Digging Deeper: Understanding Therapeutic Fit
Previously, I’ve written about key factors that will help you assess whether you’re well-matched with your counsellor or potential counsellor. In this article, I would like to go deeper into that topic and talk more about what makes a counselling relationship strong, why that’s so important and what to do when the fit isn’t right.
Counselling research suggests that the therapeutic fit between client and counsellor, also known as the therapeutic alliance, is 5-7 times more effective than therapeutic technique in determining counselling success. There is an overall consensus that counselling works, but that overall, no one counselling method stands out as better than the rest, although this is not to say that specific counselling methods aren’t important! It’s just important to find the right one(s) for each client!
What is meant by fit? Counselling research has identified three key elements:
- The client’s perception of the therapeutic relationship – does she or he feel heard, understood and respected?
- Client-therapist agreement about counselling goals
- The choice of a therapy approach or method that makes sense to the client and is in line with her or his goals
Psychologists Hubble, Duncan, Wampold and Miller, in writing about the counselling relationship, characterize it as “a resource that clients use to mobilize personal agency and change…a resource that helps, supports or focuses clients’ self-healing efforts.”
In other words, a solid therapeutic relationship has the potential to activate clients’ internal strength in a way which helps them effect meaningful life change.
Is There a Fit?
Counsellors and clients alike may also reflect on the following, when assessing fit:
- Is there a sense of ease or comfort between client and counsellor?
- Is the counsellor experienced in the areas that the client is seeking help with?
- Are there opportunities to bring laughter and levity to the counselling, when appropriate? Can the counselling be serious too, when needed?
- Is there willingness or readiness for the client to be in counselling and to participate in the counselling process? Counselling is not for everyone and this is perfectly OK!
- What are the client’s expectations for tools/homework and are they in synch with the stage of therapy or the issue(s) at hand? The client and counsellor may have different assumptions around this!
- Can the counsellor feel free to work in a genuine manner —i.e., in a way that is true to themselves as a person? If the counsellor is communicating authentically does the client receive this communication as authentic? Does the client feel able to talk in the session and if she or he feels that it may take a while to open up, can the client foresee this happening eventually? Does the client feel an absence of judgement from the counsellor?
Why Matching is Important
Counselling involves risk:
- Emotional risk: Being open with a professional, often about vulnerable topics. If the client feels a sense of ease and emotional safety with the counsellor then the potential to successfully work through challenging topics is much greater. If a sense of interpersonal incompatibility exists, the counselling client can feel worse when vulnerable topics are tackled.
- Financial risk: Counselling is expensive, particularly if clients don’t have coverage through an extended health provider Having a better sense of whether or not it’s a match earlier on, can be money-saving.
- Time-Risk: Counselling is an investment of time, with frequency ranging from weekly to every few months. On rare occasions, clients may attend twice in a week. Given how busy our lives are, counselling should be time well spent.
If a counsellor has a sense that it is not a good match, it is untruthful to continue counselling with a client. Sometimes the counsellor has this sense right away, during a short consultation, other times this doesn’t become clear until after a few sessions. Factors which could muddy the picture include:
- If original goals change substantially
- If life factors interfere with the ability to fully participate in counselling
- If, as client and therapist get to know each other better, lack of fit becomes more clear
It should be emphasized that if a client does not see it as a match, to please speak up! Clients actually have the final say in the matter – ultimately you decide whether to continue or not.
It’s also important to note that the counsellor may not sense that it is not a good fit. You may be feeling a sense of disjointedness that the counsellor has not picked up on. Again, if you feel comfortable, please bring up your concerns with your counsellor. This may even be a situation that is resolvable and could even lead to an enhanced therapeutic fit. Or maybe not. A conversation is an important starting point.
Referral is not Rejection
Sometimes counsellors may be reluctant to communicate to clients that the therapeutic fit is not optimal, out of fear of hurting clients’ feelings or sparking feelings of rejection. Certainly, such feelings may arise for a client, particularly if they like the counsellor, if the client is already in a heightened emotional state or crisis, or if the client has had painful experiences in their past of being rejected by others.
The counsellor may truly like the client too, but this is not about ‘like’ or ‘dislike.’ From the counsellor’s perspective, calling out this situation is ideally about honestly ensuring that clients receive the counselling help that will ultimately benefit them. And sometimes a different counsellor is what is needed and a referral to another mental health professional is suggested. It is not personal.
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