Generally, whenever a person starts something new, she is oriented to the structure, guidelines, regulations, and setup of that new entity so that she can appropriately adjust her expectations to her new reality. Orientation at the start of preschool might be two hours, and at the start of university, it might be two weeks. In all cases, once orientation is over, it’s done.
That should not be the case with orientation to therapy.
A therapeutic relationship is a relationship between two experts. The therapist is the expert on the treatment or treatments. The client is the expert on herself. The goal is that by combining both parties’ know-how, the client will gradually move in a positive direction toward achieving her goals. In this relationship, even the most educated therapist is not the be-all and end-all leader in the therapy space because although she possesses skilled techniques, without the client contributing her full self to the sessions, treatment interventions will get nowhere.
Theory is great but without fully and properly interacting with the client it remains just theory.
So, what is the point of orienting the client to theory and why is it important to continually orient the client throughout treatment?
Every therapist is trained in at least one specific treatment modality. Often, she is trained in more than one. After meeting a client, the therapist’s task is to infer which treatment or combination of treatments would be most beneficial for the client based on what she knows about the client’s presenting problem, temperament, history of therapy, and willingness to change. Once she has selected a treatment or created a customized treatment cocktail for the client, she must orient the client to the theory and practicalities of what that treatment entails.
It is crucial that the therapist orient the client for several reasons:
The client needs to know what to expect. For example, if the client thinks that sessions will be solely a place for her to vent and the therapist pictures reviewing homework and discussing change, this is a miscommunication that must be resolved before treatment commences.
The client needs to know how the treatment works. Since this is a relationship, it is not fitting for the client simply to blindly follow the therapist; they work together. Just like the client introduces her deep self to the therapist so that the therapist can understand her more, so too, the therapist brings the client to her perspective so that they can be on the same page.
The client needs to own her treatment. While the therapist will be fully present and bring her full self and knowledge to the relationship, the client will be the one doing the hard work of making meaningful changes in her life. For that to happen, she needs to feel comfortable with the treatment plan, have the opportunity to ask questions about it, and bring her own voice, as the expert on herself, into the treatment discussion.
For some treatments and clients, orientation could be completed in one session. For other treatments and clients, it might take many sessions. This range is based on factors including treatment technicalities, personalities, client knowledge and experience, and personal preference.
So why should orientation continue beyond the first few weeks?
Once treatment begins and is proceeding at a fair pace, the therapist should not stop treatment to re-orient the client. Doing so would be arbitrary and not serve a purpose.
As the expert on treatment in the relationship, it is the therapist’s responsibility to identify when:
The client needs re-focusing on a particularity of a treatment
A treatment is not working optimally and needs to be tweaked or changed
In both cases, the therapist must orient the client in some way to either review what was discussed originally or to introduce the client to an adjustment that she recommends and open a conversation about that.
Treatment should not be stagnant. As the client changes, treatment should change as well. Ongoing orientation strengthens the bond between the client and therapist, enables the client to own her treatment, and infuses the treatment with a sense of direction, purpose, and excitement.