The Secret Lives of Clients

The Secret Lives of Clients

Probing the Alchemy between Client and Clinician

By Marian Sandmaier

March/April 2004

What really makes therapy work? Clinicians invest prodigious amounts of time and energy trying to find out--comparing notes with colleagues, poring over journals, attending workshops, reflecting on their own recent sessions. But how often do therapists go to the source--their own clients--for wisdom on this vital question?

The essays that follow tap that primary source. Each piece is written by a former client who dives deeply--and often irreverently--into an experience with a memorable therapist. These writers describe their moment-to-moment experience of the process, from their vivid first impression of a therapist to the inevitable derailments, repairs, boundary crossings, flashes of intimacy, confrontations, and surprise discoveries. The phony responses and the genuine ones. The moments when neither person has the foggiest idea what to do, and the client knows it.

But more than anything, these pieces explore the precise alchemy of a relationship--the very particular connection between one client and one therapist. By now, both the field's intuitive wisdom and decades of outcome research point to the same conclusion: therapy is inescapably "about the relationship." But what does that mean? And, when therapy works, what singular rhythms in the rapport between client and clinician actually make the difference?

These essays make no claim to broadly (or even narrowly) represent the therapeutic experience. Certainly, the therapists who come to life in these pages wouldn't galvanize everybody; some clients might find them unremarkable, off-putting, or even threatening. In large part, these clinicians had the impact they did because of a powerful match between their quality of being and their client's most urgent, often unspoken, needs. As with falling in love, it takes more than two motivated, well-intentioned people to make good therapy happen: it also requires a dollop of the ineffable, a happy accident of chemistry.

This fortunate match, in turn, may make everything else possible--especially what psychiatrist Daniel Stern calls "a moment of meeting." In these stories, a fleeting instant of opportunity arises when clinician and client come out from behind their masks of expert and supplicant and encounter each other in the crucible of right now , without the time or reflection to do the "therapeutic" thing. Something about the therapist's being shines through, shines into the client, and the client, in turn, is able to imagine and try out a different way of being in the world.

Many of these moments seem small, almost beside the point. The clinician may never have known how much they mattered. But for the client, they were signal moments of opening. And as these writers recall their encounters with a particular therapist--years or even decades after the fact--it is the distinctive music they made together, and the grace notes that arose, unbidden, from their impromptu duets, that linger in memory.

--Marian Sandmaier


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