effective therapy

Is an Excellent Therapeutic Alliance the Secret to Effective Therapy?

Defining the Therapeutic Alliance

Sometimes called the "therapeutic alliance," and other times, the "therapeutic relationship," this term describes how the child and therapist, be it face to face or via teletherapy, engage and connect. There are those who say very simply that this intangible but genuine connection is the "bond" that develops in the therapy room.

In today’s world of therapy and counseling, most see the therapeutic alliance as an essential tool for effective therapy. Aside from the necessity of developing therapeutic skills and techniques, for a clinician to be truly successful, s/he must devote ample time and focus on developing a healthy relationship with the client as well.

In the early days of psychotherapy, there wasn’t much emphasis placed on the importance of this relationship. It wasn’t until Carl Rogers, the founder of humanistic or ‘person-centered’ therapy, came along in the 1950s, that clinicians began to see the critical connection between successful therapy and this alliance.

The Importance of the Therapeutic Alliance

Today there is a significant body of research demonstrating the benefits of the therapeutic alliance developed between therapist whether onsite or delivered via teletherapy and client.

A comprehensive 2011 overview taking into account many of the previous studies on the subject made the following assertion that “the quality of the client-therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures.”

When you think about it, this makes perfect sense. At the core of any relationship between friends, family, or colleagues is trust. And so it follows that any benefits accrued through such a relationship are built upon that trust. What transpires in the therapy room between therapist and client is no different.

Ironically, many of those who seek help from a therapist doesn’t feel at ease around other people, and that includes their family and friends. Generally, their past is riddled with events and relationships that taught them quite the opposite, to be suspect of others even when they profess to love. This is often why they are in therapy altogether!

This is why the alliance or relationship between therapist and client isn’t only valuable but is essential. The child who has been placed in therapy by a parent, caretaker or administrator can’t expect to get very far without this cornerstone of trust and genuine belief that the therapist is there to help.

For some children, the most crucial aspect of the therapy, at least at the beginning, is that the child finally can experience what it means to relate healthily to another person. Perhaps for the first time in his/her life, the child can remove the mask, stop playing the games, and feel safe interacting with an adult from whom there is no fear.

Key Ingredients of a Healthy Therapeutic Alliance

Carl Rogers, known as “the father of the therapeutic alliance,” laid out the three primary aspects of a healthy therapeutic relationship.

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  1. Empathy- Is the therapist supportive and understanding?

  2. Congruence- Is the therapist genuine and not pretending to be a ‘guru’?

  3. Unconditional Positive Regard- Does the therapist see your human value?

Ways to Nurture the Therapeutic Alliance

Keeping the client feeling emotionally safe

Children may be little, but they can often sniff very early on in the session if the therapist, whether face to face or vial teletherapy, is judgemental. While the child will want feedback from the clinician, that’s providing the feedback is given in a manner that is informative and not critical.

It is often not so easy to distinguish between criticism and feedback, but the child, while perhaps unable to articulate the distinction, knows the difference.  Both feedback and criticism involve evaluation; however, the difference lay in that criticism contains fault finding and judgment, whereas feedback is merely passing on corrective information.

It is imperative that in conjunction with sharing feedback that is constructive, the therapist maintains an abiding interest in building the child’s self-esteem. Sharing appreciation of the child, positive comments when appropriate, and expressing enjoyment of the session will often go a long way to enhancing the child’s self-esteem.

The Power of Relationship

Therapists often claim that they rarely recall either from their reading research studies, or their own clinical experience where clients reported that it was some particular intervention or technique that was most helpful to them. Instead, clinicians say that clients told them that feeling understood and heard was the most valuable part of the therapy.

Let’s not kid ourselves. The therapeutic relationship doesn’t replace effective therapy. But without the rock-solid foundation of the relationship between therapist and client, most therapists agree that anything else accomplished in the session won’t have much if any long term value.

There is no set formula that will facilitate creating the emotional bond between therapist and client. The chemistry will be different in every situation. It might be a strong emphasis on offering supportive and positive feedback, sharing humor, empathetic listening, or impressing upon the child the therapist’s genuine compassion and concern.

Acceptance, Validation, and Empowerment

Another crucial aspect of the clinical session is assisting the child to open up so he/she can be heard and understood. This won’t happen unless the child feels safe and unconditionally accepted. Once the child opens up, it is essential to validate what the child said to promote a sense of comfort with regards to expressing feelings.

Allowing the child the freedom to stray from the straight and narrow path of the session and veer off on tangents can have a potent subconscious impact on the child. The child feels more than just the object of the dialogue. Instead, by taking the initiative the child feels empowered. This can be very beneficial to the therapeutic relationship.

Bottom Line

Taken together, these various contributors can do much to cement the bond between therapist, be it face to face or via teletherapy, and client. The bottom line?  Perhaps the most significant factor in an active, healthy, effective therapeutic alliance is for the therapist to help the child. Genuine help more than anything else will build that precious trust and all but guarantee an upward spiral of success in the therapy.

loneliness children online therapy

Is the Loneliness Epidemic Afflicting Our Children As Well?

Increasing Loneliness Among Children and Adolescents

Loneliness has long been thought of as a problem afflicting the elderly. However, research suggests that both children and teenagers are also increasingly being affected by this painful social problem. It has been found that children are frequently both expressing and seeking support for their feelings of being alone and isolated.

In fact, new statistics show that there is a rising number of children who are contacting Childline (an organization that provides information, counseling, and referral services for families and children to ensure the safety and well-being of the children) about feelings of isolation and loneliness.

These figures show that girls report their loneliness almost four times more than boys. While this may or may not reflect the actual numbers as it may be that girls are more apt to reveal their feelings that boys, nonetheless, many girls are suffering.  The children claimed that their loneliness was often due to social media and parental neglect.

The Multiple Adverse Effects of Loneliness on Our Youth

The connection between social behavior and normal development

We all know that healthy social relationships are much more than just the joy of sharing experiences with friends, but are central to human well-being. As a consequence, it has been argued by many in the field of mental health that engaging in social interactions and behaviors are vital to a child's healthy development.

And the converse is true as well. Absence of these interactions and relationships are detrimental to the child's development in various ways. Research has shown that children who suffer social isolation generally perform inferior in the educational realm, are more likely to be part of a less advantaged social class as an adult, and are more prone to psychological distress throughout their lives.

How Insufficient Social Interactions Impact the Stress Response

Unfortunately, children who don't have the necessary amount of social interaction or relationships will gradually become socially isolated and experience the pain of loneliness. The research has found that this loneliness is linked to higher levels of stress.

The human stress response is designed to protect the body from environmental threats and dangers. Because social interaction is a basic human need when a child is denied the satisfaction of that need the stress response mechanism in the body perceives the situation as a threat.

When this stress response mechanism is triggered, the brain automatically releases stress hormones to protect the body from the perceived threat, thus activating the body to protect itself from danger. However, the body cannot release these stress hormones and protect the body from stressful situations indefinitely.

When this stress response becomes activated over an extended period, the body is at greater risk of developing high blood pressure, an infectious illness, deterioration of the cognitive faculties and cardiovascular disease, which depending on the severity can potentially be fatal.

Social Support Helps Children Survive and Thrive

Research has shown that when a person receives social support, stress levels not only drop but that social support helps people to cope with high levels of stress from other sources. Also, research has suggested that social support is instrumental to a person's feelings of competence and mastery, which are so critical in increasing one's quality of life.

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Social Isolation and Mental Health Problems

In a research study of 4,227 adolescents, scientists at the Norwegian Social Research Institute (NOVA) compared youths who had a close friend in whom to confide with those who didn't and found that those without such a friend had a significantly higher preponderance of depressive symptoms than those with close friends.

Other studies have shown that there is a greater connection in depressive symptoms in loneliness due to a lack of friends than isolation due to a poor relationship with parents. It could be that for adolescents, social support from friends is more critical than the support from parents.

The Dangerous Impact of Loneliness on the Brain

In tandem with those studies that show an increased stress response when a person feels lonely, loneliness increases the brain's alertness, which can cause insomnia. It has also been shown that social isolation and a lack of relationships can have a detrimental effect on the structure of the brain.

Studies done with mice and young monkeys subjected to extreme social isolation demonstrated how damaging this isolation could be upon the brain. At the beginning of their development, the mice and monkeys were quarantined for a couple of months to study the impact of being socially isolated on their cognitive functioning.

This isolation caused deficits in the chains of communication in cells known as oligodendrocytes impairing functioning in the prefrontal cortex of both the mice and the monkeys. Damaging the connections in the prefrontal cortex reduced essential cognitive functions such as social interactions and thought.

These scientists suggest that just as the social isolation of the mice and the monkeys disrupted brain functioning, the findings could be extrapolated to children as well. In other words, social isolation could be responsible for deficits in brain function.

In a different study, it was shown that social isolation retards the activation of dopaminergic and serotonergic neurons. Activating these neurons is critical to maintaining our emotional well-being.

Relieving Our Children's Loneliness

Parents who sense that their children may be suffering from loneliness shouldn't make light of it. On the contrary, they should engage their children in conversations about friends, relationships, and social interactions in general. Also, they should be very aware of how their children's' usage of social media is affecting their mood.

Sometimes children don't open about something as sensitive as their social life. In which case, Childline offers the following advice:

  • Begin the conversation at a time where there won't be an interruption such as on a ride in the car or on a walk.
  • If your child says something alarming, don't overact as that may mean the end of the conversation.
  • Don't push your child to talk if this isn't a good time. Wait a few days if necessary.
  • Be very careful to honor and respect what your child says. Being that a child's heart is very delicate, it must be treated as such.  
stuttering and speech therapy

Your Quick Guide to Stuttering: How To Cope With It and How to Stop It

1. What is stuttering?

Stuttering is a fairly common condition among children that impairs fluent speaking. While just about everyone experiences moments when their speech lacks fluency, for some stuttering can become a significant challenge that they will need to contend with throughout their lives

Fast facts on stuttering

  1. Most children who stutter when they are little will eventually grow out of it
  2. Stuttering is nearly five times more prevalent in boys than in girls
  3. If someone else in the family stutters it is more likely the child will stutter as well
  4. The earlier as a child the stuttering starts, the less likely it will continue long-term
  5. A speech-language pathologist will officially diagnose the speech disorder

2. Symptoms

Common symptoms and signs of stuttering include:

  1. Making a long pause before being able to say a word is known as a “block”
  2. Repeating either a sound, a word, or a syllable
  3. Extending certain sounds in a word which are known as prolongations
  4. Interjections such as "like," "I mean," "well," or "umm" to delay speech
  5. Hesitating or having difficulty with specific sounds
  6. Speech coming out in short or long spurts

There may be physical indications during speaking as well:

  1. Rapid blinking
  2. Foot Tapping
  3. Tightening up of the upper body muscles or face muscles
  4. Appearing extremely tense or uneasy when talking
  5. Becoming short of breath when speaking  
  6. Either the jaw or the lips will tremble

3. Causes of stuttering

There is considerable disagreement regarding the origin of stuttering. In any event, these factors may either trigger or exacerbate stuttering:

For many years it was believed that the primary causes of long-term stuttering were psychological. However, there is no longer a consensus on this. That being said it is clear from both the research and anecdotal evidence provided by both onsite and teletherapy speech therapists that psychological factors may make stuttering worse for those who stutter already.

For example, stress, nervousness, low self-esteem, humiliation, and any of a host of anxieties that often afflict someone with a speech problem such as stuttering can make the stutter more pronounced; but again, they are not seen by most as the underlying cause.

4. When to seek a professional

  1. If the kid’s stuttering hasn’t abated for over half a year
  2. The stuttering is persisting beyond the child’s fifth birthday
  3. There seems to be an uptick in the frequency of the stuttering
  4. It’s observed that stuttering is accompanied by tightness in the chest or the face
  5. The stuttering is having a detrimental impact on school performance
  6. The child is suffering emotionally such as showing fear of situations or places

5. Some quick tips to arrest stuttering

Breathing with focus

A study published in 2012 showed a direct correlation between deep, mindful breathing, lower blood pressure and the increased flow of oxygen-rich blood to all parts of the body. This breathing and consequently reduced anxiety can have a profound effect on stuttering. Teaching children deep mindful breathing will give them a vital strategy to help them in those challenging moments.

Slowing the speech down

Children like the rest of us speak quickly when they are excited or stimulated in some way. However, this could be a fatal trap when it comes to stuttering. Teaching children who stutter to speak more slowly and deliberately even when it would be natural to do otherwise could be vital in keeping the stuttering under control and preventing a downward spiral.

Staying away from certain words

Research has shown that those who stutter have their list of words that are more difficult to get out of their mouths than others. Help the child to become aware of his/her words, keep a record and be helpful in finding alternative words to use. Take it a step further by practicing these words so they will flow out of the child’s mouth more naturally in a social situation.

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6. Long-Term Solutions to Stuttering

Speech therapy

A speech therapist either face to face or via teletherapy is trained in helping the child manage his/her stuttering and thereby lead a happier more productive life. Be aware that for many kids a sustained effort over time will be needed to eradicate or to even reduce the stutter. That being said, a consistent effort can often produce a drastic improvement.

For some, the necessity for speech therapy delivered either face to face or via teletherapy may not end in childhood but may be necessary at different times throughout life. Aside from strategies and techniques designed to improve the child’s speech, speech therapists are also equipped to teach coping strategies that will minimize the child’s anxiety associated with stuttering.


Whereas the weekly speech therapy session is essential, it is generally not enough. The child must be encouraged to practice and rehearse speaking at home. This is where the help of a devoted parent can be transformative. Practicing at home should encompass these areas:

  1. Speaking slower than usual to experience getting the words out
  2. Speaking through an entire thought without dropping it in the middle
  3. Reducing the anxiety and tension associated with speaking
  4. Taking deep mindful breaths during talking

7. Debunking 3 Stuttering Myths

Myth 1: Stutterers are not good communicators

The inability to speak without a stutter says nothing about the value of the content being communicated, only about the difficulty of the delivery. In a world full of noise and nonsense, the tangible effort that stutterers invest in their speaking make them more trustworthy and genuine, and often will become the catalyst to move the conversation more quickly move beyond the superficial to the more meaningful and profound.

Myth 2: Stuttering is born of personal weakness

Often people respond to the stutterer by advising him/her to, “slow down,” “calm down” or “take a deep breath.” They sincerely believe they are helping, but don’t realize that the unspoke implication is that stuttering is easily controlled. Too often stuttering is viewed as a personal weakness rather than a physical impairment.

Myth 3: Stutterers are perpetually anxious

Many believe that there is an inherent connection between stuttering and anxiety. While the causes of stuttering remain hidden, the latest research suggests that stuttering is related to brain chemistry and the mysteries buried in the genetic code. So if we want to understand stuttering, we need to realize that it is nothing more than a distracting mask.

rural schools teletherapy

4 Strategic Steps to Improve Rural Schools

The Problem

The mantras are all too familiar, "Rural schools have terrible problems.” “Rural schools struggle to recruit and then to retain excellent teachers and administrators.” Rural schools lag behind their urban counterparts in such areas as AP and foreign language classes as well.” And the list goes on and on!

It is true that rural communities generally have higher rates of young people who are neither working nor attending school. According to a recent study, 45% of rural 18- to 24-year-olds without a high school diploma aren’t employed. This statistic goes a long way to explain the particularly high risk for substance abuse which is hurting rural communities very deeply.

Although there have been some positive changes, by and large, the education reform movement operating in the country today hasn’t adequately addressed these issues, and the rural schools haven’t been helped enough. Sometimes new policies have been forced upon rural districts without enough success to justify the resentment they have engendered.

If we want to maximize the effectiveness of these and other changes, it is time to step back and take a fresh look at the situation. Here are four powerful steps that could create an impact if adequately implemented, and significantly improve the situation for rural schools and students.

The Solutions

1. Discard Erroneous Presumptions

Contrary to what some may believe, rural communities have a lot going for them. Recent survey research shows that there is greater social cohesion in rural communities than in urban cities. Families living in rural communities generally take pride in their schools and have greater implicit trust in those who run the schools. Also, there is more of sense that schools are community linchpins.

All of this adds up to mean that rural schools are blessed with a strong foundation upon which further reforms can be built. The policies designed to improve the schools whether it be increased funding for schools or recruiting new and better teachers needs to consider this bedrock of strength and thereby move forward with greater confidence and resolve.  

2. Abandon the Deficit Mindset

We often hear of a criticism of the education reforms designed for rural communities that they stem from what has become known as a “deficit mindset.” This deficit mindset simply means that the reformers view rural communities and their institutions as broken and therefore need to be saved, fixed or perhaps discarded.  

What needs to be understood is that neither the vast majority of rural schools nor their communities are broken. To the contrary, often these communities have within them deep wells of values, social cohesion, and tradition that don’t need to be fixed. These assets need to be seen as the foundation upon which to build improvements.

It may not be widely known that the highest percentage of two-parent families raising children are found in rural communities. Consequently, children raised in those families are more likely to have their parents read to them, a clear educational benefit. In fact, according to the National Assessment of Educational Progress (NAEP) reading scores, rural 8th-grade students continually outperform their peers in urban communities.

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Solutions that will be successful and stand the test of time need to flow from the strengths deeply lodged in rural communities. These solutions need to leverage the social cohesion, sense of local pride, and trust so much a hallmark of these communities.

3. Find Top Quality Teachers

In many ways, the daunting challenges facing rural schools are found in urban schools as well. Take the problem of finding top quality teachers for example. Practically every school in the country is looking for the best teachers they can find within their budgetary constraints. The question becomes, “ What can rural schools do to be more competitive in their search?”

  • Rural schools need to work more diligently at attempting to recruit their graduates to become teachers in their hometown. Research shows that across the nation, teachers generally find jobs close to where they grew up. Whereas this is undoubtedly easier for someone who grew up in a denser urban community, the “Welcome back Kotter” card needs to be played much harder.
  • Rural communities need to innovate programs to help paraprofessionals become certified teachers. Transitioning paraprofessionals into full-fledged teachers will be a quick and perhaps easy way to enlarge the pool of available teachers who are already connected to the community.
  • Rural communities need to develop lobbying techniques and connections to help their schools to raise the wages for teachers to incentivize more quality talent to consider moving to the community.

4. Embrace Helpful Technologies

Until recently rural schools didn’t have much of a choice when it came to offering their special needs students the therapy they required. They were limited to the clinicians who either lived in the immediate vicinity or were willing to travel considerable distances to help the children in the schools.

But the advent and growing embrace of teletherapy, the online delivery of speech, occupational, and mental health therapy is changing all that. No longer do rural schools need to continue watching the children be denied services they so much need and deserve. With teletherapy, rural school children can be assigned the same high quality therapists as their urban counterparts.

When rural school administrators select the online option, they are doing more than just providing the children badly needed services. These administrators are helping to restore rural communities to the place of prominence so richly deserved.

Bottom Line

These ideas should be carefully considered for two reasons. Aside from their merit outright, they have the potential to stimulate the imagination. There are many other ideas out there as well that could easily be thought of given a little brainstorming.

The key is to realize that just because so many ideas have failed either partially or wholly, there is no reason to lose hope. Rural communities, while they may be very different one to the next, all share something extraordinary; the people who inhabit them, the values they cherish, and the traditions that they hold so dear. These beautiful gifts are their greatest reason for hope.