Client shares a lighthearted moment or joke with the therapist.
This item refers to a behavioral connection through humor or good will, typically signalled by laughter. The comment could be initiated by the therapist or the client, but both parties need to be simultaneously amused for this item to be checked.
Client verbalizes trust in the therapist.
The client’s comment might be an overt statement like “I trust you,” or a more implicit remark that suggests trust, such as, “I know whatever I say here stays in this room” or “This is something I couldn’t talk about with other people.” The comment is more than an indicator of feeling safe in the therapy context; it needs to connote a personal sense of trust in the therapist, a recognition that the therapist is a trustworthy individual. Other examples include, “I believe what you’re telling me.” In distinguishing between this item and “feels understood or accepted,” the crucial element is trusting the therapist or trusting that what is said in therapy will be held in confidence. If the comment indicates that the clients feels trusted by the therapist, consider the item “feels understood or accepted.”
Client expresses interest in the therapist’s personal life.
Clients sometimes ask questions about the therapist’s situation, such as whether he or she is married or has children or whether the therapist is spiritual or religious, or where the therapist grew up. This item can be checked if a direct question is asked or if, in response to the therapist’s self-disclosure, the client follows up with a comment that suggests interest in the therapist as a person. As one example, the therapist talks about his grief when his father died, and the client asks, “Was he very old?” This item is not to be checked if the client asks about the therapist’s credentials or professional experience, or if the question is delivered in a manner that suggests defensiveness, a lack of confidence, or testing (“How do you feel about gays?”).
Client indicates feeling understood or accepted by the therapist.
This item implies more than a sense of safety and comfort in therapy; it requires some indication that the client feels valued, respected, or trusted by the therapist. An explicit verbal comment might be made, such as, “I know you don’t judge me like other people do” or “I could tell YOU, but no one else.” Alternately, the client’s response might be nonverbal, such as tearing up after the therapist makes an empathic comment. Nonverbal responses like these, however, should only be checked if there is a clear implication of feeling understood or accepted.
Client expresses physical affection or caring for the therapist.
This item is checked when, for example, the client offers his/her hand at the end of a session, or asks for a hug. Caring can be inferred from comments like, “Are you feeling better? You were sick when we were here last week,” or “What you think means a lot to our family.”
Client mirrors the therapist’s body posture.
For this item to be checked, arms and the legs must be placed similarly. It is not necessary to try to determine whether the therapist mirrors the client or vice versa. (That is, a connection between client and therapist is reflected in the mirroring, regardless of who mirrors whom.) This item should only be checked once during a session, unless the client is clearly and obviously mirroring every move of the therapist. Mirroring can be associated with specific body posture changes, as when the therapist shifts body position notably when the discussion becomes more
intense and the client mirrors that movement. When working with adolescents, it is common for therapists to mirror the adolescent’s informal body posture.
Client avoids eye contact with the therapist.
For this nonverbal item to be checked, the client must, clearly and consistently, avoid eye contact with the therapist. There can be momentary “peeking” at the therapist, however. If the client avoids eye contact for a substantial period of time
(minutes, not seconds), this item can be checked. Also, when the therapist asks a question (“Do you want to continue our sessions?”) or says something directly to the client in a context in which eye contact is expected, if the client avoids making eye contact, the item should be checked.
Client refuses or is reluctant to respond to the therapist.
This item is checked when, either verbally or nonverbally, a client fails to respond to a direct request (question or remark) from the therapist, indicating either a negative reaction to the therapist or not wanting to comment. A lengthy silence in response to a question is one example if, in context, the silence suggests a clear reluctance or refusal to engage when invited to do so. Silence that occurs because the client is thinking hard about what to say should not be checked. Verbal expressions of reluctance include, “I’d rather not talk about it,” or “It’s none of your business” or “That’s personal.” If the client is clearly reluctant but later relents and does respond hesitatingly, the item can be checked if the reluctance was notable or prolonged.
Client has hostile or sarcastic interactions with the therapist.
This item is checked only if there is tension in the room and/or anger is expressed, not merely a disagreement about what was meant or what should be done. Essentially, this item connotes a disrespect or de-valuing of the therapist on the part of the client.
Client comments on the therapist’s incompetence or inadequacy.
Typically, it is client “hostages” who make cutting remarks about a therapist’s competence. This item is checked when the client’s comments suggest a belief that the therapist is not behaving therapeutically, ethically, doesn’t know what he/she is doing, can’t possibly understand, doesn’t have sound credentials, and so forth. This item speaks more to the therapist’s ability to work with the client than to feelings about the therapist as a person. Deprecating personal remarks are indicated by the item “hostile or sarcastic interactions with the therapist.”