Avoid judgemental

A longstanding and well-known fact is that it is important for the therapist to communicate a sense of positive regard and respect for the patient (e.g., Bergin and Solomon 1970; Egan 1975; Truax 1963; Truax and Carkhuff 1967; Truax and Mitchell 1971). Nevertheless, it is all too easy for the therapist to fall into the trap of sounding accusatory and judgmental toward a patient who is abusing drugs. If this happens, the formation of a healthy therapeutic relationship is seriously hindered. Further, the patient may become less inclined to view the therapist as an effective professional when the therapist's comments resemble those heard from exasperated relatives. Instead, therapists need to explain that they wish to ally with their patients in a mutual struggle against the patients' drug use and concomitant life problems.

Patients need to be helped to understand that they are not viewed as bad people, but rather as people with a highly troublesome habit with which to deal.

Similarly, therapists need to take care not to spew forth judgmental or hostile comments about anybody else. For example, when a therapist treats a substance-abusing patient who is involved in a romantic relationship with another substance abuser, there is a great temptation for the therapist to criticize the significant other, especially when the significant other sabotages the patient's progress toward abstinence. However, by doing this the therapist runs the risk of triangulating the patient between the loved one and the therapist (in essence, putting the patient in the position of having to take sides). When this happens, patients frequently choose to be loyal to the significant other, which may precipitate a flight from treatment.

Even if the therapist makes judgmental comments about impersonal third parties, the patient may wonder whether this is also how the therapist truly feels about the patient when he or she is not around. This will impede the formation and maintenance of a positive therapeutic alliance. It is much more prudent to evaluate the relative merits and drawbacks of the behaviors and attitudes of people, rather than make pat statements about their characters.

II. Establishing Rapport at the Outset of Treatment
6. Avoid Judgmental Comments
A longstanding and well-known fact is that it is important for the therapist to communicate a sense of positive regard and respect for the patient (e.g., Bergin and Solomon 1970; Egan 1975; Truax 1963; Truax and Carkhuff 1967; Truax and Mitchell 1971). Nevertheless, it is all too easy for the therapist to fall into the trap of sounding accusatory and judgmental toward a patient who is abusing drugs. If this happens, the formation of a healthy therapeutic relationship is seriously hindered. Further, the patient may become less inclined to view the therapist as an effective professional when the therapist's comments resemble those heard from exasperated relatives. Instead, therapists need to explain that they wish to ally with their patients in a mutual struggle against the patients' drug use and concomitant life problems. Patients need to be helped to understand that they are not viewed as bad people, but rather as people with a highly troublesome habit with which to deal. Similarly, therapists need to take care not to spew forth judgmental or hostile comments about anybody else. For example, when a therapist treats a substance-abusing patient who is involved in a romantic relationship with another substance abuser, there is a great temptation for the therapist to criticize the significant other, especially when the significant other sabotages the patient's progress toward abstinence. However, by doing this the therapist runs the risk of triangulating the patient between the loved one and the therapist (in essence, putting the patient in the position of having to take sides). When this happens, patients frequently choose to be loyal to the significant other, which may precipitate a flight from treatment. Even if the therapist makes judgmental comments about impersonal third parties, the patient may wonder whether this is also how the therapist truly feels about the patient when he or she is not around. This will impede the formation and maintenance of a positive therapeutic alliance. It is much more prudent to evaluate the relative merits and drawbacks of the behaviors and attitudes of people, rather than make pat statements about their characters.
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