As clinicians, we know that building trust in the therapeutic relationship is an absolutely essential thing to consider and cultivate. Because of the variety of people we serve and the nuances that each relationship brings, we can at times, unknowingly inhibit or disrupt trust. I will describe what I feel are some likely contributing factors.
Overly Engaging with the Story
Attending to clients’ narrative at the expense of their non-verbal communication is a tendency and temptation that we therapists can easily fall into.
People need to tell their stories. Stories lay the foundation for the unfolding of internal processes. Because so many stories hold histories that have been either ignored, stifled or made invisible, peoples’ stories do need to be told. Yet when we become so pulled in and engulfed by peoples’ stories, we can miss how the story is both a sharing of what is happening and a symbolic representation of peoples’ internal emotional, spiritual, and psychological states. Client stories, when experienced by therapists as highly compelling, can spark a response that moves us to become very involved with the specific content or details at the expense of listening for and unpacking important underlying patterns and themes.
While some stories are experienced as compelling, there are others that can seem repetitive or boring. When bored by stories, in addition to checking out our countertransference, we can think about what the person is leaving out of the story or what they are unconsciously expressing through this type of narrative.
Paying attention to what the client is not saying in words but is being conveyed in body language is just as important as their verbal communication. There are things people are conscious of but not comfortable saying out loud for various personal and cultural reasons, and instead will speak through the posturing of their body, and other physical movements, or lack thereof. In addition to what people are knowingly leaving out, the unconscious shows itself in various non-verbal ways. Think about how a person enters into your space for the first time. Look at where they initially or habitually sit. Notice the type of eye contact they hold, the movement of their eyes, silences, shifts in body positions, habitual avoidance of topics, accidental missing of appointments, etc. In working with people who have been highly traumatized and are holding much trauma in their bodies, we need to be mindful that memories, whether conscious or buried, express themselves through many somatic channels. If we are overly focused on the verbal narrative, we can miss the many unspoken signals that speak to a person’s less visible experience and we can therefore, unknowingly disrupt or inhibit trust.
Overlooking the Impact of Power Dynamics
As clinicians, we can underestimate or overlook the many ways power can play out and effect the therapeutic relationship. Regardless of who is holding the formal power in any relationship, trust is ultimately built upon a foundation of shared humanness. Historically, within the patriarchal medical model of treatment, doctors are held to the high standard and expectation that they be certain of the patient’s diagnosis and prescribe what they assume is the best course of treatment, often without the patient’s input. Patients are equally shaped by the same system, to believe, accept, or act as if the doctor alone, knows what’s best.
While I believe that human connections based on equality and generosity of the heart should be the backbone of all healing relationships, I think it is especially vital to the success of psychotherapy.
From our therapist or counselor positions, we can easily mistake a client’s compliance or agreement with our intervention or direction as a full trust, when in fact, they may be agreeing outwardly or even convincing themselves that because of our formal positions of authority, we know what’s best for them.
Because of the presence of institutionalized power dynamics, clients rarely come forward and tell clinicians that they are feeling oppressed, misunderstood, or untrusting of the relationship. Whether they are experiencing the clinician as acting out unaware biases, internalized oppression, or as blinded by positions of privilege or power, trust is impacted. I see it as our job to become self- aware and proactive in understanding the ways we have been socially conditioned by society and how the conditioning affects not only our clinical and collegial relationships, but all of our relationships. Cultivating this kind of self- awareness, along with our willingness to take emotional risks, will help us naturally find our own unique ways to build and sustain therapeutic trust.
Holding Too Tightly to Our Own Agenda
How often do we draw from the depths of our unconscious, bringing forward our best wisdom and experience, offering it up as a brilliant insight, only to be met with a blank stare, a wall, or a defensive posture? I am continuously growing and learning as a therapist and educator, and have evolved to the point at which I am mainly at ease with my knowledge and intuition. I am human though, and so, at times I can get very attached to either my uncertainty or my position of knowing. If I am unaware of these internal states as they’re happening, I can feel alone, in my own little world, uncomfortably playing out a role, and grasping for something certain or reassuring. It is easy to be swept up in the illusion of separateness and division that our professional roles set us up for.
Whether through inexperience, perfectionism, rigidity, or other mental or emotional habits, we can become overly attached to our own agendas and believe that because we understand what our clients need, they should of course, follow our lead. We may have a strong sense of some of the root causes of a person’s pain or conflict, but overzealously move toward seeking premature resolutions or pushing them in directions that may not be right for them. Timing is a major factor in regard to any intervention. People may not be emotionally or physically resourced enough to make, what we assume is their next right step. In fact, that step may not be right for them at all.
Although it can be challenging to our egos, I believe it is brave and good practice to occasionally check in and ask how the therapy is going and whether people feel their needs are being met. Asking whether folks feel they are growing and learning through the experience of therapy can be very fruitful for both client and clinician. This thread of conversation can deepen our intimacy, and open doors for exploration of relational dynamics. We find that our openness and willingness to hear feedback, fosters a deeper collaboration, which has the potential to move the work in new and surprising directions.
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