The Glass Wall:
My Response to Difference in Clinical Practice
Introduction
In my work as a student-therapist the three core contextual factors that have presented in therapy that have directly influenced and informed my world view and therapeutic process are the difference in the clients’ age (developmental phase of life) (Walsh, 2003), the clients’ gender and sexual orientation. These differences provided opportunity for me to expand my experience of the world as I work to sit with my clients in an expanded, more meaningful and impactful way.
The Glass Wall: “Seeing” But Not “Being”
The case studies portray clients who sought out therapy because of their individual distress due to job loss, unemployment or underemployment. Each also reported similar symptomology that were a mix of anxiety, depression and behaviors that included the inability to manage negative sentiment for themselves and others. Initially, my assessment and treatment assumed that their presentation of similar distress and symptomology required a “one size fits all” surface treatment plan (i.e. coping/soothing strategies and career exploration skills).
As their individual stories began to unfold however, I encountered both my clients’ and my own resistance and assumptions. It was at this point I realized that there was a glass wall that existed between us that allowed us to “see” one another but not “be” present in the room with each other. I understood that in order to develop an effective therapeutic relationship that facilitated significant and sustainable change (Nichols & Schwartz, 2008) I needed to do something different. The individual clients were chosen to explore and highlight the concept that within a family system it is crucial to understand that the “collective stories” of individuals contribute to the “whole” system.
The Clients: The Other Side of the Glass Wall
The following clients challenged my assumptions, expanded my lens of compassion and heightened my awareness of the glass wall and allowed me to be curious and apply my new awareness of differences to the therapeutic process. Although there are some demographic similarities on one level, each client represents a very different cultural perspective than my own.
Age: Developmental Phase of Life
The first client, 0015 is a 77 year old twice-divorced single Caucasian female whose first ex-husband and father of her four children just recently passed in January of 2010. 0015 presented in therapy because this recent loss awakened a fear around her financial future as she faces retirement on a fixed income with no likelihood of future employment.
In the initial two sessions during the assessment process with 0015, I mentioned to the client that we would begin the treatment plan process in the third session and over time, work on those goals she wanted to establish for herself. She looked me in the eyes and said with a laugh, “you talk as if I have all the time in the world.” And my response, “you have the rest of your life to do this work,” was inadequate and evidence that we had different perspectives of time. My statement had made an assumption of her experience of life that for her was a crucial difference.
At the age of 77 she looked back and measured her life based on the time she had lived. At the age of 49 I was looking forward and measured her life by the possibility of the time left to live. This difference although subtle could contribute to a discrepancy in meaningful goal-setting. If I am to establish a working therapeutic relationship, key to navigating this difference is my ability to understand the historical influences (events and ideas) that inform her approach to her life (Egan, 2002) without the interference of my own perspective.
Gender: Who’s The Man?
The second client 0024 is an 18 year old single Caucasian male who dropped out of high school at 16 and obtained his G.E.D. He presented in therapy due to his high levels of anxiety around finding a job that will allow him to be independent of his single-mom household. He reported he lived in a single-parent female dominated household (with his mother and two sisters). His father had been present in his early years until his parents separated when he turned twelve. Since that time his contact with his father has been minimal. He attributes his struggle towards emotional and financial independence to the lack of “male” leadership.
Initially, 0024 requested a “male therapist” because there were several topics he did not feel comfortable discussing with a “female” therapist and was very careful in discussion. I did inquire about a male-therapist but was unable to secure one that could work with my client. After hearing of my attempt to inquire about a male-therapist, the client thanked me for considering his request and agreed to continue his sessions with me. Here I learned that by addressing and not minimizing the client’s concern around gender and “turning towards” his request validated and strengthened the client’s voice in session.
Sexual Orientation: The “Retired” Lesbian
The final client, 0044 is a single, childless 57 year old African-American female. She presented in therapy after the recent loss of her position as a probation officer and subsequent loss of income. She reports that she is fearful that she will not be employable in this present economy and “at this age.” Initially, I assumed that statement highlighted her concern about her chronological age and available career options, however, as I remained curious, in later sessions the client revealed to me the primary source of her anxiety about her age and possible career.
In the sessions that followed the client referred to herself as a “retired lesbian.” This description had dual meaning for me. In my mind this description could either refer to her lesbian lifestyle and her decision to “retire” from the world of work or it could refer to her “retirement” from the lesbian lifestyle. I was hesitant to ask her meaning because of my own cultural upbringing that did not necessarily view lesbianism strictly as “taboo” but out of respect we but did not question or discuss. This upbringing hindered the therapeutic process and created “stuckness” in session. Eventually, the client missed 4 sessions consecutively. I invited the client back and opened the discussion to explore her meaning around her lifestyle. The client became “energized” around the topic of her lifestyle choice and has opened up about her situation. The client feels that she has so much more to experience in life, but because of the declining health of her “significant other” she has had to “retire” her sexuality. This was a major source of anxiety as she feels increasingly lonely for affection and repressed from expressing her sexuality. Her anxiety around her career possibilities were in anticipation of her becoming financially independent again and establishing a separate household. We were able to collaborate on a treatment plan that had her feeling enthusiastic and hopeful.
Summary of Professional Learning
Age can be considered from “two perspectives, a backward-looking one and a forward looking one” (Sanderson & Scherbov, 2008) and influenced by the social and individual belief about life expectancy. This junction is where a person’s prospective age impacted by “social and economic changes, public health improvement and personal choices” (Sanderson & Scherbov, 2008) intersect the individual’s chronological age which according to western social construct oppresses the old (DeVault, 2008). It is important to know where I stand on the timeline in perspective of my client.
In gender there are three considerations. I must consider the biological differences, social constructs and the “mechanisms by which males become masculine” (Goodwin, 1997) and females become feminine. According to theorists there exists “two kinds of gender biases: those that ignored gender differences and those that overemphasized them” (Knudson-Martin & Laughlin, 2005). To strike a balance I must be careful “not to overstate the case for gender, minimize its importance, or take sides in the gender wars” (Egan, 2002). To maintain this balance it is important to learn directly from the client how he views and experiences his “gender” through his biological, social and task-oriented lens by asking reflective questions.
Sexual Orientation is often limited by “how ideas of gender and sex” have been socially constructed (Knudson-Martin & Laughlin, 2005). The “either-or thinking”(Knudson-Martin & Laughlin, 2005) that was used by early feminist to battle “gender equality” (Knudson-Martin & Laughlin, 2005) has created a “dualistic tradition” (Knudson-Martin & Laughlin, 2005) that “assumes that anyone who desires a man must be by definition feminine” (Knudson-Martin & Laughlin, 2005) and “that anyone who desires a woman must be . . . masculine” (Knudson-Martin & Laughlin, 2005). This assumption then creates a faulty lens that all lesbian clients have “masculine” desires around career, sex and family. It is crucial to remember that gender identity is specific to each individual.
Personal Reflection: Behind the Glass Wall
Prior to the course, “Developmental Perspectives of Change,” it was difficult for me to identify the factors and assumptions both the client and I held concerning their circumstances that impacted both the therapeutic relationship and change process. My personal experiences and wounds around my own differences had me focused on the “similarities” and minimize the “differences” which I believed was my “need for inclusion and compassion” that had me “content-focused” and behind the glass wall, instead of “context focused” and present in the room. This experience has emphasized the importance of the therapist own self-work needed to be present in the room for the client.
The Process: Through the Glass Wall
Although the content driven process could assess the client differences demographically and allow me to provide age and gender appropriate strategies and skill sets, I would have done so without understanding the complex context of their lives and would have continued “pushing towards change” in the midst of resistance. It wasn’t the clients’ resistance however, that provoked the awareness of the complexity and context of their lives (Egan, 2002) it was my own resistance that provoked and perplexed me.
The reading assignment both in-class and out of class initiated the awareness of the limits of my experience. Specifically, the chapter 14 titled “The Family Life Cycle: Understanding the Life Cycle: The Individual, The Family, The Culture stressors” (Walsh, 2003) highlighted the significance of assessing for both types of stressors. In this chapter they address the two types of stressors that impact “individual, family and culture: Horizontal Stressors and Vertical Stressors” (Walsh, 2003). Horizontal Stressors are those “stressors that are developmental and include both predictable and unpredictable transitions” (Walsh, 2003). Vertical stressors are those stressors that are “historical events and attitudes or ideas” (Walsh, 2003), that influence individual development such as “classism, racism, sexism, etc” (Walsh, 2003). Cultural stressors can “heighten” an individual’s “attention” and awareness to “what matters” (Walsh, 2003) and is a “dynamic process that links their past to their present” (Waite & Calamaro, 2009) and affect their individual choices and impact individual lives. The idea that there is never just one force of impact allows me to be curious about how these forces interact and influence our interactions.
Considering the individual client’s circumstances “within the social system in which the client” (Brown, 2008) functioned and my understanding of how this functioning impacts their circumstances, their view of themselves and others, and how these differences may facilitate and inhibit the therapeutic process (for both myself and my clients) would be important to this “new” process. I needed to be curious and explore.
Conclusion
The three core contextual factors that have presented in therapy: the clients’ age (developmental phase of life) (Walsh, 2003), the clients’ gender, and sexual orientation have directly influenced and informed my world view and therapeutic process. These differences provided opportunity for me to expand my experience of the world as I work to sit with my clients in an expanded, more meaningful and impactful way. This opportunity for my own growth would have been missed had I continued to be unaware, unwilling or unable to challenge my own assumptions and world view (Swanson-Moten, 2010). Challenging my assumptions did not equate to dismissing my own view of the world but involved developing an awareness of my assumptions and the client differences, and allowing these new and unfamiliar experiences to impact and inform me. As I reflected on the impact of these experiences on my own life, I acquired a lens that helped to delineate between the person and the problem and thus allows me to begin treating the person. It is not enough to have become aware of how cultural stressors can “heighten” an individual’s “attention” and awareness to “what matters” (Walsh, 2003) but to remember that they are part of a “dynamic process that links our past to our present” (Waite & Calamaro, 2009) and affects our individual choices and impacts individual lives. This process requires that I keep pace and continue challenging my perspectives and pursue continued growth and experiences.
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