Things don’t always mean what you think they mean in Therapy. Part 5.

Read any clinical textbook from any era or school of therapeutic thought in the history of psychology, and you will find a lot written about clients missing appointments. There are thousands, if not millions, of examples of a client missing an appointment, and then the therapist (and their school of thought) explaining to you the reader why the client missing an appointment was an example of them acting out.

Acting out is code for therapists when we want to describe a client’s behavior as not positive. For example, a counselor may think or say this: Last week I confronted client X about their gambling, and they finally admitted it in session. This week they cancelled our regular session with less than 24 hours notice. I believe they are acting out.

I reserve the right to call bullshit on that premise. Let me explain.

Part of why people choose to see a therapist is because they want to pay a professional who has the skills and ability to help us with our collective baggage. Therapists are trained at seeing what others don’t see or won’t admit to seeing. I agree and I expect that when I go to my own therapy. But what if part of the baggage in being a therapist is always looking for fires where there isn’t one?

I think part of this issue stems back to the beginning of the field, when only medical doctors did what we would now call therapy. And it was Freudian psychoanalysis more than it was anything else. The therapeutic relationship was very different back then, as was the actual therapy. The doctor hardly spoke. The client, or patient as they called them back then, was expected to free associate whatever was going on in their mind. The patient often saw their doctor every day for therapy. The doctor was, given the times and circumstances, in a definite position of power and expected deference from their client (some things about doctors don’t change) and every single thing the patient/client did in “therapy” was considered significant. Kind of makes sense in a backwards 19^th century Victorian male patriarchal dominated way, I suppose. Classic Freudian analysis included such juicy tidbits as sitting behind the patient/client out of sight in order to not influence the stream of consciousness. Quite an interesting leap of logic there that in order to avoid influencing a client in therapy, you encourage them to act and behave as if you are not there at all. Who doesn’t want to be seen by whom, I have to wonder.

People can and do cancel appointments because something going on in therapy is important: feeling safe, feeling heard, being or not being validated, expressions of passive aggressiveness, etc. Yes, of course that happens. A lot of that gets labeled transference and it is part of any good therapy to address that in the session. An important part of seeing a therapist is to expect to a certain degree that they will attend to and communicate concerns that come up within the therapeutic relationship. But with all that being said, isn’t it possible that people miss their therapy appointments because they are just too busy to make it that week, are feeling tired or lazy, or maybe they really did just forget about it?

Well, of course. I know I have cancelled therapy appointments for even more trivial reasons than those. Because therapy has become a normal thing like any other normal thing that people do. It isn’t some rare event that is discussed in hushed circles. Except when it is, but those people probably don’t read a blog called Therapy is Dandy.

Keeping the archaic 19^th century model of therapy in mind, let’s turn to the topic of a client giving their therapist a gift. Right now on various online mental health forums there are therapists discussing the pros and cons about accepting or refusing gifts from clients. I don’t mean gifts like a condo time share in Croatia or a new convertible Jaguar. I mean gifts like a coffee cup or a bowl of homemade soup.

Again, the dominant paradigm in psychology is that when a client gives you a gift, there is always a hidden meaning attached to the gift. It doesn’t necessarily mean they are acting out, but you better believe it could. If upon receiving a gift of a book or homemade cookies and the very next week the client cancels an appointment or forgets to show up, or asks for a reduced fee, the gift is then retroactively used as proof of the acting out.

Because human beings just can’t up and be nice to each other without some brainiac deciding it is pathological for some archaic reason.

It makes my brain hurt.

Yes, it is true that a client may have an ulterior motive in giving a gift. That is covered in graduate school—believe me—but what is nonsensical to me is how a profession devoted to understanding human behavior can so easily disregard genuine human interactions. When we spend time with one another in whatever setting, we can actually learn to care for each other. And people like to give things to other people because they care. And caring is not yet a sign of serious psychopathology. But wait for the new DSM V to be sure.

The pushback on this kind of thinking can be summarized with a word: boundaries. As in, as a professional counselor or therapist it is on us to maintain appropriate boundaries with clients in order to avoid unhealthy boundaries. That is therapy code for having a personal or even romantic relationship with a client. That is unequivocally bad and unethical. No argument from me there. It is the realm of nearly every therapist ever shown in any Hollywood movie. But I do believe the relationship one can build in therapy is stronger and more resilient than that of a postcard.

People are penalized enough in our culture as it is for caring. I maintain that for therapy to be successful one cannot just remain clinical all the time, but genuine as well in our professional capacity. Nobody wants therapy with a robot.

Until some freaky scientist creates the first therapy robot. It’s really only a matter of time.