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The Two Most Important Elements in Counseling

Much has been written about counseling, coaching, and psychotherapy.  For someone seeking help from a professional the quest to find the right person who is a good fit can be confusing and frustrating.  Most clients have health insurance and they may search a long list of psychologists in vain because they all seem to be offering essentially the same service.  So what makes the difference? What makes counseling with psychologist A a better experience that psychologist B?  The answer based on many research studies may be surprising.  It is not technique, nor it is price, nor is it the degrees that the psychologist holds. Simply stated it is the trust that is established between the psychologist and their client and the strong hope that their problem can therefore be solved.
 
Let me also qualify the above statement by quickly adding that there are many coping skills (ie. journaling, progressive relaxation, EMDR, cognitive behavioral therapy, support groups) that add to the quality of the counseling experience and hasten recovery, or perhaps discovery, of the empowered true self.  Many of these coping skills are found in self-help books.  However, many of my clients have read many self-help books but never been able to accomplish lasting change until they started working with a psychologist who would help them hold themselves accountable for maintaining their new habits of thinking and feeling.
 
For many clients seeking treatment they come because something or someone in their lives has caused them to lose trust.  It may be that they no longer trust other people in general.  It may be they no longer understand or trust themselves.  It may be that they don't trust anyone or anything and are hopeless that anyone can help them..  In the later case, these clients are often in a more desperate psychological condition and may become very withdrawn from others.  The later group is more likely to become an addict and suffer from hopelessness that could lead to suicide.
 
I often tell clients when they enter counseling that I may not be a good "fit" for them and that I am more than willing to refer them to another professional that they would be more comfortable with than myself.  The two most important elements for the client is that they first of all feel as comfortable as possible sitting and talking with their potential psychologist.  Secondly at the end of the first meeting they must also have come to the belief that what they are suffering with is "treatable" and can be cured.  If these two things do not happen after the first session or two then it's time to go shopping again and interview another psychologist.
 
Why is trust so important? Why has it be demonstrated over and over again in clinical studies as the most important element in healing and recovery from a mental disorder?  It is because the client must have developed the confidence in their psychologist that they can tell them anything at all, no matter how embarrassing, and that they will not be judged harshly but rather they will be understood and accepted as a fellow human being quite capable of error (aren't well all?).  This confidence that  the client is totally and completely accepted is absolutely essential for a full recovery from anxiety, depression, trauma, or relationship issues.  It really doesn't matter what the diagnosis, it is still the trust level between the psychologist and client, and the client's ability to hold onto hope, that significantly determines the success or failure of the course of treatment.
 
For many clients, having established this trust may take a great deal of time and some testing of the psychologist to check to see if they in fact can be trusted with the most intimate details of their lives.  In point of fact, much of what is discussed in the later conversations between psychologist and client will be personal information that the client has never dared discuss with anyone else!  They have generally not confided their deepest secrets, doubts, and misgivings with anyone because of their fear of being judged and rejected.  It is for this reason that it is impossible to judge how quickly counseling can resolve certain deep seated personal problems.  This past week, I had a new client ask me, "How long with it take for EMDR to fix my trauma so I can be my old self?" I smiled and said kindly, "That is entirely dependent on you and your ability to eventually trust me."   She laughed and admitted, "I don't trust anybody so it may take awhile."  Then we both laughed and that led to a good discussion of the topic that we are discussing in this blog.
 
Trust is not easily given to another person; this is particularly true if those people close to the client have proved to be unreliable or even abusive.  For the psychologist, I can tell you that it is a great honor to be sitting with someone and have them trust you with their deepest secrets and most embarrassing moments and to see them look over at you and find that you are giving them support and not condemnation.  My profession is deeply satisfying, not just because I am able to help people overcome their fears and develop a truly satisfying life; but it is doubly satisfying because I am trusted by others who feel safe enough to discuss and resolve problems that may have plagued them for years.  In some cases, one client who is in her 80s, for literally six decades of her life had never discussed how miserable her childhood was with an overbearing mother and an alcoholic father.  She had been in three miserable marriages because, in part, she had held that same view of herself as her abusive mother had repeated told her, "You don't deserve to be happy!"   It was only when she was able to discuss this long held belief adopted at a very impressionable age that she could recognize how her unconscious perception of herself had kept her in unsatisfactory relationships for all of her life.  It took a great deal of courage on her part, and patience on my part, for her to disclose and then change her deeply held self-perception.  When she realized that she could now, as an adult, quite simply change that negative self-definition (she had plenty of accomplishments to refute that false view of herself) then she broke down crying (actually a shed a few tears with her) because after six decades she was at last free.  She was free to define herself realistically as  worthy and empowered woman who could now make choices to fill her remaining years with joy.  She is choosing activities and interests that keep her challenged and gratified in ways she had never experienced before.  Why?  In part, because she found the courage to trust and hope for her own recovery.  I can tell you that it is very gratifying to see someone make these changes and to rejoice with them when they come to find their own power to create a life that they choose and reject a life based on the mistaken beliefs about themselves that they unwittingly incorporate from the negative figures who influenced their thinking in childhood.  Do I love my job?  Absolutely.

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