Cultivating patience in counselors

August 2023

Maia moved to New York City during college to pursue her dream of working in journalism. At 24, she had already found success in her nascent career, landing a coveted internship and then a job at a major news network. She was bright, introspective and candid, and she was my second client ever. (Maia’s name and identifying details have been changed to protect confidentiality.)

Maia sought counseling for bulimia, which she developed as a teenager, at the training institute where I was a counseling intern. Her eating disorder had waxed and waned over the years, but it had become significantly worse three years earlier in the context of an abusive relationship. Although this relationship had ended, the trauma continued to haunt her. When she started counseling, she was motivated to put bulimia behind her; she had already gone 30 days without bingeing or purging. She also wanted to stop drinking because it often triggered bulimic behaviors. But most of all, Maia wanted to reclaim her sense of self after being with a man she said “broke her mind.”

At first, Maia’s candidness came as a relief. As a novice counselor, I was still apprehensive about silence in the therapy room; I feared it would appear as if I didn’t know what to ask or do next, which in fact was usually the truth. My supervisor often urged me to practice patience with my clients. She noted I tended to fill silences with concrete coping skills (e.g., “Have you tried deep breathing?” “Do you know the 5-4-3-2-1 technique?” “Let’s talk about distress tolerance.”) or multiple-choice questions about what a client might be feeling, rather than asking short, open-ended questions that encouraged them to unearth their own insights.

“Don’t rush in and try to fix things,” my supervisor advised. “Listen and try to understand.”

Don’t rush to fix

My first session with Maia went well — perhaps too well. She was forthcoming about her bulimia, alcohol use and trauma, but then she canceled her appointment the following week. I wondered if we had approached too much too soon. Over time, this scenario became a pattern for us. Maia would come to a session, speak honestly and openly about all that she had been feeling and reflecting on during the week — practically purging her feelings in the room — only to cancel her next session as well as any makeup session we attempted to schedule. Her cancellations were so frustratingly consistent that it was a happy surprise when she did come to a session.

On the evening of our fourth session — which by then was supposed to have been our seventh — I planned to broach the topic of her cancellations. I intended to explore them in a way that I hoped would elicit any apprehension or ambivalence about therapy without shaming her for the frequent absences. She already carried plenty of shame without adding therapy itself to that burden. When she sat down, however, she was visibly upset. Over the weekend, she had gone to a bar with her co-workers and drank until she almost blacked out. She regretted breaking her promise to herself to stay sober, and in her disinhibited state, Maia confessed romantic feelings to a female co-worker. When Maia disclosed this part of the story, she began to sob. For years she had been questioning her sexuality but never revealed this to anyone. She had been terrified to acknowledge this piece of herself. What would it mean for her going forward? What would her religiously conservative Midwestern parents think?

In the span of 45 minutes, Maia revealed one of the most hidden pieces of herself, leading us to have an open and honest conversation about her sexual identity. At the end of our session, she agreed to attend an Alcoholics Anonymous meeting and was excited to continue this conversation. I asked what we could do to help ensure she kept coming to therapy. She assured me that she would make therapy a priority because she realized how much relief it brought her and how much she needed to talk about these things.

When she walked out the door and I sat down to write my notes, I was full of energy. Although I was pained by the distress this secret caused her, I was also humbled that this young woman felt safe enough to confide in me. This session with Maia gave me the sense that we were on the precipice of something important. I thought, “She is intelligent, motivated and dynamic, and she is willing to take concrete steps to achieve her goals. Maybe I will witness the beginning of real change in this person.”

But an hour before our next session, I received a familiar call. Maia wasn’t going to make it. We rescheduled for later in the week, but she canceled that session as well. I was deflated. Had the revelation been too much? Should I have seen this coming? Could I have done something more to mitigate the aftermath of such a session?

Two weeks later, Maia made it to another session and confirmed some of my suspicions. The session had been too much for her, and she had become depressed and overwhelmed and didn’t feel like coming to therapy. She admitted that she usually dives into problems — as she had done in previous sessions — but revealing her queerness had not had the same effect. She told me she needed to proceed more slowly and create a safe space for herself. My heart sank when I realized that this was precisely what we had neglected to do in therapy. From the start, Maia shared her most searing vulnerabilities in sessions. And eager to help, I let her.

In this moment, I recalled how one of my graduate professors had compared therapists to a mountain guide. We can steer clients toward more gently sloping paths and offer reasonable expectations about what may be approaching. We can even remind them to stop and take a breath. Although we cannot make the climb less difficult, we can help grant safe passage. If I was going to help Maia make the long trek toward recovery, we were going to have to put some guardrails in place. Otherwise, therapy would leave Maia feeling as painfully exposed as all her other attempted coping mechanisms.

Unfortunately, I did not get the chance to acknowledge my mistake and repair the therapeutic relationship with Maia. After one more no-show, she wrote to say that she was grateful for the opportunity to begin thinking about these issues, but she had too much going on at work to commit to therapy.

Growth takes time

Both new and seasoned counselors know the discomfort of sitting with a client’s pain while feeling powerless to intervene. My own feelings of incompetence as a new counselor will often creep in, compounding the problem. At 30 years old, I have accumulated multiple rounds of professional and educational beginnings: acclimating to life away from home as an undergraduate, starting my first “real” job as a reporter in Scranton and working in a public relations office where I pretended I knew what my editor was talking about when he asked me to do a “prewrite.”

Now, here I am again, starting over in a new career as a counselor. I feel the anxiety and confusion that often comes when starting a new position and learning new skills. But unlike previous jobs, I do not get to endure these growing pains from the privacy of a cubicle; my supervisors, instructors and clients all witness my naivete.

In Learning From Experience: A Guidebook for Clinicians, Marilyn Charles explains how anxiety compels us to tether ourselves to something familiar and knowable, such as behavioral techniques, coping skills or clever interpretations. These impulses, while often well-intentioned, can be unhelpful to clients. “Our need to find anchors — and signposts to guide our way — can make us jump too quickly on ‘meanings’ as saturated elements that leave little room for growth,” she writes.

It is tempting to forge connections and meanings for clients to provide immediate relief and illustrate our empathy and understanding. But if we truly want to help our clients, we must first be fully present so that we can develop an understanding of their world as they experience it.

I have learned alongside my clients that deep, intrapersonal change cannot be rushed. Change can be frightening, even when we are the ones initiating it. We are leaving behind the familiar with no guarantee that we will arrive somewhere better. Maia did not know — could not know — whether processing her trauma or reckoning with her sexual identity would bring her more solace than what bulimia and alcohol offered, albeit temporarily. Likewise, I have no idea whether enduring the growing pains of becoming a therapist will ultimately bring personal meaning and professional satisfaction. What is familiar may be unfulfilling or outright painful, but at least we know what we are getting.

Working with Maia showed me that what matters is building safety into the change process. We can help clients become familiar with signs of distress and overwhelm in their body and learn to view these signs as an invitation to slow down or pause and return to a calmer, more regulated state. I also learned the value of being patient. Both counselors and clients need to allow themselves time to adjust to new surroundings or situations. With each small adjustment, we gain confidence in our ability to cope, which in turn gives us the courage to press on.

I no longer rush to fill silences when working with clients. I have learned to slow down, and I teach my clients the therapeutic value of being patient with themselves and counseling. I continue to learn, along with my clients, how to become mindful of distress and overwhelm, give myself permission to slow down or take a break and, most of all, manage expectations about the meandering and often lengthy nature of deep change.

Growth takes time, no matter how much we want it to happen. Trusting that what we are doing now will pay off in the future can be difficult. The best thing we can do is cultivate patience with ourselves and remember, “Don’t rush in and fix. Listen and try to understand.”  

Joanna Mercuri is a license-eligible professional counselor in northeast Pennsylvania who specializes in eating disorders and the intersection of religion and spirituality and mental health. She holds a master’s degree in pastoral mental health counseling from Fordham University and a certificate in the integrated treatment of eating disorders from the Center for the Study of Anorexia and Bulimia in New York. Contact her at joanna.mercuri@gmail.com.

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