Cognitive Pearl #022 Tevet 6, 5775 December 28, 14

Continuing the discussion of engaging those who have difficulties speaking of their inner worlds, the most easiest to help are those who are therapy novices. Like someone who has never entered a bowling alley before, they’re clueless about what to expect. Such confusion is enough to shut anyone down. What makes matters worse is the taboo nature of the therapy encounter. Our work is stigmatized or derided by the public. We meet with people behind closed doors often in spaces that are utterly foreign to most people.

There is much to be done to help these novices. We can take the time to explain the process: how sessions are structured, what to expect to happen by the end of the session, what to expect of the therapist and what the therapist expects of the client. We can offer illustrative examples either through directing the client to accounts of treatment or through sprinkling our sessions with bits and pieces of our or others’ experiences.

In the sessions themselves we can use forms, handouts, posters, diagrams, and metaphors that connect with the client’s frame of reference. We can seek feedback from the client during and after the session and then incorporate that feedback into the work. As a cognitive therapist, I regularly ask my clients one or more of these questions:

Is this idea, interpretation, idea etc. helpful?

Am I helping you?

Do you think that I understand what you’ve explained to me?

Is there anything that we’ve left out?

Often at the beginning of a session, I’ll say, “at such and such time, you will be leaving my office. What do you want to have spoken about or examined?”

Clients, out of pain or misunderstanding, are usually impatient; they have exaggerated expectations about how long they need to suffer, what needs to happen before they get what they want, or whatever. I share that impatience with them; I too don’t want them to suffer. What I also share with them is that they are not stupid or lazy; the difficulties that they seek help for are not trivial. Otherwise they would have solved them long ago. Therefore we both must approach the issues with respect. 

Can we make therapy as pleasant as going bowling? Sometimes. But we can definitely do much to keep it out of the gutter. 

Shavua Tov to all!