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Monday, January 29, 2018

How to Avoid Last Minute "Doorknob Comments" at the End of Your Psychotherapy Session

In prior articles, I discussed common issues in psychotherapy, including: How to Make Your Psychotherapy Sessions a Part of Your Life Between Sessions,  Psychotherapy as a Co-Created Process Between You and Your Psychotherapist and How Psychotherapy Helps You to Expand Your Inner Emotional Awareness.  In this article, I'm discussing another common issue, "doorknob comments" at the end of the therapy session, the problems with these comments, and how to avoid them in order to get the most out of your therapy (see my article: Getting the Most Out of Your Psychotherapy Sessions).

How to Avoid Last Minute "Doorknob Comments"

What Are Doorknob Comments?
Doorknob comments got their name from clients who literally have their hand on the doorknob as they're leaving their psychotherapist's office when they make a last minute comment, which is sometimes a "bombshell" comment ("I've decided to end therapy, so today is my last session" or "I was fired from my job and lost my insurance, so I can't continue in therapy").

Sometimes these comments are things that clients say at the end of their session in a vague way when there's no time to talk about it.

Why Do Clients Make Doorknob Comments?
Client who make doorknob comments are often too anxious or ambivalent to talk about these issues when there's time to discuss it, like at the beginning of their session, so they bring it up at the last minute as a parting comment.

Some clients, who make doorknob comments, are either consciously or unconsciously testing the boundary of treatment frame to see if their psychotherapist will give them more time beyond the therapy hour.

How Do Psychotherapists Handle Doorknob Comments?
There's no one standard way for psychotherapists to handle a comment that the client makes as s/he is walking out the door.  That being said, most experienced psychotherapists will recommend that they discuss the issue at the next session, including an issue about ending therapy.

There are a few very good reasons why it's best to maintain the treatment frame by not extending the therapy session:
  • On a practical level, many psychotherapists see clients in back-to-back sessions, so if they extend the therapy hour for one client, they would keep all subsequent clients waiting for their sessions.  This isn't to say that there aren't rare instances when a therapist might exceed the time limit but, for the most part, it's not fair to the other clients.
  • On a clinical level, it's not helpful to the client making the doorknob comment to extend the therapy hour because s/he doesn't get an opportunity to talk about a topic that requires more time.  Also, the client doesn't learn to communicate in an effective way with his/her therapist.
  • Equally important, the psychotherapist and client need time to explore the underlying issues which led to the client waiting until the last minute to bring up something important:
    • Was s/he anxious or afraid to bring up the topic?
    • Is there a problem in the client-therapist relationship? Is this problem a pattern in other relationships?
    • Is there a connection to the client's family of origin issues?

How to Avoid Last Minute Doorknob Comments
  • Think About the Issue Before the Therapy Session:  If you know you have a topic to bring up in therapy that you feel uncomfortable talking about, think about the issue beforehand.
  • Prepare to Talk About Issue in the Therapy Session: If it's an especially difficult subject for you, you would probably find it helpful to make notes before the session and bring your notes to the session.  You might not need the notes, but they're handy to have in case you get too anxious and forget what you want to say.
  • Bring Up the Topic at the Beginning of the Therapy Session:  You're spending your time and money to attend psychotherapy, and you deserve time to discuss an issue that's important to you rather than shortchanging yourself by bringing it up at the end of the session when there's no time to talk.  If it's a big issue ("I just found out that my mother has cancer"), you might be discussing this issue for many sessions.  If it's a matter of you're wanting to end therapy, there is such a thing as the "termination process" where, depending upon how long the client has been in therapy with his or her therapist, the client and therapist spend at least one or more sessions talking about ending therapy, summarizing the work, talking about whether the client met the goals that s/he might have set at the beginning of treatment, discussing the therapeutic relationship, and so on.

Conclusion
Last minute doorknob comments are common in therapy, especially with clients who are anxious or ambivalent about the topic.

Often, it's a matter of the client not knowing how to bring up the topic and waiting until the end of the session to blurt it out.  This is especially true for clients who are new to therapy.

Some clients, knowingly or unknowingly, try to test the boundaries of the treatment frame with regard to the end time for the session by making last minute vague comments or dropping "bombshell" comments.  In most cases, when this occurs, experienced psychotherapists will usually recommend that they talk about the issue at the next session.

When you wait until the end of the session to bring up an important issue, you're shortchanging yourself by not allowing enough time to discuss the issue at length.

Often, aside from anxiety and ambivalence, there can be earlier underlying issues for the client that are related to making last minute comments.

These underlying issues need to be explored by the client and therapist to understand the origin of the problem and how best to resolve it.

Getting Help in Therapy
Asking for help can be difficult (see my articles: Tips For Overcoming Your Fear of Asking For Help).

Psychotherapy provides an opportunity to free yourself from problems that are preventing you from maximizing your potential.

If you've tried on your own to resolve your problems and you've been unable to do it, you could benefit from working with a licensed mental health professional who can help you to work through your problems (see my articles: (see my article: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

When you have worked through the problems that keep you stuck, you can lead a more fulfilling and meaningful life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist 

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.





















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