Therapists should adapt more to clients

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Do some practices build a wall between therapists and their clients? Photo by Antonio DiCaterina on Unsplash

There is a common thought in therapeutic circles that you should have boundaries.  Now, I’m all for appropriate behaviour, but not at the expense of the client.  If by boundaries you mean enough clear outlines to guide process, then I’m with you.  But if you are secretly using so-called boundaries to put fences around the client that they don’t need, in order to make your life easier, then I’m not with you.

AN EXAMPLE FROM THE FBI

I’ll offer you an example from US politics.  The FBI has a job to do.  While it is doing its job, it is entitled to protect its work from scrutiny.  So, habitually, its officers will impose communication boundaries.  In a nutshell, they say ‘don’t ask us to talk about what we’re doing’.  Inquisitive or challenging minds will be told to mind their own business.

AN EXAMPLE FROM PSYCHIATRIC HISTORY

Equally, therapeutic clients who had treatment in the 1950s will tell me of a similar approach by psychiatrists.  When they asked their psychiatrist why they should take medication, or why such-and-such a test, they were told ‘mind your own business’.  The psychiatrists felt they had a job to do, and transparency and flexibility were not necessary.  After all, they were the experts.

The historical root of such behaviour can be traced back to psychology’s early days.  Freud and others wanted to claim to be the experts, to control their field.  So they developed standardised beliefs and protocols which protected that control.

In a way, psychological therapists have had, hanging around for years, the vestiges of those original beliefs and protocols.  You do certain things, a certain way, and you don’t have to answer to anyone, least of all the client.  It is the same logic with which the FBI defends its practices from scrutiny.  Leave us to do our thing, they say.  Don’t challenge us.  It undermines our reputation.

A NEW ATMOSPHERE

But we now live in a new atmosphere of democracy.  It is considered standard for citizens to be able to hold their guardians up to public scrutiny.  Abuse cases in the church, in health, and in public institutions, where terrible suffering has been exposed, has opened our eyes to the dangers of conducting so-called expert practices behind closed doors.

In such a new atmosphere, it is important to find new ways of conducting health practices, including psychological therapy.  Ways should be found for clients to expose practices that they find uncomfortable or unacceptable, and to challenge them without fear of being told it is ‘none of their business’.

TWO EXAMPLES

Safe Havens in the UK are officially sanctioned safe locations where people experiencing anxiety and distress can go.  Recently, a client experiencing anxiety settled themselves with a computer in a quiet area.  Being able to sit in private and screen the world out really helped them.  But they were told that this private area was only for clients in emergency.  Being thrown out of the quiet area caused them acute distress.  The organisation did not adapt to the circumstances, and imposed a boundary without consultation.  They hurt a client in need in order to preserve boundaries.

Therapeutic groups are a great way for clients to help each other in a safe environment.  Recently, a client found their group leader had changed.  The new leader considerably shortened the time everyone had to talk, and cut them off in mid flow.  When challenged, the organisation suggested the problem was the client’s problem adapting, not the organisation’s problem practising.

In both of the above cases, a boundary was imposed without consideration for the particular client’s welfare.  In each case, the client was made to feel in the wrong, and pathologised as difficult.  In contrast, the organisation kept itself in the right, even though it had caused hurt.

AN EXAMPLE FROM ISRAEL

I remember visiting Palestine once.  I was questioned by Israeli soldiers as to why I was going.  When I left, I was questioned at length by Israeli soldiers as to what I had been doing. While I was there, it was explained to me that Palestine couldn’t have its own airport, and that many resources were denied it, including clean water.  It was clear to me that Israel saw itself as the controller of situations, and that Palestinians were, unfortunately, treated as second class citizens.  The argument from my Israeli friends was security.  But I wondered how this security helped Palestinians.

This seems to happen whenever one group of people sets itself up as the master over another group of people.  Security is used as a catch-all argument, to explain controlling actions, and to prevent having to listen to dissent.

Applied to modern psychological therapies, the same thing happens.  A service comes into being, and is given the territory.  It sees itself as ‘allowing’ its clients onto that territory.  The territory can be physical, emotional or a set of practices.  Work needs to be done to ensure that this element of control is handled responsibly and collaboratively; that consultation happens; that people are not simply told to ‘mind their own business’.

A SUGGESTION FOR THERAPISTS

I would encourage all therapists to review their practices, from start to finish.  To examine their paraphernalia, the furniture of their practice.  The doors, the locks, the areas, the mannerisms.  What protocols are followed ‘just because’?  Putting yourself in the mind of your clients, what might you be doing to discourage them from asking you questions, from challenging your practices, from making themselves more comfortable?  In what ways have you adopted inflexible practices which make your life more comfortable, but make the client’s life uncomfortable?  Do you then justify it as an act of good security on your side?  If so, then you may be simply exercising control for no reason.  You may be making your client into a second class citizen.

A therapist’s job is to yes, keep themselves safe, but most importantly to do whatever is necessary to help the client be healthy and happy.  That’s what it’s all about.  You are not a dog trainer or a prison warder.  You are a friend, with all the empathy that entails.  Open yourself up to scrutiny; welcome it; explain yourself; encourage the client to tell you what is comfortable and what is not.  Why would you want to carry on doing things which are counterproductive? (…unless you think the preservation of your reputation is more important than the client’s health.)

If your bona fide processes sometimes involve discomfort (as with a surgeon or a medic), then make sure you minimise that discomfort, and for God’s sake consult, consult, consult.  It is arrogant to admire your own reputation and practice, but cut the client out of the loop of improvement.  If anyone is a second class citizen in the relationship, it should be you.  Ideally, you should recognise the client’s equality with you.

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SUMMARY

I have been a bit strong in my talk today.  I have suggested that, in the past, institutions and experts have told their clients to be quiet and behave.  But in a new atmosphere of democracy, therapists should open themselves and their practices to constant observation, scrutiny and challenge from clients.  It is no longer acceptable to say ‘We do what we do.  It’s for your own good.  Get used to it and mind your own business.’  Therapists must challenge everything they themselves do, (furniture, practices, taboos), and accept the client as the first class citizen in the relationship.

Only then can we develop mental health services that are inclusive, empathetic, respectful, and adaptable.  Until then, welcome to therapist-client apartheid.

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