Never work harder than your client. Except for sometimes.
Doing (the right amount of) The Work.
Happy fall! The sun is shining, there are like 20 block parties in my neighborhood, we’re getting a temporary second moon. Also, I heard that Kyle Maclachlan plays an evil therapist in Blink Twice so if you’ve seen it please comment or DM me your takes. I don’t think I can stomach this movie but I need to know.
Today’s newsletter is a *transparency edition* – a therapist-client gap-bridger, if you will, written with the hope of providing some context on what your therapist might be thinking when they work with you or ask you certain questions.
If you have a therapist, they are familiar with the adage “never work harder than your client.” The point of this as a guiding principle is to a) prevent burnout and b) emphasize the client’s responsibility for their own treatment: If they are not an active participant in their care, nothing will get done. Therapists on their own can’t make change.
One of the challenges of being a therapist is you don’t often really get the satisfaction of ending your workday feeling like you have solved a concrete problem with a concrete solution. I occasionally (ok, often) find myself with a completely unquenchable and impossible desire to Know That Things Are Working For Sure and that I Am Doing A Good Job.
The clinical danger of "working harder than your client” is when the desire for results becomes a driving force – overcompensating when we feel like things aren’t working, clients aren’t showing up wholeheartedly, or things just feel stuck. This feels bad for everyone, and it can actually cause harm: Falling into desperation or pushiness, trying to move a client toward doing, feeling, or thinking something that doesn’t feel right, puts the integrity of the relationship at risk. (Many people have unfortunate stories when it seemed like a therapist tried to sell them on some kind of conclusion or connection, or get them to do some sort of “therapy homework” that did not feel helpful. You can feel when you’re not being understood, and frustration on either side of the relationship is tangible.)
On the other side, the risk of “never work harder than your client,” is in the clinician stretching it to the point of absolving themself of accountability or care. This can be particularly harmful in certain instances, especially with clients in a vulnerable position or whose case requires particular care, such as mandated clients or kids. It can also limit us from doing the necessary work on informing ourselves of matters of power and privilege or social factors that might impact our clients, or working through our own internalized biases.
So what does it mean for your therapist to match your level of work? And what kind of healthy boundaries can you expect to come across?
Some ways you can expect your therapist to put in work for you:
Your therapist is willing to do (and follows through on) some basic research about parts of you that are critical to understand in order to understand you, like a diagnosis, a systemic issue that directly impacts you, a medical condition, or even something that you’re really passionate about and want to be able to discuss. They ask the right questions to gain understanding and pursue their own education.
Your therapist hears you out if there is something specific you want to talk about or try. If they can’t meet that request for whatever reason, they explain why.
Your therapist follows through on agreements and promises: Sending you homework, checking in with you about something specific you’ve discussed, etc.
Your therapist bills you correctly and on time.
Your therapist is consistently timely, engaged, and present during sessions. They remember details of your life and follow up on topics from previous sessions.
Some things that are usually not fair to expect:
Your therapist gives you answers. They can’t decide for you whether you should begin or end a relationship, quit a job, change a family dynamic, etc.
Your therapist practices outside their area of competency in order to meet a request or need.
Your therapist takes the lead in most of your sessions (i.e. telling you what they think you should talk about).
Your therapist is fine with you regularly missing or coming late to appointments, distracting yourself during session time, or taking virtual sessions in inappropriate places (i.e. public places).
Your therapist only validates you/does not apply pressure or challenge you.
It’s an impossible task to really define and measure this kind of work. There are some ways that we can, and do, try. But ultimately, pay attention if it feels off. Mutual trust and respect means that you and your therapist are both accountable to the process and to each other in your own respective ways. I love how reader and former therapist Jess Chermak put it as we discussed this topic over DM:
“So maybe the way to do no harm is somewhere in between doing and not doing more work than the client. And that balance probably requires setting expectations at the outset, having a therapist who asks *the right questions* (whatever that means) to help the client articulate what they hope to get out of therapy, so there is a mutual understanding at the outset of building rapport about how the process works […]
Not working harder than clients isn't the same as not caring anymore, it's just finding equilibrium within the confines of the system.”
In the media
The NYT published a story this week on the high costs of therapy, and some ways to make it more affordable. Unsurprising conclusion: The system sucks, and there’s not that much people can do about cost if they want to work with a therapist who is out of network. Outside of community clinics, finding in-network care, group therapy, and low cost digital platforms (sidebar: I really want to hear about your experiences with BetterHelp and the like….much to discuss on that in future editions), if you love your therapist and can’t afford them, the options depend on that individual therapist’s capacity to meet you where you need to be met. The article offers some ideas: meeting less frequently, capping after a set number of sessions, and asking about sliding scale rates. All are imperfect solutions.
You can’t therapize your way out of money stress. It’s a real limitation. But it’s absolutely worth bringing up in session. Talk about money with your therapist. They should have competency discussing finances with you in a way that is a) empathetic and b) boundaried, i.e., not offering something they cannot afford.
On the topic of medical bills…
The thorn of my summer was learning that I am in my Dental Work Era, and as the many thousands of dollars in dentist bills continue to accrue, the voice in my head whispering “dentistry is a scam” causes me much anxiety. So I was pleased to encounter this week’s Vox explainer piece on this very topic. I was struck by the parallels between the kind of conspiracy thinking that tends to follow both dentistry and mental healthcare – both underinsured, both necessary.
This newsletter has previously discussed the finances of therapy. I pretty regularly come across the theory that therapists keep you in treatment way past the point of it being helpful for you on Twitter and whatnot. Similarly, some Dentist Truthers believe that the procedures recommended to you are, more often than not, unnecessary and designed to take your money.
Now, bad actors do exist in these fields (as in any), and any feeling of warmth toward the dentist does continue to be just outside the scope of my mental/emotional capacity in this particular moment of my life. Would that I were so evolved. HOWEVER, as someone who actually needs to get this shit done, it’s been helpful to be reminded who our true enemies are here, which, as always, are the insurance companies and our horrendous capitalist healthcare system. (If you haven’t read this excellent ProPublica piece on how this impacts mental healthcare, I can’t recommend it enough.)
Thanks for reading! As always, send thoughts, feedback, ideas, smart stuff, dumb stuff, whatever, my way. Let me know what you’re reading and seeing. More next week :)
It’s wild that dental care isn’t included in standard health insurance—teeth are bones! How the fuck is a broken tooth not covered the same as a broken arm? Who made the decision to silo healthcare in this way?
On a note more related to the general topic here: this entire piece serves as a clear reminder of the importance of trusting your gut when it comes to therapy and rapport. If it *feels* like the therapist isn’t listening or paying attention or is operating outside of their expertise, trust that feeling and bail out pronto!