You sit down for your session and your client instantly dives into the following:
“Oh! I need to skip next week. Ben and I are going to Calistoga for a wedding. Ugh. It’s his friend from college. I barely know them. But hey! Calistoga will be cool, I guess.”
While there’s all kinds of interesting clinical information here, your mind short-circuited at the, “I gotta skip next week because Calistoga!”
- You’re about to miss out on income next week and that majorly sucks because your student loans just went up and you don’t know if you can cover them.
- YOU would die to go to Calistoga for any reason, but you can’t afford it, especially now that you’ll be missing a client hour.
- This client is on a sliding scale! How the fuck is she going to Calistoga for a week?!
Am I right?
Can I get an amen?
We don’t need to “Amen” this shit. We need to fix it.
I mean, yeah. This is an extremely familiar scenario for therapists in private practice but it doesn’t have to be. There are systems you can implement to make sure you’re taken care of so when your clients have a sudden vacation announcement, you can be present to think about about what’s going on and tie it into the clinical work, rather than falling into that oh-so-common spiral of fear and resentment.
I recently finished another round of Lean In. MAKE BANK. and, I gotta stop for a moment to acknowledge my students. They are fucking phenomenal and inspiring and BOLD. (Hi guys! You’re great!)
In this course, I encourage students to lean into the clinical piece, to utilize their client’s material to understand the larger patterns in the client’s lives (aka. I encourage my therapist students to do therapy).
But let’s be real! “Doing Therapy” is hard if clients are taking great vacations or buying amazing new shoes when they’re on a sliding scale. There are a ton of ways to address this.
A. Continue to spiral into resentment and envy.
B. Remind yourself that you’re a nice therapist and look within to find all the positive feelings you have for them (#avoidancemuch)
C. BRING IT UP!
When I introduce this idea, many therapists go straight to the question, “If I bring it up, aren’t I shaming my client?!”
It’s a great question.
Let’s say we utilize a clinical intervention like,
“Hannah, I notice you just bought a Gucci purse last week and now you’re leaving for a week to go to Calistoga, yet you’re on a sliding scale here. What do you make of that?”
[Are you freaking out right now at the thought of that? Take a deep breath. Roll with me here.]
If we were to do that, it might suddenly dawn on Hannah that she’s been spending all this money, yet not paying your full fee and this realization most definitely could bring up shame.
Henceforth, many therapists do the math and conclude, “I have shamed my client.”
It’s a common misconception and therapists do it a lot!
We conclude that if a client feels something uncomfortable when we make an observation, then we have done something wrong.
No. Stop. FALSE.
I want to reframe this for you once and for all.
Think about it. The REALITY is that Hannah has been on your sliding scale and she has also been spending a ton of money. This is reality. There is something going on here, a contradiction is at play. It is our role as therapists to notice and observe exactly these kinds of contradictions.
It isn’t about blame or shame. It’s not your “fault.” It’s not her “fault.” Something has been happening between the two of you and it warrants being addressed.
A. So the client can recognize she’s been scamming you all along and needs to make amends.
B. So you can raise her fee starting now and even demand a little back pay.
C. Because this phenomenon likely plays out in other areas of the client’s life and by examining it together, she will gain a greater understanding of herself and her interpersonal relationships.
Did you guess “A”? If yes, bring it to your own therapy.
But if you guessed “C” – you win!
Look, it is your job to observe and go into the uncomfortable material that ALMOST EVERYONE in the client’s life avoids. Or, if people in the client’s life are pointing it out, they are likely doing it in a problematic way that the client can’t hear. Your job is to gently take your client’s hand (METAPHORICALLY) and walk with them into areas that are too uncomfortable to traverse alone.
SO – if Client Hannah feels ashamed in response to this realization, take that up!
There are a variety of ways this can happen:
“Hannah, I notice you and I have been colluding together to avoid looking at this.” ⇒ Shares responsibility and brings you in as a teammate.
“Hannah, I’ve been thinking about my role in not addressing this.” ⇒ You’re going first and modeling a gentle curiosity about your feelings and thoughts.
“Oh, man. It seems like neither of us have really thought about this together before. What’s it bring up for you?” ⇒ Shares responsibility AND invites her to talk about feeling bad or ashamed, to which you can express curiosity and inquiry.
“Huh, shame? Like you’ve been hurting me rather than us participating in something together?” ⇒ You’re helping Hannah begin to think about the interpersonal interaction, which removes the doer/done-to aspect of relating.
When there is ‘acting out’ or ‘strange phenomena’ occurring around how money is being dealt with in the therapeutic relationship, 100% of the time, hands down, it is pointing to something else. Something MAJOR.
Money is a symbol of reality (she’s getting deep here, folks) and by not addressing this discrepancy, you are facilitating the avoidance of reality, which does your client a disservice.
Re-frame of the day:
“I cannot shame my clients.”
A client may feel shame in response to something I say, but unless my intention is to shame them, it isn’t my job to make it go away, but rather to come in closer and be with them in and curious about their shame.
Your next Step:
Leave a comment, Sweets! Does anxiety about “shaming your client” ever keep you from speaking up even when you KNOW it’s important? Got a cool reframe that has allowed you to overcome this fear? No idea?! Let us know below.