Why I Use The Client-Centered Approach To Therapy

Client Centered Medicine Client Centered Therapy Heroic Client 

Recently, I spent a little over an hour in an Emergency Room after having a mishap on my road bike while cycling in Maui. Having had my start in college in Nursing School completing the usual clinical rotations, the ER is a familiar place. There are machines that beep, locked glass cabinets with temperature controls and potent drugs, every kind of needle gauge and tubing within the push of a doctor’s exam room chair, and a crash cart ready to be used to save a life. 

Once the ER physician debrided the wound and extracted the piece of asphalt jutting out of the fatty tissue below my patella, I began my usual routine of assessing the state of healthcare from the distal end. “How are we doing?” was the question. While my practice exists in an office outside of the world of the hospital, I am still very much inside the healthcare world.  And when I am the patient, it gives me a chance to assess the power of client-centered medicine and therapy.

We didn’t do so well that day. Though the visit was quick and the experience not particularly unpleasant for what it was,  I began to wonder what happened to the client-centered approach as I ambled into the ER reception area. No one offered me wheelchair. And if that shocks you to hear that, as blood dribbled out of my knee, this wasn’t the first time. I had an experience only eight months earlier, where I had to hold myself up with the sliding glass doors of an ER as I dragged my dehydrated body towards the reception desk. It took two people to finally call someone to bring the wheelchair. Forty-five minutes later, I begged a nurse to give me water to swish out my mouth to clear it of the taste of vomit.

Really?

Yes, really.

The Sharp Samurai

When we think about the image of the Samurai, we often think about a Japanese man with a top knot and a sword. The Samurai were defenders of villages, asked by the Emperor to defend their lord and his people.

Yet the meaning of the word comes from saburai, which means to serve someone. When samurai were not sent off to protect or defend, they were often found engaged in the practices of service, whether that be tilling land, keeping accounts of food to prevent famine or starvation, or doing the daily activities of discipline that kept their bodies and minds strong but also benefited others, including worship at the temple, and running errands.

Somewhere along the way of improving the way I think about therapy, healthcare, and service, I have considered myself  a type of samurai: The Sharp Samurai. I am here to serve, and that makes me a type of servant who engages in all kinds of behaviors for the improvement of health and well-being for every person who walks through the door. Included in those activities is the knowledge of how to wield my words as to cut to the chase, get my fingers around the necrotic (t)issues of the heart and soul, and heal emotional wounds for the good of the individual, family, community, and world. 

OK, ultimately I serve a government-run program, “healthcare” lord, because I do accept insurance as a form of payment, and I have submitted myself to the university system for a degree and state law for a license to practice. I abide by what is asked of me to fulfill my obligation as a healthcare practitioner, beginning with the oath to take care not let a patient experience more suffering or harm.

But the idea of “do no harm” is not enough. The Sharp Samurai as Healthcare Practitioner must also see the client through his or her lens. Look at the way the client is sitting. Is she slouching? Is she rubbing her shoulder in discomfort, repositioning every few moments to prevent pain? Is the light in the room shining too brightly, or not bright enough? Do the blinds need to be adjusted? Does the client seem dehydrated, tired, sullen, or hungry? Is his soul heavy with grief and hopelessness?

The Sharp Samurai is not too proud or haughty to simply offer a cup of tea on a cold day, especially if it is exactly what the client needed. Just the offer can stir the therapeutic moment, creating bonds of care, trust, and acknowledge that we both stand in a healing environment pointed at wellness for both receiver and giver. And the Sharp Samurai is poised for surgery, quickly excising that which is killing the client, slowly but surely.

My Kingdom for A Painkiller

There are a handful of clients over the years who have experienced interventions on my part that go well beyond the typical routines of everyday psychotherapy practice. I have hospitalized clients who were too weakened to do it themselves; I have encouraged them to host a call in the middle of a session to their doctor’s office to assist in getting them a priority visit in lieu of a more expensive urgent care visit (based on my triage skills); I have called a client’s physician after receiving signed consent and helped in determining medication and dosages of appropriate psychotropic medications.

But after the lidocaine wore off from the four main stitches placed to seal up the hole in my knee, I was in trouble. No amount of dark chocolate or OTC Tylenol was going to help me, and at 3 am, I attempted to hobble to the bathroom to see if I might have anything a little stronger in my vanity kit. Who would help me now? Who would intervene for me?

I didn’t make it but ten feet before I was biting back tears of pain. Why didn’t the ER doc give me a prescription for pain medication? Why did he tell me to enjoy the rest of my vacation, if he knew I would be crying less than twelve hours later? 

My roommate for the week, an experience triathlete and ultrarunner, woke up out of her deep slumber and showed me her wares. I basically had my pick of a number of very good painkillers, and by knowing their compounding techniques, could pick the one I have no allergies or reactions to, namely 222’s Aspirin, Codeine, and Caffeine (essentially, Extra Strength Excedrin with morphine’s sassy little sister, Codeine).  After taking one of those, I was able to go back to sleep, even with the caffeine, and feel like a human being again.

My roommate was my Sharp Samurai. And boy, did she throw it down!

In my graduate program, one of the professors kindly reminded the students that our primary job was not to offer relief from pain (in this case, emotional pain). I hear that, and at the same time, there are some pains that if they are not diminished enough for a person to tolerate, they will feel like an animal. The pain of a sickle cell crisis, for example, is one of those kinds of physical pains that are like no other. The feeling of a panic attack is also a moment that demands immediate relief.

I will never be slow to offer a client who appears to be going into a high degree of anxiety or into a panic attack the care that s/he needs to alleviate — yes, relieve! – this kind of suffering. Similarly, I believe the client centered approach demands that that we constantly look at what the client is experiencing and messaging throughout the session hour to help them get better.

Out the Door With You

Recently, a friend mentioned to me that one of his reasons he had hesitated from

ever “trying” psychotherapy was that he worried that a therapist would have a conflict of interest between maintaining a thriving business with returning clients and helping clients so quickly that the therapist would need to constantly generate new clients to stay afloat.

After listening carefully, I said that his concerns were valid.

I followed that statement up with my personal thoughts about why I love being a psychotherapist. It is my joy and passion to help people, and by helping them back out the door and into the world as happier, stronger people, I get a real, personal “hit” from doing my work well. Sure, it’s sad for me to see a client for the last time, never knowing what happened to them unless they write or call. That is the nature of this profession: if the therapist-client relationship has ended, I don’t stalk you, you don’t stalk me, and I wish you a happy, amazing life “out there in the real world.”

And I wish you the best, I really do!

When my friend heard these words, he audibly sighed.

Whether he will seek therapy or not is yet to be seen. I spoke the truth about what I believe. Getting you out the door and back into the world as a healthy, empowered, happy individual or couple or family is at the core of my value set. I do everything in my power to help you choose this pathway for yourself, and I respect that you will go as fast — or as slow — as your healing process demands.

Slow is not necessarily bad! Fast is not necessarily good! These are relative terms to what the Client decides is right for him or her. I like to say to the question, “How do I know when I’m done with therapy?” this simple statement, “You will know when you are done. I will be the first one applauding you as you walk out the door, smiling and teary-eyed at your growth and progress.” 

So, out the door with you! In the Client-Centered Approach, YOU call this one, because I respect that you know when you are done, when you’ve had enough, when you need more, when you need to slow down, and when it’s time to stretch your legs and try some things. My main role is give you feedback, to help reflect what I’m seeing, and to resource you with plenty of examples, practice, homework, and reflection, all within the methodologies approved in counseling practice, to help you.

In essence, it does not truly serve me to do as this friend mentioned — to try to keep you returning any longer than the time you need to heal, reflect, and act.

Someday, I’d love to do a comparison study between Evidence-Based Medicine as applied to Psychotherapy, and the Client Centered Approach, where the Client is the hero and the primary leader of his or her own therapy. There are independent studies, yet not many comparatives on what heals. I have a strong theory that the Client Centered Approach, where the medical professional serves the client, is the one that heals.

Until those scientific proof are in, I hope you’ll accept and interpret my offer for a cup of tea to mean so much more than hot water with a bag of herbs in a cup and saucer.

P.S. Ten days after the stitches were placed, I had them removed. The rock is now being turned into a piece of jewelry to help me remember it always. And I’m back up on my bike and preparing for the Victoria 70.3 Half Ironman race in June.