Establishing a Therapeutic Alliance

Building mutual rapport, clarifying mutually agreed-upon goals and creating a belief that psychotherapy will work can be difficult with any patient in crisis. However, once they feel more in control, most patients are ready to find out what happened to them and to figure out what to do about it. Gifted patients, too, may feel relieved and grateful once their symptoms abate. But for them, settling into psychotherapy may be more difficult.

As they gain more control, their need for independence may stimulate a desire to leave psychotherapy prematurely. Sadly, an impulsive departure from therapy almost always ensures the return of underachievement, self-destructive behavior, and psychological symptoms. Gifted patients and individuals may also leave psychotherapy too early because they feel that therapists simply do not “get” giftedness. Many therapists can be fascinated by a gifted individual’s quirky intelligence and unusual accomplishments but may also believe that a gifted person’s painful symptoms and personality traits are part of a standard psychiatric syndrome or disorder.

I agree with Kerr (2007) that addressing giftedness early in the counseling or psychotherapy process helps develop a therapeutic alliance. However, I have found this is best done indirectly. Some of my patients adamantly refused to be identified as gifted. Many accepted the “gifted” label reluctantly and only much later in the therapy. Inquiring in a casual but informed and empathic way about special abilities, unusual sensitivities, and particular conflicts and anxieties conveys an understanding of the inner experience of giftedness. Connecting with my patients in this way helped them understand that I had more to offer than symptom relief and paved the way for deeper therapeutic work.

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Jerald Grobman M.D.

646-872-6842

Madelon Sann L.C.S.W.​

646-354-0907