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How to Become a More Flexible Therapist

3 prime principles for tailoring therapy to individual clients

Sometimes your client will need you to shift your shape a little in order to help them.

“Each person is an individual. Hence, psychotherapy should be formulated to meet the uniqueness of the individual’s needs, rather than tailoring the person to fit the Procrustean bed of a hypothetical theory of human behaviour.”

– Milton H. Erickson, M.D.

Daphne was 85 if she was a day.

She hadn’t trusted her previous therapist, who she’d hoped would cure her chronic fear of the dentist.

“He kept insisting I’d been in love with my father and must have suppressed sexual fantasies about him and wanted to kill my mother!” she said, not without an air of bafflement.

“And that’s why, he said, I had this fear of the dentist!”

The psychoanalyst she’d seen before me appeared to have been so invested in his own psychological ideology that, with no evidence, he had presented his Freudian conclusions to her as though simply knowing these ‘revelations’ would be enough to lift her toothy terror.

“It was disgusting,” she said, “suggesting I fancied my dad. Yuck!”

Blindly buying into therapeutic ideology without considering context can make us less effective therapists because we tend to see theory first and take the evidence of our senses and common sense as secondary.

Reality trumps theory

Reality has a way of interfering with our carefully laid plans and theories. We’ve learned our methods and gained all our suppositions as to how clients are supposed to be and act… but then, lo and behold! The client reacts contrary to what we’ve learned. Most inconvenient!

If we are inflexible or have learnt rigid protocols (like hypnotherapists who read a limited pool of scripts to their clients regardless of individual differences) then we struggle to make the person fit the theory or protocol.

Like Cinderella’s sisters, who try to force the glass slipper to fit their feet when it clearly doesn’t (and in the original story even cut parts of their feet off Procrustean-style to try to force the slipper to fit!), we try to get the client to fit what we’ve learned – and maybe call them defensive or resistant when they just don’t comply!

But the truth of it is that, unless clients have been trained as we have, they don’t know they are supposed to:

  • have an inner child
  • live a life of Greek metaphors in the style of Freudian therapy
  • go through five set stages of grief (as advocated by Elisabeth Kübler-Ross)
  • have an internal ‘timeline’ (as taught by Neurolinguistic Programming [NLP] practitioners)
  • have a parent-like, an adult-like, and a childlike part of themselves (as with Transactional Analysis).

Now many of the metaphors used in all kinds of different psychotherapeutic theories are or can be useful, if the practitioner remembers one important truth.

The map is most definitely not the territory

We need to remember not to mistake what is metaphorical for what is literal. The metaphor of an ‘inner child’ may be immensely useful for some clients and immensely useless for others depending on individual differences.

To use a cliché, if all you have is a hammer, you treat everything as a nail.

But when we transcend tight, one-size-fits-all theory and see the human givens that people are metaphorical beings and often use their own metaphors, we don’t have to assign tight metaphors, such as Greek myths or child/parent/adult in one person or inner child, to our clients. We don’t have to try to force technical metaphors upon people who don’t think technically. Rather, we can adopt and use the metaphors our clients uniquely and individually use and relate to.

None of this is to say that general understandings don’t apply to everyone, everywhere, to some extent.

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Shared human experience: Why the map needs precision

People tend to depress in similar ways. Trauma works in recognizable ways in people everywhere, and we all share primal emotional and physical needs to varying degrees.

These truths make up the territory of human experience, and the more they are mapped by biology, neurology, and anthropology as well as psychology, the closer our maps align with the territory that is really there (not simply fabricated by an inventive theoretician!).

For example, the Rewind Technique is aligned to what we know from a neurobiological perspective of what happens in the traumatized brain and how trauma is relieved. Freudian theory, on the other hand, was never based on scientific observations – so the map was inevitably a distorted version of real human experience.

That’s not to say that the map was entirely wrong – just as the very first maps of the world bore a faint resemblance to the actual landscape but weren’t too helpful for real navigation.

But even working from a Human Givens perspective, we need to be adaptive and flexible with each client within that framework of understanding.

We need to modify our approach, perhaps using metaphors and forms of well-tested techniques that are uniquely tailored for them.

So here I’ve put together a few pointers I hope you’ll find useful.

Principle one: Speak their language

When working with clients I might communicate basic principles of theory. I might talk about the fact we all have emotional needs, or give a rough sense of how the cycle of depression works, or explain how trauma becomes established in the brain and how the post-traumatic effect of this can be lifted.

Often clients find such rough sketches from theory and practice reassuring. But I try not to use psychobabble or jargon or go into great theoretical depth, because a client shouldn’t have to work to build rapport with us by learning our lingo.

We should learn to speak their language.

A client shouldn't have to work to build rapport with us by learning our lingo. We should learn to speak their language. Click to Tweet

If a client is interested in sports, I might use sporting metaphors or analogies with them. If it’s computing or movies or music or crafting, I might use these understandings in my communication with them.

I’ll listen to their metaphors and choice of words and use those ideas with them when I’m communicating, including when I use hypnotic inductions – which are always tailored for them, even if the induction framework is a standard one. Within a structured induction we can still use words and ideas that align with the client’s unique way of communicating.

We adapt our approach to them so they don’t have to adapt theirs to ours.

Getting too theoretical with clients, insisting the client fit a certain mould like some wrong-footed Cinderella sibling, may be a sign of therapeutic insecurity.

Principle two: Learn to tolerate uncertainty

Sometimes it’s not at all clear initially what a client needs from you, or even what the problem is. In such times, because we feel we must appear to be the professional or expert, we may leap to conclusions based on theory simply to help us feel better.

  • “Ah, you must be traumatized!”
  • “Your inner child must be hurting!” (whether this is a metaphor which chimes with them or not)
  • “You’re in denial!”

And so on.

But sometimes we need to just sit, gather information, let the client talk, and not jump to any theory-based (or indeed any) conclusions prematurely.

We need to get good at not knowing… yet.

Learning to tolerate and even relax with uncertainty so that we don’t feel the need to hide behind theory as to what should be happening is a key and core skill for therapists, and comes through experience and awareness that it is a skill we need to develop.

A good therapist isn’t wedded to a hypothesis and is prepared to adapt their response and ‘go off-script‘ sometimes.

Principle three: If something isn’t working, try something else

So often when a client has told me what they want to see me about before they actually come, I’ve prepared and planned in depth what I would do with them. Often, though, I’ve had to partially or even completely abandon those plans when I actually met the person.

In this account of my work with a client in a nursing home, I had planned to use Rewind with the elderly client who had developed a phobia. It was all going to be so simple and neat.

But when I actually met her, going from preplanned map to territory as it were, I had to totally change my approach.

With another client, Sally (who you can read about here under the “Enjoy your Trip” heading), I’d assumed I’d use hypnotic procedures… and I did, to some extent, but the real therapy happened away from my therapy room via an approach that I hadn’t foreseen at first and only tried after other approaches had been less effective.

We need to be prepared to make room in our minds for alternative motivations, meanings, and explanations for what our clients bring to us and, if necessary, try something different until we find the approach that does work.

Becoming truly creative

Ultimately, we need to remain open-minded to see what’s really going on. We need to see our clients directly and clearly, not obscured through a distorting screen of overcomplicated theory or therapeutic ideology.

We can allow for the possibility that what works for many people won’t necessarily work for this particular person.

If we use hypnotic therapy, we need to be adaptive and creative with that too.

We can learn to use and sometimes trust our unconscious minds, our intuition, to provide solutions that come from us having first relaxed with not knowing.

Ultimately theory can be useful if it’s based on the human givens of the human condition collected from scientific observation.

Rather than mistaking metaphors for literal truths and leaping to premature conclusions, we need to relax and let our clients show us who they are and what they need as unique human beings who might need unique therapeutic interventions. Interventions that, while still aligned with recognizable principles of what it means to be human, may look to the outsider nothing like any theory.

I’m happy to say that Daphne did, once we’d ditched the Freudian Greek sex metaphors, become calmer visiting her dentist!

Watch Many Clients Treated by One Therapist

Mark demonstrates the principles of tailoring therapy to your clients in over 100 filmed client sessions inside Uncommon Practitioners’ TV. As a member you can watch sessions whenever you like, wherever you like with our easy-to-use mobile App, or on your computer if you prefer. You can read more about it here.

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Mark Tyrrell

About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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