Creating Authentic Working Relationships with No Bullshit Therapy

02/05/2022

Jeff Young is the Director of The Bouverie Centre and Professor of Family Therapy and Systemic Practice at La Trobe University in Melbourne. He is a clinical psychologist and family therapist and has worked, published and presented in the area of Mental Health for over 30 years. Jeff developed No Bullshit Therapy which combines honesty and directness with warmth and care. No Bullshit Therapy informed his PhD gained supporting drought counsellors across the state of Victoria, for which he won the Anita Morawetz research prize.

Hi, I’m Jeff Young and I practice what I call No Bullshit Therapy. 

Client: What’s that? 

That’s when I don’t bullshit you and I hope you won’t bullshit me. 

 This is how I introduced myself to Gary, a man in his late 30s who was angry; angry that he had to spend $50,000 on legal fees trying unsuccessfully to have greater contact with his two boys, Toby six and Will eight; angry that his in-laws had joined forces and conspired against him. Gary’s ex-partner had initiated family therapy without his knowledge and now as a result he was expected to attend an individual session with me. Furious, he felt manipulated, lied to and cheated.

Gary’s shoulders relaxed and he responded surprisingly authoritatively, That’s exactly the way I like to operate. I spoke honestly and directly to Gary with small and judicious moments of warmth and care. I was upfront about the difficult circumstances which had brought us together. Clearly, unambiguously and unilaterally, I explained how I saw the purpose of the meeting and how I imagined it would unfold. I pointed out I was happy to help him but would understand if he walked away. In essence I broke most of the rules I had learnt in my therapeutic training about how to engage clients.

I am Professor of Family Therapy and Systemic Practice, a clinical psychologist and family therapist, who has developed No Bullshit Therapy over the past 19 years, initially as a strategic approach to engage angry men who were suspicious of me and fearful of therapy and more recently with the intention of establishing authentic relationships with clients who are cautious about receiving help. For the past 12 years I have been the director of Australia’s biggest and most renown family therapy agency, The Bouverie Centre, an integrated practice-research-translation centre within La Trobe University. The Centre integrates clinical family therapy, academic teaching, practice and service development, and research across a wide range of community programs especially in mental health and alcohol and other drugs services. The integration of these activities creates a stimulating workplace for Bouverie’s 60 staff and provides an ideal professional context for the development of innovative therapeutic approaches which embrace real-world complexities.

I love therapy. I chose to make it my career and I want to make it available to everyone. It took me several decades of working firstly as an individual psychodynamic psychotherapist and then as a family therapist to realise that many people don’t share this love. I have come to accept that people like Gary, who don’t like therapy, often don’t care much for us helping professionals either. As David Wexler, a clinical psychologist from San Diego who specialises in highly conflictual relationships points out, relying on traditional models of therapeutic practice or trying to massage people like Gary into being more like clients who like therapy does not work.

People who love, or at least endorse, therapy see it as a supportive and a safe encounter where the process of talking to a trained and empathic professional can lead to an improved quality of life. In short, they trust the therapist. People who don’t embrace therapy commonly view therapists as manipulative, indirect, touchy-feely types, who stick their noses where their noses don’t belong, or as wishy-washy do-gooders who have no idea about the real world and who, given half a chance, love nothing better than making regular folk look like idiots by psychologising everything. I realised over time, that rightly or wrongly, many people who are marginalised by traditional therapeutic approaches worry therapists like me will use their educational training, techniques and status to intimidate, manipulate and shame. I refer to people who hold these extreme negative views about therapy as therapy haters, which is meant to be a light-hearted but confronting term to acknowledge that not everyone likes therapy. I do not blame therapy haters for this stance – I blame the context which creates therapy haters or the models of practice and clinical approaches that fuel therapy hating. For example, the therapy hater may be mandated or pressured to attend counselling. I also respect that hating therapy is a reasonable stance in itself – it is simply different to my own view of therapy.

I’ve realised that most models of therapy are developed by therapy lovers for therapy lovers and when a therapy hater comes along, they are often pathologised as ‘not wanting to change’ or ‘not accepting responsibility for their problem’ (which has usually been defined by someone else). Therapy lovers afford professional counsellors the luxury of time. If something is unclear about the context of the encounter, the description of the work or the therapist’s approach, the therapy lover will often interpret this uncertainty in the best possible light, or at least in a neutral way that will allow the therapeutic process to evolve and correct itself over time. The therapy lover is usually open to co-constructing a mutually satisfying therapeutic agenda, even if the work itself may be difficult. A client showing good faith allows the practitioner time to clarify and to re-orient the work if this is needed. For example, a therapy lover is likely to interpret my questions about their family of origin as:

I guess Jeff is asking about my family background, even though I’m here to talk about why my daughter is refusing to go to school in order to understand my background so he can help me address my daughter’s truancy, eventually.

The therapy lover may even ask a facilitative question to help get me back on track or to link my inquiry with their main concerns, in this case why the client’s daughter is refusing to go to school. The therapy hater on the other hand is likely to interpret any ambiguity in the worst possibly light. For example:

Jeff is asking about my family background because he obviously thinks it’s my fault that my daughter isn’t going to school and he’s trying to rake up some muck so he can pinpoint exactly where he thinks I screwed up!

No Bullshit Therapy: How to engage people who don’t want to work with you is based on the idea that therapy should fit clients, not the other way around.

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It is an approach I created to engage people who at first, may appear like they don’t want to be helped, or more accurately, don’t want your help. Others may want you to help them: worried parents; effected partners; concerned friends. Alternatively, these clients may have been told to seek your help by other professional helpers, by government institutions or by legal mandate. Because they have been forced to seek your help in some way, or because they simply don’t believe you or your organisation can, or really wants to help them, they are likely to resist your attempts to help. Maybe by letting you know emphatically that they don’t want your help or if they are not so assertive or need something else from you or your service, using creative ways to appear like they want your help – when they don’t, such as apparent acquiescence, extreme but distancing politeness or ‘saying what they think you want to hear’.

If any of these circumstances are familiar, NBT may be helpful and it may make your work more effective, your working relationships more authentic and your work more rewarding. However, these working relationships are not easy and so there are often no simple solutions – so NBT is not a panacea – but it is an unusually simple framework that can be surprisingly effective.

As you can see by the NBT clinical guidelines below, they are embarrassingly simple, but take time to put consistently, artistically and effortlessly into practice:

  1. Establish a mandate (how or what to work on)
  2. Marry honesty and directness with warmth and care
  3. Be upfront about constraints
  4. Avoid jargon

The guidelines seek to establish authentic working relationships by creating safety, trust and respect, driven by mutual honesty and directness. Levels of honesty and directness can be collaboratively negotiated with therapy lovers but may have to be presented unilaterally, such as your favoured way of working, at least initially, with therapy haters. Either way, I have found creating contexts for mutual honesty, sometimes just by stating that is how I like to work, to be liberating and productive. If combined with warmth and care, honesty and directness can enhance intimacy, connection and trust.  Trust is further enhanced by addressing the complications and unspoken constraints to the work in a non-defensive, clear, simple and matter-of-fact way. The way to engender the elements that make all therapeutic work effective (trust, safety, openness and warmth) is different for therapy haters and therapy lovers. I’ve found therapy haters prefer an upfront, business-like approach.

Interestingly, the practice of NBT is consistent with the general trend toward greater transparency between therapists and clients about how to approach the work, how the work is progressing and whether the goals of the work are being met. Most tasks, but especially sensitive tasks are typically facilitated when everyone knows the purpose of the encounter, the process in which the goals of all parties will be addressed and the rules that will govern the work. People who are expected to be clients but who don’t know the rules of the therapeutic game are at such a disadvantage that they, not surprisingly, are likely to respond by politely disengaging from therapy or trying to actively, sometimes aggressively, disrupt it.

You can now learn more about No Bullshit Therapy via an interactive, self-paced online learning suite, produced by The Bouverie Centre. The full suite takes 10-15 hours to complete (depending on how many simulated NBT sessions you watch).

For costs and to register: https://www.latrobe.edu.au/research/centres/health/bouverie/courses/pd/self-paced/nbt
For other Bouverie self-paced online learning suites visit: https://www.latrobe.edu.au/research/centres/health/bouverie/courses/pd/self-paced

 

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