10 Ways to Enable Your Clients Feel Safe and Held in Therapy in a World Which Can Feel Very Unsafe
‘Cash for honours enquiry deepens crisis for Royals’
This was the headline on the front page of my paper this morning. It comes on the back of Prince Andrew, Partygate, Ukraine, The Met Police Commissioner resigning, huge increases in the cost of power, fuel and food and of course there’s Covid.
John Bowlby wrote about ‘A Secure Base’. Right now many of us are experiencing our collective base as anything but secure. Many of the things which we used to take as secure we’re now finding out are not. Pandemics were something from history. We could count on our leaders to take good care of us.
What has happened is that our collective caregivers have let us down.
Our collective parents have left us to fend on our own, to swim in deep waters without our armbands. In my view this perceived failure of authority figures is one of the main reasons that we therapists are seeing such an explosion in the number of people entering and returning to therapy with anxiety, insomnia, depression and relationship difficulties.
To people entering therapy it can often feel like a huge deal. They don’t know us, they could be scared of what we might discover, they could have doubts about whether therapy might even make things worse for them.
One of the most important ways in which therapy works is by providing a secure base. We need to facilitate what Jeremy Holmes calls ‘Exploring Insecurity’. The word Insecurity has two meanings here. The first is to enable the client to explore and come to terms with their own insecurities and the second meaning refers to being held in a secure, safe, reliable, containing space.
Here are 10 ways you can provide a Secure Therapeutic Space:
Regular sessions. I am a great believer in regular weekly sessions, same time, same day, same place every week. I do not like fortnightly or even less frequent sessions. In my experience therapy needs to frequent, regular and continuous to have the best possible chance of being effective.
Timekeeping. We need to be aware of clients showing up late and if they do to raise it with them. They could unconsciously be testing the boundaries, checking to see how strong the therapeutic container is.
Payment. Another way clients can check out the safety of the container is through non-payment. If clients can’t pay or don’t pay on time this needs to be explored with them without delay.
Missed and cancelled sessions. Clients can check the resilience of the container by non-attendance. Do we care, will we miss them? I believe that with a very few exceptions all scheduled sessions should be paid for.
Breaks and Holidays. Our scheduled breaks and holidays can be difficult for clients. They can represent us abandoning our clients which can feel scary. Always flag up your impending breaks well in advance and refer to them afterwards.
Regular Reviews. Sometimes our perception of how well or badly the therapy is going can be very different to that of our clients. This is why it’s good practice to frequently check out and review. No need to flag up reviews in advance, they can be introduced quite casually.
Endings. Sometimes clients can shock us by unexpectedly informing us they would like to end. Sometimes this can be by text or email. It’s always good practice to discuss endings in a session and not in correspondence because an expression of wishing to end can mask something happening in the therapy itself which needs to be explored.
Contracting. The agreement or contract with clients sets the boundaries of the therapy. Clear comprehensive contracting helps to create and facilitate that safe space. Clients need to be clear on what we can offer and what we can’t offer.
Assessment. One of my most valued experiences as a rookie therapist was my work as an intake counsellor. For many years I have asked new clients to complete a secure, comprehensive intake form online. Whether you do your assessments in person or otherwise, thorough assessment is crucial to ensuring that you are working safely and within your own competence.
Magic Question. My favourite all time assessment question is this. ‘Is there anything you can tell me which I haven’t already asked you which will enable me to understand you and your difficulties better?’
Keep safe and keep your clients safe too.
Allan
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