The document provides strategies for building a therapeutic relationship with clients. It discusses making clients feel comfortable, finding their suffering and showing compassion, evaluating their insight, demonstrating professional skills, guiding them as a navigator, and balancing different roles. The key points are: make small talk to build rapport; understand clients' concerns; recognize non-verbal cues; draw out their emotions and problems; evaluate their perspective; reassure them with knowledge and hope; lead the interaction while respecting boundaries; and adjust roles based on the client's needs and expectations. The overall goal is to form a trusting relationship through empathy, expertise, and role flexibility.

1.  Strategies for building a therapeutic
relationship

2. 1_ Make
your clients
feel
comfortable
2- Find out
their
suffering
and
discomfort
and show
compassion
to it
3- Evaluate
the client's
insight and
go along
with that
4_ Show
your ability
and skill
5_ Apply the
role of the
guide
6- Balance
the roles

3. A client who comes to visit you for the
first time is usually worried because of the
stigma associated with mental disorders.

4. Some of their concerns:
 does he/she listen to me?
 does he/she understand what I am saying?
 does he/she make fun of me or respect me?
 Can he/she help me?
 Can I trust him/her or not?
 So, Your duty as a therapist is to show that you understand his
concerns, you are on his side, you value him and his concerns, and
you are trying to help him.

5. 1. How to make clients feel more
comfortable?

6.  Start the interview with a simple conversation. Your first goal is to get to
know them and then build a relationship; not to immediately diagnose
their problem.
 Introduce yourself and ask their name. If necessary, Check how they
prefer to be called
 Some therapists recommend that it is better to use the last name for
maintaining respect.

7.  Talk to them on their own language.
For example, anxious clients want to get to the point sooner or
obsessive clients think that such conversations (preliminary
conversations and preparing clients) are a waste of time and
money.

8. How to know what to do and
when?
By reading:
 the Signs and non-verbal behaviors
 the client's voice and expression

9. Recognize the signs of clients (non-verbal
language, voice and manner of expression).
● These symptoms can not be changed easily.
● These signs express the client's feelings without using words.
● In order to make the client feel comfortable, you should address these signs
immediately.
● Start building a therapeutic relationship by studying these signs.

10. different nature of the signs
● Related to the
territory
(spatial-moving)
☆ Where do
they sit?
● Behavioral
(psychomotor)
☆ Eye
contact -
hand and
foot
movements
● emotional
manifestations
☆ Types of
poses, facial
expressions
Verbal (voice and
mode of expression)
☆ Mode of
expression,
choosing
the special
words

11. An example of a clinical interview
In this interview, the patient expresses two types of symptoms
 1 emotional = he looks back. He clenches his fist. He bites his lip
 2 Verbal = “I am nervous and depressed”.

12. Dialogue between client and novice
therapist
Therapist: You said you are
depressed. Did this affect your
sleep?
Client: Yes (the client taps his feet
regularly)
T: How is your appetite?
C: What, appetite?
T: Has it changed?
C: No (looks elsewhere)
The Professional therapist intervenes
 He notices anger and suspicion expressed
in client’s body language.
 Reacting to an emotional sign (not to a
verbal sign) can deepen the relationship.
 Expressing strong emotions may hinder
the client's emotional response. But
expressing emotion at a moderate level
facilitates the reactions of clients.

13. 2. Find out their suffering and discomfort and
show compassion

14. After identifying the symptoms
(mentioned in the previous slides) and
making the client feel comfortable, look
for their suffering and discomfort.

15. The problems of clients usually have two
aspects:
1. The facts
 Disease symptoms such as loss of appetite, shortness of breath, pain
without a medical cause, or stress factors such as the death of a child, marital
problems, unemployment, etc.
2. The emotions
 The feelings these facts provoke in the client and cause him suffering and
discomfort. The client may hide it because of the fear of being disturbed or
embarrassed.
If you can draw out his emotions in addition to the facts, you will be able to strengthen the
relationship.

16. Evaluate the client's pain and discomfort.
When the client states his main problem (main complaint), help him express
the problem in words:
 How does this issue make you feel?
This question shows that you care about his emotions and you want to know more about it.

17. It is important to let them express the symptoms freely
instead of you compiling a list.
When you give them a chance to express freely:
 1. You can evaluate mood and emotion.
 2. You understand the nature of the mood; for
example, anxiety or depression.
 3. They understand that you care about them, so you
can get closer and make the relationship deeper.

18. Show empathy!
Empathy should be genuine, correct, spontaneous and
appropriate to the patient's emotions.
For example, Therapist can say:
 You must feel bad.
 You must be fed up.
 I can understand how upset you are.

19. Some therapists have difficulty in empathy. In fact,
many clients are hard and resistant, and the therapist
can't handle it. so, If you have trouble feeling
empathy, don't try to express it.
Focused attention and appropriate questions convey
your interest to the patient better than artificial
empathy.

20. 🔸 Therapist 🔹client
When the client is faced with the Inauthentic behavior, he gets offended:
 🔸 You said you were very apprehensive about coming here.
 🔹 You heard right!! yes, that's what I said!
OR:
 🔸 It seems that you were very disturbed when...
 🔹(Sarcastic) Really? Did you think so? Doc, you're just playing a therapist
role! I know these predetermined words. I went to a damn psychologist a
lot.

21. 🔲 If you sympathized and the client distanced himself, check whether your
sympathy was sincere or not.
A principled way to create empathy is to write down the outlines of interviews
conducted with difficult clients. And make a quick note of his change in attitude
towards you. Analyze what caused this situation.
 Did you use his vocabulary?
 Did you try to understand his problems?
 When you were empathizing, were your emotions similar to those of the client?
 Were you constantly aware of the changed attitude of the clients AND did you
react?
Focus on the ability to empathize and express concern genuine.

22. 3. Evaluate the client's insight and go
along with him.

23. After empathy, start to see the client's problem from his own
point of view, which is his insight.
You should evaluate his insight for two reasons:
1. When you interview him, you look at his problems from his
point of view.
2. The distance between his degree of insight and full insight
can be used as a means of measuring the reality test.

24. 🔲 If you misjudge the client's level of insight, the relationship
will quickly disappear.
For example,for a delusional patient who believes that he is
being controlled by a computer, if you treat him as a delirious
or crazy patient, he will feel insulted because he thinks his
beliefs are true.
Or you may sometimes find that the client does not want to
talk to you anymore after he gets insight!

25. three levels of Insight
Complete
insight
a person who sees his symptoms as the result of a disorder has
complete insight. For example, a client who has panic attacks and
considers these attacks to be part of his problem.
Relative
insight
Clients who suffer from a problem and expect treatment and medication
to help them, but do not consider the source of their suffering to be a
mental disorder. They know that something is wrong, but they attribute it
to external causes. They have relative insight.
Lack of
insight
the client completely denies his problem. Most of them go for treatment under
the compulsion of others and have companions

26. motivate the patient
 The best thing to do to motivate a patient without insight to
the interview is to find out what the patient's companion used
to bring the patient there.
 Isolate the pathological part.
 Appeal to the patient’s “healthy observer” part.
 Determine which part of the patient's perception is covered by
the disorder?

27. Determine treatment goals!
 1. The goal is what you talk to the patient about.
 2. The treatment goal is determined based on the nature of
the disease.
 In patients with full insight, both goals are the same.
 In patients with partial insight, the goal of detection and
treatment will be the same after recovery and to prevent
recurrence.

28. Three elements of effective therapists
(in Truax and Mitch's research)
1. Empathize with the patient's suffering
2. be honest and fair
3. be in an interaction and unconditional positive
attention to the patient as a human being

29. 4. Show your professional skills!

30. By Using the following techniques, show that you
understand their problem:
 Tell him that he is not the only
person who has this problem. And
let him know that such problems
are normal in society.
 Tell him that you are familiar with
his problem and show your skills,
information and knowledge in this
field.
 clients may doubt your ability. Talk
about this together. You are an
expert and you are different from
his family members and friends.
clients look at you as a
professional.
 Give him hope for the future.

31. Reassure the client that many people have been
like him and have recovered.
 Tell him if he knows anyone similar to him?
 He may have seen someone similar to himself in the movie, friends, family,
etc.
 Make him understand that hiding problems is normal.
 Maybe the client is worried that you will categorize and label him as a
patient! Reassure him that some of his symptoms are the same as others.
Some of them are specific to himself and will be fixed.

32. Show your knowledge and information
■ Show your skill by carefully examining and exploring his
symptoms. When you ask questions related to his problem, he
wonders: How did you know?!
By doing this, you gain his trust. And you make it easier for him
to tell his concerns.
■ Another way is to stimulate his curiosity about psychology and,
for example, people with mental problems that he has seen in
movies and TV.
For example, talk about famous personalities who had problems.

33. 🔲 You can use sentences like:
 The discomfort you have is common at this age.
 We have found good ways to treat these problems.
If the client is educated, intelligent, etc., give him
information on genetics, heredity, and psychological
theories.

34. Important!
If you do not know the
answer of any question,
accept it easily.
By doing this, you will
make the client confident
about your honesty

35. Pay attention to the doubts of the clients.
When you feel that the client doubts you, ask him the
following questions:
1_ What made you ask this question now?
2_are you worry that I may not understand your
problem?
 Speak easily and freely in this context.
Use confrontational questions

36. Make the patient hopeful.
Most of your clients have been suffering for months and even
years, now that they have come to you, you should give them
hope. For example, clients suffering from drug abuse have
tried to quit many times, but they have failed.
Or, depressed clients have a negative attitude towards the
future.

37. Therefore, their views and attitudes should be changed and they should be
hopeful.
 Tell them that if he cooperates with you and does his homework, his
expectation of treatment will be met.
 Most clients will be more comfortable knowing the diagnosis and how to
treat it than otherwise.
But be careful not to create unrealistic expectations in clients.

38. 5. Play the role of a navigator

39. 🔲 Show your leadership and guidance role from the very
first moment of meeting with the client.
Take control of your interaction with them.
Express your desire for their comfort and health.

40.  If the client accepts your descriptions and interpretations and cooperates
with your treatment instructions, it is clear that he has accepted your
guiding role.
 Be careful not to feel too dominant. Don't think you know more than
everyone else. Your honest relationship will be jeopardized and it may
make the client fear you. And this makes him even pretend that his
problems have been solved!
⚫️ Narcissistic and skeptical or anti-social clients also ignore your guiding
role. And he may even disrespect you.

41. example
For example, he might say:
 I have to think.
 I have to ask two other people.
 I don't trust psychologists.
▪️ In these situations, confront the client with his
behavior.

42. 6. Balance the roles!

43. Clients and therapists enter the room with a set of expectations and
roles.
 In fact, clients expect different roles from the therapist:
 Rulers
 An empathetic listener
 A savior
 A law enforcement officer and...
 If you are aware of the roles that the client expects from you, you
will manage the session in a better way.

44. Be an empathetic listener.
 Being empathetic does not mean being overly tolerant.
 Sometimes therapists cannot respect their professional boundaries:
For example; For clients who are late for the treatment session, they always wait.
 He is ok with the client’s absence and his uncompleted homework.
 He Reduces the cost of treatment according to the client’s desire.
 He invites him to dinner.
 He Establishes an intimate relationships.
 And....

45. This therapist becomes a good and kind friend and
not a suitable therapist.
Whenever you find yourself empathizing too much,
try to set limits. Apply the role of facilitator. Put your
expertise into practice.

46. The role of the interviewer as an expert
 A therapist may feel that empathy is nothing but a waste of time.
Or what the client needs is knowledge and how to apply this
knowledge, not compassion.
 Such an expert prides himself with the illusion that he is infallible.
 He does not care whether the client follows his advice or not.
Because at the end, he is the one who will suffer from the
consequences of this work.

47. If you are like this and there is no friendly attitude in
your interview, you need to fix the problem.
Review your interview. See if you have empathy or
not.

48. The competent interviewer only
 A domineering interviewer emphasizes on giving orders from the
beginning of the interview and expects their clients to be implemented.
 He may consider empathy and compassion a waste of time.
 Now, if the therapist is domineering, and the client is unwilling to
cooperate, there will be a conflict between them.
 You may see that the client disagrees with you, even laughs.
 Check to see if you have empathized.
 See if you have given him enough time to talk.
 You should check and see how much you have contributed to the client's
inconsistent behavior.

49. Different roles of a client
•
Client sees a distance between himself and his disorder. For example, he says that his sleep is
disturbed, he does not have a problem.
Disease carrier
•
This role is in conflict with the role of disease carrier. The client sees himself drowning in
helplessness and difficulty. He looks for sympathy and compassion rather than expert advice.
suffering
•
This client considers himself very important. Distinguished and worthy of attention at any
moment of the day and night. He expects the best treatment. For example, he may call you at 3
o'clock in the middle of night to say that he cannot sleep!
VIP client

50. The Interaction of roles
The relationship is created when the interviewer
and the client balance their roles and act
accordingly.
If you and your client deny each other's
roles, there will be a conflict between you.

51. Note:
If the client complains of ambiguity, adopt the role of
"listener".
If he does not know about his condition and needs
information, play the role of "expert".
If the client makes a logical decision and is slow to do
it, play the role of "advisor".

52. Thank you