Article By: Dr.Martha Durham
Contributing Writer

Therapy and the Therapeutic Relationship

The therapeutic process is the same for children and adults, with a few exceptions.
Each therapist has their style, but for psychologists, there is a standard framework that
we follow. In training programs, we learn theoretical orientations such as cognitive
behavioral therapy (how thinking leads to feelings and behaviors) or psychodynamic
therapy (unconscious, buried thoughts and feelings are brought to the surface so they
can be examined). There are many other therapeutic approaches. Most therapists in
private practice understand that we use most of the empirically validated theoretical
models in therapy. That is because clients are individuals, who will respond best to
certain approaches, and you must determine which theoretical approach works best for
that client. For some clients, you are working from multiple theoretical models because
the person is a complicated individual who is learning and growing. As that happens,
the way you approach the work is different.

How do you build a therapeutic relationship with a client, and why does it matter?
It doesn’t matter how educated a therapist is, if we cannot connect to a client, therapy
will not be effective. So, there’s an art and a science to treatment. We should always
be aware of the latest research and be well-educated. However, there is also a human
connection that matters. Good therapy involves warmth, genuineness, and other
intangible factors that help build trust. Some clients will make progress with a therapist
who is not skilled in the intangibles if the client has a straightforward issue that does not have a psychological underpinning. An example is a medical condition that causes
weight gain.
Simple problem-solving, resource sharing, and a structured plan could resolve the issue. Honestly, this could be handled by a life coach rather than a licensed mental health professional though therapists are the ultimate life coaches with incredible education and training, so we are happy to work in that capacity.

Building trust can look different for children and adults. Often, young children do not
have the cognitive capacity or the emotional maturity to talk about their emotions or
thoughts. It can become very anxiety-provoking for them if a therapist tries to do that.
We often spend time with young children playing games. The games are designed to
gain the child’s trust, help them feel secure, and get them to talk about the things going
on in their world. The games have a therapeutic purpose and are not silly or frivolous.
older children who may be uncomfortable sitting in my office and having a serious
conversation with me may do better talking while doing an activity. I have had sessions
at a putt-putt park near one of my former locations, playing putt-putt and talking. I’ve
had sessions shooting baskets, walking, making jewelry, and other activities that the
client enjoys.
With very young children, I will usually talk about some fictional child who
is in a similar situation to theirs. Talking about someone else allows a child to discuss
issues they may be experiencing because it is too overwhelming to talk about
themselves. While this technique may be indirect and not ideal for adults and more
mature young people, it is less anxiety-provoking for young children.

How do you move from one level of therapy to the next, and why is that
important?
If a client is new to therapy, it may take a while to feel comfortable, so you may spend
many sessions getting to know each other. Both children and adults will often tell you
things over time and not in the first few sessions. They become more trusting and
vulnerable throughout the process. I am as appropriately genuine as possible, which
helps build trust between us. I have had clients take months to tell me the actual issue
they want to work on. I understand that they needed that time to be able to share
something they find shameful or worrisome. I am not critical of the length of time it took
them to get to that point. Clients who have been in therapy before, typically understand
if we will be a good fit, and may be emotionally open sooner.

Seasoned therapists do not want to be in a therapeutic relationship when it is not a
good fit for the client. I never feel offended if I am not the right fit for someone, and I
love it if they are confident enough to tell me that. I am happy to help them find
someone else. The therapist is usually responsible for figuring that out, acknowledging
it, and trying to help the client. My job is to find a way to connect to a human on their
terms. That does not mean that I am being fake or pretending; it means I need to adjust
my style, while being genuine, to ensure that a client feels comfortable enough to open
up and reach their goals.

I love what I do and want my clients to understand the process. So, I will explain the
therapeutic process along the way. It is incredible to me the number of clients who will
ask me if I am trying to trick them, or if I have some indirect plan to get them to reveal
things. My consistent answer is, “Oh my goodness, no! I don't have the time or energy
to plan anything like that.”
Further, if you’ve been in therapy where that was happening, that's a problem. Therapy
shouldn’t be mysterious. My goal is to have my clients become their therapists so they
can take what we're doing in session, out into the world. If it’s mysterious, then they
are reliant on me to do some sort of magic; and that’s just impossible. Therapy isn’t magic.

The last thing that is extremely important to me as a therapist is collaborating with the
family, the parents, and the primary caregivers. And yes, sometimes there are parenting
issues that are affecting the child. But if I cannot engage that parent and help them feel
safe so they can learn, then I cannot help the child. There are times when there is
possibly an abuse or neglect situation going on. Then, something else must happen on
my part as a mandated reporter. In my experience, this has been rare. I want to respect
the parenting of the adults and include them. I hear many stories from parents who say
they were excluded from their child’s previous therapy. And honestly, that burns me up.
It is not my job to parent their children. My job is to help parents be healthy and
effective. Parents should be included in therapy. Often, they allow their children to have
confidential and safe information with me, which I mentioned in previous articles.
That is very important, but I am not the parent, and I respect the parent’s rules.

Please consider bringing your child to therapy if you think it can benefit them and you.