Therapists Can’t Fix Clients

If your therapist is giving you advice, you need a new therapist. Giving advice is not counselling. It’s not therapeutic, and it doesn’t help you, the client. After almost 30 years in counselling, though, this is probably the single most common request from my clients. “Tell me what you would do.” Or, “Just tell me what the right answer is here.”

I usually ask some variation of, “What do you need to hear?” Or, “Why is it important what I would do?” Or, “What do you think is the thing to do?” Only in very rare instances do my clients not know (or don’t at least have a really good idea) what is best for them. What they really want, is to hear the solution from me. There’s lots of reasons for this, but the bottom line is that if I do offer solutions or advice, it’s not therapy.

Angry client

If a client thinks s/he is actually paying me for advice, or to offer solutions, then anger is often the response. And clients do get angry. Sometimes, “enraged” is a better adjective. One of my clients became so irate that I wouldn’t tell him which option I thought was his best choice, that he stood up, shouted at me that I was “useless,” and then stepped over me on his way out the door. (At 6’7” this was not difficult for him.) I was so stunned I didn’t even think to duck.

As a new therapist, I was pretty shaky, but after debriefing with my clinical supervisor, I knew two things – I am not responsible to solve my client’s problems, and, never sit between a client and the door. I’ve not always remembered not to take responsibility for my client’s problem, but I have always remembered not to get between my clients and the door.

Today is National Psychotherapy Day.  Alexandra Stevens, via Elephant Journal, offers some reasons why clients become angry with their therapists. Worth the read.

Professional Suicide

How can I provide a relationship which this person can use for his/her own personal growth? ~Carl Rogers

As a clinical supervisor, one of my responsibilities is overseeing professional skill development in the interns and therapists I supervise. This is something I do willingly, having always been passionate about learning myself, and by extension, about providing opportunities for others to learn.

The overwhelming body of current research indicates that it is the therapeutic relationship which is the key factor in therapy. I know there are modalities that are demonstrated to be more effective than others, and other components to effective therapy, but I want to focus on the therapeutic relationship from a clinical perspective.

I tell new interns and therapists, “The client may inconvenience you, but you may not inconvenience the client.” It is the client who shapes the therapeutic process itself through the logistics required for him/her to be able to sustain the commitment to therapy. This might include finances, work schedules, physical/medical issues, family commitments, etc. All these things have an impact on the client’s ability to invest in the work of healing, and it is the therapist’s role in a client-centered practice to take these factors into consideration in therapy.

Being client-centered extends to the way our practice is set up – the reception area looks like an inviting cross between a living room and a cozy coffee shop. The therapy rooms are warm, inviting, and personalized by the therapists with artwork, books, and mementos as they prefer. Every therapist has done something to make his/her space client friendly, but the degree of personal disclosure differs for each (though every one is entirely appropriate). Our office staff accommodate clients’ needs as much as is possible within our practice framework, and I’m personally and professionally proud of our practice.

self-careBeing client-driven is another matter entirely.

I recently had a conversation with a therapist whose schedule was absolutely crazy. Back-to-back clients for the whole day, for days. No lunch break, no time off during the day, six days a week. When, as her supervisor, I asked what was happening that her calendar looked like this, she replied, “Well, I had time off last week and everyone insists on seeing me this week.” When I sat down with her to look at her actual client list, there was no one on the list who was clinically urgent. Though her client load is full-time, she was fortunate at that point not to have any suicidal or crisis-related clients. Nearly all of her crazy schedule were ongoing clients. So much for any lingering benefits from having had a holiday!

Being client-driven is a therapist problem. It might stem from a variety of sources, but they all arise from the therapist’s internal framework, not from the client or the practice of therapy itself. It could be guilt, it could be a desire to help, it could be a tiny little tinge of Messiah Complex, it could be simply be a conditioned response to a request – being on auto-pilot.

As a group, and generalising (only a little!) I have found therapists and psychology professionals to be very, very bad at acknowledging our own needs. (You just knew this post was going to be about self care, didn’t you?) People carers in general have a habit of selflessness that makes them good at the role in the first place. But when people-caring IS what we do professionally, we no longer have the choice about whether or not we care for our own psyche, soul, body, or mind because we don’t have down time unless we consciously build it in to our lives.

Giving up my down time, or my lunch hour, or my weekend for a client who demands an “urgent” appointment is something I may do occasionally when such a choice is clinically appropriate (crisis, trauma, suicide etc), but to do this as a regular habit says more about my inner landscape than I might wish to acknowledge.

Some suggestions…

1. Build in down time on your calendar. Block off time as if you have a client session, and have a “session” with yourself away from your desk.

2. If you do assessments which require report writing, every time you book an assessment, also book report-writing time on your calendar, within your normal working hours.

3. Clinical practice guidelines say 6-7 clients per day (50 minute sessions) to a maximum of 35 clients per week.

4. Make a date with yourself once a week. Book time for yourself doing a hobby or socializing or vegging out. (I know you just rolled your eyes at me. Do it. If you feel after four weeks you’ve gained no benefit from this practice, I give you permission to stop)

5. Make sure you have good clinical supervision in place. If you work by yourself and don’t have an immediate supervisor handy, check around and find a peer debriefing group.

6.If you can’t find a peer debriefing group, check with your professional licensing body and get some referrals to experienced supervisors in your area, and go meet some/them. Establish a relationship. Meet once a month with the proviso that you can call if you have an urgent need for case consultation.  (In my own development as a clinician, I’ve had the wonderful privilege of clinically excellent supervision, and competent, on-going peer debriefing which has helped to shape my skills, hold me accountable, and keep me mindful of how I am mentally, emotionally, and physically.)

7. Learn something. Sign up for a class, do something online, follow your professional interest.

8. Change up your professional practice. Add some group work, get involved in a research project, teach a workshop, learn a new skill or technique for your toolbox.

9. Build down time into your daily calendar. (I know this is a repeat. We need it repeated) At a minimum two 30 minute breaks or a 60 minute lunch. Or 4 x 15 minutes spread over the day. Start later one day, keeping a morning a week for yourself. Close early on Fridays.

10. Book every sixth weekend as a long weekend, taking an extra day for doing nothing.

Some of these may work for you, some of them won’t. You could probably think of other ways in which to nurture your own inner resources and equilibrium. The point is to choose to do just that. I am committed to being a client-centered therapist, but I purpose not to be client-driven.

Being client-centered is clinical excellence. Being client-driven is professional suicide.