How Are Therapists Seen By Their Clients?

What Does a Client See When They Look At Their Therapist?

My friend, Kathy, is a great believer in people "living their life out loud." By this she means being as fully and truly yourself at any given moment as you can possibly be, neither trying to live up to somebody else's expectations of who or what you should do or be, nor dumbing down your own expectations of what is possible for you to achieve. Kathy is very good at living out loud, and I pride myself on doing a passable job most days. However, like most people, I have days when it's just hard to be a human being, unaffected by the opinions of others. But living out loud and being a therapist sometimes means that there's a conflict. One of the struggles, and paradoxes, I have is that since being a therapist in private practice I have lived less time in my life out loud than ever before, while I spend more time exhorting my clients to do just that - i.e. live in a way that is authentic and present, in a way that is true to themselves, and as honest as they can possibly be. I’m mindful that if too much of me, the therapist, and my life and history is in the room, there's no room for therapy to take place. It's a balancing act, as I've talked about elsewhere on this blog.

I guess the challenge for me in being a therapist lies partly in the ability to be myself, without being fully myself. This, believe me, is a kicker. It's not that my personality changes, it doesn't. That's a constant. But some of the things that I feel partially define me stay hidden. I'm aware that there are qualities that other folks (maybe even clients?) think I am defined by, and they don't define me at all. To start with I'm a zaftig, full-figured woman. I've ricocheted up and down the scales in my lifetime, trying to deny the biology of my hearty, Welsh peasant roots, but I'm 5'3" tall and have been told that I'm a dead ringer for a meatier Kathy Bates (although I've been known to quip that my driver's license photograph looks like an undercover Linda Tripp). I’m aware of the bias against large size folks in this culture, and the prejudices and stereotypes that are heaped on our heads and I’m conscious that this probably affects how some of my clients view me. I often recognize that people don’t talk about their own struggles with food and body image, probably because they fear offending me. I frequently have to reassure clients that it’s fine to talk about concerns about their own bodies and their eating habits – that I won’t snap and break if they do.

So what exactly does a client see when they look at their therapist? What markers are they looking for? Having spent time on either side of the therapy couch, I know that I want my therapist to be trustworthy, dependable, honest, respectful and respectable. It’s preferable if he or she isn’t driven to flighty impulses that might provoke unsettling changes in my therapy relationship with them, so it’s helpful if they are stable and reliable. I assume that these qualities are important for my clients too. But how can we tell? What criteria do we use to make our judgments?

For most clients, contact with their therapist is limited to 1 hour a week. During this time a therapist can present an image of calm, unflustered competence – an image, by the way, that their immediate family and close friends would frequently find at odds with the non-therapist personality that they live with or are friends with. However, therapists are only required to be able to pull this off in fifty minute chunks. It would be easy for a client to look at this magic trick and find themselves lacking, given that their “job” is to find a way to fall apart in extremely un-calm, flustering ways. A client may feel depressed and have not bothered to iron their clothes that week, while you sit there in neat, professional attire. Little do they know that the ironing basket is full to overflowing, you wore this outfit three days in a row because nothing else was ironed or picked up from the dry-cleaners – evidence of how overwhelming tasks of life can be, even for therapists. Our offices are vacuumed, dusted, our papers (probably) neatly piled up on our desks, filing cabinets with file drawers neatly labeled, the trappings of organization and functionality. When our clients look at these trappings, what are they deducing about us, about me, as a person and what is important for them about this deduction? Would it make a difference to them to know that I hadn’t vacuumed my house in two weeks, and that cat hair flies around like tumbleweed when the fans are on? And what would they do with that information? Would it be helpful, or harmful to their therapy? As a therapist, it’s helpful to know how our clients see us because sometimes it’s the unspoken assumptions that build invisible barriers between therapist and client. In normal daily life, we don’t necessarily take the risk of saying to our friend, “Your desk is so clean, I feel intimidated by it, and assume that all your life is so organized. I see you as impossibly competent, and fear that you won’t care about me, or want to be friends with me, because I’m so much less than what you are.” But this is exactly what you need to hear as a therapist. We need to know places where who we appear to be gets in the way of a client’s clinical process

Most of my clients have only the bare bones information about my life, and little beyond what feels therapeutically useful to share in their sessions and what they read here, on my blog. Clients are often left to guess a great deal at what my life looks like, based on how I look, my very limited office environment and what is expedient for me to share with them. Sometimes they have been known to talk about what they imagine about my life, how they think my home looks and how they think I spend my time. The life that they construct for me has a lot to say about them and their specific hopes and dreams, and often doesn't bear much resemblance to my real life. But it is a very useful jumping off point for a conversation about their thoughts and feelings about their relationship with me.