From One Therapist to Another: Should We Tell our Clients What We Hope They Will See?

So why would I choose this quote for today's message? I was conducting a supervision group this week and one of the members was talking about a client who was struggling with a situation with his roommate who was also his best friend. He said that he wished his roommate would share in the chores in the apartment because he was having to do almost all of the cleaning. When asked if he'd talked to his roommate about this, he said that he didn't want to come across as too picky or controlling and then told her that he didn't know what to do. That last statement is a huge hook for therapists. (Note:I have provided several links in this post to other blog posts which expand on the specific topic).

The therapist replied with a validating statement and suggestion like "I can see why you'd be frustrated with having to do most of the cleaning. It seems like you have a very reasonable thing to request and if you don't say something you may begin to resent him, he might even appreciate that you let him know. We could spend some time talking about how you might bring it up to him.

Most Helpful Therapist

This sounds like the type of helpful response (advice) that we therapists, including me, often give when presented by a concern from a client. I think one of two things could result from helpful suggestions such as these. First, the one hoped for, is that the client would see the wisdom in doing this and begin considering how to bring his concern up to his roommate. He might then talk to his roommate resulting in the desired change in his behaviors. This might strengthen the relationship and lead to positive growth in the client. The client would appreciate his therapist for pointing him in the right direction.

Hmm, there are a lot of "mights" in that depiction.

Another possible outcome, and the one that actually happened in this session was that the client spent time practicing with the therapist how he might bring up his concern with the roommate but came back the next week without having done it. He expressed guilt over not being able to do what the therapist had helped him prepare to do. When this happens, the client will either feel frustrated with himself or, as the cartoon depicts, with the therapist. I've even experienced clients who didn't come back after failing to do agreed upon goals.

In this case, I think the well-educated and caring therapist was trying to tell her client what to see rather than where to look. So how do we show people where to look without telling them what to see. I think it's best to help them see the dilemmas that they may be experiencing rather than try to solve the dilemma for them. The first step is to notice when you talk, if you are asking questions or making statements. Below are some things that could be said to help him resolve his own dilemma. They are similar to Reflective Listening, Motivational Interviewing and Solution Focused Behavioral Therapy questions. It's as if you're saying "Look, you're ambivalent; what do you see about that?"

Ways to help people resolve their own dilemmas would be by saying things like the following:

• So you wish things would change but you feel stuck because you don't think you should bring it up to him. What can happen?

• What would need to happen to make you feel like you want to bring this up?

• What do you need to do for yourself if you decide not to bring this up?

• What are your best hopes for yourself in the relationship with your roommate?

• In response to the client's comment that he doesn't want to bring it up to his roommate: Is there any part of you that wishes you would or could?

I see many benefits of using this approach:

The therapist stays neutral (though may not sound as brilliant in the moment) thus reducing the likelihood that the client will feel like he's disappointing her or that he'll feel frustrated with her.

• The conversation is more likely to stay focused on the client than the roommate.

• The eventual outcome is more likely to be credited to the client than the therapist.

• The eventual outcome is not dependent on the roommate's response.

• The work is more likely to generalize to other situations when the client explores his own reasons for ambivalence rather than just completing an assignment.

• The therapist uses a lot less words, giving the client more time in the session.

I like to tell my supervisees that every time they are tempted to make specific suggestions, they at least make two other kinds of interventions first (such as asking a question like those listed above). I call it the two-beat rule. Then if the suggestion needs to be made, go ahead. Of course there are times when we need to make suggestions but often,

if you follow the two-beat rule, you'll enable the client to find their own wisdom

and when it comes from within, it's more likely to stick.

My book A Clinician’s Guide to Pathological Ambivalence: How to Be on Your Client’s Side Without Taking a Side can help you learn how to enable clients to resolve their ambivalence and rewrite narratives. I would love to hear from you. Please scroll down to the bottom of this page (past the banner of recent posts) to leave a comment.