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Disordered Eating Handout

The counselling relationship is a very important one. How a client feels in the presence of a therapist will, in part, determine how successful therapy will be. The following information is based, in part, on research, as well as based on my own personal experience as a therapist.

Research (Bedi, R. (2006), J Counselling Psychology, 53(1), 26-35) has shown that, from the client’s perspective, there are key factors that contribute to the formation of an effective counselling alliance (i.e. one that will most likely help a client). In the following study, clients who had received counselling were asked the following open-ended question: “What were the things that helped form and strengthen the counselling or therapy relationship?” Clients identified 376 helpful factors. These factors were reviewed, sorted, and distilled into the following 11 broad categories (these are listed in descending order of importance).

• Validation (clients used words like “validated” or “normalized” to describe the counselling behaviour of their therapist)
• Education (refers to teaching done by the therapist during the session and the assignment of homework)
• Nonverbal gestures of the therapist (specifically gestures by the therapist such as nodding, leaning forward, maintaining eye contact)
• Presentation and body language (more positive if the counsellor does not sit behind a desk, postures and positioning of the counsellors chair in relation to the client (across is better), greetings at the beginning and end of sessions, sitting up straight)
• Guidance and challenging (reflection skills of the therapist (ability to summarize or paraphrase accurately), if the therapist was able to confront or challenge the client respectfully, therapist makes suggestions, the ability of the counsellor to keep the client on topic)
• Referrals and recommended materials (the counsellor is aware of related resources that are available to clients and communicates them, recommendation of additional materials to be read outside of therapy)
• Honesty (subjective accounts of counsellor honesty, a counsellor who self-discloses)
• Emotional support and care (statements about being able to cry in the presence of the counsellor, caring behaviours (handing tissue, offering to hug but only if asked for by the client) acknowledging statements made by the therapist (uh-huh, hm-mmm), joking with the client.
• Session administration (payment is made outside of the scheduled appointment time, assurances made about confidentiality, counsellor oriented clients about the process of counselling (i.e. what to expect, how counselling works, etc), if a client requires it the counsellor indicates he/she is available outside of sessions either by phone or email)
• Client’s personal responsibility (refers to the client’s contribution to the process – the counsellor came highly recommended by a friend or another professional, the client had had previous contact with the counsellor, the client came on-time to sessions, the client attended sessions regularly)
• Setting (the office was pleasantly decorated, the counsellor wore appropriate clothing (either casual or business depending on the preference of the client, the counsellor was clean and well-groomed, the counsellor offered a choice of seating, the counsellor’s office had books related to counselling in his/her shelves, support staff were pleasant when they greeted me).

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From a therapist’s point of view a few other considerations may contribute to the success of your counselling experience.

Education and Qualifications:

All of the therapists in the above study were qualified and educated professionals. Be sure to check the credentials of your counsellor. Be aware that there is no external governing body for individuals who call themselves counsellors. In British Columbia, the designation of Registered Clinical Counsellor (RCC) indicates that the counsellor has met the requirements of the British Columbia Association of Clinical Counsellors. These include graduation from a recognized Master’s program and extensive practical supervision. You may also see a designation of Certified Clinical Counsellor (CCC), which indicates the Canadian Counselling Association certifies the counsellor. Like the RCC designation, these counsellors must meet rigorous educational criteria and both will likely have a Master’s degree from a recognized University. Although a quality education does not guarantee that your counsellor will be the one for you, it does increase the odds that your counsellor will have the skills necessary to assist you. Most Master’s programs in counselling psychology take between 2 and 3 years. As with any service you seek do your due diligence when critiquing your counsellor’s qualifications and experience.

Word of Mouth

Word of mouth can also be an appropriate way to choose a therapist. The experience of a trusted friend or relative does definitely lend credibility to a therapist. Keep in mind, however, that each counselling experience will vary from client to client, depending on the problems you are seeking counselling for, your own expectations, and the expertise and theoretical orientation of the counsellor. A friend’s endorsement is helpful but you should also explore why the person making the referral has felt good about their experience. Asking the question “What was it about the counselling you received that you felt was the most helpful? Or the least?” This may help you become a discerning client and also help you distill what is important to you as you look for a caring and qualified practitioner.

When all is said and done it is also appropriate to ask a potential therapist if they offer reduced rates for the first session or a complimentary phone consultation so that you can better determine if the fit is right for you. Take the time to find the right therapist for you. After all, it is a trusted and intimate relationship.

During the first appointment, or perhaps via telephone here are some important questions to ask your potential therapist.

Questions to ask during the first appointment:

• What kind of therapy do you deliver? Is this therapy empirically validated (i.e. is there research to support the benefits or effectiveness of this particular type of therapy?)
• Do they have specific training to deliver this particular type of therapy?

• How many clients have you seen with my particular problem?
• Do you obtain ongoing supervision?
• What if something should happen to you while I am undergoing therapy?
• How is my confidentiality protected?
• What are your fees and how can they be paid? (i.e. at the beginning or end of the session, do they accept credit cards?) Are your fees in line with your professional association?
• Do you ever slide your fees in response to financial difficulty or ability to pay?
• What are your policies regarding appointment cancellations and no shows?
• Have you ever been under investigation for disciplinary reasons by your governing association?

The best therapist for you is not necessarily the one who seems to be the easiest. It’s better to have a therapist who can gently challenge you to make the changes you desire.

The best therapist for you is not one who constantly directs what you should do. Successful counselling is collaborative. A counsellor who frequently gives advice creates a dynamic of dependence in the counselling relationship.

Ultimately, the best therapists are those who are trying to work themselves out of a job. Ethically, a good counsellor knows when it is time for a client to terminate counselling.

Good luck with your search!