While doing supervision today, I found myself encouraging my supervisee to be more direct, to embrace his knowledge and his good judgment, and to share his knowledge and judgment with his client. This is an interesting (and perhaps surprising) stance for me to take, because, as some of you know very well, I lean hard toward Rogerian theory. I’m a fan of honoring clients’ expertise and of Carl Rogers’s words that it is “the client who knows what hurts and where to go.”
As I age (more like fine wine, and not like moldy bananas, I hope), one truth I keep feeling is that nearly everything is both-and—not either-or. Yes, I believe deeply in the naturally therapeutic process of person-centered theory and therapy; providing clients with that “certain type of environment” will facilitate self-discovery and personal growth. On the other hand, sometimes clients need guidance. In my supervision case earlier today, my point was that the client was a very long way away from deeper personal insights. That meant my supervisee needed to loan the client his good judgment and decision-making skills. As you may recognize, “loaning clients our healthy egos” is psychoanalytic language. Nevertheless, the guidance I offered my supervisee was to engage in some CBT coaching
All this reminded me of a section I updated in the 7th edition of Clinical Interviewing. The section is titled, “Client as Expert” and I’ve excerpted it below. It captures the essence of honoring client wisdom, which, IMHO, should always precede more directive interventions.
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Client as Expert
Clients are the best experts on themselves and their experiences. This is so obvious that it seems odd to mention, but sometimes therapists can get wrapped up in their expertness and usurp the client’s personal authority. Although idiosyncratic and sometimes factually inaccurate, clients’ stories and explanations about themselves and their lives are internally valid and should be respected.
CASE EXAMPLE 1.1: GOOD INTENTIONS
In one case, I (John) became preoccupied about convincing a 19-year-old client—who had been diagnosed years ago with bipolar disorder—that she wasn’t really “bipolar” anymore. Despite my good intentions (I thought the young woman would be better off without a bipolar label), there was something important for her about holding on to a bipolar identity. As a “psychological expert,” I believed it obscured her many strengths with a label that diminished her personhood. Therefore, I encouraged her to change her belief system. I told her that she didn’t meet the diagnostic criteria for bipolar disorder, but I was unsuccessful in convincing her to give up the label.
What’s clear about this case is that, although I was the diagnostic authority in the room, I couldn’t change the client’s viewpoint. She wanted to keep calling herself bipolar. Maybe that was a good thing for her. Maybe that label offered her solace? Perhaps she felt comfort in a label that helped her explain her behavior to herself. Perhaps she never will let go of the bipolar label. Perhaps I’m the one who needed to accept that as a helpful outcome.
[End of Case Example 1.1]
In recent years, practitioners from many theoretical perspectives have become outspoken about the need for expert therapists to take a backseat to their clients’ lived experiences. Whether you’re working online or face-to-face, several evidence-based approaches emphasize respect for the clients’ perspective and collaboration (David et al., 2022). These include progress monitoring, client-informed outcomes, and therapeutic assessment (Martin, 2020; Meier, 2015).
When your expert opinion conflicts with your client’s perspective, it’s good practice to defer to your client, at least initially. Over time, you’ll need your client’s expertise in the room as much as your own. If clients are unwilling to share their expertise and experiences, you’ll lose some of your potency as a helper.
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John Sommers-Flanagan 