Academic journal article The International Journal of Behavioral Consultation and Therapy

The Trouble with the Short-Term Therapist-Client Relationship and What Can Be Done about It

Academic journal article The International Journal of Behavioral Consultation and Therapy

The Trouble with the Short-Term Therapist-Client Relationship and What Can Be Done about It

Article excerpt

Kohlenberg and Tsai's (1987) conceptualization of the therapist-client relationship and its curative potential is the starting point of the present article. Their analysis points out that what happens between therapist and client during the treatment hour is chock-full of samples of client behavior that is directly related to exactly those problems the client seeks treatment for. By the same token, the relationship offers privileged opportunities to work on these problems in-vivo as they are happening. Different from traditional conceptualizations, Kohlenberg and Tsai's analysis of the relationship makes functional similarity between the client's daily life and in-session transactions a critical requirement for working with client behavior in this sense.

A first type of Clinically Relevant Behavior (abbreviated as CRB1) covers in-session client behavior that is functionally similar to behavior that causes and maintains the client's problems in his or her daily life. A second type (CRB2) covers in-session occurrences of what would constitute improvements in the client's daily life. Functional Analytic Psychotherapy, as worked out by Kohlenberg and Tsai (1987) provides rules that help the therapist focus on CRBs (out-to-in process); evoke them, when needed; respond to them in ways that strengthen CRB2s; increase the awareness of the potential effects therapist behavior has in relation to CRBs; and finally provide functional interpretations and facilitate generalization of in-session improvements to daily life relationships out-of-session (in-to-out process). For fuller descriptions we refer to Tsai, Kohlenberg, Kanter and Walz (2009) and to Weeks, Kanter, Bonow, Lands and Busch (2012).

What will be of interest for us here is that three conditions need to be fulfilled for the relationship to produce good in-vivo learning opportunities. Ideally, the client's clinically relevant be havior needs to be evoked by the person or the behavior of the therapist. This means that the relationship must have characteristics that promote or at least allow the occurrence of the typical problem behavior with enough intensity that it can be worked on. Second, the relationship must be an appropriate context for improvement to occur. That is, the changes that would help the client overcome his or her daily life problems must also be possible in the therapist-client relationship. And last, the same classes of reinforcement the client will obtain by this improvement in the outside world must first be available in the relationship. In other words, the benefits the client may obtain in his or her daily life as a result of the new behavior must already be naturally accessible by means of the emerging improvement in the context of the relationship.

However, consider the following puzzle. Your client is an outcast in her family. She has no social network or her long-term friendships are highly dysfunctional. Her professional life is pure hell. She tells you about what others have done to her. The interpersonal nature of the problem is undeniable. But in-session, everything between you and her feels fine. Why doesn't the turbulence of her other relationships show up with you? One possible reason is that the clinically relevant behavior may not conspicuously affect any short-term relationship. The relevant patterns may involve behavior that is meaningful or adaptive in a new relationship, but becomes abrasive in the long term.

Alternatively, standard treatment arrangements, with sessions happening in a set environment (e.g. the typical outpatient office setting), and involving a specific task, may not encourage the emergence of the behavior. The problem behavior may be the client's way of responding to unfair challenges or to being pushed around by others. These behaviors are not part of a therapist's conventional repertoire. Or, as in the cases described later, the problem behavior is the client's response to the other's open expression of disappointment in the client, or the other's clumsy, jumbled initiatives. …

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