Early in my career, I had lots of questions about how clients change. Why didn’t my clients change as rapidly or as profoundly as my grad school texts seemed to suggest would be the case? How much of my clients’ change (or lack of it) was about me? And how much was about the client him/herself? I wasn’t sure.
My early experiences were discouraging and eroded my confidence. I stumbled around looking for answers. Sometimes I’d blame grad school for not giving me what I needed. Maybe I had been duped by a set of overpromises that underdelivered.
More often though, I thought it was about my inadequacies. I felt incompetent. I went to conferences and read more, trying to develop my skills and understanding. My clinical results still fell short of what I hoped. I simply could not figure out why my experiences differed from the masters’.
Even after ten years, I was still struggling. I had learned that I was not alone in this line of questioning. Many, if not all of my therapist friends were wondering the same thing. Why were we not seeing quicker and deeper results? One colleague judged her therapy against the ideal that she called “what a really good therapist would do”. Of course, she always came up short. If that was the standard, then all therapists would come up short.
My eventual answer: Part 1
Over time I gave up on finding all the answers, but I found some parts. Here are two aspects.
First, it dawned on me that part of the reason for clients not changing is quite obvious: because everything I ask a client to do is harder than what they have been doing previously. As we all know, we all tend to choose the path of least resistance. Clearly “change” is not that path.
- Therapists ask clients to take responsibility for shaping their lives. But why should they? Far easier not to.
- We ask them to move toward difficulties–face problems. Again, from a defensive point of view, a bad idea. Easier to minimize, avoid, make excuses, or blame.
- We encourage them to be honest with themselves–no more self-deception. Do I need to explain how hard that is for those who have spent a lifetime developing complicated methods of defending against painful self-awareness?
My eventual answer: Part 2
The second aspect of why my clients did not change like the experts’ clients is this: my out-of-whack expectations. Not all clients are ready to change. Some are not able to face the self-critique that change requires or willing to move at a pace that satisfies me. And the real rub is this, that I tend, as most therapists do, to be overly optimistic about how easy it will be for my client to overcome the many obstacles to change. I asked too much of my clients and did not appreciate all that they had to overcome for change to take root.
Pace of change
I confess that I get impatient with my clients. In truth, I want each client to change partly for my benefit. The change would affirm my sense of my efficacy. When my client changes, then I can more confidently assure myself that I am an “adequate therapist” and maybe even a “pretty good therapist,” though I never allow myself to think that I might be a “really good therapist”. I want (need?) my client to change for me.
And of course, it is also true that I want my clients to be relieved of the suffering that drove them to therapy in the first place. And the sooner they get on with the needed changes, the sooner the relief comes for both me and my clients.
Ease of change
And I also find that I nearly always begin with a limited understanding of what is involved for a client to adopt a new approach to living life. My lack of appreciation for what my clients are facing is usually solved eventually–if I stick in there long enough. My clients will show me all they face. And as time goes on, that deeper understand will increase my empathy and insight.
And yet clients do change . . .
In spite of my questions and doubts, many of my clients did change. There is no doubt that I make fewer errors than I did when I was first beginning. Part of that is the work I put in to become a better therapist. Some is the experience that I have accumulated over the years. And maybe it is my increased maturity as a human being. I am a better therapist than I once was, no doubt.
Now I accept that my appreciation was limited regarding all that must be overcome by my clients in order for change to take hold. I became more patient; I’ve become more comfortable with my clients’ pace, even in the face of outside pressures from insurance companies, supervisors, or my own inner voice.
No longer do I blame the models and techniques I learned in graduate school. They are effective enough–just not as effective as I, in a wishful-thinking mode, thought they would be.
So what do we need to do?
Yes, we need to develop our skills to the best of our abilities. And yes, I think we never outgrow the need for good clinical supervision. And yes, if we can see that our expectations are at least part of what is out of wack, then obviously we need to chill a bit.
But maybe most of all, we need to listen, really listen in a way that will help us better align with where our clients are. Our clients constantly give us feedback about what we are offering them. They will tell us, or show us, what they find difficult or out of reach, what they cannot face, why they cannot change at the pace we would like. They may not always use words to give us that feedback, but they are trying to show us the way to the insight we need. As we see more and understand more, we can adjust our expectations to their pace. Our clients will guide us to what they need for change to happen.
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