In my role as a teacher and supervisor for therapists in training, I often hear questions about how to choose interventions that are effective for particular presenting problems. New therapists are often concerned about alleviating the distress of their clients and look for specific techniques to do so. While there is value in learning specific techniques to reduce clients’ symptoms and distress, I have also become aware of the limits of these techniques in many of the life circumstances in which my clients find themselves. This blog post will explore some of the capacities that enable us to be with our clients when technical interventions aren’t enough.
Even when symptoms are reduced and clients are managing their lives productively, there are painful aspects of being human that remain. A grandmother takes guardianship of her granddaughter due to her daughter’s addiction and mental illness, making decisions from week to week about how much contact is in her granddaughter’s best interest in light of the daughter’s changing symptom picture. An older woman looks back on her life aware of the impact of her mental illness, coming to terms with what she was and wasn’t able to do compared with what she wanted to accomplish. A man grieves the death of his wife of over 40 years and ponders the possibility of loving again. These are circumstances that can’t be addressed by making an interpretation or teaching a mindfulness skill or suggesting a reframing of the situation.
When our clients bring these experiences into our offices, we can feel pressured to do something, to find a solution to the problem. Sometimes that pressure comes from the client, but at least as often the pressure comes from within us. The capacity to view ourselves and our motives with openness and honesty is crucial to insuring that we are responding therapeutically to our clients. I have found that when I notice my reluctance to sit with the painful emotions my clients bring in, I can more easily refocus my attention on what the client needs. More often than not when I say something like “that seems really hard” instead of suggesting a way to dampen the emotion, clients go more deeply into their experience or sometimes bring up their own way of putting the emotion into a context that is more comfortable or soothing to them.
Another capacity I have noticed as I grow in experience is humility about the limits of what I can and can’t do. Earlier in my career I was more likely to look for change in the client as a way to bolster my sense of therapeutic effectiveness. Paradoxically, as I have become more skilled I also recognize the difficulty of change, the complicated relationship between familiar patterns of behavior and identity, and the challenges that are inherent in our relationships with ourselves and others. I am more humble about the influence I can have and more aware of the existential nature of some of my clients’ dilemmas. Sitting as a witness and sharing the client’s experience to the best of my ability seems much more important than figuring out what I can do to bring about the change I might wish were possible. Humility fosters my collaboration with my clients, conveying a respect for the complications of their lives and trust that they will find their way through these complications.
Last, I have become aware of the importance of expanding my capacity to hold intense emotions, especially those related to grief and loss. For many of my clients, coming to terms with their life circumstances means experiencing the grief and loss of unrealized dreams, deep disappointments, and an awareness of the lasting impact of one’s own and others’ choices on our lives. When I was a younger therapist, I looked at grief as a process that had a beginning, middle and end, and I believed it was possible to “get through” grief so that it would no longer have an impact on someone’s life. I no longer believe this to be true, after sitting with my clients’ grief and my own. Grief is a process that is ongoing and though it becomes less acute over time, it remains a part of one’s experience and life story. It has been important for me to face my own grief directly in order to help my clients with theirs.
Given that much of what I’ve described here involves facing painful emotions and sitting with intense distress, the question “why would I want to do this?” may arise. For me, the answer is that I feel privileged to talk about the things that matter, the relationships that are difficult but bring value to our lives, and the ways to find meaning in the existential dilemmas we face as humans. I came into this profession as a way to understand myself and others more deeply and that is exactly what it has given me. If the same is true for you, I hope you are reassured to know you are not alone in your journey.