Does your psychologist truly “get” you? What really makes therapy work – A psychologist’s reflection

In this complex demanding world, we are all searching for the best ways of achieving our goals as quickly as possible. As discussed in the previous blogs in this series on therapy, if you have come to the conclusion that seeing a psychologist could help you and that it may be worth the investment, then I bet all you want to do to improve your mental health is ensure you choose the most experienced person.

But what truly will make the process work for you? Is it experience, knowledge, qualifications, specific techniques? What will help you achieve your goals effectively?

Choose your psychologist wisely – the relationship is everything

My advice… choose wisely, as this may be one of the most important relationships you experience in your life for some time. It might surprise you to learn that studies consistently have demonstrated over many years that the therapeutic relationship is more important in achieving therapeutic outcomes than any new psychological technique or approach, the age or gender of the therapist and even the number of years of experience.

A personal reflection on being a new graduate

I certainly remember learning this insight early in my career as a new graduate.  As a young psychologist full of anticipation and excitement about my career ahead and highly conscientious by nature, I remember being both curious and daunted by how much there was to learn at the beginning of my career. I had many sleepless nights worrying about whether I asked all the right questions, spent hours planning what I needed to do in subsequent sessions and remember asking myself incessantly whether I had done enough in that one hour session that would make a difference. The responsibility to know about so many different mental health issues, how to deal with children, adolescents and adults and being able to put into practice the gold standard treatments that we were trained in was a complex balancing act.

I remember being envious of all those psychologists who had been doing this for years – surely they had this all down pat unlike me? I often felt out of my depth in those early years but I was reassured by my peers and more experienced supervisors that this anxiety was normal and like anyone new in their career I worked hard to ensure that I gave the best service that I could and kept striving to learn, always asking questions and doing my best to reflect on my practice.

Balancing that anxiety, even when I perceived I was fumbling, I noticed that there were many wins and successes. I remember my very first client to this day. His journey and his gratitude for the impact that the 6 month therapeutic process had on his life still stays with me. He felt safe and understood in a way that no one in his life had shown him. I knew then that despite the many anxieties I was on the right path towards a meaningful career and that at least I knew that I was doing something right. The outcomes spoke for themselves.

The next stage – Getting out of my mind and into building the relationship as the priority

Yes, as you can hear, like any one of my clients who see me at critical points of change in their life, being human, I am no different to the people with whom I work, experiencing self-doubt and negative thoughts that sometimes get in the way. Our job is to manage these at times when they interfere and to model those skills that we teach people.

At that time in my career, I felt at times overwhelmed but a supportive mentor stopped me one day and reminded me of the research. He said to stop worrying so much about technique and to focus on building the therapeutic alliance as without that, no client would trust me nor listen to my intervention and techniques without this foundation. He quoted research to indicate that the quality of the therapeutic relationship explained the greatest proportion of the outcome (about 40%) with specific psychological techniques accounting for a very small amount of that change – estimated at about 5-15%.

The benefit of acceptance, curiosity and mindfulness

He reminded me to put my focus on building a positive therapeutic relationship, to meet a client at their level, to work hard to understand them and to always remain curious and to demonstrate this curiosity through skillful questioning and being completely present. To this day, I’ve always remembered him saying – “Never stop being curious Alex, the moment you stop exercising curiosity everyone becomes the same and their uniqueness and difference disappears. If that happens … it is time to give up being a therapist”

At the time I remember breathing a massive sigh of relief and the weight no longer felt so heavy – perhaps I could do this well and with experience I would get better at implementing all that I had learned in terms of technique and scientifically validated interventions. What relaxed me was that I knew already that one of my key strengths as a therapist was the ability to build rapport quickly. I learned to trust my creativity, warmth and empathy and my use of language. I got better at making sense of things quickly, putting the jigsaw puzzle of someone’s life and patterns together in a way that made sense to both of us as the first step towards facilitating change. I watched as clients had those “aha” moments when something was clarified that suddenly made sense and began to realise how powerful truly searching for explanations and clarity was for people to be able to move towards change.

What did I learn from observing myself?

The challenges and anxiety of moving into a teaching role as a therapist teaching family therapy were significant, particularly with recording my sessions on video. This brought up every insecurity you could possibly experience. It also showed me clearly what truly worked… the outcomes and the video analysis showed me when therapy was effective and when it didn’t work. I would watch how people responded to me – to my tone of voice, my body language and I learned that a balance of gentleness, warmth and acceptance were key but that when the timing was right directness was also needed.

I watched people start to trust me when they did not feel judged and saw how they relaxed and felt safe when I validated and named their emotions accurately.  I notice how attuned the clients were to my responses and how much their mood or behaviour could fluctuate in response to my behavior and communication. I realised that there was a lot more happening than just the sounds heard in the room from both psychologist and client…. so much was unspoken but felt, thought but never verbalised, or shown through the body in the spaces between the words or the tears.

What I learned was how to build sustainable therapeutic relationships, to listen carefully, to manage intense emotions with poise, to know when to challenge and when to pull back. I also learned how to use language creatively to present an explanation that others in the family could not see. I also learned that sometimes therapy can go off course and the challenge is to find a way to repair ruptures in the relationship and be willing to be open to criticism and change so that the relationship may transform.

I learned quickly as I grew in confidence and experience that the research and my mentors were clearly right – when the relationship and alliance was strong everything else flowed and followed from that but when it wasn’t, therapy felt difficult for both therapist and client creating a mismatch that made progress difficult to achieve. Like with any relationship, there are times where it clicks and times where no matter how hard you try you just don’t “get” each other and at those times it is best to encourage a client to find another psychologist who would be a better match.

It is indeed a privilege to do this work. I never forget that. The opportunity to have such an important place in someone’s world is not something to be taken for granted – it is a position of great power and privilege to be managed sensitively and respectfully. The willingness of clients to trust me with things they may never share with anyone else is a journey that is unique and a relationship that facilitates growth on both sides. In the end, it is a relationship like no other, quite unique in its’ nature and therefore the ingredients of what makes it work are sometimes hard to put your finger on.

Look out for my next blog in this series that will help you identify the right person to be on your team and will consider the “10 questions to ask yourself about your psychologist and the therapeutic relationship”