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First Draft from Holding Space: Clients

November 26, 2017

Clients

 

Therapy wouldn’t exist if there weren’t people seeking to alleviate their suffering and improve the quality of their lives.  Living may be considered an attenuating condition in some ways rather than a stable one.  There’s no attainable state of perfect health because there are many ways in which life inhibits our well being that are naturally occurring.   These include illness and death.  The question comes as to whether people should come to terms with those conditions or to join others on the search for immortality or something close to it.  “Learning to die” or “living towards death” are notions among philosophers explaining reasons why people thinking past what they see in order to understand better how they should live.  Gloomy as it may sound an awareness of our “ownmost possibilities” can be just as liberating as it may be disabling.  Even with death being one of the most certain possibilities in our existence we nonetheless find reason to live and to live well.  Illness, disease, and dysfunction though prevent us from living to our fullest potential.  Just as trees grows towards the sun making twists and turns in order to get closer to it human beings grow towards the sky and contort themselves mechano-energetically in order to grow into their environment.  Many things prevent this of which we are aware and many of which we are not; some things which are in our control and others that are not.  The things that we do have the power to influence though are the grounds for interventions, for treatments, and for therapies.  

 

These are conditions which create a client or patient; the person needing care.  The client though isn’t some Platonic form of a person or type of customer.  Clients are human beings and, even more than that, they are individuals writing their own life stories.  The details of these stories are just as important to consider as what they present physiologically.  The client has unique values and priorities that correspond to their unique chemistries and body compositions.  Any element of the client is subject to intervention because each element goes to effect the whole person just like any abnormality within an object affects the integrity of the entire structure.  Clients are searching for care that recognizes the importance those separate elements have in composing overall health and wellbeing.  They want to be seen as individuals and not as anatomical replicants of a divine model of human that exists in the imaginations of people operating as purists adhering to tradition.

 

A Client Is

 

All kinds of care has been accessible to people throughout the ages and the world of today seems to offer a thousand more ways to treat illness and disease.  The field of bodywork for example has in itself numerous modalities ranging from more locally to more globally focused interventions.  To explain the various ways in which different therapist in this field might address one person’s issue take for example two kinds of therapists.  One may be more inclined to work on the person’s trigger points around the scapula in order to improve shoulder mobility while the other therapist may see the person’s lack of shoulder mobility as a result of cardiovascular dysfunction and restrictions in the heart.  Regardless of a therapist’s particular specialty and training clients come with their own preferences for what will touch on their needs whether the preference is their own, their bodies, or some combination of the two.  Clients can be further divided into categories based on physical and cognitive traits; even socio-economic or cultural backgrounds.  Clients in any category however still have their own unique needs which are difficult to categorize in order to match them with an appropriate form of therapy.  Even though clients come in many different shapes and sizes there are some universal qualities about them which we can begin to explore as a way to develop a more well rounded view of them.  By paying attention to the underlying similarities between people needing care therapists may be able to maintain a view which isn’t narrowed by the type of therapy they’re most capable of implementing.

 

First and foremost clients are people in need of something meaning that satisfying that need is the reason for the therapeutic relationship and they are the ones who will ultimately benefit from it.  They want to improve their health and quality of life, or at least regain some control of it.  They were possibly thrown into a state of disorder by conditions within or outside their control.  They may have also grown into some state of disorder overtime.  Either way they are seeking stability and support from anyone who is able and willing to help since they are not able to stabilize or support themselves.  Not all clients though are necessarily seeking to relieve conditions.  They may also be looking for some help in advancing their current conditions.  In these cases the therapist may simply serve to give them more information about how to work with what they have and provide some feedback on how their bodies are responding.  The clients who can’t stand themselves up, emotionally and physically, can’t move well and, consequently, can’t adapt well to additional changes in their environment which will further exasperate their conditions.  Their recovery to a self-sustaining state of health should be a priority in the relationship because that was their condition before they fell into dysfunction.  Oftentimes therapists and clients slow down or cease therapeutic work altogether when the immediate needs of clients are satisfied and the symptoms have subsided.  Symptoms will usually return soon after care is received or they will come up as different symptoms.  Examples of this pattern come up a lot in manual therapies such as massage but aren’t seen unless it’s by someone with a lot of skill and expertise.  A person may come in for example in order to relieve chronic pain and inflammation at the front of the hip.  One therapist may make an adjustment because it’s viewed as a spinal misalignment issue, another therapist may rub the area of discomfort because it’s viewed as an problem resulting from a hypertonic muscle, and yet another therapist may pull on the big toe and foot of the affected leg because it’s seen as potentially related to a faulty gait pattern.  It’s then revealed that the client stubbed the toe on the same foot really bad years back but didn’t realize how much it changed the client’s walk even after it healed.   The practice of chasing symptoms also comes up in other health professions but the author can only suggest the reader make his or her own connections based on personal experiences.  What is often overlooked in all of this is how dependent the clients are on the work of the therapists for their ability to regain balance and experience relief.  Therapists forget how much influence they have on shaping the client’s perception of health especially when they’re creating relief for the client which he or she couldn’t get on their own.  In targeting symptoms clients hardly ever reach a level of sustainability and thus become chronically dependent on the existing support provided by the health-care practitioners they’re seeing .  Clients, as well as therapists, acting with this level of care are operating with a fix-it mentality.  To explain take for example a client in need of relief from lower back pain resulting from an acute injury.  The client and therapist responding to the surface level problem will attempt to fix it by manipulating areas on and around the location of pain and discomfort.  The client may get relief and go on about things she gets injured again, maybe somewhere different.  She then goes back to the therapist who then sees and responds to the client’s reason for coming in to get help.  It’s a relationship that starts and stops at symptoms of which the client mostly experiences at the level of needing help with them.  They don’t quite have a healthy familiarity with parts of their bodies until they begin to be problematic.  It’s a similar relationship to the one car drivers have with auto-mechanics.  The drivers won’t experience a problem with the car until it starts smoking, it starts making noise, or it stops running.  They then bring it to the mechanic who fixes the problem and gets the car running again until something else stops working.  The driver becomes dependent on the mechanic to sustain the driver’s being able to use the car and that’s the extent to which the driver is familiar with the workings of the car.  The driver doesn’t usually have a pre-existing healthy relationship with the fundamental and hidden components of his vehicle.  In this way the initial goal of getting a client to a level of healthy autonomy gets overlooked because the symptoms become the center of the therapeutic relationship.  The symptoms become the only things clients experience and therapists touch.  Then the presence or lack of symptoms becomes the measure of how successful the therapeutic relationship is in addressing the client’s health.  A dependency develops where the client depends on the caregiver’s fixes.   The caregiver may even become dependent on the client’s problems in order to maintain a consistent practice.  The client should never be a means to sustain a practice because then his symptoms become an object with which the therapist develops a relationship further taking away from the potential possibilities of a direct relationship with the health of the person in need.

 

A client is also not a friend and definitely not a customer.  Once the relationship crosses those lines it may quickly dissolve into a relationship with extenuating conditions where it may be more difficult to keep track of boundaries and scope of care.  That may be a tough pill to swallow especially if the practitioner is a friendlier and more personable type of person.  It isn’t a bad thing to be friendly and personable in the world of therapeutics.  Therapists can definitely maintain a friendly relationship with a client for years as long as everyone in the relationship is aware of its designation by all people involved in the relationship and understand that the same expectations therapists have of their clients will become the same expectations they have for their friends.  No one should be upset if clients then start behaving as friends and seem less focused on reaching the original goals for the therapeutic relationship for the sake of strengthening a friendship.  Personal friendships in the therapeutic setting may also endanger clients to being dependent on a friendship for the feeling of being cared for when actually no measurable improvements in health are made.  In this way a therapist could be in danger of profiting from a client’s attachment to the friendship he has with the therapist rather than earning a wage from providing a service that goes to improve the client’s health.  If clients had a choice between a type of care that was dependent on their being able to see a therapist or a type of care that they could self-manage with occasional help and guidance, what would the choice be? In most cases clients seeking out better health want it to be self-sustaining and it’s a therapist’s duty to encourage that level of health to the best of their abilities if the therapist’s role in the therapeutic relationship is to be actualized.

 

A client is not a victim.  Victims are usually described as people who suffer from different crimes, events, or traumas.  Clients suffer from their present conditions which may have resulted from a string of events starting at a particular instance of victimization but any label such as victim or disabled are words denoting characters in an event.  They aren’t terms of description describing a state of being nor are they words to live by.  Clients come with qualities about their current condition they’d like to change or make easier to manage.  They want to exist past their traumas and some forget them so much they can’t figure out the origins of the conditions currently causing pain and discomfort.  Some never forget and exist as if the origins of the conditions causing pain and discomfort are ever present; as if they were stuck in time.  Whether or not they stay present with the origins of their pain or forget them clients still experience pain in their bodies which is why they sense something's not right and want to get help.  To start off seeing someone or the self as a victim,  disabled, or less in anyway sees the current state of disorder as a normal state of being.  The client and therapist should search instead for what it is in their current state that’s healthy and what potential they have for existing in the present moment.     

 

The client is a partner in the sense they are accountable along with the therapist for their own healing.  The client is also helps in directing the flow of therapy.  Therapists don’t simply choose how they’ll intervene even if clients wish them luck and pass out on the table.  Regardless of the words and thoughts presented by clients their bodies speak for themselves and have the potential to tell therapists exactly what they wants and need from someone willing to help.  Therapists help by listening to these messages and responding to them with intelligent touch.  They also help clients discover ways they can provide their own stability and support from using resources they have at their disposal.  

 

In short, a client is the Thou, a subject within a relationship with which a therapist has a dialogue.  They are the impetus for the exploration in which both parties participate.  The goal of which is to reestablish enough stability in order to allow for their growth and expansion towards healthier ways of being.

 

 

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