Client Age And Decision Making Skills

As in the rest of life, it's not too difficult for us "more mature" therapists to look at all those much younger folks and be able to notice instances of what we might more critically call foolishness, and more generously call, perhaps, inexperience. An example:  a young adult client came to therapy routinely, ie., about half the time, late. Our sessions took place in the morning - the only time our respective schedules matched up - and this person is not a morning person, so getting up and out for morning activities is challenging under the best of circumstances. In any case, I found it therapeutically necessary to broach the subject of late arrival on two occasions, separated by a few weeks. Clearly the first discussion had little impact on the client's behavior, or on the client's awareness of why this behavior might be problematic, or on what the behavior might be communicating both to me and to the client. The second discussion, which occupied an entire - shortened - session, ended with the client's comment that it still wasn't at all clear that this behavior was a problem, or that the client wasn't yet convinced of the importance of the subject at all.

Hmm. Now, we talked about things like personal responsibility to one's obligations - as in a client's obligations in a therapeutic alliance; about what demonstrating either a respect for or a lack of respect for one's own and for a therapist's time and commitment might look like; about what might be getting communicated non-verbally by the behavior; about possible feelings and attitudes the client might have had regarding authority, in particular male authority. This client wasn't especially self aware, and much of our work together was focused on developing various aspects of self awareness, which the client acknowledged was helpful and useful.

Of course, young adulthood is loaded with all kinds of challenges and growth opportunities, and the reality that developmental progress requires time cannot be forgotten. At one point in our second discussion the client said that they were starting to feel "attacked, and punished". You'll have to take my word for it that there was neither any attacking nor any punishing going on from my end, which makes this comment especially informative. And we did talk about it. Part of what became clearer to the client, I think, was that it was the client's responsibility to make decisions about their behaviors, not mine, and that it was a part of my responsibility to point out possibly self defeating behaviors. I believe that this realization was somewhat startling to the client.

Here I was, a male authority "father" figure, being uninterested in either criticizing or "punishing", and in fact articulating and supporting the young adult client's right to make and responsibility for making their own decisions. This is true for any client, of course. My musing in this post is about a way this particular theme might present itself in therapy with a younger client in therapy with a much older adult, and about how clearly it might appear that the kinds of awareness and skills required to be able to make such responsible decisions
isn't in any way a given, and about how clearly it might appear that the maturity necessary to be able to make such decisions does, indeed, often, come only with age and with experience.

Like the young substance abuser or addict whose behaviors can be clearly seen by others to be self destructive, but who is "sill having fun", the time simply has not arrived, and the awareness and skills have simply not yet developed to be able to make responsible decisions regarding their actions. Ah, perhaps it is after all oh so very true that that most precious of conditions, youth, is indeed wasted on the young.

"Part Time" Therapy: Yes Or No?

By which I mean, as a client, coming to therapy on alternate weeks, for example. People ask me about this not infrequently, and over the years I've experimented with seeing people less than weekly, almost always because of the client's stated concern about cost. You might already guess just from the title of this post that my opinion of such an arrangement is less than a enthusiastic one.

Really, I think this "part time" approach to therapy  is based in an essential misunderstanding of the nature of therapy, and of what one might hope to gain from undertaking a "course of treatment". I suppose there might be exceptional circumstances under which, for example, it might be appropriate to take only a partial course of say, antibiotics, rather than the usually prescribed full course. Three days rather than seven or ten, say.
Similarly, I suppose there might be what I'd consider exceptional circumstances under which a partial experience of psychotherapy could be acceptable. But let's put these exceptions aside, for the sake of this discussion. Under ordinary circumstances, why would a diminished approach to therapy be problematic?

Let me list some possible, or even likely, reasons:
avoidance; inefficiency; power/control issues; loss of focus;  self sabotage.

It seems to me to be a no brainer to understand how coming to therapy less than weekly could be easily used by a client to simply avoid the real reasons for coming to therapy at all. More time between sessions, more time to become distracted, more time to "forget" to do assignments, more time to lose focus, more time to avoid. Which includes all the other reasons listed as well. Such an approach is simply an  inefficient use of therapeutic time and resources; not that I think efficiency is a value unto itself. It so happens that I do not. However, a failure to consider efficiency at all, is also a mistake.

And then there are the over arching themes of momentum and consistency in therapy. These qualities of a therapeutic experience seem to me to be important and desirable; perhaps necessary for effective therapy to take place.

My conclusion:  nah. Not worth the time or effort, as a rule. Save your money and go have a lovely night out or a weekend away instead. It would probably do you about as much good.

My Website:  mdavid-lpcc.com