The Therapist’s Job.

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In Psychotherapy: What is the Therapist’s Role?

I heard this story first in Gestalt Therapy Training, some 30 years ago: Snakes live in the forest. Their daily travels take them over rough stones, branches, and uneven ground. Every Spring the snake sheds her skin. The outer, older skin loosens and gets tugged at as the snake makes her way around her world. But the outer skin never leaves until the new, baby, inner skin gets tough enough to handle all the rough stuff the snake will be going over.

It’s never the therapist’s job to rip the skin off a snake.

Your therapist sees your vulnerability/your baby skin, that you probably don’t show in normal situations. I feel this is a privileged position and one that absolutely requires respect and compassion if I am to be of use.

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Would a Therapist Ever Give Up on a Client?

That’s a very important question – in that it could be devastating to a client to be “fired” by his/her therapist. It’s tantamount to having your parent dis-own you, because of the transference.

After close to 40 years of doing therapy in private practice I think I have told a client I couldn’t keep working with them 3 times: once, the client was refusing to engage with therapy and only wanted to “use me “ much the way he used prostitutes – to feel better emotionally – and refused to have even have an area he wanted to improve himself about and ‘work on’. Another time it was very similar with a woman, and a third time I was seeing a man for the first time and intuitively felt in danger being alone with him in my office. I later heard he had attacked a female nurse in a hospital situation. In the first two examples I considered what I was doing to be therapeutic – in that the impact of having me refuse to continue seeing these people was my *final* BIG statement to them about the importance of dealing with their behavior.

All of which is to say – if you take someone on as a patient and you are not legitimately over your head with them – you have a moral obligation to them to work with them. It’s really OK to admit to a client that you don’t know how to help them and refer them to someone you think can help them. So yes, I think some therapists probably do give up on clients. Hopefully not often. It’s important for therapists to learn how to “size up” clients who show up at their door and decide if they want to work with this person or not.

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How is it for the therapist to have a client try to tell you about their attachment to you?

It feels touching,  just as seeing anyone say I matter to them would feel touching to me. Knowing that it is part of the ‘set up’ as a therapist, i.e. that if I do my job well my clients may well become ‘attached’ or have positive transference, doesn’t make it any less real a feeling to the client and thus to me when expressed. I would probably assure them that they are important to me too, but in a different way. I often say “ I am invested in you” – which means I am invested in their being OK in their lives and doing well, which is true. That seems to make things feel a bit more congruent, although they are not even at all. That’s why the therapist never takes advantage of the clients feelings towards them.

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Re-parenting in Psychotherapy

I think therapists are re-parenting all the time they are in session with a client, and being keenly aware of that is part of using transference. Recognizing that transference is going on all the time in therapy allows the better therapists to be most effective. This is what is meant by “ It’s the relationship that heals,” not the particular therapeutic approach utilized.

It’s the therapists respect, interest, affection, effort put out to help; all of this and more is apparent to the client consciously or unconsciously. And all of this is saying “you are worthy, you are of great value as a person.” Your thoughts are interesting, your feelings matter, etc. etc. These messages are the ones the person should have gotten as a child are now being expressed by the therapist, overtly and not so overtly, verbally and non-verbally. That’s re- parenting. Knowing how to do this genuinely is an important therapeutic skill.

When I am meeting a client for the first time, I look to see what I label to myself as the “beauty” of this person. If I don’t see it right away, I consciously wait, because I know I will see it soon. If I can tell I am never going to like a person, for what ever reason, I don’t work with them. It happens very rarely. I know each person deserves to have their therapist like them and find them worthy.

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How Do Therapists Stay Calm When the Client is So Very Angry at Them?

I think there are a couple of reasons. One is that we (us therapists) forgive ourselves for mistakes, and two, is that often we haven’t really done anything wrong at all and the client is angry because of misplaced transference. By the first I mean having confidence in the fact that we are 99 times out of 100 doing what is useful and if we make a mistake, we are OK with ourselves for not being perfect. The second one is about when the client is perceiving us as acting badly because they are seeing us as a family member who did act badly (transference), but we ( the therapist) actually hasn’t. Clearing that all up is called “working through negative transference” and it’s a very useful part of what can happen in therapy.

To explain further: If the client is having negative transference, they are seeing the therapist as harmful, as their parent or some important childhood figure was. They are then transferring the perception that this person is also going to harm them, onto the therapist. They are almost always transferring that onto other people in their lives also. So it’s great when it happens in therapy, and they get to realize that the therapist doesn’t mean them any harm when the therapist says “X” or looks at them “Y” – just like their mother ( or father or someone from childhood did). They may be completely right that the childhood person did intend harm and created harm, but the therapist isn’t doing that now. The therapist can explain what they meant by what they said or how they looked, or whatever.

That is so helpful to clarify. It clears up a lot of bad feelings this client may have been assigning to others in their world. It’s often hugely important.

The therapist recognizes, when the client is angry at them, if they’ve actually done something wrong and the client deserves an apology – and it’s very therapeutically useful to apologize and admit you were wrong at those times. The therapist also recognizes when the client is transferring motive, or whatever, to them and it’s not accurate, and listening respectfully and then explaining what they did intend, etc. is very powerful for the client to hear, and experience.

It takes skill and an understanding of transference to do this well with clients. It’s a perfectly OK way to use the therapist. It’s their job to help you make sense of what you experience and treat you with respect the whole way though

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Have Clients Ever Straight Up Lied In Session? Can You Tell ?

Yes, clients do sometimes lie in therapy, and I’ve had my share. Here are a few examples I remember:

An alcoholic says she stopped using when she hadn’t. I had no way of knowing except by hunch, and you can’t confront someone for lying because of a hunch; it could be very disrespectful if you are wrong. By the time the spouse was able to see the lies, the alcoholic client in this case left treatment with me.

An unfaithful partner tells me and his wife he has ended an affair when he hadn’t. The truth came out eventually and I was able to say how it felt to me, and how much time and effort I had wasted, because of the lies.

A Narcissistic Personality Disordered person told me how useful I was being to him so he could tell his wife he had “been to therapy” and in hopes of keeping me from confronting him. It didn’t work, because this one I could see through.

I’m not very patient with devious people who waste my time. I usually ask them to leave, or offer a “one more chance” proposition when I think fear is the dominating motivation rather than straight up manipulation to avoid growing.

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Do therapists ever get annoyed at or tired of their clients?

Yes, I think so.

The job of the therapist is to use yourself as an instrument, and be aware of how you ( your instrument) reacts. If you feel angry, irritated or bored with a client, very likely other people would also. So you use the information you’ve received, by your own reaction, in some manner that would be helpful to the client. The trick here is note your feelings to yourself, think about why the client is probably acting the way he is, and not express them as they are felt, for example – not speak angrily. The therapist’s job is to find a way to explain to the the client, so he can understand, how he is creating this reaction in another person without sounding critical. Then it’s the therapist’s job to help the client understand what is going on within himself.

Similarly, if, as therapist, you are “tiring” of your client, or getting bored, it is a signal (to me anyway) that the client is not being authentic, or is not going anywhere useful, i.e. being repetitive. This too can be communicated to the client without judgement and in a clarifying way to help the client in self awareness.

This takes skill, more than simple self control, because you as therapist have to know how to reach that particular client.

What you say may be experienced by the client as a confrontation but one that includes having the therapist’s arm around you, metaphorically.

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The Therapist / Client Relationship

Snakes live in the forest. Every day they travel over rough ground – pebbles, rocks, fallen trees with uneven bark. Every Spring they get a new skin, and it happens this way:  the old skin stretches and loosens. It eventually detaches, over time, from the snakes body, and  the new skin  shows up underneath.

The old skin never falls off until the new skin has had the time to toughen up and manage the rough terrain the snake goes through. When It first appears, the new skin is delicate and pink, but by the time it is ready to protect the snake from it’s daily environment, it has become brown and strong.

It’s never the therapist’s job to pull he skin off a snake.