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?