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No, I Am Not Taking New Patients…But New Clients Are Welcome

A quiet revolution is happening in the mental health field. People seeking help are realizing that ‘therapy’ can be focused on what positive patterns they wish to grow, rather than on what’s wrong with them. The focus of the work is on cultivating new habits, beliefs and attitudes- growing the toolbox, rather than on recounting at length what went wrong that week, or in a distant childhood. This reduces the tendency to see oneself as victim, broken or sick.

Believe it or not, this work can be done without a diagnosis of a psychiatric disorder, which is often the organizing concept around which much therapy is conducted.

“You have an anxiety disorder,” many people are told, when they tell a therapist or psychiatrist that they are struggling with experiences of anxious feelings or thoughts. A disorder has been established, a treatment plan put in motion, and a patient identified. Time to call the insurance company, and have the diagnosis entered into the permanent medical record.

Many of my colleagues, whom I largely respect and many of whom I care about very much, use the word ‘patient’ to describe the people they work with. For many of them, I suspect, the word is used innocently- without awareness of the patronizing quality it carries. Perhaps for some therapists this may be part of building a professional identity. The word ‘patient’, after all, makes the work sound more impressive, and lends a certain gravitas. Unfortunately, for some therapists it may be part of a self-serving (though often out-of-awareness) view that is embued with the idea that the ‘sicker’ someone is, the more therapy they need, and the longer the therapist can count on a paying customer.

It’s only a word, I know, but it’s the tip of an iceberg that encompasses assumptions about what therapy is, how it works and how the therapist sees themselves as different from, and distant from, the client. It’s part of a kind of glass partition between they who are well and those who are sick, and it supports the view that something called ‘treatment’ is necessary.

Sometimes this view is seen in graduate training programs that caution trainees to never mention any personal information or, heaven forbid, display a family photo where it might be viewed by a client- for fear this might disrupt the ‘treatment’. This fear-based fantasy is part of what can keep people stuck in ineffective therapy, as the therapist views them as sick, and communicates this to them in subtle and unsubtle ways. It’s disempowering to the client, and I believe, to the therapist. Personally, I tend to trust that the vast majority of my clients are able to process a picture of me with a family member without unraveling. I don’t believe they, or the work we are doing, is so very fragile, and I don’t want my work based in a fundamental fear of the people I work with.

How are our clients to trust the process, and take chances with us to be real, if we don’t trust them with a look at our kids, dog or partner?

I have found that sharing myself more openly with my clients lends a realness and a sense of trust to the relationship. I have no desire to even imply that I am in some way better, more evolved, or less challenged by life than my client. I often joke with my clients that I have tried all the coping skills I teach on myself first.

I am not offering ‘treatment’. I see the work I do as providing resources. I am not taking new patients- because I don’t view the people I work with as sick, and I am not a doctor. The work I’m more interested to do is teaching people options about what is likely to help them respond more skillfully to the challenges they face, and what is likely to produce thriving.

Now, would you like to see a picture of my dog?

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