People seek therapy when their current behaviors are no longer working. Change begins when clients are outside their comfort zone. Sometimes, a therapist’s job is to push our clients into the zone where change begins. This can be tricky for any level of clinician to navigate. How do you deliver observations of maladaptive behavior without alienating the very person you are trying to help?
Put in the time to build rapport
We all understand that receiving feedback about behavior is difficult. The same is true for our clients. Having a solid foundation of rapport helps soften the edges of difficult feedback. Clients often want to know their therapist is a person too, but therapists are taught to maintain strong boundaries. An effective therapist can use innocuous examples of personal experience that keep the focus on the client, while demonstrating fallibility and genuineness. This will strengthen rapport and make difficult feedback easier to hear, and tends to lower a person’s defenses. For example, I often share with my clients that as a college student I went through several roommates, until finally a close friend pointed out that I was the common denominator!
Observe and Describe
Dialectical behavior therapy (DBT) teaches to nonjudgmentally observe and describe things we see. Using these same skills can be helpful when pointing out ineffective or maladaptive behaviors. For example, you might say to your client, “Can I make an observation?” This opens the door to discuss the behaviors you are observing. It might even help to tell your client directly, “I am not passing judgement. This is a pattern I’ve noticed recently, and I think we should explore it.” Be mindful of your delivery.
Communicate curiosity through your tone and facial expressions
Starting therapy can be very difficult. Identifying and accepting the behaviors we need to change can be even harder. Your clients’ behaviors in session are giving you important clinical information about their life outside session. Observe and describe the behaviors you are seeing, not the perceived intent. This will begin an open, nonjudgmental discussion about what you are seeing. You can work together, as allies, on what effective change looks like.
Christina Kress, MSW, LICSW, is a licensed clinical social worker in private practice near Minneapolis, MN. Kress has eighteen years of experience treating children and families using play therapy and cognitive behavioral therapy (CBT), along with ten years of experience treating adults and teens using dialectical behavior therapy (DBT). Kress presents annually at the Minnesota Association for Child and Adolescent Mental Health Conference; has been a guest lecturer at St. Catherine’s University in St. Paul, MN; and provides clinical supervision to mental health practitioners through her practice.