John Norcross, Ph.D.
John Norcross Explains How To Establish
A Powerful Therapeutic Relationship
At the NJ-ACT September 16 brunch-workshop, John Norcross described the research on establishing a strong therapeutic relationship and relationship variables that lead to successful therapy outcome. Norcross recommended asking patients at the first session what kind of therapist they want: how much direction they want, how much listening they want, how much warmth, and what interpersonal characteristics they like and donít like in their friends, relatives, and former therapists.
Norcross pointed out that although beginning therapists are usually not able to use different therapeutic styles with different patients, experienced therapists are able to do this to a greater degree than one might expect. But therapists are not infinitely malleable: we should refer patients who require a style that is not within our therapeutic repertoire.
Norcross also reported that there is no research supporting the efficacy of treatment manuals, of matching patient and therapist by gender or ethnicity, or of matching the therapeutic style to the patientís diagnostic category.
Directive vs. Non-Directive Therapy
Non-directive or even paradoxical therapy works best with oppositional patients, while directive therapy is more effective with compliant patients. As therapists, we should assess this variable, often called patient motivation, resistance, or reactance, and adjust our techniques accordingly.
Many patients enter therapy with ambivalent feelings about changing. These patients should also be treated non-directively. Norcross recommended exploring the pros and cons of changing with patients who are only contemplating change, and simply being nurturant with patients who are not even contemplating change. Sometimes patients are unwilling to admit that they need to change because they fear this admission would evoke unwanted pressure to change from the therapist or from others. Assuring these patients that we will not pressure them to change often enables them to contemplate changing for the first time. Of course patients are often motivated to change some problems, but resistant to changing others. With these patients, we should adjust our interventions to the problem currently being discussed.
More Warmth vs. Less Warmth
Research also supports matching degree of therapist warmth to the patientís interpersonal relatedness. Patients who are focused on relationships or relationship problems should be treated with more warmth, while patients who are focused on internal problems, such as anxiety or negative feelings about themselves, should be treated with less warmth. This is not what we were taught in introduction to psychotherapy, but some patients prefer and do better with a more impersonal therapeutic style.
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