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Apparently innocuous comments can upset your clients. You can’t avoid triggering issues unknown to you, but you can be ready to respond if they are brought to light.
One participant in a relaxation class became increasingly agitated as the relaxation script was read to the group. She then burst into tears and fled the room. The script used a “relaxing image” of walking deeper into a cool, leafy forest: no one knew that the client had been attacked in just such a location.
Many therapists live in fear of distressing their clients by “saying the wrong thing”. Forethought and attentive listening can permit you to avoid many problems, but there will inevitably be a time when you trigger issues of which you were unaware.
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Check you have the right person before you begin your session. There is scope for confusion in busy clinics, but mistakes can occur even in otherwise empty waiting rooms.
There was only one person in the waiting area. I said her name and she followed me into my room. After 10 minutes or so, it became clear she wasn’t my client: she was in a lot of pain and had been awaiting a GP; when I walked into the waiting room, she hadn’t listened to the name I called. She missed her actual appointment and I missed my actual client.
Outside of addiction services, therapy clients rarely have anything to gain by posing as someone else. When dealing with people who are distracted by pain, hallucinations or medication, however, there is potential for confusion.
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A detailed, session-by-session account of a therapeutic intervention. Written by the therapist and detailing all the detours & blind alleys that never make it into textbook accounts of the therapeutic process.
Many clients, some famous and some not so famous, have written of their experiences in therapy. Therapists’ accounts of therapy tend to be confined to heavily anonymised snippets of conversation illustrating a particular point in therapy textbooks, or case studies in peer-reviewed journals which focus more upon the diagnosis & outcome than upon the process of intervention.
Dibs In Search Of Self is that rarest of books, an account by a therapist of every session (and the related consultations with teachers and family) of her contact with a small boy, the titular “Dibs”.
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Be aware of clients’ information sources in addition to your own. Newspapers, magazines and online forums vary widely in quality, but may contain information of use to you and your other clients.
A client who I had advised on the control of panic attacks returned a year later to discuss another matter. At the end of the session, he told me that he had found a self-help book on panic attacks and “you know all that stuff you said? Well, it turns out you were right!”
Therapists may be perplexed or dismayed when clients prefer their own information sources to those of the therapist, especially when the other source is one which the therapist may consider disreputable. Therapists may be unaware of the range of resources available to and used by their clients, whilst clients may think their therapist is merely offering their own opinions.
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Ensure that your client can tell you to stop or to go away. All but the most severely disabled clients should be able communicate these instructions and should be encouraged to do so.
Professional codes of conduct require informed consent to treatment. Clients with cognitive damage or impaired communication pose a major problem for therapists and support workers. Informed consent may be beyond the capabilities of the client and may instead be granted by a relative or guardian.
When the client is obviously distressed, therapists and carers face a dilemma: should they continue with the intervention sanctioned by the guardian or should they suspend, even abandon their intervention?
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One of the major challenges to the therapeutic alliance arises when the client fails to follow the therapist’s advice. Therapists can often be heard to complain that clients reject their instructions (sorry, “advice”) out of hand:
Don’t they want to get better? Why won’t they do as they’re told?
When considering how you will respond to a client who is not following your advice, there are three questions you should ask yourself:
- why should your clients do anything you say?
- why should your client do what you’re saying now?
- why wouldn’t clients follow your suggestions?
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