It’s important to remember whatever happens in a session is a microcosm and valuable information that represents the outside world of a client. We begin to see how the person relates to his/her environment within the therapy session. The subtle and more overt difficulties and strengths the person might have can come out and this is a powerful experience! Do you notice they urge to take care of you? Do they have problems with completion of tasks you've requested? Do they distance themselves when “tough” subjects come up and laugh when their affect and discussion don't match? Do they attempt to push/pull on the relationship in ways that might be damaging to your continued work with them? If you notice it, talk about it. How does this impact the relationship at hand?
The relationship with your client can and should affect you– it’s a microcosm of many years of conditioned experiences (from both sides!) and we can learn a great deal about what is happening in the “here and now”. A big part of me as a social worker has been trained on resources and advocacy. The other part of me as therapist recognizes how that can also be unhelpful when the timing is wrong. The challenge is to balance both. Resist the "righting reflex" -- to give advice without permission, to solve the client problem immediately (see more on this subject of the righting reflex).
Offering and suggesting resources when a person isn’t ready or you’ve ignored what is happening in the current therapeutic transaction may provide a temporary fix or might be unwanted by a client while the underlying relationship might be ignored. I’m not saying to avoid EVER giving resources as options to client. Always ask permission before doing so (a component of Motivational Interviewing that elicits respect, dignity, and autonomy.) Example – “I have some thoughts about what you might want to try and I’m wondering if you are interested in hearing about a group I know in the community.” If a client says they are not interested hearing this information, respect this at all costs. Use your intuition when the right time to suggest an outside option is appropriate and always attend to the relationship first.
“The importance of using the here and now is based upon assumptions of the importance of interpersonal relationships and the idea of therapy as a social microcosm. Our interpersonal environment influences us and our self-image is formulated to a large degree based upon what we perceive important figures in our lives appraise us to be. “ - Yalom
“The interpersonal problems of the patient will manifest themselves in the here-and-now of the therapy relationship.” – Yalom
What does this mean for you? Seeing things more analytically between sessions. Remember when I said graduate school taught you how to think about things? This is where that molding comes into play. Dig up and review what you learned about regarding family systems in grad school. You might need to go back and gather a better social history and revert back to the basics with a genogram (thanks, Jeannie Shanks) to learn more about unspoken rules and communication patterns that may be generational. History and relationships often repeat themselves and can be wonderful information about what others might be struggling with in a client life. What you are feeling might exactly be what others have felt in the interaction and the relationship is the most powerful indicator you have with your client NOW matters. Ask your client frequently, how are we doing? What is helping in our sessions? What could be better? What directions are we going that you are finding most helpful? What might we be missing?
It also means to have thick skin. Not taking something personally is something we all have to work on. Central to assumptions and agreements in the DBT world is that the relationship between client/therapist is a real relationship and this means that the relationship can affect you. Let it to a certain degree while also understanding this is probably some of the difficulty the client has had in their lives from a long history and quite possibly, your own. It’s a therapy interfering behavior if you’re not honest with a client and also therapy interfering (Linehan) if you’re not looking at parts of you that may be carried forward and triggered from your own past relationships. Ask yourself, what is happening that I am afraid of? What is making me push away from this client? Is it my stuff or something that is happening in the relationship?
Because the relationship is real between two people, it’s important to talk about it with them after you’ve done some reflecting. How you talk about these things equally important as what you say. It’s difficult to bring up subjects that might cause some tension. It’s necessary for the person in their quest in developing a life worth living. It’s also important for you to accept feedback from a client when you’re doing something they might find unhelpful.
Precise communication full of honesty and dignity leads to the real relationships you’re modeling, teaching, and instilling. We all know Maslow’s hierarchy of needs asserts that safety/security is necessary for good things to happen. Create the safety to discuss what is necessary and how the relationship is progressing. Being genuine, honest, direct, and respectful are staples for this to happen.