Chris Lloyd, London Metropolitan University

We’ve all had that feeling of stuckness with a client. Wondering whether we are competent or ‘skilled’ enough to support our clients towards change. I feel this is particularly so as we journey alongside clients who struggle with a sense of hopelessness in their lives.

Working these past few years, as I have, in a statutory therapy service has brought many opportunities for growth, as well as challenge, to my fledgling identity as a final year trainee counselling psychologist. The particular service I work in has a waiting list of over a year and operates what is generally considered to be a relatively generous time-limited frame, of up to 12 sessions.

By the time clients are seen, they often come prepared with discrete diagnostic clusters, some referring to ‘panic’, ‘depressive episode’, ‘OCD’, or ‘PTSD’. Or, for the ones who don’t fit so neatly, its ‘adjustment disorder’ or ‘mixed anxiety/depression’. Although I view these diagnostic markers critically, they can also be useful: useful for both client and therapist alike. They may afford a sense of emotional containment for the client: ‘Oh, this is what I’ve been struggling with, that makes more sense now’. Or they may provide therapists with structure to the content and process of the ensuing therapeutic work. However, they can also cloud perspectives on the person sitting in front of us: their inner directions, desires, and wants.  

This struck me recently, in working with a client struggling with a historic context of severe emotional neglect (details of the clients have been disguised to preserve anonymity). Some sessions in, I’m struggling too. Somehow, our sessions seem fragmented and I’m wrestling to piece together a coherent history of the person sat opposite me. I feel a deep pervading sadness in the room but in some way my client doesn’t connect with this. It feels like there is just no hope. Supervision is, of course, helpful. I leave it with a sense that my own feeling of fragmentation, perhaps, mirrors that of my client’s trauma history.

Still, I’m left wondering about the direction of our therapy and whether I have the competency to support my client within our time-limited frame.

It wasn’t until our session last week that I felt there was a shift. Instead of the previous collaborative exploration of my client’s past–in order to make sense of her present–we changed tack. I asked a simple question: ‘I know we’ve talked for a few sessions about the painful things that have happened to you over the last years but I wondered, just parking that for a moment, whether you might find it helpful to think about where you would like to be? What do you really value? Where do you want to get to?’

There was a glare of surprise in the client, shock even—but that moment we shifted our process to her future. Instead of what had happened to her (often at the mercy of others), there was a change. It was almost as if the very possibility of being able to act and decide on aspects of her own world (and being empowered to do so) had brought therapeutic relief. Although the vehicles for this change had not yet been determined, and our therapeutic journey was really just starting, a possibility of hope had been instilled. Goals and directions can create hope: hope for clients (and therapists) that change is possible.

Christopher Lloyd, is a final year, doctoral trainee counselling psychologist and registered member of BACP (MBACP). Some of his recent research has explored the use of idiographic goal measurement in psychotherapy and his own doctoral research is exploring psychological therapists’ experiences of goal-based-practice.