As a psychotherapist in solo private practice, I don’t see too many people outside of work. It’s not that I’m socially phobic or antisocial—I’d be in the wrong profession if I were—but that I work at times when other people play. When evenings and Saturdays roll around, you can find me at the office.
This isolating aspect of my job has an odd consequence when I take personality tests, as I might if I were hiring an executive coach for myself. One Myers-Briggs sort of test, for instance, asked me whether or not I work alone. How should I answer this question? I see people all day, but I have no colleagues. In my work habits do I isolate?
Given my office setup, how could I do otherwise? True, I welcome some time alone at the end of the work day. But am I a recluse, and does this aspect of my work define me?
This problem first came to my attention some years back, when a personality test used by a professional coach pronounced me schizoid, which I am definitely not.
More recently, Rhys Thomas’s questionnaire for determining personality profiles asked me whether I need to please people. Of course I do and on a daily basis at that! Were it otherwise, I would soon be out of business. But in my personal life? Under the circumstances, for the purposes of the questions, should I consider myself a people pleaser?
The authors of such tests obviously did not have psychotherapists in mind when they sat down at their word processors. They made certain assumptions about the work life of their clientele (an office, a supervisor, and coworkers) as well as about the ways most people spend their leisure time.
Still, the testing anomalies have left lingering questions in my mind. Given the nature of my work, am I myself when I am at the office or just when I am at home? Where precisely should the line be drawn between the private and the professional versions of me?
In social work school, instructors speak of the “differential use of self,” by which they mean that we professionals may choose to present ourselves differently, depending on the psychic needs of our clients as we perceive them.
This phrase, subtly paternalistic, suggests that we therapists are superior to our clients. We can measure them against some cosmic standard and titrate their social reality. I can tweak this client best if I act like a witch. That one will respond better to the motherly me.
But given that I do not stand in the client’s shoes, how much can I know about the client’s needs? Wouldn’t I be better advised to ask questions and listen to the answers? Anyway, don’t we all change the way we act depending on the situation in which we find ourselves?
Who is the best judge of the client’s needs? In many contexts, social workers are asked to apply standards set by someone else—a court, a medical professional, or a state agency. These rules facilitate the work of gatekeepers (those who control insurance reimbursement, for example) or upholders of the status quo (child protective services).
Still, the only rationale for relying on an outsider’s assessment is society’s interest in managing the client for the sake of what is assumed to be the common good. Otherwise, as with anyone else, we fellow humans must ask how the person feels and what he or she wants.
We social workers in private practice have an ethical obligation to do just that. We are not merely the handmaidens of social and legal services. We must allow the client to tell us what help is wanted and to achieve which goals. As consultants and independent contractors we are always free to withdraw, saying that we are not able to provide the service requested if the situation makes us uncomfortable. Otherwise, however, we must acknowledge the client’s priorities, assuming that the adult client is competent until a probate court declares otherwise.
My assumptions about the nature of psychotherapy and the conditions under which it is most likely to succeed have some corollaries. I am listing some of them below, to make it easier for any critics to target the statements they’d like to dispute.
1. Voluntary clients are people seeking to overcome obstacles that are keeping them from reaching some important goal. Mental illness may or may not be one such obstacle. It is up to us not to judge the worthiness of the client’s goal but to learn about it and to facilitate its achievement. We serve at the client’s pleasure, offering a smorgasbord of insights, ideas, and resources that the client may sample or reject.
2. The therapist’s impression of the client is neither superior nor inferior to the client’s. The two are simply different because they reflect different vantage points. None of us humans can see ourselves from outside our bodies, and no one will ever know exactly how we feel inside. Furthermore, what we hear is not necessarily what was said, since personal experience shapes everyone’s expectations.
3. To promote communication between therapist and client, it is helpful for the therapist to create a comfortable environment for the therapeutic encounter (rather than an impersonal institutional one) and to dress and act approachable (rather than aloof and inscrutable, like an authority figure claiming mysterious knowledge and powers). I am suggesting not that the therapist sport tattoos and piercings or dress in rags to match the client but that formal dress has a distancing effect just as hospital white and metal furniture create more dis-ease than would a sofa and armchairs such as you might see in someone’s living room.
4. No matter what insurance companies, physicians, and bureaucrats may say, the client alone can judge the success of psychotherapy, because the primary questions are whether the client feels empowered to deal with challenges, whatever they are, and whether he or she believes that the quality of life has improved.
5. The therapist’s first function is to listen, not simply so that the client can vent but, more important, so that the client feels understood. Part of the act of listening is validation, which the therapist performs by reaching within and tapping into a comparable experience that involved some of the feelings being voiced by the client. Another part is normalization, which requires the therapist, stepping back, to consider how the client’s concerns reflect his or her environment and life stage. By offering observations that validate and normalize the client’s experience, the therapist offers a perspective that may suggest fruitful ways of coping with the presenting problem. People benefit from being told not what is wrong with them but what is right.
5. The therapist’s second function is to build relationship. Part of this task means being available to connect with the client nonjudgmentally, empathically, as a fellow human being. To do this work the therapist must be self-aware—understanding of his or her own biases, prejudices, and other limitations. A second part of this task entails teaching clients how to communicate so that they remain mindful of their own needs, voicing their feelings appropriately while respecting a listener’s need to do the same. This skill set, taught by the therapist, includes guidelines for resolving conflict and respecting boundaries as well as expressing anger.
6. The therapist’s third function is to serve as a role model in the therapeutic relationship. A therapist who advocates but does not practice healthy living habits and communication skills is a hypocrite. Besides, learning the art of living is not like learning to ride a bicycle. For all of us, life is a matter of trial and error, involving constant correction and recalibration. We all constantly struggle to identify and accept our mistakes. We must all dust ourselves off and get back in the saddle not once but again and again and again. We therapists must model this process.
7. The therapist’s fourth function is to advocate for clients. We must champion everyone’s human needs and promote empathy and connection. In this way we encourage the wider community to embrace all of its members, rich and poor, educated and uneducated, strong and weak, old and young. Those who suffer from disadvantages we think we do not share, intellectual and otherwise, have much to teach us. This lesson is often forgotten by therapists as well as by people in general.
As professional listeners, we psychotherapists are able to hear our clients on many levels and able to highlight feelings and options they may have overlooked. This work does not require us to leave our humanity at home when we go off to work each day. On the contrary, it requires us only to focus during sessions on the client and his or her concerns rather than on our own.
We always have the choice of whether and how to share our own personal feelings and experience. Sometimes it may seem best to attribute them to someone else. Still, we cannot be therapeutically effective if we are not transparent, authentic, and fully present. No one wants to connect with a robot. We came into this world hoping to find warmth, understanding, and responsiveness. Some things never change.