Two Items To Always Focus On In Each Therapy Session as a Therapist

For every therapy session, focus on two items:

1. Goal consensus

   1. Internal problem/issue client wants to work on, and

2. Task consensus

   1. What modalities/interventions to achieve goals

Goal Consensus: Ask The Client

• "What is the internal problem you want me to help you with today?"

• "How do you want me to support you?"

Task Consensus: Ask The Client

• "Do you want to talk?"

• "Do you want to learn skills?"'

• "Do you want to do somatic work?"

• “Do you want to brainstorm ideas or problem solve an issue?”

• "EMDR?"

• “CBT?”

• "DBT?”

Without these two areas to focus on in each session, the therapist might:

1. Feel annoyed ("Why are you here then?")

2. Feel stuck ("Am I even helping you?")

3. The client's will is put onto the therapist ("I don't know what to work on..." or "I don't want to be in therapy today")

4. Act out their counter transference (e.g. annoyance, stuckness, frustration)

5. Be the rescuer/fixer/solver and the client will be dependent on the therapist (victim/powerless/helpless)

6. Be more likely to experience burn out as a therapist

7. And more

Therapeutic Alliance

For psychotherapy to be effective, a therapeutic alliance needs to be developed between the therapist and client (Behan, 2018; Horvath, Del Re, Flückiger, & Symonds, 2011).

The alliance (also called the working relationship) includes:  

1. An affective bond between therapist and client, typically called the "therapeutic relationship."

2. Agreement on the goals and objectives of therapy (typically called "goal consensus").

3. Agreement on the tasks that will be used to achieve the goals. 

In short, there needs to be agreement on what the problem is, what will be targeted in the therapy, and how this will be achieved - all embedded within the context of a warm supportive relationship (Safran, Muran, & Proskurov, 2009).

References

• Eubanks CF, Muran JC, Safran JD. Alliance rupture repair: A meta-analysis. Psychotherapy (Chic). 2018 Dec;55(4):508-519. doi: 10.1037/pst0000185. PMID: 30335462.

• Stubbe DE. The Therapeutic Alliance: The Fundamental Element of Psychotherapy. Focus (Am Psychiatr Publ). 2018 Oct;16(4):402-403. doi: 10.1176/appi.focus.20180022. Epub 2018 Oct 18. PMID: 31975934; PMCID: PMC6493237.