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Re: Babble Guide to Therapists: Do's and Don'ts dawnfawn

Posted by simcha on December 4, 2004, at 18:15:28

In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by dawnfawn on December 4, 2004, at 11:30:02

> > 1. Don't be late. If you are late don't be late at the first visit. Don't be late consistently.

Absolutely.

> > 2. Don't watch the clock.

Sorry, this is a clinical issue. I keep the clock behind my client. I must hold the frame (keep the boundaries) to 50 minutes. It's very important to treatment because most people have some sort of issue with boundary setting. Therefore ALL clinicians MUST look at a clock. It's a clinical issue. Some of us are just more discrete about it. I even mention, "Hey we have 10 mininutes left in the session, is there anything else that is brewing that you need to address." Then at five minutes before the end I do the same. Clients seem to appreciate this because they feel included in the clinical boundary setting. I also keep a clock in the client's view that is synchronized to my clock I'm usiing. Therefore they know how much time they have.

> > 4. Please explain your orientation and your thoughts on how long this will take.

Explaining orientation is sticky. Most therapists in the San Francisco Bay Area are Psychodynamic and it often takes years to do this kind of work. I use psychodynamic techiques and I'm transpersonal so I believe that the healing comes in the relationship and the spiritual heath of the therapist. Other than that I use CBT, family systems, a little Hakomi (for body tracking), and a host of other theories that fit each client. Sometimes I don't know what orientation the client will respond to the best for a while.. I've started using sandtray with one client who is very non-verbal. This seems to work fantastically for him.

Now as for how long it takes? It takes as long as it takes... It seems that clients come in with "tip of the iceberg" issues when in fact "like all icebergs" there is a whole lot underneath. Sometimes this takes months. Sometimes it takes years. It depends on what the client wants.

> > 6. Please go over your notes from last time before we meet. It is my dime we are running on here.

No, we do not share notes unless you specifically request it in California. Then we sit with you and explain the notes. Sometimes seeing your notes is very damaging to your therapeutic process because the notes usually show a progression of unconcsious material that you may not be ready to deal with. Also clinicians may change courses in the middle of treatment if they have found that their treatment is not working for the presenting issues and/or the presenting issues is changed. Sometimes diagnosis and assessment is ahuge burden to carry for some very disturbed clients. Of course, even they have a right to see the notes. You still must ask the therapist first and process why you want to see the notes. This is a major clinical issue. The notes belong to you and yet they really don't. You have a right to see them. The clinician has a right to keep them and to be the gatemaster/


> 7. Please, Please if you don't think you can help my type of problem or if you think it needs medicine or some other approach, Please do not wait until three months have gone by to let me know.

Sometimes it takes months to convince a client that they need medical attention and medication. Also, n the course of therapy, your psyche opens up and many things may bubble to the surface. This might take months or years before a therapist would feel that it would be competent to refer you to a physician for medical evaluation and treatment.

That's my two cents as a therapist in training...
Simcha


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poster:simcha thread:420851
URL: http://www.dr-bob.org/babble/psycho/20041203/msgs/424438.html