- In 2016, I was dealing with some MAJOR postpartum fuckery following the (traumatic) birth of my daughter. Postpartum anxiety, OCD, and the worst insomnia you can imagine. All at once. I was a joy to be around, just a delightful shell of a human.
- In 2017, my 38 year-old brother died suddenly and unexpectedly. We had a rocky history, my bro and I. So yeah, that brought up some complicated grief that I needed to talk through with someone.
- In 2018, I decided to get some EMDR to help get my insomnia under control because I was still sleeping like 3-5 hours a night and barely functioning most days.
- In 2019, I sought help as I grappled with a major life decision, and I wanted a therapist to serve as a container for all of the messy shit that was going through my head surrounding the decision.
- A few months ago, I had a major epiphany about my life and some of my relationships during my month-long break from social media, and I wanted to process that with someone other than my husband.
Every time I decided to see a therapist, I was looking for something different.
And with each new therapist I chose, I also wanted to experience a new perspective, treatment approach, or personality.
One thing that surprised me through each of these experiences was how different it felt to be a client. There were things as a client that I really paid attention to, whereas when I’m the therapist, I hardly think about it at all.
I got the idea to write this email after I saw my last therapist. We just met for one session, and I knew after just the intake appointment that I wasn’t going back.
I thought about writing them a long email explaining my experience and to offer some constructive feedback, but I realized that I could make a much bigger impact by writing to you instead.
I understand that some of these things might just be my own personal preferences, and as a client you may not give two shits about some of this stuff.
But your clients might. And that’s who matters here.
So here are five truths coming from someone who’s been on 5 different couches in 5 years.
1. Your therapy office isn’t just a reflection of your personal taste; it’s also a reflection of your mental health.
As a client, it’s important that I feel my therapist is present, grounded, and at least somewhat clear-headed when we meet.
One therapist I saw over the last 5 years had THE messiest desk I had ever seen in my life. This wouldn’t have been a big deal, except the room was laid out in such a way that I literally faced the desk the entire session.
When it came time to end sessions, she couldn’t even find her planner half of the time because it was buried under piles of papers, books, and random shit that always seemed to be flying everywhere. I wondered if she actually had the mental capacity to hold all of the garbage I was throwing her way if she couldn’t even find her planner.
Another therapist I saw had a wall clock that was always broken. Like, literally the thing had one job to do and it was always set to the same exact time. It was such a minor detail, but when you look in one general direction for an entire hour, small things like that make a client wonder what else has fallen into disrepair.
She was always *almost* out of tissues too. Talk about panic – when you’re sobbing and use the LAST tissue in the box, and your therapist doesn’t even notice.
Regardless of whether you’re doing telehealth or in-person sessions, take some time to reflect on your client’s view during session. Is it just a blank, gray wall? A broken clock? A messy desk? Consider that your client’s need a place for their eyes to rest during sessions, and create a backdrop that gives their eyes somewhere to land.
2. I want to feel like you took the time to prepare for my sessions and that you aren’t just winging it.
The first session is almost always the most anxiety-producing for clients, because they don’t know what to expect.
One therapist showed up to the office at the exact time of my intake – not a minute earlier. At exactly 12:30, she open the front door, sauntered into her office, and called out my name as she was turning on the lamps.
She was reading through my intake paperwork as I was talking to her, and she clearly hadn’t read it until that very moment. It felt like she wasn’t able to pay attention to what I was saying because she was too busy playing catch-up.
Not to mention, this therapist still used archaic, paper charts and made me fill out almost 10 pages of intake paperwork by hand prior to the session. I worked hard on it, doing my best to give her a thorough history. Then I actually scanned it into my computer and emailed it to her so that she would have it before the intake (what a freaking headache!).
So for her to not even take the time to read through any of it before the intake made me feel pretty shitty.
I know you hate writing your notes, and you’re probably behind on them most of the time.
Start to view your notes as a way to provide the best care to your clients by having something to refer back to before each session. I don’t care how great you think your memory is; you taking 5 minutes to look back over last week’s session or their intake paperwork might be the difference between a client having a great session or just an ok session.
Make them feel as if they’re your only client, and that you are devoted to their care. I promise it will go a LONG way.
3. Your main focus during the intake session should be creating an alliance with me.
I know you want to dig in and start helping me as soon as possible, and you want me to feel confident in your abilities to do so.
HOWEVER, when you immediately start educating me about how anxiety, stress, trauma, etc. work before you actually hear my story, I feel like you’re just regurgitating statistics from a textbook instead of seeing me as a person.
Don’t start spouting off statistics about PTSD until you have a full picture of what my life has been like. Don’t assume you know me just because of a few personal details I outlined in my paperwork.
During one intake, I was crying the. Entire. Time. I was still able to get words out and tell my story, but the tears they were a’ flowin.’
At one point, the therapist explained to me that she perceived me as being “guarded.” If she had taken the time to get to know me, she would have realized that I usually don’t openly express vulnerable emotions. So calling me guarded while tears are literally running down my face is the quickest way to get me to close right back up.
During every intake, be curious.
Make eye contact.
Then validate, normalize, and validate again.
The real work will begin later, but the intake is where the foundation is laid.
4. Show me that you have work-life balance and healthy boundaries.
One therapist I saw claimed to help stressed-out overachievers create more work-life balance. This same therapist would often text me about rescheduling appointments late in the evening or on weekends.
One time, she texted me on a Saturday afternoon asking to reschedule an appointment for the following Friday. So instead of just waiting until Monday during normal business hours, she interrupted my weekend — when I was spending quality time with my family — to ask me to move an appointment that was a week away.
I didn’t respond until Monday morning, and I found it ironic that, as the client, I was the one who ended up modeling healthy boundaries and work-life balance.
Another therapist I saw always looked frazzled, like she slept past her alarm, jumped out of bed and threw on whatever clothes were laying on the floor. She looked tired, weary, and at times, fragile.
Sometimes I even felt bad coming to session and telling her about my problems because I figured that whatever was going on in her life was probably worse than mine.
We are often our clients’ first models of healthy relationships, boundary-setting, and practicing self-love. If you can’t model any of those as my therapist, how are you supposed to help me navigate these things for myself?
5. Self-disclosure can be a helpful way for me to see you as a real person, but your anecdotal stories aren’t a substitute for evidence-based treatment.
Oof, that one’s a doozy. So as a business coach for therapists, I talk frequently about something I call Authentic Personal Branding (there’s even an entire module dedicated to this concept in my signature program). Authentic Personal Branding involves bringing your real self into the therapy room and having your clients see you as more than just a walking treatment model.
In my opinion, Authentic Personal Branding is the difference between a client who sort-of remembers you and a client who feels a true, deep connection with you.
But being authentic is not the same as self-disclosing. And there IS such a thing as too much self-disclosure…
Like when you starting using it as a way to tell me how I *should* think, feel, or act.
One therapist I saw used her own experience of grief and loss as an intervention – explaining how her loss was similar to mine, and then sharing – in detail – how she handled it, and what worked best for her.
If she was my friend and not my therapist, I could see how this *could* be relatively helpful to some degree. But when I’m paying you $$$ to help me, then just sharing your own personal journey doesn’t constitute evidence-based therapy.
Being authentic in the therapy room is an amazing way to connect with your clients. Even a little self-disclosure can be helpful depending on the treatment model you use. But your therapy framework needs to be at the heart of your sessions to guide you, not your own lived experiences.
I think it’s easy to hear horror stories of therapists who sleep with their clients or who blatantly violate confidentiality, and then turn up our noses like we’re of a higher caliber, like we’re morally superior and would never do something so terrible.
But we’re all capable of doing something that can make our clients feel shitty.
None of the therapists I saw over the last 5 years did anything illegal or unethical during the course of my treatment. They probably don’t even know that any of these things were issues.
And THAT’S why I decided to write this.
I want all therapists in private practice to kick ass, and that means that we also need to work hard to raise the bar for therapists everywhere.
We need to take such pride in the work that we do that we are continuously also trying to improve ourselves and our craft.
So next time you see a telehealth client, pay attention to your backdrop so that your client has something pleasant to look at instead of just a blank gray wall.
Next time you see someone in-person, double check that you have a backup box of tissues.
Before your next session, read through the client’s chart and make a real plan for how you want to facilitate the session.
Remember that you might be your client’s first – and only – example of a healthy relationship. So work to create relationships with yourself and others that mirror the ones you would want for your clients. That means:
- Be nice to yourself. Kick Bitchy Brendy in the face when she starts acting up.
- Take care of your body – and love it – regardless of its size or shape.
- Surround yourself with people who are supportive, loving, and who respect your boundaries.
- Create a schedule that includes set times for work and for rest so that you can be fully present and engaged with your clients.
We can all agree that 2020 has sucked the life out of us. And while the year is almost over, nothing that happens in your therapy room will change beginning January 1st unless YOU change it.
I hope this email inspires you today to take the next week to sit back and reflect on your clients’ experience in therapy with you. Challenge yourself to do even better for your clients in 2021, and make a plan to change just one thing about how your run your practice so that it doesn’t run you.