Attunement: a very important therapy skill
A few years ago I decided to put more of my time into my role as a clinical supervisor. One thing that took me a long while to appreciate and learn myself is real, deep attunement with the client, partly because it isn't an integral part of second-wave CBT, which is where I started.
I always tended to keep things on the lighter side. I didn't want topics or emotions to become too heavy, so that clients would feel comfortable talking about difficult events. Looking back, that was as much about my comfort as theirs.
To really access emotions, to connect with "that part" of the client and make room for processing and healing, deep attunement is the golden skill. It's simply necessary. I want to thank Dr. Robert Brockman here, who guided me while I learned it.
What is attunement in therapy?
Attunement is the therapist's moment-to-moment tuning in to the client's inner state, and communicating it back so the client has a sense of "feeling felt", as Dan Siegel (1999) put it. Listening and empathising are among the most important skills any therapist has. Attunement goes a step further: client and therapist share the experience of an inner state, instead of one person describing it to the other.
The idea comes from developmental research. Daniel Stern described affect attunement between mothers and infants, the way a caregiver matches and answers a baby's feeling state. Children who get enough of it learn that their feelings can be known and borne. Many of our clients didn't, and the missing attunement is part of what brings them to us. That's why it matters so much with emotional neglect and complex trauma: you can't talk someone into feeling felt.
So-called schema attunement goes beyond the basic reflecting of emotions and aims for a deeper level of understanding, linked to the client's schemas and unmet needs. It does two things. It validates the client's needs, feelings and experiences, and lays the foundation for healing the failures of earlier relationships. And it makes clients aware of their emotional needs, which is the groundwork for any effective intervention, while helping them share, experience and eventually tolerate a smaller, more manageable amount of emotional pain.
How to achieve schema attunement: six steps
- 1. Find a specific event
- Ask the client to recount a specific, recent moment when a difficult emotion was triggered, or tie a wider narrative to one event. When a client says "I just keep feeling anxious and alone", ask instead: "When did this feeling of being lost come up most recently?"
- 2. Move into the emotional reaction
- If needed, intensify by asking the client to close their eyes. Help them connect the emotions, body sensations, urges and needs of that moment, and ask them to name the feelings and sensations. "How did you feel when your husband walked out of the door without saying anything?"
- 3. Tune in
- Tune in to the current feelings, the client's and your own. Ask: "What did this mean for you?" Then connect the experience to one of the 18 schemas. With an abandonment schema it might sound like: "It means that sooner or later the people I care about will leave me, and there's nothing I can do about it."
- 4. Slow down and reflect
- Reflect your understanding back, slowly. You're looking for resonance. If it doesn't quite match, go back to step three. And don't let your client gloss over it and move on to another story or trigger.
- 5. Validate and link to history
- Validate, and link the moment to the client's history to widen the narrative: "What you've just described reminds me of something you told me when we took your history: your father always walked away in silence when there was an argument, and you never knew when, or whether, he'd come back."
- 6. Move into experiential work
- Once your client is in touch with the emotional activation and can tolerate it, move into experiential techniques such as imagery rescripting, chair dialogues or EMDR processing.
One important tip: don't assume you know which schema is activated. Take your time to explore the emotions in that particular context. The schema you expect is often not the one that's there.
What gets in the way
When attunement doesn't happen, it's rarely because the therapist doesn't know the steps. More often something in us steps in. My habit of keeping things light was a coping mode of my own, a gentle Detached Protector that kept both of us away from the heaviest feelings. Other therapists notice that they start problem-solving as soon as a client cries, explain too much, or rush past the feeling to the history.
Misattunement happens to all of us. A rupture that gets noticed and repaired can be one of the most healing moments in therapy, especially for a client who never had that at home. What matters is being able to notice it. Supervision is a good place to look at which of your own schemas a client triggers, and what helps you stay in the room. I've written more about that in Schema Therapy supervision for accreditation.
Supervision with me
If you'd like to work on attunement and experiential techniques in your own cases, I offer one-to-one supervision and consultation, online. Details and fees are on the Therapists page.
References: Roediger, E., Stevens, B. A. and Brockman, R. (2018). Contextual Schema Therapy. New Harbinger. Siegel, D. J. (1999). The Developing Mind. Guilford Press. Stern, D. N. (1985). The Interpersonal World of the Infant. Basic Books.