Affect Regulation Therapy can be used to support the initial delicate phases in psychotherapy of rapport building and contracting for treatment with the client, because it is consistently effective at immediately lowering stress levels and raising mood in a client-friendly way. Here is how it can support you, the clinician, in your practice.
When clients present for psychotherapy they are propelled by a state of psychological discomfort, which may have a variety of causes, commonly difficulties with relationships and latent immaturities.
At time of presentation, the client’s stress levels are usually high. In a general clinical psychology practice, clients may commonly present for treatment with symptoms of stress, depression and anxiety that can range from mild, moderate to severe. Without this type of psychological discomfort, clients wouldn’t arrive for help.
Clients expect assistance from the psychologist to relieve their pain and, at this point, the client wants to know “Can you help me?” “Do you understand what my problem is?” and “How long will it take to fix it?”
The psychologist is immediately faced with a number of urgent tasks at the first interview. He or she must form a working alliance and positive rapport, or positive transference, with the client and establish a relationship of trust with the client, a goodness of fit to work together. The psychologist must also communicate how therapy works, what goals can be worked on, the context or interpretation of the client’s problem and approximately within what time frame the client can expect what type of result.
This is known to be a delicate period when the contract can easily be derailed and the working relationship lost. However once these tasks are under the belt, both client and psychologist can be more confident, comfortable and relaxed about their joint project, because they have established a mutual trust relationship with a mutual positive expectation of a good result. They have made a commitment to work together, hopefully based on mutually realistic expectations.
A.R.T. can be used by the experienced clinician to support this initial, delicate phase of rapport building, introducing, and contracting, and then starting a psychotherapy process, because it is a client-friendly model that supports your relationship with your client in many ways, the most important of which is that the clinician can use A.R.T. to help the client right away.
It is important that the client feels that he or she got help in the first session. A.R.T. can support this goal by being used as a very brief 5 to 15 minute intervention in the first, second or third interview, to immediately and observably lower the client’s stress level. Generally this will elicit a comment by the client such as ‘Now I feel really relaxed’. This observable shift or change in tension level raises client confidence in the likelihood of future positive therapy outcomes.
This brief intervention, together with the supportive interview and debriefing nature of the first and second interview, will often result in an immediate, significantly reduced score on depression, anxiety and stress scales. This positive result obviously elevates client commitment and can lower overall dropout rates in a practice.
Feedback by a psychologist after she attended a recent training course in A.R.T. illustrates the value of immediate stress relief in a first session. She had been in psychotherapy for several years to resolve early childhood attachment issues, which had resulted in chronic elevated stress levels for her.
She was surprised that after one session of A.R.T., in a demonstration setting during training, she had significant relief from chronic stress. Her long term psychotherapy had been enormously helpful and she had made progress, but she had reached a point in her therapy where she felt ’stuck’ and was not making enough ongoing progress and her therapist had concurred with her on this.
She made the following comment after the A.R.T. training, ‘I am still feeling very good and even feel more sociable. I went to an outdoor boxing class last night that I have felt cynical about due to my perceived clique-iness of the local women! It was fine and I felt normal and great that I went! Thank you.’
Such a reduction in stress and positive change in emotional status can be observed by the client within minutes in a session or within a 24 hour period after a session. I find that even young children can comment on their change in mood and well being after the intervention.
This elevation of positive emotion translates directly into the client’s enthusiasm
and motivation to set up a treatment contract with the therapist, which fulfills one of the aims of the first three psychotherapy sessions.
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