The therapeutic relationship

Issue November/December 2017 By Dr. Jeff Fortgang

Q:

It was very helpful to me when I met with a clinician at LCL. Those couple of meetings really helped me identify what issues I needed to address in order to be a more successful lawyer and also a more contented person. Since LCL offers consultation but not ongoing therapy, I accepted referral to a therapist near my home who came recommended and who takes my HMO. But my experience with her has not felt the same as my LCL experience. After three visits, I still don’t feel that she “gets” me, and she seems sort of removed. Perhaps this is how people do CBT, which I thought was the type of therapy I wanted, or maybe it’s because she’s less lawyer-specialized?

A:

The poor connection that you’ve experienced probably has little to do with the therapist’s treatment model or experience with lawyers. There is an additional element, difficult to define or measure, that relates to the therapeutic relationship. Although many more studies are done purporting to show that this therapeutic modality is better than that one, there is a considerable body of research indicating that the relationship factor makes a bigger difference than the treatment approach.

At LCL, we do, of course, try to match you to a therapist, taking into account a number of factors including type of therapy. And certainly, all other things being equal, it helps when a therapist understands your work culture/environment (that’s one of the reasons to come to LCL in the first place). Most of the therapists to whom we refer have had several lawyers among their patients/clients, but of course it would be unreasonable to expect most of them to be lawyer specialists. Besides, most of the problems that lawyers face are human problems shared by individuals in many walks of life.

The research suggests that, on the whole, those therapists who forge the best connection, and who get the best results, tend to be those who are high in qualities like empathy, genuineness, and warmth. But, interestingly, a therapist who is experienced by one person as high in these qualities may not strike the next person in the same way. That variation may reflect differences in the patient or client’s personality (self-critical individuals, for example, tend also to feel more critical of the professionals they see). In addition, the client’s ways of relating may bring out different sides of therapist’s interpersonal self. I have found that, when these relationships don’t click, the feeling of discomfort usually goes both ways.

When I’m making a referral to a clinician whom I know (which is ideal, but not always possible given the realities of reliance on managed care), I do my best to visualize these two people in the same room, and get a picture of how they would relate. That is, more often than not, a successful method. But if, after a few sessions, you still feel that something is off — that you are not understood or respected, or that the therapist seems too detached, I want you as my LCL client to contact me, review what went awry, and try another referral. Please don’t be embarrassed to get back in touch with your LCL clinician (or whoever referred you); in addition to getting a better outcome for yourself, you are helping us — when we learn that a particular therapist is eliciting unsatisfactory responses from multiple lawyers, we take them off our referral list.    

Dr. Jeff Fortgang is a licensed psychologist and licensed alcohol and drug counselor on staff at Lawyers Concerned for Lawyers of Massachusetts, where he and his colleagues provide confidential consultation to lawyers and law students, and offer presentations on subjects related to the lives of lawyers. Q&A questions are either actual letters/emails or paraphrased and disguised concerns expressed by individuals seeking LCL’s assistance.

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