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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Dinah on January 6, 2012, at 20:37:52
My session today was all over the place, as I was *extremely* tired after a few late nights (or early mornings) working. I couldn't focus well, and he saw how tired I was, so he didn't press.
One of the things we discussed was this article on the Ideal Client.
http://blogs.psychcentral.com/private-practice/2011/08/who-is-your-ideal-client/
I told my therapist this is the sort of thing I read when I want to be angry with him. Along with the book "Shrink Rap". That perhaps the internal thought processes of therapists isn't something I should know.
He didn't say much (smart man) about his ideal client. He did say that I actually did meet his guidelines for ideal client. I said something cynical about a long term income stream, and he responded something along the lines of honesty being very important to him in a therapeutic relationship. He said he appreciated the fact that I was honest to a fault - to the point that I'll admit when I felt I needed to not tell the truth.
He also said that willingness to work was important to him. I pointed out that by standard measures, I'd probably flunk that one. He said that it did take him a while, but he eventually did figure out that I was working hard in my own way. And that I actually did listen to him, even if I rejected much of what he said the first time he said it. He said it was a good sign when a client began to internalize the therapist. And that he knows that I began having conversations with my internal T a while back. (And that the internal T may indeed be better than the external one. Or at least, he added, he never falls asleep while talking with me.)
Then he pointedly changed the topic to my work. I was too tired to ask if he thought I'd gotten off track in session, or if he thought there was something in what we were talking about that I'd get upset about later. Internal T could go either way. And of course external T won't remember the conversation by our next session. :)
I still don't like the idea of an "ideal client". An ideal therapist is a much more congenial topic of conversation.
Posted by Anemone on January 7, 2012, at 9:26:36
In reply to Ideal client, posted by Dinah on January 6, 2012, at 20:37:52
Hi Dinah,
I am sorry you have been so busy and tired, I hope you get some good sleep soon!I read the article and felt somewhat yucky afterwards. (And in the comments, it looks like Solstice said she was glad she didn't work with the author?).
But I think your T thinks you are quite ideal! It sounds like he appreciates you for being 100% honest, and recognizes that you ARE working hard in your own way, at your own pace. I hope you feel good about this. I personally think you are terrific, if that helps...
I like to think about both the idea of an "ideal therapist" and "ideal client", because I think my T is perfect, and I like to convince myself that my T likes me too.
I have a lot of flaws as a client, I say and do stupid things sometimes.....but my T is so warm and I can see in her smiling eyes that she is sincere and engaged when working with me. I try so hard to be as perfect as possible and to make her like me.
Take care Dinah! Get some rest!
Posted by Dinah on January 7, 2012, at 14:07:20
In reply to Re: Ideal client » Dinah, posted by Anemone on January 7, 2012, at 9:26:36
I thought of writing something to the effect that it works out quite nicely. That she was spared the clients she didn't like working with, and those clients were spared her.
My therapist was more kind. He said he thought it probably was something that should be expressed on a website geared towards clinicians, and that a newsletter routinely sent to clients, among others, might not be the best venue.
I like that about my therapist. He generally is more kind (at least in his professional life).
The funny thing is that I believe he was being perfectly sincere. He does, at this point, consider me an ideal client - if not the type of client his practice is generally geared towards. But at one time, he didn't much like me as a client. The difference owes more to changes in him, I think, than changes in me.
Posted by Daisym on January 8, 2012, at 0:08:27
In reply to Ideal client, posted by Dinah on January 6, 2012, at 20:37:52
I struggle a lot with the idea of the ideal client. First off, my therapist's web site describes him as "an expert on relationships" - couple's therapy. So I am in no way his ideal client based on his area of study and apparent interest. His PhD was in a couple's counseling area.
But I find the blog that was cited pretty arrogant -- (OK, remember I'm in social services) but who doesn't want highly functioning, intelligent folks who respect boundaries and pay the bill on time? But clients who never test their therapist's patience are not probably growing or doing the deep work that causes regression and neediness. I guess there are folks who only want to do short term CBT work...
It is kind of like talking about the ideal child. No one really wants that child - we are suspicious of the perfection and waiting for the shoe to drop. And who wants to know that their parent likes their sister better...this is not something an ethical therapist should put out there.
Posted by Anemone on January 8, 2012, at 11:13:10
In reply to Re: Ideal client » Anemone, posted by Dinah on January 7, 2012, at 14:07:20
Dinah, I like your T, too. He sounds so kind. I am glad he grew to like you more. I imagine he appreciates that you are kind, too.
Posted by Solstice on January 8, 2012, at 11:19:21
In reply to Ideal client, posted by Dinah on January 6, 2012, at 20:37:52
Grrrr! That woman's 'advise' to other therapists really got under my skin. She responded to my comment, and her response bothered me even more because it was clear she didn't even 'get it.' I tried multiple times to craft an answer to her arrogant supposition that I very well might have been grateful to land on her doorstep, but the whole thing was so irritating to me that I finally gave up, thinking she's just too thick to get it.
Her notion that therapists should walk into the field dreaming up 'ideal client' criteria is so fundamentally anti-therapeutic that I am dumbfounded that someone who is properly trained in the field could even come up with the idea in the first place.
People who call up a therapist and ask to be seen are, for the most part, at the end of their rope. People entering therapy are often hanging by a thread - and would not be able to give a therapist the adulation Julie Hanks seems to expect.. I mean at the top of her list is "My ideal client appreciates my education... my expertise and life experience." OMG! How on earth does someone in crisis even have an organized enough thought process to even think if that?? When I walked into my therapist's office the first time, I was entirely focused on my fear, my anxiety, my desperate emotional pain, and my morbid belief that I had to stop living in order to stop the pain. And Julie Hanks would hope I'd walk in appreciating her education? I spent the first good while of therapy being totally self-absorbed, which is why therapy is supposed to be about the client in the first place.. not the therapist's need to be appreciated.
All I can think of is that Julie Hanks' 'expertise' that she is so hopeful that clients will appreciate is limited to clients with very mild and simple life situations and no long-term or deep psychic pain. She's the 'oil-change' of therapy, I guess - not able to handle what comes with doing an engine overhaul. All I can say is Thank God I didn't end up on her doorstep! She seems very self-UNaware. And it's funny.. she counsels me to understand that her blog is directed at therapists - not potential clients. Well.. so she thinks there's something *right* about having disguised prejudices against potential clients who are in too much pain to be as healthy as her 'ideal client' is? I doubt she's the only therapist out there who thinks like she does, but I think it's just so arrogant of her to imply that these beliefs she has are meant to be hidden from the populace. I think what provokes me the most, is that clients are generally not going to be healthy enough to spot her underlying agenda so they can run from her. I had a life-changing toxic 'therapy' that left me more damaged than I was when I went in, so her article hit me on a very deep level. I think she should post her list of criteria on her office door - advising anyone who does not meet her 'ideal client' criteria should find another therapist - one who is capable of caring for people who are not psychologically healthy.
Again, I thank God that I did not land on her doorstep. Her beliefs would have eventually broken through and contaminated the therapy.. and may have been my undoing.
Solstice
Posted by sleepygirl2 on January 8, 2012, at 14:36:12
In reply to Re: Ideal client, posted by Solstice on January 8, 2012, at 11:19:21
It has been my experience that many therapists forget that therapy is for the patient and not the therapist.
They spend a lot of time excluding those not "appropriate" for therapy as they'd like to do it. "ideal" circumstances however, don't often come along.
I get it though. Perhaps a therapist wants to have experiences in their work in which they feel effective, where they can see a benefit.
It could be about recognizing their own limitations, a quality of life for them.
That being said, I'll look at that ideal client stuff again.
Posted by sleepygirl2 on January 8, 2012, at 15:08:17
In reply to Re: Ideal client, posted by Solstice on January 8, 2012, at 11:19:21
My ideal therapist appreciates Imperfection, humor, education, experience
My ideal therapist values kindness, empathy, experience, education, listening, honesty, integrity
My ideal therapist understands..theory, practice, that ones view of the world is shaped by experience, but that always changes
My ideal therapist agrees to.. not be judgmental, be available when needed, take good care of themselves, have good boundaries, give a damn, not hate me
Posted by sleepygirl2 on January 8, 2012, at 15:14:44
In reply to I'm adapting it for my own purposes ;-) » Solstice, posted by sleepygirl2 on January 8, 2012, at 15:08:17
is less freaked out by my emotions than I am, and doesn't blame me for them
Posted by Solstice on January 8, 2012, at 16:33:47
In reply to Re: Ideal client » Solstice, posted by sleepygirl2 on January 8, 2012, at 14:36:12
> It has been my experience that many therapists forget that therapy is for the patient and not the therapist.
It appears Julie Hanks does...
> They spend a lot of time excluding those not "appropriate" for therapy as they'd like to do it. "ideal" circumstances however, don't often come along.
> I get it though. Perhaps a therapist wants to have experiences in their work in which they feel effective, where they can see a benefit.
> It could be about recognizing their own limitations, a quality of life for them.Might not be apparent, but I did have those kinder interpretations in view as I considered my very strong reaction to her article. I think that the things you mention here are important, and can certainly have a bearing on whether a therapist refers a client to someone else. I think it's important for a therapist to know what they are good at, and what they aren't. They should be aware of how their therapeutic style fits with various client issues or disorders. And I think it's especially important that a therapist balances their caseload so they don't have a bunch of clients with complex/time-consuming issues that overly taxes the therapist, which can lead to burn-out.
The problem I have with Hanks' article is that it reads like a list of the attributes of a relatively psychologically healthy person that might just be looking for guidance on how to handle a parent who has gotten old and cranky. I doubt many people who have been through serious trauma or who have a serious mental health diagnosis would meet her criteria.
I have a problem with there even being 'criteria' like that. I don't even like the term 'ideal client.' I mentioned that I was in a toxic therapeutic relationship - for about 3.5 years. That was before I got with the therapist I have now. Anyway, I'll never forget a story Mr. Toxic T told me (and he's a PhD, mind you). I think I was attempting to tell him that something about our relationship wasn't working.. that there was some negative transference on my part at least (only I didn't know those words then). Anyway, he told me a story about a man coming to see him.. a guy in his late 20's who was very depressed. Toxic T said that during their initial first few appointments, the man noticed the numerous photos around the office with his beautiful wife and two adorable children in them. The client told Toxic T that he felt great agony about his failures with relationships, and looking at those pictures, particularly the one on the table right beside him (the client) that was in clear view, brought to the surface his acute pain over the abuse he suffered at the hands of his own parents. He asked Toxic T if it would be possible for him to lay that picture face down while he was in for his session. Toxic T said "I told him that I would not make any changes for him, and that if it was a problem for him then I probably wasn't the therapist for him." That struck me as so terribly unkind. He said the man never came back. Toxic T seemed very satisfied with what he had done. I just kept thinking about how easy it would have been for him to put the picture face down and say "I am so sorry that you have experienced so much pain in your family of origin, and I want to help you heal yourself to the point that the pictures I have in here of my family do not cause you pain."
Anyway, I just think that people who have been traumatized and are in great pain do not need therapists who fantasize about filling their practice with 'ideal clients.'
> That being said, I'll look at that ideal client stuff again.:-) And her article might not strike you like it did me. I know that my experience in toxic therapy plays a large role in how much her article affected me.
Solstice
Posted by sleepygirl2 on January 8, 2012, at 18:31:14
In reply to Re: Ideal client » sleepygirl2, posted by Solstice on January 8, 2012, at 16:33:47
Toxic T is an *ss.
Posted by emmanuel98 on January 8, 2012, at 18:46:48
In reply to Re: Ideal client » Solstice, posted by sleepygirl2 on January 8, 2012, at 18:31:14
My p-doc told me the ideal client is someone willing to change and grow in the least amount of time. I changed and grew very quickly and felt such trust in him. But now I can't let go and I'm afraid of losing his respect. I see him every other week for an hour. Last summer, I met with him and my DBT social worker and they both felt she (the SW) should take over primary responsibilty for therapy. I feel like I should stop seeing him, or cut back to once a month, but I can't. I miss him too much when I've done that in the past. I feel like I am no longer his ideal client, but am instead one of those "therapeutic lifers" Glen Gabbard talks about who can't let go.
Both he and my SW think I should continue to see him every other week and that, eventually, I will be able to let go gradually. But I've been seeing him for 7 years and I still feel so much emotion for him.
Posted by Solstice on January 8, 2012, at 20:27:20
In reply to Re: Ideal client, posted by emmanuel98 on January 8, 2012, at 18:46:48
> My p-doc told me the ideal client is someone willing to change and grow in the least amount of time. I changed and grew very quickly and felt such trust in him. But now I can't let go and I'm afraid of losing his respect. I see him every other week for an hour. Last summer, I met with him and my DBT social worker and they both felt she (the SW) should take over primary responsibilty for therapy. I feel like I should stop seeing him, or cut back to once a month, but I can't. I miss him too much when I've done that in the past. I feel like I am no longer his ideal client, but am instead one of those "therapeutic lifers" Glen Gabbard talks about who can't let go.
>
> Both he and my SW think I should continue to see him every other week and that, eventually, I will be able to let go gradually. But I've been seeing him for 7 years and I still feel so much emotion for him.The therapist I see now initially seemed to believe that keeping therapy as short as possible was ideal, and that if it got stalled or went on for an unnecessarily long period of time, it was a problem. One time T said to me that there would be a time when I would start cancelling because I was too busy for therapy.. would have things to do, places to go, people to see... and that that was how T would know that I was getting better. I have certainly gotten to a place where I don't 'need' my therapist as much. I've internalized T, I guess. And when I made huge jumps in progress recently, I cautioned T saying "Please don't take it as meaning I don't need you, and please don't be the one to let me go. I have to be the one that does that." That seems to work real well for me. I used to think about therapy throughout the week.. but now I rarely think of therapy or my therapist between sessions. I've been out of town for the last three weeks - haven't seen my therapist for almost four weeks, and it hasn't bothered me one bit. I look forward to my next session, but I'm not feeling off-balance with the long gap. I think I have a baseline assumption that I'll always have access to my therapist, who is attuned to me and capable of 'being' whatever I need at the time. Earlier in therapy (I've been with T for four years now), I saw T at least twice a week, sometimes more. And then, and even when it was only once a week, I would have periods of needing between-session contact, which my T has always been fabulous about. But for about a year now, I haven't needed it... and I see T every week or so. I think I could easily handle every other week.
Anyway, I wonder if your angst could be eased by a frank talk with your therapist about the issue of whether you are somehow disappointing him? What I understand in retrospect about my situation is that the more convinced I was that my therapist was wholly available to me and not in a hurry for me to leave, the more that enabled me to 'let go' and feel less 'need.' Does that make sense? But the arrangement my therapist and I came up with that has worked so well had to be worked out along the way.. and the kind of angst you're describing was always what pushed me to discuss it. Is there anything I've shared here that might help in your situation?
Solstice
Posted by Dinah on January 9, 2012, at 10:50:34
In reply to Re: Ideal client, posted by Solstice on January 8, 2012, at 11:19:21
Well... I'm thinking there are some thoughts that therapists have that really should be hidden from the general populace. Perhaps not this thought. As you say, it should be stapled to her door like the 99 theses. Probably because it seems so global. She states in her article that when she made this list, she was dealing with eating disorders, anxiety and depression. But it sounds more like she was ideally suited to her current elevator speech.
"Im therapist xxxx. I help overwhelmed women find a healthy balance between caring for themselves and their family relationships so they can live fulfilling and meaningful lives."
At any rate, she now describes herself as being involved with her clinical staff and motivating other therapists, so it all worked out pretty well for all involved.
I think what upsets me about it is that she is encouraging practitioners to judge clients with an eye to, if not terminating, then at least weeding out clients who might well be like us. That can feel a bit threatening. If she reached all therapists, would anyone still see me?
I think it's natural to feel defensive.
But... Not all therapists would have her ideal list, thank heavens. And many therapists have a goal of professional service to those in need, not creating a cozy, happy workplace for themselves.
Hopefully when she said that her ideal client would appreciate her training and expertise, she meant that they would be more or less respectful in their interactions with her. Not that they would be admiring.
So... Maybe this blog should be on the reading list of all clients. To remind ourselves what we're looking for in a therapist. Were I ever to look for a gung ho cheerleader life coach, she might be right at the top of my list. But if I'm looking for a therapist, I'd be more interested in an elevator speech that said something like...
"I'm xxxxx, and I'm a psychotherapist. It gives me satisfaction to help people develop resilience, and skills to deal with anxiety and depression. I'm very excited about the new studies on attachment theory, but I consider myself eclectic. I base my treatment on the needs of the client, and don't try to fit a client to my theory."
Maybe we should ask to hear a prospective therapist's elevator speech.
Posted by Dinah on January 9, 2012, at 10:53:20
In reply to Re: Ideal client, posted by Solstice on January 8, 2012, at 11:19:21
Although, I must say I didn't much like the questions.
"In Ms Grodzkis book she suggests completing these phrases to help you define your ideal client:
My ideal client appreciates
My ideal client values
My ideal client understands
My ideal client agrees to"
I think I'd prefer something like
"My ideal client would benefit from the skills I have to offer, such as...."
Posted by Raisinb on January 9, 2012, at 20:37:27
In reply to Re: Ideal client, posted by Solstice on January 8, 2012, at 11:19:21
Amen, Solstice! This woman sucks.
Posted by Raisinb on January 9, 2012, at 20:50:17
In reply to Ideal client, posted by Dinah on January 6, 2012, at 20:37:52
I doubt any good therapists really think this way. This is a bunch of this woman's counter transference (she apparently thinks she is a victim of her own clients) dressed up to look like professional advice. I wish reputable websites would vet their content more carefully.
All that stuff that good clients are supposed to be and do--well, as a good shrink once said to me, "but that's what you came to get help for!" If clients were collaborative, boundary-respecting, engaged, and healthy, they would not be in the T office. That's like me (an English professor) demanding that my students be perfect writers and thinkers to be in my class. I have a job because they aren't.
Posted by emmanuel98 on January 9, 2012, at 20:58:32
In reply to Re: Ideal client » emmanuel98, posted by Solstice on January 8, 2012, at 20:27:20
I talked about this with him today actually. I told him I was afraid he no longer respected me because I couldn't let go and move on. He told me that was completely distorted thinking, transfering my own tendency to drive myself too hard onto him. He said if you need to keep seeing me to maintain equlibrium in your life, then we will keep seeing one another. That it is fine with him. My SW says I still need him and will gradually be able to let this go. But I feel like my relationship with him causes me such pain. It is not him, but some yearning in me that I associate with him. He said I have to learn to let that go, to accept that niether he nor anyone elso can really fill this yearning in me because it comes from being abused and neglected as a child. My SW says I need to learn to give this unconditional love to myself. That noone else can ever provide it. I saw them both today and felt so sad and overwhelmed. Yet I am so lucky to have not just one, but two very skilled therapists in my life.
> Anyway, I wonder if your angst could be eased by a frank talk with your therapist about the issue of whether you are somehow disappointing him? What I understand in retrospect about my situation is that the more convinced I was that my therapist was wholly available to me and not in a hurry for me to leave, the more that enabled me to 'let go' and feel less 'need.' Does that make sense? But the arrangement my therapist and I came up with that has worked so well had to be worked out along the way.. and the kind of angst you're describing was always what pushed me to discuss it. Is there anything I've shared here that might help in your situation?
>
> Solstice
>
>
Posted by Beckett on January 10, 2012, at 0:48:24
In reply to Re: Ideal client, posted by emmanuel98 on January 9, 2012, at 20:58:32
e, how courageous of you. I hope amidst the saddness you can feel maybe strength, connection?
Posted by Beckett on January 10, 2012, at 1:05:44
In reply to Ideal client, posted by Dinah on January 6, 2012, at 20:37:52
I could barely make my eyes move across the words. My thoughts: this is new age prosperity consciousness-speak gone mad. How terribly skewed to see another person in need as part of one's prosperity model. This offends my sensibilities.
Yes I understand that therapy is a multi-leveled transaction.
No I am not I dork. I get it that therapists need to have their
work be enlivening and profitable.But help! No one is a commodity or adopted child that you can take back if you do not work out.
Solstice, I am still thinking of that man who never returned....
Then there are the power/control issues. Countertransference. Oh boy. Not good bedtime reading, I'll say that much.
Posted by Dinah on January 10, 2012, at 9:36:32
In reply to Re: Ideal client, posted by Beckett on January 10, 2012, at 1:05:44
But you must admit that she might be a good choice for a prosperity minded client who wants to maximize their own potential. :)
It's a good thing there are so many therapists out there so there's a good fit for anyone.
There is a sense, though, that therapy is a business for therapists. They need to meet the bills, worry about building referral sources and marketing themselves (especially when they first start), differentiating themselves. And even worrying about working conditions. Even the best therapist might need to diversify his client load a bit so as not to burn out. If they didn't consider business concerns, there wouldn't be any therapists to go to.
This one is extra open about the prosperity model of her practice. But even my therapist, who likes money quite well but who is not a businessman, worries about job security, lack of paid vacations and retirement, etc. It's come up from time to time when he took other part time jobs that interfered with his availability in therapy.
Still, I wonder at the venue. Is this a newsletter geared towards professionals? Is it in clients' best interests to see this side of therapy? I did it myself, by reading "Shrink Rap" and professional magazines. I did it to keep myself safe. To remind myself what therapy is, and what therapy isn't. But that was me, and I'm not sure it was helpful for me, much less others.
Posted by Beckett on January 10, 2012, at 9:53:03
In reply to Re: Ideal client, posted by Dinah on January 10, 2012, at 9:36:32
>But you must admit that she might be a good choice for a prosperity minded client who wants to maximize their own potential. :)
:-) yes, I do admit that. What a lively session that would make. Two very happy people agreeing and agreeing.
Like others who commented, I am glad to have found my own therapist whom I like very, very much. I believe that if I brought her a copy of the 'The Ideal Client' she'd help me laugh that deep laugh that just bubbles up from within when encountering something truly absurd.
This is the end of the thread.
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