A Mental Health Counselors Guide to Working with Clients

by Tony Vasquez, Edited by Laura Morrison, for GradSchools.com


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As mental health therapist you are likely to come into contact with many types of clients seeking help for a myriad of psychosocial issues or mental health problems. There are many interventions and talk therapy models that you might utilize during your work with clients. Many of these methods are based on the dynamic between the therapist and the client, some are based in play or narrative methods, some are long term and some are very brief, while others are based on early life experiences as the cause of mental dysfunction (psychoanalysis). Regardless of which type of therapy we practice here are some important factors to consider when working with clients during therapy.

Defining the problem from client’s perspective

To begin with you must identify and clarify why the client is seeking help. You should be able to get an objective definition of the problem from the client in order to try to understand the issue from their perspective. It is vital to try to understand where the client is coming from, where they are now and what coping strategies have worked in the past or if they lack those skills all together. You may have the opportunity to review a psychosocial assessment completed by another health care practitioner if the client has been referred from an outside source. If they have come in for help on their own accord you will have the opportunity to complete an assessment yourself during the initial consultation. Your intervention method will be determined and will depend on why they have come for help and what issues are disrupting their daily functioning.

Setting professional relationship boundaries

After working with the client to determine the reason they are seeking therapy, you must discuss the parameters of therapy and explain the therapeutic technique that will be instituted and how it may help. Your other responsibility is also to set defined boundaries and explain the professional relationship that you are entering with the client. This usually covers all privacy and confidentiality issues, dual relationships, moral and/or ethical dilemmas, and also the subject of when confidentiality must be broken. You also must inform the client that you will complete clinical supervision periodically and may have to discuss some subject matter related to therapy if there is an impasse in treatment. This clinical supervision is intended to assist you in directing the most effective path of therapy. The therapist must be clear with setting the parameters and explaining boundaries with the client in order to set a good professional foundation and therapy milieu which may be challenged from time to time.

Securing clients’ idea of an expected outcome

Another responsibility therapists have to the client is to inform the client of any expectations. Help the client understand some of the subjects that will be discussed in therapy, depending on the client’s issue, and make sure that they understand what is expected from therapy and the therapist. It is equally important to ask the client if they have any questions and what are their expectations of therapy. Remember for some this may be the first time in therapy and may bring about more questions than answers. For others it may be their 2nd, 3rd or 4th therapist they have worked with. You must also remember that each experience, regardless of how many therapist they have worked with, will be different. So securing their idea of an expected outcome is important to gauge.

You must treat clients as equal working partners in therapy. Depending on the therapy method used it is beneficial to give our clients tasks or homework to complete between therapy sessions. When the client is able to process with the therapist “their work” it can give the client a sense of investment and empowerment into their own treatment. Reviewing their tasks also can give you, the therapist, insight into how the client is processing therapeutic methods/interventions. In my experience, using tasks, I have seen how clients have changed how they view therapy, are cognizant of what or what is not working, and how it shifts the accountability toward themselves with the therapist assistance.

Varying degree of clients’ participation

In the process of our work in therapy it is essential to understand that there will be a varying degree of participation from the clients. Some of the client have been referred, some mandated, and others have chosen to seek help themselves, you need to be aware that regardless of what you do as therapist you cannot be successful with every one that you come into contact with for therapy. You must remember that not all clients will terminate with all of their life’s issues resolved. Some will quit in the middle of treatment. Some will want to continue as long as they can even though they are not in need of therapy. As professionals we must assess if treatment are deemed appropriate and our work continues to be relevant and helpful for the client.

Learn from the client

Remember that each client will bring a unique set of circumstances and also supply a distinct opportunity to help us evaluate our work as clinical professionals. To grow as therapist you must learn from the client regardless if they complete therapy successfully or you had to refer them to another therapist because you could not reach the goals that had been set forth in the initial session or their problems fell out of the scope of your expertise. By being able to do some introspection of your work with each client will create learning opportunities to improve our methods and more importantly, better help the next client you work with.

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