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#6 Who is doing the work here, is it the client(s) or me?

This time I will be using my psych-dynamic lens to consider both relationship work and individual work with clients. Have you ever had this experience as a therapist, after lots of self examining after feeling more exhausted after some sessions and not after other ones? I have, and after looking more carefully, I decided that I needed to set up a better boundary for myself: I am only willing to do up to 49% of the work here, the client(s) have to do at least 51%. And I try to live by this in my work. At times I find this boundary both challenging and important to honor.

I also must point out there is one exception to this rule for me. If someone is sitting with me in my office and they are feeling suicdal, I need to do more which can include that I will take them to the Emergency ward myself and see that they get the services they need to be safe at that time. I will also follow up with them, and only then will I return to my promised boundary.

Aside from this noted exception, I notice just how easy it is to get pulled into our own energy when working with clients. We see where they could go, that we think would make a big difference in their lives. We offer them tools to get there, insights to motivate them and often a nudge to energize their efforts. We give them specific homework to do that will support this new perspective. We carefully pace it so they will not get too uncomfortable, but just uncomfortable enough to try this 'something different'.

Then we notice they are not doing this homework, so we try to scale it down or find a new one to offer them. To borrow a metaphor, we are now glimpsing one particular sapling tree and rushing to place it in the mature forest that we can also see by what we are offering them, but perhaps missing some important perspectives of that actual tree in front of us. That may be when we notice that we are doing most of the work and they are not actually engaged with our plan for them.

So what can we do then. Well there are are several options at that point to consider. Looking at the therapeutic engagement level, perhaps doing a review of the clients original goals, progress to date and your treatment plan to help them get there, could open the conversation. That could set up a re-contracting conversation to alter the original 'helping contract' in light of the current observations that homework was not being completed and exploring their perspectives on that.

We would often want to think of this as their 'resistance'. Here I might suggest a rather non-traditional psycho-dynamic view of how to approach this 'client resistance'. My own approach to clients' resisting my recommendations would offer the option of my accepting this resistance as exactly what the client should be doing at this point in our process, not something they should stop doing because they were being non-compliat. I would then become actively curious with them about how their actions, or inactions (not doing the homework), is working better for them than doing it would have turned out, at those precise times.

Finding out how their resistance protects them, and from what, within our dynamic, (or perhaps a dynamic with someone else in their life), and how that may be keeping them safe. This is the inverse of how resistance is often traditionally viewed in the psycho-dynamic framework. It does not place the client's behaviour within the client doing something to the therapist dynamic, instead placing it just within the client's self protection dynamic. It is not about them resisting our plan for them, it is more about them taking good care of themselves when our plan is not working for them.

This could give rise to another aspect for us to consider. What exactly is it we are offering, or imposing, on them by our perscribing that precise homework assignment? What is it that we had hoped they might gain from doing our assigned homework exercise? How would or could that have improved their outcomes re their goals? What is our investment in the homework assignment process and where is that coming from for us?

Another lens that could be useful at this point could be to explore how we are conceptualizing their current issues and how well that matches how the client understands their wants and needs at this precise point in this process. At times like this when I may be experiencing confusion, frustration or a stall in our progress, I will use the following 4 filter questions: 1. What is the problem? (There can be more than one) 2. Whose problem is it? (For each identified problen) 3. What is their currency? (This means what is it that they pay most attention to) 4. What aspects of Cultures are in play here, ours and/or theirs? These questions help me to re-focus myself and get back into the immediacey of the moment in the session. I typically use the dynamic energy in the room as my orienting framework.

My basic question presented here, who is doing most of the work, us or our clients and why is that the case ultimately revolves around clients agency. When we do more than half of the work to be done, our clients do not get the earned benefit of their own discovery. Doing their work is how our clients can move from where they were when they came to us, to the desired place they would prefer to be. Desired change does not come without some effort to shift their awareness and utilize some of theswe new skills to produce new outcomes.

Another issue for us to consider, is in our own self interest, that is our own longevity in this field. When we are doing too much of somebody else's work for them, we are increasing the risk of our own burnout which can often result as an un-intended consequence for us. Becoming aware of our over-involvement in our part of the process can alert us to our need to install some better personal/professional boundaries. The reasons that we are becoming overly involved is an important dynamic to consider as well, perhaps best done by getting supervision or our own therapy. This topic will expand into my next discussion next month.

I will pause here for this time, and welcome you back March 31st when I will be considering When May the Helping Hand Strike Again? Hope you are all well, safe and practicing good Public Health hygene. Ciao, David

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