Counseling is a little like couple's dancing: two people are endeavoring to link up and learn to step together. In this endeavor, every therapist walks a fine line with her client of knowing when to lead, and when to follow. I'm seeing it depends upon the client's personality. Some clients appreciate the unconditional positive regard and empathetic listening skills of a receptive counselor, while others crave a more assertive, solution-focused and goal-oriented approach. For a personality like mine which is direct and expressive, being completely non-directive or "Person-Centered" in approach (Rogers, 1942), doesn't come naturally. For me, learning to "follow" the client's lead is a learned skill. It takes a great deal of restraint on my part not to "dash off" in dialogue towards the "obvious" solution, and to allow the client to discover the answers in her way, in her own time; to allow an organic process of self-discovery to unfold for the client. An ancient Chinese proverb says, "Give a man a fish, and he eats for a day. Teach a man to fish, and he eats for a lifetime." As an expressive and extroverted personality, I'd be just as happy handing the "fish" to the client as teaching her how to fish for herself. However, as this Chinese proverb teaches, if the client discovers for herself how to fish, she will have learned a skill which will serve her well the rest of her life. And, some clients will benefit by the ego-strengthening which comes by leading the therapist. So as a therapist, how do you know when to lead, and when to follow?
I admit that I still struggle to understand how much help is too much. Many clients come to counseling to find their own unique voice in the world. How can they exercise their will if they don't speak it in the safe confines of the counseling room? Therefore, some clients are not helped by directive counseling, and would benefit by a receptive counseling approach, such as Person-Centered Therapy. And yet it is the client low in self-esteem, ego strength and identity who appear to need the most direction. Many will present as "lost souls," having been blown off-course, and seemingly directionless. A therapist's first instinct will be to "rescue" the "drowning" person. Yet if Rogers was correct that all people have an "actualization tendency," which is the potentiality to be self-directed, the therapist should only act as the environment that the client "pings" off of, in order that she may make her way in the darkness. It was Gestalt Therapy's co-founder Laura Perls who wisely advised, "Give the client the least amount of support necessary for growth." According to Roger's theory, "The client centered-therapist does not intend to diagnose, create treatment plans, strategize, or employ treatment techniques" (Corey, 2009, p. 171). However, in times of crisis, the Person-Centered therapist makes suggestions, offers guidance, and even direction might be called for if clients are not able to function effectively (Corey, 2009, p. 179). If a client's mental illness has incapacitated their ability to navigate, that client will benefit from a directive approach from the healthcare provider. For them, the provider becomes their "port in the storm."
How to assess whether the client would benefit from a receptive approach or a directive approach can be based on the client's reaction to the therapist's attempts at intervention. I think of a client I had who became defensive, suspicious, and perturbed when I attempted even the slightest of experiments. She scoffed at my attempts to introduce even small interventions into the dialogue. When I brought this to her attention, she would again retreat into defensive postures. It was as if she was daring me to "get through to her." What I learned from this "resistive" client was quite important for my growth as a therapist. I learned that some clients have a high need to be "heard," and to direct the operation. She had a low tolerance for others opinions, and a high opinion of her own. Gestalt Therapy's Dr. Fritz Perls would have referred to her as a "closed system." And yet, she had presented in therapy. Perls used to refuse to work with these sorts of "difficult" clients. However, perhaps the therapist should give the client what they are asking for...what they can assimilate, rather than what we wish they could assimilate! If a baby isn't ready for table food, we don't demand he eat it anyway. Instead, we spoon-feed the baby, until such a time when they develop a tolerance for adult food. With no insult intended, there will be clients who are not ready or able to assimilate the interventions the counselor would like to make. Should counselors be willing to work with this kind of emotionally immature client? Moving slowly, cautiously and tentatively will require great patience from the counselor, and he will need to abandon his "agenda." All his great skill, techniques and experiments will have to be put away, and what he has left to work with is simply himself, his personality, and his ability to empathize, to understand, and to confirm the client. He is stripped of his therapeutic "armor," and left standing in what sometimes feels like his undershorts! Then, he will be asked to follow rather than lead. He will have to find a way to "check" his ego, so that the client can shine. For an extrovert who doesn't enjoy dancing in the first place, taking my cues from the client (in my underwear) is uncomfortable business. And this is why I believe Dr. Perls wouldn't work with resistive clients; he wasn't accustomed to "following." But for some clients, this may be the best they can do to make contact.
Contact is a strange thing. Too much of it and it causes repulsion. Too little, and longing for contact sets in. Most clients struggle with making contact with the therapist. I watch clients talk to the wall, the ceiling and their feet to avoid making contact with me, to avoid "being seen," as it were. They are avoiding my reactions and expressions. What they are "tuned into" is their inner world. The client who struggles to make eye contact in therapy is lost internally. They have disengaged with the environment, and lost touch. They have withdrawn. They do this to protect themselves. Hyper-verbal clients use words as a shield to keep others from seeing them; almost as if they keep talking you will be distracted and not notice them. Both methods of avoidance are ways of retreating from contact. When there are obvious signs of contact boundary problems, the person has often been the victim of abuse or neglect. They may have survived boundary violations but consequently, these violations served to breakdown healthy contact with others. In simplest terms, "getting too close to the fire" frightens these skiddish, ego-fragile individuals. The hope is that through a process of unconditional positive regard in therapy, the client learns it is safe again to trust the therapist with feelings.
It takes a large portion of academic skill and humanistic sensitivity to become an integrated, whole of a counselor. In fact, I can see I'll be working the rest of my life on it. I'm finding that what may feel like modest gains for me may feel like milestones for clients. When I see them progress, I know that in a sense, I have, too. I'm learning as much about this dance as they are. I'm learning how to establish contact in the counseling room, and so are they. This is a collaborative journey. Sometimes I'm not real sure where we're headed, and in those moments of blind faith in their ability to grow, and in my ability to catch them if they slip, I'm learning to relax my grip and let the client lead. Sure enough, they don't disappoint. They pick up the dialogue and we're off again exploring from a different angle. The longer I do this, the more I'm willing to set aside my my theoretical learning and to discover how to dance with the unique and sometimes puzzling individual before me. Clients don't "fit" perfectly into the "boxes" or diagnostic labels psychology has given them; these are real human beings before me, with real lives, and their challenges are about as diverse as they are. I'm learning to "toss aside" the way the books say it should be done in favor of whats happening; my hypothesizing and theorizing is lost in trade for exploring with the being before me. This "being with" is what Relational Gestalt Therapy refers to as the "between" which is created in the space of two people trying to relate to one another. And this is the magic of the therapeutic relationship! It is in the relational, dialogical interactions that the bond is formed. This bond is therapeutic, and is the goal of humanistic therapy. When I am attending to the person rather than to the problem, then I am in a position of effecting the healing work which is psychotherapuetics. This is what I've trained for! I am finding there is wisdom in waiting to be asked to dance.
References:
Rogers, C.R. (1942). Counseling and psychotherapy. Boston: Houghton Mifflin.
Corey, G. (2009). Theory and Practice of Counseling and Psychotherapy. Eighth Edition. BROOKS/COLE CENGAGE LEARNING.
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