1/6 I get weekly coaching with Alex Vaz. Here's what I learned on 12/1/23.
For about 11 months I got once a week coaching from the world's best therapist coach - Alex Vaz [1].
For long-time readers, that won't come as a surprise. I've written before about getting coaching with Alex Vaz.
Initially when I started I was nervous. I'd tried to become the world's greatest therapist and failed. I didn't want to go through that again. On the other hand I was burnt out and needed something.
Over my 11 months working with Alex I learned a ton.
It was easily the best training I've been through. Giving back and sharing what I've learned is meaningful, so I've been cataloging what he taught me so that you, too, can learn from Alex Vaz.
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2/6 Why it's important to give rationales in therapy.
Near the end of our time together I realized Alex continually used a certain technique, rationales, which I think had a lot to do with why he was so good at what he did.
Although he used rationales constantly, we'd never talked directly about rationales. So I decided to ask him about them.
I realize how un-sexy rationales sound as a technique. They are such a small thing. But one of the big lessons I've learned from Alex is that consistently doing the small micro moves of therapy is more important than the big interventions.
You actually get farther by consistently giving clients rationales for why they should do something than doing more big interventions (ie EMDR, empty chair work, exposure), because clients simply don't know why big interventions are valuable.
So how do we use rationales? Well in a very specific way.
3/6 The best way to use rationales for maximum therapeutic impact.
Using rationales in this way takes a lot of practice.
If you're like me, then as soon as you learn how important rationales are, you plan a speech to give each client before you ask them to do anything.
That's like going to your dentist for a cleaning and instead of getting started with the cleaning your dentist gives you a 30 minute lecture on why dental hygiene is important.
While you sit in the chair are you thinking, "oh wow, this is so valuable, thanks for the information"?
Personally I'd be thinking, "when are we going to get on with the cleaning?
On the other hand say your dental hygienist is cleaning your teeth and you're squirming from the pain. What if in that moment she says " I'm sorry this is so painful. I'm cleaning now so this infection doesn't get worse. Are you okay if we keep going?"
She just gave you a small, empathic, rationale for why you should continue. It feels totally different than a 30 minute lecture.
When rationales are this small, though, you'll need to give a lot of them.
4/6 Why you need to give a lot of rationales as a therapist.
These small rationales will probably only take you so far. If the dental hygienist wants you to change your behavior, she might need to give you several of them throughout the cleaning.
For instance the second time you wince she might say, "I know it hurts, but it's going to hurt so much more if we don't do this. It's good you came in now. "
The third time you wince she might say, "if you could find the time to floss, I think it will help you a lot next time."
The fourth time you wince she might say, "You'll be sore after this, but we have this new mouthwash which is really soothing. I'll give you a sample at the end so you can feel the difference."
Each rationale is a little nudge for why you should continue with the cleaning and how you can take care of your teeth afterwards. And all the while the hygienist is continuing to work.
The same is true for therapy.
5/6 If we don't give rationales, sometimes, it's because we've stopped pushing for therapeutic change.
Oftentimes we ask clients to do uncomfortable or difficult things in therapy and they squirm and try to get out of it. And oftentimes, therapists get derailed by the client's squirming and the session becomes just chit chat or venting.
The trouble is this means we've stopped working and the client will leave our office still in pain.
It's our job to keep cleaning.
Very often when clients begin to squirm, therapists stop pushing because we're afraid of breaking the alliance. Pushing into client pain is painful, and most of us don't like it when people touch our places of pain.
Rationales though, give the client a sense of confidence in the therapist. When we give rationales, we're subtly communicating, "we know why we're doing this," and "if you can do this, then you can feel better." This message of confidence also seeds hope.
And it's those twins of confidence and hope which help clients stay engaged in the process.
6/6 Therapeutic rationales are about hope and confidence.
Of course, we have to do this with compassion and therapeutic skill. We can't just tie clients down and force them to deal with the pain.
However, clients also know when the therapist isn't pushing in on the hard things. A buddy of mine regularly calls this therapist "my talking buddy" and says it with a bit of a bite. He wants change, and therapy feels unproductive.
Another friend of mine just told me she's bored with her therapist. Each week she goes to therapy, dumps her "tea" (meaning trauma) and her therapist listens and validates, but there's no change-work happening.
Both keep going because they're in pain and hope to find some relief, and in both cases the therapists have stopped cleaning.
Our job is to support the client in doing the work necessary to deal with the pain. Rationales are one way to do that.
Otherwise we back off, leaving clients to suffer, when they come to us for relief.
Best,
Jordan (the counselor)
-Fin-
Notes
[1] Alex Vaz is the co-author of literally dozens of books on deliberate practice, has written academic papers on therapeutic change, has trained with the best trainers in half a dozen different models, is now the Director of Training at Sentio, ran a popular YouTube series interviewing therapy experts, and at one point had some of the highest clinical outcomes of any therapist on record.
If you liked this post, consider reading this next. I think you'll like it ;) It's what Alex taught me about listening.
Jordan Harris, Ph.D., LMFT-S, LPC-S, received his Doctor of Philosophy in Marriage and Family Therapy from the University of Louisiana Monroe. He is a licensed professional counselor and a licensed marriage and family therapist in the state of Arkansas, USA. In his clinical work, he enjoys working with couples. He also runs a blog on deliberate practice for therapists and counselors at Jordanthecounselor.com.