Lessons from the Therapy Room: Clients as Our Greatest Teachers

I have learned much from highly acclaimed mentors and supportive colleagues during more than 50 years of clinical practice, but the most impactful teachers were my clients. My clients have been amazing teachers, but it took me a while to recognize how to absorb and apply their wisdom and subtle teachings.

We can get stuck in therapeutic process, assessment, and diagnosis—especially when trying to master clinical models and satisfy the demands of agencies, supervisors, referral sources, or insurance companies. And as we’re trying to figure things out, we often miss the clues from clients about what they really want and need—their strengths, their expertise in their own lives, their philosophy of change, and the ways they’ve already begun searching for solutions.

I’m saying that we can become “model-driven” instead of “client-need driven.” Over the years—especially after the first 15 or 20—I finally opened my mind to the possibility that there was a better way to accomplish client engagement and successful outcomes. And by “successful,” I mean outcomes with authentic, lasting change.

But first, I had to internalize and grow into new ways of thinking—like recognizing that it’s our clients who are the experts on their lives and their change process, and that we are merely catalysts. I became curious about how change happened and how to identify and build on the increments of change that were happening between sessions. So, I departed from the “problem talk” wagon and found a new ride on the “solution talk” streamliner—beginning each session by asking, “What’s better?” and “How did you do that?” and then, “What needs to happen for you to do more of it?”

That perspective led me to understand that, metaphorically, we are “tourists” in their “country.” We don’t really know or understand our clients. We often see them at their worst, and the reason or purpose we’re given for their referral is merely a snapshot—not a video of their life. We don’t exactly speak their language. They likely feel vulnerable—and as anyone would, they are going to be selective about disclosure. We need to give our clients more than one chance to make a first impression.

Until we learn from our clients who they really are and what they truly want—and demonstrate that we can be trustworthy, understanding, and helpful—therapy will not accomplish authentic change. It all makes sense and comes together when we think in terms of client-centeredness and a client-need driven approach: a focus on client strengths with solution applications, and an understanding that every family system has its own unique culture.

Insoo Kim Berg asked reluctant clients two questions in the first session that I believe set the tone for client-centeredness:

“What needs to happen today for you to say that our time together was worthwhile?”

“How will you know when you don’t need to come here anymore?”

We need to be better than the perspective that we can standardize, categorize, or squeeze clients into a subjectively conceived diagnostic model and then plug them into a clinical approach based on stereotypical assumptions about behavioral change—especially those derived from a biostatistical calculation applied to a screened, preselected group. Too often, we overlook those who need our help but don’t trust therapy or the referral source, or who haven’t responded to talk therapy previously, or who believe it’s all someone else’s problem—or who have tried but recidivated or relapsed again and again after several therapists applied that “golden” evidence-based clinical model. Do we give up on them because they don’t fit into those “success” measures?

In private practice, I see real-world clients who walk through my door—not subjects screened by exclusion criteria or study protocols. I’m accountable for helping clients facilitate a plethora of meaningful life outcomes—not just a selected area of measurement targeted by research. I would hope that in our field, there will be more acknowledgment and understanding that it doesn’t work to just plug a round client into a square-hole clinical model. I believe that whatever works for the client in front of you is “best practice.” Evidence-based is not necessarily the gold standard.

This belief led me to one of the most profound insights I’ve acquired in my journey: there are no throwaway clients. Therapists need to figure out how to engage and join with each client. The truth is, if we do not know how to engage with and communicate effectively with our client, it’s not the client’s fault. We need to stop blaming clients for what we do not know or understand.

It is confounding how we ever got off track and into client-blaming. And yet, the positive is that my clinical thinking—and the impetus for my book—evolved after I witnessed, again and again, what I call “client scapegoating”—the idea that if therapy failed, it was the client’s fault.

“Client scapegoating” became my pet peeve 15 or 20 years into my clinical practice. Although my work with clients was progressing in what felt like a successful direction, I came up against a clash of ideas that unnerved me. It was a time when I was interacting more often with colleagues at conferences and workshops, and I was hearing disparaging stories about their clients. The consensus seemed to be that, regardless of what we did, 30% of clients were simply not amenable to therapy or change. They blamed the client and labeled them as resistant, impossible, uncooperative, or as having a Borderline Personality Disorder. They were giving up on those clients.

I believed it was ludicrous to blame a client when the therapist didn’t know how to engage that client. So, my focus and work with clients took a radical and productive turn. For the last 30 years of my clinical practice, I made it my mission to focus on clients whom others considered difficult—even impossible. Many of these clients had been coerced or mandated into therapy, were in dire straits, and believed they were being treated unfairly. I believed there had to be a way to successfully engage almost anyone.

I became mission-driven. I sought out referrals for those so-called “difficult” or “impossible” clients from many sources: other therapists, EAPs, managed care, community resource centers and agencies, inpatient treatment programs, juvenile justice and child welfare systems, family courts, and drug court programs. If someone didn’t want to work with a client because they were too difficult, too complex, or labeled in some unhelpful way—that was the client I was looking for.

I contracted with and engaged in “side” employment with agencies and programs that served these clients. I accepted referrals for foster children; immigrant families whose culture was misunderstood; families in multigenerational poverty; and families whose kids were medicated into zombies because schools complained about their behavior.

I refused to accept that there were “impossible clients.” I believed it was my responsibility to figure out what worked for each of them—to elicit what they really wanted. And I found that the process worked when clients were engaged in what I eventually termed an individualized, client-need driven, collaborative intervention. After a relatively short time, I was able to constructively engage nearly every client, hear their real agenda—what they truly wanted—and work with them toward that vision.

My belief progressed into a firm conviction: there are no throwaway clients. The therapist is responsible for accomplishing a collaborative therapeutic relationship and eliciting what the client really wants—their authentic agenda.

So, I had to write a book. It’s about decades of work with amazing clients who overcame adversity, and the tools, strategies, metaphors, and language that worked for them. The book is titled: Brief Therapy for Clients with Challenging or Unique Issues: A Clinician’s Guide to Enhancing Outcomes, published internationally by Routledge in 2023.

The book features over 20 client stories, with examples that highlight solution-focused, empowering, neurolinguistic, and client-centered processes and tasks used to foster collaborative engagement and mold clinical interventions to fit each client’s uniqueness and tolerance. This book is my legacy work. I want to share with other therapists and future generations the strategies and tools that I know are effective.

Once we established a collaborative relationship and began working from the client’s agenda, the client became an active customer of therapy—not just a participant aiming for compliance or temporary change. Clients could tell that my curiosity came from a place of genuine interest, not interrogation or blame. Feedback and compliments felt authentic and empowering. We became clinical partners on the “client competency and solution” expressway. Clients knew that I believed they could succeed. From there, therapy was fulfilling—and even fun.