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Do you ever terminate counseling service?

March 29, 2013

I will terminate service, and I am more apt to fire a client than a client is ever apt to fire me. I tell clients so, as part of an informed consent process at our first meeting.

I explain that when I have terminated service, it has always been for the same reason.

People come to see me. We sort out what the problem is and then develop a plan to address the problem.

Assuming part of the plan is a return visit, when they do, I naturally ask, “How are things?”

This is when people look at me rather bold-faced and say, “Same sh-t, different day. Not a thing has changed.” The client then launches into the same litany of issues of which they advised me of at our prior meeting.

I quickly redirect to the plan, because if you follow the plan, something should give and if nothing did give, then maybe we have to tweak the plan. But at least we have some new data.

That is when these very same people move from being bold-faced to sheepish. They say, “We didn’t follow the plan.”

Indeed, they tell me they didn’t do a blessed thing differently upon leaving my office from the time before.

This is when I then advise that if someone doesn’t follow the plan, I don’t know how to be helpful. I explain that I not here to just register client complaints or issues, I am here to help clients address them and if they are not seeking to change something, then I am not the right person for the client. I always offer to refer to another therapist who would happily sit and meet with the client to listen to whatever they had to say, as much as they would like, but that just isn’t me to do.

I take the view that given my approach to working with people, if they are not really engaged and working towards change, then it is not right to receive their money. I am of the opinion that it is in fact unethical for me to receive a payment for a service that really isn’t being utilized and I withdraw. I may add that I am busy enough that my income isn’t dependent on keeping them in therapy, which actually is a good thing for them as their needs will clearly proceed mine for an income.

Since I have started telling people this at every first meeting, I have rarely had to terminate service. Perhaps paradoxically, clients quickly come to understand that the magic of counseling is only one part what happens within the session and that the bigger part is what you do with it, outside of the therapy. I clearly put the onus, expectation and responsibility for change squarely on the client. I can provide the insights, connections, guidance and even direct instruction. The client is responsible for implementation.

No implementation, no service.

Just like the guy who always prayed to win the lottery, at one point the voice of the Almighty spoke and said, “I would like to answer your prayers. Meet me half way. Buy a ticket.”

Gary Direnfeld, MSW, RSW

For mote tidbits into therapy and insights into successful marriage, read: Marriage Rescue: Overcoming ten deadly sins in failing relationships.

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13 Comments
  1. YES, Gary, I do the same thing! In my first meeting with new clients I tell them that, if you have gathered insights and information from being here and you have agreed to “best next steps” and you do not take even the smallest of them, we are then in agreement that this is not the time for you to benefit from counseling. Having made that agreement in the initial meeting, it is easy to revisit and make a decision to terminate, with the invitation to return when ready to work.

  2. I would never work with a client in such a manner. If people who seek therapy are unable to take necessary steps towards change, no matter how long it takes them; I empathize with their ambivalence and employ a motivational interviewing strategy based on the transtheoretical stages of change work of Prochaska and DiClemente. This is a solid research based, empathic,client centered approach that allows for clients to change at their own pace; not at ours. I would never “fire” a client unless they act abusively towards me in some manner. It is my job to stay with a client and not abandon them for their inability to change.

  3. Thanks for you comments Belinda. I have opened up dialogue on this issue with other groups and the comments are polarizing, with therapists typically falling on one or other side of the fence, just like what is seen here. Some like yourself clearly feel quite strongly. I am looking forward to receiving other comments.

  4. Carol Esposito, Psy.D. permalink

    I am with Belinda on this one. Thank you Belinda for expressing my view!

  5. Here is the discussion on this blog from another discussion group:

    Lucille Barish • Interesting because I did just, after many years of being a therapist, fired my first client. Borderline personality and abusive – i am a phony therapist, “I know that”, when she didn’t. You’re not helping me – when actually I did see some changes. I talk psychobabble, etc. I finally got annoyed because she would not address the angry – rage – in a direct way and had enough, all of which provided to her I was, indeed, a poor therapist. However, since I have not had this problem before, it has not occurred to me to say in advance, I would terminate treatment if there were no changes and client did not comply with treatment goals. Not sure how I feel about that, but it was a pleasure to “fire” this person.

    Gary Direnfeld • The key is to manage your counter transference such that the firing is not a reflection of your anger, but actually an intervention on behalf of the client. The firing sends them a message that they must take some responsibility for their life and their issues are their

    Russell Beazer, MS, LMFT • I agree with you Gary. I prefer to send clients on their way then to be another notch in their list of failed therapy attempts. It sends the wrong message to facilitate the false sense that they are doing what they are supposed to by simply attending therapy sessions. In most cases I give one warning, and that tends to get action between sessions, but sometimes I deliberate if that models patience, or if it models a lack of seriousness about the therapy process.

    Heather Dale • This comes up on other threads too, but I do not think we should be talking about individual clients on Linked In as it is not a private site and it would be easy for clients to recognize themselves.

    Lorrine Marer • Lorrine Marer. I think Gary is absolutely right. It is comforting to know I am not the only person who makes thi kind of statement. As an ADHD Coach it is imperative that the client knows you will only work with them if they do some of the work themselves

    Wendy Fredricks • I think it can be pretty clear when faced with a client who has bounced around from therapist to therapist, and they tell you all the ways you cannot help them, that the likelihood of the therapy taking hold is pretty slim. Cutting the losses for both the client and me seems appropriate at the earliest possible moment.

    I must say however, that if a client comes in for the second or third visit not feeling much better, I would explore what is getting in the way rather than fire them for not following a strategy. I feel therapy is about getting to the truth, and not simply following a game plan to try to feel better. It may work in the short term, but if it doesn’t solve the underlying issue, it will keep popping up. I don’t tend to get clients who are so clear about their issues that a strategy can be struck in the first or second session. I’m still information gathering at this point, because I want to know what is driving them unconsciously so we can begin to work on belief systems and parts of the psyche that are preventing a client from personal fulfillment.

    Dr Bryan Knight • I agree entirely with Gary’s position (although not with his belief in counter-transference). Much to my wife’s regret (because of the shortage of income) I refuse to continue seeing a client who has no intention of changing, who just wants to vent week after week.

    Sarah A. Kass, PhD • I’m shocked by this entire thread–how do you know that your presence alone in some circumstance may be exactly what the client needs at a particular time in his or her life and that cannot be measured by some yardstick you might have for therapeutic change. “Firing” a client may be the most detrimental thing you can do to a client, especially when you confirm for them a limiting self-belief that nobody wants to hear what they have to say or who they are as human beings. A desire to “fire” a client speaks more to the therapist’s frustration with a particular client than to what that individual client truly needs as a individual human. This is where the therapist needs to have some supervision–to have a space of his or her own to discuss what is going wrong in the therapeutic alliance. Therapy is not simply amount measuring change on some sort of objective measuring device–it’s about cultivating a relationship in which both therapist and client learn and grow. If someone is not learning and growing, amputating the “alleged” problem is not the solution.

    Michael Hoffman, Dr.AD, MRAS, AAPC • That’s easy….. when you know you are working harder than the client, when you’ve discussed it with them, when they are chronically late, when they miss without cancelling …. or most importantly……… when you know the patient needs care you don’t know how to give.

    Ronald B Cohen, MD • I don’t fire patients but I have resigned from the treatment team.

    Lisa Berendts • We assign a negative meaning to the word “firing”. I chose to view it as me no longer meeting their needs, and as such I am not the therapist for them, and give referrals.

    To echo what Michael wrote: I refuse to work harder than clients.

    Mary Moonen, L.C.S.W;C.A.P. • Hmm..I can understand many points made here, and they are very valid. My take is that I hate the word “firing”…it has such a harsh sound, and to be honest, it sounds like anyone who “wants to fire someone” has some issues to look into. “I’ll get you fired!” “Your fired!” How about being “fired up”…these words, at least to me, convey anger, judgementalness, and total frustration.
    Having said that…I certainly have been guilty of all the above. When I look at what’s getting me angry, my own counter transference…it isn’t always so pretty. I consult with someone once a week, we go over the caseload..etc.
    Consulting helps me regain my objectivity, as well as offering me other ideas to approach something. I also use a great deal of Motivation Enhancement, CBT. I have found that people may take longer to make healthier decisions, but if they are working towards a goal..I am fine with it. I will not work harder than a client…but I also won’t terminate them, unless they have violated my office policies, several times, and after discussing each incident. Cancelling last minute..no shows…etc..after all options have been addressed, then per policy, they will be terminated and referred. I have to say, speaking for myself, I am so happy I didn’t’ “fire” some clients due to lack of movement on their TX plan goals…Now, many are doing fantastic! I actually LIKE working with “resistant clients”…There are always underlying reasons why they are resistant, and in my experience , if I can reach for that…then often more progress is made. I have many mandated clients, and have seen people’s live’s change. Very rewarding.

    Russell Beazer, MS, LMFT • Sarah – I don’t interpret “firing” in this thread to mean “You suck, get out of my office.” It is a recognition, through a supportive conversation, that the client is either not ready to put in the effort necessary, or they are looking for something that I do not offer. So they are referred to their insurance company or to another therapist. It’s just easier to use the word “fire”. These moments happen, unfortunately. Michael made a good list of the symptoms above. I have read a number of Gary’s posts and find his ideas to be ethical and professional, so I did not assume that he was referring to something harsh or unfair to the client, but the recognition that client and therapist are wasting time together.

    Sarah A. Kass, PhD • Thank you for your thoughtful reply, Russell. This is an issue that I have been studying a lot of late and have noticed, like the majority of replies in this thread, that most practitioners are very willing to quickly pull the trigger on the client when the therapeutic relationship is not working, as well as blame that failure in the relationship on the client. But every relationship is a relationship and while, yes, some simply do not work, our culture is very quick cut off and move on (aka “fire” or “divorce” or “terminate”) rather than do the hard work required to see if the relationship has any life left in and if it doesn’t, to help the client transition to the next phase. I did not do the hard work to get into this field simply to tell clients that they are somehow disappointing me or not living up to my expectations….. if that’s happening, I need to look at my expectations and the client and I need to renegotiate the terms of our therapeutic alliance. I’ve found that most clients are smart enough to know when a situation is beyond hope, and will leave on their own. But the ones who stick around but their therapists want to “fire”–there’s potential for some really amazing healing to happen…. but only if the therapist doesn’t liken therapy to Celebrity Apprentice.

    Leah Szemborski • By never “firing” (or terminating or whatever verbage you prefer) a client who perpetually mistreats or misuses others, are we allowing them to perpetuate unhealthy behaviors at our expense?

    I mean, if my sister constantly calls to complain about Mom and it gets to the point where I’ve heard her story 17 times and it’s becoming a drain on me emotionally, what good is it for her or for me? Maybe instead I should say, “Sister, this venting isn’t helping you or me. Please don’t call me about this anymore.” Then when she calls to complain about Mom I say, “Nope, I’m not listening to this anymore”, perhaps she’ll change her behavior in response to my boundaries. It has the potential to be helpful to her whereas just “listening” wasn’t helpful at all. (I don’t have a sister–I’m just saying…)

    Maybe I didn’t explain this well, but I think setting boundaries with clients–maybe sometimes to the point of termination–can be really beneficial to clients in some instances.

    Ruth Braunstein • A very important topic. Also agree with Heather Dale’s reminder, we must be diligent in not talking about individual clients, who could be identifiable as she describes. Hoping to write more later.

    Sarah A. Kass, PhD • There is a HUGE difference in setting boundaries (usually highly beneficial) in relationships and terminating them.

    And if anyone thinks the client benefits from termination, or “firing,” I’d like to see the double-blind research.

    Leah Szemborski • Maybe the client would benefit–maybe not. But we are people too, and sometimes we have to do what’s right for ourselves.
    Sarah A. Kass, PhD • How would we feel if our medical doctors said that to us? “I don’t think you are working hard enough at recovering from your cancer so I’m going to drop you as a patient.”

    Russell Beazer, MS, LMFT • I have not, and can not picture a time when I would, chosen to refer a client away from my services out of a need to do something for myself. Every decision in a session is based on what is best for the client.

    Leah Szemborski • Well I have referred clients to someone else when I felt the therapeutic relationship would have been harmful to myself.
    If my doctor thought that the treatment he/she was using wasn’t effective in helping me and suggested I go elsewhere I would be glad for their honesty and would happily find a dr. who could do a good job for me.

    Sarah A. Kass, PhD • Then go ahead and fire your clients….

    Lucille Barish • I never “fired” a client ever before. This one really got to me. Takes a huge amt. to do that! She keeps e-mailing me, has contorted everything I wrote back to her in past week, very borderline. I can’t feel too sorry. She was dripping with poison. i have great clients and don’t need that.

    Carol Kirby • It sounds like you became one of her victims and she wasn’t learning to let go of her role as perpetrator, so I understand your decision and can relate to it although I can’t go into details. I’d say you were modeling self-preservation.

    Michael Cooter • this is an excellent issue – there have been times I have been irritated by a client’s noncompliance and resistance – I have wanted to be “done with them” however; they keep coming back – so perhaps I have minimized some benefit they are getting. I continue to confront as indicated and reinforce even the most miniscule effort they may be making – attachment is a very important aspect of therapy…. and looking at ourselves and our own reactions.

    pawan kalia • I fully agree with Sarah A Kass

    Jamaica Chenoweth • If a client was to become overbearingly emotionally abusive to the point of having to protect your own self esteem, etc., I would refer out. Usually Axis II disorders are the saddest.

    Johanna Lamm, PsyD, LP • I’ve never fired a client before, even when things have gotten uncomfortable or a client has stopped paying. I always treat these situations as therapeutic issues that can be addressed in session. Clients with personality disorders may be challenging but they can also be rewarding and deserve the same high level of care as every other client.

    Ilo Milton • Only once have felt that a client was determined to remain status quo for the long term necessitating my initiating termination. It was a long process in which I had to sort through the transference/counter transference, old and new resistances, traumatic reenactments, etc. After this process, with the aid of a senior mentor/supervisor, I was clear that my ethical and moral standards would have been compromised had I continued to work with this client. With options and referrals given to the client, the client ended the non- work with me, never to be heard from again.

    I must add that in my over 30 years of practice, there have been numerous occasions in which I was able to work with a client to move past a temporary impasse. This is to say, that the impulse to “fire” a client deserves time and attention to sort out the array of clinical components….. so that a clinician does not act prematurely or Impulsively while missing the clinical golden window of clinical opportunity that the client’s wish to remain unmotivated may present.

    Ruth Braunstein • An excellent reference text I recommend highly for the bookshelf of every practitioner: “Terminating Therapy: A Professional Guide to Ending on a Positive Note” by Denise D. Davis ISBN: 978-0-470-10556-6

    In my independent practice, I have had cause recently to review and revise my client contract ( client informed consent) documents to specifically include therapy termination policy and procedures, and found this book invaluable.

    An up-front discussion about how and in what circumstances terminating therapy typically occurs helps us minimize the risk of early termination and the harms that can arise in abrupt, ill-considered breakdown of therapy alliance, whether termination is initiated by the client or the practitioner.

    I have now recommitted myself to discussing termination with all clients up front as part of initial client informed consent. This is because – from time to time – problems can arise that can result in a breakdown of the therapy alliance and/ or even threaten the ‘integrity’ of the practice itself. Examples might include: a pattern of client non-attendance and/or client refusal to pay even nominal pre-agreed cancellation payment or agree to a flexible payment plan.

    The book (above) explains that practice integrity includes the capacity of the practice to be financially viable, and the practitioner to be accorded basic courtesy. For info, here is a link to the book “Terminating Therapy” where you can see chapters, sample content. http://au.wiley.com/WileyCDA/WileyTitle/productCd-0470105569.html

    Ronald Mah, M.A., Ph.D., L.M.F.T. • Sometimes… not that often, I find myself extremely ill-suited for a particular client and his or her needs. Sometimes, it’s a lack of knowledge or expertise, but usually I can take care of that with research and consultation. I stretch and adapt as a matter of course to meet clients where they’re at, but once in a while I just can’t get there.

    Ironically, it’s not the narcissistic critical client that I can’t deal with. I know he or she is a narcissist and when the duck goes “quack quack quack,” I’m not surprised or hurt. I’m prepared for the narcissist to question my credentials, tell me how I’m doing therapy wrong, and competing against me. It may be ducked up if I need his or her admiration to be criticized, but “quack quack quack,” it’s what narcissists do! I have ways to handle that with therapeutic integrity. That’s a whole other topic about how to manage the narcissist. (side note and promotion… I’m presenting a full day training for the California Association of Marriage & Family Therapists on May 16 on “Narcissists, Borderlines, Addicts, and Affairs… Oh My! Assessment and Practice in High Stress Couples Therapy”).

    Part of the sometimes, is that sometimes (fortunately not very often) I am completely inadequate and/or the therapy is not going anywhere at all by any reasonable criteria: change in behavior, deepened relationships, greater attachment between self and client, and so forth. It is an ethical standard for psychotherapists not to continue therapy that is ineffective. It doesn’t have to be anyone’s “fault”… if it isn’t or hasn’t worked, I may fire myself. Clients should not be “fired” or terminated for being… clients!! “What they have problems in life that become problems in therapy… with me!? How dare they?!” Continuing therapy gives an implicit (and unethical possibly) message that the therapy will or can be effective… and sometimes, the therapist is stumped or the client is not there for it to happen.

    Then the termination however can be framed as a therapeutic termination that can promote growth and change… again, another topic.

    Gary Direnfeld • So pleased to see this spirited discussion. It seems much has hinged on my choice of words – “fire a client”.

    This posting may also be polarizing, but hopefully folks will key in on a few key messages:

    https://garydirenfeld.wordpress.com/2013/03/28/piled-higer-and-deeper-i-hope-not/

    Gary Direnfeld • Brilliant Ruth, and always a part of my upfront informed consent process. As a result, clients appreciate that there is an onus on them to do some work and thus rarely do I actually ever fire a client.

    Kay Whitehead, MSW, LCSW • I have not “fired a client” but over the years it appears to me that clients self-select to leave the practice when the fit is not a good one, or when they are not getting what they need…even if the “goals” are being met. Good therapy is not always about black and white “goals” because I think goals are often something that continue to emerge over time, just as healing does. Someone can come in with a list and say “here is what I want out of therapy” and as the time goes on the deeper truth of what they want and need surfaces. And it may not have to do with the “goals” that were originally set. I have discussed with clients if they would have a better “fit” with someone else due to personality styles. I am aware that some clients who are axis ll with borderline features may be recovering from PTSD or attachment issues and while they can challenge my socks off, I try to hang in there with them. I also make sure that I stay involved in peer supervision for my own well being to check in with my own issues as I work because it is difficult work. We never know when reparenting is happening for a client…or when our “firing” could be reinforcing parental shame. This is a very interesting discussion and I want to hold room for both discussions. Polarizing is not really helpful because I believe there is a both/and in every discussion. I would like to know more about why “firing” is chosen related to a client. Sometimes I think a client’s work is subtle and not time referenced. That has been the case in my practice which is all about traumatic grief and loss. And in grief and loss, I have every kind of dx issue possible.

    Susan Toohey, LPC,NCC, CHT,MEd • When I was in supervision years ago, one piece of advice from her really resonated with me. She told me if I was working harder than my client, it was time to fire him/her. I have done that without any doubt a few times since I’ve been on my own without any regrets.

    Ruth Baron • Gary: I agree 100% with your idea – I realized my big mistake with a client. She was not working at all and continued with more of the same issues. After 6 sessions I started to fel uncomfortable and uneasy. I guess she was not worried at all and, I was; no commitment for herself in the relationship with her partner, with her job, in general …
    Now I´m sure to explain what you suggest in the very first meeting. While I was thinking how to “Fire” her, she surprised me: She ended it.
    **LOVE YOU DOG**

    Gary Direnfeld Thanks – and as for my dog, he’s actually a certified therapy dog, through St John Ambulance Therapy Dog Program:
    http://www.yoursocialworker.com/Kugle/kugle.htm

  6. It appears a wonderful success to Mr. Direnfeld to render his clients –sheepish. At risk of being vivisected as “material” here, can I venture my consumer viewpoint?

    The therapy relationship is intimidating asymmetrical. It teases out the client’s shortcomings and failings, while the therapist assumes the role of the powerful guru. Often clients enter therapy with unrealistic expectations–that life’s inevitable pain will be lifted or they can transform into different people. Sometimes these magical delusions are collaborated verbally and non-verbally by the therapist.

    As I understand it. Mr. Direnfeld’s opening salvo is a threat– to pull the plug on this salvation unless the sheepish client obediently complies. He says this is effective, and indeed I visualize his self-selected client base whipped into submissiveness lest they receive their punitive butt-kick.

    I don’t know the specific changes that Mr. Direnfeld commands. I do know–from living several decades–that change often demands new skills and that many attempts at change illicit powerful blow-back from the worlds that we’ve created. Therapy happens in a vacuum, but clients operate in a draining, competitive multidimensional universe.

    My younger self would have put on a performance for Mr. DIrenfeld. I eventually would have left, client and clinician convinced of my tremendous progress. But in reality, his treatment would have reinforced my cowering obedience to contemptuous authority, an infantilizing, regressive construct that’s antithetical to authentic agency or life satisfaction.

    Perhaps the contempt Dr. Direnfeld conveys is his loudest bark. But I feel respect and equality are the most powerful healing agents between two people. The consulting room creates no magical context for rudeness or disrespect.

    • Hi “disequilibrium1”;

      It may come as a surprise to you that I actually approved your comment for posting given its very critical nature.

      While advising clients that I am more apt to fire a client, than be fired may seem draconian, intimidating or controlling on my part, it is with purpose to the benefit of the client.

      From my perspective, therapy is not meant as a navel gazing endeavor. Rather, I see people in distress, who at times are entrenched in their distress and who seek to project blame upon others and take no responsibility for their situation or at least extrication. They at times present themselves as hapless victims with no alternatives in life. As such, I view therapy as a very active process designed to help people address their distress, such that relief may be obtained. In so doing, I do put people on notice that it is my expectation upon them to consider feedback and guidance provided and take steps to better their circumstances.

      I am of the view that far too many therapists inadvertently enable their clients, the result of letting their clients continue to relay their situations of distress, week after week, with nary any work towards remediation.

      When I ask some of my peers why they let clients go on complaining week after week after week – sometimes years at a time, with no effort at behavior change, they tell me they believe the client is still getting something out of the process.

      I have a different view.

      I am of the view that therapists who let clients continue to vent their distress, project blame and present as victims or utterly powerless without expectation of change, are actually acting in their own interest. I concern myself that such therapists keep clients in that kind of therapy to meet their own needs, be it to have an active caseload, earn their fee or whatever. Even those therapists who are on salary within an organization want to get paid and having an active returning client assures that outcome – whether or not the therapeutic encounter facilitates change/relief.

      I have always taken the view that the needs of the client come first and that the client must take some responsibility for their situation to thus bring about change. Thus I, in transparent fashion, make the expectation that they must work explicit. Further, I never worry about having an active caseload, keeping a client in therapy any longer than necessary, concerned for my income. With this perspective, clients come remarkably first.

      Given my approach to therapy, I happen to have an active caseload. Having researched outcomes for folks who do see me, I have also learned that I am helpful to 92% of people who come to see me. I am unhelpful to 8% of folks who come to see me.

      No one approach is suitable for everyone. I get and appreciate that. Because I am transparent though in my approach, those who see me are self-selecting and typically do well. Because they are self-selecting and are aware of my approach, this also mitigates against the harms you attribute to my approach.

      So I will certainly respect that my way of working with folks in distress would not work for you. I could only hope that for your sake though, who ever you would chose to work with would also be transparent in their approach and would so clearly advance your needs over their own in a therapeutic process.

      Best,

      Gary

  7. Susan Kehaya, LPC, NCC permalink

    It has been my experience that I don’t have to do the ‘firing’. Generally speaking, the folks who ‘fit this category’ are, sadly, the ones with the heaviest Axis II traits and those who are in greatest need of change. I find that when I outline my approach to their issues they are the ones who will either not return or ‘fire’ me.

    • That too is consistent with my experience. But having said that, because I make explicit their role in the change process, I tend to see these people more engaged at times. It seems they see the process as more of a challenge which seems to draw them in. Like all therapists though, we see there are certainly those clients who are quite treatment resistant.

  8. I hope you don’t mean that clients who fail to respond to the therapist’s superlative ministrations are, by definition, Axis II. That’s bleak and a convenient dustbin for the therapist’s failures.

    At risk of going all Axis II on you, I see a hazard in your posture. I’ve found one’s perch in social hierarchy and relationship to authority can be a direct source of powerless and distress. So by playing a role of the intimidating, punitive authority figure to which the cowering client is accountable, you actually may reinforce dependency and feebleness. Your subtext is modeling the as the client as inferior to a powerful expert. I hope you don’t want your clients negotiating life with that mindset.

    I hope your life is pristine and perfect, but mine has its share of unfairness, dilemmas, shortcomings and uncertainty and…mortality… that even an omnipotent guru, if he existed, might be unable to fix. “Direct instruction? How marvelous that you know the client’s life so much better than she, so your prescriptions prove a magic bullet.

    I was once was the mesmerized, compliant client. I left the job with the unappreciative boss, for the sake of change. My therapist crowed in pride I’m sure. Neither my therapist nor I understood I had my larger obstacles to workplace success and that I abandoned a stable workplace for a risky, failing one.That’s the hazard when you purport to “fix” someone else’s life.

    As I get older (we look about the same age) I understand how personal and ever changing that Serenity Prayer wish.These aren’t assessments that an “authority” can make for me: “God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.” It’s always an endeavor in progress.

    At risk at going all Axis II on you– I found occasionally wailing IS the only remaining option.

  9. Noon permalink

    You don’t hire your clients, so you’re not firing them. They hire you. No longer providing your services is you quitting the job the client hired you to do (which may sometimes be necessary), not you firing the client.

    That aside – this may not be the reality of your situation, but the way you’re talking here makes it sound like you greatly enjoy being in a position of power over your clients, and by informing a client in the very first meeting that you expect them to meet your demands, you ensure that any clients not inclined to obedience and submission won’t return. The “you may be surprised I allowed your comment” response to another commenter really reinforces that impression; why wouldn’t you allow critical comments from a client perspective, especially when you’ve expressed appreciation of and respect for critical perspectives from other service providers?

    The dynamic your description sounds like to me actually reminds me of for-hire dominants in the professional kink & BDSM who provide “motivational” services [do or accomplish x, or face x (consented to, agreed upon) punishment]. It might work and may be what someone needs, but it seems out of place in a psychotherapy context.

    • Does anyone see the irony, complaining about complainers?

      If a consumer is allowed to speak again, I’m pessimistic I’ve succeeded communicating anything to Gary. I’m not writing about taking action vs. whining.

      I’m trying to impart that the very act of surrendering to therapy, opening one’s life to an authority figure and focusing on pain and distress can be inherently infantilzing and enfeebling. This can be compounded further if the therapist takes the role as the Angry Taskmaster, an Almighty-Authority On-The-Mountaintop delivering fear-based counseling. I speculate clients might go through the performance of pleasing the therapist, but I’m less certain this creates authentic maturation.

      This treatment tone might even habituate clients to be beholden to other angry taskmasters in their lives, to see themselves as the hopeless inferiors accountable to whatever domineering person manipulates them.

      Authentic change isn’t always quick and tidy. It’s often messy and slow, forged on the long trail of life challenges and experiences. Large-crossroads decisions sometimes demand rumination and apparent stagnation that can’t always be hurried. Like a house under renovation, all you might see is disarray until the drywall is up and the second paint coat is applied.

      I’m challenging therapists to stop looking at clients as an inferior and alien species, and yes, I get that from this blog. Please consider it might be your own stagecraft that creates the dynamic you so disdain. If you can’t authentically see yourself in their life, in their shoes, you have no business pretending you understand them.

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