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Saturday, 31 May 2008
Clients and counseling
Two days ago I ran a training group and we had a grand old time. Lots of good laughing and lots of good learning. I know some of you trainees read this blog so I thought I would comment. One woman who is a very experienced teacher and educator presented on the stages of treatment which was interesting. But I was especially interested on how she presented it. She did it as a sort of group exercise. I am going to pinch that presentation style and use it my self!!
Amidst the various discussions one trainee asked how long had been my longest client and I said 14 years. I thought about it later and that was not actually true. There are two men who I have seen over a period of about 20 years. They have been less consistently seeing me than the woman but there has never been any very long breaks in that 20 year period.
I have seen another man for 11 years and that was some time ago now. A very paranoid man who just seemed to get on well with me. He stopped seeing me about 10 years ago. When christmas day arrived that year there was a knock on my front door at home. So I opened the door and he was standing there. He gave me a christmas card and a small gift. I had a brief chat with him and then he left. I thought about it for some time. Should I say anything about it to him as here was a paranoid ex-client appearing at the front door of my home. However I did not hear from him again so I left it. Then when the next christmas day arrived the same happened and has happened ever since. Some times he comes alone and sometimes he brings one of his sons. Each time he gives me a card, a small gift and we have a short chat. The rest of the year I hear nothing from him.
There was also a woman who I saw for about 7 or 8 years. For a significant period of that time she was seeing me three times a week - Monday, Wednesday and Friday. That is not an easy thing to do (for the therapist) for a number of years. What do you talk about when you see someone that regularly! But we managed and of course it was not the ‘talking’ that was important.
Another interesting development I have noticed in more recent times is my weblog. In pre-blog days a client would come for their one hour appointment and then wait a week for the next appointment. So there was a short contact with the therapist (me) and then a week long break of no contact. However, I know some of my clients read this blog as they tell me they do. This is providing a form of contact that was not possible in pre-blog days.
So the therapeutic relationship with me and some of my clients has been altered due to this weblog as it provides a form of contact. This has been particularly evident with clients who have a strong transference with me and in particular those clients with object constancy problems. That client with an insecure attachment style. This means the person never learnt that the primary attachment figure (originally mother and now it is me) was secure. So when the client moves away from the therapist it is like the therapist disappears and thus they can feel strong anxiety, anger and so forth. These clients can now watch this blog and see me do posts, make comments and so forth. So in one sense the primary attachment figure is “there” for them. So it provides a sense of security in this way. However the therapeutic relationship is changed by this blog and we will have to wait and see what are the long term effects of that change.
The outcome will be?
There was one client about a month ago who expressed some displeasure with me in his session. He stated that I write about my other clients on this blog but have never written about him. Why are they more special to me than he is he complained? So here is an instance of this weblog having an effect on the dynamics of the therapeutic relationship - sibling rivalry in action.
Expressing displeasure
Over time I find I am slowly doing more and more internet counselling and supervision. This is both directly and surreptitiously. Some of it is directly requested by the client or the trainee. In addition to this I know that it is highly likely that he will read this and he will know that it is him I am writing about. So by doing this I am sort of doing a piece of therapy right now. Or at least it will have an effect on our therapeutic relationship. As you can see a whole new area of study is evolving. The use of the weblog as a means of communicating with a client. Or the use of a weblog to do therapy and supervision.
Graffiti
17:13 Permalink | Comments (26) | Email this
Comments
I like the story of the former client seeing you at Christmas. That is very, very sweet. And I did not know that clients read here. Here is a special hug for the client who felt bad about not being mentioned on the blog before. Maybe he reads the comments, too.
{{{{{{{{{{{{BIG HUG!!}}}}}}}}}}}}
I think if my therapist had a blog, I might be afraid to read it. It might feel kind of weird to me. Like spying or intruding or... hell, I don't know, it just might feel like when you are a kid in school and see your teacher in the grocery and they are dressed differently from how they dress at school. That is probably a strange way to feel about it since I wish he was my mother and all. Oh, well. I guess I'm just contradictory in some ways.
{{{{{{{{{{{{Tony}}}}}}}}}}}}
Posted by: Lynn | Saturday, 31 May 2008
Hi Lynn,
Yes the comments are read. Well at least by some as they have commented to me about some in the past.
Yes I remember that. When you are a kid and see your teacher or even the big bad HEADMASTER at the local supermarket!!!!.
it seems all weird and disorienting
Cheers
Tony
Posted by: Tony | Saturday, 31 May 2008
Nah, Tony and Lynn. In my day, teachers and principals didn't go to the shop. They lived at the school. They didn't have families or go to the shop or play sport or anything like that. hehehehe!!!
Posted by: Madeleine | Saturday, 31 May 2008
Madeleine
When I was 16 I worked saturdays at the local M&S store. Mostly I worked on foods but one day I was put on lingerie. It was dead embarassing as the headmistress of my school came over to me carrying these massive hip hugging panties and asked if we did them in a size 20. I never saw her the same way after.
Posted by: Kahless | Sunday, 01 June 2008
Hello Tony's client who felt bad about not being mentioned on the blog before.
{{{{{{{{{{{{BIG HUG}}}}}}}}}}}} from me too.
Posted by: Kahless | Sunday, 01 June 2008
Hi Tony,
I would feel odd if my therapist had a blog. Strange really. I would read it avidly though, no doubt, but just not comment.
Do any of your clients blog and do you read their blogs?
And what did you mean about doing more and more internet counselling? Does that mean you only interact with some clients via a computer? If the therapeutic relationship is key to effective counselling then if i recall you have asserted previously that internet attachments are not really attachments? So how on earth does internet counselling work?
Cheers
Kahless.
Posted by: Kahless | Sunday, 01 June 2008
great blog.
i am sending the link to Shrink rap as they discussed this transference issue in their blog just a few days ago.
Posted by: psychiatry101 | Sunday, 01 June 2008
Ok psychiatry101, I'll bite, what's "Shrink rap"?
Posted by: Madeleine | Sunday, 01 June 2008
Oh Kahless,
That is horrible!!
Seeing your headmistress with her size 20 knickers!
You obviously needed some trauma debriefing after that one
Tony
Posted by: Tony | Sunday, 01 June 2008
Hello Psychiatry101,
Glad you like the blog. Have enjoyed reading yours as well
Tony
Posted by: Tony | Sunday, 01 June 2008
Kahless,
These days as you know many people are on the www in some form or another. Bogs, websites and so forth. So yes I have come across clients on the www and I have read some of what is there.
I am just about go off to the beach for a little bit of exercise and I will address your comment on internet attachments later today.
Oh yes and we have a 'bank' holiday tomorrow!!
Tony
Posted by: Tony | Sunday, 01 June 2008
I would think that some people in the Psychologists association Grafitti, would think what you are doing is wrong. Risky business with clients and therefore out of bounds according to them. You get that in life as you know.
I would be ok for some clients to see my blog and other clients not ok. But how does one know who visits the blog? In my mind, I write as though everyone is reading the blog and that at least they understand the internet is a freehold place for expression.
Obviously some clients will benefit the extra "engaging" or attachment with their counsellor on the internet, but for some other clients perhaps that might be enabling their dependance factors?
I remember one blog that was frequented by many 12 stepper types. In the end, the many readers there almost became besotted by their involvement with this person. Their idealization of her nurturing-caring self became intoxicating in my view. Well, she didn't have training as a psych or a therapist and that might be the difference to the potential of cult like followings on the www that breed co dependance.
kenoath
Posted by: kenoath | Sunday, 01 June 2008
sorry for not giving Shrink Rap's link earlier.
Here is the blog
www.psychiatrist-blog.blogspot.com
Posted by: psychiatry101 | Sunday, 01 June 2008
I think you make some very pertinent points Kenoath.
You state:
"I would be ok for some clients to see my blog and other clients not ok."
We therapists don't have a choice. When ever I get a new person comment and they don't provide their URL I am suspicious and tread cautiously. I have on occasion just deleted their comment but most often don't but I comment back with the view that I have no idea who this person is even if they give identifying information such as their gender and so forth.
Yes the professional bodies are sooner or later going to have to move with the times. I can have the dual relationship of client/therapist and blog writer/blog reader. I don't see a solution to avoiding that dual relationship. Then there is all the Facebook like sites as well.
However even before the internet clients did behaviors like drive bys or ringing up or coming into the office to alter appointments and so forth. Proximity seeking behavior that goes along with the therapist/client attachment.
As I keep saying never underestimate the power of human attachment, it is a very powerful motivator of behavior.
Tony
Posted by: Graffiti | Sunday, 01 June 2008
Well said Grafitti. It is interesting that today I received a bog comment from the ex wife of person who is the subject of his new partner's blogging activity. Sounds complicated? I occasionaly comment on blog where a woman writes almost everyday about her relationship. I think she will turn the blog articles into a book one day. Anyway the ex wife of this person witten about in the blog apprently reads the blog also.
I was left a comment about the man and the relationship even though I have never written or talked with him. People can feed their ok and not ok needs on the internet. As you say it used to be drive bye's and degrees of stalking in the dark. The intenet does seem to be a place for dark stalking.
kenoath
Posted by: kenoath | Sunday, 01 June 2008
Tony,
The gusset on them was larger than the thongs you can buy today. I debriefed myself by having an internal chuckle every time I saw her.
I hope you enjoy your bank holiday, though it seems you have far too many! What with your sickie culture no wonder aussies are good at sport.
I look forward to hearing what you have to say about internet attachments.
Kahless.
Posted by: kahless | Sunday, 01 June 2008
Oh, just got the 'debrief' play on words!
Posted by: Kahless | Sunday, 01 June 2008
Well Kenoath,
that does seem like a conundrum and I am not too sure if I worked it out as to who fitted with whom.
Yes the internet can feed OKness or not OKness as you say. I suppose that is the human condition.
Graffiti
Posted by: Graffiti | Sunday, 01 June 2008
Kahless,
It as an accidental pun I am afraid to say. I didn't get it until you said it.
But forever now, every time I say debrief or hear it said I am going to think of you, your headmistress and her size 20 knickers and chuckle to myself
Graffiti
Posted by: Tony | Sunday, 01 June 2008
Tony,
Are you seriously going to attack the "internet attachment" idea from the view point of what others say?
Well, if you must. Have fun then... roses
Posted by: roses | Monday, 02 June 2008
Hi Roses,
I don't think I am attacking anything!
I don't understand why people are so intent on their being an "internet attachment" concept. And what is wrong with attachments fading over time. It does not mean you love the other person less.
Tony
Posted by: Tony | Monday, 02 June 2008
Tony,
You don't need to understand. There's a heap of things... actually - Most things - i just don't understand for some reason and i think that it's ok to not understand. Really - you don't need to. But who's to say that the people who say they understand actually do understand?
Meet people face to face and all you see is who they want you to see. They tell you only what they want you to believe they believe. They behave only how they want you to see and think is their natural behaviour whether it is or not. They - we are so frightened of what the other person might think of us that we never really can know anyone. Not really.
Meet someone on the internet and nothing is different. Can't touch, look into their eyes, see their gestures/body language, learn their scent, hear their heart beat and watch if they move in time to their internal clock. It's so much less work. But no different really.
I don't believe we can ever really know anyone. Only the someone they want us to believe they are. People are people and that's that.
Attachments fade, but what's with the 'love the other person less' thing? I don't understand that. Of course you love the person less! Other wise we wouldn't let the attachment fade would we?
How can 'love = attachment' if one can fade while the other not? This my friend is just something i don't think i will ever understand. But its all good. It just musn't be that important a thing.
Gosh i hope your Monday is treating you well and - why do you have your long weekend this week and ours doesn't happen till next week? I wish this nation would get some consistancy happening! Sheesh!
Cheers... roses
Posted by: roses | Monday, 02 June 2008
I haven't had coffee with Madeleine for ages but I still luv her. I know and admire her as a person, she is "consistent" in who she is. It is the person who begins to feel insecure about the attachment or perhaps becomes scared the relationship is detriorating who will have some issues. Perhaps they might be self driven to change the relationship to avoid feeling insecure?
I think it is normal for relationships to change as Grafitti says. If we stuck to some scientific fact about how relationships have normal and healthy attachments we wouldn't be here in Grafitti's blog perhaps?
kenoath
Posted by: kenoath | Monday, 02 June 2008
Ken,
I don't understand. It has to be ok for me to not understand i guess.
I just can't seem to get the bit where if an attachement is love then how can one fade while the other doesn't? They're either the same or not - aren't they?
roses
Posted by: roses | Monday, 02 June 2008
I think that I am understanding your question Roses. I like what you say "they are either the same or not" Roses. Perhaps it is simple as that. I think psychology has not explained "love" very well over the years however attachment theories have a more measurable outcome.
I felt dissapointed when love was explained to me in the transference model Roses. I like the unexplainable aspects of love, the passionate involvement and the journey of really knowing a person.
kenoath
Posted by: kenoath | Monday, 02 June 2008
They are not the same are they? That's the problem isn't it? People feel they need to have an answer to the question of love, so they make up a theory to make themselves feel adequite - but somethings aren't answerable are they?
Somethings we don't and probably won't ever understand and that's ok isn't it?
Thank you Ken... roses
Posted by: roses | Monday, 02 June 2008