Practical Advice for Stuck Clients

Posted November 30, 2015

So many of us consult on the intervention level when a client is not making significant progress.  We offer therapists advice like, “try a cognitive reframe,” or “be mindful of the behavioral contingencies,” or offer some other “ingredient” from our preferred therapies that we think will be the catalyst for change.  And why not?  We need interventions to do therapy, and our treatment manuals are basically recipe books full of ingredients that promise results for our clients.  In fact, most seminars rally around a particular treatment manual, and some even go so far to say they have the 5 (or 10) best strategies to help even your most stuck client!

Therapy manuals and their ingredients are important, and the team at Mental Health Systems, like many others, believe we should learn to do our therapies well, but research shows that the interventions we use in therapy actually account for a small amount of the variance in change.

So what influences outcomes more than interventions? 

Unsurprisingly, the therapy alliance is of vital importance.  However, you may be surprised to learn that the therapy alliance accounts for 5 to 7 times more of the variance in change than treatment manuals and techniques!

Thus, while intervention-based consultation will always have its place (again, we need interventions to do therapy), it may be wiser to consult on how the quality of the alliance is affecting the outcome.  To this end, consider these three factors related to the alliance, ALL of which research shows need to be present for a positive outcome.

Three Key Factors To A Therapy Alliance

1) Relationship:

This is a factor of alliance most obvious to therapists.  Relationship is definitely about rapport and the therapist-driven variables of authenticity, empathy, and respect.  While providing these qualities along with a nonjudgmental stance seems like common sense, it can nonetheless be difficult at times when working with a stuck client.

2) Agreement on a Goal:

Having a common goal for the therapy defines the work and speaks to the active part of alliance.  Often when therapy is not working it is because there is not a shared goal to bind the alliance and create active roles in the therapy.  Ask yourself: “What does the client want?”  Without a shared goal, there is no therapy!

3) Agreement on the Therapy and its Methods as being Legitimate to Reach the Goal/Solve the Problem:

This third part of alliance speaks to how successful outcomes result from an interactive connection between therapist, client, and therapy/interventions in the pursuit of the identified goal.  To be effective, agreement on the therapy and methods needs to be based on genuine belief and expectancy on the part of the client and allegiance on the part of the therapist.

Without therapy alliance, virtually no intervention will carry much success. Therefore, whenever you have a stuck client, start with making sure all three parts of the alliance are present and in play!

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