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When clients and therapists don’t connect

Another therapist commented on this post about finding a new therapist and I thought it’d be great to bring it over to a new post and continue the discussion. Anna said:

I agree that being a good fit is important. I try my best to be a good therapist and I believe I am open to clients sharing anything with me. I believe in creating a non-judgmental environment. I even like when clients say they are mad at me or didn’t like something I said. It tells me we have that open relationship to talk about those things and sometimes those discussions lead to a greater understand of the situation. Yet, I sometimes get clients who don’t seem to connect with me, or maybe I don’t connect with them. These are the clients who don’t stay long. I’d love any suggestions on how to improve this (if it can be improved). I wonder if sometimes you just have to find the right therapist for you. I have an example without giving any specifics, I had a client recently who called asking for help with a certain issue. Whenever I brought the issue up, the client deflected. I tried working on other issues because I didn’t want to push too hard but the client kept going to “safe” topics. Needless to say, the client quit coming. Do you have any suggestions for this situation? Does it mean it isn’t a good fit or the client isn’t ready? Any suggestions are welcome.

smallcouch-insideI don’t think that any therapist can be the right counselor for every client because we are all so very, very different. I think sometimes a client who doesn’t get very far from us may not be ready to go far but also I think sometimes they just aren’t going to be able to do that work with us.

As to whether it’s because we’re not a good fit or because the client isn’t ready, sometimes I don’t think we’ll get to know. Sometimes it might be a little bit of both.

And that makes me think about counselor ego (not that Anna brought this up but it made me think about it).

Being a therapist is weird because we don’t really get any feedback. I mean, we do, we get feedback from our clients but given the nature of counselor/client relationships, we can’t really go with that. Sometimes a client will say, “I love working with you!” and it’s because we’re not being confrontational enough (like Anna says, sometimes our clients need to be mad at us and maybe NOT love working with us, at least not right in that moment). And we get to be witness to client success but any therapist worth her salt knows that client success belongs to the client.

Besides we can’t get our egos all wrapped up in any definition of success like a marriage saved or a job promotion secured or a child who learns how to behave because that’s a very limited view of success. Sometimes success looks like understanding a marriage is over or quitting a job or realizing that “good” behavior in one child doesn’t look like “good” behavior in another.

But back to the bad fit — this is one of those go with your gut things. If you feel like it’s time to push a client, then push. If you feel she isn’t ready, don’t push. I also think that in these cases where we’re not sure that we should seek out peer support. I don’t think any counselor — no matter how experienced — ought to be working in isolation. That means finding peers whose skills and knowledge overlap in some ways (so they can help give you perspective on kids if you work with kids) and don’t overlap in other ways (so they can help broaden your ability to work with all kinds of people).

If connection is an ongoing problem, if a counselor is feeling like her connection rate is down, then I’d say it might be time to look into some counseling ourselves. When we’re depleted or overwhelmed or preoccupied with other things, sometimes this can come through in our ability to be present with our clients. We might need help focusing on some self care or getting the attention we need (because to give loving attention we need to be getting loving attention).

If you are the client who isn’t connecting, I’d bring it up to the therapist if you feel comfortable or if you think the relationship is worth salvaging. Remember, it’s your relationship with your counselor that is the best predictor of your success in therapy so if you’re not feeling it, talk to her or go elsewhere. Just don’t give up on counseling because there are a zillion and one counselors out there, which means there is definitely the right one for you.

 

Counseling by text

counseling by textThis is what my social media policy says about texting (this is part of the intake paperwork all of my clients receive and I have them sign something that says they have read and understand my policies):

You may text me with questions about appointment times, to reschedule or to cancel (please note my cancellation policies require 24-hour notice). You may also text me if you would like me to call you back. However please know that I do turn my phone off during client hours, meetings and outside of office hours so I cannot guarantee when I will read your text and get back to you. If you do text me, I will assume you welcome a text back. While it is unlikely that someone will be looking at these logs, they are, in theory, available to be read by our cell phone service providers. You should also know that any texts I receive from you and any responses that I send to you become a part of your legal record.

I’m a late adapter to texting and most of my clients are much more comfortable texting than I am. Originally I was reluctant to add texting to the ways clients can get a hold of me because our profession is still struggling to know how to ethically manage all these (fairly) new developments. After consulting with colleagues I decided to very cautiously add texting with clear limits. The reason I’m so cautious is:

  • People think of texting as immediate but I’m not on call 24/7. Unlike my voicemail where you’ll get a response that specifically says you may not hear from me for 24 hours (and will give you a referral number to Netcare in case you are in serious crisis) or email, which people don’t necessarily expect you to check constantly, texting feels like it should be immediate. But it’s not. I may not get the message until the next day and there’s no way to tell you that your text remains unread. (This is, for me, the greatest issue with texting; it gives the illusion that I am more accessible than I am, which is why I try to be so clear in my social media policy.)
  • Texting is a lousy medium for processing problems. It’s great for quick messages, “Hit traffic! Running late!” but not so much for big issues, “I saw my ex today and we had a discussion …” It’s best to save those issues for in-person sessions.
  • What you text (or email for that matter) — the exact words — becomes part of your paper record. Ethically I have to record any written contact we have and while your record is theoretically confidential there are times where other people could get access to it. (For example, if the counselor was subpoenaed by the court.) It’s one thing if a client rants about an annoying co-worker in session because I can record our discussion as, “Client shared frustrations w/colleagues” but it’d be another thing to have the whole rant there in the records verbatim because she sent it via text.

Some counselors have more flexible texting policies and some counselors do not text at all. It’s important that you talk to your counselor and be very clear about what she is open to when it comes to electronic communication.

Crying in front of your counselor

Crying In Front of Your CounselorI generally don’t think that your therapist’s personal experiences can tell you whether or not he or she will be a good therapist or the right therapist for you but there is one exception to this: I think every therapist ought to have had his or her own therapy. Not just to work through our stuff (‘cuz we all have stuff), but to intimately know the vulnerability of pouring your heart out to a stranger who is getting paid to listen to you.

Some of us decide to come see a counselor because we have thoughtfully considered our options with logic and care and we have decided that therapy makes the most sense. That’s some of us. But most of us come because we are desperate and we need things to change; most of us come because we’re in crisis. So we come, shaken and perhaps scared and perhaps defensive and we sit down in front of someone we have never met and who we might be afraid will judge us and find us wanting, and we try to open up.

And sometimes, when we are feeling very fragile we may start to cry and that may feel terrifying or humiliating. We might be afraid that our therapist is disgusted by our tears or is anxious for us to stop.

So I thought I would tell you what it’s like for a therapist (at least this therapist) when clients cry so then you will know. And you can ask your therapist what it’s like for her so you can know that, too.

I used to worry before I had clients that I would cry, too, because I usually cry when other people do but it turns out that the boundaries of our relationship protect me from this. That’s not to say that I don’t sometimes get a lump in my throat or have to quickly blink back tears before I catch myself but when my clients are crying, I’m very aware that I can’t let myself have the luxury of falling in with them. I feel both expansive — like I’m making way so there is room for all of the tears — and small — because I’m humbled by their vulnerability. I know that a big part of my job is being strong enough to stay exactly where I am and to allow my client to have her whole entire feeling without needing to share it with me or protect me from it or even to protect the feeling from me.

  • I do not judge her.
  • I do not feel annoyed.
  • I do not feel uncomfortable and wish she would stop.
  • I do not think she looks ugly or silly or weak.

I do trust her and I trust that crying is what she needs right then. I am a great believer in the power of crying to make us feel better. (I listened to this song a lot as a child.)

The counseling office is sacred space and part of what makes it sacred is that it’s a safe place for shedding tears.

Does my therapist care about me?

heartWhen I was in my late teens I began seeing a counselor because I was depressed. I was taking a full load of undergrad classes at OSU and working 40 hours a week and living by myself without roommates or family for the first time ever. My weekly visits to Barbara (my therapist) quickly became the center of my schedule. I’d drag myself to work and school, grind my way through my day, all the while focused on that bright spot, once a week, when I would sit in her office and feel safe.

I loved Barbara even when I didn’t love therapy, which was hard and often painful. I didn’t always leave her office feeling better. There were days I left feeling raw and fragile, my face swollen with tears. I started scheduling my work so I had the day off on therapy days so I could come home, curl up in bed and sleep away my emotional exhaustion. I could feel myself growing stronger and straighter but it was hard going.

I think I saw Barbara for about a year, maybe a little more, maybe a little less. I saw her weekly and then I saw her every other week and then we agreed I didn’t need to see her anymore at all. But for the time I was in her care, I felt very dependent on her and I wondered how it was for her because she may have been the person I centered my weeks around but I was just a client on her schedule.

I wanted her to call me up to have coffee. I wanted her to like me best of all of her clients. I wanted her to lean in one day and whisper, “My sessions with you are my favorite!” And I was free to want that as much as I liked because I knew it would never happen. It was a little like Lisa Simpson’s copies of Non-Threatening Boys Magazine; a celebrity crush, all safe and worry-free. I knew I could tell her anything and she’d have to like me — or at least pretend to like me — because it was her job.

But I always wondered if she cared about me for myself and not just as a name in her appointment book.

Now I know because I have my own appointment book (well, iCal calendar — same difference) and I can tell you that yes indeed, Barbara cared about me and your therapist cares about you. But we care within the boundaries our profession sets for us and those boundaries are what allow us to serve you. It’s not like caring for a friend or family member because it has specific limits and in other ways it is limitless. The space we hold together in the counseling relationship is full of unconditional positive regard (loving acceptance of all you are), which is harder to maintain in real life relationships. In that way the counseling relationship is boundless. On the other hand, I would never call a client up and say, “I’ve been thinking of you; let’s have coffee on Thursday.”

I remember when my son was very small and I heard about a preschool teacher who made space in her evenings to think about every single one of her students for a moment, hold the thought of each child close and then let it go. This is a little bit like how it is with clients. Before work, I review my schedule and mentally and emotionally prepare for the specific clients I will see that day. Each night, before I leave my office, I review them (usually as I write up case notes) and then on the way home, I give myself permission to stop thinking about them by the time I arrive home. This is because it’s easy to worry about a client going through a particularly tough time and worrying does neither of us any good. When I do catch myself feeling anxious about a specific client, I take a page from the preschool teacher and give myself permission to sit with my thoughts for a discrete time. This helps me come to my sessions fresh and focused instead of wrung out and worried.

So this love and caring I have for my clients — and that Barbara had for me — is not the love and caring I fantasized about when I was in therapy (there are no intimate coffees, there were no confessions of favoritism from Barbara) but it is good and solid and dependable.

Therapists are screwed up, too

Worthington counselorAt the last parenting class, one of the participants said something to me like, “But you’re supposed to have it all together!” She was joking but kinda not because if you’re standing around giving classes and being all expert-like on parenting, it’s reasonable for people to assume that you have it all together.

But therapists are people and so we are as screwed up as anyone because being screwed up is part of the human condition.

Did you ever read The World According to Garp? (Or see the movie but if you only saw the movie, please go read the book because it is excellent.) When T. S. Garp takes his children to the beach he warns them about the undertow but Walt, his youngest, mishears and thinks he is warning them about the under toad. Later in the novel, the under toad finds them and tragedy hits their family. (No spoilers here! Read the book! It’s so good!)

And that is the thing about life, it is full of under toads. Some of them are small and petty (a flat tire, a 2-year old tantruming with exhaustion, a burnt casserole) and some of them are very big and scary. Therapists, just as much as anyone, have under toads and so we are constantly learning and running into walls and backing up from walls and trying again because we are people and no person escapes the under toad.

I think what makes therapists different is that we’ve made careers out of the work of growth and transformation and meaning-making. We are voyeurs; we watch our own lives and we watch other people’s lives, trying to understand them.

It’s true that sometimes we know stuff that you might not know because part of being a therapist is being committed to reading and consulting and going to a lot of trainings. We read the research so you don’t have to, just like the tree guy learns about pruning so you can be busy doing the things you need to do.

But I learn as much from my clients as they do from me because you know a lot of stuff, too, and you know way more than I ever will about you and your experiences and your family. Therapists learn to listen so that we can help you know the stuff that you know. A therapist can help you better understand and accept yourself. It’s a bit like having someone come “do your colors” because you don’t know whether or not you look good in that particular shade of yellow even though you see your own shining face in the mirror every single day.

People joke that counselors get into counseling because we’re screwed up and this is true. But then, like I said, we’re all screwed up because being screwed up is part of the human condition. Therapists are generally more interested in ruminating on the screwed up nature of being alive. Many of us were kids who got told we worried too much or thought too hard about things and so we were very happy to find out that over-thinking is a plus in the counseling field.

So that’s what makes us different, not that we have it all together (because I haven’t met a person yet who does) but that we like to listen to people talk about their problems. We like to help them deal with the challenge in front of them as well as build skills for the challenges ahead of them.

Nobody’s perfect and that includes your therapist.

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