Lessons from the Couch: Client Perspectives About Counseling
It comes as a surprise to some clients that not all counselors are required to experience counseling as a client during their education and training. I remember in my graduate program that at least 1/3 of the students training to be counselors had never been to counseling, and a few others had only been for 1-2 sessions. This was a disappointment for me to learn, however I do still believe in the motto, “you don’t need to have had cancer to become an oncologist”, so I do not think it is a hard rule that a counselor who has never been a client cannot be extremely effective at what they do. It is still important in my opinion though that counselors who have never been on “that side” of the room in a therapy session are aware of some of the lessons that clients learn about therapy. Some things are lessons learned about the therapeutic process, others are things clients learn about therapists themselves as helpers that give a more accurate picture of the role of a therapist. Let’s explore some of these lessons from “being on the couch” in therapy that I have heard from clients and as a long-term client myself.
“So, do I have to lie down and cry about my mom?”
As comedic as it may seem, I have been asked this question by first time clients who have never had any previous experience with therapy. Due to a bit of historical oversimplification as well as media depictions of therapy not always being so accurate, there can be a strange expectation for first time clients that good therapy requires frequent tears, long discussions about deep seated issues with one’s mother, and perhaps most strangely, a lying down position during session. These conceptions of therapy are grounded in the early years of the profession during the time of Freud and his compatriots. They would typically have clients lay down and face away from them while encouraging them to speak without the therapist responding much. There is very little in the way of this type of therapy done now-a-days, as we have learned that these are not necessary parts of a successful therapeutic process.
Talking about mom is not uncommon in therapy, but it is interesting when clients report that they expected there to be a lot more questions about their mother in first sessions. Obviously, if a client’s presenting issue is related to childhood trauma or current conflict with their mother there will tend to be a lot of discussion about motherhood and their mom. However, the majority of issues people present with in therapy are not directly related to their mother so it is not necessary for clients to spend a lot of their session time talking about dear old mom. It is totally normal for a client to work with a counselor for weeks or even months and not spend much time talking about parents in general, particularly for adult clients who are working through a current stressor that is unrelated to their family of origin. Plus, let’s give credit to all the moms out there who were not the primary cause of distress for their children! Fathers, siblings, and other extended family cause plenty of problems themselves!
The feeling that crying is necessary for a good therapy session has been reported to me by quite a few clients. Not in the way that they feel that their inability to cry is a problem, more so that they are worried that if they are not moved to cry at least sometimes in session it means they are either not delving deep enough into their emotions and/or the topics of discussion are not important enough. This is not always true though, as sometimes life stressors can be extremely difficult while not pulling on our emotions that illicit crying as much. Career changes are a generally good example of this. It can be distressing, exciting, scary, intimidating, and other powerful emotions that could be helped to manage by therapy while someone is switching careers. Do any of these always include crying though? Not for everyone, and even for those that do shed tears for some of those emotions it usually isn’t the deep cathartic crying that is classically thought of as happening in therapy session. My personal rule of thumb for crying in therapy is if you feel you need to, and you prevent yourself from doing it, that was a less than optimal session. But if you do not feel the need to cry, and you force yourself to than it may have been an inefficient use of your energy during session as well. Cry if it comes, don’t worry about it if it does not! Therapists do not get into this career because we hope every client comes in weekly with major tears to shed. Speaking of therapist expectations:
“I’m sorry, I have had a good week”
Clients of my own and myself as a client have said some form of this to therapists, and while it seems silly when reading it to apologize for having a good week, it really is a worry some clients report having during therapy. You may come into session after a good week or weeks and be worried that your counselor will feel that they are not being effectively challenged or used properly when there hasn’t been a major stressor you have been struggling with. On the contrary, we therapists want to hear the good and the bad because there is a lot to learn from both! On top of that, I for one can say that I got into the field of counseling not just to be there for people at their lowest, but also get to see and feel their positive emotions when things improve. A young client once even asked me if a good week for me was when a major national tragedy occurred, because obviously a lot of people would be upset. I said I wouldn’t consider that a good week for me anymore than a surgeon who sees a lot of injuries due to a major highway accident come through their hospital. I am here for it and don’t regret doing what I can to help, but no I do not celebrate the “busy” feeling of having a lot of clients in crisis.
I have heard that some clients learned from doing therapy that not every session has as much content as some others. While this is only natural, some clients say it makes them question if they are doing something wrong and not bringing up the right topics. I believe there are two things we need to keep in mind regarding this question: it isn’t always on the client to fill the session time, and there’s no need to create hypothetical problems just to fill a session. Counselors have a role in making sure that sessions are productive and if a client is having trouble directing where they want to go in a session, a counselor should attempt to look for areas of interest that could be useful. At the same time however, I am a big believer in not creating problems where there aren’t any. For instance, if a client comes in has had a good week overall, I do not believe it is helpful for a counselor or client to spend time on hypothetical situations where things can go bad. Questions like: “what if I get sick?”, “what if I lose my job?”, “what if my partner leaves?” are not worth exploring when there is not immediate risk of these things happening. Let good times be good! Don’t use them as times to play hypothetical negative scenarios out.
“So, therapy doesn’t cure anything but helps a lot”
This particular lesson that clients learn and have told me may seem like a negative thing, but in reality it is a mix of a truth with a positive. Therapy as it is understood in modern times is almost never going to “cure” any kind of condition. Reduction of symptoms in many mental health disorders is definitely a part of therapy, but rarely does someone stop therapy and say they no longer have any symptoms of depression, anxiety, or interpersonal conflicts. This is because a “cure” by medical terms does not quite fit in the mental health world. When your cold virus gets cured, it is because your immune system and some medications have eliminated the virus. The virus no longer exists in your body. When we reduce anxiety symptoms from chronic and severe to mild and rare, the brain will always have the ability to turn back into a state of high anxiety. Mental health is not about eliminating the brain’s ability to go into negative states, but making sure that the brain goes into those states at appropriate times where it needs to protect itself and not constantly.
Clients have told me that they have been pleasantly surprised with the amount of things therapy can help with, but sometimes disappointed that it does not totally solve problems. This is a mistake in expectations. As counselors, we are here to be WITH you on your journey to healing and problem solving. We are an anchor of support and can contribute greatly to certain areas of self-improvement, but at the end of the day most of the work is still done by the client. Being the client is actually being the authority in the room when it comes to your own issues, so you are the expert and we are learning and helping with you.
If you would like to start your journey “on the couch”, please contact Life Enhancement Counseling Services today at 407-443-8862 to schedule an appointment with one of our experienced mental health counselors.