RECOGNIZE AND CONTROL

JUDGEMENTAL TENDENCIES

I expect that my therapist to be compassionate listener who will

address their concerns in a

reasonable and non biased manner.

Of course my professional role as a

therapist implies reserving personal

judgment and focusing on patients needs.

The patient will typically be more

open and less resistant if the

therapist models the ability to weigh

the problem without judging the

person

WOW, you are extremely irritating

to me.

Do your friends or family ever

seem to be exasperated or short-tempered

with you?

Lets talk about some possible triggers for

that.

Elicit Input and Feedback

A contemporary collaboration include an active exchange of information and shared

decision making.

The therapist is reasonable for structuring both individual session and the therapy as a whole, this objective can only be achieved with active input

and feedback from the patient.

This important process of negotiation between patient and therapist (Safran & Muran, 2000) is more than

superficial consensus; it is both a necessary condition and an intrinsic part of a change process.

PROBLEMS IN COLLABORATION

With other patients, more specific effort is needed because there

are particular problems in therapeutic collaboration.

Two types of problematic collaboration

1. Passive Noncollaboration- may stem from low expectations for success.

2. Active Avoidance- suggests negative, personalized meaning such as distrust of therapy or externalized blame.

To avoid problems in collaboration How do you feel about your progress so far in

overcoming your anxiety and doing

things are difficult for you to do?

Frustrated. I want to be a lot further along.

What do you think has gotten in your way, or

held you back?

Nothing really, but I think I need someone to force me to do what is difficult.

I'm not very good at disciplining myself, and I

need a demanding taskmaster to make me do what I don’t want to

do.

Id like to hear about your homework, which if I remember

correctly, was to schedule an hour for doing something just for yourself that you might enjoy. We discussed some ideas, as I recall. Were I able

to try out any of the things we considered, or did you try something

completely different?

Well, I thought about the

assignment a lot, but didn’t actually

do anything

That sounds like some important cognitive work. Can we talk further about that?

Okay, but I don’t know

what there is to talk about. I

didn’t do anything

That’s okay; what is important is to understand your thought process. Can you tell me about

your internal conversation about this idea? Was there sort

of a back-and-forth deliberation?

Yeah, there was. I really sort of wanted to do

something just for me. The idea sounded good,

like something I never do. I even called and

scheduled an appointment at a nail

salon to get a pedicure and was looking forward

to a nice treat.

There is a coffee shop next to the salon, and I was going to get one of those delicious caramel

frappachinos and just relax and enjoy being pampered for a little bit. But then I realized that I would be taking time away from my family and spending money on myself, and I just didn’t feel right about it. I guess I felt that taking time for

me was going to turn me into one of those selfish, uncaring, “high maintenance” types and I just couldn’t do it. If I took that time for myself, I felt like I would be letting my family down. So I

spent the afternoon ironing clothes instead.

I noticed you winced just then, and seemed a bit

agitated. Was there something that crossed

your mind just then?

Actually, I was feeling irritated.

Was the irritation related to the topic

we are discussing, or possibly something in

my manner?

Well, I don’t like answering

question. I feel uncomfortable

trying to put my feelings into

words. I wish you already know what

is bothering me

I really appreciate your effort to be thorough in telling me how you are doing.

I want to ensure that we stay productively focused, but it’s a little hard to do that and take everything in. I’d like to check out a possibility with you that might help us be more efficient.

Do you think that it is necessary for me to know everything that has happened to fully understand and help you? Is that maybe one reason why you work so hard to tell me everything?

Well, yes. I don’t really know what is

important. So I need to get all the information to you so that you can figure out how to solve

my problems.

So your assumption is that I need to know everything so that I can figure out the solution to your problems.

Yes. Is that strategy working very well so far?

Not really. I’m working really hard and I haven’t really gotten to hear what you think I should

do yet.

How about if we consider some different ideas

about how to make our work

more productive?

Five Indications of a Good Working Relationship1. There is a desire to have contact.2. Information is shared.3. Positive affect is expressed.4. Sense of teamwork.5. Negative sentiment is productive.