The therapeutic relationship doesn’t come first when treating a new client

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When I start work with new clients, I’m very mindful of working to help them get the changes they want as soon as they can. I want them to get their money’s worth from treatment.

People come to therapy because they want things to be different. There is something that is making them unhappy or uncomfortable. My job, as I see it, is to help clients figure out what they need to do/think differently and help them get there as soon as they can.

I do not think I am unique in this desire.

But therapists I train often talk about “working on the relationship” prior to working on change for the patient. This is where I differ. To me, that’s putting the cart before the horse.

We know from research that a client will feel better about the therapeutic relationship if the therapist helps him or her to do things differently.  We don’t need to wait for the client to feel good about us in order to ask for change. This is an error in thinking, and it slows down the process.

In eating disorders, for example, research on “the impact of early symptom change and therapeutic alliance on treatment outcome in cognitive-behavioural therapy for eating disorders” informs us that:

  • Greater early reduction of symptoms predicts later reduction in eating pathology.
  • Early symptom reduction results in a stronger early therapeutic alliance.
  • Early change is a stronger predictor than the therapeutic alliance of greater change.
  • The early alliance doesn’t mediate the relationship between early and late change.
  • Early change has a positive impact on the therapeutic alliance and treatment outcome.

So when meeting a client for the first time, we need to get to work at helping to make things different from the first session onward.  That will do wonders for the relationship.


About the Author:

Dr. Lucene Wisniewski is an internationally recognized leader in eating disorder treatment and Dialectical Behavior Therapy, with more than 25 years of clinical and training experience. She may be reached for consultation through the "contact" page on this website.