For Mental Health Practitioners: How to correctly attune with your client?

Attunement: A Very Important Therapy Skill

This year, I want to engage and focus more on my role as a Clinical Supervisor. One thing that took me a while to deeply appreciate and learn is “real” or deep attunement with the client, especially because this is not an integral part of second-wave CBT.

I always tended to not make topics or emotions too heavy and to keep it on the lighter side, so that clients feel more comfortable to talk about different difficult events.

However, to really access emotions and connecting with “that part” of the client and to create the room for processing and healing, deep attunement is the “golden skill” and simply necessary. I would like to express here my personal thanks to Dr. Robert Brockman that guided me in this journey.

One of the most important skills of any therapist is the ability to listen and empathize. So-called “Schema attunement” goes beyond the basic level of reflecting emotions to provide a higher level of understanding.

The purpose of attunement is for the client and therapist to share an experience of an inner state to give the client a sense of “feeling felt” (Siegel, 1999). 

The following benefits are received through attunement: 

  • The communication of attunement validates the client’s needs, feelings, experiences, and foremost lying the foundation for healing the failures of previous interpersonal experiences. 
  • Making clients aware of their emotional needs provides the groundwork for effective intervention and helps the client to share, experience, and ultimately tolerate a smaller more manageable amount of emotional pain. 

How to archive schema attunement? 

  1. Ask the client to recount a specific event when a difficult emotion was triggered OR tie a wider narrative to a specific event e.g. “I just keep on feeling anxious and alone”, ask instead: “When did this feeling of being lost come up most recently?” 
  2. Move into the EMOTIONAL REACTION and if necessary INTENSIFY attunement by asking the client to close her/his eyes to increase the level of emotional experiences. Let the client connect emotions, body sensations, behavioral urges, and needs at that moment. e.g. “How did you feel when your husband walked out of the door without saying anything?” Ask to label emotions and bodily sensations.
  3. TUNE into current feelings: both for you and the client. Ask: “What did this mean for you?” Connect the experience to one of the 18 schemas (more about schemas) e.g. Abandonment schema: ‘It means that sooner or later I am going to be left by people I care about and I feel like I cannot do anything about it”
  4. SLOW DOWN and reflect on your understanding. You are looking for their resonance. If it does not quite match, go back to step number three. IMPORTANT NOTE: Do not allow your client to gloss over and move on to another narrative or trigger.
  5. VALIDATION and provide HISTORICAL LINKING to expand the broad narrative. “This scene you just describing to me reminds me a little bit on a scene during our history taking where you shared with me that your father always walked silently away when there was an argument in the house and you never knew when or if he would come back”
  6. Move into EXPERIENTAL TECHNIQUES, such as imagery rescripting or chair dialogues, or EMDR trauma processing. once your client is in touch with his/her emotional activation and can tolerate it.

Important Therapist Tip: Don’t assume that you know which schema is activated, but take your time to explore emotions in a given context!

If you are intersted to become a supervisee, I offer online and offline supervison cosultatations.

Reference: “Contextual Schema Therapy” by E. Roediger, B. Stevens, and R. Brockman.

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