By David Joel Miller
Are you sure you really know what your problem is?
There has been a disturbing trend lately in the psychotherapy business. To hear some of my colleagues talk, clients do not have a clue what is wrong with them. Worse than that, if the client did know, they are convinced the client would lie to them.
I have to question these premises. First some fictional examples may help.
A male client goes to see their therapist. The man says he and his wife are quarreling and he is afraid their marriage will end in divorce. The therapist does a full assessment and informs the client that his problem is not his relationship. His problem is he did not have a good attachment with his mother. He needs to work through all his childhood issues of wanting more from his mother than she gave him.
The client, not conscious of psychological principles, continues to insist that he and his mother got along just fine. The client says that it is possible that all men have mother issues they need to work out before they can properly relate to a woman. What does he know about psychological principles?
So the man undergoes a long examination of his childhood and his relationship with his mother. At the end he sees how he was not really as close to his mother as he thought.
In the mean time his wife leaves him and files for divorce. As much as it pains this man to lose the relationship with a woman he really loves and he is also sad about losing contact with his children because the wife has moved them to another state where she lives with her parents.
Still the man now understands how his underdeveloped relationship with his mother has resulted in his attachment issues with women and he now understands why he will never be able to make a woman happy.
Sound far-fetched? I see things like this more often than you might guess.
Second example. A woman comes to see her therapist because she has been out of work for many months. She is discouraged and getting depressed because of her employment situation and her economic troubles. I am thinking either treatment for depression or help with career counseling, but the treating therapist tells me that would be wrong.
The problem here is that this client grew up in a home with an alcoholic parent. This has left all sorts of scars on the client and the client undergoes treatment for her anger towards that alcoholic parent. The client insists that she got over that stuff a long time ago but the therapist informs this client that she is sicker than she think and that she will never be happy again until she gets these childhood issues treated.
The client talks with this therapist for a number of sessions, still unconvinced that she has all that big a problem with her childhood. Eventually the therapist tells the client that this client needs to stop lying about her hatred towards her father.
Clearly anyone who grew up with an alcoholic parent has been scarred for life and will probably never be able to work again
By the way these are fictional composite examples so do not go thinking you know the people I am talking about. You would be wrong.
The problems these vignettes illustrate are a phenomenon known as counter-transference. The counselor who has had issues in their childhood, or has others in their life with these issues, is insistent that the client must have the issues that the counselor sees and if the client disagrees then the counselor believes the client is lying.
It can also come from a theoretical orientation that asserts that all adult problems are the result of childhood events.
A more productive approach is for the treating professional to consider that some people who had mother problems or an alcoholic parent may be having problems today because of that past, but most people really have the problem they say they have.
I try, in my practice, to always accept that the problem is what the client says the problem is. This can save a lot of time by working on that issue first and then get back to the other stuff if that still needs doing.
I also find that it saves a lot of my time and the client’s time to avoid arguing with the client. If they tell me things I take it that they believe what they are telling me. They may be mistaken but most people really do believe what they are saying.
Certainly there are times that clients might stretch the truth. Especially if they have something to gain, like child custody or disability. In those cases, where my results will go to anther person or agency I ask a lot more questions. But if the purpose of the therapy is to help the client resolve issues or cope with life problems I find it is worth the effort to start from a place of believing the client.
Most of the time the problem that needs treating is the thing the client says brought them to my office in the first place. If your provider is insistent on treating you for their issue instead of yours consider getting a second opinion.
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books