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Tuesday 28 August 2012

Practice: On Inequity in the Therapeutic Relationship

Even the presenter can be fired.

The relationship between client and therapist is inherently unequal: The client is more important than the therapist.

The client is the employer. The therapist is hired by the client to perform a task, much as the client might hire a masseur, a bookkeeper, or a cab driver. The client holds the ultimate power in the relationship: the power not to show up, to leave at any point during any session, the power to complain to the therapist’s governing body.

The therapist has a job to do, within a strictly defined role.  The client’s role is much broader and permissive. The client’s needs are more important than those of the therapist, at least for the hour of therapy.

I made this point at a workshop on practice recently and got some raised eyebrows. People were accustomed to seeing the problem the other way around: as one in which the client, experiencing an unmanageable problem, goes to the capable expert and receives a gift of insight or comfort. The therapist is obviously the powerful one, not the client.

But look again: One person is paying (or they are securing the funds to pay, either through insurance or from another third party). The other is paid. Traditionally, the person who pays the salary is the boss. In effect, the therapist is paid to be the less important person in the room.

Therapists sometimes forget this. I see many clients who report that previous clinicians talked about their own issues a great deal of the time. “We spent more time talking about his problems than mine.”

There is sometimes a justification for shifting clients to the helper role. It enables them to see problems from a different perspective, and proves that they have resources to offer rather than just needs to fill. But the agenda should always be to aid the client, not to serve the therapist. If clients pay for a session and we waste part of it talking about our own issues we are essentially stealing from the client. We deserve to be fired.

Some therapists don’t like the idea of being the employee, even though they are. “It’s my job to bring up uncomfortable issues, and to confront the client when necessary.” Yes. Just like a good accountant.

People fear that if they see themselves as employees they will have no power at all. But employees have rights too. They can quit, they can talk back to the boss, they can be assertive about what happens and what duties they are assigned.

The objection reminds me of an observation that often comes up in assertiveness training workshops. When I get to the part about assertiveness with one’s employer, people often object that they can’t impose boundaries with an employer or they will be fired. But of course every employee is assertive at times; it is their job to be. “I can’t stay later tonight; I have to pick the kids up.” “Which of these tasks is higher priority?" “Let me know how this draft looks, then I’ll clean it up.” A completely passive employee is not an asset to an organization. True, the employer can always fire the employee; if they have justification then that is their right. But employees can decide whether an issue is important enough to run that risk.

What if our clients fire us? The question raises the obvious reply. Every therapist will be fired – or laid off – by a great number of their clients. They seldom do this in the operatic rage that the word “Fired” sometimes evokes – though we will all live through these terminations too. More often they will simply not return to our little shop to purchase additional sessions, or they will thank us for what we have provided and indicate that they don’t need us any more.

Put like this it becomes obvious that the whole point of therapy, in most instances, is to be let go by our client.

Rather than resisting reality, we need to embrace it. Yes, we are less important during that hour the client is in the room. Our problems at home, our financial issues, our physical discomforts – they don’t really matter that much while the client is paying us. The masseur does not ask the client to rub his aching shoulder, nor should the therapist impose her issues on the client unnecessarily.

We are the ultimate part-time workers. If we see 25 clients a week, we have 25 part-time jobs. We may be laid off from any of them at any time, and we will replace them by applying for other jobs or hoping new customers call us up. We cannot fear being let go. Being let go is precisely the point of the job. Nor can we deny our status as servants. The task is to be the best servant we can be.

A friend of mine, whose business is helping organizations with their branding, has a card that identifies his profession as “Consultant Storyteller.”  Perhaps ours should read “Life Janitor for Hire”.

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