Enhancing the Alliance Clinical TIP: Positive Affirmations
The quality of the therapeutic alliance consistently predicts treatment outcomes regardless of what kind of modality is being used. Unconditional positive regard and acceptance are fundamental to providing a warm, nonjudgmental environment for clients. In this Enhancing the Alliance Clinical Practice Tip, we will explore the practice of affirmations which demonstrate a practitioner’s unconditional positive regard and acceptance.
A practitioner’s unconditional positive regard and acceptance can reduce drop out and improve collaboration and faster improvements with symptoms and problems. Furthermore, behavior that is affirmed will continue and often increase!
This clinical tip is a step-by-step guide to putting affirmations into practice.
Values are central to how we understand ourselves and how we make decisions. Values inform what we find important in life; they are our guiding principles.
Examples of Values: Family; Faith; Compassion; Trustworthiness; Determination; Honesty; Justice; Loyalty; Citizenship; Openness; Respect; Service; Knowledge; Growth; Simplicity; Cooperation; Tolerance; Thoughtfulness; Sense of Purpose; Hope; Optimism; Fairness.
Notice the affirmation of values in the following examples:
“When you talk about your family, your affect changes, and you light up. I get the sense that your family is important to you, and you are thoughtful of them in your decisions.“
“During our group meeting today, Jonathan talked about politics, and I know that you hold differing beliefs. You showed an openness to hearing his opinion and respect for his viewpoint.“
“After so many attempts at securing housing, you finally made it happen. You show such unwavering determination.“
Accomplishments can be anything a person does that takes effort. Each accomplishment is specific to that person’s situation.
Examples of Accomplishments: Reaching out for services; Abstaining from or reducing the amount of substances being ingested; Setting a boundary with another person; Completing probation; Volunteering in the community; Applying a new parenting skill; Finding employment; Completing paperwork; Attending a doctor’s appointment.
Notice the affirmation of accomplishments in the following examples:
“Stephanie arrives at the clinic behind schedule, looking flustered. Immediately upon catching your eye, she apologizes for being late. You reply by saying, “It’s remarkable that you made it today given all that’s going on in your life. I know it was a struggle to get here today.”
“Jack is consistently asked to stay late at work, and it is putting a strain on his relationship. You role-play in therapy what he could say to his boss to set boundaries with his time. He goes on to have the conversation. In your next session, you say, “I saw you wrestle with setting that boundary. What a huge step in advocating for yourself.”
“Brenda confides in you her disappointment that she drank a glass of wine after remaining abstinent from alcohol for six weeks. You inquire what a typical day of drinking might have included in the past, and she replies two bottles of wine per night. You respond by saying, “It appears you have made incredible strides towards your goal of reducing your drinking; even your temporary return to use was much less detrimental than it was in the past.”
Strengths are attributes that come naturally to a person that helps them achieve their goals, relate to people, and complete work.
Examples of Strengths: Kindness; Generosity; Capacity for Love; Teamwork; Equity; Leadership; Self-Control; Discretion; Modesty; Humility; Gratitude, Forgiveness; Mercy; Enthusiasm; Zest; Curiosity; Love of Learning; Creativity; Social Intelligence; Wisdom; Bravery; Perseverance; Genuineness; Humor.
Notice the affirmation of strengths in the following examples:
“This has been a challenging week for you, and you are still able to find humor in your experience! I appreciate that so much about you!”
“I have witnessed how much you struggle financially, and yet you found a way to help your friend. I am deeply touched by your generosity.”
“You are a single mom, you work two jobs, you are an active and valued member of your church, and you speak about yourself with so much humility. I want you to know that your zest for life is an inspiration to me!”
Effort is the energy or work that an individual puts into something regardless of the outcome.
Examples of Effort: Moving through a treatment plan; Saving money for a security deposit; Working to stay calm during an argument; Questioning maladaptive thoughts; Reducing the number of cigarettes consumed a day; Applying for jobs; Developing insight into a problem.
Notice the affirmation of effort in the following examples:
“Henry has talked for months about sorting through his deceased mother’s belongings to donate to charity. When he arrives at his session, he declares that he began the process. You respond by saying, “I know this task has been weighing on you; it’s significant that you started this process.”
“When you check in with Sophie about her goal to reduce her tobacco use, she indicates that she hasn’t smoked a cigarette in two weeks. You reply by saying, “That’s unbelievable! Once, not too long ago, you couldn’t imagine a day without a cigarette!”
“Jessie indicates that she has meditated before bed every night, which has helped her get better sleep. You respond by saying, “You have shown such commitment to this new practice, and it sounds like you are seeing some new benefits. I’m curious to hear more about it!”
