3 Factors That Lead To Successful & Supportive Therapy Sessions
Research has shown that for high-functioning people, a therapeutic alliance may be an even greater predictor of therapeutic success1 than the style of therapy being used. The therapeutic alliance is important for all therapy clients, but it may be especially important for high-functioning people—so let me unpack this for you.
What is a therapeutic alliance?
In layman's terms, the therapeutic alliance consists of the therapist and the client having the same goals for treatment, mutual belief in each other's ability to use therapy sessions to achieve those goals, and the presence of rapport between the therapist and client. There's a lot of overlap between these three components, as we'll soon see, but each one is important in its own way. Let's dive just a little bit deeper so you can really understand this—and let me assure you that most good therapists will be aware of the term "therapeutic alliance," so feel free to discuss any of this material with any potential therapists you interview if you feel it may be helpful in your selection process.
The 3 factors needed to form a therapeutic alliance:
This might sound obvious, but you and the therapist absolutely must be on the same page about your therapy goals as being healthy and desirable. For example, a high-functioning person might come to therapy seeking stress management skills because their need for achievement is driving them to get excellent grades in graduate school while working full time, and they need a way to manage the extra demands of their situation. Or they might seek a therapist to help them manage inevitable rejection as they climb the ladder of success to become a Broadway star. I have encountered clients in both of these situations and similar situations, whose previous therapist refused to partner with them in these goals.
Instead, the therapist insisted on helping the clients develop an "insight" that the clients needed: to "learn to sit with failure" or "drop their unreasonable expectations."
While it is true that sometimes high-functioning people can get on a hamster wheel of achievement, where nothing is ever good enough—and it is essential that a therapist be able to help clients avoid this pitfall—it is also important that a therapist be able to recognize a client's potential and help them develop skills to reach that potential.
Of course, I'd want a therapist who was able to help me see when I was being too hard on myself or trying for a goal that wasn't actually good for me. It is essential that the therapist and client can have transparent discussions about what exactly is being labeled as "overboard" by the therapist and/or the client and that the client understands if the therapist is casting the client's goals as problematic in any way. Otherwise, you essentially have a ship on which all the oars aren't rowing in the same direction, which is counterproductive for everyone. So, please—confirm that what you want for yourself is the same thing as what your therapist wants for you.
Mutual belief in each other's ability to achieve those goals
Remember I said there was a lot of overlap in the three components of the therapeutic alliance? Well, here we go: Just as you and your therapist need to have agreement that your goals are healthy, it stands to reason that if your therapist doesn't think your goals are reasonable, then that therapist may not believe in your ability to achieve those goals. However, just because a therapist doesn't think a goal is achievable for you does not necessarily mean the goal is unachievable!
In a similar sense, if you appraise your therapist as somewhat lower functioning than you, then you may (very legitimately) question whether that therapist is equipped with the skills, grit, intelligence, sophistication, self-awareness, or whatever else is needed to help you attain your goals. Not that all therapists must have personally accomplished every goal their clients are targeting, but it helps if a therapist can display markers of significant achievement in terms of work, social dynamics, or whatever general domain the client wishes to develop.
Obviously, if you and the therapist can't agree on appropriate goals, or if you don't believe your therapist is capable of helping you achieve those goals, then it will be difficult to establish a genuine therapeutic rapport.
Whatever the reason (except in cases when the client has problems forming rapport in general, even outside of the therapy room; or in cases when a client is unable to manage their life in basic terms), if you don't feel rapport with a therapist, please feel free to consider the possibility that the problem is with the therapist rather than with yourself—and keep shopping for the right fit.
Of course, if you've seen 10 therapists in a row and they all seem "off" in some way, then it's possible that you're being hypercritical or you just have a very hard time trusting. The general idea is just that in most cases, a high-functioning person's positive gut-level feeling about a therapist is often an important predictor of therapeutic success.
While discussing issues of fit may be less important with a new therapist, discussing problems with a therapist you did at one point feel very positively about can be a good opportunity to see if you and that therapist can course-correct together. Having candid talks to re-clarify your therapy goals, or making an adjustment in the therapist's approach to your situation, or reviewing issues that have left you feeling dissatisfied with the therapist can actually be very illuminating. You may even find that by hearing your trusted therapist's perspective you'll come to realize ways you had been unknowingly sending mixed signals about what you wanted from therapy. But if you and the therapist never really had a strong "therapeutic alliance" in the first place, then shopping around without investing much (if any) time and money into therapy sessions just to discuss a lack of fit may be your wisest move.
So while you may notice that I sometimes urge readers to consider therapy, I also encourage you to pay attention to your "inner antennae" about whether or not the person seems truly qualified to help you. Academic credentials and licensing are necessary but not sufficient for a good, helpful therapy relationship to take place: Don't underestimate the importance of your natural sense of whether or not you feel rapport with the therapist and a sense of confidence about their overall abilities, intelligence, and level of conscientiousness.
Even though you may not feel qualified to assess a therapist's clinical skills, remember that their clinical skills hinge at least partly on their ability to help you feel comfortable to open up and share yourself.
Adapted from Nervous Energy by Dr. Chloe Carmichael. Copyright © 2021 by the author and reprinted by permission of St. Martin's Publishing Group.
Chloe Carmichael, Ph.D. is a licensed clinical psychologist. She graduated Phi Beta Kappa from Columbia University with departmental honors in Psychology, and earned her Ph.D. from Long Island University’s program in Clinical Psychology, which is accredited by the American Psychological Association. She emphasizes positivity and wellness, often through the lens of anxiety management, relationships, and goal attainment. She is the author of Nervous Energy: Harness the Power of Your Anxiety, and Dr. Chloe’s 10 Commandments of Dating.
She heads a successful private practice in New York City that focuses primarily on relationship issues and stress to help high achievers. She is a member in good standing of the American Psychological Association and the National Register of Health Psychologists, an elite membership for psychologists with the highest standards of education and board scores.
As an expert in anxiety, Carmichael has taught stress management techniques at Fortune 500 companies as well as in her own private practice. She launched an online anxiety treatment program: Anxiety Tools, which has users throughout the United States and around the world. As a certified yoga instructor, Carmichael is an expert in both the science and meditation side to anxiety treatment. Her holistic approach integrates a special blend of techniques that have been shown to help people overcome anxiety.