"1. The therapist understands that a therapeutic relationship is very different from a social relationship. My
view is that good therapy requires the patient to take off the social
mask, but therapist behaviors that are social keep the mask on.
Regardless, though, of the rationale for doing so, competent therapists
promote a mode of relating that is very different from social relating,
and from other forms of (non-therapy) professional relating. In
particular, the therapist must accept responsibility for his or
her setbacks, potholes, and failures.
2. The therapist establishes a joint sense of purpose and a mutual understanding with the patient about what they are there to do together. This
is captured in a clinical case formulation that is unique to the
individual patient (versus a generic, off-the-rack formulation that
could apply to nearly anyone). By “unique,” I mean unique.
3. The therapist interprets the patient’s speech as metaphorical or literary, not as merely literal. The therapist can never know what happened in someone's childhood,
and can’t even be sure about what happened to a patient yesterday. The
therapist understands that this is not a limitation on effectiveness,
because the meaning that experiences hold for an individual is all-important.
4. The therapist interprets the patient’s speech—not only as a window into his or her narrative, constructed self, and world, but also as a metaphorical response to the environment
in which it occurs—a commentary on the therapy itself. This is the
therapist’s primary source of feedback about what works and what
doesn’t."
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