Renovating the self

My last client of the day came in tonight and settled into her chair.  "So," I said, as I always do, "What are we working on tonight?"  I didn't know what to expect.  She had missed her last two appointments, so it had probably been 6 weeks since I'd seen her.  

"Well," she said, and she shifted a little in her chair, "I think I might need to get a new therapist or something.  I don't know.  Maybe it's me.  It's probably me.  But I just don't feel like I'm making much progress."

I thought a moment, nodded.  "Well, you're right, of course.  We're not making a lot of progress."  She looked surprised that I'd agreed, and maybe a little offended, which amused me. 

But we went on to talk about why that might be, without me even mentioning the fact that she'd missed her last two appointments.  We talked about change, and she was quick to say that she thought change was scary and she didn't much like the idea of it, even though she knew she needed to change. 

We talked about the cycle of change, and agreed that she was in the contemplation stage - thinking about changing, not ready to do it.  I talked about therapy.  I said there were three paths to change.  The first one was the quickest and it involved doing new things - going to group, trying new things at home.  I said, "But when I suggest those things..."

She shook her head, "No, I'm not gonna do that."  

I agreed, "Right.  You're not ready to do that." 

The second path, I said, involved thinking about things differently, talking about using wise mind, identifying automatic thoughts.  I said, "But when I suggest those things..."

She shook her head, "No, it don't seem like those things apply to me."

"Right," I said.

"The third path," I said, "involves you coming in and just talking to me about whatever you want to talk about.  Then I listen.  I tell you what I hear you saying.  You talk some more, I listen.  That's old school therapy, and it takes a long time.  We can do that, but you won't make a lot of progress real fast."

So we went on talking, and she began to be able to describe what she thought she might want to change about herself, and really did some good work in the session.  And she felt better about therapy, and I told her how helpful it was that she could come in and say she didn't think she was making any progress.

But I was thinking about it while I was driving home.  I thought, you know, it's like if you decided to renovate your house, and you hired an interior decorator or a contractor or something.  And if the contractor came in talking about tearing out walls and ripping up carpet, it would make you a little nervous.  And if you agreed in theory that it might be a good idea, but then he came back with sledge hammers and saws and ladders and buckets of paint, you might not want to let him in. 

I thought, if I'm going to make major changes in my house, I want to walk around with the contractor for a while first.  I want him to admire the things that are nice about my house.  I want to feel confident that he won't ruin anything that's good now.  Then I want to think about it some more.  Try to imagine it.  Look at paint chips.  Spend time at Lowe's. 

I wondered how it seems to our clients - is it like we're rushing into their heads with our little psyche sledge hammers poised, ready to wipe out all the thinking errors?  Yikes.  No wonder so many of them don't come back, just quietly disappear.  On the discharge summary, we say, "No longer seeking services..."  and code it "2."  I wonder what stories lie behind all the "2's" I've used to terminate my charts.  

"But wait -" you may be thinking, "Your client wasn't complaining about you moving too fast, she was complaining about moving too slow."  And you're right.

When all the ways I'd tried to move her didn't work, then we didn't begin to move at all until she complained that our progress was too slow. 

That's what I love about therapy.