Other modes of therapy have a long history of examining therapy interfering behaviours, emotions or beliefs that can impact on the therapy or therapeutic relationship.
In CBT, the literature on drift and improving outcomes has detailed the ways in which our own beliefs and subsequent actions may impact on the effectiveness of the treatment that we deliver. One area in which this is particularly focused is on how these can decrease use of the behavioural change methods needed.
In a therapeutic relationship, there is an unspoken metacognitive inner dialogue taking place in the mind of the therapist and also the Client whilst the process of treatment is taking place within the session. At times, our own beliefs may impact on what we do, leading to the use of our own set of safety behaviours. This has been noted as particularly pertinent when we are using exposure based methods which can initially raise the affect of the Patient. As a result, we may avoid delivering the treatment to its optimum effects or enable greater use of safety behaviours on the part of the Patient that minimise its effectiveness. We may not challenge things within the session if these lead to the Patient feeling distressed and therefore the Therapist or Practitioner feeling uncomfortable.
We also know from a recent study in 2015 that over 90% of Patients surveyed admitted to not telling their Practitioner or Therapist accurate information or feedback so as to not affect the relationship.
Waller (2016) recommends the use of supervision to use exposure based methods on our own TIBs. This should then in turn lead to greater adherence to the evidence based methods. Derek Milne in his fantastic work on evidence based supervision also calls for more active supervision methods with greater levels of affect experienced within it.
This is a really interesting and developing area and certainly one it is worth consideration of adopting into any supervision we provide.
Coming in our next blog we will be considering how to make supervision more active and experiential to manage our own emotions and be able to tolerate those of our Patients........