This submission is a follow up on the previous ‘ask Jimmy’ post, which can be found here. This exchange was from April this year. There were a few follow ups after this as well, I’ll post those in the coming months as well.

Click here if you would like to submit your own question to Jimmy.

Please note: I have shortened the responses for somewhat to help anonymity and for conciseness, so some of the niceties have been removed as well.

The submission (via email)

Thank you! This was very helpful!

There is still one thing I wish you could address (if possible). My issue has something to do with “what works” in therapy. As far as I can tell, one isn’t really certain, but it seems intuitive that there has to be some kind of change for the client between session (because if nothing changes, either externally or internally, for the client) then the ORS will not increase. I think your suggestions are on point (in that they will help make the client “change” in certain ways), but maybe you have something more to say about why doing “so little” can still make people change?

One clue might be with what you wrote in your blogpost titled “If science is nothing but trying – how much should we try?”. I am thinking of the figure of the contextual model. In that figure there seems to be three things that will lead to symptom reduction. Two of them seems to imply “techniques” (the middle and bottom “paths”), while one is only about the “real relationship”. Maybe this is a clue? Can you rely (at least initially) on the relationship alone to get some initial changes in the client?

I am interested in hearing what you think about this!

I am also interested in litterature on this, so any good books or articles you know about is appreciated. The above mentioned figure is from Wampolds “The Cycle of Excellence”. Have you read that, and can you recommend it?

Thank you again for taking your time on this. I really appreciate it!

Jimmy’s response

A little more context about how I operate before I answer your next email as best I can. One of my weaknesses, is that I’m not all that across books or research when it comes to my understanding of Deliberate Practice or therapy outcomes (except for those mentioned on my website). I predominantly lean on ‘practice based evidence’ and coaching. I only read to answer questions and once I find an answer I’m happy with, I stop reading. It’s partially because reading can take ages and sometimes I don’t even end up close to an answer. What I actually prefer to do most is ask others for their opinions and experiences – I find that far more engaging, interesting and fulfilling. That’s not to say I won’t have any suggestions at all (more on that at the end).

The reason I want to give you the above context, is so that you understand my response below will largely be coming from my own beliefs and experiences in my work – so please take it with some a grain of salt.

Now onto your email. Yep, I would also agree that a client has to experience some sort of change for the ORS to change (the challenge is knowing where that change is coming from, but that’s another topic).

Here’s why I think “doing little” is often key to help in maximising a client’s change. It’s a central belief in that doing little, you are actually doing a lot. There’s a number of underlying reasons for this belief, but these are all theoretical:

1. In doing little, you are effectively getting ‘out of the clients way’. You are encouraging, supporting and allowing them to lead and fill in their own therapy journey. It’s a journey that is more likely to be centred around their individual, preferences and needs – not my interpretation of such things. One thing my DP journey has taught me, is how incredibly easy it is to misunderstand or mishear someone – which can have integral impact on the likelihood of positive therapy outcomes. As Daryl said to me “ a mind cannot survive without another mind” (we all need belonging). It’s when a mind feels heard and seen, truly and deeply, is when it best opens up to another mind (I added that bit). In more therapy terms, I believe doing little in this way helps strengthen the therapeutic relationship.
2. When the therapeutic relationship is strong, the client is more likely to then engage in ‘therapeutic’ or ‘healthy’ actions. I think of this one anecdotally from my own therapy as a client. I was far more likely to try homework suggested by a therapist when I felt heard and understood. The more heard and understood I felt, the more I was willing to try. For therapists where I felt unheard, I didn’t try anything they suggested.
3. It also means that when a client feels heard and seen – your interventions are more likely to ‘fit’ better. Because you heard them, you more likely heard the nuanced ways they need an intervention or strategy tailored to them as an individual. The client will hopefully then be more likely to put effort into trying those strategies, increasing the likelihood the strategy has a positive impact.

It’s also akin to “work smarter, not harder”. The reason I lean on this idea of doing little is not just for the client, it’s for me too. It helps me manage my own engagement and fatigue levels. I can quite easily experience tension headaches if I work too hard and that includes in therapy sessions. I’m also starting to wonder if I have ADD (or at least traits) – which if true, would mean I need systems to help me manage my brain in sessions.

All this isn’t to suggest I have mastered “doing little” myself. It’s still something I am working on, especially via Deliberate Practice coaching that I do with the great Daryl Chow.

In essence though, I think my point today is that ‘doing less’ is more about listening better, to help a client feel as heard, seen and understood as humanly possible. When you achieve that – magic happens.

I’m also saying that yes, you can rely on the relationship to get some initial changes, which is done by listening better. In my view, the relationship is an integral first domino to fall, the bigger that domino is, the more that will subsequently fall.

As I mentioned at the beginning, unfortunately I don’t have any suggested readings. I haven’t come across the book you mentioned actually. I found the figure in Bruce’s other book “The Great Psychotherapy Debate”. What I can say is that I believe the way forward is to open yourself up to listening as best as possible. Do that by continuously asking questions (to listen to the responses), practice listening in your personal relationships and obviously to your clients. If you don’t already, I often simply google what I’m trying to improve, some of the best information I found on listening was actually in blog posts that other therapists had written. I think I googled something like “the power of listening”.

I hope that’s helpful, please let me know if I didn’t answer your questions in any way. I am more than happy to keep going back and forth as long as you like. Even if it’s about something else 😊

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