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Some rules of thumb are derived from experience, accurate or otherwise, (eg: the praecox effect) and some from hard research (eg: people with memory problems don’t admit to them), but all have a common flaw: even if true, they are both generalisations across a population and specific to the circumstances of their origin.
In an undergraduate lecture over twenty years ago, a senior Clinical Psychologist described the “praecox effect” (as in dementia praecox, or schizophrenia):
if, after having spoken to someone for half an hour, you have no idea what they’re on about, they’re schizophrenic
To an undergraduate struggling to cope with the complexities of psychology, psychiatry and mental health, any simple rule was welcome. Reading the literature on the high rate of psychotic diagnoses in immigrant populations, it didn’t take me too long to see the problems with this rule of thumb.
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A guide to psychotropic medication for therapists and their clients. This book lays out the pros & cons of mind-altering prescription drugs from a critical but balanced perspective.
Books considering psychotropic drugs tend to one of two extremes: either uncritical accounts of their effectiveness and the presumed biophysiology underpinning their action or highly critical “anti-psychiatry” polemics which damn the entire concept.
Psychiatric Drugs Explained, now in its third edition, manages to occupy the middle ground. Explicit details are given of the desired action of commonly used psychotropic drugs (with both UK and US names), but equal attention is given to their side effects and alternatives to their use (eg: in the management of sleep disorders).
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Trainees (and clients) need to know that crying is common in therapy. Experienced therapists need to remember that crying may be common in therapy, but that crying in front of a stranger is probably a rare experience for any given client: you may now be relaxed about the situation, but they aren’t!
Every trainee dreads this moment: your client is crying. You probably are unaccustomed to strangers crying in your presence. The fear is that their distress is your fault, that you weren’t sufficiently sensitive or supportive: now you have to manage the situation you’ve “caused”.
More experienced therapists will have seen literally hundreds of clients cry. You know that people in therapy will cry for a variety of reasons, usually unrelated to the therapist. Knowing how common crying is, you’ve evolved your own set of responses. You’ve probably forgotten how awkward you used to feel…and how awkward the client still feels.
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Judicious use of open & closed questions can empower clients. Restricting the range of responses when some are inappropriate or unavailable demands more of the therapist, but can be more supportive for the client.
One benefit of speaking slowly is that you get to think about how you frame your questions. The considered use of open & closed questions is a therapeutic skill often mentioned in workshops and textbooks but neglected in practice.
Open questions can be used for initial information gathering (“Tell me about your childhood”) and closed questions used to clarify the information given (“Were you abused as a child?”).
Closed questions restrict choice of response. They allow only a handful of responses (eg: yes or no) without stepping outwith the frame of the question (“I don’t feel comfortable talking about that”). Many clients are insufficiently assertive to sidestep the question and may feel pressured into premature disclosure of information (or lying) by closed questions.
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Use of a client’s name to foster engagement may mask flagging concentration and inattention. Using a client’s name sparingly permits more accurate judgement of attention to the conversation or task.
“…a person’s name is to that person the sweetest and most important sound in any language.” (Carnegie, 1936).
Whilst using client’s given names uninvited can backfire, a genuine (and successful) attempt to remember and recall someone’s name can pay dividends.
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Using supervision to plan ahead for common and uncommon events has advantages for therapist and client. Both gain when the therapist has considered their range of responses ahead of time.
Ideally, clinical supervision is proactive. You discuss the progress of your cases and identify opportunities to be developed and pitfalls to be avoided. Inevitably, some supervision is reactive. You describe a problem or crisis and decide how such a situation can be avoided or better managed in future.
Reactive supervision can be dispiriting, even disempowering. The supervisor is given the role of dispenser of wisdom to the supplicant supervisee. A directive supervisor can leave you with the impression that you are still a novice (whatever your actual stage of training) with much to learn. Hopefully, we all still have much to learn, including our supervisors.
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