In literature classes, students are not only expected to read the text, but also to understand everything around it (e.g., the context and subtext). In fact, in higher level classes, the text is conceptualized as just the beginning, a prompt to understanding the more important material at hand, which is what the text points at, suggests, or illuminates. Good therapists should strive to do the same: what a client says in session is merely an invitation to understand much, much more about what they are communicating.
The difference between focusing on what a client has said and paying attention to how it was said, within what context, and what was not said, is the difference between content and process. Therapy is especially valuable to the extent that it engages with the latter and is not bogged down by the former. Certainly, the what and when of a client’s life are important. The why and how, though, are what matter most. Because while process is originally created by content, increasingly it becomes what content falls into.
Likewise, in creating a therapeutic space, the therapist should focus on process. We might say, “The therapist emphasizes showing over telling.” I can tell my clients that they should trust me and say everything that comes to their mind, but it will be far more effective if I show them. For example, if every subject the client brings into the session is treated with a similar level of interest and openness, then the underlying message received is that whatever is brought into the room will be treated with interest and openness.
From this perspective, suddenly questions like “How do I handle xxx issue?” “What if my client tells me xxx?” “What do I do with a client who presents with xxx?” become less relevant. The mistake behind these questions is that the therapy should change based on what is being talked about. In my opinion, the therapy should only change when the how of talking is changing, not the what. In other words, should the therapy change just because the client has gone from talking about lunch to talking about childhood trauma? Not at all. It is even more paramount at that point that the process does not change, because it was specifically the message that everything can be talked about with openness and interest that allowed the client to bring such a difficult matter to the table. If the process were to change with the content, it would send a host of unhelpful subliminal messages, e.g., from now on, we should only be talking about this trauma.
The process should only change when it is no longer facilitating an environment in which the client feels comfortable discussing everything. Then we must ask what it is about the process that is getting in the way. When we say that each client is different, what we mean is that each client will need a different environment to be comfortable. Obviously every client’s story is going to be different, but more important is whether we are dealing with a person who needs us to shut up and be quiet, or someone who wants us to chime in and give advice. Of course, this same person’s needs might change over time.
In the next post, I would like to address two further questions. The first is: How do we know what process a client needs? The second is, How do we know when that process needs to change?