Research shows clearly that there is one element in counseling that correlates most strongly with success. It is called the therapeutic alliance. If this therapeutic connection between counselor and patient is good, they experience mutual respect. They are working toward shared goals, and the process in the counseling room is comfortable for both of them.

Therapists don’t like this research, because we want to believe that it is our favorite theories or practiced techniques that help our patients. These can be good elements of a patient’s experience, but it’s the quality of the therapeutic alliance that counts the most.

We had an in-service training recently on how this therapeutic alliance can be strengthened. Our presenters had a whole list of good ideas, most of which were familiar to me. They made one point that was new, and I have been thinking about it ever since.

One of the presenters had made an arrangement with his coworker to use “the waiting room factor” to strengthen the therapeutic alliance at the very beginning of treatment. When a new patient arrived in the waiting room, the therapist who was not treating the patient greeted him/her, offered beverages, started the paperwork, and in those few minutes, found an opportunity to say that the treating therapist was a kind, skilled clinician, predicting that treatment would go very well.

This technique had the purpose of reducing the patient’s anxiety before meeting his/her therapist and increasing the patient’s optimism about the outcome of treatment, thereby enhancing the therapeutic alliance from the very first moment of treatment.

If these two clinicians had not had genuine appreciation for each other, this technique would have been false and manipulative. But, both of them were speaking the truth and predicting a good outcome based on their experience with each other. Our presenter’s opinion was that using this waiting room factor was a good thing, improving the patient’s feelings about the first session, enhancing the prospect of success for the whole counseling process.

In my thinking about “the waiting room factor,” one thing seems clear so far.

This process of providing a positive, optimistic welcome for new patients should be expanded beyond two therapists to include every part of that patient’s experience with our center. In the first phone call, the insurance verification, scheduling, and instructions for parking, the atmosphere of the waiting room and the comfort of the chairs in the counseling rooms, we should be communicating to patients that their experience at our center will be positive and successful.

New patients are never comfortable when they call our center or arrive at our front door. They are admitting that something is wrong in their life, and their emotions are on edge, despairing, afraid, ashamed, guilty, angry, etc. Clearly it makes perfect sense that a positive, hopeful experience, regardless of the therapist’s theories or techniques, would contribute to their comfort and healing.
Copyright Gregg Dana 2007