Therapist Do's and Don'ts

[Dan Metevier]

Things not to do: Don't become a crutch to your client else when the time comes to end the therapeutic relationship the client will be without support.
Encourage the client to think about their issues in a safe way and to help them develop their own coping skillls.

Things that are helpful: Talk to the client on the level they set. If they talk on an adult level then treat them like an adult. Respect them.
Be a guide to them during the therapeutic relationship but don't get too close.

Great advice. My motto is that my job is to work myself out of a job. I also find that people, if they are listened to and understood, can most often find their own best solutions. I tend not to give advice because, after all, how the heck would I know what's best for you?

Thanks again.

 

[Dan Metevier]

Always fully explain any conclusions you come to and the reasons for any "treatment". Also listen if they think you're wrong!

I have never seen a therapist but have had both good and bad experiences with psychologists. When I was 17 the psychologist I saw formed his conclusions and then never explained them. I was too nervous to ask what was going on, eventually it was my parents (whom he had told) who explained it to me. I then tried to tell him that his conclusions were wrong (he was so far off the mark it's almost funny, 2 hours of questioning and he never even asked me "what is making you unhappy?") and he basically told me "I'm a professional and you don't know anything so shut up and do as your told" (yeah I'm paraphrasing a bit but that was what I got from it). The result was that the weekly counselling sessions became one more added source of anxiety and misery, and even when I was transferred to a different (good) counsellor at 18 I was so alienated from the profession it took month to even begin to respond to and trust her.

hmm sorry for the rant

I didn't experience your posting as a rant and I appreciate your story. I have had therapists like this too (yes, even therapists see therapists) and tend to run away from them as fast as I can. Great that you recognized how this person was and that it was not for you. Sorry this happened.

 

[Dan Metevier]

You're very welcome. And thank you.

One "best practise" I haven't seen covered yet: Paraphrase back to the client, without sounding patronising, please, before making notations or forming a response. I can have difficulty finding the right words to express myself. I'm dealing with complex, sometimes confusing thoughts and feelings. I crave understanding. Make sure you help me get it right for the record, for the best chance at productive therapy. From what I've seen here, you're excellent at this, but many therapists aren't.

One bad move: Don't disregard anything I say, just because it doesn't seem important from your clinical perspective. Back to challenges with communication...if I say it, it's important.

.
Thank you for saying all this. I find that understanding someone is absolutely essential. Otherwise, you're no where. I know many therapists who seem to be blinded by their favorite theories, methods, or personal issues (especially the last one). I can pick this up pretty quickly and tend to fire them if I'm the client. No reason to stay.

I also find it important to at least notice everything someone does and says. Not to make them self-conscious, but to understand them better and pick up on what they are saying with their bodies as well as their mouths. "Everything you say and do can and will be used to help you."

One of the reasons I joined this forum and website is to enhance my ability to understand my clients and family members. I so much appreciate your and others' willingness to help me with this.

 

[Dan Metevier]

Thanks again for your interest. I don't mean to sound like I am accusing yourself, or all specialists, so forgive me if it does come across that way, but there is one reoccurring issue that I think is quite important for me to bring up.

While I have yet to be diagnosed, I have read many complaints from quite a few of our female members, of some specialists being unable to recognise their AS.

Some of the common complaints have been the following:

• Specialist informed that the client appeared too "normal" to have AS.
• Specialist analysed, by comparing the client to the typical male behavioural traits related to AS, but did not seem to recognise the more prominent female behavioural traits.
• Specialist advised that only men can have AS, or advised that AS in women is extremely rare, and therefore dismissed the case.
• Men, who are more feminine-minded, or who have adopted a female gender, tend to share in these issues.

Of course, I can not say for certain that all of these complaints were made by those who definitely have AS, as I am no specialist, but it seems to be an issue that is quite common, on a global scale. As a self-diagnosed woman, I can appreciate how this issue can be upsetting; especially to those who have had to struggle in life, or to those who have had to spend large sums of money, only to feel that their disgnoses was not accurate to their own circumstances.

Wow, do I ever take your point. First, I am surrounded by female Aspies personally. Also, before becoming a psychologist, I spent 20+ years in the computer industry, where I met plenty of both male and female Aspies, sometime widely different types of people. Further, coming to psychology later in life (after I've learned many of the games people play), I find that, until recently, most psychological research has been done on males (especially college freshman taking Psych 101). Therefore, many of our most "sacred" theories do not fit at all for women. Hello!! The great majority of people who engage in therapy are female. Might we want to know something about them? (No, I'm not bitter.) At any rate, thank you for your valuable feedback.

 

[Dan Metevier]

A major don't in my experience is that they should not rely heavily on certain stereotypes and don't don't focus on a certain momentary "snapshot".

Granted, perhaps appeance is the first thing one sees and might at times be a result why you have issue X. But if he/she doesn't know anything about me yet, it's nothing more than a "snapshot" of what I'm like. Example; if I dress in black, I might appear a bit glum, I might appear a bit depressed. However, if, like me, you've been dressing like this all your life, the notion of "how are you feeling right now" does become a different matter when you think it is reflected on wardrobe and such.

Besides; I've found that in general, asking me what I like to do (and most likely not just me, but in general), does not always reflect my life that well. This might very well be a momentary snapshot as well. Where I am right now in life, does not mean that I've been there for the past 5 years.

Nicely stated. I appreciate the "snapshot" concept. Much like a medical blood test or blood pressure reading is a snapshot of how you are in the moment of the test or reading. May or may not say much about how you were half an hour ago or will be three days from now. I try never to assume that how you are with me in the therapy room is how you are in the outside world. For this reason, I try to invite significant others (spouse, parent, friend, child, etc.) into the sessions so I can experience the person more in their "natural habitat." If time and ethics allowed, I'd love to be able to hold sessions in people's homes, to get even more of a sense of who they are. At any rate, enough of my rambling. Thanks for your feedback.

 

[Dan Metevier]

Wow! I want to say a big thank you to all of you who have responded to my questions (and to all of you who will respond in the future). This has been very enlightening for me. It is people like you from whom I learn the most, not from psychology textbooks or journals. You know what's really going on, where it "hurts" and (eventually) what to do about it. For some reason, I feel a sense of sanity here that I often don't feel when talking to my colleagues. I'm not sure what that says about my profession or me, for that matter. But I do appreciate your taking the time to educate me.

 

[Dan Metevier]

I can't stand platitudes, cliches, generalities, or mental trickery. I don't want to be babied or coddled, and I don't want to be treated like I can't handle truth, even if it's difficult truth. I choose not to be easily offended by truth, so if there's some negative feedback that needs to be said, just say it.

I don't like fluffy compliments. Honest feedback on something that I've done well is useful, especially if you can tell me specifics about what is good about it and how it affects people. But don't smother me in compliments that are designed to "make me feel good".

Clearly stating what my choices are, and what consequences those choices are likely to entail, is helpful. Then giving me freedom to make my own choices...opportunities to determine what my life looks like. Reminding me of truth when I lose touch with it helps a lot.

It's especially important to me, because of my background, to work with someone who is not easily flustered or overwhelmed, but who also isn't unreachably distant and emotionally unengaged. There are so many people I've not been able to open with because I sensed they weren't "strong enough" to handle what's inside me.

At the risk of complimenting you, I really like what you've said. I do believe that "transparency" is essential, as well as the accompanying honesty. Therapists are human too, even though some have lost sight of this. And, there's nothing wrong with being human, right? Further, I believe it's important that a therapist know their limits. Someone once said that the job of a good therapist is to be like a chameleon and "match" the client's style, where they're at, etc. At the same time, not all chameleons can do plaid. So, if the person is plaid and you don't do that, help them find someone who can. Thanks for the feedback.

 

[Dan Metevier]

Yup. Looking at myself, I hate it when someone pulls a trick on me, that is when I notice. I imagine it not being a very nice conversation afterwards

An other key factor for me is that it shouldn't only be business, there needs to be something personal too. If you share something, I do too. Remember! We aren't people that trust someone very quickly.

And honestly I want to believe I trust my therapist, but I don't. I always think: What does she think about me saying this, or doing that. I always get the feeling that People think of me in a bad way (probably experience)

And the last one. There are some things that I don't trust even a therapist with telling. And that is for all of us. You might think that we tell all we know, but what you don't ask, you don't get to know.

This seems very fair to me. Many therapists believe (for whatever reason) that the person they work with should not know anything about them. I find that to be a ridiculous assumption. How can you trust someone you don't know. On the other hand, if a therapist goes on and on about themselves, I sometime feel like I (as the client) should charge them for the session. Lastly, I always assume that each person I work with is frequently (or constantly?) testing me as to whether they can trust me. It's up to me to earn their trust. It's not up to the person to force themselves to tell me stuff. "You have the right to remain silent." Thanks for your feedback.

 

[Dan Metevier]

One thing I can say, is quick judgement.

Example:
This may be my own warped perception, but I was meeting with a therapist for first time, and was immediately condemned and felt judged, for self medicating with Cannabis. And pushed towards pills! I almost decided to not go back, but I stayed and gave her the respect she deserved, eventually deciding to stay with her.
I would have preferred a detailed explain of why I need to immediately stop, aside from its side effects. Pills have side effects too. Severe ones for me, that only add to problems.
I don't disagree with the general adversity to this self medicating choice, but get to know me or ask why before dismissing it as something to change, or suggesting some pills.

My reasoning for self medication is over 17 years experience with and without the Herb, on anti depressants, ADD meds and in every imaginable situation. I lived life "sober" in war, school, training, and general life, I lived other periods of life with low levels of herbs consistently and seen better performance academically, socially, and emotionally. Sorry to rant. I appreciate good natured advice and expectations. I am open about my use of herbs when using, with doctors, and the dosages.

I'm very sorry you felt judged. You refer to the "respect she deserved," but I'm not clear on why she deserved respect. I have come to appreciate people who "reserve judgement" about me until they know me better and feel comfortable with me. Just because I have a fancy degree and license and all that, doesn't mean I deserve your instance respect. This is not a criticism of you at all. Just a bit of advice for next time.

As for your use of Cannabis, I don't know but it seems like some part of you felt the need to do this to cope with life. I sometimes (jokingly) recommend that someone try alcoholism for a while to see if that helps. (Joke!!!) I wish your therapist would have explored with you (with your permission) how the Cannabis helped you and see if maybe there was some other way to get that help that was more "healthy" (if you wanted that). Then to suggest pills as an alternative seems quite ironic to me. But, I'll reserve judgement. Thanks for the feedback.

 

[Spiller]

I can't stand platitudes, cliches, generalities, or mental trickery. I don't want to be babied or coddled, and I don't want to be treated like I can't handle truth, even if it's difficult truth.

What she said!

I don't mean to sound judgmental, but I cringe at the difference between what the books say and real life situation. After years of trying to explain my experience of a lifetime of isolation to someone who's thinking of impaired social communication/interaction in a clinical setting, or of a lonely period they remember in their own life, I now have to take a translator (my sister) with me as backup.

it's very important for a therapist to call out BS when they see it and help change problematic behaviors or thought problems.

I have a social worker now who shares a little of her own life and personality because she understands that that's the only way I can share with her. I've not known her long, but I'm hoping she'll feel able to offer me 'right' ways of thinking and acting, to correct my errors.
I also medicate with cannabis and always take pains to explain that I don't just kick back and smoke joints all day; I do on-off experiments with different dosages/strains/methods of ingestion and I know from years of experience what works and that it does work. It irritates me no end that my efforts are so casually disregarded.

 

[Dan Metevier]

Just a general communication pointer, make sure your questions are very specific and direct, and understand that strange answers might be the most honest ones. Don't question them, rephrase yourself without judgment.

Good point. Thank you for this. At this point in my career, I am very much used to "strange answers" and find that they eventually make sense as I get to know the person. In the meantime, I will work on making my questions more specific and direct. Thanks again.

 

[Dan Metevier]

This might not apply to you, but to your colleagues:

Don't: take on new patients when you are less than a month from retirement. (This has happened to me multiple times.)

If you hear a rattling sound, it's me shaking my head. I'm so sorry this happened even once to you. :-(

 

[Dan Metevier]

Flexibility? Medicine and treatment is not black and white, so maybe what would be best for a patient could be anything from pills, to vitamins, to a bit of exercise, to a new puppy, or just simply pacing the room and ranting.

I've never been to a therapist, but I did have a counselor. So my "do not want" advice is to not to threaten to kill the individuals your patient is having trouble with, and don't make up lies about them based on their dislikes. In example, claiming they're refusing to take their son to his check-ups just because the mother has had some very bad experiences with doctors.
Oh, and please don't tell your patients they have no right to complain about financial difficulty if they refuse to submit their bodies to medical experimentation. When the weight of the family is resting on your shoulders, you can't gamble with terrible side effects from being a lab rat for new drugs. You need your health to get what normal jobs you can and provide for them.

It never ceases to amaze me the experiences people have with therapists, counselors, doctors, etc. Yes, flexibility is important. Also, to consider the person as a whole, not just a body or a mind, but a parent, breadwinner, caretaker, employee, etc. Thanks for telling your story.

 

[May Black]

I have to tell you how impressed I am that you're taking the time to reply to everyone here, I love your approach. If all people put as much effort into trying to understand each other, the world would be a much better place.

 

[Dan Metevier]

What she said!

I don't mean to sound judgmental, but I cringe at the difference between what the books say and real life situation. After years of trying to explain my experience of a lifetime of isolation to someone who's thinking of impaired social communication/interaction in a clinical setting, or of a lonely period they remember in their own life, I now have to take a translator (my sister) with me as backup.



I have a social worker now who shares a little of her own life and personality because she understands that that's the only way I can share with her. I've not known her long, but I'm hoping she'll feel able to offer me 'right' ways of thinking and acting, to correct my errors.
I also medicate with cannabis and always take pains to explain that I don't just kick back and smoke joints all day; I do on-off experiments with different dosages/strains/methods of ingestion and I know from years of experience what works and that it does work. It irritates me no end that my efforts are so casually disregarded.

Thank you for all this. Regarding your first point, I agree. In fact one of the reasons I joined this forum was to get the "real" story from people like yourself, rather than rely on books, which may contain a neurotypical's view of things or one person's experience that may or may not pertain to anyone else's experience. Point taken.

Regarding your second point, I'm glad you're finding a way to work with this person and hope that you get what you need. I'm also glad you're finding what you need with cannabis. It sounds like you're developing some good expertise with it that maybe you can share with others. BTW, I live in California, where medical marijuana is legal at the state level.

 

[Dan Metevier]

I have to tell you how impressed I am that you're taking the time to reply to everyone here, I love your approach. If all people put as much effort into trying to understand each other, the world would be a much better place.

Can I put a double "like" on this? OMG, ain't that the truth!!!

 

[DogwoodTree]

At the risk of complimenting you, I really like what you've said. I do believe that "transparency" is essential, as well as the accompanying honesty. Therapists are human too, even though some have lost sight of this. And, there's nothing wrong with being human, right? Further, I believe it's important that a therapist know their limits. Someone once said that the job of a good therapist is to be like a chameleon and "match" the client's style, where they're at, etc. At the same time, not all chameleons can do plaid. So, if the person is plaid and you don't do that, help them find someone who can. Thanks for the feedback.

Honestly, I think my issues with compliments come from my background with enmeshed, codependent family and all the stuff that goes with that. And the AS produced a different set of coping mechanisms in me than in my family members.

You're right about therapists being human, of course. Same thing with parents, who aren't perfect either. I realize a lot of my struggles with therapists have come from my own misconceptions. But shouldn't therapy be able to address that issue, rather than failing because of it?

Not blaming anyone...I realize it's still a developing field. My bachelor's is in psychology, did a year in a master's social work program before switching to education, then continued to get lay counselor training since.

 

[Dan Metevier]

But shouldn't therapy be able to address that issue, rather than failing because of it?

Yes, I believe it should, as one of the (or maybe THE) most important aspects of therapy is the relationship betw the therapist and client. I could see many sessions being productively spent in clearing up misconceptions. I wouldn't consider that a waste of time.

In the meantime, I wish you the best with your training. I hope you find whatever fits best for you.

 

[Dan Metevier]

Honestly, I think my issues with compliments come from my background with enmeshed, codependent family and all the stuff that goes with that.

A further thought. AS aside, I find many people (myself included) have a difficult time with compliments. The way I see it, as we grow up, our brains may not get "programmed" to deal with compliments, especially if we're not given many or there are strings attached or something like that. Then, later on, if we are given a compliment, our brain doesn't know what to do with it or does something weird with it. Fortunately, our brain can change in this regard and we can get used to receiving compliments and doing something more "appropriate" with them. Anyway, that's my thought.

 

[Rocco]

For me, having been compliment starved for most of 30 years, I may get bashful or blush, or even feel a little embarrassed, but I love them, and the way they make me feel. Maybe this is due to a distinct lack of positive reinforcement in my life, or something darker, but I dish out a lot of compliments to others, hope that doesn't make people so uncomfortable.