If the Shoe Fits……

Sometimes a therapist and a client are just not a good fit. People have reactions to little details about other people that are not rational. Perhaps one of them has a physical feature or mannerism that reminds them of a person who hurt them in some way – but the memory is old and fuzzy and the search for the reason is likely to take the focus away from the presenting issue, and not really yield much help for the client. Perhaps their communication style is out of kilter – they just don’t “get” each other. We encourage clinicians to self-disclose judiciously – but we do a great deal of self-disclosure just by the way we dress, wear our hair, choose our business cards, and decorate our offices. Perhaps something in that first-level self-disclosure puts a client off. Perhaps the reason for the lack of fit is something else altogether – but what it is, is not the point. The point is, it happens. Sometimes there just isn’t a fit.

When this happens, clients may just disappear (miss an appointment and not return phone calls), or cancel and reschedule frequently, or just spin their wheels in the treatment. Or they may say that they’ve changed their minds, they don’t really think they need treatment, they’re not coming back. Unfortunately, at the same time they often decide not to pursue treatment elsewhere – they give up on therapy all together – although working with another clinician might have been extremely productive.

I like to tell clients, finding the right therapist is sort of like shoe shopping. You walk into the store with an idea in your mind of what you’re looking for – and then you think you see it. It’s just the right color, just the right style. You look it over – it’s well-made. And – how about that! The price is even reasonable! So you try it on. Uh oh. It doesn’t fit. It pinches here, it bulges there, it hurts when you walk. That doesn’t mean it is a bad shoe, and it doesn’t mean you have bad feet. All it means is that there isn’t a good fit between your foot and that shoe. Time to go back to searching.

We might suggest to clients that, when you realize that the therapist you are sitting with is just not a good fit for you, the thing to do is NOT to give up on therapy. It is also not to disappear. Tell the clinician that you’d like to transfer to someone else. Your therapist knows these things happen and knows not to take it personally. (And as clinicians, we should know that, if we ARE taking it personally, we need to address that in supervision. This is the case if it happens from time to time. However, if it happens quite frequently, perhaps we do need to explore, in supervision, what we might be doing that sabotages the engagement process.)

So – uncomfortable differences with others don’t mean either party is “bad” or at fault; it’s just not a fit. This idea is relevant in other areas as well. We don’t all want the same things in a partner, coworker, employee, roommate, or therapist, because we don’t all have the same needs and tastes. One person’s ideal roommate might be neat, quiet, and always have their part of the rent paid two days early. Another person’s ideal might be someone who is quite social, a good listener, great with decorating ideas, and willing to live in some disorder. Intimate relationships can be the source of great enjoyment and growth in our lives – but if there is not a good fit, they can also be quite painful. Rejection isn’t pleasant for anyone. Nevertheless, it is possible to tell oneself, “N not being interested in me doesn’t mean I’m a worthless or undesirable person – it just wasn’t a fit.”

When clients begin working with a therapist, or interview for a new job or a new roommate, and the hoped-for connection doesn’t work out, they can remind themselves of the analogy of the shoes: it can be a beautiful, well-made, appropriately priced shoe – but sometimes, despite all its good qualities, it just doesn’t fit. Having to continue the search may be disappointing – but it is not a disaster. Much better to find the right shoes!

Passengers on a Bus

At a training I attended some 18 mo. ago, the speaker shared an analogy I used numerous times afterwards, in which the individual is compared to the driver of a bus. The explanation of the analogy was brief and, as it turns out, I apparently misremembered parts of it and perhaps misunderstood other parts – but the “twisted” version I used after that, with clients, worked, too. I just found out that this is a widely-published analogy in materials related to ACT, Acceptance and Commitment Therapy, a type of CBT. What follows are two links to materials explaining the ACT version, including a video and a written description. There is also a reference to a publication in which the written description is quoted, in the context of a larger discussion of the use of ACT/CBT. Following that are my own thoughts about the “bus driver” analogy that I used with clients.

The video:

The written description:
http://forum.psychlinks.ca/acceptance-and-commitment-therapy/24748-the-passengers-on-the-bus-metaphor.html

The reference:
Luoma, J. & Hayes, S. C. (in press). Cognitive defusion. In W. T. O’Donohue, J. E. Fisher, & S. C. Hayes
(Eds.), Empirically supported techniques of cognitive behavior therapy: A step by step
guide for clinicians. New York: Wiley.

Anita’s version:

You are the driver of a city bus. You know how to drive and you know the route. You decide when to stop and you turn on the sign, at the end of your shift, that says, “Garage,” to tell people that you aren’t taking on any more customers. BUT – you can’t control who gets on your bus. Sometimes it will be people you like a lot – people who are quite pleasant, or just quiet. Sometimes it will be people who grumble or criticize or try to tell you how to do your job. (Just as, in real life, there are people in your life that you didn’t invite into it – perhaps coworkers, or next-door neighbors, or in-laws, or customers.) Your job, regardless of what they say or do, is to keep on driving the bus. You don’t let them tell you where to go, you don’t let them sit down in the driver’s seat. It’s your bus. You just keep on driving, do your job, and don’t let grumpy or critical or bossy people get you off the track.

In this version, unlike the ACT/CBT version, the people on the bus represent real people, not thoughts or feelings. I often used this analogy with people who had difficulty with assertiveness, who felt unempowered, who allowed others to “get under their skin.” The driving of the bus represents their moving toward their goals regardless of others’ agendas, nagging, naysaying, etc. It was important for some clients to realize that they didn’t necessarily need to remove those people from their lives – they just needed to get better at tuning them out at times. I recall a couple of clients who told me later, “I keep telling myself – ‘just keep driving this bus.'”

The interpretations, while very different, are certainly related and for some clients, particularly those who are more concrete thinkers, the first version might actually be a good introduction to the analogy – to be followed later by the idea that those other people on the bus might represent various voices in your own mind – as a less concrete interpretation it might be easier to get the second after coming to understand the first interpretation.

In any case, this is a rich analogy with several useful levels of meaning – and a great video to go with it!