Thursday, June 30, 2011

Client Comments

Among some old files I found a group of notes I’d written of comments that various clients had made, which had impressed me as particularly insightful or pithy, and which I'd written down after asking for, and receiving, permission to quote anonymously:

•“You think, because you’re brought up with a set of rules, that you have a set of values.”

•A client, describing early family history, said: “They were practicing Catholicism at the expense of Christianity.”

•“Her way of healing old wounds is to open them up and play with them.”

•“I’m so open-minded--but with gates.”

•"It's the unquiet spirit that breaks down the body."

•A client said, “You have to think through what you want to do and what goal you want to achieve.” I said, “Let’s do some of that now. What do you want to do, and what goal would you like to achieve?” She said, “That’s a loaded question.”

•Speaking with a client on the autistic spectrum, I said, “I’m trying to teach you that there’s something more to relationships than self-preoccupation and manners.” The client replied, “I don’t agree.”

•A client said, "I know that I've always felt like a dunce in my family. I just never said it out loud." I said, "Congratulations," for saying it out loud. "What difference does that make?" asked the client.

•Palpably describing what psychodynamic therapists call "dissociation," a client described coping with a mother's harangues: "I'd sit tight, put on a face, and not be there."

•A former client who returned to see me, commented: "Gee, the last time I saw you, you had a little more brown in your hair. What'd you do, eat something grey?"

Saturday, June 11, 2011

Coaching and Psychotherapy

A colleague asked how I understand the difference between coaching and psychotherapy, and how I use Skype. Here's my reply:

Dear .......

Sorry for not being able to reply sooner to your question about services I offer to coaching clients, where I draw the line between coaching and psychotherapy, and where Skype fits in.

I offer coaching services to clients who want to improve their personal and professional effectiveness in areas where I can add value. That includes the human relations side of supervision, leadership in organizations, and the learning styles and outcomes side of education. Clients consult with me around career issues, to help them reflect on their careers and see if they might want to modify or change them, as well as for help with job searches. Clients may seek coaching for evaluating and improving their relationship skills, whether personally (with a spouse or partner) or professionally (with a supervisor and/or colleagues). Parents may wish to improve their parenting skills. In the organizational consulting side of my practice, I've learned something about helping people to develop attitudes and skills for having difficult conversations more effectively, and sometimes people come for that. Some clients come for help in understanding their learning styles and how to learn more effectively given their particular cognitive and personality styles. Relaxation training can be a part of coaching, where the client can benefit from it as a health enhancement rather than as a treatment for a diagnosable mental disorder.

Where I draw the line is between these kinds of mentoring/coaching/consulting/counseling (in the sense of providing counsel) activities and psychotherapy as a treatment for a mental illness. Therapy patients qualify for a DSM-IV diagnosis of a mental disorder, and psychotherapy is a treatment for that and has a procedure code on the bill or receipt which patients submit to third party payers.

Sometimes a coaching client is actually in psychotherapy already with another therapist, to which coaching can be complementary, but the foci are different and neither coaching nor therapy replaces the other. In coaching mode, I've said things like, "This is what I advise you to do in order to take the next step toward achieving your goal. If you have a problem doing it, you should talk to your psychotherapist about it." And, while it isn't always the case, my coaching clients often come at less than weekly intervals; semimonthly (EOW), monthly or at even longer intervals, and usually that's fine with me, but I've declined to work with potential psychotherapy patients who weren't available for the session frequency that I felt was appropriate to the presentation and intensity of their symptoms.

About Skype: My current practice is to offer psychotherapy in my office, and only to add remote methods (Skype, telephone) if the person moves out of the area (or, on occasion, is too ill to come to the office) after getting a good start to the therapeutic relationship in person. That's because there are intuitive aspects of the therapeutic relationship that require personal presence; at least as I understand and practice psychotherapy. So I don't offer psychotherapy, in the sense of a treatment for a mental disorder, remotely from the beginning. I do offer coaching, consultation and counsel from the beginning via Skype or telephone. .

I hope that helps.