You will upset your clients

Apparently innocuous comments can upset your clients. You can’t avoid triggering issues unknown to you, but you can be ready to respond if they are brought to light.

One participant in a relaxation class became increasingly agitated as the relaxation script was read to the group. She then burst into tears and fled the room. The script used a “relaxing image” of walking deeper into a cool, leafy forest: no one knew that the client had been attacked in just such a location.

Many therapists live in fear of distressing their clients by “saying the wrong thing”. Forethought and attentive listening can permit you to avoid many problems, but there will inevitably be a time when you trigger issues of which you were unaware.

Some might argue that the visual imagery offered in the relaxation script was inoffensive and the client’s traumatic associations with such an image were rare and could not be foreseen, but this argument doesn’t wash.

A few moment’s consideration reminds us that “one man’s meat is another man’s poison”: what you find rewarding might be a disincentive for me; what you find relaxing I may find dull or irritating. Assuming that an image I find relaxing will relax you also is a procedural blunder on my part, even without the traumatic associations.

If participants in the group had been invited to think of somewhere they found safe and relaxing, the client’s distress could (probably) have been avoided. The undisclosed issue would remain, however, and might still be brought to light.

Without knowing all the details of a client’s history, a therapist’s passing comment may trigger insecurities or traumatic memories which are rare, if not unique in the general population (e.g. memories of a former husband’s extra-marital affair triggered by a reference to Winnie the Pooh: husband and lover referred to each other by names from the book).

Psychological therapists ought to be alert for apparently unjustified distress and changes of mood. Physical therapists’ attention will often be elsewhere and initial signs of distress may be missed. Whenever and however the client’s distress comes to light, it is the response to this distress which should be the primary issue.

Few therapists would deliberately make crass and offensive comments, but it is inevitable that you will triggers hidden issues at some point. You should be prepared to respond appropriately and sensitively when it happens, rather than worrying about whether it will happen.

My client is crying

Trainees (and clients) need to know that crying is common in therapy. Experienced therapists need to remember that crying may be common in therapy, but that crying in front of a stranger is probably a rare experience for any given client: you may now be relaxed about the situation, but they aren’t!

Every trainee dreads this moment: your client is crying. You probably are unaccustomed to strangers crying in your presence. The fear is that their distress is your fault, that you weren’t sufficiently sensitive or supportive: now you have to manage the situation you’ve “caused”.

More experienced therapists will have seen literally hundreds of clients cry. You know that people in therapy will cry for a variety of reasons, usually unrelated to the therapist. Knowing how common crying is, you’ve evolved your own set of responses. You’ve probably forgotten how awkward you used to feel…and how awkward the client still feels.

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