One of my earliest clients was a young woman suffering from chronic depression and anxiety. As she told me in the intake session, I would be the sixth counselor she had seen over the last few years.
I’m an expert, I know what I’m doing.
I was still in the midst of my graduate program. Feeling like an expert with a good skill set, I resolved to be the one to finally help this client. Five previous therapists had failed her, but I would be the one to succeed.
The hubris, while obvious, wasn’t the real mistake. For what is the difference between hubris and confidence, except a rearview perspective? The mistake was setting a firm goal for this client (my goal), that she feel better. Then, I attached my self-evaluation of my ability as a counselor to her achieving this goal.
Or, maybe I’m actually bad at this…
We got to work, starting with simple behavioral activation assignments, in session de-fusion from negative self-talk, and identifying values and valued action in her life. Initial sessions showed progress and I was ecstatic. I had learned these techniques, and was now using them, and they worked!
And then, they stopped working. The client stopped making progress, or rather it became cyclical. Some days felt productive, while others were groundhog-day-esque repeats of sessions past. That’s when my frustration with her set in. I started to feel irritated when she didn’t follow through on something we’d discussed. I started to feel helpless in the face of her depression.
Expectations get in the way of good therapy.
My supervisor helped me to see that I had fallen into the same trap that many clients do. I set her feeling better as the marker of success. When that didn’t seem to happen, I felt like I was failing. But, that’s just the nature of the beast. Feelings come and go, and when dealing with chronic depression, feeling bad is always just around the corner. Also, my measure of success was something that was outside of my control, and on which I had only limited influence. My fixation on her feelings blinded me to the actual progress that she was making. Her relationship to her depression shifted toward acceptance, her conception of herself became more flexible, and she put real effort into her movement toward more valued actions.
Fixing the client isn’t my job.
Once I realized that the problem was with me, and what my expectations were, it all became clear. Even though I never cured her of her chronic life-long depression, I did good work with her on a number of fronts and enjoyed our working relationship.
I learned to check my expectations, and to see them for what they are: thoughts in my head, that have little to do with the client. That flexibility allows me to work toward my own valued action of providing my skillset to the client, and to accept the feelings I have along the way.
As an LMFT-Associate, or a graduate intern, part of your job is to make mistakes. Your mistakes, coupled with the insight of your supervisor, are the best tools for growth you can get.