As a therapist, I work to build a therapeutic space for clients to come into. I focus everything from the color of the paint and carpet, to the comfort of the furniture, to even where to place pictures and clocks. Everything in the room has a purpose to help clients feel comfortable and to have the best session possible. However, that becomes more difficult with online therapy. On my end, I work to make sure what fits within my screen is fitting for the therapy session. However, I have found that the environment on the client’s end isn’t always the most conducive to a therapy session. The following are some tips to make your environment therapeutic in order to get the most out of your online therapy session. Show
Mentally Prepare For The SessionWhen you come into the office, there is typically at least a five to ten minute drive to get there and a short wait in the waiting room. This gives you time to think through your week and what you want to discuss in the session. You don’t have this same time when you are at home, so it is helpful to set an extra 10 minutes aside prior to your session to reflect on your week and what you would like to discuss in the session. Ensure There Are Minimal DistractionsOne benefit to coming into the office is that it is free of distractions. At your home, this would mean that the TV isn’t running in the background, you aren’t waiting on someone to call or come to the door, children have someone else responsible to watch them or are able to manage themselves for the full hour, and even pets are not able to come into the room and distract from the session. Be In A Comfortable But Somewhat Separate SpaceDoing therapy from your bed might be comfortable, but it isn’t fully conducive to a therapy appointment. You are almost too comfortable and less able to step out of your home space enough to really reflect on where you have been for the week and where you are going. By stepping into an office or an area you aren’t in as much, you are in a way taking a step back from your day to day activities enough to be more reflective and less in the fray. Tidy Up Your Therapeutic SpaceThis isn’t for the benefit of your therapist, but for your. If you are in session, but thinking about the mess around you, then it won’t be something that you can fully focus on. By taking a couple of minutes to tidy the space around you, it will also prepare your mind to do the difficult work of therapy. Online therapy has been so helpful during COVID and is an ongoing helpful tool, and by taking some of these steps you will ensure you get the most out of your next session. For Mental Health Professionals - The Practice Resource Section of GoodTherapy Join Now
 Successful therapy depends on a client honestly sharing their experiences and behavior. Yet many clients have spent a lifetime avoiding or concealing the very things they most need to discuss in therapy. Many people harbor secret thoughts, feelings, and shame. Sharing these with a stranger, even a therapist, can be difficult. It takes time for a therapist to earn a client’s trust, and therapists should not expect that all clients will immediately open up. Mandy Rubin, a licensed professional counselor in Denver, Colorado, explains how therapists can help clients feel comfortable from the start of their first session. "At the outset of therapy, it is vital to level the playing field—openly ask for the client’s expectations for therapy and gently correct any misinformation about the therapeutic process," she advises. "Continue that openness by sharing how the process might unfold; initial sessions can be far less comfortable than future ones." Rather than seeing clients who won’t talk as “difficult,” therapists should devise strategies for building a safer and more supportive therapeutic environment. With patience and the right approach, therapists can help their clients talk openly about their lives. What Causes Clients to Feel Tense in Therapy?Numerous issues can make clients feel anxious or tense in therapy. Some of the most common include:
Therapists should be willing to address barriers to opening up before asking the client to share the intimate details of their life. Treat discomfort as the first therapeutic issue to be tackled, and listen with an open mind about how therapy makes the client feel. How Therapists Can Strengthen the Therapeutic AllianceThere's no one-size-fits-all approach to helping clients feel comfortable in therapy. To strengthen the therapeutic relationship, therapists must first identify factors that undermine it. Some strategies that may help include: 1. Help the client feel more welcome.Consider specific steps that might make therapy more welcoming for the client. Is the room too cold? Would a white noise machine help the client feel less anxious about privacy? Is your body language standoffish? Tailor the structure of each therapy session, as well as the room itself, to the needs of your client. 2. Know that relationships take time.The therapeutic alliance is a relationship, and ideally a close and trusting one. Relationships take time to build. Your first few sessions may be fairly surface-oriented, built on small talk and only occasional disclosures. Your investment in these early interactions is an investment in the trust that will ultimately help a client open up. "The therapeutic bond can be strengthened with authenticity in-session by sharing genuine reactions to the client’s story—when appropriate, of course," says Rubin. "A constantly neutral presence in the room increases emotional distance rather than closing the gap to allow the client to feel authentically heard." 3. Never judge the client.It's nearly impossible to go through life without judging people. Judgment, however, is therapy's death knell. While all therapists strive to be nonjudgmental, clients can pick up on the slightest hint of judgment. Avoid giving advice that might feel like a condemnation or giving insight that is outside your scope of practice. For example, therapists should not generally give religious or medical advice. If you feel yourself judging the client, the client may feel it, too. So work to keep your own feelings in check. 4. Manage your own emotions.When a client won't open up, therapists may feel anxious before therapy. This can erode trust. Commit to managing your own emotions. Meditation, validation exercises, and planning ahead for each session can prevent your emotions from intruding on the session. 5. Talk about what the client wants from therapy.The client's goals for therapy might be very different from what you assume they are or think they should be. Talk to the client about what they hope to get from therapy. Then use these goals as guideposts. When the client clams up, explain to them how discussing a particular topic can help them achieve their goals. 6. Ask more or different questions.Asking a single question or two may not be enough to get a client to open up. Sometimes you may need to ask more questions, different questions, or present the same question in a different way. Ideally, your questions should feel like an interview by an interested person, not an interrogation. Respond warmly and empathically, and follow the client’s lead. Stoic silence when the client laughs or a light-hearted approach to something the client takes seriously can make them clam up. 7. Don't make the client feel rejected.People seeking therapy are vulnerable, both because they may struggle with mental health issues and because they are sharing their most intimate thoughts and experiences. Make the client feel interested and heard. Don’t trigger feelings of rejection by daydreaming, shutting down their ideas, or dismissing their values.
8. Refer to another therapist.If you feel ill-equipped to help the client, are not an expert in their specific challenges, or foresee a serious personality mismatch, refer the client to another therapist whom you believe might be a better match. Don’t just make a blind referral. Spend time seeking out a therapist who is equipped to support this specific client. Then make sure the client knows the referral is an admission of your own shortcomings, not a condemnation of the client. 9. Plan questions ahead of time.Good therapy doesn't just happen. It demands planning, research, and diligence. Plan your conversation with your client ahead of time, and jot down some questions. This ensures therapy follows a productive path. If you’re struggling, consider seeking insight on your plans for therapy from a supervisor or other trusted advisor. 10. Focus on the client's needs.Therapists are human beings with their own emotional baggage, just like their clients. It's easy to feel rejected or judged by a client who does not talk. Remember therapy is for the client, and the only needs that matter are the client’s needs. Don’t make the client feel like they're harming you. Talking with another therapist or a supervisor can help you sort through your own emotions about a client who doesn't want to open up. Therapy demands a lot from therapists. Compassionately serving clients isn’t always easy, especially when you’re not sure why a client won’t open up. A GoodTherapy membership offers access to a wide range of resources, including continuing education seminars, that can help you build and strengthen your skills as a therapist. References:
Last Update: 10-01-2019 More Like This
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What is the most favorable seating arrangement of the nurse and the client in an interview *?The preferred seating arrangement for a nurse-client interview should incorporate which positioning? The nurse behind a desk and the client in a chair in front of the desk.
Which intervention by the nurse would not be appropriate in a therapeutic relationship quizlet?Giving advice. Giving and receiving advice is acceptable in a social relationship, but it is not in a therapeutic relationship. In a therapeutic relationship, it is appropriate for the nurse to assist the client in exploring alternative solutions to problems and in making his or her own decisions.
Which therapeutic communication technique does the nurse implement when conducting a clinical interview with a patient?Focusing. Focusing with the client is a therapeutic communication technique used by nurses, and other members of the health care team, that facilitates the client's abilities to focus on and pay attention to the matters at hand, which should reflect the client's priorities.
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