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!

A Sentry with Good Judgment

The inspiration for this analogy actually comes from one of the psalms – Psalm 141, vs. 3, to be exact. It is translated, of course, in numerous ways, but I like the first:

Lord, place a sentry at the door of my mouth.

And the second:

Set a guard, Lord, before my mouth; keep watch over the door of my lips.

Completely aside from any specific religious beliefs, the idea of a guard or sentry to help one use discretion in speech is a useful one. I have shared this concept with numerous clients – the idea that, the presence of a guard avoids two extremes: keeping everything in, and keeping nothing in. The idea of a guard is that someone is there to decide – should I let this one pass or not?

Some of us – and some of our clients – err on the side of saying whatever comes to mind, with the effect that confidences are broken, relationships are damaged, dangerous impulses are indulged, boundaries are violated, unwise commitments are made that cannot easily be unmade. And some of us (including clients) err on the side of sharing only the most basic or innocuous information or feelings, with the effect that our relationships are shallow, we feel distant from others and they from us, issues that need to be addressed are not, assumptions are made in the absence of actual information. Neither extreme is helpful.

So we need a sentry. That sentry can be conceptualized as a Higher Power or Divine Guide, but it can also be conceptualized as someone in our life whose judgment we respect (a parent, teacher, best friend), or simply as our own best judgment.

A client’s image of a sentry or guard may be a big man in a military uniform, which may not be helpful – it may arouse anxiety and bring up negative associations to authority figures. For these clients, the image of a school crossing guard may be especially helpful. We know that crossing guards are not interested in keeping kids from getting to school or home – just in having them do so safely and wisely.

Saying to oneself, when trying to decide whether to share a certain remark or not, “Check with the sentry,” can give us the moment we need to access our best judgment and make the right call. Clients who tend toward either extreme can use this analogy to their benefit.