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Home » Psych Central Professional » How Clinicians Can Strengthen Their Connection with Patients: Q & A with Frank M. Dattilio, Part 2


How Clinicians Can Strengthen Their Connection with Patients: Q & A with Frank M. Dattilio, Part 2

motivational interviewing clientThe interview with Frank M. Dattilio continues. He offers his thoughts about the therapeutic relationship.

Q: Your book includes a chapter on working with couples and families. What is one way clinicians can improve their relationship with each patient in these groups?

A: The most concise answer to that question is to engage the energy that exists within the intrafamilial dynamics and draw the family members in on a common goal that will enhance their individual and joint lives. In this respect, the therapist actually joins the couple and family during the intervention process. A therapeutic bond with both the system, as well as the individual components of the system, provides the therapist with the power that they need to facilitate change.

Q: What surprised you the most about the therapeutic relationship in your own work with patients throughout the years?

A: Probably the fact that it can change rapidly depending on the circumstance. We advocate for an evolving case conceptualization in our book. It is tricky to keep all the aspects of the client’s history in mind, while attending to and adapting all the features of the relationship we cover, while also using techniques, and being a centered and authentic human being in the room with the client.

It takes on-going practice and good supervision.

We have had cases that we thought were a foregone conclusion and that the client wasn’t likely to last in treatment, only to be astonished when they hang in there and continue despite how rough the course of treatment unfolds.

On the other hand, there have been cases in which people appeared to be making good progress and evolving in an ideal fashion, only to spontaneously drop out of treatment with no explanation. Anything and everything can happen when you work with people, particularly when dealing with very personal and critical issues in their life.

Therapists must be very flexible in accepting the direction the treatment sometimes takes due to the complexity of the human condition and the multiple factors that are at hand.

Another challenge of the therapeutic process is for therapists to try not to take loss or failure personally, since that’s often a part of what we do. Therefore, another unique feature of our book is our attention on the aspect of the “person of the therapist.”

We introduce the reader to the importance of their own values as a therapist, and consider how those values determine preferences for their work with clients (e.g., structured vs. spontaneous; emotion focused vs. perspective taking, and so forth).

We also advocate for a dyadic conceptualization of client and therapist emotions, cognitions, and physiology from moment-to-moment (what we can call “transference” and “countertransference”).

Again, these processes add complexity to an already intricate therapeutic set of interactions, but CBT therapists need to bring these issues into awareness so that they can make informed decisions about relationship issues such as alliance ruptures. Some cases are extremely complex. Sometimes, there is no clear reason why patients react the way they do, or even surprise us as they make much more headway than we ever anticipated.

Q: What else would you like clinicians to know about enhancing their relationship with clients?

A: Our key messages are that the development of a sound therapeutic relationship can be very complex, and that it requires a comprehensive case conceptualization. We are at an exciting time for both CBT and process research, as these two streams of research are merging.

Another challenge of the therapeutic process is for therapists to try not to take loss or failure personally, since that’s often a part of what we do. Therefore, another unique feature of our book is our attention on the aspect of the “person of the therapist.”

We introduce the reader to the importance of their own values as a therapist, and consider how those values determine preferences for their work with clients (e.g., structured vs. spontaneous; emotion focused vs. perspective taking, and so forth). We also advocate for a dyadic conceptualization of client and therapist emotions, cognitions, and physiology from moment-to-moment (what we can call “transference” and “countertransference”).

Again, these processes add complexity to an already intricate therapeutic set of interactions, but CBT therapists need to bring these issues into awareness so that they can make informed decisions about relationship issues such as alliance ruptures. Some cases are extremely complex. Sometimes, there is no clear reason why clients react the way they do, or even surprise us as they make much more headway than we ever anticipated.

Q: What else would you like clinicians to know about enhancing their relationship with clients?

A: Our key messages are that the development of a sound therapeutic relationship can be very complex, and that it requires a comprehensive case conceptualization. We are at an exciting time for both CBT and process research, as these two streams of research are merging.

The advent of “process-based CBT” is an opportunity to recognize and study the nested structure of “technique” (and treatment processes) and “relationship” (and the array of generic and CBT specific in-session processes).

As with all things, there is a connection between these component parts. We view this as a case of treatment via the relationship, rather than one versus the other. One of the reasons that Nikolaos, Keith, and I authored this book is to convey all of the important concepts that we have learned during the course of our combined 100 years practicing psychotherapy.

We have worked together professionally for over a decade, and the book reflects our shared ideas in the research and training spheres of our work. We had talked about this project for a long time, and formalized it over a dinner at the Boston WCBCT in 2010. It’s a great feeling to have produced what we view as a vital contribution for the practicing clinician.

Many colleagues may have the impression that they know all there is to know about the therapeutic relationship, especially if they have worked in the field for a long time. Our book brings a fresh, clear and specific account of existing ideas.

For example, empiricism is an expected construct in the context of a “collaborative-empiricist” CBT relationship, but our work is the first to convey specifically what that term means. Thus, both seasoned practitioners and trainees will benefit from this material. The feedback so far has been very encouraging and heartening.

All of the ideas we have shared, enriched by the results of the research and clinical case examples that are incorporated in the book, make it a rich resource for clinicians. But the journey is far from over. Our science still lags behind what each of [us] experiences in session with our clients, the beautiful and complex array of factors that we can scrutinize and study in their component parts. But we can also feel it when  we simultaneously sit back and experience the interaction as its whole. We sincerely hope this discussion and our work makes a useful contribution to the field.

Margarita Tartakovsky, M.S., is an associate editor at Psych Central. She also explores self-image issues on her own blog Weightless and creativity on her blog Make a Mess: Everyday Creativity.

About the Interviewee

Frank M. Dattilio, Ph.D, ABPP, is a teaching associate (part-time) in psychiatry at Harvard Medical School and clinical associate in psychiatry at the University of Pennsylvania School of Medicine. He is also a practicing clinical psychologist in Allentown, Pennsylvania, where he provides individual, couple, and family therapy.

Dr. Dattilio has presented extensively throughout the world on treating a wide range of disorders using CBT and has been active in research, professional education, training, and supervision of psychiatrists and mental health professionals. His more than 300 publications include 23 books in the areas of couple and family therapy, anxiety and behavioral disorders, and clinical and forensic psychology.

 

How Clinicians Can Strengthen Their Connection with Patients: Q & A with Frank M. Dattilio, Part 2

 

APA Reference
Tartakovsky,, M. (2018). How Clinicians Can Strengthen Their Connection with Patients: Q & A with Frank M. Dattilio, Part 2. Psych Central. Retrieved on November 11, 2018, from https://pro.psychcentral.com/how-clinicians-can-strengthen-their-connection-with-patients-q-a-with-frank-m-dattilio-part-2/

 

Scientifically Reviewed
Last updated: 15 Aug 2018
Last reviewed: By John M. Grohol, Psy.D. on 15 Aug 2018
Published on PsychCentral.com. All rights reserved.