In Psychotherapy: Clients are neither saints nor children
They lie, they manipulate; and that's okay.
The lies we truth!
I once made a LinkedIn post (https://www.linkedin.com/posts/samuel-atilola-24bba81a6_except-you-give-me-a-reason-to-doubt-you-activity-6999257935033851904-icAG?utm_source=share&utm_medium=member_android) in which I asserted that a psychotherapy client, technically, never lies. And though I still stand by that assertion 100%, I'll now add that I don't think clients are always right (unlike customers, as the shop joke goes). What is 'true' for the client, as perceived and expressed by them, is not necessarily true beyond and outside of the client's experiential and perceptual boundary. The truth a client conveys with speech is essentially a psychological truth and, by definition, strictly subjective and bounded. Also, because speech, unlike behaviour, is constructed, it’s more susceptible to conscious influences of all sorts. This means that the validity of a client's verbalized truth outside the psychological space commandeered by him/her becomes progressively less objectively tenable as we move away from that space. This fact becomes even more relevant in psychotherapy when one is in fellowship with a client unpracticed in the habit of venturing and operating outside of their own bounded reality. But this is by no means a fundamental drawback since therapy essentially operates in subjective realms and transacts in subjective language.
Unfortunately, clients manipulate truth, a lot; to themselves, about themselves, about others, about the world, and to others, sometimes without realizing it, and sometimes knowing fully well what they are up to. (And by the way, therapists do, too.) It is usually not a straightforward lie, and if anything, it is often a sincere lie, a functional lie - a lie with a goal in mind or out of mind. There's nothing wrong with this self-protective, often instinctive behaviour in itself as it's universal. The ego dreads exposure and would not ordinarily offer to reveal its messy and guilty underlayers, hence its ingenious adoption of diverse mechanisms to defend itself against crude unraveling/awakening.
However, if therapy must transformatively impact the client, it must transcend (not ignore or dismiss) the subjective dimension of client's experience. It must always strive to project itself beyond the subjective space and language into co-subjective (with the therapist) as well as intersubjective (with significant others) spaces and language. It must strive to move from the oft dominant first-person perspective and narrative into the more difficult other-person(s) perspective and language. The "I/me" becoming the "she/her" or "they/them" and vice versa, as the case may be. There are a few class of clients that suffers from the reverse of this problem: their discourse, both internal and external, is largely focused on extra-subjective (outside-the-self) spaces. Here, it is the chief task of the therapist to help client reorient inwards in order to redress this imbalance of awareness. I must acknowledge that these operations are better explained than achieved.
Hence, as a therapist, I'm increasingly realizing the need to learn to hold two mental attitudes towards psychotherapy clients: one of empathy (support, regard, validation, acceptance) and one of antipathy (opposition, challenge, question). The first attitude builds therapeutic alliance, interactive congruence, and emotional resonance, while the second ensures psychosurgical penetration, treatment impact, and process integrity. In other words, while I want my client to optimally feel safe and supported, I also don't want them to feel psychologically complacent and static. Empathizing doesn't care much about objective, co-subjective, and intersubjective truth as it does about subjective experiences. Antipathy, however, ensures this vital goal isn't lost while trying to validate the experience of the client.
How is this delicate balance of therapeutic dance to be achieved without compromising either of the humane or the scientifico-logical aspects of therapy? How is one to deal with hypersensitive and fragile clients without alienating or intimidating them away? The trick, I believe, is in timing and weighting.
Timing: there is a period in the therapeutic encounter that empathy must predominate over antipathy (especially at the beginning when the chief goal is to establish connection, catalyze hope, as well as engender a sense of psychological safety). At this initial stage, the Rogerian, nonspecific factors has the greatest utility and ought to be prioritized. But it is highly crucial that even at this stage, one takes care to signal (in subtle ways) to the client that this isn't going to be an exclusive exercise in emotional cuddling and universal validation. It is similar to the act of dabbing the injection spot with some soothing ointment before the skin receives the needle or to the application of anaesthesia before a surgical operation is executed. The client must be made to realize that you're going to poke and probe when and where necessary but not without sensitivity to their comfortability while taking active measures to reinforce their sense of safety. (Client needs to understand that the alternative to psychological exposure is psychological enclosure - an alternative that promises and secures safety in the short-term but tend to worsen misery in the long-term.) The deployment of antipathic techniques is then expected to increase in frequency and intensity as the client becomes increasingly assured of their therapist's genuine commitment to their wellbeing - this is the art of weighting. In other words, when the client no longer has reasons to doubt their therapist cares deeply about them, their fragile and sensitive ego may be more willing to submit itself to and tolerate painful psychological operations.
This is crucial as it helps to signal to the therapist whether this is a client who has come for serious work on the self or merely for endless validation and soothing (which in itself is both diagnostic and prognostic). If it turns out they're the latter sort of client, the therapist must ask themselves (1) if this client’s need is consistent with and sufficient for their presenting problems (2) if the client's expectation is consistent with their own practice philosophy (which isn't the same as practice model).
It becomes detrimental to the therapy process when therapists allow themselves to be completely absorbed into the deeply motivated narrative world of the client so much that they lose touch with grounded awareness and sound judgement. Mindless and endless validation is not the sole task of therapy and psychotherapists (except in some very limited subtherapy sense), and a client who is incapable of even the least critical engagement is perhaps better off staying away from therapy if they're not to end up blowing a lot of money on ephemeral feel-good moments with no lasting impact. In fact, this intolerance of critical self-examination is diagnostic of not just therapy outcome but of general interpersonal difficulties and can be a focus of therapy in its own right.