The Importance of Flexibility
Psychologist L. Kevin Chapman’s toughest client was a 28-year-old woman who struggled with significant panic and agoraphobia. Her beliefs about anxiety and doubts about her ability to overcome her disorder were deeply engrained.
Other factors created more complex circumstances: She hadn’t worked for several years and lived with her parents, siblings and partner (whom she used as a buffer for her living situation). Her parents were supportive of treatment, but the home environment was chaotic.
In working with this client, Chapman, Ph.D, learned the importance of remaining flexible in your interventions. He spent much more time helping her learn cognitive skills and navigate “mini exposures” (see more on exposure therapy).
“Although treating anxiety follows a relatively predictable plan, clients are never the same,” he said. They may have similar beliefs about anxiety. Similar factors may maintain their anxiety. But they still have different experiences and symptoms, which “require significant patience and flexibility.”
On Patience And Progress
“My most challenging client was a highly intelligent and successful businesswoman who had a pattern of unhealthy relationships,” said Bridget Levy, LCPC, the director of business development at Urban Balance, a counseling practice in the Chicago area.
Over time Levy’s client realized that her poor relationship choices stemmed from her low self-esteem. Despite this realization, she was still resistant to changing her ways.
According to Levy, “she once said, ‘Men treat me badly because they’re intimidated by my intelligence and success. So I’ll play their childish games and let them bully me; it’s actually quite amusing to see just how afraid they are of me. Plus, I don’t expect anything more from them, so I’m never disappointed.’”
During their sessions, Levy started feeling frustrated with her client — usually a sign that she’s doing more work than necessary. This is one of the lessons she took away from this experience: “I can’t do more work than the client.”
Like Chapman, she also learned the importance of being patient and remembering that progress and change take time. “[Y]ou have to … remember that it’s a process.”
Recreating Patterns in Therapy
Early in his career, clinical psychologist and author Lee Coleman, Ph.D, was working with a college student who was having severe problems completing her assignments. In one session, her parents attended to share their concerns. Coleman wanted to be supportive, so he listened intently to her parents. Halfway through the session, he saw that his client was sobbing and shaking with anger.
According to Coleman: “I had inadvertently joined the family’s pattern of talking about her as if she weren’t even in the room. We all sat in silence as we realized what had just happened, and after I apologized, we fortunately had the chance to understand how in the world we walked into that same old pattern without even realizing it.”
“To this day, it was my first and strongest lesson on how we unwittingly enter into enactments with our clients and their families, and how emotionally intense this can be as it’s happening.”
Meeting Clients Where They Are
“My toughest client was the client who dropped out of therapy without giving me any notice,” said Jennifer Kogan, LICSW, a psychotherapist who works with individuals, couples and families in Washington, D.C.
Kogan worried that she’d failed her client. Today, however, after growing as both a therapist and person, she’s learned that everyone works at their own pace.
“It could be that an issue we touched upon was upsetting and sitting with the feelings that came up was just too painful. It is a real honor for me to meet my clients where they are. What I know now is that sometimes that means saying goodbye before I am ready to let go and that’s OK.”
Ryan Howes, Ph.D, a clinical psychologist in Pasadena, Calif., also learned about the power of meeting people where they are from a young client: a 10-year old girl. In their first session, the girl’s mom warned Howes that she wasn’t going to talk to him.
According to Howes: “Now that mom said it, the client [had] to stick with it. I understand that kid rule. So we started with ‘one blink yes’ and ‘two blinks no,’ which got tiring after a few minutes. Then we moved on to ‘point to the letters of your response from words in a book,’ which worked for several minutes, until the sentences became too long for me to follow. Then she just wrote down her answers, including the answer to my question of whether or not she’d talk the next session. ‘Yes,’ she wrote.”
Howes learned that clients will communicate what they’re comfortable with in therapy. “It’s not my job to impose my format or disagree with theirs, but to find a way we will best work together.”
And his client did start talking in their later sessions. In fact, she and Howes often laughed about that first session, which became “kind of a bonding story.”