What you’re proposing and the status quo

Emily Rose asked 'Are we asking too much from our clients?' (February 'Letters'), addressing the issue of depressed clients who are not 'completing their homework'. Whilst I applaud her desire to review what is going on, I would like to share my experience as an integrative psychotherapist working in a private practice with clients presenting with symptoms of depression.

First, I would challenge the 'mind-set that to have successful therapy, the majority of the work should be done by the client outside of the sessions'. For my clients to dare make changes outside our sessions, first and foremost a solid alliance must have been co-created between us. And at the forefront of forming such a good alliance I would put 'do not shame' and 'talk about shame!'. Clients, and particularly those suffering with symptoms of depression, are very shamed-based. It follows that not doing a 'goal' might exacerbate this shame, self-loathing etc. So, rather than seeing the 'homework' or any change that my client might make outside sessions as a 'goal', I use their attempt, refusal, forgetting etc as a process to be phenomenologically explored in our sessions. This is where the fruitful work takes place… instead of talking in terms of goals, we end up talking of needs: what do they gain from staying in the status quo?

For some it is allowing themselves, for the first time in their life perhaps, to say 'no' to a figure of authority (here, the therapist). For others, it might be the need not to take on any more responsibility, having had to shoulder too much too young for too long. For others, it might be the need to not stop loathing themselves, believing they do not deserve a happy life (and we then go on to explore this masochistic need). And so on.  

Only once this more important need(s) in my clients has been seen, spoken out and not judged, can we together explore how this need(s) might be addressed more helpfully today. And only then will my clients move on towards allowing themselves to make more helpful change towards leaving their depressed position.

Corinne Lowry
Barnet