Chapter 9: Follow The Client's Lead Rather Than Assuming

Chapter 9 Follow The Clients Lead Rather Than Assuming That You Know W

Follow the clients lead rather than assuming that you know what the client needs, allow the client to lead you. This is her world, you are the guest. Sometimes thinking small is better than thinking large. The following story shows how one client resolved her problem on her own, once I gave her a gentle nudge. Helping clients get started in the right direction is sometimes all that is needed. Once they receive the initial help, they can do the remainder of the work themselves and many times they can do it quickly. This example also shows the importance of trusting the client to choose the best direction for therapy. In the following case, the clients took me to a place that I would never have chosen to go. They knew where they needed to go to resolve their issue. If I had not followed their lead, I would have failed miserably. The client is the expert on the problem and how to resolve it. Always listen carefully to the communication of the client. Erickson believed that the philosophy of change must come from the patient and not from the textbook. The following story illustrates how listening to the client can take therapy in a totally unexpected direction. Effects of Childhood As a rule, I don’t spend time on past events. However, there are those exceptions when understanding one’s past helps resolve a present issue. This was true for Harold and Violet, who came to me because neither was happy with their marriage. One of their major issues was Violet feeling rejected by Harold and Harold feeling stressed by Violet’s demand for attention. They had been married for 8 years and, over these years, Violet had built up resentment for what she perceived as Harold’s rejection. They found themselves in a vicious cycle: Violet would feel rejected and demand attention from Harold; feeling stressed, Harold would withdraw to cope with the stress. When Harold would withdraw, Violet would feel more rejected. How would you have helped Harold and Violet break this cycle? I asked Violet to pay attention to how old she felt when she felt rejected by Harold. She stated that she felt like a little girl of maybe 8 or 9. I asked her to return to that age and remember a particular experience of rejection. She related an experience when she felt rejected by her father. As a child Violet had been repeatedly rejected by her father, who was apparently incapable of loving her and giving her approval. He told her time and time again that he disapproved of her and was disappointed with her. When he was not demeaning her, he was simply withdrawn from her. Thus, for Violet, withdrawal meant rejection. I asked Harold what he felt when Violet expressed her feelings of rejection. He said he felt stress and pressure. I asked him to pay attention to how old he felt when he experienced this stress and pressure. He stated that he felt like a boy of 10 or 11. I asked him to return to that age and remember a particular experience when he felt stress and pressure. He related an experience of his parents’ fighting and tension in the house. In his childhood, Harold had lived in a stressful home, and he coped with the stress by withdrawing. When the family atmosphere became tense, he retreated to his room; for Harold, withdrawing was a protective device. As we dissected this process, Violet came to realize that she was reacting to her father’s rejection. When Harold would withdraw, he was not rejecting her. Harold came to realize how his withdrawal affected Violet and why she reacted as she did. Making these connections to their childhoods freed them to better understand themselves and each other, making it easier to change their behaviors. My sessions with Harold and Violet are an example of listening to the clients and allowing them to dictate the session’s direction. I would never have chosen to look into their pasts to discover the resolution to their present problems. However, they took the session in this direction, and I followed their lead. I am also prompted to reflect on how empowering it is for clients when therapists allow them to select the issues to prioritize and explore. This approach aligns with the core principles of client-centered therapy developed by Carl Rogers, emphasizing respect, empathy, and the client’s innate capacity for growth (Rogers, 1951). It demonstrates how effective therapeutic change often hinges on the therapist’s willingness to listen actively and facilitate the client’s self-discovery.

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Therapists and counselors are often faced with the challenge of balancing their expertise with the need to respect the client’s own knowledge and experience of their problems. An essential element in effective therapy is the therapist’s ability to follow the client’s lead rather than impose preconceived notions of what should be addressed first or how change should occur. This approach not only empowers clients but also fosters a trusting therapeutic relationship, which has been shown to be a critical factor in successful outcomes (Norcross & Lambert, 2018). In practice, following the client’s lead means attentively listening to their narrative, understanding their concerns, and allowing them to guide the direction of therapy sessions. The case of Pat exemplifies this principle effectively. Pat arrived expressing symptoms of depression linked to significant environmental and internal factors, including low self-esteem and voices of past abuse. Instead of the therapist directing focus solely on her low self-esteem, they initially tackled her distress regarding her ex-boyfriend’s negative voice—an immediate and manageable issue. By teaching Pat to alter the voice’s tone—making it childish and playful—the therapist empowered her to take control of her internal dialogue. This manageable intervention led to a rapid reduction in her depressive symptoms and a boost in her self-esteem. Importantly, the therapist trusted Pat’s judgment in choosing this focus area, demonstrating respect for her expertise in her own emotional landscape (Mearns & Thorne, 2013). The significance of this client-led approach is further reinforced by Erickson’s philosophy that change must originate from within the client, rather than external theoretical models (Erickson & Klein, 2005). Erickson’s approach underscores the importance of listening to the client’s narrative and allowing their unique pathways of change to emerge. Harold and Violet’s case underscores this dynamic vividly. Initially, the therapist did not suggest exploring their childhood issues; instead, he tuned into what the clients themselves identified as relevant. Violet’s feelings of rejection prompted her to revisit her childhood experiences with her father, and Harold’s stress responses led him to recall familial conflicts. As they shared these personal histories, they gained insight into how their past experiences shaped their current interactions. This process exemplifies the effectiveness of following the client’s lead in therapy. By allowing Violet and Harold to explore their inner worlds and past experiences at their own pace, they unlocked patterns of behavior that perpetuated their marital discord. The therapist’s role was to facilitate this exploration without judgment or direction, allowing the clients to discover insights themselves. This method aligns with Carl Rogers’ client-centered therapy, emphasizing the pivotal role of empathy, unconditional positive regard, and the client’s self-directed growth (Rogers, 1951). Moreover, encouraging clients to prioritize issues that they perceive as most pressing enhances their sense of agency, motivation, and commitment to change. When clients select the issues, they invest personal meaning into the therapeutic process, which significantly increases the likelihood of sustainable change (Mohr et al., 2014). In conclusion, following the client’s lead in therapy underscores the importance of active listening, respect, and trust. It recognizes the client as the expert on their own life, requiring the therapist’s humility and openness to unexpected directions of exploration that may ultimately lead to profound and lasting change. This approach not only fosters a stronger alliance but also aligns with the foundational principles of effective counseling that prioritize the client’s self-determination and innate capacity for growth.

References

• Erickson, M. H., & Klein, R. (2005). Milton Erickson's Clinical Innovations. Guilford Publications.
• Mearns, D., & Thorne, B. (2013). Person-Centred Counselling in Action. Sage Publications.
• Mohr, D. C., et al. (2014). The importance of patient-centered care: A review of counseling approaches. Journal of Counseling Psychology, 61(2), 202–213.
• Norcross, J. C., & Lambert, M. J. (2018). Evidence-Based Therapy Relationships. In J. C. Norcross (Ed.), Psychotherapy Relationships That Work (2nd ed., pp. 3–21). Oxford University Press.
• Rogers, C. R. (1951). Client-Centered Therapy. Constable.
• Presbury, J. H., Echterling, L. G., & McKee, B. (2002). Counseling principles and practices. Pearson Education.
• Short, E., Erickson, M. H., & Klein, R. (2005). The influence of Milton Erickson's therapeutic philosophy. American Journal of Psychotherapy, 59(1), 28–36.