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Thursday, 21 February 2008
What clients want
Madeleine, myself and Kahless have commented on therapists who want to fix problems, clients who want to tell their stories and make connections, and solution focussed therapies. Perhaps a good time to examine what clients want.
In my now 28 years of counselling I will make some off the cuff calls on percentages. How long clients come for counselling.
1 session = 10%
2 - 10 sessions = 80%
10+ sessions = 10%
This is a rough guess but it is meant to show that there is only a small group of clients who actually do want to tell and look at their story in any depth.
Retail therapy. I once had a client come in and say, "I was looking in my wardrobe last night and saw just how many tops I had. I realized that every time I felt bad I went and bought a new top!!"
There is a small group who only come for one session. Sometimes these people have a clear and specific question or goal and they come for one session get that information and go away satisfied. This group can also include those infrequent times when the personality of the therapist and client just do not fit. In fact there can be a big mis match so the client does not return and/or the therapist refers the client.
Then there is another subgroup here that is well articulated by KazzaB’s recent comment:
“The first therapist I went to, I was only about 23 I think and she was so in my face it was the first and last appointment. “
In such cases like this the therapist may not have been perceptive enough to pick up what was going on in the client. Sometimes there are counsellors who are of the view that one size fits all. The theory and practice they learnt at counsellors school is what they apply to any client that walks through the door. They make the client fit the therapy and not the therapy fit the client. Sometimes these are the newer therapists because they as yet have little experience and they only know of one way to do therapy. If the client happens to fit for the counsellor’s approach then that is good. If they don’t fit then that is not so good!
Group therapy
Then there is the scenario when the client is just incapable of articulating what they want and thus the therapist can not do anything. Years later you hear these people (at 40 years old) say things like,
“I tried counselling when I was a teenager and I was just not ready for it then”.
Their frame of mind was not right at the time or they had not felt bad enough for long enough to take the risks that intensive psychotherapy requires. So they have one session and don’t come back.
By far the largest group come for no more than ten sessions. They are interested in telling their story but they don’t really want to go that deeply into it. They have a problem such as anxiety, depression, insomnia, smoking and they want the problem to go away and they can do some very good work to achieve that. They want to reduce their problem but have little interest in changing the basic script path that they are on. So sometimes this group is referred to as those who come to counselling to improve their neurosis. They are just making their neurosis more pleasant to live with which really is an unkind way to describe them.
The dog of Pavlov
This group is less concerned with a connection with the therapist, or a strong desire to be heard and accepted, or to feel like they can trust the therapist. All these things are nice and good but this group is not actively seeking such things.
Then there is a small group who are very interested in these things like connection, trusting, feeling heard and understood and so forth. This of course takes longer as it requires the development of a relationship between therapist and client and that takes time to evolve. So this group enter into longer term therapy. The good part about this is you can get some significant changes in the client’s basic script as well as the more surface problems being addressed.
Body dysmorphia. A misperception and belief of ones self physically
In such cases I usually see a client once a week or once a fortnight. That usually seems to be enough for the person to get a sense of connection, trust and so forth. And there is also a luck factor here as I have mentioned before. The more the personalities of the client and therapist naturally click the better.
There are variations on the number of times I see a client and sometimes it can be twice a week. I am reminded of one woman whom I saw three times per week for what would have been three years. That was quite a challenge really as the relationship is quite intense when you met with a client three times per week for such a long period of time. Of course this cannot happen very often as there are financial considerations in meeting so regularly. However there are some people in the world where money just is not an concern!
Shame. The cinderella of the destructive emotions
Also at this time I have 2 clients whom I see about once a month. These are revisiting clients . I did see them before quite intensively and then they stopped coming for a few years and now they have reconnected and we meet about once a month. I see this as a kind of check in therapy. Yes there are times when they do struggle a bit with life and will probably do so for the rest of their days, but generally they cope OK with life now. Having that connection there seems to be important for them and I like meeting with them so that is what happens.
Probably the longest client I have ever had is about 14 years. But the vast majority is much shorter than that. That seems to be what clients want.
Graffiti
14:57 Permalink | Comments (20) | Email this
Comments
Hi Tony,
Do you like being a therapist?
Sorry about the miss communication before. I was accusing you of sarcasm and me of being cynical. Awaiting for your continuation of that post too - the 'magic' one.
roses
Posted by: roses | Thursday, 21 February 2008
Love this post; loads I want to write but outside having a *sinful* ciggie then back in the pub.... Am I being antisocial blogging mid night out lol!.
Alcohol doesn't do much for blogging but I feel enthused....
Saw my counsellor tonighjt (before pub) and I am going to write my story and pull photo,s together and woa.... I have a project that excites me.
Free child pissed....
Be back tomorrow.....
Posted by: kahless | Friday, 22 February 2008
Hi Tony,
I was interested in the idea of a "lifer" after reading your blogg Tony. I suppose such a person exists but wonder whether they naturally have to become a therapist themselves after their own therapy as client. Is it inevitable that they move over to the dark side, i wonder?
A while ago I drove an old volvo. It kept breaking down and needed regular servicing. I tinkered around with it myself occasionally but often had a mechanic look at it too. In the end I had to let it go. It was the car that most sticks in my mind, even though it cost me a lot of trouble I guess i formed a kind of attachment to it.
Best wishes
Nick.
Posted by: Nick | Friday, 22 February 2008
Nick,
I agree. It's a great vehicle to use (it seems to be to me) even if it isn't perfect. I don't remember having an appointment to see a therapist but the people i know are quite good at it. Some have studied but others seem to be gifted naturaly and have achieved or grown their own (rather useful) techniques.
I guess it's inevitable to move on to other types of therapy but i think it's the first time that sticks in the memory.
roses
Posted by: roses | Friday, 22 February 2008
Hi Roses,
Yes I like the idea of growing your own. It sounds kind of organic. I'm not sure how successful applying text book interventions would be. I expect it'd kind of ruin the fun.
Nick
Posted by: NIck | Friday, 22 February 2008
*after pub moment in the taxi home*
I think perhaps most clients are not sure what they want initially. They present with one "thing" which ultimately is not the nitty gritty. Recognisinng that they need help but with what. I smile to myself but too a*seholed to explain. :-)
So many words, so little abillty.
Pooof!
I'll be beack!!
K. Xx.
Posted by: kahless | Friday, 22 February 2008
Oh, Kahless. You are funny blogging pissed. I wish I could have a little nip, but alas... no can do.
Hi, Tony. I like this post. There is a lot of truth here. I want to say more, and perhaps will later, but right now my abilities are a bit off. It's a variaton on a wasteland issue, I suppose, but I appreciate this post.
{{{{{{{{Tony}}}}}}}}
Posted by: Lynn | Friday, 22 February 2008
Sounds like a good night out Kahless,
Booze and blogs! What a combination.
Look forward to your project
Tony
Posted by: Tony | Friday, 22 February 2008
Not too sure what you mean by a 'lifer' Nick,
Do you mean a person who is a client for life?
The old Volvo sounds good and yes I think the attachments to things is quite possible.
As a surfie the most important thing in your life is your surf board. You ate breakfast with it at the breakfast table in the morning and slept with it in bed at night which didn't really do a lot for the relationship with the girlfriend.
Tony
Posted by: Tony | Friday, 22 February 2008
Hi Lynn,
I look forward to your thoughts later and hang in there with the wasteland and what it means
Tony
Posted by: Tony | Friday, 22 February 2008
Hi Tony,
I wasn't exactly sure what I meant Tony. I suppose I was getting at the idea of someone who makes an almost lifelong commitment to therapy. I guess I'm thinking of the person who goes to therapy and gets into the process, and decides to stick around, does their training and makes a career of it. I suppose they may not seem that much different to the client who only sticks around for 2-10 sessions at the beginning?God I need a drink. I'm beginning to sound sober.
Cheers.
Nick.
Posted by: Nick | Friday, 22 February 2008
Hi Nick.
Hope you had a good pint or two.
it is an interesting phenomena you describe and one that happens reasonably often. The person who becomes a client first and then as a result of that becomes a counsellor them self.
Tony
Posted by: Tony | Friday, 22 February 2008
The image-object of the surfboard is interesting Graffiti. Something in life that contains all the elements to keep one satisfied so to speak. Its a passionate blanket we wrap ourselves in which seems to become an over arching goal in life.
I found out something interesting about Sigmund Freud tonight. Apparently he was into collecting egyptian artifacts associated to life beyond. Figures of ancient gods, egyptian, greek and roman dieties along with all manner of other paraphanalia. He was into retail therapy it seems and he started this practice after his father died.
I guess that was his passion and investment into the objects that helped him develop great theories in later years.
there you go, thats me for the evening.
kenoath
Posted by: kenoath | Friday, 22 February 2008
Nick,
My sons have been muso's for as long as they can remember. I on the other hand remember earlier than they and they've displayed a natural gift since I can remember too. I could only teach them the very very basics of the musical/art language but it was all they needed. It was as if i'd offered them oxygen and once they'd tasted it, sought it out and began to grow and grow like never before. They each went to lessons for a few months to learn how to apply for uni and each of them recieved entrance first try. When things happen they just do, and when they don't they just don't i guess.
In Uni, they learned why, what they do worked, and how to use the tools they had learned and were learning while at uni, with much broader vision.
Perhaps that's how the text books help? Perhaps they help us to see the tools (the ones naturally learned and the ones that need to be practised and learned) in a far greater perspective?
I guess adding a text book messes with innocense or what is naturally grown. Personally when i think of your statement just now,
"I expect it'd kind of ruin the fun."
I want to grow and in amongst it all, lots of growing is 'fun'. If talking 'organic' i guess it's fertilizer. Are you aware of what most fertilizer is made of? *giggles* Yep! Stinky but all good in the place most useful. So strange
Thanks for the thoughtful thought ... roses
Posted by: roses | Saturday, 23 February 2008
It tends to be the way it is doesn't it Ken? If something is attached, when it goes somewhere our gaze or focus tends to follow?
roses
Posted by: roses | Saturday, 23 February 2008
That sounds true as you say Kenoath,
Freud was into retail therapy.
I wonder what he was repressing
Graffiti
Posted by: Graffiti | Saturday, 23 February 2008
They said he was grieving his father's death and bought at least an item per week to amass a huge collection.
Perhaps he was repressing his abuse as a child Graffiti, some say he was sexually abused.
k
Posted by: kenoath | Saturday, 23 February 2008
Wasn't the Egyptian thing on death all about the becoming alive again? Isn't that why they took lots of their 'stuff' or ways to find their 'stuff' into the burial chambers with them? Also weren't they embalmed so they can come back in their own bodies again?
Isn't that what Freud was thinking when he was focusing on death? That he watched his father walk through that door and needed to know about the 'come back to life' of it all?
"Perhaps he was repressing his abuse as a child Graffiti, some say he was sexually abused."
He must have loved his father very much. If what 'they' say is true Ken, I hope he enjoyed the sexual advances of his father. I imagine if he did, it would have created in him some 'stuff' but if he didn't find any pleasure in it then, I would think that the sex would create a whole different load of 'stuff'.
I don't understand the sex 'thing'. Just don't understand how it works and stuff like that. I understand intercourse and the physical touch but the 'sex' thing - the guy, girl thing. What's with that!?!
roses
Posted by: roses | Saturday, 23 February 2008
Yes it was a good night out. Somewhat jaded on friday though.
The 'stats' are interesting. As a 10+ person (well actually count me in as at least a 60+ person!) I do think a lot now that either I must be dead slow in my thinking / remedial or I just better buck my idea's up and get a life. But then I tell myself to give myself a break.
I remember when i poked my toe in the waters of counselling in my 20's I was scared off because the woman was so direct. I dont mind it now but not back then. She pronounced at the end of my first session that she thought my parents conditionally loved me, which upset me so I ran a mile.
The other thing that really makes me laugh to myself (inside) is a counsellor who has a box of tissues on the table in front or to the side of the client. I will look at it and think "if you think I am going to cry then you are misguided cos I aint."
Tissues *in yer face* are so presumptative and off putting
Or maybe that is me, ha!
:-)
A good post Tony.
Posted by: Kahless | Sunday, 24 February 2008
Glad you had a good night out Kahless and interesting to hear about your counselling experience in your 20s.
Tony
Posted by: Tony | Sunday, 24 February 2008
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