Establishing Direction in Therapy

I have become increasingly intrigued by Carl Rogers' work as of late. He really is an incredible inspiration to me and a pioneer in the field of mental health. Carl Rogers is like that badass grandfather that's kind of the rebel of the family, adopting modern ideas that people of his generation don't really jive with. I love his rebellious spirit and I imagine that he had kind of a cool edge to him as a person.

The majority of the clients that I work with present with pretty complex cases and diagnoses, and they land on all ends of the spectrum in terms of mental health. Dealing with such complexity and variation of issues can be difficult at times in terms of direction in therapy. In trying to get "unstuck" when feeling overwhelmed by this, I have found myself looking to the work of Carl Rogers for inspiration and I have started to adjust my approach to therapy.

As therapists, we often put this pressure on ourselves to be "the expert in the room."

This pressure can actually cause us to clam up and be inauthentic. Carl Rogers' person-centered approach challenges this idea that we are the experts. The client is actually the expert of their own life, and I have started to remind my clients of this in an effort to empower them and let them take the reins in therapy.

In working within this framework, I have also begun having the "direction" conversation. Personally, I have been to many therapists in my lifetime. I have never had a therapist ask me about previous experiences in therapy and what works/doesn't work for me. In retrospect, I probably would have wasted much less time in therapy if this conversation had taken place. Many times I was not mentally/emotionally in a place to advocate for myself and was afraid to tell my therapist that their approach was not working for me. By having this conversation, we avoid this happening to our clients. Asking certain questions that give us an idea of the client's past experiences in therapy and their expectations is extremely helpful to us in terms of establishing direction in therapy. It also establishes the fact that the client is in charge, which I am finding is so important and often leads to more positive results.

Some of the questions I ask, ideally during the first session, include:

1. Have you been in therapy before? If so, when and for what length of time?

2. What was your experience in therapy in the past?

3. Were there any methods used in the past that have worked for you?

4. Were there any methods used in the past that HAVE NOT worked for you?

5. What do you need from me in order to best support you?

These questions have elicited some very interesting, sometimes unexpected, responses. As an example, I had a client recently who has PTSD. Her trauma history is extensive. Asking these questions not only gave me a good idea of which direction we should go in in therapy, but also what pace she is comfortable with and what kind of structure works for her. So for example, she shared that a previous therapist would give her an assignment to work on in between sessions and that this was very effective. However, she has had therapists push her too quickly to share traumatic memories, and this has not been helpful. I also got a very good idea of what her triggers are, which is something that's really important when working with clients with trauma.

So I encourage you to let go of this notion that we should be the experts and immediately know what direction to take with our clients. Treat them as though THEY are the experts and you will see how they flourish. If you're struggling to find inspiration, check out some Carl Rogers demonstration videos online and enjoy a nice perspective shift!

Your hustler,

Karina G.