In my early practice, in my anxiety about having enough clients, I would try to be whatever they wanted me to be. I also felt that I had to be “convincing” as a therapist. In other words, I needed to present a cogent idea about what caused their discomfort and a clear path toward helping them.
Among the clients who comprised that part of my practice that I enjoyed, were those who were an energy drain. Some see themselves as victims of their pain or have a certain pride in the narrative of their struggle toward health. Others need a
master, a wise therapist, who knows all, sees all, and cherishes them.
Then I have my own psychological problems. I noted, early on in my practice, that I often had difficulty working on grey-haired old ladies. I could interpret any lack of encouragement, silence or glance as a judgment of my inadequacy or failure as a therapist.
All of the above are boundary issues. In that terrain of client, condition, treatment and therapist there is a struggle over turf. It is within the context of this struggle that healing occurs. If it weren’t for these pesky clients, my practice would run more smoothly.
Let me present a prototypical structure or flow which sets the beginning point of an effective therapeutic relationship and is a guide through process of developing treatment strategies and forming agreements with your clients:
It begins with setting a long term goal. It would probably be freedom from pain, some enhanced feeling state or performance goal that the client is willing to spend time and money to achieve. The therapist and client, as clearly as possible, make an explicit agreement about what constitutes “success”.
Next, decide what might be a first step, a change in tissue or performance which might lead to the long term goal. Engage the client in that consideration.
Then perform a treatment strategy to achieve that short term goal. This can be a simple action, a segment of work from your skill set, or a harebrained idea that came into your head or you saw somewhere.
Assess, was the short term goal achieved? This can be objective, a client sensation or an observable action. If yes, go on around to the long term goal again. If no, go back and try another strategy. This is why harebrained ideas are okay, all that matters is if it worked. It’s not failure if it doesn’t, just keep working the system.
If you get stuck in the strategy-assess loop then you need to choose a different short term goal. You might find that even long term goals change. A different emergency emerges as client become acquainted with their internal terrain.
This process frees you from undue responsibility for client satisfaction. They become consultants in your work. You are the expert advisor, and they are a colleague. If you work this well they will come up with ideas of their own. A performer can say “I hope you like me singing”, or “I’d like to share this song with you”. The work is the focus of what’s occurring, not you.
This was presented to me as “The self-teaching cycle” because it allows you to puzzle through problems and discover new treatment pathways with an empowered client as your collaborator.