If our effectiveness as clinicians hinges on cultivating rapport and strengthening the relationship–no matter what theoretical orientation we work from–it raises the question, what can we either do more of, or differently to ensure this occurs?
We want to look at our existing strengths and from there assess what we need to learn, or ways we want to grow. This can be both a painful and awakening experience. Any growth experience is, and becoming an increasingly more effective therapist certainly can be both.
So, if the foundation of being effective with clients boils down to being seen, heard and understood, let’s consider what that even means. Of course, effective therapy goes beyond those facets and I plan to get into that, but for the purpose of this article we’re unpacking some elements of what it means to be seen and heard.
First of all, what do you think the emotional and psychological state our clients are in when they come see us? We’ve probably all heard we need to “meet them where they’re at,” and being able to do that requires us to understand both the plight of our clients and their general life circumstances.
If our clients are functioning or high functioning, meaning they’re not hospitalized and are handling daily life tasks:
- Most have some relationships in their life, even if they’re not especially close to anyone. Even clients we’d consider as having avoidant, disorganized or pre-occupied attachment styles have some level of attachment to people in their lives. They talk to people about certain problems or situations–be that friends, colleagues or family members.
- Desire that certain aspects of their life be better, and haven’t been able to enact that change fully on their own. They may be stuck or feel the small changes they’ve made haven’t led to the kind of satisfaction or fulfillment they want. They could be stuck in deep depression, have significant anxiety or are dealing with ongoing relationship conflict. And there’s a myriad of other symptoms they can present with.
- Circumstances in their lives have led them to suffer in distinct ways, which usually is the precipitating factor that led them to look for someone to see. In my first sessions with clients, I always like to find out what was going on in their life that led them to look for a therapist. As they disclose this, you can hear the problems that’ve been mounting.
Being Seen and Heard Occurs Within the Frame
Because of these possible states and situations our clients are in when they find us, being seen and heard is the first task of therapy. They present to us what’s going on within “the frame” of therapy, which can be considered the set-up or situation clients walk into–the parameters we conduct our work within.
It occurs in a private, confidential office (usually) that’s comfortable and designed for a client and therapist to talk in 50-minute increments. Clients know the expectation is to come in and disclose things going on in their life, that the session is focused on them and not the therapist. It’s different because it’s not a friendship, it’s not a family member and it’s not like any other social relationship they have. The therapist’s aim is to understand and help the client in the ways they’re requesting, not serve personal interests. The therapist may share a thing or two that’s relatable in order to establish rapport and then they’re tasked with seeing and hearing clients in increasingly more meaningful ways.
This “framework” for therapy provides a canopy of expectations and structure that allows clients to develop trust with their therapist. If sufficient rapport has been forged clients feel able to talk freely without censoring themselves in the way they do with people outside the therapy room. (There are other dynamics and phenomenon occuring in the room that can also hinder them opening up, but for the sake of breaking down what it means to be seen and heard, we won’t go into that quite yet.) By coming in, sitting down face to face with a therapist, the client is opening themselves up to be known by you.
Because your sole focus is on them, the client in the room, you’re seeing them in a fresh light, which is different than most people do. You’re taking in what they have to express to you, attempting to hear them accurately and attuning yourself to both the non-verbal and verbal communication in the room. You want to stay with the communication they’re giving you and not veer from where they are emotionally.
Staying with the Emotion
For example, are they telling you they’re having trouble with their dating life, and feeling depressed because they want to find someone and get married? Stay with that and help them open up more. When you listen to them, what are you naturally curious about that’s in the aim of why they’re there? What do you need to know so you can be sure you’re following and hearing them right? Find out what is connected to their desire and frustration. Your attunement and ability to stay with them on the topic they’re discussing or expressing will encourage them to open up more. Your curiousity then should come from a place of trying to understand that more. Watch for what they’re not outright telling you, but emotionally or non-verbally through their gestures and tone of voice.
There’s a term called emotional contact, and this is what you want to stay in touch with throughout their communications. What are they communicating emotionally to you? We can also think of this in terms of the process versus the content they’re disclosing. We want to respect what they’re verbally or concretely telling us while also paying attention to what they’re not saying. Empathizing with them is key when it’s in the aim of “getting them” and letting them know you feel their pain.
Helping Them Feel Heard
Clients need to know you’re hearing them, because it’s a vulnerable situation for them to be in, opening up and exposing their problems to you. So communicating throughout the session periodically that you hear them is helpful when it’s done in a way that doesn’t interrupt their train of thought or processing. You can express to them non-verbally in a non-intrusive way that you’re following their thought process. Ask questions or gesture in ways that encourages them to clarify or tell you more when you’re not getting what they’re saying. This tells them you’re accepting of who they are and that you have a geniune desire to understand and learn about them.
In most conversations outside of therapy, your clients aren’t being fully seen, heard or understood. Most social relationships are comprised of one person saying something and another saying something relatable, or whatever they happen to be thinking about that’s unrelated. If you eavesdrop on conversations, you’ll be able to hear the lack of attunement and how often in every day conversation people are “left hanging” emotionally-speaking. Not too many are being heard and seen in ways that are therapeutic. On top of that they may be dismissed, invalidated or given unsolicited advice, furthering their feelings of despair or stuckness.
So, we have the task to step into their lives and help them feel known. As we get to know them, they might begin to feel better simply because it can feel good for our clients to be seen and heard in increasingly more complex ways–and ways that don’t lead to them being rejected, hurt or invalidated. It’s not that we have to get it right every time. There’s room for us to reflect back things inaccurately and still be effective, because that inaccuracy can prompt them to clarify and correct you. And then you can explore from there.
I’ll get into this in a subsequent article, but it’s in the trying to “get them” that’s key. Most people in their life aren’t making this effort and by you doing so, you’re repairing something within them that can feel good for them, even if they can’t pinpoint what felt good. It’s in desiring to know them and help them that keeps them coming back–to give you the opportunity to take it a step further and see if you can begin to understand them in increasingly more complex ways that make sense.
Next article: It’s All About Relationships: Part III
Tyra Butler is a therapist and the founder of the Facebook group Early Career Clinician Community where she gives some of her best tips to succeed on the road to licensure. She works with pre-, provisionally-licensed and early career therapists to help them find paid work, start and grow their practices and make important decisions and career moves. She offers coaching and consultation, and as a professional writer provides copywriting coaching to create web site, marketing content and formulate innovative ideas to create additional income. Tyra has been in private practice for 10 years, with 15 years in mental health, business and professional copywriting. Learn more about her services and blog here. Contact her here.