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Getting 'Style' Conscious in Therapy

By Karen R. Koenig, LICSW, M.Ed.

As social workers we are in the business of encouraging personal evolution, of fostering change. We insist that change is possible, preferable, that it is ultimately what therapy is about. However, it is no small irony that the prerequisite for a client’s transformation may sometimes be a change in the therapist, more specifically a modification of her or his therapeutic/clinical style.

Though we may rarely think about our clinical style per se, it is a powerful, albeit nearly unconscious, force in the therapy and is often key to unlocking clients’ secret fears, desires, wishes and dreams. It can accelerate a client’s progress and lead to miracles or it can delay or deter any major, meaningful work from ever getting done. It can serve as catalyst or roadblock and is worth a close examination if we are to give clients exactly what they need when they need it.

A therapist’s style is unique as a fingerprint, as distinctive as voice or gait. It forms the backdrop before which therapist and client play out the latter’s personal historic drama. But because it is so much a part of us, so instinctive, we may view our clinical style as mere background scenery, even as it plays a crucial part in this unfolding drama. While we may spend time reflecting on our abilities to connect, empathize, diagnose, and intervene effectively, we often ignore or underestimate the impact our clinical style has on our clients.

Therapeutic style is a descriptor of how we act during the therapy hour. It is a product of our theoretical orientation -psychoanalytic, cognitive-behavioral, solution-focused, insight-oriented - as well as of the population with which we work - couples, addicts, families, children, gays and lesbians, clients with a specific clinical diagnosis such as schizophrenia or bi-polar disorder. It also draws from our area of clinical expertise - dissociation, trauma, chronic illness, addiction, divorce, ADHD, or bereavement.

Therapeutic style is all of the above and more. It is the way our theoretical orientation and area of expertise interact with our personality, values and treatment approach to produce our unique clinical persona. It is the product of a singular, unduplicatible alchemy that identifies us as us and as different from any and every other therapist on the planet. Everything we are and ever have been - the broad strokes of experience and heredity as well as the finer ones of our peculiar individual characteristics - is synthesized into our clinical style. Our creative gifts, aesthetic taste, physical strengths and weaknesses, appearance, education, intelligence, disposition, and sense of humor are all contributors. Our therapeutic style is the shoe that fits so comfortably we forget that we are wearing it.

When a client is progressing, we take for granted that our style is part of what is working well. But when a client does not progress, it is worthwhile to examine what part our clinical style may play in the impasse. For instance, if we are verbally active and rapid responders, are we giving the client enough time to process what is going on in the hour? Might he or she feel unable to keep up with us and give up? If we tend to be laid back and patient as Buddha, might the client read us as uninvolved and disinterested, and, if so, are there ways we can tighten engagement? With a client who takes therapy too lightly, can we forgo a natural inclination toward humor and the absurd to crank up the message that therapy is serious business?

A style of constant nurturing - encouraging a client to borrow our books, reminding them not to forget their keys, offering a tissue when tears begin to fall - may have been just what the doctor ordered in an earlier stage of therapy. But such efforts may thwart the client’s growth later on, sending out the message that the client cannot manage alone. A contemplative, slow-to-respond style may lead us to meditate and cogitate at length before answering a client’s questions. But the client may interpret our turning inward as incompetence or may feel frustrated that our long silences impede forward momentum.

The right style for a group of heroin addicts who are used to the fast pace of the streets will be the wrong style for a group of frail elders dealing with end-of-life issues. A quick, upbeat, proactive style that matches that of a goal-oriented overachiever may overwhelm a shaky, confused client who struggles for ten minutes before stumbling through an answer to our greeting inquiry of how they are. A pensive, passive, distant, cool style may mesh perfectly with a client who has to be in control every minute of the therapy hour, but may alienate a needy client requiring a therapist who will don a pair of hip boots and slog along with them through the swampland of their life.

Our clinical style, like other facets of our work, is one to occasionally pause and consider, and it should be on our clinical checklist when therapy comes to an impasse. Does our style add to or detract from work getting done? Does it overpower or underwhelm clients? Are we able and willing to modify it as needed among varying clients as well as over time with a single client? How might clients describe our style and does that fit with our self-assessment? And, if there’s a discrepancy, which one of us is seeing things more clearly?

For many of us, how elastic our clinical style is and how far we are able to stretch it and still maintain our therapeutic identity and integrity remains unknown. Understandably, we may feel that it has taken a long enough time to finally feel comfortable in our therapist skin and we may not want to risk even tweaking a style that seems to be working just fine. But, perhaps, we could be even better therapists if we took the risk - if we asked, or held back, the slightly impertinent question that’s on our tongue, if we waited a minute more, or less, to answer a client’s question, if we offered, or withheld, an encouraging smile.

Like our clients, we won’t know if we can change until we try.



FOCUS Newsletter - February 2001

 


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