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Dr. Dana Rhule: What Makes Therapy Work?


As part of an ongoing series, the staff at Union Square Practice will be sharing their thoughts on an important question: “What makes therapy work?” This week, Dr. Dana Rhule, Union Square Practice’s Child and Adolescent Program Director, shares her thoughts.

Unlike the other clinicians here at Union Square Practice, I am a child psychologist, which means that I provide therapy almost exclusively for children and adolescents. So that’s what I will focus on here: what makes child therapy work.

I believe that many indefinite variables contribute to the success of a child or teen in therapy. But at the end of the day, three ingredients seem necessary, if not sufficient:

  • A positive, safe, and judgment-free relationship of the therapist with both the child and parents.
  • An agreed-upon course of action.
  • An ability to access a family’s motivation to engage and change.

I’d like to explain what I mean by each of these ingredients below:

A positive, safe and judgment-free relationship: In therapy, both children and parents are first asked and then dare to be incredibly vulnerable, open and brave. Parents place ultimate trust in a therapist to guide them and their child; to do so, parents need to know that their therapist is putting their best interest at heart. For therapy to be effective, both parents and children need to feel safe enough in order to be honest about their feelings and behavior, to acknowledge their struggles, and to take risks to grow and change, oftentimes facing their biggest fears.

An agreed-upon course of action: To help create the safety I mentioned earlier, it is so important to establish mutually acceptable goals, as well as the expected steps to get there. These goals and steps may shift over time. But confusion, disappointment, misunderstanding and broken trust are much more likely to arise without a shared understanding of the journey and destination.

An ability to access a family’s motivation to engage and change: Finally, therapy works when a therapist can tap into and foster a child’s or family’s motivation to make important changes. It’s important to keep in mind that this motivation is further strengthened by a safe and positive relationship and agreed-upon goals. Additionally, the most effective child therapists (and teachers and parents) harness the power of positive reinforcement, creativity and FUN to engage a child in the process of learning and change.

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