Tag Archives: evidence-based relationships

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Personal Reflections, Writing

Relationship Factors in Counseling and Psychotherapy

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Hardly anyone with common sense or social skills ever argues about whether or not relationship factors are crucial to effective counseling and psychotherapy. Nevertheless, some scientists are reluctant to put relationship factors on par with counseling and psychotherapy techniques or procedures. IMHO, relationship factors are every bit as essential as so-called empirically-supported treatments.

This post is a pitch. Or it might be a pitch in a post. Either way, I am honored to share with you a hot-off-the-presses new book, titled Relationship Factors in Counseling, by Dr. Kimberly Parrow. Here’s the publisher’s link: https://titles.cognella.com/relationship-factors-in-counseling-9781793578754. The book is also available on Amazon and other booksellers.

Below, I’m pasting the Foreword to this book. Not only am I jazzed about the book, I’m also jazzed about the Foreword. You should read it. It’s really good. You’ll learn about Kimberly Parrow, as well as a bit of trivia about relationship factors that you should definitely know. I haven’t mentioned who wrote the Foreword, but I’m sure you’ll figure it out.

I first met Kimberly Parrow, before she was Dr. Kimberly Parrow, in a letter of recommendation from a psychology professor at the University of Montana. Having read well over 1,000 letters of recommendation over the years, this one imprinted in my brain. The professor wrote something like, “Kimberly Parrow is the real deal. You should admit her to master’s program in clinical mental health counseling. You will never regret it.”

We did (admit her into our master’s program . . . and our doctoral program). And we didn’t (ever regret it).

Kim Parrow was, is, and continues to be one of the most enthusiastic learners I’ve encountered.  She walked onto our campus at 44-years-old, as a first-generation college student, having waited with bated breath for the money and opportunity to pursue her college degree. Nine years later she strolled off campus with her bachelor’s, master’s, and doctoral degrees. If we were Notre Dame, we’d call her a triple domer (n.b., that’s what you call people with three degrees from Notre Dame). At the University of Montana, we just call her amazing.

In one of her first doctoral classes, I introduced Kim to the concept of evidence-based relationship factors (EBRFs). She was hooked; hooked in the way that only graduate students get hooked. She was hooked by an idea. So hooked that she immediately wanted more; she wanted to write a journal article on EBRFs (so we did). She wanted to do her dissertation on EBRFs (so she did). She wanted to do extra additional trainings for practicum and internship students on EBRFs (and so she did).  Kim’s attraction to EBRFs stemmed from her belief that relationships constitute the core of what’s therapeutic. As we explored EBRFs together, noting all the research supporting the idea that relationships drive counseling and psychotherapy, I came to see that Kim’s judgment was, and continues to be, practically perfect.

I’ve been reading dissertations for 30+ years. I’m embarrassed to say that I find reading most dissertations—even those written by students whom I love—drudgery. But Kim’s dissertation was electric. Page by page, she kept surprising me with new content and new learning; it was more than I expected. Kim had taken the basic knowledge and skills linked to EBRFs, contextualized them within the scientific literature, and then wrote about them in ways that inspired me to keep reading and keep learning. As she wrote more, her writing got better and better, and the content more illuminating.

About a month ago, I was unable to make it to my initial lecture for an advanced counseling theories course. I asked Kim to fill in. She quickly said yes. I offered to pay her. She quickly said no. To stick with the money theme, if I now had a dollar for every time one of my students has, since Kim’s lecture, mentioned Kim Parrow, eyes agog, and referenced the central role of relationship factors in counseling and psychotherapy, I would have many dollars. What I’m trying to say is that Kim is a natural and talented clinician-teacher. That’s a rare version of the real deal her former developmental psychology professor was trying to tell us about.

And now, a few words about this book. Kim has done what most scholars and professionals are unable to do. She has taken theoretical principles, empirical research findings, blended them with her common-sense-salt-of-the-earth style, and created a practical guide for helping counselors and psychotherapists be better. The book is aimed to slide into the educational development of practicum and/or internship students who have learned microskills and are facing their first clients. This particular point in student development is crucial; it’s a time when students sometimes lose their way as they try to make the improbable leap from microskills to counseling and psychotherapy techniques. In making that leap, they often fall prey to the urge to quickly “prove up” and “do something” with clients. In this process, they often abandon their microskills and forget about the therapeutic relationship. Kim’s overall point is this: Don’t forget about the therapeutic relationship because relationship factors are every bit as evidence-based as theory-based or research-based technical strategies. The renowned writer-researcher John C. Norcross put it this way:

Anyone who dispassionately looks at effect sizes can now say that the therapeutic relationship is as powerful, if not more powerful, than the particular treatment method a therapist is using.

The fact that therapeutic relationships are empirically supported makes Kim’s content relevant not only to students early in their clinical development, but also to all of us. Having taught this content with Kim, and to groups of professional counselors, psychologists, and social workers across the United States, I can say without hesitation that the content in this book can and will make all of us better therapists.

Kim covers 10 specific, evidence-based interactive relationship skills. What unique—and possibly the best thing about Kim’s coverage of relationship skills—is that she provides specific, actionable guidance for how to enact these 10 skills. As a preview, the 10 skills include:

  1. Cultural humility
  2. Congruence
  3. Unconditional Positive Regard
  4. Empathic Understanding
  5. The Emotional Bond
  6. Mutual Goal-Setting
  7. Collaborative Therapeutic Tasks
  8. Rupture and Repair
  9. Countertransference Management
  10. Progress Monitoring

In the pages that follow, you will get a taste of Kim Parrow’s relational orientation and a glimpse of the evidence supporting these 10 relationship factors as therapeutic forces that innervate counseling process. You will also experience the magic of a talented clinician-teacher. The magic—or, if you prefer, secret sauce—is Kim’s ability to make these distant intellectual relationship concepts real, practical, and actionable. To help make relationship concepts real, she has engaged several contributers (and herself) to write pedagogical break-out boxes titled, “Developing Your Skills.” Engaging with these skill development activities will, as the neuroscience fans like to say, “Change your brain” and help you develop neural pathways to enhance your relational connections.

As I write about skills and skill development, I’m aware that Carl (and Natalie) Rogers would view the reduction of his core conditions to “skills” as blasphemy. This awareness makes me want to emphasize that Kim “gets” Rogerian core conditions and does not reduce them into simple skills. Instead, she embraces the attitudinal and intentional dimensions of Rogerian core conditions, while simultaneously offering behaviors and words that counselors and psychotherapists can try on in hopes of expressing congruence, unconditional positive regard, and empathy.

I’ve had a few conversations with Derald Wing Sue over the years and he has always emphasized that culture in counseling and psychotherapy shouldn’t be relegated to a separate chapter at the end of the book—as if culture is ever a separate or standalone issue. Reading how Kim handles culture reminded me of Derald Wing Sue’s message. Instead of relegating it to the end, Kim begins with the relationship factor of cultural humility. That makes for a beautiful start.  Cultural humility involves, above all else, the adoption of a non-superiority interpersonal stance. . . which is a simple and excellent anti-racist message. But Kim doesn’t stop talking about culture after Chapter 1. She does what Derald Wing Sue recommends: She integrates cultural awareness, knowledge, and skill development into the whole book. This stance—non-superiority and anti-racist—is consistent with Kim’s interpersonal style and is also the right place to start as counselors set about the journey to collaborate and co-create positive outcomes.

One of Kim’s writing goals is to offer ideas and activities that are likely to increase counselor cognitive complexity. You can see that in the two preceding paragraphs. Instead of reducing Rogerian core conditions into skills, she honors how they can become both attitudes and skills. And instead of putting culture into a silo, she spreads seeds of culture through all her chapters.

This book is a remarkable accomplishment. The language, the examples, the science, the skill development activities, and the tone, welcome readers to engage with this book, and bring the material to life. I believe if you read this book and engage in the activities, your counselor self-efficacy will grow.

For anyone who has gotten this far in reading this foreword, I have some reading tips to share. First, read this book with your heart wide open. I say this because this book is about the heart of the counselor or psychotherapist. Second, as you read, keep yourself in relationship with Kim. The book is about relational factors and the details Kim shares will not only help you in your relationships with clients, but, as she often reminded me and other people whom she cornered so she could talk to us about relational factors, these relationship factors are relevant and applicable to all relationships. 

Obviously, I respect Dr. Kimberly Parrow and believe she has produced an excellent book. Obviously, I think you should read this book and do as so many of us have already done, learn about evidence-based relationship factors from someone who is a remarkably talented clinician-teacher.  To paraphrase what that developmental psychology professor wrote about Kim many years ago, you should accept Kim Parrow into your personal program of learning immediately, and begin learning from her as soon as you can. You will not regret it.

All my best to you in your counseling and psychotherapy work.

John Sommers-Flanagan

Missoula, Montana

Cool Counseling, Counseling and Psychotherapy Theory and Practice, Writing

Building Better Counselors

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JSF Dance Party

This is a link to a hot off the presses article in Counseling Today. The focus is all about how professional counselors (and all psychotherapists) can be BOTH evidence-based AND relationally oriented. My co-author, Kindle Lewis, is one of our fantastic doctoral students in the Department of Counselor Education at the University of Montana. And . . . by the way. . . the University of Montana is NOW the NEW best college destination on the planet. Ask me why:).

Here’s the link: http://ct.counseling.org/2017/11/building-better-counselors/

Counseling and Psychotherapy Theory and Practice

Check Out the April 2015 Issue of the Journal of Mental Health Counseling for an Article on Evidence-Based Relationship Practice

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This is an excerpt of the first portion of an article I had the honor to publish in the Journal of Mental Health Counseling. My thanks go to Rich Ponton, the JMHC editor for both his patience and for making this article possible. The first 835 words of the article follow. For the whole thing, you can go to the JMHC website: http://www.amhca.org/?page=jmhc

Competence in mental health counseling is inevitably complex and multidimensional. Ironically, the complexity can become overwhelming when well-intended professionals work together to identify the knowledge and skills counselors need to be considered competent. A good example of this is the standards defined in 2009 by the Council for Accreditation of Counseling and Related Educational Program (CACREP, 2009). To establish competence in mental health counseling, the standards require that counselor training programs integrate into their curricula eight core knowledge-based standards and six specialty standards. The eight core standards are splintered into 67 learning objectives and the six specialty standards into 61 critical knowledge and skill components that must be measured as student learning outcomes (Minton & Gibson, 2012). To further elaborate the complexity, the American Mental Health Counseling Association (AMHCA, 2010) has its own Standards for the Practice of Mental Health Counseling.

The myriad standards mean that counselor educators and counseling students must determine exactly how the 128 CACREP competencies (many of which are clearly unrelated to actually doing counseling) and the AMHCA clinical and training standards together translate into mental health counselor competence. Although meeting this challenge can be intellectually exhilarating, moving from the standards to how mental health counselors should act in the room with clients is far from intuitive.

This article represents an effort to gather evidence-based practice (EBP) principles and describe them in terms of practical behaviors or approaches that contribute to counselor competence and positive client outcomes. Although considering the standards conceptually is necessary and sometimes helpful, the purpose of this article is to present a straightforward EBP model that can be tailored to fit different theoretical orientations and individual counselor styles.

What Is Evidence-Based Mental Health Counseling Practice?
Historically, the counseling profession has not had a strong science or research emphasis (Sexton, 2000; Yates, 2013). In fact, a PsycINFO title search of the top five professional counseling journals revealed only 12 articles over the past 15 years that had “evidence-based” or “empirically-supported” in their titles (the journals were Counselor Education and Supervision, Counseling Outcome Research and Evaluation; Journal of Counseling and Development; Journal of Mental Health Counseling; and Journal of Multicultural Counseling and Development). In a systematic review, Ray and colleagues (2011) reported that only 1.9% of articles in counseling journals are concerned with outcomes research. No wonder, as Yates (2013) wrote in Counseling Outcome Research and Evaluation, “Despite the recommendations for infusing outcome research and evidence-based practices (EBPs) into the counseling profession, there still exists uncertainty and confusion from educators and students about what EBP is” (p. 41).

In some ways it is right and good that professional counselors have a less scientific orientation than related disciplines. After all, mental health counseling evolved, in part, as an alternative to treatments provided by psychologists and psychiatrists (Gladding, 2012). This less rigorously scientific approach may partly explain why the public usually views professional counselors as more “helpful, caring, friendly . . . , and understanding” than psychologists and psychiatrists (Warner & Bradley, 1991, p. 139). The purpose of this article is certainly not to make a case for professional counselors to become more rigidly scientific but rather to help counselors embrace practical and relevant scientific research while maintaining a friendly interpersonal style and a wellness-oriented professional identity (Mellin, Hunt, & Nichols, 2011).

Terminology
Like all words, the terms used to describe evidence-based counseling and psychotherapy are linguistic inventions designed to communicate important information. Unfortunately, evidence-based terminology has by now evolved into what might best be described as Babel-esque. Therefore, before outlining an evidence-based mental health counseling model, I look briefly into the politics, history, and usage of evidence-based terminology.

Evidence-based terminology originated in medicine, spilled over into psychology, and from there made its way to professional counseling, education, social work, prevention, business, and nearly every other corner of the first world. Recently I was at a conference where the keynote speaker described not including purple on Powerpoint slides as a best practice. Although no doubt the speaker’s comments were based on something, I was not convinced that the something had anything to do with scientific research.

In mental health treatment, at least some of the confusion about EBP originated in 1986, when Gerald Klerman, then head of the National Institute for Mental Health (NIMH), remarked in a speech to the Society for Psychotherapy Research (perhaps with irony) that “We must come to view psychotherapy as we do aspirin” (quoted in Beutler, 2009, p. 308). Klerman was promoting the medicalization of psychotherapy as a means to compete for limited health care dollars. He was advocating scientific analysis and application of psychotherapy for specific ailments. The use of aspirin as his medical analogy was ironic because, although the active ingredient in aspirin is well-known (acetyl salicylic acid), until the early 1980s little was known about how and why aspirin worked—and even today there remain mysteries about aspirin’s mechanism of action and range of application. However, like aspirin Klerman’s comments had a specific effect but also triggered gastrointestinal side effects in some professionals .

Bowling

Clinical Interviewing

An Intake Interview Outline and Activity

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Aloha from Honolulu. This week Rita and I have been working from Honolulu, Hawaii as we attend and present at the annual convention of the American Counseling Association. Yesterday we presented on how counselors can integrate evidence-based relationships into the first interview. This is mostly based on John Norcross’s excellent work on evidence-based relationships. After the presentation one attendee asked if I could send him a copy of an intake interview outline. . . and so I’m posting a brief intake interview outline and an associated classroom activity below.

More on Highlights from Honolulu soon. But here’s an intake outline for now. This is from the Clinical Interviewing text, but you should keep in mind that the Clinical Interviewing text also includes a more extensive outline. See: http://www.amazon.com/Clinical-Interviewing-John-Sommers-Flanagan/dp/1118270045/ref=la_B0030LK6NM_1_1?s=books&ie=UTF8&qid=1396163487&sr=1-1

A Brief Intake Checklist

When necessary, the following topics may be covered quickly and efficiently within a time-limited model.
______  1. Obtain presession or registration information from the client in a sensitive manner. Specifically, explain: “This background information will help us provide you with services more efficiently.”
______  2. Inform clients of session time limits at the beginning of their session. This information can also be provided on the registration materials. All policy information, as well as informed consent forms, should be provided to clients prior to meeting with their therapist.
______  3. Allow clients a brief time period (not more than 10 minutes) to introduce themselves and their problems to you. Begin asking specific diagnostic questions toward the 10-minute mark, if not before.
______  4. Summarize clients’ major problem (and sometimes a secondary problem) back to them. Obtain agreement from them that they would like to work on their primary problem area.
______  5. Help clients reframe their primary problem into a realistic long-term goal.
______  6. Briefly identify how long clients have had their particular problem. Also, ask for a review of how they have tried to remediate their problem (e.g., what approaches have been used previously).
______  7. Identify problem antecedents and consequences, but also ask clients about problem exceptions. For example: “Tell me about times when your problem isn’t occurring. What happens that helps you eliminate the problem at those times?”
______  8. Tell clients that their personal history is important to you, but that there is obviously not time available to explore their past. Instead, ask them to tell you two or three critical events that they believe you should know about them. Also, ask them about (a) sexual abuse, (b) physical abuse, (c) traumatic experiences, (d) suicide attempts, (e) episodes of violent behavior or loss of personal control, (f) brain injuries or pertinent medical problems, and (g) current suicidal or homicidal impulses.
______  9. If you will be conducting ongoing counseling, you may ask clients to write a brief (two- to three-page) autobiography.
______ 10. Emphasize goals and solutions rather than problems and causes.
______ 11. Give clients a homework assignment to be completed before they return for another session. This may include behavioral or cognitive self-monitoring or a solution-oriented exception assignment.
______ 12. After the initial session, write up a treatment plan that clients can sign at the beginning of the second session.

Prompting Clients to Stick With Essential Information

Using the limited-session intake-interviewing checklist provided in Table 7.2, work with a partner from class to streamline your intake interviewing skills. Therapists working in a managed care environment must stay focused and goal-directed throughout the intake interview. To maintain this crucial focus, it may be helpful to:
1. Inform your client in advance that you have only a limited amount of time and therefore must stick to essential issues or key factors.
2. If your client drifts into some less-essential area, gently redirect him or her by saying something such as:
“You know, I’d like to hear more about what your mother thinks about global warming (or whatever issue is being discussed), but because our time is limited, I’m going to ask you a different set of questions. Between this meeting and our next meeting, I want you to write me an autobiography—maybe a couple of pages about your personal history and experiences that have shaped your life. If you want, you can include some information about your mom in your autobiography and get it to me before our next session.”
Often, clients are willing to talk about particular issues at great length, but when asked to write about those issues, they’re much more succinct.
Overall, the key point is to politely prompt clients to only discuss essential and highly relevant information about themselves. Either before or after practicing this activity with your partner, see how many gentle prompts you can develop to facilitate managed care intake interviewing procedures.

 

 

 

Clinical Interviewing

What I’m Writing Today: CI5 Chapter 5

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With a February 1 deadline looming, I’m in all out writing and editing mode. Today’s topic: Congruence. Below is an excerpt from the draft of the upcoming 5th edition of Clinical Interviewing. I gotta say, Congruence and Carl Rogers—good stuff—way better than any NFL playoff games:). I know, Empathy would be a little better, but you can’t always get what you want.

Here’s a glimpse of the opening of chapter 5: Evidence-Based Relationships in the Clinical Interview

In 1957, Carl Rogers made a bold declaration that has profoundly shaped research and practice in counseling and psychotherapy. He hypothesized in a Journal of Consulting Psychology article that no techniques or methods were needed, that diagnostic knowledge was “for the most part, a colossal waste of time” (1957, p. 102), and that all that was necessary and sufficient for therapeutic change to occur was a certain type of relationship between therapist and client.

Although we could go back further in time and note that Freud (of course) had originally discussed the potential value of therapeutic relationships, Rogers’s revolutionary statements refocused the profession. Until Rogers, therapy was primarily about theoretically-based methods, techniques, and interventions. After Rogers {{365 Rogers 1961; 690 Rogers 1957; 363 Rogers 1942;}}, we began thinking and talking about the possibility that it might be the relationship between client and therapist—not necessarily the methods and techniques employed—that produced therapeutic change.

For years, a great debate has fulminated within the counseling and psychotherapy disciplines {{499 Wampold 2001;}}. Norcross and Lambert (2011) refer to this debate as “The culture wars in psychotherapy” (p. 3). They describe it as a polarization or dichotomy captured by the question: “Do treatments cure disorders or do relationships heal people?” (p. 3). As academics and professional organizations have engaged in this debate, typically there has been little room for moderation and common sense. There have been assertions about the “rape” of psychotherapy as well as strong criticisms of practitioners who blithely ignore important empirical research {{4453 Baker,Timothy B. 2008; 5969 Fox, Ronald E. 1995;}}. The heat of this controversy continues, in part, because we live in a world with limited health care dollars . . . and the fight to determine which forms of therapy are included as “valid” and therefore reimbursable will likely continue.

But the focus of this chapter is about a part of the controversy that’s really no longer a controversy at all. In the past two decades excellent research and research reviews have settled at least one dimension of the argument. Evidence now overwhelming shows that therapy relationships do contribute to positive outcomes across all forms of therapy and setting {{2241 Goldfried 2007; 285 Sommers-Flanagan 2007; 4074 Norcross 2011;}}. The question is no longer a matter of whether the relationship in counseling and psychotherapy matters, but how much it matters.

This chapter focuses on what has come to be known as “evidence-based therapy relationships” {{5958 Norcross 2011;}}. Although organized around specific theories and supporting research, the chapter also provides clinical examples for how the theories and evidence translate into specific evidence-based relationship facilitating behaviors that occur in the clinical interview.

Carl Rogers’s Core Conditions

Carl Rogers (1942) believed that the necessary and sufficient therapeutic relationship consisted of three core conditions: (a) congruence, (b) unconditional positive regard, and (c) empathic understanding. In his words:

Thus, the relationship which I have found helpful is characterized by a sort of transparency on my part, in which my real feelings are evident; by an acceptance of this other person as a separate person with value in his own right; and by a deep empathic understanding which enables me to see his private world through his eyes. When these conditions are achieved, I become a companion to my client, accompanying him in the frightening search for himself, which he now feels free to undertake. (Rogers, 1961, p. 34)

Congruence

Congruence means that a person’s thoughts, feelings, and behaviors match. Based on person-centered theory and therapy, congruence is less a skill and more an experience. Congruent therapists are described as genuine, authentic, and comfortable with themselves. Congruence includes spontaneity and honesty; it’s usually associated with the clinical skill of immediacy and involves some degree of self-disclosure (see Chapter 4).

Congruence is complex and has been described as “abstract and elusive” {{5961 Kolden, Gregory G. 2011;}} (p. 187). The ability to be congruent includes an internal dimension that involves clients being in touch with their inner feelings or real self plus an external or expressive dimension that involves therapists’ being able to articulate their internal experiences in ways that clients can understand. The following excerpt from Rogers’s work illustrates these internal and external dimensions of experiencing and expressing congruence:

We tend to express the outer edges of our feelings. That leaves us protected and makes the other person unsafe. We say, “This and this (which you did) hurt me.” We do not say, “This and this weakness of mine made me be hurt when you did this and this.”

To find this inward edge of my feelings, I need only ask myself, “Why?” When I find myself bored, angry, tense, hurt, at a loss, or worried, I ask myself, “Why?” Then, instead of “You bore me,” or “this makes me mad,” I find the “why” in me which makes it so. That is always more personal and positive, and much safer to express. Instead of “You bore me,” I find, “I want to hear more personally from you,” or, “You tell me what happened, but I want to hear also what it all meant to you.” (pp. 390-391)

Rogers also emphasized that congruent expression is important even if it consists of attitudes, thoughts, or feelings that don’t, on the surface, appear conducive to a good relationship. He’s suggesting that it’s acceptable—and even good—to speak about things that are difficult to talk about. However, as you can see from the preceding example, Rogers expected therapists to look inward and transform their negative feelings into more positive external expressions of congruence.

Guidelines for Using Congruence

When discussing congruence, students often wonder how this concept is manifest. Common questions include:

  • Does congruence mean I say what I’m really thinking in the session?
  • If I feel sexually attracted to a client, should I be “congruent” and share my feelings?
  • If I feel like touching a client, should I go ahead and touch?
  • What if I don’t like something a client does? Am I being incongruent if I don’t express my dislike?

These are important questions. Watson, Greenberg, & Lietaer {{4387 Greenberg,Leslie S. 1998;}} provided one way for determining the appropriateness of therapist transparency or congruence. They wrote: “. . . it is not necessary to share every aspect of [your] experience but only those that [you] feel would be facilitative of [your] clients’ work” (p. 9). This is a good initial guideline: Would the disclosure be facilitative? In fact, sometimes, too much self-disclosure—even in the service of congruence or authenticity—can muddy the assessment or therapeutic focus. Perhaps the key point is to maintain balance; the old psychoanalytic model of therapist as a blank screen can foster distrust, reluctance, and resistance, while too much self-disclosure can distort and degrade the therapeutic focus {{2454 Farber 2006;}}.

Rogers also suggested limits on congruence. He directly stated that therapy wasn’t a time for clinicians to talk about their own feelings:

Certainly the aim is not for the therapist to express or talk about his own feelings, but primarily that he should not be deceiving the client as to himself. At times he may need to talk about some of his own feelings (either to the client, or to a colleague or superior) if they are standing in the way. (pp. 133–134) {{760 Rogers 1958;}}

Let’s say you’re working with a client and you feel the impulse to congruently self-disclose in the moment. If you’re not sure your comment will be facilitative or whether it will keep the focus on the client (where the therapy focus belongs), then you shouldn’t disclose. Additionally, you should discuss ongoing struggles with self-disclosure with your peers or supervisors because by so doing, you’ll deepen your learning about how best to be congruent with clients.

Since the 1960s, feminist therapists have strongly advocated congruence or authenticity in interviewer-client relations. Brody {{331 Brody 1984;}} described the range of responses that an authentic therapist might use:

To be involved, to use myself as a variable in the process, entails using, from time to time, mimicry, provocation, joking, annoyance, analogies, or brief lectures. It also means utilizing my own and others’ physical behavior, sensations, emotional states, and reactions to me and others, and sharing a variety of intuitive responses. This is being authentic. (p. 17)

Brody is advocating many sophisticated and advanced therapeutic strategies; but keep in mind that she’s an experienced clinician. Authentic or congruent approaches to interviewing are best if combined with good clinical judgment, which is obtained, in part, through clinical experience.