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How to Keep Your Therapy Client on Track

Four motivational principles for ratifying client progress


It can be a wonderful moment when clients come to realize how far they've traversed across their own internal landscape and enjoy the vistas of self-understanding.

“Do not confuse motion and progress. A rocking horse keeps moving but does not make any progress.”

– Alfred A. Montapert

Stuart shook his head as he summarized his week with one word.

“Disaster!”

The week before he’d come to see me to quit smoking. Here was a yellow-fingered man who’d puffed and sputtered his lung-damaging way through “never less than 45” cigarettes a day for 30 years. That was getting on for a total of half a million “cancer sticks”, as he called them.

In our previous session I had used hypnosis with him. I’d used many of the smoking reframes I’d later develop into the ‘How to stop anyone smoking’ course, and I’d felt as if we’d really made some progress. So had he – when he’d made the appointment for this week, he’d referred to it as merely a “top-up”. But what he’d said just now had me worried.

Resisting the temptation to feel crestfallen, I decided to dig deeper and learn what the nature of this disaster might really be.

What is really going on?

Stuart had seen me on the previous Tuesday. He had not smoked on the Wednesday, Thursday, or Friday, but had gone out on the Saturday and had five cigarettes, which he hadn’t enjoyed at all. He had not felt like smoking again since, and it was now Tuesday evening!

This ‘disaster’ was clearly nothing of the sort.

I gently pointed out that it was a good initial improvement. Going from compulsively smoking 45 cigarettes a day to only 5 in a week – which he hadn’t even enjoyed! – was, he conceded, an improvement.

And yet I had to remind him of this. Stuart, like so many others before and after him, had been looking at quitting in all-or-nothing terms.

Sometimes a depressed, addicted, or compulsive client will need help to be able to see how far they have come, and how far they might well go. Along with helping clients believe they really can get better, this ratification of progress can be vital to therapy.

Monitoring then ratifying client progress

We practitioners need to know where the therapy is going. This means being aware of the ‘signposts’ on the way to therapeutic success.

We need to develop goals with the client so we, and importantly they, will know when they’re on the right track, and also when our work with them is done.

So establish early on the answers to the following questions:

  • What do you want from therapy?
  • How will we know when these improvements have occurred?
  • What will others notice about you?
  • How will we know that we’ve reached the last session and that our work is done?

All these are great questions for establishing goals, and for clarifying the signposts to success.

But we can and should also remind our clients of the journey and the signposts as we go, especially if they are used to looking back rather than forward. As with Stuart, clients sometimes need improvements pointed out. This is what we mean by ratification.

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So how can we best monitor and ratify?

Step one: Begin the process immediately

Often clients notice an improvement before even coming to see you! Why? Well, it might be a combination of positive expectation and hope.

We might say:

“Often clients tell me they’ve actually felt a bit different since making the appointment, even before coming along. Have things altered a bit between when we spoke on the phone/emailed and now?”

Sometimes clients might say they have felt a little calmer or more hopeful or energetic. If so, then we can really dig into why. This can give valuable information as to what the client needs more of.

Sometimes we can find markers of progress even further back. I have certainly ratified client progress retrospectively. A client might come into therapy and say “It’s not as bad as it used to be!” Don’t waste this! Ask them how it improved and how they noticed. They are telling you about resources they have or have had which may be the basis of future therapy.

We can also ratify client progress in the present moment.

Step two: Ratify progress within the session

When someone first comes to see you they may be anxious, especially if their primary issue is anxiety.

You can ask them how anxious they feel at that moment with you, on a scale of 1 to 10 (10 being the most nervous). They may say something like 8. We might then suggest that it can go way down, as you are simply going to talk in a relaxing way with them.

After the session, when they have been deeply relaxed, you can ask them what level it has gone down to. If, as is usual, they feel much more at ease, we might say something like: “That’s great, you’re clearly the type of person who can change unhelpful behaviour very quickly considering how nervous you were when you arrived!”

This is an example of monitoring and ratifying the client’s progress right from the start of the first session. It also sends the message that therapy is all about progress.

These might seem like small or inconsequential interventions, but they are a foundation from which we can start to build.

If we have done a procedure, like the Rewind Technique for PTSD, then again it’s important to ratify, through the use of scaling, the client’s improvement.

Especially for clients who are in no way used to seeing progress or positives, but are instead emotionally attuned to looking out for what isn’t working, we want to make it as easy as possible for them to see even incremental progress.

Especially for clients who are in no way used to seeing progress or positives, but are instead emotionally attuned to looking out for what isn't working, we want to make it as easy as possible for them to see even incremental progress. Click to Tweet

And we can do this in quite a structured way.

Step three: Keep progress records

It’s important to remember that therapy doesn’t have to be dramatic. Once there is a change, no matter how small, this can lead the way to more change. It just takes one initial foothold for the climber to begin the ascent.

Or, as another analogy, we might compare small indications of progress to rolling a snowball down a hill: it starts off small but gains momentum over time.

So it can be a great idea to keep records and carefully note changes. As you do, you can keep referring back to the way things were when the client first came to see you. Change is, after all, the only constant in life. Change always occurs in some direction or other, but it can be easy to miss it if you’re not looking for it.

Watch and listen very carefully for even the tiniest telltale signs that the situation is improving, and make a note of them. Then, at some point, feed it back to the client.

Referring to your records, you can say things like, “So, three weeks ago you rated your anxiety as an 8, and now you’re down to 5. What needs to keep happening in order for that to improve even more?”

But we can do something else, too. We can help the client take responsibility for their own progress.

Step four: Ask your client to notice and record

We might ask our client to grade and monitor their own improvement by keeping an ‘improvement diary’. This encourages them to inhabit the observing self more, which separates their core identity from the problem behaviour.

Watching our own behaviour is the first step towards separating from it, or at least controlling it, as we begin to see it in the wider context of who we are.

‘Less bad’ means more good, and clients need to feel that.

We can give credit

As with my smoking client Stuart, we can help clients see that improvements often happen incrementally. Though Stuart wasn’t able to quit completely in that first week, I know for a fact he wasn’t smoking at all 6 months later, which was the last time he contacted me.

Ratification means emphasizing any improvement and bringing it to the client’s attention. If, for example, your client only had three panic attacks during the week instead of their usual ten, you need to point this out and ask them how they think the improvement came about. This is a total reframe for someone who may have been focusing on the fact they panicked at all.

We can also give the client credit for their own improvement. How did they manage to do it? It can be astonishing how blind some clients can be to improvements in their condition. They can become so used to regarding their own behaviour as something ‘not good’ that they need help to recognize when it shifts to ‘good’.

Client progress can, of course, waver, stall, and sometimes even fall into reverse, but we can keep our eyes – and those of our clients – on the general trend, that of a movement towards greater health and happiness.

None of this is to say that we don’t sometimes, especially initially, need to listen to and understand our clients before we start jumping in with any kind of “Ah, see, you have improved!” interjections. But ultimately we are paid to help get the client moving.

It can be a wonderful moment when clients come to realize how far they’ve traversed across their own internal landscape and enjoy the vistas of self-understanding.

I sometimes use this very analogy with clients – of someone who spends a long journey focused solely on the small steps, then looks up at last to see the wonderful progress they’ve made. Each small step seems, in itself, of small account – and yet here they are in a totally new place.

Ultimately, we all are a work in progress.

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Mark Tyrrell

About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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