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Therapists should be aware that clients may see them in a very different light. They should also be aware that these impressions are a matter of perspective and there may be fewer real differences than either therapist or client imagines.
Robert Burns wrote
Wad that God the giftie gie us
To see ourselves as others see us
In principle we all have such a gift (except perhaps people with autism, but that’s another discussion). In practice, this gift tends to be underused, especially in the consulting room.
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Be prepared to deal with the companions clients may bring to therapy. Dealing gracefully and helpfully with them can’t hurt your relationship with the client.
With the obvious exception of Marital Therapy and Child & Family Therapy, models of therapy tend to assume a 1:1 interaction between a therapist and a client.
In practice, most clients are accompanied, at least to their initial interview, by a parent, partner or friend (sometimes all three). Service information leaflets often neglect to advise clients whether their companion can join them in the consulting room, creating the potential for an awkward first interaction with the therapist: “can my Mum / husband / friend come in with us?”
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Therapists often assure clients that the information they provide is confidential. Confidential is defined as “intended to be kept secret”. Whether the information will be kept as secret as the client (or therapist) imagines depends upon the therapist and the service.
Confidentiality in the strictest sense implies that only the therapist will be privy to the information provided by the client. In practice this level of confidentiality is impossible to offer, as therapists have professional and legal obligations to uphold.
Most professions and services require that clients give informed consent to all assessments and treatments, which includes basic information gathering. Clients must therefore understand the limits upon the confidentiality you can offer before beginning to discuss their case. Clients who provide information which necessitates breaking confidentiality may feel betrayed by their therapist if not first advised of their therapist’s obligations.
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Clients’ perceptions of rapport may be enhanced by silences. Therapists who are uncomfortable with silence should remind themselves that their client’s interpretation of the silence may be much more positive.
A client once asked me not to delay speaking once he finished a comment. He explained that his school report was always sent home in a sealed envelope. He would be forced to stand in silence while his father read the letter, not knowing whether the report was favourable or how his father would react. Three decades later, he experienced the same anxiety during silences in therapy. Agreeing that he was no longer a school child and that a considered response from me was likely to be better than a hasty response helped him overcome his anxiety about my silence.
Therapists may also be uncomfortable with silence in therapy. Time or results conscious therapists may feel that silence is not the best use of the limited time available in a session and may seek to pack as much into the discussion as possible. Other therapists may wonder whether silence means that their question or comment has confused, distressed or even offended the client. Rather than endure the silence, they may rephrase their question or seek to clarify or qualify their comment. Further silence may lead to further rephrasing.
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Some terms used by therapists to describe clients have meanings which won’t be found in textbooks. Use of these terms is rarely of benefit to the client, although the term may say as much about the therapist as the client.
- resistant to treatment
- lacking motivation
- poor historian
- manipulative
- demanding
- somatising
- chaotic
- personality disordered
As diagnostic systems have developed, common place words have been redefined more narrowly & precisely for clinical use (eg: anxiety, depression).
As therapeutic professions have developed, there has been a less auspicious development: diagnostic labels have developed double meanings and common place words have been elevated to the level of diagnoses without the scientific scrutiny afforded official classifications.
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If you don’t know your client’s strengths, how can you capitalise upon them? Client factors account for 40% of the variance in outcomes and a wise therapist will play to their client’s strengths.
Clients are often defined solely in terms of their difficulties. “I’m seeing my obsessional woman this afternoon.” “When that guy with MS turns up, tell him I’m running late.” “Can someone attend to the broken leg in cubicle three?”
Modern medicine has come to be construed as an interaction between a physician and a disease rather than between a physician and an ill person striving to get well. (Scovern, 1999)
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