What the Client Brings and What the Therapist Needs

The vast majority of emotional/psychological problems have their origins in early relationships. Genetic and cultural imperatives play a role, in some cases more strongly than others, but formative relationships most clearly set the child on a road toward relatively healthy or troubled adult interactions. We learn to relate to others by the way that we have been related to. We learn to look after ourselves and others in the way that we have been looked after. When parenting or life’s conditions are such that we falter in establishing good relations with others and in knowing how to take good care of ourselves, we may have to, in a sense, begin over again. If our troubles have their origin in relationships, their solutions can be found in that same place. More important than any theory or technique that a therapist may espouse is the relationship that she endeavours to establish with her client. Her relation to the client is not one of a friend, a parent, a teacher, or a professional exchanging services for fees, yet all of these components play a part in their relationship.

Anyone who comes to see a therapist is looking for far more than she is conscious of. By this stage she has already gone through a considerable period of awareness that she is struggling with troubles that seem beyond her capacity to deal with alone or with the resources that she has at hand. It can feel something like going to a dentist for a person with a bad tooth but who is reluctant to having it cared for. It makes her feel vulnerable, it hurts, and it is expensive. As pressure from the day-to-day pain increases, however, she takes courage in hand and makes an appointment.

Leaving this analogy behind, we will now follow her into her first appointment with the therapist: she brings with her not only the problems that are clear to her at that time, but also the whole of what she is about. However she has been treated up to that moment and the way that internally she treats herself, is present in that first exchange. Her defences, the ways that she has learned to protect herself from possible injury, the ways that she has learned to charm or to annoy, and the narrative about herself and her life that she has honed to serve up to those whom she meets, all are there in that first meeting. The problems that she presents are but the upper layer of the complexities that she brings to that table. Without her deeper pains, longings and fears, most issues could be dealt with by some judicious counselling. The very fact that they cannot points to places within that are as yet unacknowledged, even unknown, places that are cut off from her conscious awareness.

Whether a therapist or a client, we bring all of ourselves to every relationship that we enter into though we are selective about which components are visibly on the surface. This selection process is mostly unconscious and reflexive and follows patterns that we have shaped and made use of in many locations in our day-to-day lives. It is a truism that a teacher can take a student no further than she herself has gone. This is eminently true in the realm of therapy. Whatever lies within me that I know nothing of, that I fear, or that I have learned to make use of to gain my own emotional needs, will play out within the therapy relationship with my client. The degree to which I have faced and am struggling to resolve my own troubles and confusions, to that degree I can assist the client in her quest for liberation. Otherwise it’s simply a case of the blind leading the blind – and, as we know, lots of accidents can happen that way!

The training of the vast majority of mental health workers does not take this reality into account. Rarely does a program acknowledge in a practical manner that its trainees need their own emotional education every bit as much, and maybe more than, an academic and practical one. This is the root cause of “burn-out” and even of the unusually high rate of suicides among, for example, psychiatrists. If we only do short term, fairly practically-based counselling work or use a strictly patterned technique like some cognitive behavioural programs, we can avoid interacting at a level with the client that might engage our own deeper selves. In longer term, psychodynamic psychotherapy, however, this is not possible. Or, perhaps I should say that to the extent that we hide our own feelings and reactions to the client from ourselves, to that extent we will block the work that we are attempting to do with her. It can happen that we believe the client to be blocked in her therapy work when, in fact, it is we ourselves that are blocking her. Just as we pick up her emotional nuances in a session, so she picks up ours. These may not be conscious to her but they can be confusing and may in some fashion dovetail with issues from her own background that she is struggling with.

A therapist who has an on-going therapeutic and supervisory relationship with a seasoned worker has a location of her own in which to examine the problems arising in her work. This is of tremendous advantage both personally and professionally to the therapist. In every area of our beings, we are changing all of the time. Just as we are always engaged in physical and intellectual changes throughout our lives, so too we are constantly changing emotionally. Each new experience can confirm or disconfirm patterns that have their origins early in our lives and can bring us new, unknown feelings that can set us on wholly different paths. It isn’t true that people are set by the time they are six, or sixteen, or even sixty. Emotional development is a life-long process. Having a good foundational therapy at the outset of her training and an on-going connection with a supervisor and/or a community of other workers with whom to share her experiences and problems allows her as well as her client the possibilities of on-going growth and development.