2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43
Portrait of a modern client: dynamics of client position
This client typology is the result of my professional activity reflection on who the client is, what is he like, how does he change in the course of therapy?
The proposed typology of the client is based on the level of his awareness and responsibility for his own life. The highlighted levels also act as stages or steps through which each client inevitably goes through in the process of his psychotherapy. The pattern of this process is its sequence - each client inevitably goes through all the stages of psychotherapy in this order, but not necessarily starting from the first stage. Most often, therapy begins with the second stage.
Inevitably, in parallel with the work on the client's problem, changes occur in his personality, in his picture of the world. These changes can be seen in how his client characteristics are transformed.
I will describe the levels of the client's dynamics from the standpoint of his subjective experiences (phenomenological) and objective manifestations (ontological). I will name them metaphorically.
"What does psychology have to do with it?"
People of this type are characterized by a low level of psychological culture. In their picture of the world, the psychological factors of the emergence of problems are either absent as such, or are depreciated. In this case, material values are dominant - physical health, material well-being.
The subjective experiences of people of this type can be described in the following position: "There would be health, more money and all problems would be solved …"
Actually, here we are not yet dealing with the client as such. And the magic of psychotherapy is powerless here. There is no need for psychotherapy in a person at the described level, since they have not yet identified psychological reality as such. A possible form of psychological influence here can be psychological education in order to form a psychological culture in a potential client, as a result of which a need for psychological help may appear.
"If not you…"
In the picture of the world of people of this type, elements of psychological culture are already present, psychological reality is highlighted along with other realities, and the role of psychological factors in the occurrence of problems is recognized. Consequently, the fact of the existence of psychological problems is already accepted and there is a need for psychotherapy as a field of professional activity dealing with the solution of such problems.
However, a person has not yet recognized his own contributions to the problems of a psychological plan, the leading role in their occurrence is assigned to other people, chance, fate. This position is characterized by a pronounced externality and ego-syntony, manifested in the setting of dependence on another, chance, fate and the absence of reflexivity.
The subjective experiences of people belonging to this type can be described in the existence of the following attitude: “Others are to blame for my problems. I'm fine. Something is wrong with others, the world. It is not me that needs to be changed, but the other one”. The other person is credited with power and responsibility for himself and for what is happening in his life, including for his own psychological problems. Such a client does not come to psychotherapy of his own free will, but because of another.
This is the patient's level. As in the case of somatic problems, a sick person “brings his sick body” to a doctor, so here he “brings his suffering soul to the psychologist” or a psychological symptom.
Such a person considers a psychotherapist as a professional "rescuer", and psychotherapy as a kind of magic or "a reference book of useful recipes." From a psychotherapist, as from a doctor, he expects clear instructions, exercises, directions, healing recipes. At the same time, he gives all the power and responsibility for the process and the result of psychotherapy to a specialist.
At this stage, it is necessary to pay a lot of attention to working with the client's personality. The task of therapy at this stage, in addition to working on the client's request-problem, will be to form his idea of responsibility for what is happening in his life, including for his psychological problems.
"Something is wrong with me …"
A client of this type, unlike the previous one, realizes that something is wrong with him, but at the same time he experiences the inability to fix it himself, hopes that someone else will do it for him,
Subjective experiences can be described in the following position: "Something is wrong in me, but what exactly is not clear …". A beautiful illustration of the experiences of this type of client is the poem by Yevgeny Yevtushenko ""
This is what happens to me
My old friend doesn't come to me
And they walk in idle vanity
Various … not the same …
This is what happens to me
The wrong one comes to me
Puts his hands on my shoulders
And it steals from the other
And the end:
Oh how nervous and sick
Unnecessary connections, unnecessary meetings, I already have devilry
Oh somebody come break
Aliens connectivity
And the disunity of close souls!
In these, given for example (and in others too), the lines are clearly traced, despite the pronounced reflexivity of the hero, his external orientation, dependence on another, fate, inability to solve his problems himself, the expectation that someone / that something / other / other will solve them for him. The author manages to convey this through the use of the following literary forms: it is happening to me … someone, come, break …
A client of this type will be characterized by similar perceptions-attitudes towards the psychotherapist and psychotherapy, as well as for the client of the previous type - shifting responsibility onto the psychotherapist, expecting a miracle from him.
The therapeutic task in working with the client at this stage will be similar to the task of the previous one - the shift of the client's locus of responsibility from external to internal, the formation of an ego-dystonic position.
"What am I doing wrong?"
The client of the described type not only realizes that something is wrong with him, as in the previous position, but he already understands that he is making certain contributions to the emergence and maintenance of his problems.
Subjective experiences can be presented in the following position: “I am doing something wrong, and I have a problem from this. Help me understand my contributions to the problem."
Such a client considers a psychotherapist as a specialist, a professional who can help to sort out his own problems. They recognize and accept the idea of their own responsibility for the process and result of therapy. The presence of reflexivity and ego-dystonicity creates a willingness to cooperate with a psychotherapist with minimal resistance.
This is the client level.
The therapeutic task at this stage will be to support the client in realizing his own contributions to his existing psychological problems. Here, the focus of attention is already shifting from the client's personality to his own problems.
"I can change my life"
The client, who is in this position, actively participates, together with the psychotherapist, in the study of his psychological problems and the personality as a whole.
The subjective experiences of clients of this level can be described in the following position: “This is My life, I am its author, I“write”it, and I can do it!
This is the personality level. Actually, the achievement of such a level of client development is already a good result of therapy in itself. A client with this kind of experience, as a rule, already ceases to be a client of the psychotherapist. He becomes a psychotherapist for himself, a subject of his life.
Thus, the main task of a psychotherapist in working with a client is not to solve for the client, and not even together with him his problems, but to bring him to the state of experience: “This is My life, I am its author, I have it "Write" and I can do it!"
And in this regard, a psychotherapist, especially at the initial stages of working with a client, inevitably has to work in parallel with his request-problem with the peculiarities of his worldview, forming in him the elements of a psychological picture of the world.
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