Are All Clients Equal...or Not?

Do you think therapists are intrigued by, interested in, challenged by, and very excited with, some clients more than others primarily because the client has interesting symptoms and an unusually colorful life story?

Absolutely, yes. I think it varies from therapist to therapist but they all have preferences for the type of client they like to work with. My first T admitted that he enjoyed working with more complex clients because it challenged him and therefore he could set himself little goals to achieve along the way which made him feel good (looking back at that comment now, I should have realised that he had an ego the the size of the globe).
My third therapist said he wouldn’t ever work with anyone with BPD again due to it being too ‘draining’ as conventional once a week therapy was not enough to help.
I do think therapist egos can play a big part in these types of things if they aren’t self aware. They like an intriguing and colourful case as it makes them feel good for working with it.

All clients are not equal. Yes, professional intrigue can make a difference.

However, my experience is that some therapists feel more of a connection with some clients over others. And their attitude (behaviour + emotions felt) will change accordingly.

I would say so, yes. Or they might feel intrigued and excited by a client for other reasons, like if that client is, say, dedicated to doing the work and/or always have things to talk about. Or maybe they prefer the challenging sort who need to be drawn out and encouraged to talk. Or the client have an issue/condition that connects to them personally. Or they simply click with them.

I imagine it could also shift throughout the T's career. Maybe early on, they're excited by more difficult/complex cases. But then as years go by, they get sort of burnt out on them. Mine said early in his career, he'd be OK with a client, say, calling him in the middle of the night. But then he came to learn that he had to set more boundaries, how that works better for him. So he tries to avoid taking on the sort of cases where someone is regularly in crisis--I imagine he wouldn't want to work with someone with BPD, for example, or to do intense trauma work. (Though he's completely fine meeting with me multiple times a week.) I think that self-awareness is a good thing, to know their limits. Rather than trying to take on too much and getting burned out and not being able to serve any of their clients well.

But like KLL said, it could partly be about ego, or about "saving" or "rescuing" people, like a savior complex. And that would potentially be more problematic.

Mine has said she wanted to do more than "10 sessions and goodbye" therapy that's focused on "just" symptom reduction. Back then, I had a lot of symptoms, and was really ashamed of not finding CBT (from a previous therapist) helpful.

Another time, I was talking about how it's disheartening how stigmatised certain diagnoses are, and she said she likes complex, challenging clients. She's a clinical psychologist, so her focus tend(ed) to be people with several psychiatric diagnoses, who may have "failed" a couple of therapies.

Clinical guidelines where I live shuffle everyone through basic solution-focused-brief-therapy first, then short CBT, and so on.

Now that she's in private practice, I think she likes variation, and that doesn't necessarily come with a diagnosis. Nor does it need to be long term therapy. She's quite a fan of working with people on building the kind of life they want, as well as helping struggling healthcare workers.

I don't think clients should be treated equally. I'm not saying a therapist should have favorites. Or the reverse, a therapist should be forced to work with a client that they can't help. But each client has different needs. Even two clients with the same symptoms/diagnoses have different needs especially at different stages.

L has told me a few times that if I didn't have the skills work I did with T, I wouldn't be a good fit to work with her. And T was all about short-term (normally 2 years) skills work; not long-term relational work like L.

This is such an interesting thread.

So if a client gets more attention, devotion, and - let's call it what it is - special treatment - by a therapist, what is the motivation for a client to "get better" only to risk losing the therapist's attention and becoming "just another client"?

Ooooh this is an interesting topic. Deep down I know that part of my resistance in making changes is the fact that if I start to get better, I worry my T won’t care as much. So I kinda have to justify that I’m worthy of his time by being more messed up. However, I’m also equally aware that if I don’t make any progress then I could lose him that way as he may terminate because he doesn’t seem to be helping me.
Like I said, really intriguing topic!

I think you have to take into account that this is a very select group of people here on the forums. We might only represent a small fragment of what therapy is like for the majority of people. I find a lot of people have either had trauma due to therapy or are very interested in the ins and outs of therapy and discovering themselves.

Now I am one who does feel special to my T. She tells me that as well. That doesn't mean I'm her favorite nor does it mean that her other clients aren't special. To me special means that I'm unique and important to her. That I'm not just another number/client. That she sees me as a whole, accepts me as another human, and that we affect eachother.

I fear not being special because of my past, because I've experienced a lot of relational trauma. I fear once I lose that specialness that they will leave me. But what L is teaching me is to accept my humanness, that I don't need to be perfect to be safe. And that I can still be special even when I mess up. She teaches me through accepting me and through her own examples. Like cursing or talking about bodies, etc.

I could go on, but I think I'm going off topic...

I definitely don't think they are equal. I know I keep going on about it (when relevant) but my T said he sometimes hugged his clients, but wouldn't hug me. So I know I'm not equal to those ones. Sometimes the way he reacts to me tells me I am quite different to some people he sees, because what works for them clearly doesn't work for me. This is an interesting topic.

Yep I can get this feeling with my T quite a lot as well. Things that he appears to have done with other clients that have been successful do not have any impact on me. His reaction tells me he doesn’t understand why something isn’t helping.
His comment of saying the past year working together had been ‘challenging’ confirmed that for me last week!

Okay, so to steer back to the question...what is the incentive to become well enough to eventually leave our therapists if we are attached to them? Might this be an innate flaw in the therapeutic paradigm?

I, personally, have no intention of leaving therapy with L. That's not part of my goals. My goals are to work on myself and learn about how to have relationships with people. I'm not working towards independence, but interdependence. But that's just me.

I think there is a right balance to strike. I believe giving too much to the client can, like you said, not make them want to improve and subsequently 'lose' T. Some might want to 'please' T by showing that they are making progress.

Ts can sometimes offer too much and that is not to the benefit of the client. Yet, some T can also be so withholding that is just plain hurts. Neither extreme is good

I imagine the incentive to become well enough to leave is just to be well enough... to be able to function without depending on or paying another person, therapist or not. To build a healthy attachment to them so you can internalise them and go it alone. Sort of like when a kid is happy to be away from its care givers? Though you still might want to check in with them sometimes. I may be the wrong person to talk about attachment though, I'm not very good at it.

Pretty sure I'm special to my T, in that I'm a very unusual client. He wasn't even sure if he could work with me in the beginning (though he made way less of a mess of his insicurity that my xT did). Now he's kind of enjoying the challenge, I think. Ego is a big part of that, I'm assuming.

I like him, but I want to get better and I want to leave him some day, once this has been achieved to a sufficient degree. Not everyone craves attachment that much... though granted, I am appreciating having someone in my life who knows all there is to know about me and who for some reason still doesn't leave.
So perhaps in time, I'll get so attached that I won't want to get better? I doubt it though. Violent fantasies aren't very life affirming or competible with anything.

I felt like my transference T cared about me more then some of her other clients. Since she was the first one I came out to and she helped me tell my mom. I felt like we had a deep connection. Especially when she'd email me in between sessions to ask how I was feeling

But I was told she was too involved in me and I ended up just getting hurt in the end and I had to claw my way out of my feelings about her after we ended things. At times I still feel like I'm picking up the pieces. Ending things with her was harder then my dads death. I think the only thing that topped ending therapy with her was my Grandmas death in 2006. I mean, I was seriously ****ed up in my head when we terminated.

I don't think my current T cares for me much. I asked her at our last session if she was going to fire me and she said I'm more likely to fire her. So we don't really have a connection and I am not attached to her but we work well together most of the time and honestly I just don't have the energy to start over with another therapist so I think thats kinda why I'm staying with her. So I'm trying to just make things work.

Quote:

Originally Posted by Mountaindewed I felt like my transference T cared about me more then some of her other clients. Since she was the first one I came out to and she helped me tell my mom. I felt like we had a deep connection. Especially when she'd email me in between sessions to ask how I was feeling But I was told she was too involved in me and I ended up just getting hurt in the end and I had to claw my way out of my feelings about her after we ended things. At times I still feel like I'm picking up the pieces. Ending things with her was harder then my dads death. I think the only thing that topped ending therapy with her was my Grandmas death in 2006. I mean, I was seriously ****ed up in my head when we terminated.

I know, and I'm sorry. I fear that is what will happen with my t and I. "Claw my way out" is a good analogy.

Quote:

Originally Posted by ScarletPimpernel I, personally, have no intention of leaving therapy with L. That's not part of my goals. My goals are to work on myself and learn about how to have relationships with people. I'm not working towards independence, but interdependence. But that's just me.

But is that realistic? Never leaving therapy with L.? I mean...something will eventually lead to you ending therapy.