For many years I have worked in different organisations and institutions as a Dramatherapist.
In my experience, the length and accessibility of treatment is often limited. For example, insufficient funding or perhaps individuals are considered not ill enough to warrant treatment. These expectations and restrictions always challenged and impacted the therapeutic relationship. How can I work with someone successfully with so few resources and so little time?
Seeing people with multiple, complex needs that could only be met in more secure environments made me wonder about the majority of the population who may be suffering in silence and needing mental health support.
This is what led me to set up a private Dramatherapy service in the community.
I believe in making mental health services more accessible for individuals who are less visible with their mental health issues and trauma experiences. I feel it is important for people to take charge of their mental health before reaching a point of crisis, and I believe in empowering people to ask for help.
Since the birth of YTherapy in 2017, I have taken my knowledge, skills and experience into a private community setting so that I can focus on fostering the therapeutic relationship between myself and my clients. It’s been over a year now and I have learned a great deal from my clients in private practice. Here is what I will continue to take with me into the New Year and beyond.
- Trust takes time.
Trust is paramount to the work between a therapist and a client. Trust has to be earned. A client needs to establish trust with their therapist to know this person is safe.
In institutional settings (such as hospitals or prisons), clients referred to therapy often have difficulties forming relationships, and much of their sessions (especially in the beginning) are focused on developing a positive rapport and healthy therapeutic relationship. This also needs to happen in private practice. To expect a private client to freely hand over their entire personal history and experiences in the first few sessions without any psychological consequence is a mistake. In any type of therapeutic relationship, trust takes time for deep work to take place which may include telling the very story of why they are here or expressing their innermost thoughts and feelings.
I’ve learned to always take time to establish a firm bond of trust with my clients.
- There is no rush.
It is so important for clients to go at their own pace. Everybody’s different – some feel ready to talk immediately whereas others need time to warm up. An essential part of the process is being able to communicate how fast, how much and how deep a client wants to go.
Therapy is a process. To expect great change, an epiphany, an ultimate resolution within the space of ‘x’ amount of weeks is not realistic. It is healthy and safe when clients do not feel pressured or rushed (even when challenged to address something that may eventually need looking at).
I’ve learned that it’s important to let the therapeutic process happen naturally and organically.
- A story can be told in many ways.
In popular media, a therapy session is usually seen as the client and therapist conversing, revealing details over time – maybe lying on a couch. However, there are many ways for clients to tell their stories.
Sometimes it can feel safer for clients to project unprocessed or unbearable thoughts and feelings into objects, by drawing or painting images that become symbolic and meaningful over time, or by creating different narratives through other characters.
This is all part of the work – there is no linear way to do therapy, nor is there a linear way to tell a story.
I’ve learned how to help my clients tell their stories in whichever way they feel comfortable.
- Fears are real. Fears are powerful.
Fears of being seen and fears of being judged are very much linked to shame which can sometimes feel overpowering and all-consuming.
I have experienced clients coming to their session with a “brave face” and I know it may take time for them to share about themselves. I have heard similar expressions such as “I’m scared you won’t believe me”, “I don’t want you to see me this way” and “You’ve seen too much”.
This fear that someone (even a therapist) will see their vulnerable side may feel too uncomfortable. In an institutional setting, clients often have a well-planned timetable with other treatments and support in place alongside their therapy; but things may be different for those accessing therapy privately in the community. Not everyone will have the same kind of support systems in place, and it can feel destabilising to go to therapy and then go straight to work or back home (especially if clients are talking about issues to do with their job and family).
I am always reminded by my clients about how much of a big, courageous step it is for them to come forward to ask for help.
I’ve learned to help my clients address their fears of therapy and fears of sharing.
- There needs to be space for the “good” and the “bad”.
If in the session a client wants to talk about what’s happening in their external environment, perhaps by using humour to deflect from what makes them feel pain, or by bringing the conversation to focus on their hobbies and what makes them happy, then we should make space for this.
For some, trying to fill the space by only talking about what makes them feel anxious, depressed or low in self-esteem will not be helpful. It’s important to build on a person’s strengths and this means giving clients a platform to show their therapist what makes them feel happy, attractive, smart, funny and strong.
Equally, it’s important that clients can address their darker thoughts and feelings. Therapy needs to be a space to help clients embrace and better understand the ‘shadow’ parts of themselves.
I’ve learned that bringing balance to a session with a client is healthy and essential.
- It’s okay to just be with the unknown without trying to solve it.
People come into therapy with bigger questions that don’t feel appropriate to impose or expect a clear answer or solution. Trying to push or move this mysterious something forward may not be helpful when it just needs to sit still in a space. Sometimes there are things that just don’t have an answer and can’t be forced.
I’ve learned that not everything needs an answer or solution. Sometimes, it’s okay to let things just be.
- Play is a necessity.
It is important to realise that ‘play’ is not just for children, and adults should have the opportunity to play or be playful in therapy. For many of my clients, therapy can really be a space for them to let go of their current role and everyday regime, a space to relax and try out something new. Playing can bring a new dimension to the therapeutic relationship and help foster a positive rapport and greater feelings of trust.
Play helps tap into other areas of the mind and the very act of playing (whilst having fun too) can bring on a new level of confidence and self-esteem. To be able to experience creativity, freedom, adventure, innovation and spontaneity is so necessary to build on one’s strength.
I’ve learned to help my clients enjoy play as an important part of their therapy.
- The therapist can “join in” and break the fourth wall in therapy.
The “fourth wall” is a concept in theatre which divides the actors from the audience. If you’ve watched a TV sitcom or a film – you’ll have experienced this. The actors do not normally interact with the audience.
Some people may feel similarly about therapy and believe that the therapist and client are separated by these very roles. As a Dramatherapist, I know that it’s important to join in from time to time and that it’s okay to participate and experience different ways of relating – particularly for those who find it difficult to express themselves.
I’ve learned that joining in and taking on different roles can help clients better understand relationships and become more empathetic.
- There needs to be a way of letting go and a safe route back into the outside world.
Most clients who seek therapy may come with an open mind and are very willing to share. For those who are able or feel very comfortable with talking, it may feel therapeutic in the moment to disclose sensitive information or a personal traumatic event. They may not realise until afterwards that they need time to carefully “close up their box”, find some distance from what they have shared, and then prepare themselves before they commute back to work or home.
I’ve learned that what is opened and processed in the session is a big deal and it’s very important to ensure clients have time to wind down. I often help my clients by guiding them through an end of session ritual so that they can feel grounded before they leave the room.
- Don’t go by the labels, listen to the story.
In the world of therapy, it’s important not to categorise a client or reduce their issue to a common pre-configured label. In my experience, clients seek out my help on their own, rather than being referred by other health professionals, or as a result of coming through a calculated medical system. Because of this, their issues don’t often come with a well-defined mental health diagnosis. Their narratives are more unique and therefore the approach becomes tailored to the individual.
There is no expectation in the diagnosis or treatment so the approach to treatment and the therapeutic journey itself can be more flexible and collaborative. Clients feel most empowered when they have the choice, feel heard, and become an active agent in the healing process itself.
We are in the journey together; to explore and examine the unknown, and to strive to achieve an attainable road to recovery.
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If you have any requests for a blog post, please feel free to send your questions, comments or ideas to: jamie@ytherapy.com
Please note that this blog is meant to be educational and should not be a substitute for therapy.
If you would like to enquire about therapy, please contact me or book an appointment: https://ytherapy.com/book-an-appointment/
*Image courtesy of City Road Therapy, at my therapy office in Angel, Islington.