Where Have All the Clients Gone?

Well, they have not gone far. Not all of them anyway, but a few therapists are noticing that some clients have strayed away over the holidays and not come back. And we are talking about this here at Good Practice.

Some questions we've been studying are:

What disrupts treatment?
What gets in the way of clients telling us directly if they have a bad feeling about us, or about the work?
What if we are more interested in doing the work then the client is?
What is subjective countertransference and what is objective countertransference, and how do they affect our work?
What can we learn about ourselves to help clients to stay and do good meaningful work?

And really...when someone is coming on a regular basis and then they don't want to schedule again, or they say..."I'll call you..." What do therapists do? How do therapists decide when to help a client to stay and when to let go. And how do we do this?

What exactly is the balance between rejection and intrusion? Between holding onto the work and going deeper, and following the contact, the surface presentation that a client makes?

First things first. And case by case we think. We must know our own intentions. And we must know our fears. Many therapists I know are ruled, in some way, by their own fear. They fear being too forceful. They fear being solicitous. Or being rejected. In an effort to not act on their own fears, they sometimes do the opposite of what might really be called for.

We do filter things through our own lenses and experiences. One therapist in our groups terminated treatment with her own therapist, who then called her every few months to see if she wanted to return. This gave our colleague the idea that her therapist was pursuing her for money, or because she was bored, or needy. "It gave me the feeling I was just a paycheck to her," she told the group, "and I don't want to do that to my clients."

So how do we know what's really going on when clients disappear? Look back, we think. Look back and see if possibly we've hit the wrong note. If we may have implied that they have to talk about their father when they don't want to or are not ready. Or perhaps they thought that we were sick of hearing about that relationship that ended three years ago, and they should not talk about it anymore. Perhaps they don't even know the source of their discomfort. Of course clients project their feelings onto us, but we have to be good catchers. It helps to study the feelings, and see who is tired of what and why.

Are we understanding of client's narcissism? That they are not trained to notice us, to know that we exist. Our existence may be frightening to them. The connection may be too strange, the relationship not understood. We may have to tend to this. To help them talk about it, about us.
Do they feel too cared for, or not cared for enough. We never really know the effect we have.

Sometimes, not pursuing a client who leaves can feel rejecting to the client. While clients need to be able to say everything to us, sometimes they need to go at their own pace. We may be going too fast. One client I know recently said to me, "If you keep helping me, I will stop coming." So we talked about how I was helping her, what I should stop doing and what might be a better way to talk.

Talking is, after all, what we are here to do. It is still curative, still productive, still life giving and relieving.

Its hard to know which resistances are treatment destructive and which are not. And when to join such resistances and when not to. Its hard to know who is feeling bad and about what. But we study. We ask. We can even prevent. We can ask sometimes, about how the work seems to be going. We can remind clients about the the five topics, which includes the treatment itself, that can be discussed in treatment, so that we can create a space to talk about everything, including everything about the treatment.

There is an ebb and flow to private practice. Things shift; They are fluid. Life is fluid. We have to talk. We have to take good care of ourselves. We have to take note of our fear of being abandoned. Our fear of being disrupted. Of being bumped around. We are supposed to be trained to study and tolerate our own feelings. To use them to advance our good work. We cannot always call it right. There is so much ambiguity in our business. But we can let people know they can tell us whats on their mind. We can build our resiliency and our own knowledge and we can stick together and advocate for our work, on its own merits, and for its own sake. We can hold the hope and the value of what we do, and not let go of what we know to be true: that its worth it.