फ्य्सिचियन हेअल थी सेल्फ एंड थे रिघ्त तो नोट एक्सेप्ट क्लिएंट्स

Physician heal thy self and the right to not accept clients

I remember clearly the day a client walked into my office and told me that I was to be the next in his long line of therapists; He continued to inform me of why he thought accessing therapy with me or any other therapist would not work, including the fact that he had been accessing therapy through different modalities, practitioners and platforms for many years with absolutely no luck, and that he had an unmanageable mental illness.

I listened keenly to his story and after about 25 minutes I asked “what did you find particularly useful in the therapies you have tried”? He looked at me strangely and raised his eyebrows questioningly? I replied to his response that I was curious to find out what he thought was useful about spending so many years in therapy, I followed on with, and I am interested to hear in your experience what was most beneficial in this history of support that you have received”

The gentleman’s response astounded me, he advised me that the last therapist he had was probably the most useless therapist he had ever seen. While muttering that most had been useless she had really topped the cake as she did not bother to iron her clothes, she was constantly late for appointments, she was rude and obnoxious and obviously never heard of being professional in her service delivery. During this conversation the client was animated, energetic and had a smile on his face.

On this particular day, I had what I call a ‘aha moment’, these are moments you often see on a clients face when they work out what they want and how they want to get it. The moment is not reserved just for clients, and I have these moments regularly. Often as therapists we are eager to present a purely professional response to our clients; this includes, our appearance, through to our verbal and non verbal language as we are trained to be professional, we and our clients expect a standard.

My “aha” moment was, this client enjoyed knowing that his former therapist was not what he envisioned a therapist should be. Even more than this the client enjoyed telling the therapist that they were not good enough, that there was no way that they had the skills required and then this client enjoyed sacking them.

My next question was what the client wanted from seeing me? What led him to the idea that seeing me might be useful, he took great pleasure in informing that he did not think he would gain anything from seeing me, that he believed that the only reason he was in my office is because he had run out of options, and he might as well give this a go as he had tried every thing else.

So I rephrased the response into something like so you are only here seeing me because you have run out of options, you do not expect to see any changes at all from accessing my services, you believe this is a hopeless case. I received an affirmative. I then went on to ask. If it was possible to change something, what would it be that you would like to see changed, not saying I can deliver, and I know that you have seen greater therapists than me, but what if you could have it, what ever it is what would you find useful? He said that he liked having a routine, so if we could maintain appointments this would be helpful.

In this moment of clarity, I realised that I had nothing to offer this client other than routine!!! I am sure that this is something he could get else where. In this moment I knew that I did not believe I could be useful for this client. I asked the client if it were ok with him, if we set up a calendar of appointments for the year and he could routinely miss them, he told me to get ###### and left my office.

I am not saying what I did was useful or right for the client, but it definitely was useful for me. This is an uncommon response, I know I could have had this client coming to appointments for years, and he may have enjoyed the routine, but I don’t know that I would have been able to offer anything more than that. I mentioned this to a colleague who informed that I had acted in a unprofessional manner. Interesting that she believed this.

As a professional I have come to the conclusion that I want to do good work and I want to offer myself the opportunity to work with people that want to be worked with. I do not want to play politics, semantics or put myself in a position where good work is not possible. This is just being clear about my role as a therapist.

I often work with people that have not had success elsewhere, so I am not afraid of hard work, I just dislike the thought of not being effective, I don’t even mind if a client wants to take time to get results, in fact I enjoy the process. How ever, if a client asks you to just set up a routine so that they can be displeased with their appointments on a regular basis, how helpful am I being by agreeing to do this? Or are my skills and resources more useful working with someone who wants to do some work? And do we have the right to choose this? A point of discussion.