Overusing clients’ names can mask inattention

Use of a client’s name to foster engagement may mask flagging concentration and inattention. Using a client’s name sparingly permits more accurate judgement of attention to the conversation or task.

“…a person’s name is to that person the sweetest and most important sound in any language.” (Carnegie, 1936).

Whilst using client’s given names uninvited can backfire, a genuine (and successful) attempt to remember and recall someone’s name can pay dividends.

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Using clients’ given names uninvited can backfire

Uninvited use of a client’s given name can impede rapport in a number of ways. Moving from a position of formality to informality and intimacy is easier than backtracking.

A therapist’s first encounter with a client usually requires the use of their name, if only to ensure that you haven’t picked up the wrong person. The usual practice is to use either the client’s full name (as given on their referral letter or case file) or their title and family (last) name. Some therapists attempt to establish an air of informality by using the client’s given (first) name, but this is a risky practice for a number of reasons. In decreasing order of seriousness:

The client’s given name is first and most commonly used by their parents and siblings. Being called (without invitation) by one’s given name can throw the client into a child role with the therapist as parent (especially if the therapist then goes on to introduce themselves by their title and family name). Depending upon the client’s experience of childhood, this might be reassuring or anxiety provoking. It is definitely disempowering and may be seen as patronising.

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Manipulative therapists get manipulative clients

“Manipulative” clients may be reacting to overly controlling therapists. Before using such a destructive label, it is worth asking why someone would need to manipulate their therapist if they have agreed common goals.

“Manipulative” is one of a therapist’s most damning criticisms. While not as bad as “malingering” or “personality disordered”, both of which have their place in formal diagnoses, the label has similar power to influence the client’s future treatment as it implies that there is something bad about the client’s behaviour or the client themselves.

“Manipulative” is defined as “tending to control or influence others cleverly or unscrupulously”. “Unscrupulously” is, in turn, defined as neither honestly nor fairly. The stereotypical manipulative client is one who misrepresents their symptoms to obtain extra medication for abuse or resale, or who exaggerates their symptoms or situation in order to obtain financial benefits they don’t deserve.

Some clients will be deemed “manipulative” when they give different accounts or responses to different professionals. I have observed therapists respond to a client sympathetically or supportively in the session, then speak critically or dismissively of the same client in supervision or at a multidisciplinary meeting.

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Disclosure is promoted by permission not to speak

Giving clients permission not to speak encourages disclosure. Explicitly granting the freedom to subvert our power frees the client to tell us what they need.

The first time is to check out the therapist, the second is to tell you the real problem.

I was given this advice in training and for years it seemed to be true. Now, in my practice at least, it is the exception rather than the rule.

The balance of power in therapy lies with the therapist. We decide when, where and for how long is each appointment. We set the boundaries and grant exceptions. The client must work within our framework.

Clients can exercise control by withholding information or themselves. Failure to attend is the ultimate means of regaining control of therapy. More subtly, the client can, without overtly challenging the therapist, keep back important facts for as long as they choose.

Full disclosure can occur in the first appointment if the client has permission to withhold. I tell clients “if there are any questions you don’t feel comfortable answering, that’s OK”. It is now rare for clients to surprise me in the second appointment (unless I forget my line).

The underlying process may be that, having been given permission to withhold, the client can now exercise control by disobeying you…and telling all. This appears manipulative but this accusation would be genuine only if the permission to withhold were false, given only to manoeuvre the client rather than arising from a genuine respect for their privacy.