In Support of Supportive Therapy By Audrey Sherman, PhD on 1/22/19 - 3:54 PM

I am a practitioner who primarily uses cognitive and cognitive behavioral techniques. I like the structure, the science, the goals and being able to both see and measure the outcomes. My continuing education has typically been in CBT or a related subspecialty of interest. In short, I am a believer. I recently had the good fortune of being introduced to a client who taught me a new appreciation for the very non-directive and perhaps non-measurable art of being supportive.

I live in Florida and this client, like many of my clients, was retired and in her 70’s. She had no family to speak of other than a daughter who didn’t pay much attention to her other than a random call now and then. However, my client did have a dog that meant everything to her and was a powerful source of support. Though she was also under the care of a psychiatrist, my client remained depressed, isolated and lonely. My treatment plan included attempts at motivating her to become involved in social and recreational activities by expanding her support systems, and coming to some kind of terms with her absent and seemingly neglectful daughter. I had it all planned out; after all, I did specialize in an action-oriented, proven-effective and pragmatic form of psychological treatment.

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However, my client preferred discussing her dog. He liked ice cream and they had quite a full schedule of procuring it at various fine dessert emporiums around town. He had certain preferred flavors and was drawn to ice cream-related novelties including cones, sprinkles and sauces. They also had specific ice creams and treats they enjoyed while watching television and favorite procurement spots--ones they could walk to and those that required a car ride. The dog very much enjoyed his rides in the car.

As a relatively new therapist with this population I was very eager to fix what was wrong--her depression and loneliness. I was also quite eager for her to talk about her symptoms and our intervention, not ice cream. I suggested useful homework assignments and therapeutic exercises. In short, I pulled out everything from my bag of tricks. She would have none of it.

As hard as I would try to get the discussion back on track, she would invariably stick with yet another ice cream or dog tale, or both. I would bring up the daughter, she would bring up their favorite detective show. I would bring up loneliness, she would bring up the dog again. It was a dance between two partners who were not quite dancing together. I felt like I was failing her horribly by not being able to shift her to focus to her symptoms so that we might work together at alleviating her symptoms. I believed her resistance to be remarkable in its strength. I not-so-musingly wondered (silently) if I were committing insurance fraud by accepting payment for this.

I brought it up to her at one point that I wasn’t sure I was helping and asked if she wanted to pursue another avenue of treatment or another therapist? “Oh no,” was the reply, “You are helping me a lot.” So on we went dancing together-alone. I didn’t want to add a perceived abandonment to her list of difficulties.

Around the same time, I noticed I was receiving many calls from new clients in this woman’s general area. Sure enough, one by one as I met with them, they would say my client was their referral source. “So and so told me how much you help her and I just wanted to come in and talk about my son.” “So and so told me how you helped her with a depression and I wanted to see if you could help me.” Are you seeing the pattern here?

I thanked my client for the referrals when she came in and her response was, “You are welcome, you are the best therapist I’ve ever had, I tell everybody about you.” “Everybody” turned out to be the people she met at the ice cream places! Apparently the more I encouraged her to get out and get involved, the more ice cream places she and the dog visited! She chatted up whoever was there eating their ice cream and swapped stories of neglectful children, doctors, medical conditions and therapists.

So in an indirect way, I was indeed affecting her behavior, but she affected mine as well. I gained new clients from her referrals for several years after our treatment ended, and she would come back from time to time to check in. I know now that just having someone to listen and share her life with was what was important to her and I didn’t need a doctoral degree to do that, although it helped. Her meetings with me alleviated some of her loneliness and gave her a place to go, an appointment to keep, someone to talk about to the people she met at Dairy Queen. I filled a gap, I provided support, I hope I didn’t commit insurance fraud.

I now never underestimate the importance of support and of just being there. A treatment plan is great but the connection of the human spirit can truly be what heals. Ice cream helps as well! 

File under: The Art of Psychotherapy, Musings and Reflections