[SarahSweden]

I would like to recommend this video clip where a T talks about the therapeutic relationship and about new studies that have been done. He says he regularly asks his clients about their relationship and he also claims it´s not the T:s own apprehension about being empathic but if the clients feel empathy that are crucial to a succesful therapy. Very interesting.

Therapeutic Relationship and Individualized Treatment for Successful Psychotherapy

Yes, short but very interesting! Thanks for posting. It makes perfect sense with psychodynamic therapy, which is primarily a transference relationship (so, driven by the patient's subjective perceptions). Not sure it would be equally true for a more practical approach (like CBT) where the focus is meant to be more on the tools and the relationship is more a background mechanism providing it.

[Argonautomobile]

I wonder, when the patient's and therapist's assessments of the alliance don't align, is the therapist usually leaning in one direction or another? That is, do they consistently see a good alliance where the client does not? Or feel less close than the client feels?

Interesting. Thanks.

[SarahSweden]

I think this depends on the therapist. I think a good T wouldn´t claim there´s a good alliance if the client says there isn´t. I think a lot T:s protect themselves by claiming there is a good relationship and that the client just can´t feel it. I think it has to be a T who keeps updated on research and who is willing to learn new ways in relating to clients to create a good alliance.

Originally Posted by Argonautomobile

I wonder, when the patient's and therapist's assessments of the alliance don't align, is the therapist usually leaning in one direction or another? That is, do they consistently see a good alliance where the client does not? Or feel less close than the client feels?

Interesting. Thanks.

[BudFox]

This borders on parody. He acts as if it never occurred to him that the client's perspective on the relationship might be important, let alone the most important. Speaks volumes about how detached from reality these guys are, and how convinced they are of their own superiority and insight. I can imagine in his mind the client is a slobbering, bewildered simpleton who can't add 2+2 without the therapist's help.

[Argonautomobile]

Here we go:

"The results of the study show that client ratings of the working alliance are more strongly associated with treatment outcome and that clients typically rate the alliance higher than the therapists.The results also show that treatments where therapists rate the alliance higher than clients produce worse outcome. The results of the study were interpreted as showing that clients and therapists perceive and understand the concept of the working alliance from different viewpoints that do not necessarily match. It also seems that discrepancies in alliance ratings typically are of no discernible consequence for psychological treatment to yield acceptable outcome and that clients’ perception of the alliance is a key factor for a positive treatment outcome which mirrors previous results from research on the association between the working alliance and treatment impact."

From this source http://www.psykologforbundet.se/Documents/Specialist/Abstracts%20140603/Congruence%20in%20the%20therapists%20and%20clients%20ratings%20of%20the%20therapeutic%20alliance%20does%20not%20predict%20outcome%20in%20psychological%20treatment%20av%20MIKAEL%20SINCLAIR.pdf

I don't think it's particularly surprising that the client's perception of the alliance is the most important factor in a positive treatment outcome. (that, as BudFox said, would seem obvious). But I do think it's interesting that clients typically rate higher than therapists--I would expect it to be the other way around, if there's any truth to that stereotype of therapists as arrogant or at very least Self-protective (as Sarah brought up).

That congruence doesn't seem to matter is very interesting to me. Seems like a highly-rated alliance would also be highly congruent.

[luvnola]

Surely this isn't something new and something t's don't already realize?? I mean, of course it's the clients perception that is most important and not the ts. I've had t's who checked in with me from time to time to ask how I thought therapy was going, the rel'ship and if it was productive, etc. I've had a couple ts think I was feeling stuck or that therapy wasn't really progressing, when that wasn't true for me. I've had a t think she wasn't helping me at all when I thought she was. Feedback is good for both client and therapist.

I don't think all ts are capable of empathy and I think some are so full of themselves that they automatically think all clients will love them. I don't stick around too long when I run upon one of these. (and I have)

[CantExplain]

Originally Posted by SarahSweden

He says he regularly asks his clients about their relationship and he also claims it´s not the T:s own apprehension about being empathic but if the clients feel empathy that are crucial to a successful therapy.

Yay! But it's too late for me and I doubt Madame T would have listened anyway.

[Soccer mom]

Originally Posted by SarahSweden

I think this depends on the therapist. I think a good T wouldn´t claim there´s a good alliance if the client says there isn´t. I think a lot T:s protect themselves by claiming there is a good relationship and that the client just can´t feel it. I think it has to be a T who keeps updated on research and who is willing to learn new ways in relating to clients to create a good alliance.

Totally agree. I kept telling my ex-T. that I didn't feel she cared or was reassuring. She told me it was my transference blocking me from seeing/feeling it. She told me that her other clients think she is which totally invalidated me. New T. says all that matters IS MY perception.

Thanks for sharing the video.

Originally Posted by Argonautomobile

. . . . But I do think it's interesting that clients typically rate higher than therapists--I would expect it to be the other way around, if there's any truth to that stereotype of therapists as arrogant or at very least Self-protective (as Sarah brought up).. . .
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See, I interpret it completely differently! I'm not at all surprised that many clients rate the alliance higher than the therapist. Why? Because I think that many therapists are NOT honest with clients about the therapeutic alliance. They aren't open and straightforward about what's happening in the room between two people. In fact, I think that they are so focused on fostering the alliance/attachment, that they snow the client into believing that things are peachy keen. Clients enter the relationship told to be honest and open, but they have no idea that their therapist is not playing by the same rules. The therapist is attempting to foster an alliance that is based on a false premise of everyone being honest and straight forward in the relationship--this is why we see so many clients on PC forums talking about their confusion and distress about their therapist suddenly pulling the rug out from beneath them in regard to boundary issues. Unskilled, dishonest (and I'm not talking about dishonesty in the sense of purposeful hurtful behavior) therapists stretch and give beyond what they want or are truly willing to give. And then, when he/she is overwhelmed by the demands, he/she pulls back and tells the client that he/she overstepped the bounds. The therapist was dishonest in his/her attempts to foster a positive alliance. And you can be SURE that the therapist was feeling that the alliance was going down the tubes waaaaay before it happened, but he/she didn't express it honestly and openly when it first began to deteriorate.

I am a person who has benefited from therapy. I believe in therapy, but I also believe that training and mentoring in working therapist in the U.S. is HORRID! If a person can take a college course and score a B or better, he/she can obtain some kind of therapeutic license. The exam for licensure is ridiculously laden with facts that have NO bearing on how the person will function as a therapist. It takes much more than that to be a good, well trained therapist with a handle on your own issues and an ability to function productive and intelligently as a therapist.

Do I think there are good therapists out there? Absolutely. I've worked with three. But finding them was hard hard work and I'd hate to be a person who didn't have my ability to evaluate what kind of things were wrong with the person I was interviewing. I'm an "old" person, if I was a 20 year old or 32, I wouldn't have the understanding that I have now. I was just lucky when I was 45, that I stumbled on a skilled, well trained and competent therapist. I took what I learned from her, to find the two others.

[UglyDucky]

Originally Posted by SarahSweden

I would like to recommend this video clip where a T talks about the therapeutic relationship and about new studies that have been done. He says he regularly asks his clients about their relationship and he also claims it´s not the T:s own apprehension about being empathic but if the clients feel empathy that are crucial to a succesful therapy. Very interesting.

Therapeutic Relationship and Individualized Treatment for Successful Psychotherapy

Interesting, but short, video...I guess. I didn't not like it, but wonder if taking such a structured stance toward soliciting input from the client is the best way to go about it. My T tends to ask questions like, "Do you feel I've judged you?" when we've been talking about my experiences of feeling judged in past relationships, etc. I'm not saying this is the way to get the information Ts may want, but I'm not so sure I would complete a short interview or questionnaire on the spot...I have to have time to think.

Originally Posted by Soccer mom

Totally agree. I kept telling my ex-T. that I didn't feel she cared or was reassuring. She told me it was my transference blocking me from seeing/feeling it. She told me that her other clients think she is which totally invalidated me. New T. says all that matters IS MY perception.

Thanks for sharing the video.

Thanks for posting this, Soccer Mom. This is very similar to the problem between my T and me, and he has said exactly the same thing over and over. It feels like he is like that because of me, which hurts my self esteem, because after all, no one else seems to see him that way.

After I quit the last time, he seems to have been trying more, although I'm not sure yet if its gonna work. It feels nothing less than traumatic to me to end the therapy. I give you much credit for leaving the relationship. I am barely getting through life lately and just don't have the strength.

[Soccer mom]

My ex-t terminated me because she felt I was in too much distress due to the transference. I now understand it wasn't the transference and it wasn't me. It was her temperament and reactions to me. I've had a few therapists tell me she was emotionally abusive and I have every right to file a complaint. I'm not that type of person. So it wasn't up to me but I do feel better. Watching the movie Gaslight brought out a lot of anger as I felt that was a lot of my therapy. I understand not wanting to leave. You should talk about how his reactions make you feel. I hope things get better for you.

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[Eucalyptus]

The presenter used a term that is commonly used by therapists, including mine: Empathic. If asked, would many therapists say that they had been trained to be empathic? Or is true empathy not in fact an inherently subjective concept, training or no training?

Originally Posted by Eucalyptus

The presenter used a term that is commonly used by therapists, including mine: Empathic. If asked, would many therapists say that they had been trained to be empathic? Or is true empathy not in fact an inherently subjective concept, training or no training?

We had a lot of training around empathy but I do believe it's not a skill that comes naturally for some and can be hard to learn. Others have too much of it, so much that it can cripple them emotionally. I believe that it is easy to spot when someone is faking empathy and noticed a lot of ts doing it.

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