Client = Therapist: Equality in the Therapeutic Relationship

Therapists often report the feeling that they are “in the same boat” as their clients. That is, they understand that the behavioral processes used in session apply to human beings in general, and that they, too, have many of the same sorts of struggles as do their clients. Many seem to understand the role of verbal dominance in psychopathology, and how remaining fused with rules around being the expert, or with labels such as “client with PTSD,” can work against the psychological flexibility we hope to develop.

Within the community of acceptance and commitment therapy (ACT) providers, most practitioners have seemed on board with the notion that being stuck might not be so much about a particular diagnosis as it is about the difficulties of being a verbal being. But too often, the verbal identification of the therapist and client as “fellow human beings” is missing. There is a pervasive tendency to keep the focus solely on the client, to remain staunchly in the expert role rather than getting more personally in the room. And yet it is when the therapist steps out of the therapist/expert role and meets the client at a more equal and authentic level that the full power of ACT is accessed.

Darrah Westrup, PhD, author of Advanced Acceptance and Commitment Therapy: The Experienced Practitioner's Guide to Optimizing Delivery, has explored the issue at length with numerous ACT providers. Many who are new to ACT report frankly that they are struggling enough to just convey the main ideas of ACT to their clients—putting themselves in the room as well simply seems out of reach.

When we look at this struggle more closely, it is often the case that the provider is feeling intensely incompetent, and working hard to conceal that uncertainty from himself and most definitely from his clients. Westrup suspects that new ACT providers do not have the corner on this one. Some reasons therapists give for not being more authentic in their therapy include beliefs that not knowing, hesitating, pausing to think, fumbling, or simply not knowing all equal incompetence, which is, by nature, bad. Here are some more relational frames that present as reasons therapists give for not being more authentic in therapy sessions:

Feeling uncomfortable with the material = incompetence

Confidence = competence = success

Not feeling confident = not knowing = failure

Self-disclosure= regular person = nonexpert = fraud = bad

“Let me just say that never in my personal work with clients or with consultees or supervisees have I seen a therapist lose credibility by owning his own uncertainty, fallibility, or downright confusion. We providers seem to be the ones putting such expectations on ourselves, thinking that it is our ‘expertise’ that matters. I believe it is our humanity that clients connect to most,” says Westrup.

But getting rid of this desire for competence presents a perhaps insurmountable challenge. The desire for certainty, for composure, for feeling competent, is here to stay. The trick is to have it for what it is, not what it says it is. Yes, as a therapist you must be thoughtful about self-disclosure. Yes, you can go too far in one direction. But if the value of therapist/client equality is to be upheld, it is imperative that the therapist be out in the room with the client, where the possibility for genuine, authentic connection exists. 

Next week we’ll explore more about self-disclosure as a clinical tool and present some guidelines for thoughtful connection with clients.