It is a reasonable question. “Does my therapist like me”? In the bizarre, boundaried, prescribed therapist/client relationship, where clients can come to have such potent feelings about their therapists, it is fair for the client to wonder where they stand.
For some of our clients, having to pay us throws into question whether or not our relationship is authentic. There are many aspects of this quite intimate relationship that can trouble clients. Basically, all the elements that define the boundaries of the relationship, otherwise referred to as the frame. Examples include but are not limited to the following:
Because this is a relationship with specific boundaries and pre-defined structures determining many aspects of the relationships, clients can fear that everything about the relationship is contrived, including any care or tenderness we might show in our work with them.
The false premise is that “caring” is one of our tools, or mechanisms for change. They are imagining that our care for them is what heals them, but that they have to pay for that. We all know money doesn’t buy feelings of concern, care or love, so surely if that is what they were paying for, they would be receiving an empty exchange. The thing is, it isn’t our job to care about them. That isn’t one of the tools of our trade. That isn’t the thing we set out to offer that is potentially healing or transforming.
This can even be confusing for some entry level clinicians, who might have been drawn to the field because of a general caring of others and wish to take good care of people that are suffering. There is nothing wrong with that impulse, but is not what we operationalize to help clients. In fact, “caring” about some of our clients would only serve to injury and further distance the client, for instance with clients who had emotionally inauthentic care-takers, or emotionally impinging care-takers. While there are many different approaches to therapy, I would challenge any discipline that argued that caring or love was a tool of the trade as lying outside of the theoretical stances of the discipline of psychotherapy.
In my own discipline, which is analytically oriented psychotherapy, our primary pursuit is knowledge. My approach focuses on helping the client in developing a clearer channel of communication between their conscious and unconscious minds. I work towards this goal through noting associative thinking, pointing out conflicts between words and affects, highlighting links between current and past relational dynamics, and reflecting on the client’s and my own relational dynamics, among other things. None of these tasks ask me to have emotionally positive or caring thoughts or feelings about my clients.
Some of what we offer in sessions gets mistaking experienced as care because of elements shared in common with a caring stance. Firstly, we listen. And we are good at listening. We don’t interrupt. We don’t re-direct the conversation to talk about ourselves. We ask good follow-up questions to hear more. We offer up language that further elucidates their feelings. Folks rarely in life have an opportunity to sit down for 50 minutes with the focus exclusively on us and our struggles. Clients can experience this as a kindness, even though in actuality, that is a by product, not the goal or intention.
Another example of what gets experienced as caring is that in our pursuit of the details that make up the client’s suffering, we are disinclined to judge, as judgement interferes with our curiosity. When a client reveals something that they expect to be judged or reprimanded for, we are likely to respond with questions, or to point out elements that give the the detail context, or some other such move that does not embody shame. For the client, they get to have an experience of not being judged, even though we are leveraging that mental stance for other purposes.
I am not arguing is that we don’t care about our clients. Most of us do care about, and sometimes even have loving feelings towards our clients. In fact when we don’t, we are often aware that it means something clinically important, worth thinking through in supervision. Not because it is our job to care about our clients, but because when we want to truly understand another person, we must take into consideration the whole context. When we understand the source of someone’s suffering we know the cause of their negative attributes as well. Compassion is a natural response to knowing the big picture of someone’s life.
Clients don’t pay us to care about them. Nor are we their friends. They pay us for our professional skills and knowledge. They pay us to use the tools of our trade to help them. They pay us to think with them, to notice links and discrepancies, to help them sit with certain feelings or truths.
It is true, we often care about them. But they get that for free.
Smith is an analytically oriented psychotherapist with 25 years in practice. She is additionally the Founder/Director of Full Living: A Psychotherapy Practice, which specializes in matching clients with seasoned clinicians in the Greater Philadelphia Area.
If you are interested in therapy and live in Philadelphia or the Greater Philadelphia Area, please let Full Living: A Psychotherapy Practice match you with a skilled, experienced psychotherapist based on your needs and issues as well as your and own therapists' personalities and styles. All of our therapists are available for telehealth conferencing by phone or video in response to our current need for social distancing.
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