The three steps to effective alliance repair
Updated: Nov 17, 2022
Skills of an effective counselor part 11
There are two types of people who become therapist.
The first group are people who've been therapy adjacent. Usually these are older people who've decided to become therapists because they're tired to of feeling like they don't have the skills to really help.
It's the teacher who spends extra time with kids and sees how their home life impacts their grades.
It's the pastor who saw another couple divorce, despite his best efforts.
It's the parole officer who wants to actually help addicts, rather than babysit them.
The second group are the students. They've not had a full time job, but have decided to go into grad school straight from undergrad.
This group tends to be younger.
I was one of these counselors. When I did in-home therapy, often with court mandated families, one of the problems I routinely faced was people looking down on my for how young I was.
Grandma might say something like, "Do you have kids?", "How old are you?" or "Have you ever been married?"
I was taught to respond to Grandma with an explanation.
"Well, a doctor doesn't have to have cancer in order to treat cancer do they?"
I don't know who thought that explanation was good idea. But I don't think it convinced a single family I worked with. Instead, it did something worse. They probably left thinking, "Okay, this guy doesn't get it."
They never actually said "this guy didn't get it,". At least not out loud.
Instead they just smiled and nodded politely. And then would miss session after session.
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The therapeutic alliance is the biggest factor in effective therapy.
We've been talking about the Therapeutic Alliance. To recap the therapeutic alliance is the biggest change factor in therapy. It not only consist of the client-therapist bond, but also agreement on the goals and tasks of therapy. And most importantly, if there's a mismatch between you and your client on any of those three levels, client-therapists bond, goals of therapy, or tasks of therapy, you have an alliance rupture.
So, if the alliance is so powerful, and if the mismatches create ruptures, then one of the most important skills in therapy is knowing how to handle alliance ruptures.
The secret to repairing ruptures in the therapeutic alliance.
When I survey various models there are a few different themes that continue to pop up when addressing alliance rupture's.
And the big over arching idea is:
Lean in. listen.
This idea, of "Lean in. Listen." is the exact opposite of what I was taught to do with clients.
See when grandma said "you look a little young to be a therapist," she was telling me we had a rupture in the client-therapist bond. My response of explaining was actually negating the core concern hidden in the her complaint.
But what if I'd been able to lean in and listen and attend to the hidden concern.
What if when Grandma had asked, "hey you seem pretty young" I had been able to respond with :
“Yeah, I am pretty young. And maybe you’re worried you’re not in good hands? But you tell me, what concerns you most about my age?”
What would it had been like for this grandma to know she'd had a therapist mature enough to actually see her how concerned she was?
I can tell you one thing, it would have been better than saying, "well, a doctor doesn't have to have cancer to treat cancer."
Let's pull this thread a little more. I don't just want to give you platitudes, I want to give you actual micro skills.
Across models this "Lean in. Listen." idea is built on three distinct micro-skills.
Take responsibility for some part of the stated rupture.
Reflect the core emotions embedded in the client’s statement.
Ask an open ended question inviting the patient to share more.
1. Show them you see the same problem.
First, we need to take ownership for some part of the rupture. I think this is the hardest part. Sometimes we feel the rupture isn't our fault. But as we learn from people like John Gottman and David Burns, there usually is some part of the rupture that we can take ownership for.
When we take ownership for our part, no matter how small, it has a powerful disarming effect. I think that's because when we take ownership we're effectively saying, "yes, I see the same problem you see."
All of this is conveyed in the above response when I say:
Yeah, I am pretty young.
The trap here is to take too much responsibility. Watch out for that. Notice I'm not saying "your right I have no expertise." "I know nothing." or "I can't help you."
I know its a lot to ask, but I'm going to ask it. Find a third way. Accept some responsibility. But not all. And show that you see the same problem they do.
2. Demonstrate understanding
Second, we reflect the core concern or emotion embedded in the rupture. This is important because we're demonstrating understanding. We're not saying "I understand." We're showing that we understand.
And maybe you’re worried you’re not in good hands?
This is soo important because it's a form of validation. You're validating the heart of the matter.
Of course they're worried! Everything they've tried in the past hasn't worked! And now they've been forced into counseling! They probably think this kid with a masters degree is looking down on them.
When we can validate the core concern, when we can show them we understand their fear, it's actually the exact thing they need in that moment.
So reflect their core concern and begin the healing process.
3. Change how they see you
Third, you ask for more information. It's pretty simple. You're just asking an open ended question. This conveys openness instead of defensiveness.
But you tell me, what concerns you most about my age?
I think the real beauty of this is it subtly changes your counterparts perception of you. If you remain open, it reminds them that you are human, instead of whatever image they might have in their head.
It helps them to see your real intentions.
Show clients having a problem won't break the relationship.
There are, of course, other aspects, context, and nuances.
This is not the only thing you need to do.
But this is the core skill, because what we want is to show clients that you can stay in relationship even when there is a problem. We want to show clients we can have a real conversation about real problems and it won't break the relationship.
I think this has the potential to be very powerful, because if we engage in it genuinely then ruptures become the very moments where we build deeper trust.
I actually made this into a deliberate practice skill. You can get a free copy of the Deliberate Practice skill here.
Jordan (the Counselor)
Note: If you want to learn amore about this approach, I recommend you check out the work of Jeremy Safran. He's featured in the video below and dealing with ruptures was his specialty.
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