Friday, July 31, 2009

Why therapists do what they do

One of the things I have noticed being in the blogosphere is the meeting ground between people who are therapists and people who are clients. It provides an interesting forum as one reads things that are written by both sides of the coin.



Although I kind of knew it already I am a bit surprised at the amount of thinking that clients sometimes do about their therapist’s and their therapy. There are sometimes endless blog posts on this topic which I read with interest. There seems to be much less written by therapists about specific clients so one could say that this is another example of how the relationship is not an equal one. It seems safe to say that generally speaking therapists are more emotionally important to clients than clients are to therapists.


I am reminded of an event that happened many years ago early in my working life that I have never forgotten. I was running a therapy group that had about 10 participants. The usual few hours one morning of the week that would go for about 6 weeks in a row. On about the third week just before the group was to start we were all sitting there and then was an exchange between a number of the group members that did not involve me. I was just sitting there listening to it.


Barrel bolt


The door of the room had the usual door knob that one would turn to open the door. I had also placed a small barrel bolt higher up the door which I also latched each time we shut the door for the group to start. The group members had about a 5 minute discussion about this barrel bolt and how I latched it before each session. Some were saying that it was there to provide a sense of safety and others said it was done for the boundary of the group and to build a sense of trust and so forth.


I said nothing and just sat there listening. Eventually it was time for the group to start, their discussion concluded and we began. The door knob latch on the door was a bit faulty. Occasionally it would just pop open and the door would swing open a few inches and I would have to get up and close it again. I had put the barrel bolt on the door to stop that from happening which is the reason why it was there.



I hate saying this but I have to because it’s true. Being a therapist at least in part is a job to earn money to live. I don’t like saying it because I have never wanted a client of mine to become just a case number and I have always worked at trying to achieve that. I think I have been successful to some degree at least.


Depending if one works in a hospital or in a private practice a therapist may see 30 clients a week. For each individual client the therapist sees another 29 each week. For each client there is a client before you and a client after you. Sometimes there are long blog posts I read about what a therapist did or said. Much conjecture and thought over what he/she meant by a certain comment, their motives for doing something and so forth. I would imagine that some of the time, the therapist hasn’t even thought about it. Like my barrel bolt on the door. It didn’t mean anything and was turned into a significant psychological undertaking by me.


Graffiti




59 comments:

  1. "It seems safe to say that generally speaking therapists are more emotionally important to clients than clients are to therapists."

    That's the hardest part!

    I think it's human nature to want to know about someone who is helping you with something like therapy...

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  2. 1. I find it interesting that you were sat there and no-one actually asked you.

    2. I totally agree that the therapist has to earn a living and to earn a decent living you have to see a reasonable volume of clients. And on those days that we all have, where you may be hung over, or stressed about something in your own life, you must try and conceal that and pretend to be giving 100%.

    Yet some theory suggests about the relationship between Client and Therapist being key. And you have spoken yourself about clients who have the need to overcome attachment issues by forming an attachment with the therapist and going through the attachment cycle with them.

    But it is all fake. And that puts me off the whole thing. No criticism intended but the attachment wont be an equal one because the therapist has many clients but the client only one therapist.

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  3. And I guess also the thing that bugs me, is that the client may share something that is really important to them and even say it is important to them. And the therapist will forget, even promising that they wont forget. And can you blame them given they have many clients.

    Anyway, rant over!!

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  4. And I think the picture you have of the two barrel bolts with one bigger than another is meaningful.
    !!

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  5. I can definitely relate to this, as I am probably one of the people to whom you refer. I write posts about my therapy and my therapist all the time. I analyze every thing he says, every move he makes. I'm sure I think about him a lot more than he thinks about me. He thinks about me when he checks his calendar the night before my session, when I'm in the session, and when he is printing out my bill at the end of the month. He has 35 other clients to think about too.

    He talks about his other clients a lot to me. Not enough that I would ever know who they are, and usually it's brought up because the topic is relevant to what we are discussing. It's like he doesn't want me to forget that I'm not the only one.

    My greatest fear is getting attached to my therapist. It's not that he doesn't care about me, I'm sure he does, the same way he cares about the other 35 of us. But he'll never be attached to me.

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  6. Sorry, it's rude to follow up my comment with another comment, but I'm wondering why you are surprised that clients think about their therapists and their therapy so much?

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  7. Yes April,

    I does seem like the hardest part and it does seem natural to want to know more about the therapist as you say.

    I am amazed that they even noticed that I locked the barrel bolt in the first place.

    Tony

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  8. No they did not ask me Kahless but it was not like we were all just sitting there quietly. It was just before the group was starting so there was a lot going on with people getting their seats, using the restrooms, getting coffee and so forth. Even a few probably having a quick ciggie (in those days you smoked inside) because they know that they are just about to do some work on giving up smoking.

    As you say the relationship between the client and therapist is pivotal in the therapy and so the therapist has to walk a fine line because of the valid points you raise like the attachment not being the same and the fakeness. I might write something more about this today.

    You barrel bolt comment was a bit too cryptic for me however.

    graffiti

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  9. Hi Harriet,

    I have read your posts about your therapy and I am gald that you write them. I suspect that such an exercise is quite therapeutic for you so keep them coming. I don’t know if I agree about the comment that he will never be attached to you though.

    In blogs I have not been surprised that people do talk about their therapy and therapists, but I have been a bit surprised at the volume of writing about it. I suppose I am reminded again of just how important such an undertaking is for clients. So thank you Harriet for reminding me as I don’t want to loose sight of that.

    Graffiti

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  11. Sorry Anon,
    I had to remove your comment
    I will only accept anonymous comments if they are benign. If you are going to say something that is more 'forward' or arguable then you will need to not be anonymous.

    Graffiti

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  14. Hi Lynn,

    Good to hear from you. I suspected it was you but I obviously could not know for sure.

    The comment had your no nonsense articulation so it could have read as being a bit more than benign. Anyways good to hear from you as I said before.

    Tony

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  17. I know I've said things offhand-ish to a patient that they took to heart, that wasn't at all what I meant.

    I also had the other experience though, of minor things I said in therapy being blown way out of proportion and having these massive deep meanings to the shrink.

    Any interaction between people, I think, is nothing like either one expects for the other.

    Good post.

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  18. Harriet, why is it rude to follow up one comment with another. Isnt it just we forgot to say something after we pressed the 'post comment' button?

    I hate being rude so am I missing something?

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  19. Tony,
    one bolt bigger than another.
    attachment bigger (potentially) for the client than the therapist.

    That is what I meant.

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  20. Lynn,

    I have always assumed that every anon comment on Tony's blog is yours!

    xx.

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  21. Kahless - I don't know. I just like to point out the fact that I'm being rude before someone else does I guess.

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  22. And were is our Roses?

    We are missing you.

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  23. Hi Harriet,
    I didnt think you were being rude.
    if you want to see rude, look at some of the comments I have posted in the past - I have a habit of making an arse of myself! Sometimes I cringe at myself. Or rather duck for cover!

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  24. I'm on holidays Kahless. Its nice but a bit crowded. I'm never alone while away with my husband. I'm in the lobby of the appartments we're staying at right now just expecting him to come down the elevator to check up on me. I've been here for a little while this morning.

    I have this amazing feeling or pull to get up and go to the appartment just to let him know i'm still ok and not doing anything that he wouldn't like me to do.

    I'd not noticed how those feelings rule my life. Totally - and i don't know what to do about if... even, if i want to do anything about it.

    I can't believe how much noise he needs to live around. I live my life in as quiet a place as is possible but he lives with both tv's playing and the radio going. I went to sleep on the lounge last night but it was so uncomfortable!

    I'm a selfish insensitive witch!

    I've always known it but its so yucky when the truth hits me in the head so hard and cold.

    Apart from my running away to get away every moment i can Kahless, it really is a lovely holiday. This place is a lovely place and we're living it up.

    Perhaps i'm going crazy because its only our first week and next week will be better. I can't believe he hasn't checked on me yet!

    I'd better go. Cheers...

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  25. Hello Roses,

    Does he know you like quiet? I am a bit the same at times. Some times I like noise and sometimes I just don't want any.

    maybe you are dyslexic - that is one of the symptoms

    Graffiti

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  26. That is a good point Sara,

    That no interaction between two people is really like the other person expects.

    In training counsellors one of the big milestones is to get a somatic understanding that all others in the world do not experience the world the same way I do.

    Graffiti

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  27. I have never experienced you as being rude Harriet,

    But for some reason with you I have this urge to provoke you. I don't know why and this is not a common thing for me at all. In fact usually I am the opposite I would say.

    Tony

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  28. OK Kahless,

    Big barrel bolt, small barrel bolt.

    Now I get it

    Tony

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  29. Lucky no one in the group thought you were keeping the ghosts out by using anti ghost barrel locks Tony. When the door swings open making a bit of a creak it would seem like something has come into the room. At the least the creaky door might disturb more quieter moments of the group dynamics.

    I like a good seal on my door.

    Kenoath

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  30. You've mentioned your urge to provoke me before, Tony. I wonder why that is. I must be doing something to cause you to have that reaction towards me. I wish you would figure out what it is, perhaps it would help me.

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  31. Graffiti said ""long blog posts I read about what a therapist did or said. Much conjecture and thought over what he/she meant by a certain comment, their motives for doing something and so forth.""

    This goes both ways - perhaps clients are mirroring their therapists. There isn't always hidden meaning in every comment or gesture -Crossing or uncrossing my legs may mean I'm trying to get more comfortable - not that I'm opening up to or closing out my therapist :)

    Been reading your blog for awhile - always enjoyable. Love the first photo - the bear looks almost real.

    Take care.

    OLJ

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  32. Well that is a good point Kenoath about the anti ghost barrel bolt and that interpretation of circumstances.

    hadn't considered that one.

    Hope your Monday is going well

    Graffiti

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  33. I wonder why as well Harriet. I don't know at the moment but I will see if I can find some kind of answer. But I take OLJ's point and do not want to ascribe meaning to some thing that is not there

    Cheers

    Tony

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  34. Hello OLJ,

    Good to hear from you. I assumed the bear in the photograph was real but maybe it is not. It looks pretty authentic but these days you never know.

    You will get no argument from me that therapists can overly diagnose and analyse actions of the client. I would agree that that certainly can happen.

    I suppose I would also say that the importance of those interpretations are different for clients and therapists. A change in the therapist's tone of voice can have much more of an emotional impact on the client than the other way around. Perhaps the client is also much more likely to personalize it than the therapist

    Graffiti

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  35. And another thing I was thinking of today. What I remember most from my last therapy session last week isn't the "therapy" part of the therapy. It is the fact that three times during the course of the 45 minute session my therapist brought up the fact that I am "different" than most people. Well, one of the times I asked him if anyone else ever said "...", so he didn't initiate that, but his answer was "no, only you."

    I bet if someone asked him about our session last week he would have a totally different view of it than I did.

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  36. I went to this place Tony.

    http://www.dyslexia-adults.com/a6.html

    Everyone does what these people do to remember or to get by. I must admit that after a bit of a search, well, your suggestion may not be far off target. You think and its lovely.

    He knows about the 'noise' thing, and last night we didn't have to sleep with the telly on all night. I don't remember anything from when i closed my eyes till - the telly (vaguely) @ around 6 this morning and then the time we got up at around 7.30. Oh my goodness! It was wonderful!

    We usually have the telly going while we sleep and though i don't sleep well because of that, the days are usually filled with quiet times, and somehow that makes it ok.

    It isn't easy for him, his ears buzz... umm, tenitus(sp?) And since we began our holidays his muscles are cramping up causing terrible head aches and bone strain. If we keep on holidays for just a few more days he'll begin to relax and then a week more and i'll meet with the man i fell in love with again. That's the only time i get to meet him. Once, for a few days, every few years, and only if we get through the initial stress-detox week at the beginning.

    He's considering going home tomorrow and building the fence and then attempting to go away again the following week or so. I hope that doesn't stop the de-stressing. I guess its his holiday and so i'll leave it up to him to make the choices.

    I hope you're having the funnest Monday you've ever had.

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  37. I think that there are therapists out there that might post in depth blogs about their clients except that wouldn't it be considered a breach of ethics to do so?
    As clients we are free to post and publish and disclose to whatever degree we feel comfortable, but it doesn't seem appropriate for the therapist to do the same.
    I wish I hadn't missed all Lynn's comments...
    -else

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  38. I think you observations of therapy is quite apt harriet. That the actual therapy techniques are sometimes not as important as other non-therapy occurences.

    Sounds like you might have a good functioning relationship with your therapist

    Graffiti

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  39. Hi Roses,

    One of the symtpoms of dyslexia is what is known as 'distractibility'. They have changed all the names in recent years and now it can be referred to as attention deficit disorder = distractibility. One has trouble with their attention because they get distracted.

    Some when having a conversation can't have the radio going on in the background because the radio grabs some of their attention and thus they can't properly attend to the conversation.

    If a young child is in a classroom and there is other significant noise or movement going on they find it hard to 'attend' to what the teacher is saying and thus the under perform = dyslexia


    Tony

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  40. Hello else,
    Thanks for your comment.
    I would gladly put Lynn's comment back if I had it. When I deleted it it disappeared into cyber space.

    I think it is OK to comment on clients (I do it) as long as the client data is fictionalized. It is regularly done in the professional literature which is also information in the public realm.

    Regarding ethics it depends what type of indepth comments by the therapist of the client. Cleints often comment about their strong emotional reactions to therapy and therapists in blogs.

    It is probably generally accepted that therapists can have some emotional rections as long as they are not too strong. Certainly not as strong as one reads of clients comments about their therapists in blogs

    Graffiti

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  41. Working with contracts is helpful. The contracts do not have to be written in stone however if they help the client to remain on track with their issues that is good. It is all very well to say things about ones therapist and even more helpful to reflect on ones own feelings as they do that.

    Recently an alternative therapist I saw stepped beyond the bounds of what I had come to know as our "work together". This was very confusing after my treatment. I just let it go. I havent done anything to her - she must have been having a bad day?

    Perhaps I will bring that up with her next time or I could have a whinge about her or never go back? Aint it awful!

    kenoath

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  42. Good morning Tony,

    We arrived home yesterday afternoon.

    I don't like lables. Being easily distracted my be a symptom of a lable or it could be that one is simply being distracted.

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  43. Yes Kenoath,
    It is awful!

    I like playing that game as well at least for a while but I am really a half glass full person.

    But i do hope the over stepping of boundaries did not cause you too much disquiet my friend

    Graffiti

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  44. I am glad you have returned safely from your journeys Roses.

    Well you have been labelled Roses, you are a dyslexic.

    Do you have any tattoos? They are labels for life.

    Tony

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  45. I have a tattoo. Yep, it's my label for life. I got it when I was 48 years old.

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  46. That is good of you Harriet, a tattoo at age 48

    Take a photograph of it and post it on your blog so we can see it

    Tony

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  47. Here you go Tony:

    http://harrietmwelch.com/?p=147

    Do you have a tattoo? How old are you?

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  48. Hello Harriet,

    that is a good looking tattoo and I like your cake as well.

    I am 52 years old my friend. I don't have any tattoos because I have always felt that over time I may not like it and then can't get rid of it. Also I don't like pain and I have been told that being tattooed can be painful.

    I haven't even ever had any part of my anatomy pierced, nor do I wear any jewellrey. Just not my thing really.

    It seems I like o'natural

    Tony

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  49. I don't have tattoos for pretty much the same reasons as you Tony. I do, however, have pierced ears. That hurt so bad i didn't dare let the holes close up! I tend to like o'natural too - but sometimes i like ear rings too.

    You can put lables on me if you like but it doesn't make it true no matter what glue you use to adhere them to my life.

    So there!

    Cheers... roses

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  50. I agree that there are different levels of games that are good value sometimes Tony. I am pretty assertive when it comes to boundries.

    kenoath

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  51. The label is stuck on with super glue Roses

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  52. I think so also Kenoath that you are quite well boundaried

    Graffiti

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  53. Ohh... super glue huh? Hmm... let me think.....

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  54. Ohhh! So that's how you spell label. I thought it looked a bit funny.

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  55. No. It doesn't matter what glue you use - still doesn't (necessarily) make it to be true!

    (Gosh! You nearly tricked me with that one.)

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  56. I think it goes both ways Tony. After all don't therapists have a reputation for overanalizing everything? I know I've had tiny things made to seem bigger by a therapist.
    That said I overanalyze the meaning in tons of stuff my therapist does. Or did since I'm no longer in therapy as on wednesday

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  57. Yes we do over analyse at times Lee.

    So therapy ends on Wednesday?

    That means you must be moving I think and will have no laundry.

    Graffiti

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  58. Yep. working on moving into the new apartment. I'm crashing at my parents for a little bit right now though. They have laundry machienes in their house. I have to pack up all my stuff that's been accumulating here since 3rd grade because they've decided to move so I can no longer treat their hose as a storage locker. It's busy busy busy here

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  59. Times they are a changin' Lee with the parents moving on, but it must be better for you having a washing machine at home!

    Tony

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