NYC Psychotherapist Blog

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Sunday, January 27, 2013

How Psychotherapists Listen to Their Clients

Psychotherapists in training often feel they should immediately know and give advice to clients who present in therapy, especially with clients who are upset during the first session.  In situations where new clients come in very upset, sometimes even demanding, "Tell me what to do!,"it's better to help clients to get emotionally grounded, and not fall into the trap of giving advice with potentially disastrous results.  

Psychotherapist Listening to Client

The Therapist's Experience of Getting Comfortable with "Not Knowing"
Fortunately, for most therapists, getting comfortable with "not knowing" during the initial stage of treatment gets easier with time and experience.  Rather than assuming that they're supposed to know immediately what's best for clients, skilled therapists know that they need to listen and learn about the client from the client rather than adhering to any particular theoretical orientation.

Even though the client might not get "the answer" from the therapist, this doesn't  mean that the client doesn't experience emotional relief during the initial stage of therapy. A skilled therapist knows how to create a therapeutic "holding environment," which often, in itself, brings emotional relief.

When the Therapist is Tempted to "Rescue" the Client 
When therapists feel pulled to "rescue" the client, who is not a danger to himself or others, this urge to "rescue" is potentially important information about what might be going on unconsciously in the consultation room with the therapist and client as individuals as well as dynamically between them.

This can happen to even to the most seasoned therapist.  Experienced therapists usually recognize it more readily than psychotherapists in training.  If a therapist finds it happening a lot with particular clients, it's best to obtain clinical supervision, talk to experienced colleagues or address the issue in her own therapy or all of the above if it's a big problem.

It's also important to recognize that not every therapist is for every client (see the link below for my article on "How to Choose a Psychotherapist").

Listening, Learning and Becoming Attuned to the Client
It takes more than one or two sessions for a therapist to get to know and become attuned to a client.  No matter how experienced, a therapist can't assume that she knows what's best for the client without first listening to and learning from the client, except, of course, in cases when a client is in a dangerous situation or a harm to himself or others.  (Then, it's important to know how to handle a psychiatric emergency and determine if the client is in the right level of care.)

Clients Are Looking For Answers
Clients are, understandable, looking for answers to their problems.  Why else would they come to therapy?  If they've never been in therapy before, they might equate the therapy session to a medical exam with their doctor.

During medical exams, unless further tests or consultations with specialists are needed, a doctor often gives a diagnosis and prescribes a course of treatment in one session.  In a day or so, the client might be feeling better.  But the human psyche is much more complicated than taking a pill, and it's rare that a therapist can help a client to resolve a psychological problem in one or two sessions.

What new clients might not understand, and what therapists need to help clients to understand, is that the therapist isn't there to give advice or tell the client what to do.  And even if the therapist was willing to give advice to a new client, who's to say this advice would be right for the client without the client participating in the process?

What Does the Therapist Do, If She Doesn't Give the Client "Answers"?
As mentioned before, the new client often comes looking for answers to her problems.  It might be disappointing to hear that the therapist can't provide immediate answers.

No matter what type of therapy the contemporary therapist practices, basically, the skilled clinician is trained to help the client, in collaboration with the client, to develop greater insight into her problems and work through the problems--rather than telling the client what to do.  Over time, the client, who has never been in therapy before, learns to become more open and curious about her process.  She also learns to become more resilient.  And, the healing process continues unconsciously for the client between sessions.

Mistakes, Ruptures and Repair in Therapy
Of course, therapists are human and make mistakes just like anyone else.  As I've written before, when a psychotherapist makes a mistake with a client, the most important first step is for the therapist to acknowledge the mistake to the client, and make an effort to repair the rupture with the client as soon as possible (see link below for my article, "Psychotherapy:  Ruptures and Repairs in Treatment").  Hopefully, the mistake isn't egregious, the therapeutic relationship remains intact, and the work continues.

Thank goodness, the days when therapists and doctors were assumed to be almost infallible are gone.  These days, many clients are better educated about the psychotherapy process, and they're more likely to approach it as informed consumers.  They know that during a psychotherapy consultation, they're interviewing the therapist and asking questions just as much as the therapist is interviewing the client.

Patrick Casement's Book:  Learning From the Patient
When I was in my first year of psychoanalytic training in 1996, I read Patrick Casement's book, Learning From the Patient.  It wasn't part of the curriculum in the first year.  At the time, the reading list for first year psychoanalytic students was mostly works by Freud.

While I enjoy reading Freud (especially his papers that read almost like poetry) and admire his genius, as a first year psychoanalytic student in training, I didn't always find his papers helpful when I was in the psychotherapy consultation room with a new client.

Somehow, during my first year in training, I came across Patrick Casement's book and, along with the guidance of seasoned clinical supervisors, I found it enormously helpful.

Some of the concepts that Casement writes about are now incorporated in current training programs in the first year, rather than waiting for the second or third year.  I'm sure it's a relief for first year psychotherapists in training, as it was for me, to realize that it's okay, and even not helpful, to think they should know the answers immediately, and it's more important to listen and learn.

Since my early days of training, I've learned other therapeutic ways of working, aside from talk therapy, including EMDR, hypnosis and Somatic Experience.  Whichever method I use, I value listening to and learning from the client.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.  I work in a contemporary, dynamic way in collaboration with the client.

I work with individual adults and couples.

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.