Impact and Intention: How to Communicate with People in Therapy

Story: “Once, at the end of a first session, a person asked for some ‘homework,’ so I suggested she do some journal writing about a habit she had discovered during the session. When she arrived for the next session, she sat down, looked at me, and immediately began almost screaming that she ‘couldn’t trust me … I was just like all the others … she knew this wasn’t going to work … I had a formula that I applied to all people in therapy with me … and I wasn’t going to take a personal interest in her…’ ‘My goodness, you certainly have strong feelings!’ I replied. ‘Yes, I do! I just can’t believe you gave me journal writing. I hate journal writing, and I bet you do that with everyone!.’ ‘Well, I guess I’ve learned something about you. I’ll never ask you to journal again!’ She then burst out laughing at the absurdity of this much anger. Soon we were both laughing. I let her know I understood how important my personal attention and care were to her. She sat back and said, ‘I can’t tell you how touching it is that you are interested in learning about me and willing to change how you are in response. And, even more amazing that you didn’t just reject me as a client.’ My intention with journaling homework was to offer her something to think about and help her get more involved in therapy. The impact was that she felt distanced and uncared for. Her unconscious intention in her anger was to prove to herself that once again therapy wasn’t going to help. The impact of my response was that she got treated the way she had longed for.”

Impact is the effect your behavior has on others. Intention is the effect you want to have.
The most effective and skillful use of power is made possible by being aware of and responsive to your impact on others. When your goal is to be of the best possible service to your clients, it is imperative to be interested in and attentive to their responses to your use of your self, your role power, and your expertise. The best training and the best modalities will ultimately be compromised if you are not paying attention and then adjusting to how your clients are responding.

You may say one thing—for example, “I’d like to suggest you try…”—but your impact may cause unexpected and unintended pain if the person takes this suggestion as a putdown or manipulation. There need be no argument or defensiveness when this occurs: you and the person in therapy are both right. Your intention was good. Your client’s experience (probably based on their past history) was of feeling misunderstood, judged, or disrespected. In other words, they felt harm.

Tracking and Housekeeping
Tracking is the moment to moment process of noticing your clients’ responses to what is said, what they feel, the memories that emerge and the relationship itself. These responses will be visible or felt through tone of voice, postural movement, direct words, gestures and other physical manifestations. These can be quite subtle (for example, an emotion, if unnoticed and uncontacted, disappears in a few seconds) or quite obvious changes in body language such as folding arms, looking away, tears.

By tracking for your impact, you can clarify and repair the relationship and prevent the difficulties from escalating. For example, you might say, “I notice that you had quite a strong reaction to what I just said. I wonder if you understood what I said in a way I didn’t intend.” Clients let you know that they feel confused, misunderstood, or hurt. If you don’t notice, they will keep letting you know in ways that become more exaggerated. Good tracking skills are one of your best resources for preventing harm and repairing the relationship.

Housekeeping is the process of keeping the relationship clear and productive. Just like houses, relationships need periodic cleaning—airing out, dusting, fixing a stuck window, water drip. It’s no big deal, not good or bad – just some attention needed. If you break an egg on the floor, you clean it up. If there is a break or lack of clarity in the relationship, you clean it up—no big deal. Tracking is the moment to moment process of noticing your clients’ responses to what is said, what they feel, the memories that emerge and the relationship itself. These responses will be visible or felt through tone of voice, postural movement, direct words, gestures and other physical manifestations. These can be quite subtle (for example, an emotion, if unnoticed and uncontacted, disappears in a few seconds) or quite obvious changes in body language such as folding arms, looking away, tears.

Examples of Impact differing from Intention
You may intend to support your client’s independence, and your client may experience your support as rejection. Your client’s perceptions may be influenced by past history and therefore expectations of being abandoned may arise and bring feelings of rejection.

You may intend warmth and compassion, and your client may experience this as pity. Your client expects pity and therefore does not perceive compassion even when it is offered.

Your client may intend to be clear about a boundary, and you may experience this as non-cooperation. You may be concerned about being good enough, and therefore perceive every criticism as noncooperation on the part of your client.

You may intend comfort by a hand on your client’s shoulder, and your client may respond as if you were a former abuser. Your client may transfer feelings, responses, or expectations onto you that belong to someone else in their life.

You may intend respect, and your client experiences disrespect. The meaning of direct eye contact differs in your client’s culture.

Misperceptions of intention can occur on the part of either the caregiver or the client. In human beings, past experiences often become beliefs that then become embodied as self-protective strategies. These strategies then become expectations about how they will be treated. People often have different experiences of the same event, because we all bring our own history and expectations to every relationship.

Tracking and contacting your impact can help the relationship self-correct quickly and successfully. Like navigating a sailboat, the person at the helm keeps the goal in sight, but uses the wind to tack and then correct. The journey seldom takes one straight line to the dot on the horizon, but the more frequently you self-correct, the smoother and quicker your arrival. A big self-correction takes a lot more effort than a little one, but too many tiny corrections can slow the process to a snail’s pace.

Related Articles:
Right Use of Power: Ethics as Soul Work
Can Reading an Article Improve my Relationship?
You Never Told Me! Listening Well in Family Life

© Copyright 2011 by Cedar Barstow. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • 11 comments
  • Leave a Comment
  • carlton

    carlton

    December 20th, 2011 at 5:38 PM

    So I am assuming that from the first of this narrative that this was someone who had previously had a bad experience in therapy and was projecting that onto the current therapy experience. This is a time when I would have to remember not only my intention for this patient, but to also clearly realize the impact that my words and actions can have on someone who has had a bad taste in their mouth from a previous therapy session. Personally this is probably a good lesson to take with us in all facets of life. You may think that you intend one thing but you must recognize that the impact can be completely different..

  • P.H. Moore

    P.H. Moore

    December 20th, 2011 at 8:26 PM

    “The most effective and skillful use of power is made possible by being aware of and responsive to your impact on others.” This is an excellent point for the layman as well as the professional to take heed of! Thank you for a good article, Cedar.

  • w. simmons

    w. simmons

    December 20th, 2011 at 11:00 PM

    I run into this often (not a therapist, mind you) and I don’t understand why I don’t come across as intended when I speak to some of my coworkers. They have said I’m very abrupt before. I like to think of it as clear talking. How they can misconstrue things I will never understand.

  • PETE

    PETE

    December 21st, 2011 at 12:00 AM

    Certainly,Carlton.I always say this-we go through a lot of things in life,every single day.And no matter how small a thing,it does get absorbed into us.And it all combines and plays a role in how we perceive what somebody tells us.So when you’re speaking to another person,know that his perception is influenced by a lot of things.So be clear!

  • Bernard Noakes

    Bernard Noakes

    December 21st, 2011 at 12:02 AM

    I feel when you attempt to be subtle, you run the risk of it going way over their head. Subtlety is a way to soften the blow so to speak. However if you are too subtle, the message can be lost entirely as it passes between you both. There’s a fine line between subtlety and dilution.

  • carroll

    carroll

    December 21st, 2011 at 2:52 PM

    sometimes turning things around so that someone can see the ridiculousness of their behavior goes a long way toward getting someone over that barrier that they have put up and will then make them a little more open and agreeable

  • Pat Adler

    Pat Adler

    December 21st, 2011 at 4:07 PM

    God, I hate therapists that don’t lay their cards on the table. I don’t want you to beat around the bush thinking it will spare my feelings because it won’t. All that does is annoy me. If I knew what was good for me,I wouldn’t be there in your office now would I. Talk to me straight and we’ll not have any miscommunication! Thank you.

  • Leigh Summers

    Leigh Summers

    December 22nd, 2011 at 12:23 AM

    The closer emotions are, the more of a challenge it is to separate them. I think pity and compassion are hard to differentiate for example, so I can understand why a client may misread one for the other. They are very intermingled, both being gentle emotions that reach out to the person.

  • shaun

    shaun

    December 23rd, 2011 at 12:55 PM

    there’s always room for misunderstandings in an interaction.when you say something with something in your mind the person may not interpret it the same way-because what’s in their mind is different from what’s in yours!quite simple isn’t it?yet we always expect others to understand everything we say in the very same manner as we intend to.

  • Cedar Barstow

    Cedar Barstow

    January 21st, 2012 at 2:32 AM

    Hey, what a great little discussion this article provoked! Thanks for talking with each other. When we think we are talking “straight” as you say, Pat, it is truly hard to understand how someone could misconstrue what we have said, even when it wasn’t at all subtle. And yet, they do. People often have “unstraight” associations with what seems straight to us. Wow. Amazing. And so important to be sensitive to. Cedar

  • FRANK

    FRANK

    December 13th, 2012 at 6:19 AM

    OK, FROM NOW ON I’LL SECOND GUESS EVERYTHING I SAY TO A CLIENT.

Leave a Comment

By commenting you acknowledge acceptance of GoodTherapy.org's Terms and Conditions of Use.

* Indicates required field.

 

Advanced Search

Search Our Blog

   
GoodTherapy.org is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.org.