How I treat my clients
Your client is not your friend. You’re not going to be inviting your client for a drink after work or to your home for dinner. Every therapist knows that the imaginary barrier between the client and the professional has to remain firmly in place.
But working with clients can often be a battleground. Here are some ways to win the war.
Therapy is really divided into four parts: Opening, Exploring, Problem Solving and Closing. It’s just as important for the therapist as it is for the client to get into the right frame of mind. I always have a brief (up to 10 minutes) chat with a client on the phone to find out what they expect before I decide if I can help them. Before the session, I also mentally practice what I’m going to say.
It’s important to prioritise the client’s needs, but you can let them do that – they’re going to do it anyway, it’s just that sometimes they might need help putting their thoughts in order. As the therapist, you should be able to spot action points that will enable the client to move toward what they really want, which is very simple – to feel better. Feeling better is all the client really wants, and you simply have to gat this to happen before they leave.
The main thing that should be uppermost in your mind is what’s in it for the client? I have always said that it’s a mistake to give the client what you think they should have rather than what they really want – it’s their session not yours, and what they want usually coincides with what they need, so with this in mind, the next step is to make them do as much of the work as possible.
I always try to tap into my client’s self-interest, using questions to persuade, such as
‘How do you see the problem? What do you think would happen if…?’ and so on.
More examples would include phrases such as ‘lets do a bit of brain-storming; lets consider some different possibilities; one option might be to; what if we were to…’ and so forth.
Sometimes I encourage clients to map out what they want visually by making diagrams (pens & paper at the ready!) This will more easily help the client see ways of getting from a to b. They needn’t be any good at art or drawing because no one is ever going to look at what they’ve drawn, not even me most of the time, but the diagram should include references to all the factors involved, including all the obvious key points. From there, a process of working backwards from the goal will help to identify some key steps. It’s important to get the client to do as much of the thinking as possible – if you can get your client to bring to the surface that which they already deep-down knew to be the truth in the first place, then that’s a massive leap in the right direction.
People are too often influenced by the beliefs of others and this can be especially true if one of these the ‘others’ is the client’s own therapist. It’s vital that the client is free to make his or her own decisions without any interference from you. It’s one thing to act as guide but you must never suggest solutions. These will be discarded anyway – therapy only works when clients are allowed to discover their solutions, although it’s also OK to carefully drop hints. I often leave sentences unfinished and then pretend to suddenly remember to ask the client something else – and let my client fill in the blank.
Once the client has made a decision about the way they want to be, they can start to practice mentally, imagining how their feelings and emotions will change, the better behaviour will follow automatically, although sometimes it can take a little time for clients to get used to this new way of being. I once had a client who at the end of the session remarked that she didn’t really need me after all, and that she had been able to work it all out for herself. She was of course correct.
It’s up to the client to ask themselves the questions ‘who do I want to be? and how do I want to be? Actually, they all want to be confident, charming and unstoppable, but they have to realize that by themselves, on their own, and without it being handed to them on a plate. A good way to achieve this is to get the client to practice the images of themselves as if they were watching a movie.
Rapport establishes trust. I try to connect at a personal level, and a little small talk at the outset, peppered with some gentle good humour often helps. I’m sometimes self-depreciating but I try to find some common beliefs to can talk about or some common interests to talk about. All this helps to get the client on board. Good therapy is all about being able to connect at the human level.
I’m informal (I gave up wearing a suit a few years ago) I smile, I’m relaxed, friendly, helpful, and understanding. Above all, I try to relate to my clients in such a way that they feel good about themselves.
My credibility is established by employing measured speech – that means no waffling! I occasionally pause if I need to think. If I need to get an important point across, I place my hand palm down on the table to signify it’s not negotiable, although I avoid engaging in too much gesturing (except on stage or when dealing with groups.) I avoid pulling faces unless it’s to smile or gently nod in agreement. If I don’t agree with something, I don’t shake my head. A gentle nod is a reward. Body language has to be flexible and loose and relaxed. A palm up shows empathy with the client and your willingness to listen.
I try to be the example of the behaviour I want to see in the client, but I definitely avoid ‘mirroring’ NLP style, which is of course all bollocks, and can be irritating.
Here’s another thing to remember – it’s OK to be tough on the problem (but not on the person.)
And I do find a well-timed joke – relevant to the problem – helps! Laughter excites the pleasure centres in the brain, producing endorphins that make them feel good – in other words the client not only gets a reward, but a small dose of humour, delivered correctly, will make them think about the problem in a completely new way, and this can often lead to a solution in itself. Stand-up comedians can do more to change or reinforce political beliefs with one clever line that hours of speeches and political rhetoric can ever achieve.
Conversely, when clients are confronted with uncomfortable truths, the fight or flight mechanism kicks in and the body produces adrenalin. This is counter-productive so I avoid confrontation at all costs. Anyway, humour is what I’m good at and more important, I’ve found it works very well indeed!
Listening to the Client
Listening to the client takes a lot of practice and a lot of patience. These days I set aside at least two and a half hours for individuals and the time really goes by quickly. I prefer to get the job done in one session, and that can sometimes mean spending a whole afternoon with just one person. This is something I’m doing a lot now and I’ve found it to be a very effective way of working because I believe in ‘flow’ – bringing them back in a week or two weeks is just an interruption. The client benefits more from continuity to achieve the change they’re looking for.
Listening to what the client says is of course all-important, and I firmly believe they should be doing most of the talking – and therefore most of the work. Anyway, when a client is talking, they are also putting their thoughts in order, collating if you like, all the relevant information. But listening to the words alone is only half the story. Often it’s what the client doesn’t say that is just as revealing. I listen for the meaning behind the words – that is very often what is actually being said!
Paying attention to the client’s non-verbal communication, listening to the sub-text and identifying the client’s emotions are just as important, and sometimes even more so.
I check constantly that my understanding is correct. In this respect it’s perfectly alright to let the client to drive the session. In fact, I prefer it when this happens. For me, it’s a perfect situation. It means that the client is actively participating in the process and that has to be a good thing!
But I also employ very careful questioning. For example, it might not be good enough to ask the client did you like (or dislike) the experience? You will get more information and it will be more helpful to the client to ask what was it about the experience you liked (or didn’t like) in particular?
I constantly refer back go the bigger picture. This keeps the client focused and helps keep everything in perspective. Of course it’s up to the client to try to work out the real underlying reason or reasons for the way they feel, just as Carl Rogers said, but it’s also good to get into detail as well as be objective and creative. Always remember – there’s plenty of time – never hurry! Even if it means finishing later than you expected.
I understand the whole process can be a difficult balancing act, especially if there are time constraints, but that is exactly my point. You’re not going to get anywhere if you’re in a rush – that’s why I now set aside long periods of time where both the client and the therapist can explore different solutions to problems, although the solution is nine out of ten times blindingly obvious. I encourage them to come up with their own ideas, even if all I’m really doing is letting them come up with my ideas! That’s OK too – they can assume ownership of my ideas if it helps them move forward.
I often use metaphor (an old method that goes back to Jesus and the New Testament and has since been purloined by the cult of NLP) to describe similar circumstances or problems in search of solutions: A friend/colleague of mine had a similar problem…
I recently had a client with a very similar problem – he/she found x useful…
Sometimes clients do not always heed what they say themselves. You should watch out for this. Bear in mind that said does not always mean heard, and heard does not always mean understood.
Let’s take that one step further… understood does not necessarily mean agreed and agreed does not mean an agreed solution will always be applied. And even if it is applied, it does not mean it will always be maintained.
I am aware that some clients are not always entirely honest. Of course it’s only natural that human beings, with all their frailties and weaknesses sometimes seek to paint an improbably perfect picture of themselves, especially when it comes to matters of morality, but this is normal and you should be prepared to allow for it.
However, if you start to spot contradictions in your client’s story, this is cause for concern. At that point you should start to question your client’s motivation. Suddenly there is a whole new spin on where the session is going and on what might actually need to be done! You should be able to spot narcissism for example – a client suffering from narcissism (they are admittedly rare) will spin you a line that will tie you up in knots if you’re not careful.
But generally speaking, telltale signs include, but are not limited to, hesitation, vagueness of detail or far too much detail. This is when you have to use your own experience of life to make some decisions about the direction the session should take.
I know I have used this example in other pieces, but you don’t need a degree in psychology to know when someone is flirting with you. Likewise, you should be able to spot when someone is taking you for a fool. If you think that something has been planned or rehearsed, it should make you suspicious as to what the client sat in your therapy room is really there for. Are they after confirmation that they are right and someone else is wrong? Are they trying to use the session (and you) to prove a point? Is the client using the session to confirm they need to be treated as someone special, or that their particular phobia or aversion means that others must see them as special and give them special treatment? Maybe they just want to feel special themselves – this is often true of people who have supposedly lived ‘past lives.’ If you’re not careful, pandering to beliefs like this may impact on the lives of others and even exacerbate a client’s mental illness.
Exploring the emotions attached to what is being concealed might be a good direction to move in because it’s very hard to conceal emotions. Facial expression is the dead giveaway of faked smile, enthusiasm, sadness etc. Lack of eye contact where there has been plenty of eye contact – if they suddenly look away – is also a good indicator.
Psychology is not, as most people think, the study of the mind – it’s the study of behaviour. Behaviour forms patterns and it is vital to recognise these.
As clients talk about their problems, their lives and the people in them, they will give away clues as to how they view the world and their place in it; they will also give away clues as to how they think the world perceives them. This is all good information. It will help you to eventually see the truth lurking behind the smokescreen.
The fact is that most clients are honest. Therapy is a two-way street. It’s a fair exchange of ideas between two people in search of a solution to a problem, and with a little co-operation, it should be an easy road to travel – it usually is. You just have to remember what you’ve just read.