Being picky about our clients

Some approaches to psychotherapy are very picky about with whom they will work. Almost the first thing that the therapist in training will need to learn about a new approach is what the exclusion criteria are, who are the people that the approach will not work with. Now Solution Focused Brief Therapy has always taken an inclusive approach and has been prepared to work with anyone, taking the view that there is nothing that the therapist could find out about the client that would determine that the approach is not going to be useful. So what was going on when Steve de Shazer on being asked to explain his good outcomes in therapy, would respond, with a twinkle in his eye, by saying that it was because he got such great clients? How come he only worked with ‘great clients’? What sort of procedure enabled him to be so selective when SFBT does not assess clients prior to therapy? Now while it is not possible to rule out the possibility that Steve got an unusual proportion of ‘great’ clients I suspect that the clients who came through Steve’s door were pretty much the same as the clients who arrive in all of our offices. So if we are going to take Steve’s comment seriously then this raises the question of how Steve’s clients ended up, by the time they finished with him, by being ‘great clients’. Now curiously we can find a partial clue to this question in Proust’s ‘À La Recherche du Temps Perdu’, where the narrator says of his mother “. . . and as she was incapable of deceiving my father, she compelled herself to admire the Ambassador in order to be able to praise him with sincerity”. Now what Proust tells us less about in his great novel are the mechanics of exactly how “she compelled herself to admire the Ambassador”. But here SFBT might be able to return the favour. The only way of being able to “praise (him) with sincerity” is if the narrator’s mother were to consistently choose to search for and to notice whatever the Ambassador did that was admirable, indeed slightly more broadly to watch out for all of the Ambassador’s admirable traits. What Proust hints at here is the idea that we do not discover people, we do not see them as they are. We can choose to see people in a variety of ways. The client we meet is just the particular version, of many possible versions, of the client that we can construct in our interaction with them.
Having great clients therefore, as I would see it, is based on a discipline of listening and of attention. As we listen to our clients we need to pay particular attention to anything that might tell us that this client will find a way of moving forward purposefully. Listening generically for strengths and skills and resources and competencies is likely to be useful. We know that we tend to hear what we listen for so if we listen for abilities we are likely to hear evidence of abilities and we therefore are more likely to say to ourselves ‘this client will succeed’. Just being able to say that to ourselves is likely to build confidence in the chances of good outcome, which in turn will impact on the way that we interact with our clients, giving them the message ‘this person believes you can change’, which in its turn is likely to impact positively on the clients response to therapy, which in its turn is likely to build our belief in the client’s capacity and so on.
So it seems that we never can meet the client. We only ever meet the client that we meet, mediated through a filter of theory and idiosyncratic therapist related factors. Bill O’Hanlon refers to this as ‘theory countertransference’. Two different therapists of different theoretical persuasions literally construct different clients, with the danger for us as therapists residing in becoming fixed in the idea that we are meeting the client, rather than meeting one of the clients that is there to be met and worked with. So if we assume that ‘great clients’ are engaged, confident, hopeful, energised, hard-working and cooperative then there are things that we can do to maximise the chances of us getting ‘great clients’. So, as it happens, with no exclusion criteria and with no assessment process, SFBT is in fact very picky about the clients with whom it works – we only choose to work with those who are going to be successful!

Evan George
August 2012

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