speak directly

The development of rapport is hindered when patients cannot understand their therapists due to the therapist's unbridled use of psychological jargon. Similarly, patients often do not appreciate it when they perceive that their therapists are talking down to them, or are speaking to them in the manner of a teacher addressing a grade school class.

The remedy is to endeavor to speak adult to adult, rather than authority to subordinate.

For example, the cognitive therapist would be ill-advised to speak in the following manner:
"I'll be assessing your thought processes so as to spot the kinds of cognitive distortions that lead you to engage in dysfunctional and antisocial activities."

Instead, the therapist might say:
"If it's okay with you, I'd like to understand your point of view about things. I don't want to assume that I already understand what it's like to live your life. I'm interested in listening to your thoughts so I get the real story."

Although the therapist in the second example does not really start teaching the patient about cognitive therapy, he or she establishes some of the groundwork. More important at this early stage, the therapist comes across as being a real person who is understandable. As the patient progresses through succeeding sessions, the therapist will be able to elaborate gradually on the specifics of cognitive therapy, and to teach some of the basic nomenclature.

Additionally, it is important for therapists to share their own thoughts and opinions openly (and diplomatically) when patients ask for them, rather than remaining mysterious figures. Substance abusers, either by virtue of their own developmental/personality issues or their experiences with dishonest drug-abusing associates, often have major problems in trusting others. A therapist who makes an earnest effort to respond to questions can provide the patient with evidence that the therapist does not have a hidden agenda. As a qualifier to the above, it is important to note that the therapist should feel free to ask the patient many questions as well, lest the patient put the responsibility for the work of therapy entirely (and inappropriately)on the therapist.

A Reminder: Do you have your "self-check" printed out and ready to rate yourself with? II. Establishing Rapport at the Outset of Treatment
1. Speak directly, simply, and honestly.
The development of rapport is hindered when patients cannot understand their therapists due to the therapist's unbridled use of psychological jargon. Similarly, patients often do not appreciate it when they perceive that their therapists are talking down to them, or are speaking to them in the manner of a teacher addressing a grade school class. The remedy is to endeavor to speak adult to adult, rather than authority to subordinate. For example, the cognitive therapist would be ill-advised to speak in the following manner: "I'll be assessing your thought processes so as to spot the kinds of cognitive distortions that lead you to engage in dysfunctional and antisocial activities." Instead, the therapist might say: "If it's okay with you, I'd like to understand your point of view about things. I don't want to assume that I already understand what it's like to live your life. I'm interested in listening to your thoughts so I get the real story." Although the therapist in the second example does not really start teaching the patient about cognitive therapy, he or she establishes some of the groundwork. More important at this early stage, the therapist comes across as being a real person who is understandable. As the patient progresses through succeeding sessions, the therapist will be able to elaborate gradually on the specifics of cognitive therapy, and to teach some of the basic nomenclature. Additionally, it is important for therapists to share their own thoughts and opinions openly (and diplomatically) when patients ask for them, rather than remaining mysterious figures. Substance abusers, either by virtue of their own developmental/personality issues or their experiences with dishonest drug-abusing associates, often have major problems in trusting others. A therapist who makes an earnest effort to respond to questions can provide the patient with evidence that the therapist does not have a hidden agenda. As a qualifier to the above, it is important to note that the therapist should feel free to ask the patient many questions as well, lest the patient put the responsibility for the work of therapy entirely (and inappropriately)on the therapist.
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