Monthly Archives: September 2013

What really goes through my head when I care too much for a client or dislike them.

Cynics sit down to read this. In brief I care about all my clients in equal amounts, but the way  in which I think about them and approach them in therapy can be qualitatively different.  Read on to find out why disliking myself is much more of an issue for me than disliking a client. Thank you to @SecretSchizo for suggesting such a great topic.

This question was posed to me by @SecretSchizo on twitter (thank you for such a great topic suggestion). For ease of reading let’s split it into two sections. Firstly I will talk about what goes through my head when I care too much for a client. Ok, brace yourselves (especially the cynics amongst you). I genuinely care for each and every client I have ever had. I can honestly say I have never encountered a client in any of my different roles within mental health care that I have not cared about.  So what about those I care for too much, or like more than others? For me I can’t write about this without considering what happens to my thoughts about clients after work. I have always been very lucky in that I can always switch off very easily after work, no matter how distressed clients have been. I believe that the reason for me personally is this; I know that during my time with my clients and any time spent working for them (even when not in direct contact with them), I know that I have done my very best for my client and everything within my power to help, support and safeguard them. I suppose having this resolve means that whilst I still have a healthy concern over their well-being, I am at ease with my own conscience as a professional and more importantly as a caring human being. So in this respect I never ‘care too much’ about any clients, as I care a lot about them all! Of course, just as in everyday ordinary life, there are some clients that I build a rapport with more quickly and that I have more in common with (although they probably do not know that, as I do not disclose much about my personal life) and it is easier to relate to them. However this in itself is dangerous: if I think I ‘know how they think’, I am more likely to make assumptions about them, which could be inaccurate. This is something I try and be aware of at all times.

In terms of how I respond to clients in terms of anything other than the actual therapeutic process, I have a fierce dislike of injustice (even though I understand that life cannot always be fair) and so I always treat clients the same in terms of missed sessions, abusive behaviour etc. Boring, but true.

Ok, so on to what happens when I dislike a client. Again, make sure you are sitting down. I have never encountered a client who I do not like. Now, that is not to say I don’t deal with clients whose behaviour I do not like, or their attitude, but I essentially believe that all humans are good. I may not like the way a client ‘presents’ i.e. their behaviour towards me, their actions, the severity of their problem etc, but for me I see this as an opportunity for me to learn how to build a good therapeutic relationship in circumstances that may not be the easiest. Also in these situations, I am less likely to make assumptions about ‘what they think or feel’ if their behaviour or attitude is very different to that I may have experienced personally.  For me the biggest problem, and something I have explored in clinical supervision, is that with certain clients I dislike myself. I have a tendency internalise situations, so if a client isn’t reaching their goal, the negative automatic thoughts that go through my head are ‘it’s my fault’, ‘I am not a very good therapist’, ‘I bet Joe Blogs (insert the name of any other therapist I respect) would have dealt with this much more effectively than me’, and so I have to work at challenging these thoughts and assumptions in exactly the same way as I teach my clients to. Above all I am learning to accept that I am an imperfect, flawed human being. Ultimately whether I like a client or dislike myself when with a client, I am eternally grateful to my strong sense of self in that I always know that I do my very best for my clients – from the moment of first contact, until our last contact, and what more could anyone (including myself) ask from me than that?

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What really goes through my head when a client is late.

In brief, when clients are running a bit late, I can often be found sharpening my non-mechanical pencils (read on for my feelings about different pencils and an analogy featuring a roast dinner). When clients are consistently very late, it is an indicator to me that there is a big practical issue or a psychological barrier, and these things can be worked through together.

When clients are late, the same thoughts go through my head as in my personal life, if a friend was running late. Typical thoughts I have are ‘the traffic might be bad’, ‘perhaps they have finished work late’. Nothing much more exciting than that really, I am sorry if it is a disappointment. I don’t take lateness personally; the modern hectic lifestyle of today provides so many obstacles to punctuality. The main emotions I feel are frustration and sadness, not directed at my client, but at the situation, and the reason is this: When my clients are late (regardless of the reason) it means our time together is shortened, which means less time for therapy, in turn leading to reduced opportunities to work on their goals. If a client’s lateness is something that is within their control, then this can often be used as tool for discussion and implementing cognitive-behavioural techniques.

More often than not clients will tell me why they are late without me asking. If they do not, I do always enquire as to the reason to try and understand whether it is merely a practical issue (such as a traffic jam) or whether it may be more directly linked to their emotions, i.e. perhaps they are nervous about something we might discuss in the session. If a client is more than around twenty minutes late, it is often not appropriate to start a session as there is not time to cover and properly review the necessary items and it is much better to reschedule. To put this in an analogy, you wouldn’t begin eating a roast dinner only eat half of it, stop (even though you are still hungry) and then leave the other half until a week later would you? However, eating a roast dinner, and missing a roast potato or two isn’t the end of the world (the couple of roast potatoes representing being 5 minutes late).

It’s great when clients are able to let me know they are going to be late, often they will text me and let me know. That being said I would much prefer it if clients who are driving and running late, do NOT to text me and put themselves and others in danger. I am quite content sharpening my pencils (I have a healthy stationery obsession, how I love a freshly sharpened pencil, mechanical ones just don’t do it for me), chatting to reception staff etc.  Ultimately, when clients are late for their session, it is them that is missing out, not me and so I don’t get my knickers in a twist. In fact I have the upmost respect for clients that manage to get to therapy every week, despite often leading incredibly busy lives, sometimes with others dependent on them. What a wonderful commitment to themselves and a huge compliment to me that they see me as a therapist that is worth investing their time it takes to travel to see me. Yes, it would be wonderful if clients could always be on time, but as soon as my client arrives, whether it be early or late, my aim is always to make the best of the time we have together. I guess I have mainly talked about lateness in terms of being 5 or ten minutes late. If a client of mine is consistently very late, I always address this quickly. If it is a practical problem, we try to find a solution to this. If it is psychological in nature then this is explored too.

I think it is worth noting that being late and missing sessions are two completely different things in my view. This post is about lateness, if you are interested on my thoughts about missed sessions please comment and let me know.

Welcome to The Inner Workings of a CBT therapist

Here it is! I have decided to take the plunge and begin a blog that will hopefully give a glimpse into what actually goes on inside my head as a therapist. Before I started my training and indeed when in therapy myself, I often wondered, ‘what does my therapist really think about (fill in the blank) the price of fish, my dress, that fact I was ten minutes late?’ etc. I hope my blog posts are insightful, genuine, and respectful both to my profession, clients and humankind. My hope is to demystify therapy. Of course in my therapeutic work I always aim to be as objective as possible. However, luckily first and foremost I am a human being, just like anyone else with my own thoughts, feelings and life experiences –  which for better or worse influence every part of me, and whether I intend them to or not, my therapeutic practice. I would also like to promote cognitive behavioural therapy as the empathic therapy it is, and should be when delivered properly.  I am also interested in attempting to answer any questions anyone reading this is kind enough to pose, to try and let you know what really does go on inside this particular CBT therapist’s head. Welcome, and thank you for reading.