The Therapist Practitioner Client Dilemma

I use the word practitioner to represent those skilled professionals such as psychotherapists, osteopaths, acupuncturists, and all those who are charging a fee to a client seeking help.

Having worked as such a practitioner for over twenty years I have been forced to confront the dilemma now facing not only practitioners, but also clients seeking their help. To boldly state what the dilemma is, let me say that when I was a youth I worked in my father’s shop. He sold vegetables and other groceries. The transactions were very straightforward. The customer/client would enter the agreement for something like potatoes and a tin of soup. There was an agreed price and the goods were taken away. If there was a problem with the goods they could be returned and exchanged. Satisfaction was therefore reached a hundred percent of the time.

In today’s marketplace, especially in the competitive European and American markets, any faulty goods, or goods that are not satisfying, can be exchanged. Or they can be taken back and the client’s money returned.

This is not the case in the marketplace of practitioners using such skills as psychotherapy, osteopathy, etc. To give an example, a long-time friend who was struggling with his homosexual tendencies attended a very well-known and high-ranking psychiatrist. In search of change in his life he paid over $10,000 to the practitioner. There was no observable change in himself, yet he could not ask for his money back.

Another friend, a woman suffering from arthritis, attended several practitioners all of whom gave her a very positive suggestion that she could be helped. In no case, with no practitioner, was there any sign of change. She spent a great deal of time and a lot of money seeking help, and when no change occurred she could not ask for her money back.

I am not suggesting in any way that no clients gain help from such practitioners. But the point is that before such transactions begin there should be some statement, some agreement of what can honestly and realistically be achieved. For instance my female friend was very thoroughly checked over prior to treatment by one of the practitioners. Surely, as a professional with long experience, he must know what the chances are of producing any change in her before he induces her to spend hundreds of pounds on the treatment he offers?

Obviously, in some of these treatments, the client must bring qualities or activities to what is given. For instance, in some cases there may be a need for certain types of diet or exercise. Having observed my female friend closely, she applied all these needs rigorously. So, even taking this into account there is still a failing in the promise of many practitioners.

As a practitioner I know that there is a temptation to keep clients coming because, after all, with no clients there is no income. But that temptation is overstepped radically when the practitioner does not honestly tell the client that no change can be produced, or that treatment is given with no effect and there is no offer of returned fee.

Talking to one frustrated client of such a practitioner, she told me that all of the practitioners were so glowingly positive that she had felt real hope for change. She said, “At least such positive attitudes were a change from the non-communication and negative views of doctors.” However, such positive attitudes did not cure the complaint she sought to heal.

I wonder in fact if such positive attitudes are part of the need to gain clients and an income, or a form of defence against the knowledge that in many cases change cannot be brought about in the life and body of the client.

My suggestion to any client approaching practitioners is to be aware of this situation and ask for a very definite statement of possible change from the treatment being sought. It is also worth saying that if there is promise of change and no change can be brought about, does the practitioner offer a return of the fee. After all, this is common practice in most other forms of transaction.

I suggest also to practitioners that they become more honest in regard to what they are capable of. This means checking with clients to see what change if any has been brought about. It means facing failure and recognising where personal limitations are. It means being honest with clients about what those limitations are in regard to the clients needs. It means facing ones own skills and reaching out for more — more skill — more insight — more humanity.

The Most Powerful Reaction

Is something I met many times, it is that the so called therapist has never explored thier own depths and so whenver a client starts really experiencing a trauma, start crying or trying to heal, the ‘therapist’ stops them. I see this as a fear the therapist has never faced and so tries to stop it all.

Once while helping a woman who was obviously discharging strong emotions a social worker shouted that this must be stopped. The woman who was crying was obviously happy with what was happening, but the social worker whose job it was to help people was obviously terrified.

Another time I was not leading the group but a woman chose me to work with  her, she quickly showed sings of releasing a long held traumatic emotions. She was near to doing this when the leaders came and demanded she must stop. The woman was keen to carry on, but distance prevented me carrying on working with her.

The therapist usually has some escape method such as telling the client, “You mustn’t upset yourself/me by crying and feeling your pain – it is in the past so let go of it.”

One woman who worked with us allowed the shaking to express itself freely. As it developed, emotions arose. She remembered her only baby which, because she was unmarried, she had handed over for adoption. She had returned home and started to cry, but a neighbour quickly stopped her. Now the crying she had withheld 17 years before flowed freely. Afterwards the shaking stopped, the crying subsided and she felt relieved at last.