As I wait for my clients to log in for their sessions, I find myself revisiting the doubt I used to have as a fledgling therapist about my skills and the words of a colleague that gave me confidence.
When I started out, I would schedule about 8 clients every day, 5 days a week. 40 clients in a week would be a lot, but I was still on the new employee high, and I wanted all the experience I could get right off the bat.
Needless to say, I didn’t see 40 clients a week. There were days where none of them showed up. Other times, I’d have one or two. Regardless, my caseload wasn’t really growing at all, and I began questioning myself as a clinician. For those who didn’t come, did they not come because they heard my name and already felt I wouldn’t be someone they wanted as a clinician? For those who DID come, it felt worse – did I do something wrong that turned them off? Basically, did I make them feel worse instead of giving them hope?
In my first year of work, I broke my knee. FMLA wasn’t an option since I hadn’t been a staff member for at least a year. So, I continued working full time, crutches and all. I was still losing clients the way I already did, but now it took a new meaning – I really wasn’t good enough. Surely they thought “she can’t help herself, how’s she going to help me?”
There are times when I’m thankful that I talk too much – this was one of them. I was talking to a senior colleague about how I felt, and she said one thing…”has it ever occurred to you that maybe they aren’t ready?” I stated, “I get that for the no-shows, but those who came for the intake and saw me for a bit…they came in because they wanted therapy, no?”
That colleague introduced me to the concept of ambivalence in therapy. Everyone has a push and pull that plays a role in behavior…”I want to do this but I don’t want to do this”. Think about it – we all have changes we want to make in our lives, but we find that there’s reasons we want to change and reasons why we don’t want to change. One of the reasons we don’t want to change may be because change is scary; “what if making the change will make things worse and not better? What do I do instead of what I have been doing so far?”
As a client, I believe that when we seek therapy, there is a much deeper level of change that can happen. Thoughts, behaviors, and emotions are ALL involved at once. Indeed, it starts right from the moment that we made an appointment to see the therapist. The key is how we react to the ambivalence. Do we return to our comfort zone, and not go see the therapist or stop going? Or do we push through the ambivalence by seeking more reasons for the “I want to change” part of it?
As a clinician, this was a choice I couldn’t make for my clients. Some were ready for change, and some weren’t. Indeed, if the choice for going to therapy isn’t even made by the client (such as when the client is a child or if therapy is court mandated), finding the reasons to change is all the more challenging.
If the clients came in, I could help them in their journey to find out what could be reasons for change and how the reasons for not changing weren’t helping them. But I am not a reason for their readiness for change. That comes from within themselves.
So, when you’re starting off as a clinician and wondering why your clients don’t come in, ask yourselves whether or not they’re ready to. Maybe it’s NOT you!
Think Again 