The Most Worrying Things We Hear from Clients as Therapists

Working as a therapist, there are often moments when we hear things that are both profound and unsettling. These moments are a testament to the sacredness and trust inherent in the therapeutic relationship. As professionals, it is crucial to recognize and address these concerns with sensitivity and care.

A Note on Terminology and Professional Roles

Firstly, it's important to clarify the distinctions within the field of therapy. The term “therapist” can refer to various professional roles, such as physiotherapists, radiotherapists for cancer, occupational therapists, and speech therapists. When discussing this article, I assume we are referring to psychotherapists, also known as psychoanalysts. Unlike these roles, psychotherapists do not have clients; we have patients. This distinction is crucial because it underscores the professional and medical nature of our practice.

The Revelation and Disguise of Concerns

Psychoanalysts often face deeply concerning statements from their patients. A client might reveal, for instance, wanting to have sexual relations with both parents simultaneously and expressing the desire to murder them. Along with these, the client might also voice feelings of wanting to die, never having been born, or striving to be omnipotent gods. Such disclosures are not just shocking; they are also a sign of deeper underlying issues that require careful and sensitive handling.

Interestingly, these disclosures are frequently made in disguised or coded ways. In psychoanalysis, the therapist’s role is to help the patient reveal and unpack these hidden desires and fears. Therefore, when such travesties are voiced outright, it often indicates progress and an approaching end of the treatment. This is indeed a core part of our professional clinical formation.

The Core Concern: Risk of Harm

While deeply distressing statements are significant, the most concerning aspect of our practice is the risk of harm to self or others. This risk relates not just to potential physical harm but also to safety and one's presence in the world. As therapists, we are deeply concerned with the well-being of our patients and the potential danger they may pose to themselves or others.

The level of concern varies based on the nature and intensity of the risk disclosed. For example, a client discussing fleeting suicidal thoughts, which may stem from a desire to escape overwhelming feelings, raises initial concerns. However, when a client expresses regular suicidal thoughts, these worries intensify significantly. A client with persistent suicidal thoughts and who has started to isolate themselves by deleting social accounts is a clear alarm bell, prompting immediate action and intervention.

The subtle signs of someone transitioning away from the world, often referred to as “goodbyes,” are perhaps the most concerning. These may be subtle and not explicitly stated, such as changes in behavior or social interactions. Recognizing these signs is paramount in ensuring the safety and well-being of our patients.

Conclusion

As therapists, we are entrusted with the care and safety of our patients. The concerns discussed here highlight the critical need for vigilance and support within the therapeutic relationship. It is essential to approach these delicate topics with empathy and professionalism, ensuring that our patients receive the necessary support to navigate their challenges and ultimately lead fulfilling lives.

For further insights and resources on therapeutic practices and mental health, consider exploring the following: