Psychotherapeutic Relationship "Therapist Driving Away Clients"

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

“Clients don't come,” “All my clients disappear after a few meetings,” “I can't get a stable practice,” is what novice therapists talk about in supervision. High threshold for entering the profession? Lack of self-confidence? Looking for marketing tools to tell your story and attract customers? Perhaps so, but sometimes the therapist himself unknowingly drives away clients. Our article focuses on why this happens and how the therapist can notice their contribution to the absence or breakdown of the practice.

A few words about the reasons

The psychologist decides to start a private practice, completing his studies at the university or working in another profession. His life at this moment is filled with various important things for him: students have studies and relationships, mothers - raising children, people who have other jobs have different jobs. Therapy at this stage of professional life can play the role of an additional activity and an irregular income, an interesting hobby or a promising main business in the future. Rarely does anyone take and give up all other business in anticipation of clients. In this case, there is a desire to start working with clients, but it may turn out that there is no free time. It is a little easier for a therapist if he works in a psychological center, because this implies that an organization will look for clients, but when such a therapist tries to start a private practice, he will face the same problems, for example, to allocate a place in the schedule for private clients.

Curiously, if a novice psychotherapist is asked: “Do you have time for a client,” he will naturally answer that there is, “I can work in the evenings after work, on weekends when there is no school, in the morning when the family is busy by itself yourself … . But in fact, this approach to the perception of its time turns out to be unstable. Personal social activity and other life tasks, as a rule, are underestimated, and they can fill the entire life space-time. And it would be wrong to say that people simply do not have enough time management skills, more often it turns out to be a fear of radical changes, an unwillingness to take risks with a new and undefined job. Being a private psychotherapist is not only a job, it is also a way of life.

In the case when a full-time person tries to organize a private practice, he wants to find a client who, for example, will agree to come only on Saturday and only from 12 to 16 hours - and finding such a client can be a problem. However, it is more correct to assert in this case that it is not a matter of time, it is a matter of priorities. As long as life is adjusted: work and leisure have a certain look, it is not easy to rebuild life by daring to set aside a clear time for a new job. As they say, you cannot pour water into a full glass. What could help a psychologist: it is important to remember about the limitations of your abilities and understand that changing a profession is a risk.

There are times when clients have already appeared, but something important or unforeseen happens in the life of the therapist: the defense of a diploma, moving, repairs, problems of loved ones requiring immersion, illness, internships abroad, changes in personal life. This can be reflected in practice. The number of clients begins to decrease and the practice falls apart (this, by the way, also happens for experienced psychologists with established practice), when a specialist, captured by his own processes, begins to organize the space of his practice differently, carelessly.

Another case is when a specialist is faced not with life, but with professional limitations: for some reason it is difficult for him to work with a client, perhaps the topic is incomprehensible or, on the contrary, strongly affects him, since he repeats some of his personal problems. It happens that the values, ethics, competencies of the therapist do not allow to work with what the client brings, or in the form the client asks for. And if the therapist deprives himself of the freedom to transfer the client to another specialist, to legally end the relationship, then he can unconsciously "squeeze" the client out of therapy.

How to nudge the client to quit therapy

Ignore initial appeal

It is worth emphasizing that sometimes the reason may be the lack of willingness of a novice therapist to let new people into his life with whom he will have to be in a relationship: to meet regularly, every week. Then the therapist can "chase" the client out from the beginning. Do not pick up the phone when calling from unknown numbers. Or even answer and promise that he will call you back. And it would seem that such a person is not comfortable talking now, he is going to call back a potential client, but … he does not call back.

Do not follow the setting

How can the therapist "get rid" of clients yet? The therapist can reschedule the sessions, the place of appointment and even be late for the client or not come at all. The very change of location, to which the clients are accustomed, especially without prior discussion, can lead to a decrease in practice. Changing the time, which may be uncomfortable for the client and may increase his anxiety, create a sense of instability. It would be nice if clients had a constant appointment time, but novice therapists in this case turn out to be the most vulnerable: if you rent an office one day a week, that is, there is a financial risk - clients will not come, and you still have to pay for the room. More often, novice specialists rent a room, renting an office by the hour in psychological centers, which leads to the risk of being left without the usual office and the right appointment hour at any time, or, if the client asked for a transfer (perhaps, in response to the psychologist's instability), to face the difficulty find an alternative time suitable for both.

Ignore the client's individual situation

Sometimes therapists are inclined, closing in the role model, to ignore the client's requests: to reschedule the session, to change the setting due to the life situation; rigidly refuse attention to oneself, from gratitude (without clarifying the relationship). The trap of novice therapists here is that the attitude and desire to be the right psychotherapist turns out to be more important than an individual approach and attentive attitude to each specific case, satisfying the therapist's desire to protect himself from uncertainty at any cost. In this case, therapists refuse to notice the client's needs for violation of personal rules and setting, perceive any change as a threat and pressure, harassment and violence, react with greater demands to comply with starting agreements or general rules.

Chase customer

Some psychotherapists may be inclined to over-control the client's presence in therapy: call, remind of sessions, - be overly directive (not suitable for the client), insist on "working through" specific problems and topics of the client, react negatively to the client's desire to end therapy or take a break, insist on the last few meetings if the client has already expressed reluctance to come to complete the work, compulsively suggest a discussion of the client-therapy relationship, despite the client's apparent reluctance. And in some cases, persistence is adequate and supportive, and in some cases repulsive and intimidating.

Ignore the client's pain

It happens that values, ways of dealing with them, vocabulary, understanding of life between the therapist and the client do not coincide. In this situation, the therapist may inadvertently injure the client by speaking, evaluating, inaccurate, inaccurate formulations about his central values. As Alexander Mokhovikov said, “values that do not hurt, we do not perceive as values”. By devaluing, not noticing the customer's gained value, we can cause an experience of mental pain. This is an extremely important point - how will the therapist deal with the client's vulnerability, will he see what he has hurt, will he ignore verbal disagreement, facial expressions and bodily phenomena of pain, will he admit the damage, will he be willing to discuss and comfort? Will this crisis be retraumatizing or developmental for the client? This is what can propel the client forward on his topic and make the therapeutic alliance stronger. However, if the therapist ignores the client's mental pain, then contact will become impossible, the client's anxiety will increase, and in other places the therapist will ignore him. The chances that the client will leave in such a situation is extremely high.

Ignore the client's anger towards the therapist

It is well known that the client can violate the setting, the agreement due to the inability to directly express anger to the therapist. When the situation is clarified, with the support of the therapist in expressing anger by the client, it becomes possible to strengthen the client-therapeutic alliance and go through the crisis, for the client to find new ways of contact with the world. In the event that the therapist is not ready to face the client's anger, he can avoid clarification by containing his anger - in this way he forces the client to use withdrawal as the only way to express anger.

Ignore resistance and resist resistance

The client may disagree with the therapist's interventions, skip sessions, refuse to participate in experiments suggested by the therapist. It is important that the therapist is willing to discuss what is behind rejection and withdrawal, to support the client in exploring ways to avoid contact and awareness, even if this is a difficult moment in therapy. But it seems to us that breaking through the resistance is not worth it - if the therapist resists the client's resistance instead of exploring - it can be a painful experience for both. It is also worth remembering that the client has the right to resist and resist resistance research.

Ignore reality

Sometimes it takes courage and perseverance for the therapist to confront the client with reality, to help put aside illusions and hopes, to begin to make do with what he is. Talking about the danger a client is in, about the toxicity of the relationships he maintains, about addictive or narcissistic patterns of behavior, about the depth of personality disorder, about the unfoundedness of his grandiose fantasies, about the expected duration and possible results of therapeutic work can be difficult. But deceiving the client by avoiding his own anxiety by the therapist will sooner or later also be a good way to get rid of the therapeutic relationship.

Ignore affection

The practice is often diminished when the therapist goes on a long vacation, leaves without making enough efforts on his part to ensure sufficient reliability of his relationship with clients during the vacation period. Fixing the date of the session after the vacation, sometimes a call or SMS from the therapist after returning, discussing the possibility of calling, sending messages or, if necessary, the possibility of skype sessions, of course, in the context of what is happening in therapy - actions aimed at maintaining relationships. Without these actions, some clients, with a high degree of probability, will interrupt therapy, not feeling their importance for the therapist, the reliability of the therapeutic relationship, and risk devaluing the results obtained. It is also important to note here that any abrupt actions of the therapist, not only going on vacation: canceling the session, changing the setting, increase the client's anxiety and force him to think about interrupting the therapy. It is important not to "throw" the client, not to ignore his disappearance from therapy, to maintain a moderate proactive position.

Ignore relationships

The therapist and client have to talk about their relationship with each other. At the same time, if the therapist says general phrases, telling the client that "he is" just a client ", for example:" I increase the value of everyone, and for you now, too, the price is now such and such, "- closing in a role position, then this devalues the personal aspect client-therapeutic relationship humanistic approaches. Sometimes, on the contrary, the therapist over-emphasizes the individuality, the peculiarity of the relationship: "For you, I will leave the same price." It should be noted that “equal” attitude will calm some of the clients, hurt someone; the individual approach can be pleasant, or it can be overly obligatory. The main aspect of such a relationship is to be in dialogue, to understand the peculiarity and need of a particular client, to discuss how he perceives the therapist and his position. It is important to discuss upcoming changes with the client: prices, locations, setting, transition to "you", ways of working, duration of therapy, termination issues, etc. - in advance, leaving room for compromise or legal termination of therapy if a compromise is not possible.

Any relationship, including psychotherapeutic, ends sooner or later. The client has the right to leave at the moment when he feels an improvement or when he is not ready for further work, when he has encountered his own resistance - it is not worthwhile and senseless to keep the client in therapy by force. However, the client has the right to stay. We, therapists, can in this case defend his freedom of choice: how to leave and stay. If the therapist finds it difficult to support both poles, a supervisor should be consulted.