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The reason that compassion and rapport are so important is not just because it creates the safe, trusting and respectful environment that is the bedrock of the kind of vulnerability that is called forth during therapy. It’s also because the evidence tells us that this is the single most important variable in successful counselling.
The “common factors theory” says that despite the over 400 (!) different counselling approaches, each of their success is owed to common factors found in them all, rather than individual factors found only in particular therapy styles. The critical common factor is the relationship between the Counsellor and the client. What this means is that even a therapy approach which was highly efficacious for a particular problem (e.g. Emotion-focused therapy for couples counselling), it just wouldn’t work very well if the approach didn’t suit you or if the Counsellor didn’t connect with you.
This is why every Counsellor emphasizes their capacity to connect with you. At Nightingale, the relationship between the client and Counsellor is an absolute priority; however, we believe that this a core capacity of all Counsellors rather than a distinguishing feature of a select few. This is to say that if a Counsellor is not capable of what one of the forebears of modern Counselling, Carl Rogers, called “unconditional positive regard,” then it’s going to be tough sledding. Warmth, compassion, and capacity for rapport is a minimum requirement and precondition for practicing as a Counsellor rather than an accomplishment, and it is something you can expect from every member of our team.
On first googling a particular experience or problem, most of us will quickly be bombarded with information about pages about diagnoses and specific treatment approaches. The idea in these pages seems to tell the opposite story of the common factors theory: that there is a particular approach matched to a particular problem!
To this end, therapists are trained in a variety of particular approaches which guide their practice (and which contain the common factors!). Some of the most common approaches today include:
● EFT – Emotion Focused Therapy
● CBT — Cognitive Behavioral Therapy
● ACT — Acceptance and Commitment Therapy
● DBT — Dialectical Behavioural Therapy
● EMDR — Eye Movement Desensitization and Reprocessing
● SE — Somatic Experiencing
● IFS — Internal Family Systems
And that’s just 7 of over 400! How can a prospective client be expected to make sense of all this?
The truth is the following: every counsellor needs training and experience in at least one particular modality (and probably more than one), BUT this doesn’t actually tell the story about whether or not they are the best Counsellor for you.
At Nightingale, our thousands of hours of research and practice have demonstrated that no single pathway works for all people, no matter how specific the “problem.” Instead, effective and professional counselling therapy requires the ability to put it all together. For us, this means that our therapists needs to be proficient in our understanding and relationships of the following:
● cognitions
● behaviours
● emotions
● biological and physiological factors
● somatic (bodily) sensations
● affect assembly
● symbol/imagery/dream
● attachment dynamics
● existential dilemma
This is a rough list of the many “entry points” into all of our human problems. For each of us, a different combination of these is most strongly felt in any given experience, and this unique combination requires the attention of therapeutic conversation.
It goes without saying that no single “modality” covers all of these. And by the same token, a purely “compassionate” approach doesn’t generate the expertise required.
Talk therapy is only the beginning, and successful therapies need to incorporate real life into the therapy room, and therapeutic change into real life.
Research around the theory and practice of Counselling therapy is constantly evolving, just like other medical practices. Counsellors who stagnate fall behind. Counsellors as individual practitioners and clinics as the institutional settings in which those practitioners work need to be constantly thinking about ways of integrating effective practices in the day-to-day of therapeutic engagement.
Because no one therapy and no one therapist is right for every person, each practitioner as well as the clinic as a whole should be agile in responding to the dynamic needs of clients. This means accessing the wide variety of “entry points” (as written above) and having a wide variety of clinicians to find the right fit.
Many traditional psychotherapeutic modalities are orthodox and manualized. This means they have very specific ways of doing things, and Counsellors are measured by their adherence to these protocols. At Nightingale, we believe that eclectic and dynamic approaches lead to better outcomes, although we recognize that it takes significantly more intellectual and creative capacity on the part of our Counsellors.
Traditional approaches to “mental health” have been and continue to be “pathologizing”—meaning that they take the problems of being human—of life itself—and turn them into categories of illness. This is not to say that we recognize categories of experience, illness or otherwise, as illegitimate. But we do believe that the singular and medicalized/pathologized orientation to client’s struggles in the world as profoundly limiting. We have a strong commitment to understanding and treating problems without resorting to “pathology” as the more productive road to healing.
Many of our problems in living come from the disempowering and antagonistic relationship structures that are prevalent in our society and culture. Anti-oppressive Counselling is an ethical commitment and an outcome-based practice.
The critical role of therapeutic compassion and empathy, on creating space for being seen and heard, cannot be overstated. However, too many Counsellors take this to mean they should not speak at all. At Nightingale, we believe in conversation as a dialogue, with both parties able to bring themselves forward as full humans.
Non-pathologizing and compassionate inquiry is not in contradiction to a muscular approach, which marches towards goals and needs. Although we are not solely driven by goals, we are oriented towards them. Therapy should always have direction and purpose, and both client and therapist should know it. But goals are not static. Goals can change substantially in the process of therapy, and there needs to be space in the therapeutic relationship and process to allow for goals to shift as the path towards healing is travelled. This is to say that the path toward healing can be forked many times along the way.
Therapy is as dynamic and unique as you are, and what looks like “the problem” or “the solution” on Day 1 is often not the final movement. Process-based therapies do not get stuck in “treatment plans” but instead respond to the shifts and changes in your experiences and conceptions of what is needed most.