It’s funny how easy it is to open an unexcepted can of worms. I’m almost surprised, but its happened so many times. It’s not uncommon that when I start to work on something new, I expect that the upcoming journey will be relatively simple. As times goes on the worms just keep coming and coming. When I think the can might be empty, I turn it upside down and tap the bottom – more worms will just keep falling out.

*side note: This is also me foreshadowing a future blog post, sharing an analogy of how my mind works like an accordian when it’s problem solving. About how my divergent and convergent thinking plays out in almost everything I do.*

That has been no less true for my main focus this year – listening better. What started as generating some small ideas, has cascaded into many different elements. All these little side roads I could so easily travel down. For instance, I have begun to appreciate more over time, that listening better isn’t just about how I use my eyes and ears, it’s also about creating more opportunities to listen in the first place.

What do I mean by that? Lets take a common situation I run into with most of my clients. At the start of the session I’ll ask them if they have a ‘focus’ in mind for the session itself – a main thing we need to talk about and address – in order for them to cope better or grow.

The most common answer I get from clients is that they didn’t have anything in mind. They don’t offer a focus.

It feels like I’m pressing play to hear a song but I’m getting an automatic voiceover telling me that ‘the song you are trying to play is not available’.

A recent lesson about listening better is that it’s also about investigating further when it seems there’s nothing to hear – there is a metaphorical silence. In the past, when I would press play and there was nothing, I would just move on and not think much of it.

Recently I decided to change that. I decided to run an experiment to gather more information. Whenever clients have told me there is no focus in their mind for the session, I have ask them one thing – why?

The answers I have been getting have been very interesting and quite varied:

• Some have said they found choosing a focus constrictive, that it felt more authentic to follow the ‘natural thread’ of the session.
• Some felt that everything they have in mind felt equally important – leading to a sense of choice paralysis.
• Some clients said that picking a focus was overwhelming out of a fear of picking a ‘wrong’ thing to focus on.
• Most said they didn’t have anything “pressing” (nothing causing them overt distress) recently, so therefore they were happy to talk about whatever.

For some clients, it’s possible that they are not in a place yet of trusting themselves enough to pick a focus. It’s also possible that choosing a focus feels like they are giving me negative feedback on my ‘process’ and they may fear a negative response from me if they were to give a focus. In all these cases however clients have found it easier to defer to me – to delegate the decision making. It makes sense, it’s very easy to hope that as the ‘expert’ I should have a good idea on where to take things.

It also raises some interesting questions. Is it that there is often a different set of expectations between clients and therapists in how they measure ‘success’ in therapy? Do many clients measure success based on how much their distress has reduced, where as therapists will base it on how well a client has addressed what’s ‘under the surface’?

After all, it’s common for clients to end therapy once they are no longer distressed. They might feel there is no sense of need or urgency to address something like perfectionism at a deeper level.

What makes that so interesting to observe is it appears to present some dissonance. While on one hand clients will often choose to end therapy when their distress is gone, but this can be at odds with what clients will tell me is their initial desired therapy focus, which is to work ‘under the surface’ at underlying contributing factors.

When I’m just starting out with a client and I ask them if they want to focus on distress management or address an underlying contributing factor (e.g. perfectionism) most of them will elect to focus on the underlying factor. What could be going on there?

It also raises a key challenge in Deliberate Practice – one I hadn’t thought about. Which is that it’s easy to get pulled into focusing all your attention on addressing the ‘therapist factors’ when doing Deliberate Practice. It even means a good amount of guilt when I start to consider that slowed progress or stagnation in therapy may be due to client factors. While this way of thinking is imperative to Deliberate Practice, it creates an unintended consequence, which is that it’s easy to forget that at the end of the day change almost entirely sits with the client. That when it comes to therapy outcomes, client factors influence up to 80% – 87% of the outcome (page 209 of the Better Results book). Client factors are many; they can include internal factors (e.g. their strengths and weaknesses) or external factors (e.g. if they gain or lose a job) – I’m sure you could imagine a near endless amount.

It’s a reminder that while working on the therapist factors is vitally important, we cannot control the client’s part in the journey, at best we can only influence it. Creating a positive influence is all we can hope to achieve, what happens beyond that is up to the client and their circumstances. We can only do so much to manage things like transference from a client. While I can do my best to create a safe space for things like gaining feedback, I can’t instantly remove past pain that may be preventing a client from opening up. That all I can do is try – and that’s enough.

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