Do Therapists Think About Their Clients Between Sessions?

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How do therapists prepare to see a client right before a session? Also, do they often think about their clients in between sessions? originally appeared on Quora - the knowledge sharing network where compelling questions are answered by people with unique insights.

Answer by Anita Sanz, clinical psychologist, on Quora:

Before a session, I may have to finish notes, take a phone call, or handle an emergency and may not have much time to prepare to see the next client. Because of the realities of working in a busy practice, I have learned to do an abbreviated version of what I do when I have more time. Time to think about who I am and what I am trying to accomplish, what I do and do not have control over, and what I do and do not have as a responsibility.

I remind myself that I am a human being, well-trained and experienced, yet always capable of learning. I need to go into each session with a balanced combination of confidence and humility. I try to go into each session with as little active memory of the previous one, open to what is possible in the new one, and not thinking about anything else that's going to happen later in the day. Very easy to set as a goal, very hard to do.

I often try to ground myself by looking outside a window at the trees and the sky to get some perspective, take deep breaths, and even "shake off" the last session. You might laugh at me if you saw me in between sessions doing what looks like a bizarre interpretive dance, but there is nothing like moving and shaking things up to begin fresh. I know therapists who climb up and down a flight of stairs or walk around the building between clients when it's feasible. Sometimes the requirement to remain calm and thoughtful regarding responses during sessions means that in between sessions, it can feel superb to be the opposite. I guess that if you saw ER physicians or EMTs between crises, they'd not always look composed. Antics are useful for stress management. Being silly on a regular basis is good for the professional soul.

I'll nuke my coffee or tea, or get more water and offer to get the same for my client before we head back to my office. I'll take a moment to look at the note I made in the last session about my client's therapy homework assignment or what the focus of this current session was going to be, if that was decided. After finding out how things have been going since the last meeting, we get down to work.

I think about clients in between sessions the same way that thoughts about the office, school, or work probably filter into the minds of others as they are driving or commuting home or they are having downtime. Even with healthy boundaries and not being in the habit of work following me home, my mind will naturally replay a comment or an incident that happened in therapy sometimes. Rather than spend a lot of time outside of sessions trying to figure out what that's about, I will "note" it and ask myself to give it some serious consideration when I am back in work/therapist mode.

I liken it to walking up to your house and noticing some weeds growing out of the gutters. You aren't going to drop everything and throw a ladder up and start scooping out the stuff right then and there, but you'll make a mental note that "I need to get up there when I have time this weekend and get that done." I know it's probably important if something about a client is coming to mind, but it's a "not now" prioritizing that must be done to protect my time away from the office. I can't keep doing work away from work, or I would burn out.

If something about a session keeps "breaking through" and I can't push it away until I'm back at work, I will take the time to sort it all out so I can put it away again, so to speak. It takes time and energy to do that, which is why it is "work" and I try not to let "work" impose upon my non-work time. But as other therapists know, we are human, and our clients and their stories and their experiences can have an impact on us. We have to process that impact emotionally, intellectually, professionally, and as fellow human beings, or the work we do will begin to cause us harm.

I may need to let myself feel something like anger, sadness, or confusion either because that's appropriate for me to be feeling after having listened to or helping with an individual problem and I couldn't feel it/process it in the session. Or I may find that I am feeling something powerful partly because my client wasn't feeling what would have been congruent given what they were bringing up and discussing. That will give me relevant information about what I need to focus on next time, if I'm feeling my client's feelings instead of my client being able to feel his/her emotions, that's important to know and address.

Sometimes I just find myself thinking about a client whose work or progress in therapy I am jubilant about, and that's a good thing. Sometimes I reflect on a patient and just hope they are doing okay and just send that thought out to the Universe. Those ways of thinking about clients not only don't cause any harm, but they are also beneficial. Just like you might think about a goal you achieved at work that makes you feel good or a co-worker who is going through a rough time and hoping they are having a better evening, it doesn't take anything away from you. It makes you feel happy, connected and reminds you of one of the reasons why you are where you are and why you're doing what you're doing.

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