Building Bridges: Overcoming Therapist-Client Relationship Barriers

Therapy can be a positive tool for change in a person’s life. However, the relationship between a therapist and their client significantly impacts the effectiveness of the treatment.  Unfortunately, many barriers can threaten the therapist-client relationship, including communication breakdowns, power imbalances, and conflicting goals.  

Addressing these struggles early can prevent them from escalating and affecting treatment outcomes. In addition, when therapists approach these struggles with intentionality and self-awareness, it can ultimately improve the relationship and help the client reach their therapy goals. 

Common Barriers in Therapist and Client Relationships

Power imbalances

Therapists may hold significant power over their clients due to their professional position and knowledge. In some cases, this power dynamic can cause clients to feel disempowered, which may discourage them from engaging in therapy.   

When providing therapy for juveniles, the age difference between an adolescent client and an adult therapist can add another layer of complexity to the relationship, as the therapist is older than the client. 

Children and teenagers may view their therapist as an authority figure. They may: 

• rebel against their therapist
• feel condescended to 
• avoid being honest out of fear 
  become defensive during sessions

If an authority figure has harmed a child, they might also feel unsure of their therapist, leading to them being less engaged during therapy sessions.

Communication breakdowns

Misunderstandings or miscommunications between the therapist and client can lead to frustration, confusion, and lack of progress in therapy. Sometimes, communication breakdowns can occur because the therapist misunderstands their client’s culture, values, or communication style.  

For example, clients might use metaphors and allegories to explain their feelings and thoughts. Unfortunately, some therapists might take these metaphors literally, causing them to misunderstand their clients or overanalyze these metaphors instead of addressing what the client is trying to say.

Conflicting goals 

If a therapist's treatment plan doesn’t align with a client’s goals, the client may feel discouragement or frustration, which can also impact the therapeutic relationship. 

For example, a teenage client wants to discuss school-related anxiety. However, the therapist believes the client’s primary issue is their fraught relationship with their parents. Now, whenever the client brings up their anxiety about schoolwork, the therapist gradually changes the topic to their parents. Eventually, the client feels unheard, frustrated, and dismissed. They ultimately decide not to open up to their therapist about their feelings.

Impact of Relationship and Engagement Barriers on Therapy Outcomes

Negative relationship dynamics can cause a client to: 

• be less engaged and less forthcoming during sessions 
• become further discouraged about their situation 
• discontinue therapy without reaching their goals 
• feel wary of getting mental health support in the future 

However, addressing these relationship barriers early on can positively change the therapeutic relationship and ultimately improve therapy outcomes.  

When a therapist deals with the conflict healthily, it can: 

• reinforce the clients’ self-confidence, as they feel respected  
• set a positive example of conflict resolution 
• strengthen the client-therapist bond 
• boost a client’s trust in their therapist  
• encourage a client to engage more during sessions 
• improve a therapist’s understanding of their client 

Ultimately, this can result in a more positive and collaborative therapeutic relationship, leading to better treatment outcomes. 

Multisystemic Therapy and Therapist-Client Relationship Struggles 

Multisystemic Therapy (MST), an evidence-based practice, addresses power imbalances by involving the entire family in the treatment process, empowering both the youth and their family members to take an active role in addressing the behavioral concerns at hand. This collaborative approach helps to ensure that the family sees the therapist as a team member in addressing their goals rather than someone coming in to tell them what to do.  

MST therapists take responsibility for addressing any communication breakdowns with clients.  MST emphasizes cultural competence and understanding the unique needs of each client and their family. All interventions are tailored to ensure they meet the client and their family rather than a one size fits all intervention. This approach helps therapists to better understand and respect their clients' communication styles, values, and cultural backgrounds, ultimately reducing misunderstandings and fostering open communication. 

MST also avoids conflicting goals by developing individualized treatment plans that are tailored to the specific needs and goals of each client and their family. MST therapists place the family in the lead to share their desired outcomes and goals for treatment. This ensures that the therapist and client are working towards the same objectives, reducing frustration and increasing engagement in therapy.

MST Strategies for Addressing Engagement and Relationship Barriers 

MST employs several strategies that can help therapists address relationship barriers, including: 

• Family engagement: Involving the entire family in the treatment process helps to build trust and rapport between the therapist and the client, as well as between family members. 
• Strength-based approach: By focusing on the strengths and resources of the client and their family, MST helps to empower clients and build their self-confidence. 
• Cultural competence: MST therapists are trained in assessing and gathering information regarding the client’s beliefs and culture , enabling them to better understand and respect their clients' unique backgrounds and communication styles. 
• Collaborative goal setting: MST involves the client and their family in setting treatment goals and developing a tailored treatment plan, ensuring that everyone is working towards the same objectives. 
• Emphasis on community resources: MST encourages therapists to connect clients with community resources and supports, further empowering clients and helping them to build a network of support outside of therapy. This ensures that clients and their caregivers have built in support to sustain change after MST treatment ends.

By incorporating the MST Nine Principles and the MST Analytical Process, therapists can effectively address the struggles that often arise in therapist-client relationships, ultimately leading to improved relationships and therapy outcomes.

MST is an evidence-based alternative to incarceration or severe system consequences due to serious externalizing, anti-social, and/or criminal behaviors. MST effectively treats youth and their families by utilizing a built-in suite of interventions within the home, school, and community settings. Treatment is tailored to the family and their individual strengths and needs, which could include but is not limited to the following types of therapies: Family Therapy, Cognitive Behavioral Therapy, Drug and Alcohol Treatment, Mental Health Services, Peer Ecology Assessment and Intervention, Trauma-informed treatment, and Educational/ Vocational Support.  

If you or someone you know is interested in learning more about Multisystemic Therapy,  contact us here.