If your client is coming back, they are getting something out of therapy.

Over the weekend I was talking to a close friend of mine about his experience in therapy.

“I love my therapist,” he said. “I really have trouble naming my emotions. So my therapist pulled out this thing called an ‘Emotion Wheel’. It really helped. My previous therapist just kept badgering me about how I felt. Which was really frustrating. I couldn't tell her. I didn't have words.”

“Wow,” I replied. “Sounds like you’re getting a lot out of therapy. But you don’t have insurance. How much longer do you think you’ll go.”

“Well the sessions don’t cost that much and since my anxiety has been getting worse over time I don’t see myself stopping any time soon.”

Photo by Etty Fidele on Unsplash

I was shocked.

What struck me about this conversation was how different clients (my friend) and therapists think about therapy.

I was trained under the assumption that therapists helped clients resolve their problem and then terminated therapy.

This was never stated explicitly. But the assumption was there. I always imagined it would go something like:

“Well it looks like you reached your goals. How would you feel about termination in the next few weeks?” Says bold and confident therapist.

“Gee thanks doc. You’ve been super helpful. I love talking with you, but I guess my time with you is done. Let’s do 2 or 3 more sessions and terminate.” Says grateful and admiring client.

I used to think if a client was getting worse we needed to make a change, or even a referral to another therapist, but that’s how therapists think, not clients. Whatever my friend is getting out of therapy is clearly valuable enough for him to keep coming back, and has little to do with whether or not his anxiety is going away.

Even as I say this, a little voice in my head says: You’re telling me to never terminate clients? So we’ll just keep them dependent on us?

The problem is “dependence” is a therapist idea, not a client idea. Most clients, if they don’t like therapy, will drop out. And client’s have no problem dropping out. The vast majority of client’s who come to therapy drop out before having any change. The ones who keep coming are getting something out of talking with us.

I think this is really hard because we've all had those clients where we feel we're spinning our wheels. We've all wondered, "am I really helping you?" We've all had moments, at our lowest, where we look at our schedule, see a certain client, and feel the creep of hopelessness.

Those are the moments to remember that we offer more than just change. In fact change is secondary in the work we do. The first thing we offer clients is our presence as a supportive other.

And that is something that's getting harder and harder to find these days.

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