The Clinical Dialogue: Knowing What to Say to Your Clients

There is a common misconception that talking comes naturally and psychological therapy is a rather straightforward process of adding interventions into otherwise naturally flowing dialogue between two people. But as therapists, we know that talking with our clients is much more than that.

The dialogue we share with our clients is one of our greatest responsibilities because it is the main way in which we shape and transform their lives. We have a small amount of time, sometimes weekly or less, for a short period of months in the client’s life to do what we need to do, which will hopefully have a lasting effect. These are very tight time constraints.

How Does the Magic Happen?

So how and where is the magic or art of good therapy occurring in terms of our clinical dialogue? We have been looking at this issue carefully as we have been building the first training course in PBBT. We have come to realize the centrality and criticality of teaching therapists what to say, when to say it, how to say it, why they should say it that way at that point, and what they are likely to say next. You can immediately see from this list that we are juggling many things at one time in our sessions. We have all felt the pressure of that juggle and long to acquire the skills that will help us to do this better.

A Simple Example

Let’s take a simple example to illustrate just how much is going on for the therapist in-session and what is at stake at any given time. Let’s imagine that you’re doing PBBT and you’re at the stage where you have identified that one part of how the client identified themself has consumed them since adolescence - we might refer to as the struggle with “I am a bad person.” In PBBT, this painful element creates a powerful emotional trap for the client and as such will dictate many of their actions. In PBBT, we might say something like the following:

“Perhaps you think that what I am going to do now is argue with you about whether or not it’s really true that you are a bad person deep down. But it might surprise you when I say that I believe 100% that you believe that it is 100% true that you are bad. There is no doubt in my mind that it’s as true for you that you are bad, as it is true for me that night follows day. I really get that you hold something to be true, whereas I just hold other things to be true.”

The Best Interventions Are the Most Subtle

Validating anything that a client believes, says, or does provides a really good example of the complexities and subtleties of our clinical exchanges because if validating doesn’t feel totally genuine to a client, it might actually come across as an insult. That means that using the technique of validating isn’t just about what you say but how you say it. It has to be real, authentic, and convincing.

Validating is also a useful technique for highlighting the distinction between what you see the client believes deeply, usually about themselves, versus what you as another human being believe about them. What makes validating so powerful in your clinical dialogue is that it offers respect for what the client believes but is not saying that you believe it too or that it is either true or false. Indeed, if you look closely at the exchange above, you will see that the therapist does not specify what they do or don’t believe. And this subtle omission creates an opportunity for what the client believes to be potentially untrue or inaccurate. And it is in that subtle space that the absolute truth of what the client believes about themselves can be slowly undermined without the belief itself being negated or the client feeling invalidated.

The Power of Thoughtful Dialogue

Mastering clinical dialogue is not just about having the right words—it’s about understanding how to deliver them with precision and authenticity. The most effective interventions are often the most subtle, creating small but crucial shifts in the client’s perspective. When we truly engage in this way, therapy becomes more than just a conversation; it becomes a powerful process of transformation.

We believe that refining the art of dialogue is one of the most impactful ways to enhance client outcomes. If we can skillfully navigate these exchanges, we can help clients move beyond deeply ingrained narratives and into a space where new possibilities emerge. And that is where real change begins.

In PBBT, we show you how to direct the clinical dialogue at every stage of the Clinical Pathway, ensuring that your words have the precision and impact necessary to foster meaningful change in your clients' lives