To be the last therapist

This article was supposed to be about how to be “the last therapist a client needs” but I have realized that there is no way to define that mystical creature.

Therapists always dream of being the last one. We want to be the one who solves the problems and helps healing happen. How many of my clients have seen multiple therapists over their lifetimes? How often do they have less than flattering things to say? I can’t tell you, except that the answer is most! (Of course, why would they becoming to see me if they had great feelings about their last therapist?)

Perhaps, the crux of the problem is in the mandate to be genuine. All therapists have a style and way of interacting. We can alter that to some degree and find ways to maintain unconditional positive regard. However, no particular style works for all clients. If you want to be the last one for all clients, you are doomed to fail.

Being a therapist is often very emotionally difficult but so is being a client. Clients must expose deep emotions and dark secrets and the therapists must bear witness and provide healing. There is a vulnerability and a tension that exist between clients and therapists. Sometimes is provides a way to heal and sometimes it doesn’t.

I am desperately afraid of the “doesn’t”. I remember being a client that hated my therapists, at least as a child. It’s a strange irony that I went into the profession, for sure. My parents send me to therapists left and right, and I hated all of them.  The idea of being one of those therapists kills me.

 I am desperately afraid that I will somehow make things worse for a client; that I will unknowingly harm them because I miss an important context clue or do not conceptualize the problem correctly. Obviously, I continue my work. I stay educated and get all of the proper supports. I do everything I can but that fear stays with me.

Research suggests that a therapists ability to apply an evidenced based therapy is the best predictor of client improvement but the best therapies still only have a have a success rate around 60%.  What about the other 40%? What makes the difference?  It’s those clients that I have been and am so interested in. It’s those clients for whom we want to be the last therapists.

Clearly, this will continue to be a struggle for me and for other therapists until we have more research. Until then, let me ask you. Have you found your last therapist? What do you find helps you the most?



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