Friday, December 3, 2010

What would I do?

Harriet raises an interesting point in her comment on the previous post. So I will ponder the hypothetical.

If a client told me he had a terminal illness with a few years to live but did not want to talk about it or deal with any emotions about it what would I, as the therapist, do?

According to contract theory, therapy cannot progress unless both the client and therapist agree on the goals of the therapy. Would I be prepared to work with a client on things like loosing weight, dealing with past issues about siblings and so forth and not discuss the impending death?

My initial reaction to this is probably yes, but maybe only for a limited period of time. If the client wanted to make the contract to give up smoking cigarettes, I would feel some need to ask them why they want to do that? If they enjoyed smoking and were going to die reasonably soon, why give up.

In fridge
Possible or impossible?

I have worked with clients in the past who did not want to discuss certain matters and I have agreed, but their very life is clearly a very significant matter that to my mind could not simply be ignored. So it is quite possible that at some point I would raise this issue and we may part company as therapist and client because we could not agree on the contract.

To me it involves too much pretence or as it is called in Transactional Analysis a discount of reality. I would not be willing to have a relationship with the client which involved such a discount of reality. I would not be willing to have a relationship with a client that included such a profound level of fantasy.



  1. I’ve been giving thought to these last two posts you’ve written. Doesn’t everyone think about things they never talk or write about? At first, I didn’t see how keeping something private is, as you stated, discounting reality. Giving this more thought, it seems like if I keep something private, it doesn’t minimize the overall impact to me, but it changes reality for everyone else who can’t know this untold thing about me. Reality is what we assume or perceive things are. I’m not sure I agree that not knowing something is a discount – maybe more like an alteration of potential reality. Splitting hairs? Feel free to disagree.

  2. Hello KYLady,

    In the theory there are 4 levels of discounting and discounting reality is the most severe form. The man i talk about was probably going to die. Obviously if he never told me then I could not make the diagnosis of discounting reality. But since I did know then if I agreed with him to never talk about it then in my view we would be discounting reality because of the importance of the information and us both sort of pretending it did not exist.

    In theory this would be considered a counter therapeutic thing to do and as i mentioned I would not be willing to have a therapeutic reltionship where I went along with such a profound pretense.