My clients usually tell me about the symptoms first:
“I can’t sleep.”
“I worry all of the time.”
“I can’t focus.”
The symptoms are certainly important. They tell me about what is happening in the here and now. They tell me something about the client’s everyday life. However, the symptoms are not the story. The story may have started recently, or a long time ago. The symptoms represent a turning point in the story, and that old coping mechanisms are no longer working. The clients arrive at the end of their rope, feeling overwhelmed and out of ideas.
The first task of counselling is to slow things down. We need to take a step back from the symptoms and see what exists around them. This is the story. The problems that people experience are embedded in a complex history that contains memories, thought patterns, habits, and ways of relating to others. This goes far beyond the symptoms, and usually reveals the client’s background and enduring ways of relating to the world (the personality). By slowing down, we can examine personality patterns of acting and reacting. This acting and reacting is often automatic and outside of conscious awareness. This is why people feel that the same things always happen to them – over and over again. By slowing down and examining the story, the automatic moves into conscious awareness. From there, we can work towards establishing new patterns and making different choices.
A good outcome is defined by the client. It usually involves the alleviation of symptoms, but most people want something more. The research indicates that when counselling focuses just on symptom relief, clients might experience short-term improvement but often relapse (and usually pretty quickly). Most researchers suspect this is because the enduring patterns (the personality) were not addressed in the first place. These enduring patterns often prevent people from living the life they truly want. Although every client has a different aim for therapy, the most common goals are: 1) A strong sense of self-worth and identity; 2) To improve the quality of relationships, and; 3) To understand their own feelings and behavior. Obviously, goals like these require a trusting relationship with a counsellor and a commitment to change.
There are many people who want to change, but there are obstacles in the way. Cost. Waiting lists. Difficulty accessing services. The Psychologists’ Association of Alberta is currently advocating for increased funding and public support for mental health services: (https://psychologistsassociation.ab.ca/about-paa/).
We believe that all Albertans, regardless of income, should have access to psychological services. To protect the public, we believe that psychotherapy should only be provided by a regulated health professional (e.g., Registered Psychologist; Psychiatrist). I am hopeful that our advocacy efforts will improve the lives of all Albertans and make accessing psychotherapy much easier. All Albertans deserve a chance to make positive change, supported by a regulated professional committed to ethics and competence. As it stands, it is far too difficult for most people to share their story. Many Albertans do not have the extra money to establish a trusting relationship with a psychologist. They feel rushed because they have finite resources or a limited benefits program. In psychotherapy, this has been referred to as the “tyranny of time” (Shedler & Gnaulati, 2020). In fifteen years of practice, I have yet to meet anyone who wants to be hustled through their story. We need to give people a real shot at change and connection.
References:
Lambert, M.J., Hansen, N.B., Finch, A.E. (2001). Patient-Focused Research: Using Patient Outcome Data to Enhance Treatment Effects. Journal of Consulting and Clinical Psychology, 69, 1590-172.
Shedler, J., & Gnanulati, E. The Tyranny of Time: How long does effective therapy really take? (Psychotherapy Networker, March/April 2020).