Integrating Existential and Narrative Therapy: A Theoretical Base for Eclectic Practice

9. Beginning Therapy I: Co-constructing the Therapeutic Bond

170 9 Beginning Therapy I Co-constructing the Therapeutic Bond The preceding chapters have described the underlying assumptions about human functioning in which the existential/narrative approach to therapy is rooted. What are the implications of this view for the actual conduct of treatment? What do therapists who understand human functioning, distress, and change in these ways do to help those who seek their assistance? The remainder of the book will address this question. Whatever therapists do with or on behalf of their clients is an expression of their stories about human functioning, distress, relationships , and change. For this reason, the following pages will not merely present various possible therapist activities, but will attempt to place them in the context of the existential/narrative approach to treatment. THREE BASIC CONSIDERATIONS Several ideas are worth emphasizing in beginning a discussion of the conduct of therapy and the development of the therapeutic relationship. The most important of these is that everything that the client and therapist do together is the therapeutic relationship. The relationship is not merely some sort of setting in which the work of therapy is conducted and that lies apart from therapeutic interventions . All the things that the client and therapist say and do with one another in the course of their struggling to help the client deal more effectively with life’s challenges is the therapeutic relationship. Since Co-constructing the Therapeutic Bond 171 they have never engaged in this process together before, flexibility must be a central characteristic of the relationship if the client and therapist are to be truly present to one another and to engage in a process of co-creating a new story for the client. Prior experience in dealing with persons struggling with a particular type of problem can be incredibly valuable in sharpening therapists’ sensitivity and helping them recognize the possibilities and pitfalls frequently associated with particular types of problem-saturated stories. Yet, because the therapist has never worked with this person before and given that the client is fully one half of the therapeutic relationship, each therapeutic encounter remains uncharted territory for the therapist. Thus neither client nor therapist can rely upon fixed procedures for engaging in treatment but must remain flexible, ready to deal in novel ways with the particular circumstances that each pairing of client and therapist presents. A second important idea, corollary to the first, is that developing the therapeutic relationship is a project that endures as long as treatment lasts. It is a fallacy that the initial stages of therapy are concerned with relationship building and that the real therapeutic work is done later. It is certainly true that as client and therapist begin their journey together, each is curious about who this other person is and how they will work together and that therefore the relationship is more in focal awareness for both participants than it may be later on in their work together. It is also true that the quality of the bond developed early in treatment provides a resiliency that allows client and therapist to remain committed to working together even when that bond is strained, as Safran and Muran (2000) have discussed. Yet as these authors have also pointed out, bond is never a fixed entity; it requires periodic attention and changes as treatment progresses. Further, it is quite important to recognize that (ideally) the only reason clients have for being in this relationship at all is to receive assistance with their problems and that this will be true throughout the course of treatment. This means that from the very beginning the relationship must be built in terms of how client and therapist work together on promoting change, that is, new lived experience storied in fresh, more empowering ways. A third important idea is that because clients are half of the relationship , therapists cannot simply create the therapeutic relationship 172 Integrating Existential and Narrative Therapy according to their preferences. Like all other reality, the therapeutic relationship is co-created. Therapists must know what qualities they would like to foster in the relationship with each client and be aware of various ways in which they can invite clients into this manner of relating. Yet, all the therapist can do is invite. Early work on Rogers’s (1951) basic relationship qualities showed that therapeutic success was found to be only inconsistently related to the relationship qualities offered by the therapist but more consistently...