first time can be a challenging experience, which is why the therapeutic relationship is a crucial component of mental health treatment. A client might be reluctant to share due to a bad history with therapy, stigma, trauma, fear of judgement, or something avoidable – an uncomfortable therapeutic environment.
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Why is the therapeutic relationship important?
Apart from developing trust and warmth in the therapeutic space, a positive therapeutic alliance is also associated with better treatment outcomes and improved adherence to therapy. It helps retain clients to therapy, it motivates both the client and therapist to work on a collaborative relationship, it encourages deeper disclosure, and it allows for a safe space.
What are the elements of the therapeutic relationship?
The key components of a therapeutic relationship include:
: This means the respect and concern one has for their client regardless of their lifestyle, background, and socio-cultural identity. This can be expressed by considering the client’s opinions and feelings while planning interventions and the line of treatment.
Empathy: Empathy and a non-judgmental approach are irreplaceable components of a successful therapeutic relationship. Empathy is the ability to put oneself in the client’s shoes and understand their perspective. This helps the client feel safe and understood.
Trust: Trust can only be developed when the client perceives the mental health professional as consistent, reliable, honest, and caring. Congruence (consistency between words and actions) is also an aspect of trust.
Confidentiality: At the beginning of the therapeutic process, communicating the notion of confidentiality is crucial to developing trust.
Collaboration: Forming a mutual and equal relationship with the client is critical. The essence of the relationship is making collaborative decisions about the therapeutic direction and interventions.
Warmth: The client should feel that their issues are important to the mental health professional and that they care.
Genuine Interest: The mental health professional should genuinely be interested in what the client is saying. A client can detect any artificial or non-genuine behavior – which will immediately rupture the therapeutic relationship.
Clear Communication: Communication does not only involve the words a therapist says, even though that, too, is crucial. It also includes the non-verbal actions – the tone of voice, the body language, etc. The verbal and non-verbal elements should clearly communicate warmth, empathy, and unconditional positive regard to the client.
Rapport: All of the above culminate into a good rapport with the client, which is one of the foundations of a positive therapeutic alliance.
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How to develop a therapeutic relationship with a client
Apart from the components mentioned above, other things can also help build a therapeutic relationship:
- Help the client feel welcome in the therapeutic space. Make sure the room is comfortable regarding seating arrangements, lights and temperature. Tailor the structure of each session according to the client.
- Manage your own emotions, and be self-aware. Emotional regulation can be vital in setting up an alliance with the client.
- Take feedback from the client, and do not be defensive about it.
- Focus on the client’s needs. Remember that therapy is for the client. Talking with another therapist or a supervisor may help you separate your needs from the client’s.
- Don’t rush the alliance. Know that any relationship takes time, as will the therapeutic relationship.
- Therapists are human. It is okay to make mistakes. If you feel like the relationship has been ruptured, put in efforts to overcome the rupture. If done correctly, this may even increase the trust within the relationship.
The therapeutic relationship in online teletherapy
Since the pandemic’s onset, online therapy has become more common. It can be challenging to develop a therapeutic relationship – since screens can make the process distant. However, there are still ways to work on the alliance.
Just as in traditional therapy, building a rapport is the first step. Using non-verbal actions is challenging, but make an effort to lean in towards the camera, tilt your head and nod towards the screen. You will have to make more of an effort to stay engaged with the client and be responsive to them. Addressing the online therapy model and its advantages and disadvantages can also help the alliance. Talk about how you are feeling and listen to the client’s opinion of the modality as well.