Nice in concept and it sure made sense to me, thus I never thought much about, or questioned it at the time.
Once getting through grad school and getting experience in "real life", as in gaining employment, rendering counseling services and building a "client load", it wasn't long before I was re-visiting that fundamental principle of "the client is never to blame." Initially, this wasn't because I was struggling with my own clients, but my involvement in "case conferencing" with fellow colleagues was a stark and rude awakening. My training and ethical belief about who is to "blame" when therapy stalls (remembering NOT the client) was in full frontal assault.
.jpg)
I was amazed in listening to other "highly qualified" (and supremely more experienced and "seasoned" than I at the time) therapists discuss cases in which progress was either stalled, or not seeming to make "progress", transgress into discussion related to a client's "diagnosis", their "resistance to treatment" or lack of "motivation." Rarely did I hear subsequent discussion focus on what the professional (how I came to despise that term regarding many of my colleagues) might need to examine regarding their own intervention techniques, which were and still are in too many instances, subjective analyses made by, who else? ... the therapist themselves!
On very rare occasion was that ever questioned. Instead, it was almost always about, you guessed it, the CLIENT. "What makes the client so resistant, or lack motivation, or demonstrate lack of progress ..." A convenient and pernicious way of, in essence ... yup you got it ... blaming the client! Nice and neatly packaged so the therapist could keep that dammed ol mirror neatly out of sight
.jpg)
.
I am not implying there is universal application to all therapists in the world here. There are many fine, experienced, competent and compassionate professionals out there who are delivering quality and impressive services to client's. I speak from my personal experience and journey through the jungle of my career and "socialworkdom". :) Thirty years of it and counting ...
Hindsight has left me with this "bee in my bonnet" so this post reveals the anger and pain that I hold for so many of those in the field who are rendering services to people they are more in need of themselves. Why anger? Because the quaint little adage that a "therapist can only take a client as far as they are", is likely true! Meaning of course, that if the professional has not "cleaned their own house", how can they assist others to "clean" theirs? The answer is, in lieu of miracles, they can't. The risk for clients in these situations is often either further trauma/re-abuse at most, and/or a waste of their (or their insurance's) money at least.
.jpg)
Either way, these situations certainly do not speak well of our Mental Health System, whatever that term really even means. (I pause at using the institution of Mental Health and "System" in the same sentence)... our political "system" is NOT the only thing broken in this country. And the fix has no easy answers even if there are answers to be had. What are the chances they will be identified much less implemented and achieved? And why the pain I referred to? It is reflected in the answer to my last statement ... "not in my lifetime."
.jpg)
I welcome responses, agree/disagreements, or thoughts in general.
some images borrowed from google
I agree and disagree. I think somehow all of us as both patients and providers need to realize it's a SHARED responsibility. But I totally agree that everyone often blames the patient and get a bunch of patients together and they'd probably blame the provider. We need to acknowledge to our patients when we feel something isn't working and explore other avenues and not be worried that it's a reflection on either of us alone. I have patients that many might think we hopeless, but I believe that's just because they are in a stage of pre-contemplation. So if goal is a quick fix forget it. But I try to step back when I'm frustrated and say is there another way to make suggestions and possibly embed ideas that would lead to contemplation. I'm an internal medicine doctor, so in my mind if they're already sitting in the seat and talking to a counselor, hooray!!!! They're in contemplation in so many ways. I can't get people to even go. So my big concern about all the healthcare reform talk is how will we shape the system so that we share responsibility. From my perspective, there's a lot of talk about measuring outcomes in my practice that are influenced by so many socioeconomic factors that if these measures they employ get more difficult I see the future doctor's avoiding the "difficult" patients so as not to ruin their numbers. When I'm audited by an insurance company I sometimes have the opportunity to explain yes this diabetic patient didn't get 4 A1c's this year but he's paraplegic and has been in and out of the hospital and wound clinic so much that it wasn't a good year for him. Fine they ignore him. Will that work in the new system? I also imagine it's even harder in your business than mine to figure out where to meet people. I want to meet people half way and not enable and sometimes that requires some tough love. I'm very tough when it comes to narcotics and sometimes offend patients but when I explain that it's for their own good they usually come around. But it still doesn't help when they still end up abusing a medication I wrote and I terminate the relationship. Because they may no longer be my problem but I'm fully aware the problem may be long from fixed. Again I feel there has to be some punishment for crimes or bad behavior so if I say that is what will happen it has to happen. Oh well enough diatribe. We all have to try to be objective about ourselves both as patients and providers and that ain't easy!
ReplyDeleteRebecca, thank you very much for your enlightening response.
ReplyDeleteI don't disagree with any of your thoughtful, obviously experienced and caring professional opinion. The point I was attempting to make, and perhaps not too clearly, is how often I became frustrated with colleagues who would become "stuck" with a client for any number of reasons, and the client would get the blame. My training and experience taught me that more often than not, to blame the client for counseling gone awry was not fair and sometimes bordered on unethical. Of course there are myriad circumstances and assessments for "stuckness", but in this context it is incumbent upon the professional to identify the problem and manage the solution. Since I practiced most of my years in the field of Chemical Dependency, I was impressed with your statement regarding termination of a non compliant patient in their medication regime. A few times I worked with client's who became addicted to prescribed narcotic medication and presented with an added dimension to their denial stating "but the doctor GAVE it to me, so how can I be to blame?" I understand "iatrogenic" addiction, because I was fortunate enough to work with a few physician's who referred an INFORMED client to me with a treatment plan for de-tox and tappering of the medication which included the client's input and agreement. Such clients were few and far between, but were more likely than not to successfully complete treatment without incidences of relapse. Without such understanding, unfortunately many others did not fair so well.
I thoroughly believe it is the responsibility of the treating professional to terminate a client when there is non-compliance or obvious INTENT to refuse following a mutually agreed upon treatment plan, particularly if there were instances of multiple revisions focused on maintaining compliance. I think that is the only responsible thing to do irrespective of the client's response. I was much more comfortable with a client blaming ME or "hating" me for doing what I believed was ethical, than continuing with a client when it was clearly not in either of our best interests, or terminating a client and blaming THEM. How does it make sense to blame someone for being sick?
I didn't and don't mean to imply a client has no responsibility in their treatment, no matter the context. But it is the trained professional who must manage the relationship, set the boundaries mutually develop the treatment and to the best of their ability, assure the client understands and agrees with same.
I think I may have posted too succinctly an incredibly complicated issue, but my goal for this blog is to appeal to a potential readership who may hold unwarranted guilt/shame stemming from an incompetent therapist who caused more harm than good. As much as we wish this weren't true, it IS, because I saw way too much of it.
Thanks again for your input and I suspect you have a medical practice that consists of many satisfied patients!