Engaging the patient
(see E Beginning the therapy in Chapter 5, pp. 158-9; Therapy in clinical practice in Chapter 5, pp. 154-63; What constitutes good therapy? in Chapter 11, pp. 523.)
A good therapeutic alliance goes a long way towards engaging a patient, once the therapy is firmly established. However, at the start, it requires an interested, concerned, and committed therapist who can convey a sense of optimism and confidence in themselves, in order to enable the process to begin. An ability to adapt personal style to the patient, as well as pragmatically meet change as it happens in the therapy, is a crucial skill that fosters positive engagement in a genuine process between therapist and patient. Being non-judgemental means that the therapist is open and curious, encourages the patient to speak openly, and is sensitive to a different world view. Thus, such a therapist is not threatened by the patient’s curiosity, reluctance, or hostility, and will instead seek to understand the reasons behind such a stance. Any therapy runs the risk of alliance ruptures, and often it is the way in which the therapist addresses these—sensitively and in the interest of the patient—t hat can ultimately strengthen and deepen the therapeutic relationship. It is important for a therapist to be able to admit to their own contribution towards an alliance rupture, whilst seeking to understand it better. As is often the case, such threats mimic similar ruptures in relationships in the patient’s external world, and a skilled therapist is able to point this out sensitively to their patients in a way that helps them to think about their experiences in a safe setting. An ability to create just such a dynamic process, of moulding an intervention to the here and now of the patient, could be thought of as a key engagement skill in the repertoire of an experienced therapist.