Read your clients’ information sources

Be aware of clients’ information sources in addition to your own. Newspapers, magazines and online forums vary widely in quality, but may contain information of use to you and your other clients.

A client who I had advised on the control of panic attacks returned a year later to discuss another matter. At the end of the session, he told me that he had found a self-help book on panic attacks and “you know all that stuff you said? Well, it turns out you were right!”

Therapists may be perplexed or dismayed when clients prefer their own information sources to those of the therapist, especially when the other source is one which the therapist may consider disreputable. Therapists may be unaware of the range of resources available to and used by their clients, whilst clients may think their therapist is merely offering their own opinions.

Therapists usually derive their information from peer-reviewed research articles, professional journals, scholarly textbooks and teaching & training by eminent colleagues. This information is then implicitly or explicitly conveyed to clients in therapy sessions and associated handouts & leaflets.

Clients may have great difficulty accessing therapists’ information sources other than via their therapist. Even if aware that they exist, they may be barred from accessing professional journals or unable to afford necessary memberships or subscriptions. Textbooks are usually much more expensive than comparable self-help books, have opaque titles and tend to be jargon-heavy.

Clients usually derive their information from a wider array of sources, many of which may not be accorded much credibility by the therapists. Newspaper articles, magazine features, self-help books and groups & online discussion forums abound. Therapists who are unaware of these sources may be advised by helpful clients, although this assistance may not be welcomed by the therapists.

Secure in the knowledge that their information sources are of superior quality (which may well be a false assumption), therapists may be dismissive of clients’ newspaper-derived knowledge and online tales of others with similar difficulties. Clients may pick up on such condescension and react similarly to their therapist’s sources.

The science fiction writer Theodore Sturgeon, when told that 90% of science fiction had no literary merit, famously replied “90% of everything is crud”. There are many more newspapers than journals, more self help books than textbooks and more online forums than conferences: you can’t read them all, but if you don’t include some in your reading, your clients may keep the 10% that isn’t crud to themselves.

Work with, not around, chaotic clients

Therapists can either work on, or work around, the chaos in client’s lives. Identifying clients, rather than their circumstances, as chaotic risks disempowering the client.

“Chaotic” seems to be one of the mildest “unofficial diagnoses” a therapist can apply to a client: it seems more descriptive than derogatory. “Chaotic” is defined as being “in a state of complete confusion or disorder”. This would be an accurate description of the circumstances of a large number of mental health clients, especially those who come to the attention of psychiatric services.

The stereotypical “chaotic” client would be someone who misses appointments, over- or under-uses prescription medication, has disrupted and disorganised home and work routines and struggles to achieve any consistency or reliability in their interactions. This state of affairs would usually have been at least part of their reason for seeking therapy.

Continue reading

Demanding clients make legitimate requests

“Demanding” clients are often making legitimate requests. Therapists applying such a label should consider whether it is the client’s requests or the service’s lack of resources which is unrealistic.

“Demanding” is a label often applied to clients by therapists, although rarely within earshot of clients. The label influences the responsiveness of the service to the client’s stated needs by implying that their requests for assistance are in some way inappropriate or excessive.

The stereotypical demanding client is therefore one who places undue demands upon the service, seeking longer or more regular contact with their therapist than is usual or seeking access to medications and other resources which would drain the budget of the service.

Continue reading

Know your client’s strengths

If you don’t know your client’s strengths, how can you capitalise upon them? Client factors account for 40% of the variance in outcomes and a wise therapist will play to their client’s strengths.

Clients are often defined solely in terms of their difficulties. “I’m seeing my obsessional woman this afternoon.” “When that guy with MS turns up, tell him I’m running late.” “Can someone attend to the broken leg in cubicle three?”

Modern medicine has come to be construed as an interaction between a physician and a disease rather than between a physician and an ill person striving to get well. (Scovern, 1999)

Continue reading