Welcome to the December edition of Tips and Topics. Wishing you a healthy, happy holiday season.
In SAVVY, Angela Haupt wrote about “5 phrases that drive therapists up a wall.” Clients demonstrate a variety of issues that become the work of therapy. I organized those phrases under three SAVVY tips.
In SKILLS, I wrote 20 years ago about how to develop a truly participatory treatment plan, one most likely to succeed in being followed. Exploring the “what, why, how, where and when” with a client focuses on how to develop the Treatment Contract.
In SOUL, I address issues relevant to paying a fee for therapy. It is an investment in the current process of therapy and in the future wellbeing it can bring. If you are a therapist, counselor or coach, the personal work you do sharpens your effectiveness for the good of your therapy clients.
In last month’s TIME magazine, this article caught my eye: “5 phrases that drive therapists up a wall” by Angela Haupt. She had earlier written about “9 phrases that drive your therapist up a wall.” Haupt “asked a handful of therapists which phrases drive them up a wall and why.”
Having done a lot of psychotherapy in my career, I was curious to see if I resonated with the phrases she came up with. I did. I organized her top five phrases under the SAVVY Tips that they represented, but all the content is directly from Angela Haupt’s article.
Tip 1
Note the low self-esteem of clients that will become some of the therapist’s work.
No. 1: “I don’t want to take up too much time.”
When someone spends 15 minutes apologizing for being in Lauren Auer’s office, they’re burning through the exact time they’re worried about wasting. “They made the appointment,” says Auer, a therapist in Peoria, Ill. “They know how long it is, so it’s nothing worth apologizing for. It’s literally my job.” Yet she ends up needing to devote part of the session to convincing her client they deserve to be there.
There may be underlying beliefs about worthiness at play: “A lot of times, it’s rooted in what they’ve learned about taking up space or being too much,” Auer says. If she and the client haven’t established a therapeutic rapport yet, she responds gently: “Let’s talk about that. What I’m hearing from you is…” But if they already know each other well, she might laughingly remind them: “It’s your appointment. You know you don’t need to apologize.”
No. 2: “Sorry for crying.”
Uttering these words “is like apologizing for breathing in my office,” Auer says, yet she hears them daily. She typically reminds clients that “crying is actually really healthy, and it means they’re feeling safe enough to let their guard down, which is a good sign of healing.”
When someone clearly feels bad about all the waterworks, Auer smiles and says, “Hey, no crying allowed in therapy,” in a way that makes it clear she’s joking. “It usually gets a laugh, and that can break the shame spiral,” she says. “It helps them realize how ridiculous it sounds to apologize for crying in therapy.”
Tip 2
“Therapy is a collaborative relationship...that requires engagement and work on both
parties’ part in order to be successful.”
No. 3: “What should I do?”
Only your grandma can truly answer this query, says Nicole Herway, a therapist in Murray, Utah, because she probably has plenty of opinions. Therapists, on the other hand, “have absolutely no idea—and we’re not supposed to know what you should do,” she says. “We’re here to empower you to make decisions for yourself, to try things and fail, and to learn and to grow.” A better way of phrasing things, Herway adds, is to ask your therapist: “Can you help me consider some options?” They’ll be happy to oblige.
No. 4: “Therapy has never worked for me.”
Clients often ask Lisa Shows to make promises or guarantees about therapeutic outcomes. They might add that therapy has never worked for them in the past—so why would it this time? “They’re trying to hook me into saying, ‘Well, this therapy will work for you,’” says Shows, a licensed professional counselor in Flagstaff, Ariz. “I absolutely want it to work, and I also want to instill hope that it can work. But at the same time, I can’t promise that it’s going to be the thing that’s suddenly helpful.”
Therapy is a collaborative relationship, she adds, that requires engagement and work on both parties’ part in order to be successful.
Tip 3
Proper etiquette around phone usage during therapy is no phone usage for both therapist and client.
No. 5: “I’m just going to take this call real quick.”
You might be surprised how often clients check their phones throughout therapy sessions, texting or taking non-emergency phone calls. “They’ll be a little preoccupied with it, and getting notification after notification, and even if they have it on the chair, I can hear it buzzing,” Shows says.
So what’s the proper etiquette around phone usage during therapy? Ideally, clients will silence their device and drop it into their bag, Shows says, so that it’s there if they need it (or want to reference a specific text, which can be helpful for her to see verbatim). That way, they’re not distracted—and are able to give themselves the space “to do something a little different than we do the rest of our lives,” she says.
When working to help people change, I wrote 20 years ago about the “What, Why, How, Where and When” to Develop the Treatment Contract. In any therapy or helping endeavor, the first priority is to develop a truly participatory treatment plan, one most likely to succeed in being followed.
Tip 1
What is the client a customer for in therapy? Developing the treatment contract.
Clinicians are often more focused on what they think the client needs than on what the client wants. It isn’t that we shouldn’t do an assessment and identify what the client needs to achieve wellness and recovery. It is just that if we start on what you think they need versus starting with what they are a customer for, you will spend more time cajoling, nagging, shaming and trying to convince the “resistant” client into seeing things your way.
What
First, be clear what the client really wants, not what they’ve been told they need; not what you (perhaps correctly) feel they need to change; and not what they think the clinician wants to hear.
What is the agreed upon treatment contract collaboratively arrived at?
Why
Why is it now that the client wants help; and not a year, a month, a day ago?
Did someone threaten a loss of job, or loss of children or a relationship so that what they want is to keep their job, children or relationship, not wellness and recovery? Have I dug deep enough?
Determining what the client wants means going deeper beneath the surface of a rote presenting complaint like “depression” or “I’m sick and tired of being sick and tired.” Are they just saying what they think you want to hear?
Or has life and functioning gotten so painful and onerous that they will do whatever it takes to feel less depressed, anxious, or compulsively addicted?
Tip 2
If the client has their own clear ideas about how they will get what they want, start with their plan and then hold them accountable to its success or not.
How
How does the client plan to achieve his/her goal?
Do they have their own tenacious treatment plan, which blinds them to your plan?
If you have laid out your plan and tried to attract them into seeing the wisdom of that course of action, but the client disagrees, start with their plan.
Hold them accountable to its success. If it works, great, you are happy to be wrong so long as the outcomes are good. But if it doesn’t work, you have a client more willing to listen to other ideas and recommendations as they got to try it their way first.
Tip 3
Assess how determined the client is on where and when they want to get treatment.
Where are they willing to receive treatment? Do they have tenacious ideas about the level of care and type of program?
Where
The client may have strong reasons for wanting outpatient treatment versus more intensive levels of care (I have childcare responsibilities; work obligations; financial constraints etc.) Unless there is imminent danger of harm to self or others, treatment starts where the client wants it to start.
When
When are they willing to receive treatment?
Are they ambivalent about when to start getting help?
Are they strongly committed to doing whatever it takes for wellness?
Do they have tenacious ideas about when to start and the length of treatment?
Example:
Family may well have brought in the client to get help, but what the person states is that he/she want “to be left alone.” The treatment contract can genuinely be based on this specific “want.”
Client: “I want to be left alone.” Therapist: “I will help you to be left alone.”
Take the client at his/her word. You can then discuss:
Why people are not leaving the client alone; what is the client doing to attract attention and to have people telling them what to do?
How does he/she plan to think, feel or act differently to get people to leave him/her alone?
Where and when do they plan to do this to achieve their goal of being left alone?
This is person-centered work.
I’ve had a lot of personal therapy in my early career and life. Individual psychotherapy, psychoanalysis, couples therapy, Human Awareness Institute, Landmark Forum and body work models. I like to think it has changed my life – or I spent so much time and money on these various therapies that they better have changed my life!
When it comes to paying for therapy, there are a couple of issues that arise:
If clients question the value of the fee, help them see therapy as an investment in their mental health and wellbeing. Many don’t think twice about a night out for an expensive concert and dinner as an investment in relaxation. Or a monthly gym fee and exercise trainer as an investment in physical fitness, trim figure and strength and mobility.
The other point is that the therapy fee is all the client owes to the therapist. There are no gifts needed, censoring what to talk about, hiding angry or anxious or mistrusting feelings and thoughts. The fee means the client can show up just as they are...warts and all. And the therapist is there to be present for the client, not “using” the client for their self esteem, sense of power or any other self-centered need. The therapist is being paid to be truly client and person-centered.
If you are in any helping profession as a coach, counselor, therapist, or clinician, doing your own personal work is an important priority.
As you unearth your childhood wounds and survival adaptations in thoughts, feelings and behavior, you will be more centered and grounded to be present to really hear and appreciate your client’s productive and counterproductive ways of being.
You will be able to recognize any of your tendencies to “use” clients for your own self-esteem, words of affirmation or non-person-centered purposes.
You will be able to use effectively any of your internal reactions to what they may be saying or doing to guide you in helping your client, not soothing yourself.
If ever our paths should cross, don’t worry about talking to me and wondering if I am “psychoanalyzing” you. I am retired and off duty.
Thank you for joining us this month. Have a great holiday season and see you next year!
David