There’s a mystique surrounding therapists that is hard to appreciate until you become one. Here, for the record, is my account of what clients desire, that therapists cannot provide.
A Funny Thing Happened on the Way to the Session
Early on in therapy, I usually tell my clients the following joke:
Q: How many therapists does it take to change a lightbulb?
A: Just one, but the light bulb has to really want to change.
Sometimes I’m embarrassed by how corny this joke is, but I keep using it because it provides a memorable way to begin dividing up responsibilities between therapist and client. Given the expense and time committed by clients, I can see why they feel that I should be changing them.
If only such a feat were possible. The truth is that any therapist is at best a catalyst for change. Until a client buys into the proposition that they alone are ultimately responsible for their change, there’s not much hope for progress.
Can You Fix my Spouse?
I know I’m in for a difficult conversation when a prospective client calls in asking for help with their spouse, their child, or their parent. It is hard for people affected by others’ bad behavior to hear the unmanageability of attempting therapy on someone who is not the one who wants the change. Without fail, I ask the caller to have this third party call me for a consultation. Their willingness to call me signals at least a glimmer of motivation.
Sometimes I encounter couples where one partner wants to change the other. Rarely have I met a couple where both partners were equally motivated to seek treatment. Usually one person is leading, if not outright dragging the other into therapy. Unless I establish motivation on both sides pretty quickly, I have a hard time imagining a productive outcome.
Sometimes, just recognizing lack of motivation in one partner is a kind of progress. One client drags their significant other to therapy and they get a crystal-clear picture of their partner’s level of commitment to change. The unfortunate truth is that couples therapy is as likely to result in a breakup as it is to bring two people together. I do not believe this is a defect of therapy. Rather, many people turn to therapy only when the relationship is already fatally flawed. In that case, the best thing a therapist can do is help the couple see things as they truly are and make well-informed, if painful, decisions.
Right, Wrong and Therapy
Another common client request is for the therapist to give an ethical analysis of some situation or choice. It’s not that I don’t like ethics — I love ethics. And it’s not that I don’t have an ethical opinion — often I’m cringing or cheering on the inside in response to their choices. The trouble is one of self-determination. If I start giving my clients ethical feedback, then there is the very real risk that they might start living according to my values instead of their own. While I have my own moral code, and it works well enough for me, I can see how the way I value things wouldn’t make sense for someone else, or even for myself in a different stage of life. I’d much rather they developed their own ethical stance that they can access when I’m not close at hand. While handing down morals from therapist to client is a definite no-no, helping my clients refine their own moral convictions is a part of my job I relish.
Are We There Yet?
In a world full of fast food, express checkouts and instant messages, the therapeutic process remains stubbornly non-instant, non-express, and non-fast. Managed care has tried to hurry up the pace of therapy by limiting the number of sessions for which it will pay. I have also worked in treatment settings where the number of session is strictly proscribed. Neither of these factors does anything to improve the speed of change, but instead to simply limit the amount of progress a client makes before they are booted out.
Even in the absence of external drivers, clients want to know how long change will take. While I’m not against ballpark figures or historical averages, the course of therapy is affected by so many things beyond the control of therapist and client alike.
The first big variable is the problem itself. As often as not, the client believes they’re coming to therapy for one problem, only to discover their true issues lie elsewhere. Likewise, early on in therapy a problem may appear more or less serious before in-depth inquiry and exploration have taken place. This goes double for cases involving alcohol or drugs, where denial is not only part of the problem, but also an obstacle to diagnosis itself.
Second, there is no way to know in advance whether a given therapeutic intervention will succeed immediately, succeed over time, or fail outright. As much as the client may wish to deliver a knockout punch to their problems in the first round, and as much as I’m hoping they do, this isn’t always a realistic hope. Often the best thing that comes out of a week is that the client finds out what won’t work, freeing them to try something else.
Third, life happens while we’re busy making treatment plans. The problem that was front-of-mind last week may be irrelevant this week. Perhaps there’s been an illness or a death in the family. Or maybe the client fell in love. Either way, whatever plans and expectations existed prior to these curveballs, it’s time to reassess and maybe even start from scratch. If I’ve learned anything from my therapeutic experience, it’s that there’s little use in making overly detailed plans too far out into the future. Given the tentative nature of plans, I can’t in good conscience give my client a timetable for when they’ll reach their goals.
All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by Pat Orner Oliver on .on and was last reviewed or updated by