More than rapport: What is the therapeutic relationship? (with Claire Trevitt)

[00:00:00] Bronwyn: Hey, mental workers. You're listening to the Mental Work podcast, the podcast about working in mental health for mental health workers. As always, I'm your host, Bronwyn Milkins, and today we are talking about the therapeutic relationship and why it's so much more than just building rapport.

Early career mental health workers often hear about the importance of rapport and that the therapeutic relationship lies with everything that we do, but what lies beyond it and what is it? The therapeutic relationship is often thought of as the foundation for effective therapy, but there's lots of complexities in creating and maintaining it that are left out of our training.

In this episode, we'll explore how the therapeutic relationship goes deeper than rapport, how it impacts client outcomes, and why it's worth your ongoing reflection and attention. Here to help us out with this is our wonderful guest today, Claire Trevitt. Hi, Claire.

[00:00:53] Claire: Hi, Bronwyn.

[00:00:55] Bronwyn: I'm so excited to have you on the podcast. It's a real pleasure to meet with you because I do listen to your own podcast and what's the name of that?

[00:01:02] Claire: Between Two psychs.

[00:01:03] Bronwyn: It's such a good podcast, so I'm so glad that we can have you on today. Could you please tell listeners who you are and what your non-work passion is?

[00:01:11] Claire: Thank you. I'm delighted to be here today. Um, thanks for having me here. Um, I have a lot of interests and when I'm not being a psychologist, I'm always busy doing something, so I really had to narrow this down.

[00:01:23] Bronwyn: Okay.

[00:01:25] Claire: So I really love creativity and being crafty. So I think one of my favorite things to do is to knit.

[00:01:33] Bronwyn: That's so cool. I love knitting too.

[00:01:35] Claire: Oh, do you?

[00:01:36] Bronwyn: I do. What kind of things do you knit?

[00:01:39] Claire: I did anything, um, like jumpers, scarves, hats. Yep.

[00:01:44] Bronwyn: Okay, so you do the flat knitting, but you do garments.

[00:01:47] Claire: Yes, I do.

[00:01:49] Bronwyn: Excellent. I do the circular and double pointed needle knitting. 'cause I like toys.

[00:01:54] Claire: Oh, yeah. I like the toys too. I went through... and a bit of a fruit and vegetable stage once.

[00:01:59] Bronwyn: Wow, that's so cool. Did you have a fruit bowl?

[00:02:04] Claire: Yes.

[00:02:05] Bronwyn: That's so cool. Oh, I love it. And do you prefer knitting or crochet?

[00:02:09] Claire: I don't crochet.

[00:02:10] Bronwyn: Neither.

[00:02:11] Claire: No, I...

[00:02:12] Bronwyn: yeah, it's, it's like I can do it, but I just prefer knitting. I don't know why.

[00:02:16] Claire: Yeah, same. Same. I think I've just got my fingers know how to do it. Yeah.

[00:02:21] Bronwyn: Yes, I think so. I think it's 'cause and then I, I prefer the style. I think I like the squishiness anyway. It's your, it's your hobby. Okay. So you like knitting. Was there something else that you do in your non-work time?

[00:02:31] Claire: Yes. The other thing I love to do is I am a very amateur paddle boarder.

[00:02:37] Bronwyn: Wow, that's so cool.

[00:02:39] Claire: And I'm lucky enough to live near the water. And so I really, really enjoy being on the water and literally paddling around. But, um, I've got no idea what I'm doing. And all the seasoned paddlers, they stop and give me tips every now and again, so...

[00:02:54] Bronwyn: Oh no.

[00:02:55] Claire: I'm getting better. But, uh, it's just relaxing being out in nature and, um. It's, it's not something that I strive to be particularly good at, and it's good to actually just be learning something brand new.

[00:03:08] Bronwyn: Oh, that's really lovely. Oh, I can imagine you doing that and just enjoying and soaking up the nature around you. It sounds so peaceful.

[00:03:14] Claire: It is.

[00:03:16] Bronwyn: Hmm. And could you tell listeners, uh, just a bit about your professional background as well?

[00:03:21] Claire: Sure. So I'm a psychologist in private practice, and so I see clients predominantly presenting with, um, early or complex trauma. And I'm an EMDR practitioner and currently completing training in somatic therapy.

[00:03:36] Bronwyn: Cool.

[00:03:37] Claire: But my primary background was psychodynamic therapy, which is where my interest in therapeutic relationship comes in. And I also board approved supervisor and I love supporting provisional psychologists and early career therapists, um, in those early stages of the, of their journey to becoming a psychologist. Because there's just so much to learn and I just really love that stage of sort of growth and curiosity.

[00:04:03] Bronwyn: And that's how I know of you through the podcast, which your podcast focuses on early career psychologists and really helping and guiding them through those early stages. And you do several supervision groups with early career psychologists, is that right?

[00:04:15] Claire: Yes, I do. I've run supervision groups and some training, training specifically focused on the internship tasks, like the mandatory assessments, the case reports. And yes, and this year we started the podcast, so I co-host the podcast with, um, Isabelle Tombleson, who's a clinical psychologist and we're both board approved supervisors.

And it was really our way of giving back to early career psychs and trying to answer some of the questions that we had when we were in that position and to, I guess, normalize and validate some of those questions and concerns. And, and it was also, it's also been really fun. We've really enjoyed them.

[00:04:53] Bronwyn: Yeah. No, that's so cool. I can really hear that come through in your podcast episodes as well. Like you guys have a laugh together and yeah, you seem to have a passion about talking about the subjects.

[00:05:03] Claire: Absolutely. Absolutely. So.

[00:05:05] Bronwyn: Well it's so lovely to have you on, and we're gonna be talking about the therapeutic relationship today, kind of doing a deep dive into it. And so you mentioned just before that you started out with psychodynamic training and that led you into being interested in the therapeutic relationship. Could you tell us a bit more about that?

[00:05:22] Claire: Yes, absolutely. So I trained, um, did a four plus two internship and like most provisional psychologists, I was trained in CBT and I was trained, I think pretty well in CBT. And I really enjoyed it.

And, but then I started wanting something a bit deeper and I wasn't quite sure what I meant by that. And I got talking to some colleagues and eventually settled on some training in psychodynamic therapy, which also included me having my own therapy. And I think it was my own therapy actually, that was the game changer because I remember walking in the first time I'd been to supervision, of course, um, but walking in to see a therapist and I remember feeling actually quite terrified. Um, I was gonna be sharing really private, vulnerable information, very personal information as we do in therapy. And I just thought, oh my gosh, this is how my clients feel. And, and so I began to almost track the therapeutic relationship as part of my process and think about what I found really helpful, and I really wanted to mirror that with my own clients.

And the psychodynamic model does work very much with the relationship. And so we are looking at concepts like transference and countertransference, which would arise in the therapy room. And of course I was noticing these things coming up. The more I sort of learned about these things, the more I noticed this and I realized that this isn't provided in so much of our training.

And so when I became a supervisor, I began to, I mean, I took a lot of this for granted. This is what I had always done. And then when I became a supervisor, I began to notice that there was often a theme of asking questions like, you know, how do I work with anger? Or, how do I work with depression? And I was like, well, let's, let's bring it back to this individual and see what's happening for them. And, and often finding that we were spending the sessions really trying to work out how we could develop the connection more so than those interventions. And so I, you know, I realized that there was a, a gap I felt that was, that was missing in some of the training. And so in the supervision that I do, I really bring that in.

[00:07:41] Bronwyn: Yeah. No, I think that's really cool. And just to touch on that gap in training it's something that I've noticed for myself because I was trained quite heavily in CBT, and then I was coming across these concepts like countertransference and transference and not knowing what they were. And so I went back to my CBT textbooks, like the ones written by Judith Beck, and I'd try and find these concepts in the whole textbook, and I couldn't find any mention of it to the, to me, the only mention in these textbooks were like, the therapeutic relationship was important in so far as you were being collaborative and nothing else. And I was like, but there's so much more to this. So I can resonate with what you're saying in that I feel like there's this whole other world that like I hadn't been exposed to.

[00:08:23] Claire: Yeah, and, and I think, I mean, it's such a good point because regardless of what therapy model we are trained in, we are in a relationship with the client. And so it's not so much, I mean, I think about when I, I've run, um, trainings or supervision groups in psychodynamic therapy, I talk about the principles and, and integrating the principles as opposed to, you all need to go off and learn psychodynamic therapy, which takes years, but trying to introduce people to some of those principles that could actually be brought into the work with any model of therapy.

[00:08:56] Bronwyn: So just for listeners who have never heard of psychodynamics psychotherapy, could you just give us a very brief overview of what it is and how does it think of the therapeutic relationship? Like is it integral? I don't know. What role does it play?

[00:09:09] Claire: Yes. That's a, that's a very big question, but a...

[00:09:11] Bronwyn: okay.

[00:09:13] Claire: I'll, I'll, I'll do my best to answer it succinctly. And psychodynamic therapy is a therapy that really focuses on unconscious processes and it really looks at developmental processes. So it looks at how the past impacts the present. And within that, um, some of it, some of it we're very aware of. You know, so sometimes we are very aware of our past and, and how it's playing out, but sometimes we are not. And in therapy we are often looking at those unconscious processes that play out.

And so as part of the therapeutic relationship, we've got these two concepts called transference and countertransference. And transference is where the client is going to treat the therapeutic relationship to some extent or at some point, like another relationship that they have been in. So factors will come into the, the therapy room that may play out outside of the therapy room. And so they're sort of, if you like, transferring some of their experience with others onto the experience with the therapist.

Countertransference is the therapist's response. And so when the therapist has a response to what's happening in the therapy room, that may either be in relation to what's happening for the client, or it may be something that's actually happening from their own experience and it's maybe triggering a response from their own history that they may or may not be aware of.

This is why therapy is very important in a psychodynamic model because it's, it's essential that therapists do understand their own unconscious triggers so that they don't then play out in the therapy room.

[00:11:01] Bronwyn: Yeah, that makes so much sense. So they're not reenacting the relationship that that client might have outside of the therapy room in therapy.

[00:11:09] Claire: Exactly. And, and when you say reenacting, that's, that's a term that's commonly used because, absolutely, we are not wanting to reenact that. We're wanting to really enact a healthy relationship.

[00:11:21] Bronwyn: Yeah, so maybe tell us what does a healthy relationship look like in psychodynamic therapy? I guess I'm asking like, what is a therapeutic relationship in psychodynamic psychotherapy?

[00:11:32] Claire: So a healthy relationship will model all facets of a healthy relationship in the sense of it's a reliable and um, supportive environment. And so, and when I say reliable, meaning that the client can know what to expect, so often we would set sessions at the same time each week. We would have sessions in the same therapy room if we're in the group practice, there will be consistency. And so the client knows that from three to 4:00 PM on a Tuesday, that is their therapy time. Um, and it becomes like a, I call it the container, but it, it does feel, it feels containing in the sense of that is, that is belongs to the, the, the, the client, sorry. So that is the client's time and space, and they can reliably have that and they know they're gonna get it from week to week or fortnight to fortnight.

[00:12:28] Bronwyn: Yeah.

[00:12:29] Claire: Um, and so that's what I mean by reliable, but also it should have all those other factors around. It needs to be safe. It needs to be. Um, I mentioned supportive. It needs to be validating, but it's also gonna replicate a normal relationship, which may also include ruptures. It may also include challenges. And it's, it's about being good enough as opposed to, you know, I'm gonna be this perfect person for you and you are gonna have the best time with me, and, and I'm gonna make sure that you're protected from anything, you know, that that doesn't feel warm and fuzzy. That's not really an ideal relationship 'cause that's not what happens in real life.

[00:13:09] Bronwyn: Yeah, so that raises a really interesting point to me because I feel like in my early training, that's what I was taught, what the therapeutic relationship is. It was this concept of unconditional positive regard. So the Rogerian principles, and it was like if you create just that safe space and that validating space, then that's your therapeutic relationship. And I'm not sure if, if, if you experienced that as well, but it didn't mention to me that there might be ruptures, that there might be other. I guess dynamics at play. So I wondered whether that was your observation. If so, why do you think it's oversimplified to that in our training?

[00:13:47] Claire: Well, I think when we're starting out we're, we're, we're trying to grasp so much.

[00:13:51] Bronwyn: Yeah.

[00:13:51] Claire: ...to grasp concepts. We're trying to grasp the relationship and I mean, absolutely, I agree with the unconditional positive regard. I want a client to come in, in their very first session to be a good experience. Because of course we, we, we do want them to experience that kind of, you know, that slightly warm, fuzzy, um, feeling that they have while they're in the room because we want, we want enough good. And so, yeah, I think there's, there's a lot of merit to that, but it's not, as you say, it's not just that.

[00:14:24] Bronwyn: Yeah.

[00:14:24] Claire: But I think that it's not emphasized in our training, and there's such a focus on intervention, like the strategy for this and the strategy for that. And so therefore, we are kind of, and, and I, I think it begins to feel a bit more generalized as well. They're like, a presentation of depression can be treated in this way, and a anger can be treated in this way. Whereas really, we're all individuals. Everybody's experience of something is going to be very different.

[00:14:53] Bronwyn: So you're, I guess, are you saying that maybe, uh, applying a single way of treating depression, for example, might not work with every person who comes through our door with depression?

[00:15:04] Claire: I just don't think it could. I think that, you know, we all go into this profession because we wanna help people. And I wonder if there's also an assumption that some of that, um, that knowledge and that skill about developing a relationship is already within us because, you know, we, we wanna do the right thing. We wanna be warm and we wanna be empathic and collaborative and all of those things that are really important. And, but I think as you're saying, I think there's another layer to that that we don't often get taught. Not in the early stages.

[00:15:39] Bronwyn: Yeah. I mean, do you think it is something that we could be taught in the early stages or is it like a level thing? Like I'm thinking of a pyramid of like a therapeutic relationship. Maybe we should start out just learning the unconditional positive regard and the rapport building, and then as we get a few years in, we should learn about the ruptures and dynamics that could happen. Is that your way of conceiving it?

[00:16:00] Claire: Um, I like the idea of the pyramid in learning these things first.

[00:16:04] Bronwyn: Yeah.

[00:16:05] Claire: Um, but I'm not sure I'll be waiting the timeframes that you're stating there, I, yeah, I think it would, it, it, yeah, there's, we wanna start with that sort of broad concept of unconditional positive regard. You know, being very empathic, um, being very considerate, giving the client a good experience.

But I think if we don't prepare people for the fact that there might be ruptures and that there is more to the therapeutic relationship, that we are not doing the, the new therapist, uh, a service. And we're also, um, doing the clients a disservice because we are not actually covering the full range of experience that is gonna come into the room.

[00:16:45] Bronwyn: Yeah. Maybe we can go through an example. So I'm thinking like, okay, so one thing that people can bring to supervision with, um, a client who has depression for example, is they might be like, okay, I am applying CBT with this client. Everything's been going well until I tried to talk with them about this technique of behavioral activation. And then the trainee might say, I noticed some resistance. And that might be an opportunity to go deeper into the therapeutic relationship. So that could be an education point. Question mark.

[00:17:16] Claire: Absolutely because what is creating that resistance? Um, it may or may not be associated with the therapeutic relationship necessarily. It may also be associated with the client's history because any kind of resistance really is usually there for a reason. Avoiding whatever it is that's hard has, has often been a way the client's got by and then we begin to challenge that and try and break that apart that could be really, really difficult. And so in context of the relationship, perhaps I might say, look, you know

what's happening here as I... as I'm suggesting this, I'm noticing this isn't landing for you in the same way, or it's feeling harder. Like what, what is, what is happening here? And giving the client the opportunity to say, oh yeah, this makes me uncomfortable. Or, yeah, this, yeah, I don't know what's happening.

[00:18:11] Bronwyn: Hmm.

[00:18:12] Claire: Um, but if we are allowing that space for the client to really explore that rather than making assumption of, well, this isn't working, then it's gonna give us a sense... we're back to the connection. We're back to saying, I see you. This isn't working for you.

[00:18:27] Bronwyn: As I go further into my career, I really do see the therapeutic relationship as essential, like something I can't ignore. It's like maybe when I was starting out, one of my first, uh, places that I was employed in was in a six session service. So it was a public health service, and they had a max of six sessions. So it was very much, you do your assessment in session one, you have the treatment plan by session two, you deliver that in session two. Sessions, three to five are delivering specific techniques. And then session six is a closure and referral. And so it, and there was no encouragement to have a look at the therapeutic relationship in that service.

Um, and then now as I've gone on, I, I see it as essential in something that I can't ignore. And I guess I was wondering, like when you mentioned at the start that you wanted something deeper and psychodynamic provided that, like do you feel like it's something essential and that you can't ignore?

[00:19:15] Claire: Oh, absolutely. Absolutely. And even in those six session models, which is not a psychodynamic model, I think we can bring the therapeutic relationship in because clients are less likely to engage in... in any kind of intervention if the relationship's not established. I mean, I think that if you've got a really good, solid, solid therapeutic relationship... you could deliver almost sort of slightly sloppy or imperfect interventions, and they might land.

But you could deliver an absolutely perfect intervention. If the therapeutic relationship's not being established, it'll probably fall flat.

[00:19:55] Bronwyn: Yeah, that sucks. It's, it's like you'd be thinking, I'm doing such a good job, I've delivered this perfectly, and then like just no engagement.

[00:20:05] Claire: And then therapists begin to doubt themselves and that's where I feel that if it was introduced earlier on in the training, and, and really, and even if it's not provided in the, in the training, which I, I mean ideally it would be, um, you know, to be introduced early in supervision so that it doesn't become... I'm not doing these interventions, that must mean I'm a crap therapist because I just can't do this. It's about, well, actually this client's, you know, not feeling necessarily safe enough or there's not been enough time to establish the relationship. And then of course they're saying, well, there's not enough time because I'm feeling rushed.

So it's learning how to integrate it into those sessions. It, it's, it's more of something I think that you integrate in rather than necessarily have to spend three sessions doing... you're doing it all the time.

[00:20:56] Bronwyn: I love your observation that if we don't pay attention to it or have some knowledge of the therapeutic relationship, it can lead us to perhaps falsely having self-doubt about ourselves when actually, like in supervision, the supervisor may point out that, oh, it seems like you're being drawn into this reenactment of a relationship and then you are concluding this. But maybe that's a client's projection of that. Something that they had in the past with somebody else, like if that happened to me, I'd be like, oh, I feel so relieved. You know? Like, is that something that happens in your experience?

[00:21:29] Claire: Yeah, all the time. All the time because then we've got the opportunity to even go back and say, you know, I think even if we have a terrible session with a client, you know, we might say, um, it just doesn't feel good afterwards.

[00:21:43] Bronwyn: Yeah.

[00:21:44] Claire: We can usually go back and say, you know, I came out of that session and I wondered whether I said this or I said that, or, you know, we talked about something and I wasn't sure. I mean, I'm just trying to think of an example, um, where I might have said something and then the client goes away and I think, I dunno if I should have said that. I do it all the time, you know, I try not to do it.

[00:22:06] Bronwyn: Yeah.

[00:22:10] Claire: ...you know, it's better for me to go back and say, I just wondered about that. I didn't think it landed, or I may have sounded insensitive. And they sometimes they say, no, no, it's fine, and then we'll move on. But sometimes they'll say, yeah, that was a bit uncomfortable. And then I can say, okay, well yeah, I can see why it would've been and let me know how it felt. And then I've observed something about themselves and about their reaction that they maybe might have been fearful to tell me.

[00:22:37] Bronwyn: Hmm.

[00:22:39] Claire: That really deepens the therapeutic relationship. So sometimes when we make a mistake, it can actually make things better and they can trust us more because they feel seen.

[00:22:48] Bronwyn: Yeah. So huge benefits here if we pay attention to that. So maybe what are some of the challenges that early career psychs might face when trying to develop a strong therapeutic relationship, I guess beyond rapport building with clients?

[00:23:02] Claire: Yeah, I think it's um... we are trying to hold a lot. I, I always sort of go back to that. I think as a early career psych, we are really trying to hold onto so much and am I doing it right? You know, what is happening with this person? Do I take notes or how am I gonna remember this? Oh, I wanna do this intervention. They've come in for this. And so I think that that's a big challenge.

And I think that when I learned to take the pressure off myself. This is my experience and, and I think what I learned to take the pressure off myself and think I'm not gonna fix whatever it is in those six sessions. I can do the best I can, but actually it's really important for me to connect with this person and that's gonna be my focus. And I allowed myself to do that... I felt some of the pressure drop and then I was able to be in the space with the client as opposed to three sessions on session where I thought I should be.

[00:24:04] Bronwyn: Hmm. So alleviating some of that pressure of yourself helped reduce, I guess, all of that stuff you're holding in your head and just focus on, on this, on this moment.

[00:24:14] Claire: Yeah. And, and trusting that we actually do know how to do that. If we, and it's more about, it's not that we dunno how to develop a relationship because most of us do have those key ingredients to start with.

[00:24:27] Bronwyn: Yeah.

[00:24:28] Claire: It's learning to listen to things or when there something doesn't land, to think, okay, well, let's explore that. Let's be curious about that. As opposed to, oh, no, I, I've done something wrong. I'm a bad therapist. I'm gonna take this to supervision. And then profusely apologizing or go, or going through the rest of the session awkwardly.

[00:24:48] Bronwyn: Yeah.

[00:24:48] Claire: So I think that it can be quite challenging sometimes to bring things up, you know, sometimes... sometimes naming what's happening can feel quite confronting and I think that's quite challenging. You know, how are things going here? You know, how is this relationship going? Um, you know, well, I wish you'd do more in this respect. Like, ah, now I say, I am really pleased you brought it up. Rather than, oh, I'm so sorry. Um, you know, it's more about inviting responses from the client and, and allowing whatever is to be there.

Another thing is, I think, um, just come to mind differentiating between like strong emotions that it may be a need to either vent or let off steam, or really be heard versus feeling attacked. Sometimes clients can have quite strong emotions and, and sometimes they can be directed mildly towards us recognizing when it feels violating or when it feels like, you know, the client maybe has a fair point or it's their way of expressing themselves because we should not be violated.

[00:26:01] Bronwyn: Yes.

[00:26:02] Claire: So sometimes we are against strong emotions as well. We're taught anger management. You know, we've gotta not get angry. We've gotta not express those things. And so sometimes modeling that in the therapy room in the same way that a parent might handle a child. For a teenager, you know, screaming or having some kind of tantrum. Um, and they're the tuned parent that's really able to manage what's happening inside for that person, and not just sort of feeling completely overwhelmed. Which is really common. We can feel quite overwhelmed by difficult, difficult feelings, and that's where our own therapy can really be really helpful too.

[00:26:41] Bronwyn: Yeah, I was thinking like that must be where personal therapy comes into it because it can feel really scary when you say, say to a client like, I noticed something changed there, and I'm wondering how that landed for you. That can feel terrifying. Like your heart rate can increase. What are they gonna say back to me? It might be said in a negative tone. How will I interpret that? How will I manage that whilst also needing to be like the contained person in this situation?

Um, yeah, like for me, I think that's a huge. That, that was a huge barrier. And I think like as an early career psychologist as well, my predominant emotion was anxiety in sessions. So I was like, crap, how am I gonna do everything here? Um, so to add that on top of that, it did, it did just feel like too much.

[00:27:22] Claire: It can do, it can do. I mean, I would recommend therapy and I'm surprised in a way that it's, it's not mandatory. You know, it would help us manage some of our own, um, emotions in session because essentially there is an expectation, and this also comes up in some training, uh, with, particularly with trauma training, for example. We need to hear difficult things, so we need handle it, but no one's telling us how we do that.

[00:27:47] Bronwyn: Yeah, exactly. Yeah, it, we've talked about that idea of not having mandatory training on the podcast before because it is interesting, because I know in some countries and in some modes of therapy, like psychodynamic therapy, it is part of the training and it seems like at minimum you could get insight into what it's like to be in the hot seat. And at maximum you could get, you know, significant insights into your own, um, psyche, um, you know, plus, plus, plus plus.

[00:28:13] Claire: Yeah, I mean, you really benefit professionally and personally. Yeah, I mean, I was a, I'm a very different person coming outta my therapy, and if I hadn't had my therapy, I would've been a very different type of therapist. I would've taken things more personally. I would've felt very, very anxious in the hot seat. I think I would've quite easily, I mean, even now, I can still sometimes get involved in reenactments and I try and catch them when I do. Um, but I think I would've been reenacting things with my clients in a way that I try not to now. So it's been enormously beneficial enormously.

[00:28:47] Bronwyn: Yeah. And I'm just curious about your perspective on how we could use our self-awareness in therapy. Like, I don't know if this is, 'cause I don't know too much about psychodynamics psychotherapy, but I think there's like a school where you should be like the blank person and you shouldn't do anything, and then there's like another school, which is like, you should use your own feelings in that relationship. Could you just help me? I don't know what I'm asking.

[00:29:14] Claire: It's absolutely true. It's absolutely true. So there is that sort of, that very sort of classic old school psycho psychoanalytic style where person's in therapy three or four times a week. I mean, even these trainings, um, to complete the training, the therapists have to be in training four times a week.

[00:29:31] Bronwyn: Oh my gosh. How intense.

[00:29:32] Claire: -training. Yeah, it's intense. And, and that is where the therapist is seen as a blank slate. So there's that sense of free association. And so the therapist isn't interrupting the process. And, um, to some extent, I mean, I was taught not to say anything when clients come into the session and so that it's up to them. Now that works for some people. It doesn't work for other people. And I'm really not in the service... I'm, I mean, I'm trying to keep. Help my clients feel safe... so I'm not gonna sit there in silence when that's not right for an individual. So sometimes I'll help the process along a bit, but I try and get the client to start the session, um, and to try and get the client not to come in saying, oh, how are you? And me saying, oh yeah, I'm fine. And then we're having this general chitchat. I want 'em to come into the session and it's their session and their time.

So that's really how I set things up. Um, I think the, the neutral component, I was actually thinking about this the other day. Someone asked a question about this in supervision and, and then I began to really reflect on this. And I think that there is a sense of trying to be neutral. And I feel that, that actually a lot of us adopt these principles of being careful with self-disclosure, for example. But I am also a human being and I am gonna bring certain things, uh, elements of my personality into the therapy room. And there are some things we can hide and some things that we can't. And so, for example, I wouldn't, um, talk about my family. I wouldn't talk about my weekend plans. Um, you know, I'd be very careful about what I disclosed about my own life, but my clients might get a sense of, you know, I have a strong sense of justice and when I think something's really unfair, when a client is, is giving me, you know, telling me a story that is, you know, full of injustices and violations, I'm usually quite, quite vocal about that because I kind of want the client to feel... it is sometimes it's absolute and often they're, they're, they're wondering, they're sort of like, oh, you know, I wasn't sure if, you know, that was just how things are done. And so sometimes be a lot clearer and saying that's not really, you know, what a good relationship looks like, for example.

[00:31:44] Bronwyn: Yeah.

[00:31:45] Claire: Sometimes we'll bring ourselves into the room, uh, unconsciously, and clients will just make assumptions. Like I've had clients assume that I've got, you know, five children and I live in this type of, um, house. And, you know, and they'll make these assumptions and, and I don't correct those. Sometimes they'll make assumptions and they'll be absolutely spot on, and so we can't be completely neutral.

[00:32:09] Bronwyn: Yeah, why don't you like, I know like with like not correcting the assumptions, you don't have to be like, oh, well actually I've got three kids and a horse and I live in X suburb. But like, why don't you be like, oh, that's an interesting assumption. Like, but that's not factually correct. Like, do you ever do that or do you just let them continue on with like the incorrect assumption?

[00:32:28] Claire: I think it depends on the context, but if I then begin to start correcting them, they're going to want to know the details.

[00:32:33] Bronwyn: True.

[00:32:36] Claire: And then I take the emphasis of them. But I use the information because often it'll be some sense of, you know, you have got it so much better than everybody else. You have struggle in the same way that I have. And, and, and you know, that will be the sense that that comes across. And sometimes the absolutely correct. Um, but I'm not gonna say, well, actually I have struggled too. Um, but I think we can bring our lived experience into the relationship without disclosing our lived experience.

[00:33:06] Bronwyn: Yeah. Um, I, I wanna just check something out with you to see if it's similar with psychodynamic, because I've been talking to a few clinicians lately about mentalizing based therapy and something that they've been saying to me along these lines have been like, some clients have missed out on early attunement experiences, so they might be feeling happy and they've never had that reflected back to them in their early life. So they're unsure about what they're experiencing and what other people are experiencing, and that can lead them to make false assumptions about other people.

So the way that mentalizing based therapy might work is that if something happens in therapeutic relationship, the clinician might say, like, this affected me and I noticed that I felt, um, upset or I felt, I, I noticed a bit of anger rise in me just so that the client can know that their, their actions or what they're experiencing is reflected back in somebody else and that they can understand that they're being attuned with their experience. Is that similar to psychodynamic or, or is that It's slightly different.

[00:34:06] Claire: I think mentalizing therapy... I don't know much about it to be honest, but I do think that it developed as, um, quite consistent with the psychodynamic model. That does sound like a psychodynamic principle. Sometimes, um, I might say, you know, I've noticed myself feeling like this, or, um, you know, I'm not sure why, but I'm getting this sense of sadness. I'm not sure that I would say that I'm feeling, but I, I mean, you could say that. I'm trying to think of an example where I think it could work. I, I'm not, I'm just trying to think of an example. It's not something that I do particularly, but I do know it's something that, that can be done and when done well, can be really effective.

But I might say, you know, sometimes I've noticed this sense of like, if a client's getting frustrated or something, I'll say sometimes I've noticed, you know, I've noticed that myself, you know, I felt that, you know, there's been some of this or that, that sense of criticism that might come in towards other people or towards the client self, I might say, you know, sometimes I, I've, I have felt that.

[00:35:08] Bronwyn: Yeah.

[00:35:09] Claire: Um, and so, but I'll do it in a very safe way so that, because I don't want the client profusely apologizing for having said that. And I also, um, don't want it to become, um, I don't want it to feel defensive either.

[00:35:25] Bronwyn: Yeah.

[00:35:26] Claire: So yes, I do believe that that is, is would be consistent and used well. Could be. Could be really effective.

[00:35:33] Bronwyn: Hmm. So I guess what I'm hearing in your description is that there's this deep thinking about how the way you say things and how you act, how that could impact the client, and then how that could take away from therapy being about them. Is that right?

[00:35:46] Claire: Yeah. I always want it to be about them. Anything I reflect back is to be about them. and so even, um, I mean like, so for another example might be a client, um, who maybe gets really quite frustrated or angry with people and really struggles with friendships because their friends don't wanna be shouted at, for example. Um, you know, which is really quite reasonable. But, you know, of course they're really struggling with those, those relationships. And sometimes I might say something like, you know, I... I feel like I get to know you. I, I know you quite well. I feel like I know you maybe better than some of these other people, and so I, I know that there's this part of you that struggles with this, that also struggles with this, but I also know you got a kind heart underneath it. But if I didn't know those things, then I might be scared of you.

And so it, it's confronting, but I'm also saying, look, I see you.

[00:36:41] Bronwyn: Yeah. I can see when you say that, that triggers me to remember that there, like some circumstances, for example, where, um, let's say a person is behaving in a way that they think makes sense from their experience. Let's say that they, um, had a, had a, had a faulty product and then they went back to the store where the faulty product was bought from. Um, but to really be heard, they felt that they needed to raise their voice at the customer service person. And the customer service person was quite frightened, but the client felt like that's what they needed.

And it sounds like maybe an approach could be like, Like when that's happening. Actually, I don't even know how to word it, but I think, I think the point that I wanted to get across was that like, we can use that perhaps they felt frightened and I don't want that to happen to you in other relationships with this behavior. Does that make sense?

[00:37:31] Claire: A lot of sense because it's about saying , you know, imagine how that person might have felt when you said you were frustrated and you know, if you know their history, you might say, yeah, I know you've had to really talk, you know, you've had to raise your voice, you've not been... raising your voice has sort of maybe sort of been a strategy that you've used to be heard. Uh, and maybe that was needed at some point, but actually it backfires on you. It doesn't work.

[00:37:55] Bronwyn: Yeah. I'm just kind of like laughing 'cause I'm just like, do you ever think that this is just too hard? Like I'm just like, oh my God, this is so hard to think about and like deal with. Or is this like your jam? You are just like, this is my intellectual, like it gives me a lot of joy to go through these like complex situations.

[00:38:11] Claire: Well, they're not always there. They're there in, in drips and drabs. I think throughout, throughout them. Look, I'm always looking for them, but also sometimes, you know, we don't wanna analyse everything.

[00:38:22] Bronwyn: Okay.

[00:38:23] Claire: When a client, and I say, you know, last week when I said X, Y, Z, I just wanted to check in how you felt. And they said, fine. I'll be like, okay, and move on . Because sometimes, sometimes a spade is a spade.

[00:38:40] Bronwyn: Yeah, like I've heard that quote, like, you know, a cigar is a cigar sort of thing, and not everything is linked back to your mom, you know? Yeah.

[00:38:47] Claire: Yeah. And so it's knowing what, and I think we can tell when it's, you know, when we've got strong emotions or things aren't progressing, then, you know, we can usually tell, or, you know, the clients, um, not showing up for sessions or sometimes it's in other factors.

[00:39:05] Bronwyn: Yeah.

[00:39:06] Claire: Yeah, so I mean, I, I think it's something that, I mean, I've been doing it for a long time now, so it feels second nature . And, and, I'd like for that to be integrated for, for early career sites early on. So it did become- feel second nature regardless of the modality. So I, I'm really not trying to plug psychodynamic therapy.

[00:39:25] Bronwyn: Yeah. Yeah. No, I'm hearing that it's like the principles you would like to be adapted across.

[00:39:31] Claire: Yeah.

[00:39:32] Bronwyn: I think that would be so helpful.

I guess like on that early career focus, what might be the signs that the therapeutic relationship is going well and when it might be in trouble? I guess just like on a basic level, when when should we be attuned to, it's like, I don't have, like, I don't have to worry. It's, it's fine right now or it's could be something that I need to inquire about further or take to supervision.

[00:39:55] Claire: Yeah, that's a good question and I think a common question that will come up.

[00:39:59] Bronwyn: Yeah.

[00:40:00] Claire: I think when things, things are going too well... sometimes the client comes in and says, oh yeah, I did all this and I did all that. That's not to say that therapy's not going well and that they may not be integrating all of the interventions, but sometimes I would look at that and think, you know, is there an element of compliance here that they really wanna please me? Like why is it, why is it, is it too smooth? Um, and I think, I think we would know the difference between that and the therapeutic relationship that just seems to be flowing and going well.

Um, and I think that normally we can get some other information or some other clues as to whether or not there is that, um, you know, that compliance factor, you know, you are the therapist. I'm gonna do everything that you say because that's actually not what therapy is. We wanna support our clients, but we don't want them just, um, you know, having to follow our orders because what are they doing outside? Is that how they work with everybody. So I would be looking for that as a sign of, you know, and you are the best therapist, you're the best person that's ever helped me, and that it's like the black and white thinking, but it's all white.

[00:41:10] Bronwyn: Yeah. And I mean, just on that, I'm so glad you brought that up. 'cause I used to be like so non curious about that. Like in my early days I was just like, fantastic, this is going so well. You know, when you've got a caseload of like 40 people... it's like, I'm not gonna, to me, I was like, I'm not gonna bring that one to supervision. I'm gonna bring this other case that is like having air quotes problems. To me, that was like a non case.

But, something I've been reflecting on supervision over the past few months, has been this concept or idea of idealization as well. That... that whole, like you're the best therapist I've ever, I've ever had, and this is going so well. And what that might be alerting me to might be that this is a a common thing that they've had growing up, that they've always looked to other people for the answers, and then I might be reenacting that relationship. Um, so it's, yeah, it's really good that to hear that from you, that that might be something to, to query further.

[00:41:59] Claire: And I, and it is about querying further and being curious about every client that comes in.

[00:42:05] Bronwyn: No, exactly. Exactly. Not that. Yeah. Not that it's always like a, a, a sign of pathology or anything.

[00:42:11] Claire: No, it's not. But you usually get a sense of when it might be.

[00:42:16] Bronwyn: Yeah.

[00:42:17] Claire: And the other thing is, I think, is when, when it's not going well, when, you know when clients are, uh, skipping sessions or they're not coming, um, they're coming really late or they're, they don't seem receptive or responsive to what we have to offer. And so any factors... I, I think it's usually fairly obvious when it's not going well.

The other thing is when we're taking a client home with us in our, in our mind, and we're replaying this particular client over and over and over, and that client is showing up in supervision constantly. Um, and we're not feeling as though there's any progress, even though, you know, the supervision feels robust, um, being able to act on.

Um, because, and that that could often be our own, um, our own fear of confronting. Um, because I mean, I, I personally find some clients much, much easier to challenge than others. Um, I'm sure that's, that's most people's experience. Um, and so sometimes it's hard in that, in that respect. Um, I think good, good supervision and good reflection.

Um, and I... I know I've talked about therapy a lot, but I, I think I, I, I also need to acknowledge this because I haven't done yet, done so yet here, is that, I mean, I went into quite an intensive therapy and for me, I saw it as an investment. and so I did have to make some compromises, but it was accessible to me and I feel fortunate to, to have that. It's not always accessible to people, and I think that it's really important to acknowledge that.

An alternative to therapy would be, first of all, reading about the, uh, these types of principles, um, but also reflecting, reflecting... so self-reflection. Um, and most provisional psychs would be used to reflecting, but the type of self reflection that really looks at, okay, what happened in that session? Could it be related to this? And trying to see whether or not there's any transference or counter transference and reflecting on that and taking that to supervision... Because although supervision is not for personal therapy, I think countertransference has a place in supervision.

[00:44:40] Bronwyn: Yeah. Hmm.

[00:44:41] Claire: And, it's in the service of the client.

[00:44:44] Bronwyn: Mm. Yeah. Agreed. Uh, thank you so much for bringing that up. It's, it's something so important to acknowledge. And like, I remember when I was a provisional, you know, I was paying a few hundred dollars for supervision and then that represented my portion of my rent. And then to add personal therapy on top of that would've been the same amount. And it's like, well, I don't, I can't afford like three times the rent. And so it's like, I can't afford that. Um, so it's like you had to do one or the other.

But like you said, there are alternatives where you can have that reflective practice within yourself and then bring that to the supervisory space, which can be really helpful.

[00:45:19] Claire: Yeah. And on, and even like joining supervision groups that have an emphasis on the therapeutic relationship where the, some of these, some of these sort of concepts might be explored further. And sort of taking an interest in the relationship. So I think there are things that we can do. Um, we need to have sort of, you know, the, um, plan A, B, and C if you like.

[00:45:41] Bronwyn: Yeah.

[00:45:42] Claire: You know, if, if, if personal therapy is not accessible to you right now, it may be in the future. I mean, we're talking to provisional psychologists... there's a big difference as we know, between the supervision that we're paying for as provisionals and then, um, you know, not having to have usually the, the same, I mean, it's two hours a week if you're working full time. Um, and even if you move to fortnightly sessions, or sometimes it's monthly sessions, the support internally, um, there's usually a, there's usually a, a big difference, and plus you, you sometimes get paid more as well, so it might be accessible later on. So, um, yeah, I just sort of put that out there because there might be people here listening saying, that's just not available to me.

[00:46:24] Bronwyn: Yeah, absolutely. Yeah. Totally 100%. So one of the things that has been talked about a lot in the mental health space, probably over the past year, a few years, has been this concept of trauma-informed therapy. And the idea like, which I completely agree with, which is that we should all be practicing it. That we should acknowledge that people might be coming from difficult circumstances and that might be impacting how they're presenting in the therapy room, but also making sure that our space is safe and containing, and that we have the skills to be able to regulate people's arousal levels. If they're too much up here, then we can help them get back down there, um, acknowledging that trauma might be present.

So I'm wondering... How does a therapeutic relationship, like if it's more than rapport, how can we use that to help us in this trauma informed approach? And I'm doing lots of gestures and I dunno why, but I'm hoping that makes sense.

[00:47:15] Claire: Yeah, it absolutely makes sense. And I think in more than ever when working with trauma, the relationship, um, you know, needs to be emphasized. There's people with trauma, and you know, have usually, usually. It, it entails some kind of relational wounding, um, and particularly when it's early trauma. Um, and the people that, that are likely to feel very unsafe are those people that have come with usually very complex backgrounds where their environment was never safe.

So yes, cultivating a safe environment, I think is the primary. Um, priority really for us as therapists, and that includes us being a safe person as much as we can be. As I say this, I'm really aware though that me saying, yeah, I'm gonna create a safe space. Doesn't -client's gonna come in and feel safe?

[00:48:13] Bronwyn: Yeah. I like, I, I can't think it'd just be the most dicky thing to be like, this is a safe space, and it's like, oh, okay. That's nice, you've decided that.

[00:48:20] Claire: Yeah, because. I think that could almost be invalidating. And so sitting with that is really important. And sometimes when it comes up, I might say, look, it, it is really hard for you to trust people. You know, you experience, you haven't had this and you are not feeling safe. And actually it makes sense that you are feeling this way. You've never met me. This is who I'm, you know, and, and you've never met me and you...

When I invite people to share and give some kind of intake information, I don't ask for the full story. Um, because that's really respecting where the client's at. And like you said, it's about being really attuned to that client, noticing when they're maybe getting outside of that window of tolerance, and helping to bring them back into the space in a way that feels safe for them so that they, they know it's doable. You know, don't wanna send the client out in a state of like, you know, hyper arousal so that they then with no means to, you know, um, bring there level of arousal back into a manageable state.

The, the creation of safety for those clients is just, it's, it's the primary, primary factor. So, yeah. I'm glad you brought that in. We just need to be really attuned to, to those clients, and we really usually need to go a lot more slowly and at the client's pace. And even if we're working in services that are limited to a few sessions, I'd still emphasize this because if we rush things, we do nothing, and then we create an experience that can either not be effective or even be damaging.

[00:50:09] Bronwyn: Mm.

[00:50:09] Claire: I would rather create an experience that began to work on some kind of safety and some kind of modeling a healthy relationship so that the client then got a sense of this is what therapy could look like. I can go back to it some other time, hopefully with a service that can provide them with, um, additional sessions or longer term support, because that's usually what's needed.

[00:50:30] Bronwyn: Yeah, I did my EMDR training with Graham Taylor, and I always remember he said in his training, like, you can go faster by going slower. Um, yeah, if you go too fast, then you can potentially do harm. Um, and then the client may not come back and they may lose faith in the services and may think that maybe recovering from trauma isn't from them. Um, so yeah, there's a lot of value in, like you say, in attuning and really regulating what you're doing, what the client is doing. Um, I'm just curious because did you mention that you're an EMDR consultant?

[00:51:01] Claire: I'm an EMDR practitioner.

[00:51:04] Bronwyn: Okay, cool. So with that, like, you know, one thing that I feel like wasn't emphasized enough was the therapeutic relationship, but it sounds like you see that as really important, integral in like EMDR therapy and just trauma therapy in general.

[00:51:17] Claire: Absolutely. I think most people go into EMDR therapy as trained therapists.

[00:51:22] Bronwyn: Yeah.

[00:51:22] Claire: And so there probably is some assumption that,

[00:51:25] Bronwyn: I, I think you're right. Yeah. The, there must be the assumption. Yeah, that makes sense. I was like, I don't remember saying that in there, but then I'm like, oh, okay. That makes sense. That is, it's an assumption.

[00:51:34] Claire: But I think that the concern is that it might be an assumption in different therapy trainings and that it never sort of gets fully addressed.

[00:51:44] Bronwyn: Yeah. Interesting. Okay. so one thing that I thought might be helpful for listeners is if you could share with us a concept or a tool maybe from your supervision groups or just, uh, your practice in general that listeners might find valuable in enhancing their therapeutic relationship. Like they've listened to this conversation and they're like, I'm keen, I'm keen bean to pay attention to this aspect. How do I get started?

[00:52:07] Claire: Okay. I think there are two things. The first thing I would say is that we've got what we see on the surface and we've got what's, what's underneath the surface. So really be curious about what's underneath. And, and by that I mean, you know, it's easy to take things at face value and sometimes we need to, but begin to look for, um, you know, things like, um, being late to sessions, things that happen repetitively or patterns that you begin to notice, and begin to really try and think about the impact for the client. So the client's running late , for example, I would say something like, um, you know, I've noticed it's really hard for you to get here on time. And they might say, oh, the bus is running late, or This is running late, and it may just be public transport. But, you know, I, I might say, I'm wondering if there's something else that's happening and they might say, yeah, it's really hard to come here.

[00:53:03] Bronwyn: Yeah!

[00:53:04] Claire: You know, I know I wanna come and I need to come, but it's really hard and, you know, I find myself delaying and slowing. And then we've named something that we could so easily miss. So, you know, begin to look for like repetitive themes and patterns when the client says the same thing over and over, for example. Let's just get curious about that and don't be frightened to ask the question because it may mean nothing and that's okay. But the client will at least feel that you are interested in curious about knowing more about them.

And the other thing is, is that, you know, remembering that we are humans and we are gonna bring ourselves into the therapy room so we don't to be perfect. And that if we do make a mistake, we've got the opportunity to go back and acknowledge and talk to our clients about that if we do it delicately and in their interests... then they're, again, gonna see that as we care. We've thought about them in between the sessions and, and they're interested and it's okay for me to be annoyed or frustrated or have a reaction. We can cope with that. Yeah, it's all right for you to feel a bit frustrated or, you know, I'm sorry, I said that it's a really corrective experience.

And so just, yeah, and I think that gives us permission, hopefully, to be who we are and to... you cannot be perfect. We will make mistakes. I say the wrong thing or the thing I wish I hadn't said all the time. Every day I probably say something I wish I hadn't said.

[00:54:30] Bronwyn: Yeah, I, I love reminders of humanity, like, so thank you. As my very wise supervisor, uh, has said to me before, he's like, Bronwyn, we are rupturing the relationship all the time. And like, I think it was in response to me being like, I'm afraid if I do this, then this. And he was like, we're, we're rupturing the relationship all the time, Bronwyn, like that this is happens, this happens in relationships and it might be something to repair or it might be something that's just part of our humanity. And I was like, that is awesome.

[00:54:56] Claire: Yeah. Yeah. I think we really do have to be human, which is so hard on ourselves. I think psychologists particularly where you get very anxious and that this tends to be, um, you know, you know, a reasonably common trait for, for a lot of therapists, we really, really want to do a good job.

[00:55:12] Bronwyn: Uh, totally.

[00:55:13] Claire: We hold ourselves accountable to these ridiculous standards that we, we cannot possibly realize.

[00:55:19] Bronwyn: Yeah, yeah. It's, it's so true and it, it just makes it so hard for ourselves.

[00:55:25] Claire: We do. We do. So, I mean, and, and that's like, you know, when we talk about self care... that's self care.

[00:55:31] Bronwyn: Yeah. Absolutely. And Claire, it's been so lovely to have you on. What do you hope listeners will take away from our conversation today?

[00:55:39] Claire: I hope that people will just feel curious and my hope is that people walk away feeling as though there's something they can add to therapy and be curious about this. Um, it's not about what you are not doing, it's about what we can always continue to, to add in.

Um, so my hope is that people will be, will be curious. Um, and I hope I gives people a little bit of. Food for thought that we've maybe given a few practical examples of, of maybe how people could begin to introduce some of this into their own work.

[00:56:14] Bronwyn: Yeah. I love the language that you give. I always really love practical stuff in the podcast where it's like, what language do I put in my mouth that I could use in a session to practice? And I, I found it really helpful, some of the phrases and language that you gave us, so thank you.

[00:56:29] Claire: You are very welcome. Yeah. That's, that's, I think that's what we need is sometimes is, is this is 'how'.

[00:56:35] Bronwyn: Yes. Yeah, because it's, it's sometimes so hard to know the language and just how to, how to bring it up, and sometimes it can just feel so clumsy. So just having a single sentence can be really helpful.

Well, Claire, if listeners wanna learn more about you or get in touch, where can they find you?

[00:56:53] Claire: I have a private practice, Holistic Psychology Services. Um, my website is psych.services.net.au and that's where I receive inquiries for supervision and therapy. I also have another business focusing on provisional psychs and early career therapists, but really around resourcing and uh, resources and training, and I've got a lot of free resources if anyone wants to access those at thegrowingtherapist.com.au. And you can also find me on Instagram and Facebook, The Growing Therapist, and a podcast Between Two Psychs.

[00:57:27] Bronwyn: Lovely. I will link to all of that in the show notes and listeners, I do encourage you to check out Claire's podcast. It's really fabulous and make sure you put it in other people's ears as well. I've been really enjoying all the topics and Claire did an episode on psychodynamic psychotherapy as well, which I found really interesting to listen to. So Claire, thank you so much again for coming on. I think listeners would've really benefited from hearing what you shared with us today.

And listeners, if you enjoyed this episode, please support us by following the podcast, leaving a rating or review or sharing it with your friends and colleagues. So that's a wrap. Thanks for listening. I'm Bronwyn. Have a good one and catch you next time.