On Support and Authenticity in the Therapy Room
Reflections from a doctoral student on being supportive and authentic
Posted Jul 20, 2012
As a supervisor of emerging clinicians, one of the most common growth edges for students to learn is how to share with clients what they authentically think without rupturing the therapeutic alliance or making clients feel blamed for their difficulties. Consider that one of my supervisory tactics is to ask my supervisees in supervision what they think is really going on with their client and then follow that question up with, “Did you tell your client that?” Usually the answer is a resounding “No!” The reasons are plain enough. Many clients come to therapy with neurotic dilemmas, meaning that their fears, perceptions, and defensive justifications block them from finding adaptive solutions and instead function to perpetuate their difficulties. For example, some are insecure about their relational worth and this insecurity leads them to either lash out at any potential slight or isolate themselves out of fear of criticism. Unfortunately, both strategies ironically result in vicious cycles and the loss of relational value over the long term. Yet such processes present a dilemma for the therapist, for they imply at some level that the individual is to blame for their difficulties; and this is not something a supportive therapist wants to communicate! The flip side of the interpretation, however, is actually good news because it means that there is potential to change and ultimately get more of the client’s needs met. The trick is how to achieve the insight without the implication of character blame and subsequent defensiveness or shame.
Indeed, much of the training in our doctoral program is on how to be effective at communicating what the clients need to hear, but doing so when and in a way that they can hear it. It is a dialectic between being authentic and supportive, and between fostering acceptance and the motive toward change.
An excellent book that explores this dynamic extremely well is Paul Wachtel’s Therapeutic Communication. And what follows is a reflection from Christen Pendleton, a doctoral student in clinical and school psychology at JMU, which I think offers a nice description of how students develop managing this dialectic.
"The counseling program from which I received my master’s degree was predominantly humanistic in its orientation. My understanding at that time was that being humanistic meant being kind, supportive, client centered, authentic and displaying unconditional positive regard. I felt pretty good about the first three, but the last two gave me pause. I wondered how I could simultaneously be authentic and unconditionally positive. I misunderstood what unconditional positive regard meant and believed it to mean that I should be unconditionally positive in the counseling room and towards my client; that I should be one hundred percent accepting of him or her and should not have any negative feelings or reactions to them. I was confused as to how this was possible. I wanted to ask how anyone could really do that. None of the other students appeared to be concerned with their capacity for unconditional positive regard. This caused me further concern, as I began to worry that my questions were indicative of my own shortcomings. I worried that perhaps I should not be a counselor, because sometimes I felt emotions other than positive ones towards my clients.
Currently I am enrolled in a doctoral program, and the topic of unconditional positive regard recently was revisited during a personality psychology lecture. As part of the class we watched a clip of process group led by Carl Rogers in which he demonstrated use of humanistic therapy (see here). The clip was such a good choice in terms of demonstrating what humanistic work actually looks like. I was shocked to hear Rogers say directly to a client (min 6), “It is pretty damn pathetic isn’t it to feel that your cat is the only one who accepts you as you are.” This to me is a wonderful example of authenticity, of being transparent in terms of what the therapist is feeling and what he is conveying to the client. I think that this works because Rogers comes across as a truly kind person. You get the sense from watching him that he genuinely cares about his clients. While his statement was shocking to me because it was so direct and was not what I would consider to be “positive,” it was tolerable for the client, and authentic to Rogers’ experience.
Counseling programs are often labeled as overly supportive and humanistic. Now that I have a better sense of what humanistic really means, I find this to be inaccurate in the sense that they would only be providing support and reassurance. While Rogers is supportive, he is also willing to be very honest about his full range of emotional reactions to the client. Thus, it would seem that a humanistic therapist would be honest in her or her experience of the client and would be doing far more than offering an ear and kind words.
There are certain phrases and pieces of feedback that supervisors give that stick with me. I clearly remember a former supervisor telling me not to share my emotional experience or reaction to the client in the room. She said something to the effect of, “Therapy is about the client, not about you.” I have always remembered this and it has given me pause on many occasions when I have wanted to say a particular thing to a client in session. I was surprised, then, during the first semester of my doctoral program to learn about the interpersonal process approach and how to use my own reactions in the therapy room. Essentially I was being asked to do the very thing that my former supervisor advised me against. The concept of interpersonal process seems to me to be humanistic. I am therefore confused as to why a supervisor who identifies as humanistic would caution me against it, and why this very essential part of the therapeutic process was not taught in my masters program.
In my current program, the faculty’s style of conveying more authentic and negative feedback to clients exists along a continuum in term of how direct and confrontational it is. But everyone agrees that confrontation is sometimes necessary, and as long as done with respect and out of the client’s interests, is often a powerful tool in the therapy room. Much of my work this semester has focused on trying to find my comfort level with this and to be less hesitant in my delivery, less fearful about the client’s reaction, and more confident in what I am presenting. It is hard to say something that the client gets angry about or that you fear may rupture the relationship you have established. One of my goals for the coming semester is to speed this process up somewhat so that I am able to move more quickly to the heart of the issue while still maintaining the therapeutic alliance. It is this aspect of therapy that feels to me like more of an art than a science."