Every river has its banks, every ocean has its shores. Limitations should not always be seen as negative constraints. They are the geography of our situation, and it is only right to take advantage of this.
Taoist meditation
Primary Skill Objectives
• Understand and be ready to implement the structures of therapeutic relationships in counseling.
• Anticipate potential difficulties in structuring time in counseling.
• Be ready to give a general explanation of the normal structure of therapeutic interactions in counseling.
• Be ready and able to provide customized explanations of counseling use for a variety of persons and situations.
• Consider how helpful explanations of therapeutic interactions for clients may also be helpful to significant others in clients’ lives.
Focus Activity
Imagine yourself going to see a counselor for your first time during a time when you are upset and hurting. Assume that you know very little about counseling and that some of what you know may be unrealistic. Discuss with others or describe in writing what would be helpful for you to know about counseling. Consider what anxieties you may feel over not knowing or perhaps initially not receiving what you expected from counseling. From what you know of counseling now, consider which of your anxieties it would be helpful for your counselor to attempt to assuage with structural information or explanations in order to guide your use of counseling and to help make your use of it tolerable to you, not overwhelming to the point where you quit. Imagine the information and explanations that would have been helpful to you. Also, consider which of your understandable anxieties would be best for you to work through without your counselor attempting
to relieve them with information or explanation. Speculate why it might be best to work through some of your anxieties related to counseling. Then, discuss or describe several ways that you believe the experiences of others may vary from yours in regard to these questions.
Introduction
Because many clients either come to counseling not knowing what to expect or with mistaken expectations, one of your tasks as counselor is to structure or clarify clients’ use of counseling. This includes the basic time structure, as well as explaining what the person’s best use of counseling may be.
Time-Frame
Session Length and Ending Sessions
Some of the arrangements of counseling that we find important to explain to clients include the length and frequency of sessions, and issues related to scheduling and rescheduling. Regarding the length of sessions, we usually tell clients, “Our meetings will normally begin on the hour and end 10 minutes before the next hour. I will let you know when we have about 5 minutes left in our meeting.” As with all statements we make to clients, we watch to see how our clients react and then respond with empathy. Normally after this statement, clients look at their counselor as if to say, “OK, that’s fine.”
To such a look we respond, “That makes sense and is OK with you.”
On hearing this advice for letting clients know the time structure of counseling, one of our beginning counseling students exclaimed amusedly,
“Oh, I wondered why my counselor always ended before my hour was up.
I thought he was cheating me out of 10 of my minutes.”
Letting Clients Own Their Endings
Within this explanation of session length is the structural information that you will give a 5-minute time warning. These time warnings and generally ending your sessions on time allow your clients ultimate responsibility over use of their time in counseling. For example, if your client is working up to telling you something before the end of the time, it is helpful for her to know when his meeting with you is nearly ended for that day. Or, if your client has been quite emotional in the session, he may choose to take time to dry tears and pull himself away from the strong emotions before going out in public.
To maintain your client’s right to choose how she uses her time with you, it is also important to end your sessions on time. We have sometimes found that clients want to tell their counselors about parts of their lives over which
they may feel shame or embarrassment near the end of a session in order to say it with no time remaining to see their counselor’s reaction. We think it is true for many of us humans that no matter how much we have come to trust others, we would sometimes rather not see their reactions when we tell them the things of which we feel shame.
An extreme example of this comes from early in Jeff’s work: I had worked with a young man for 10–12 sessions. I am confident that he had perceived the core conditions from me. He had shared with me parts of his life that were important to him and difficult for him tell me. In the time that we worked together, he was recovering from cutting and other self-injurious behaviors.
Just before we began working together, he had left his family’s church, to which he had belonged all his life. He helped me understand that he had internalized many self-criticisms from the teachings of that church and from his perceptions of his parents’ criticisms of him. His parents had broken off contact with him after he left the church, but he and they were working to reestablish a relationship over the weeks that he worked with me in counseling. His girlfriend, for whom he had very strong feelings and had hoped to marry, had broken up with him shortly before he left the church.
His life had been in turmoil. During our time together, he had worked hard reviewing and reconsidering many of his former critical beliefs and self-doubts. When we began, he had seemed quite fragile. By the time we ended, he was strong and seemed to be getting stronger each day. Much of his process had been to tell me things from his past over which he felt shame or guilt. It seemed to me, as he told me of these actions and worked through his self-criticisms, doubts, and feelings of shame and guilt, that he had come to deeply trust my respect for him and for his judgment, and that he was taking clear responsibility for and ownership of his use of counseling. I thought he had finished this work, as his time of telling me such things had seemed to reach a crescendo, then subsided. He had also known well in advance when our ending would be.
Then, in the last 5 minutes of our last meeting (we had known that it was definitely our last session, as we would be unavailable to each other after that time), it seemed to me there was something more on his mind. I reflected this.
He paused and hesitated. He told me again how much he appreciated our time, how much he had grown, and how much of a support our work had been. I knew that he meant these things and that there was something more he was ready to add. In our last moment, he told me that he had pressured his girlfriend to have an abortion a year before and that I was the first person he had told. He said this at the door and left immediately, leaving me no chance to respond. I took this to be a huge disclosure, as I knew that his former church would have considered it a great sin.
However, it became clear to me that this was his choice of how to end, that it was no accident. For myself, I wanted him to stay. I wanted him to have more time to discuss his reactions to the abortion. I wanted to hear more of his reactions to the abortion. Yet, my role had been to respect and accept
him as he presented himself to me. This included his decisions of how to use his time in counseling. I thought quickly as to whether I should seek him out for safety concerns, but I knew that he was future oriented, strong and gaining in clear-headed strength, and had given me believable, solid reasons why he had stopped any self-injurious behavior and would certainly never suicide (we had discussed these things earlier in his work). If it had been possible for me to call him back, this may have conveyed to him how much I cared. Yet, I was already confident that he knew I cared deeply. So, if I had had an opportunity to call him back, it would have communicated that I did not trust him and his decision of how to end, from which he may have generalized that I hadn’t trusted others of his decisions. Then, because he had made it clear to me that my views were very important to him, he may have concluded that his self-doubts and self-criticisms had been deserved after all.
That experience serves as a strong reminder to me to remember to allow clients to know how much time we have, then to stick to my commitment of that time. Endings of sessions and counseling relationships are important.
They belong to your clients. As I was able to rule out imminent danger concerns, I needed to trust his decision of how to end, of what he wanted to tell me in our last moment and how. Such trust had been my role with him, and it would have been a violation to change in his final moment, even as I wanted to know more and do more for him. As you structure your counseling consistently, your clients are empowered to use their time, including endings, as they see best.
Exceptions to Ending on Time
As with any guidance, there are always exceptions. An example of an exception to ending on time comes from a client that Jeff first mentioned in Chapter 2. In an initial session, she had explained that she had something big to say and that she just had to get it out. She told a story of sexual abuse in her childhood and explained that she had never told anyone and it was hard for her to say. At 45 minutes into her session, instead of giving a 5-minute warning, I interjected something like the following, “We are nearing the end of our normal meeting time length. It seems that you are in the middle of telling me of a part of your life that is very important to you right now. I can extend our time a half-hour if you wish.” (I was fortunate not to have another meeting scheduled immediately after hers. If I had, I would have had to schedule a time to continue.) She agreed and stated her appreciation. Near the end of our extended meeting, I gave time-structuring statements as usual.
Another exception to ending at 50 minutes, and the only obvious situation for which counselors should allow themselves to be made late for a following meeting, would be sessions in which risks of imminent danger are unable to be resolved by the normal ending time. When such situations occur, you have a legal and ethical obligation to resolve safety issues before your client leaves.
While this is true, we still don’t like the message this may give to the client
for whom you are late—that the time of persons who are in crisis may be more important to you than those who are not. So, avoid this exception to ending on time whenever possible by addressing issues of imminent danger within the normal meeting time (managing situations of imminent danger is addressed in Chapter 10).
Guidance for Awkwardness of Giving Time Warnings
Some beginning counseling students tell us they feel awkward learning to give time warnings. They worry that the time warnings stop their clients’
communication and perhaps make it appear that they (the counselors) are more interested in time than in their clients’ communications. We offer a few thoughts for such situations:
• Pair 5-minute time warnings with reflection. An example is, “We have 5 minutes left today. You were telling me that while you feel uneasy, you are proud of the break you have made.”
• Sometimes clients will change the subject following time warnings to discuss rescheduling or ongoing work. This does not necessarily mean your client thought you were disinterested. Perhaps she simply saw a need to take care of planning for ongoing work at that time.
• Once your clients are used to your routine, you can usually give time warnings quietly, without even stopping their communication to you.
• Endings have to come some time. Endings based on time are artificial.
Yet, our culture and its institutions are based on coordinated time use.
Thus, for you to make your time available to a number of persons, you must use the artificial endings based on time.
Varying the Time Warning Structure for Some Clients
Again, there are always exceptions. You may choose to give a client who has difficulty ending first a 10-minute and then a 5-minute warning, in order to give that person more time to prepare to end. Also, we often give a 1-minute time warning. In some situations, a 5-minute plus a 1-minute time warning can be overdoing it. But when we sense the ending is still going to feel abrupt after a 5-minute time warning, we will also note when there is one minute remaining: “We just have about 1 minute left today.”
A Few More Suggestions on This Time Thing
Place your Clock Conveniently
Place a clock you can easily read in your field of vision so you can be aware of the time without having to be highly distracted or having to make a distracting motion to check the time.
Realize Your Keeping Time Maximizes Your Client’s Freedom to Express
You are keeping track of time so your clients do not have to. Rather than being restrictive, your keeping track of time is freeing to your clients. Because you keep track of time and give time warnings, your clients are free to focus their attention on their self-expression and use of counseling.
Losing Track of Time
There will be those sessions where you simply lose track of time. This is usually due to having gotten so caught up in your client’s experience that you simply forget about the time. In those cases, once you realize your mistake, simply do the best you can to approximate a compromise that allows for time warning and ending close to on time.
Helping Clients Understand the Structure of Interactions in Counseling or How Counseling May Work for Them
The primary and most frequent structure of interactions between counselor and client is this: A client tells the counselor about his self and life; the counselor reflects the part of that communication that she saw as most im -port ant to her client; the client reacts to reflection in deepening communication of his self and life. Some clients come expecting such interactions. In a great many cases, clients learn this structure of interactions and its value simply through participating in it, without explanation.
You may remember our base explanation of counseling that goes something like, “Your role is to help me understand you. You can start with any part of yourself and your life. My role is to strive to understand and to say back to you the parts that I think I understand, first little pieces, then a larger picture of who you are.” We sometimes add to this explanation one of the purposes of this process: “You can then use my understanding of you to increase your self-understanding. When I am wrong, you may come to a more accurate understanding of yourself by correcting my misunderstanding. When I am right, it may spur deeper self-understanding on your part. You can then use these new understandings for improved decisions based on knowing who you are, and who and how you want to be.”
This explanation is imperfect and not entirely accurate. We use the word understanding, when what we really mean is empathy. This is because
“empathy” may be harder for clients to understand, without too much thinking. Yet, “understanding” is usually readily understood. Also, this explan ation does not capture the essence of therapeutic relationships, which is each client’s perception of genuine empathy and unconditional positive regard from his counselor. While these qualities are more important than the description of new insight in the explanation above, the explanation does
reasonably describe counselor and client interactions (i.e., what each does), and gives clients a useful initial idea of what counseling can be like.
A very helpful way to improve such explanations, especially when clients continue to struggle with how to use counseling, is to customize your explanations to individual client situations. Examples of personalized explanations follow below.
A Client Who Asks for Guidance—Empathy to Expectations, then Response
We have served many clients who have become accustomed to being controlled by others yet, especially as an adolescent or young adult, resent this control. The following is an example from Jeff’s work.
I was working with a young man who was referred by his physician for stress-related health concerns. He had described his father to me as very controlling and communicated that he felt great pressure to perform for his family. He was studying in a very difficult field, which he explained he did not have much interest in but knew that it was what his father wanted and his family expected.
Respond with Warm Empathy to his Expectations for Counseling
I felt his intense frustration with this dilemma. At first, when he asked in exasperation for my guidance regarding how to solve the dilemma, I reflected,
“That’s how frustrating it is for you, so much that you really like guidance from me.” When, after further expressing his frustration, he confirmed that he really would like guidance from me, I responded by briefly reflecting, “That really is what you want,” then continued explaining: “I’d like you to think of counseling working this way . . .” (I gave our explanation of roles in counseling, from the previous section.) When I saw a look of dissatisfaction cross his face, I reflected, “I get the idea that you were bothered by the suggestion for counseling that I just gave.” He responded, appearing to make great efforts to maintain respect for me while expressing his dissatisfaction,
“Yes, I need help. I don’t know what to do.”
A Rationale for Not Guiding (Guidance Available in Existing Relationships; Guidance May Impede rather than Support
A Rationale for Not Guiding (Guidance Available in Existing Relationships; Guidance May Impede rather than Support