Knowing what our clients need from us in session is the number one thing to keep our pulse on. From the moment they enter our door, we need ways to tune into them.
This is especially true in private practice because if they’re private pay clients, they’re offering to pay a fee in exchange for our help. If they don’t feel it’s going anywhere, they’ll see someone else or give up on therapy altogether. If they’re using insurance, they can also easily decide not to show up or cancel. So, we as therapists shoulder the responsibility of figuring out what they need.
We can get so in our heads and think, “Do they need me to implement an intervention, give advice, offer an interpretation or explore more?”
This question (and more) can swirl about in your head as you’re trying to grasp for what they need, especially when seeing clients early on. Later in our careers, knowing what our clients need from us remains a top priority. And even though it’s both complex and sometimes illusive, it feels so good when we’re in the flow with them–it’s the grease that keeps the therapeutic momentum going.
So how do we know what they need from us?
Clinical research, which encompasses neurological (brain) science and findings on affect (emotional) regulation, tells us the number one need our clients have is to be attuned to. Now, this may sound simple but it’s quite nuanced and layered. You may think paying attention and being present aren’t anything new to you, but there’s more to it.
Much of what I’m talking about here is based on Dan Siegel, M.D. (who’s written a plethora of mental health-related books) and his friend and colleague, Louis Cozolino’s work (known for his books, “The Neuroscience of Psychotherapy” and “The Making of a Therapist”). Siegel says the attunement of the therapist is more important than theoretical orientation, which he describles as “critical micromoments of interaction with the client—including tone of voice, facial expression, posture, motion, eye gaze—that “reveal otherwise hidden states of mind (quoted from “The Attuned Therapist.).”
This raises the question, What is it about attuning to our clients that makes it more important than even theoretical approach?
Siegel teaches in his books and presentations about the concept that social relationships fundamentally shape how our brains develop, the way our minds construct reality, and how well we adapt to psychological stressors throughout life, known as interpersonal neurobiology. This concept is also based on John Bowlby’s research on early bonding and attachment, in addition to the more current findings from affect regulation research, by Alan Shore, et. al., and Siegel’s writings on integration.
Cozolino (The Neuroscience of Psychotherapy, 2010) says our brains are wired to help us survive in a variety of environments. Our culture, language, nutrition, even our climate affects how our brains develop. But our parents undoubtedly shape our brains in the most unique and profound ways.
With good enough parents during good times, a child will grow up in adaptive ways. With parents who either have to separate from their children or who have mental health issues, a child’s brain will develop in ways that help them survive but tend to be maladaptive later in life.
“It’s in these instances that a therapist attempts to restructure neural architecture in the service of more adaptive behavior, cognition, and emotion. Building the brain is vastly complex. Rebuilding it is a difficult and fascinataing challenge (p. 9),” Cozolino said.
We develop and learn in relationships to others, and therefore our arrested development in certain areas is also attributed to the relationships we’ve had, especially early on. Imagine that all our experiences and communication in childhood shapes who we are.
But because we’ve found the brain to have neuroplasticity, meaning it can change in real time through relationships and experiences, that tells us if we have emotionally-rich connections with our clients, those interactions can also change both the brain and mind. It’s through the communication of emotion that attachment experiences organize the brain.
So, the good news is our work with clients has the potential to shape or shift their attachment style!
In order to do this–work from an attachment-based, neurobiologically savvy therapeutic approach–according to Siegel and Cozolino, the therapist must feel the feelings of their clients with them, not merely understand them conceptually (Wylie and Turner, The Attuned Therapist).
This requires the entire mind, body and soul of the therapist, in which the therapist’s “whole self vibrates like a tuning fork to every quiver in the client’s being without, however, losing the basic emotional stability that the client needs to help regulate his or her own runaway emotions (Siegel, 2010).”
By using your sensitivity, or all your senses, you engage in a kind of communication that can establish new pathways in the client’s brain that increase his capacity for self-regulation, according to Wylie and Turner in The Attuned Therapist. This results in the client learning to tolerate emotions he couldn’t handle before. Furthermore, claims Siegel, by helping the client become more capable of self-regulation, “the therapist is actually helping him coordinate and balance neural firing patterns and promote greater integration of different areas of the brain—right and left hemisphere.” This is actually describing what we might call healing or helping a client change.
Working in this way requires us as therapists to be in touch with our inner worlds and how we experience relationships, encompassing how we feel in response to particular personality traits and issues. “We are the tools of our trade, the primary creative instrument with which we do the work,” says California clinical psychologist David Wallin, author of Attachment in Psychotherapy. So, we’re tasked with being able to use our whole personhood while staying within appropriate boundaries.
Wylie says we need to have one eye on the patient, and one eye on ourselves. She describes how we may need something like “triocular” vision as we try to be in the client’s mind, in our own mind, and in between both minds, establishing and maintaining between ourself and the client mutually resonant affective, cognitive, and physical states of being. What this is saying is we need to feel emotionally, think and notice our bodily sensations in session, being both in it and above it at the same time–capable of looking at things on a meta level while being in it.
This is all in the aim of “changing, shaping, soothing, controlling, redirecting, harnessing the emotions, even freeing some of them up for more robust expression (Wylie Sykes, p. 18),” which is what affect regulation is about.
Getting to this affect is done as much or more through nonverbal cues as through words. Through our facial expressions, how we look at our clients, how we speak to them and our pacing and breathing, we have the potential to create a charged felt presence–that is felt as being in tune with and getting them. And this experience permeates the being of both therapist and client where both people are affected and changed in the moment.
So in your next sessions, consider the greatest need in all of us lies in being seen, known and understood in a loving, ever-expanding way. For in that brains rewire, shift into more adaptive ways of being and wellsprings of life come forth.
Tyra Butler is a licensed 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. Be sure to get on her email list here: www.earlycareerclinician.com, where she delievers her latest blogs, inspirational and informational videos, free consultation and supervision-like advice. 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 (www.earlycareerclinician.com). She offers coaching and consultation, and as a professional writer helps therapists create web site copy, marketing content and formulate innovative ideas to create additional income. Tyra has been in private practice for 10 years, with an office in Norco, CA (www.tyrabutler.com) with 15 years in mental health, business and professional copywriting. To sign-up for her email list, click here. Contact her here.
