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Tuesday, 4 September 2012

Process: Greeting the Client

The cliff over which students would throw me.

Although I’ve been a therapy supervisor for ages, I suspect that I would be a terrible training coordinator, hated by all. In Vietnam, some commanding officers were apparently so unpopular they were “inadvertently” tossed a grenade, a creative human resources solution known as “fragging.” I’d get the therapy equivalent from students, I’m sure. Spit in the coffee. Something.

Whereas much therapy training is done in broad strokes (“Be empathetic!”), my natural OCPD-ish style is to be behavioural and nit-pickingly prescriptive.

I once told a training coordinator I know that if I was doing a course on psychotherapy, I would probably spend an entire day on how to get the client from the waiting room. Not that I’m so great at it, mind you, just that I have (considered? irrational?) beliefs about how it should be done.

Today: One of my pet peeves. I hesitate to post about it because half of all therapists reading it will roll their eyes and say “That’s too obvious to comment on” and the other half will say “That’s too reductionistic for words.” Oh well.

So your client has arrived and is in the waiting room. Hopefully on time, you head out to greet him or her. (Just did a coin flip: It’s a man.) You have a good working relationship. He stands up and about 60% of the time (yes, I’ve counted: remember the OCPD?) he says something along the lines of “Hey, how are you?”

“How are you” is a social reflex, obviously, not an expression of deep curiosity, so rather than going into your bum knee and the mailing you received that morning from the tax bureau, you offer some version of the customary response. “I’m fine, thank you.” “Oh, I’m very well.” And so on.

And then there’s the moment that puts my teeth on edge. The clinician, ambling down the hall with the client, does the customary thing and returns the tennis ball. “And how are you doing?”

If I had a training class I’d set up the role play, lie in wait for the offending phrase, then jump to my feet, shout “Aha!” and begin the process of becoming despised.

Think about the situation: Perhaps your assistant is there, perhaps another clinician is lurking about, or perhaps the clinic has hidden corners where someone might be sitting out of the client’s view. It’s not as private a spot as the consulting room, a magical space where the rules of normal social interaction are suspended.

And out here in the socially conventional hallway, the client will issue the standard reply. “Oh, I’m good.” “Great.” “Fine, thanks.”

Then we’ll take another four steps into the room, close the door, and the client is faced with retracting their reply. “Umm, actually, not so great.” There’s the natural reluctance to launch into painful experience, plus a tiny drag on the process from having to contradict something they just said. The clinician has also put a small dent in the alliance by insensitively asking the client how he’s doing in a public space.

A student I was supervising raised the obvious question. “What should I do?” I suggested she waste time.

The client asks how you are as he’s getting up and getting his coat, umbrella, and notebook together. Relax and take your time with your reply. What’s the rush? Then make some other appropriate but inconsequential comment that will occupy the rest of the walk to the office. “Beautiful day out there.” “Looks like it’s started to rain.”

The client precedes you into the office, the door clicks shut behind you, and you’re in the different social space of the consulting room. Sit, pause, and then return the ball in a way that communicates your genuine interest, rather than social banter. “And how are you?” And the real work begins.

FYI: On October 18 2012 I’ll be presenting a day-long workshop called “Process Made Simpler: A Behavioural Guide to the Therapeutic Alliance” at the Holiday Inn Vancouver Centre. Registration info here. (I’ll also be offering it for Alberta Health Services in Calgary November 23.) And no, I won’t spend more than two minutes on getting the client from the waiting room. Promise.

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