Workshop Therapeutic Practice: Proximity Disclosure Ending and Appreciation
I have divided my original document into separate topic documents and will post each separately - so look out for Proximity, Disclosure and Ending
Introduction
This workshop came out of requests to include various aspects of therapeutic practice, particularly disclosure. Allowing myself to freefall from these requests led to the arrival of four aspects of this workshop.
Originally, I had desire, rather than appreciation, in the title. For me, desire would be about my own desire as therapists. I shifted to appreciation quite quickly, this is client focussed.
Through all my work there is an appreciation for my client; appreciation for being invited into their world, for taking the risk to ask for help. I share this appreciation with my client when I first meet them. So, this is the context in which I talk about appreciation. Of course, appreciation is not one way and clients also express appreciation. What do we do with our appreciation of the client, and their appreciation of us? Do we maintain an ongoing awareness of appreciation?
In laying out my therapy room I hope it is appreciated by my clients. I hope they will be comfortable and find the room calm and safe. More accurately, how the therapy room is arranged suggest my appreciation for my work and for my client. In what way do you make the room welcoming for the client?
The end of the time together with your client is a time in which appreciation for the experience may be thought about, and articulated.
Appreciation
Expressing appreciation is a relational action of communication (Erskine et al 1999) and appropriate responses to receiving appreciative comments will lay a foundation for the development of the relationship. Any interaction is potential for contact, in the Gestalt sense, and as such there is fulfilment and satisfaction in the situation with appropriate and authentic responses.
Think about what it really feels like to receive appreciation for what you do as a therapist; indeed, think about what it like to be appreciated in any aspect of your life. When appreciation is expressed do you deflect this away, even if the deflection is minimal - “oh, it’s nothing really” – because if you do then you are in danger of reducing any appreciation being voiced with you. Ultimately you never receive appreciative comments and often this leads to resentment that “no one appreciates anything I do”. Do you recognise anything here?
If your responses are self-deprecating along the lines of something like “it’s nothing” or “it’s what I do” what are you really telling the client? Maybe you are saying “you make an observation of me and appreciate me and when you tell me I tell me I dispute your appreciation”; or bluntly “your appreciation is not welcome” which can mean “you don’t know what you are talking about”. Now, is that really what you want your client to be hearing?
On the basis that such responses to an appreciative client are not rebuttals of the client then perhaps they are rebuttals of the therapist. The rebuttal is actually a deflection by the therapist to avoid receiving the appreciation in its fullness. Deflection is a way to interrupt full contact with the other; contact that would be real, intimate, relational, and authentic.
From the Client
Clients might remark on how supportive you have been in a session. The appreciation might be a smile or a look. How to respond and in what way influences the relationship.
A client being appreciative is a client expressing value in the experience; is expressing love in the experience. We need to be able to respond appropriately which means with acceptance of the client’s truth in the value of the experience. Our response might be a simple “thank you”. Whatever is said, or not said, models a mutual responsive engagement for the client.
I have met a number of colleagues that limit their value in the face of the client. Some of this I relate to; it is the client that ‘does the work’ and in any case I am being paid for what I do! Well, behind any salary is a person wanting to be valued relationally rather than monetarily. Since the work is relational it is also inclusive to recognise that it is more than the client that does the work, you work too; so, we do this work together. There is place for appreciation of what we, client and therapist, do together; as some of my clients remind me – ‘I wouldn’t have made it without you’; ‘I have needed you to be here’; ‘you are part of my change’ … I am deeply moved by such words, to feel and be appreciated for my input, and its acceptance.
Client Gifts
In the therapeutic context client’s might well express appreciation with a gift in the course of therapy. In my early days of being a therapist a colleague in supervision was shocked that a client gave an expensive gift. The shock was around the gift being expensive, so much the gift was refused on the grounds of its cost.
Whether gifts are accepted or not is not the focus here, rather it is about our responses and, importantly, the therapeutic meaning. The receiving of a gift draws on our own relational need for acknowledgement and our therapeutic positioning in acting for the interest of the client.
I focussed here on the client giving a gift, maybe a card, a trinket, a soft toy, a book …
? What is the client doing in giving a gift?
? What is being said?
? What does it mean in the context of past relationships?
? What does it mean in this relationship?
? What value does it place on you?
? How does it support or interfere with the work?
? How important is it for you, for your client, to accept the gift?
Consider, though, the ‘gift’ to be words. How does this alter the context of the above questions? Because in many ways the gift is replacing words not said.
From the Therapist
We can model appreciation, and all that flows from it, in our own appreciation for our client. This is appreciation for the client being in the room (even when we sense, so much, that they are distance or absent) with you in the session. We need to hold on to the complexities experienced in bringing any past experience to a stranger – that’s us, the therapists. Consider what it was like when you first went to see a therapist; how did you feel, what were you thinking? Remember when you first started to divulge your inner most thoughts?
We need to remain aware of the courage and fortitude of our clients and be ready and able to give our appreciation.
At times, I have offered a client something to take with them between sessions. Usually this is described as a transitional object for the client. Yes, ok, and it is a gift, in the moment, with a purpose. I will at times make a point in emphasising what I am offering is a gift, to keep, and will also give my reason. In other words, I make it explicit the intention of the gift. This ensures clarity in what I am doing; it models a directness is saying what I am doing; not leaving it disguised in the gift. The gift is the reinforcement of my words and my relationship with this person.
The purest gift to our client is our undiluted self; being the best we can be in each moment appreciating this other person.
References
Audet C. T., 2011 Client perspectives of therapist self-disclosure: Violating boundaries or removing barriers? Counselling Psychology Quarterly, Vol 24 No 2, 85-100
Barb 2012 Self-disclosure what you need to know. Accessed at www.mastersincounseling.org/author/barb Posted on November 1, 2012 www.mastersincounseling.org/self-disclosure-what-you-needto-know.html
Francesetti, G., Gecele M., Roubal, J. 2013 Gestalt Therapy in Clinical Practice: From Psychopathology to the Aesthetics of Contact (Gestalt Therapy Book Series 2) FrancoAngeli Milan. Kindle Edition
Hargaden H., 2010 When parting is not such sweet sorrow: “Mourning and melancholia,” projective identification, and script analysis. In Erskine R. (Ed), 2010 Life Scripts: A Transactional Analysis of Unconscious Relational Patterns. Chapter 3 Karnac, London
Little R., 2009 The Therapist’s Self-Disclosure: A Developing Tradition Some considerations and reflections. Enderby Associates. www.enderbyassociates.co.uk Accessed 3 March 2017 at www.relationalta.com/admin/docs/resources/the_therapist_self-disclosure.pdf
O’Brien M. and Houston G., 2000 Integrative Psychotherapy: A Practitioners Guide. Sage London
Perls F., Hefferline, R, Goodman P. (1951) Gestalt Therapy Excitement and Growth in the Human Personality, Souvenir Press, New York.
Resnick R., 1995 Gestalt Therapy: Principles, Prisms And Perspectives, Robert Resnick Interviewed by Malcolm Parlett. British Gestalt Journal Vol4 No1 p3-13
Resnick R., 1996 Differences That Separate, Differences That Connect: A Reply To Wheway And To Cantwell Robert W. Resnick. The British Gestalt Journal vol5, No.1 pp43-53
Ziv-Beiman S., 2013 Therapist Self-Disclosure As an Integrative Intervention. In Journal of Psychotherapy Integration Vol. 23, No. 1, 59–74. American Psychological Association