The clock-watching therapist

large old-fashioned orange alarm clock being held with outstretched arms above the white person’s head

Photo courtesy of Malvestida

Being a psychotherapist is the best job in the world – in my humble opinion. But even the best jobs have their drawbacks, one of which is that it can often kill the enjoyment of drama (TV, films, plays, and so on), because of the way psychotherapy and psychotherapists are portrayed. The latest example of this for me is the new Nicola Walker crime series, Annika. Series one was originally screened on Alibi but now getting an airing on BBC One and BBC iPlayer (https://www.bbc.co.uk/iplayer/episodes/p0fjh17b/annika). Annika is now on its second series, but I am a bit behind, having just finished series one. If you are yet to watch, I don’t want to give away any big plot spoilers, so I’ll be careful!

Annika’s teenage daughter, Morgan, is struggling with the fact her mother’s new job has led to a move to an area she doesn’t know. She opts to have psychotherapy to help her make this transition. In one scene, she is telling her mother, Annika, about the therapy and how she felt annoyed when she noticed the therapist looking at the clock. Mother and daughter seemed to agree that this was a ‘bad thing’ and that a new therapist needed to be found.

It’s the theme of clock-watching by therapists that I want to explore. This scene triggered a big tut and eye-roll moment for me as I squirmed with frustration on my sofa. I find it irresponsible that drama writers, keen to entertain, show counselling and psychotherapy in a cliched way because it is more entertaining. So, I want to offset any sense that we therapists clock-watch because we are just interested in when the session will end and offer an explanation as to why we glance at the clock from time to time.

Psychotherapy and counselling sessions are generally a specific length (although there are some exceptions, such as in Lacanian therapy). My sessions are 50 minutes long, which tends to be the norm for therapy with individuals. Keeping to the boundary of that time limit is important, partly for me (so I can manage my schedule and be available physically and emotionally for my next responsibility) but mainly for the client. Many people come to therapy because important people in their lives have not been able to respect or maintain healthy boundaries (an obvious example is sexual abuse but there are a myriad of other boundary violations that can have a cumulative and significant effect on us, especially in our early years). So it is vital that I demonstrate consistent and appropriate boundaries, including that I start and end sessions on time.  Which, of course, involves checking the time. Towards the end of a session, I tend to be explicit about this, saying something like, “I just want to check the time - we’ve got X minutes left.”

Person or colour holding an hourglass in their fingertips with black sand beginning to trickle from the top to the bottom

Photo courtesy of Denilo

Time management is also important during a session. I need to ensure my client is in a fit state to leave a session and return to their normal life, be that to travel safely from the venue of an in-person session or to get back to work or other commitments after they log off from a video/phone session. Therapy sometimes, perhaps more than sometimes, involves connecting to pain and suffering, and/or a sense of vulnerability. This can leave a person emotionally and physically wobbly which takes time to move out of. It’s incumbent on me to have a sense of the time available in a session, either to help my clients reconnect to their grounded, adult, functioning selves before they leave the session, or to check if there is enough time to give this important material the space it needs and deserves. In this latter case, I might say something like, “I can see we only have 12 minutes left of the session and that this area feels like something that needs more time than that. What would you like to do?”. They then may pause to reflect on how they want to use the remaining time optimally or carry on regardless. Either is fine - it’s their session.

Finally, I wanted to share how I might respond if I notice that my client has clocked my clock-watching, especially if I can see that it causes distress or, in the case of Annika’s daughter, frustration. I’d probably say something like, “I think you noticed me checking the time – I wonder how that felt for you?”. Opening up a conversation like this can give me a chance to explain some of what I’ve outlined above, but it also gives us an opportunity to explore how it feels to be my client. To take Annika’s daughter as an example, my sense is that she saw her therapist checking the time as an expression of boredom or frustration with her, perhaps of wanting to be free of her so she could get on with something ‘more interesting’ or ‘more important’. That would certainly fit with the way the mother/daughter relationship is portrayed in the series, especially as we know that Annika - a single parent - has struggled with the tension of wanting to be both a good mother and a good detective, a job that she loves but which can be demanding, unpredictable and pull her focus from other important responsibilities, such as being a parent.

So there you have it - the main reasons why you might spot your therapist glancing at their clock from time to time. We’re most likely not bored (far from it!) but are managing the time to offer the client the therapy they need.

Slow and steady wins the race. Or, how psychotherapy doesn’t have to wipe you out for days after a session

I recently tweeted about how feeling wiped out for hours/days after your therapy session isn’t necessarily helpful.  In fact, in my experience it can be very unhelpful, both to the therapy process (as it makes clients understandably anxious and reticent about coming to therapy), but also because it temporarily stops them from living their life and can leave them feeling more, not less vulnerable.  Therapy should be about supporting people to feel more able to live their lives, not less so.  Sure, therapy is often about working through some deeply painful or overwhelming stuff, but it feels like a widely held belief (dare I say, myth) that to do therapy ‘right’ it needs to hurt – really hurt.  I think that’s a belief that needs to be debunked because it’s potentially toxic.

In my tweet I suggested if this is what therapy feels like for you, then it would be a good thing to talk to your therapist about it.  ‘Great advice’ came a response, followed by, ‘but what should a therapist do if a client raises this?’.  That’s such an important question that I decided to write this blog.

I think the ability to name this as an issue is an incredibly crucial step.  Because in my view, if it’s not identified and addressed it rarely, if ever, goes away on its own, and can derail the therapy.  So, the first thing I do is acknowledge that this is an important and brave thing for a client to say.  Clients might feel anxious that any expression of disappointment or struggle with an aspect of the therapy might lead them to be rejected by the therapist (perhaps as their childhood or later experience has borne out).    

Next, I work with the client to help them feel calmer in a session.  I might use a grounding exercise at the start and at various points in the session, enabling the client to feel safe, to connect to the room they are in and to themselves, perhaps via supporting them to slow down and deepen their breathing.  I might think about how the space between us feels – do they need me to move my chair back, or sit at an angle rather than opposite them (so they don’t feel stared at)?  As the session progresses, I encourage clients to tune into how they are feeling moment by moment – for example, what is happening to their breathing, what do they feel in their body, are they finding it hard to think or is their brain feeling ‘foggy’?  If I observe them becoming overwhelmed, I might say something like, “I notice your breathing has become really shallow so let’s pause and take a breath here”.  Sometimes clients feel able to go deeper into the material, but sometimes not.  If not, that’s absolutely fine – it’s vital to feel more in control of the impact of our ‘stuff’, and to go at a pace that is right for us.  Once we can do that, we naturally tend to go further into the material because we know we can control our responses to it.  

I work hard to manage the time in sessions.  I give a time check around 10 minutes before the end, so that clients can begin to manage their transition from the therapy space to the outside world.  It’s important for clients to be grounded when they leave – too often I have heard clients say they felt ‘spacey’ after a session or can’t remember how they got home.  So, I might end a session with another grounding technique, and/or encourage them to take a moment outside of the room before they leave the venue. 

All of this is the ideal, but I know how tempting it is to feel like you must get as much as you can out of a session (especially if your therapy is time limited for whatever reason).  If I recognise a client hasn’t left in a calm state, at our next appointment I would be interested to know how a client felt after the last session.  This can be an opportunity to open a discussion about all the above points.

Finally, I want to think about how attachment can inform this work.  Attachment-based psychotherapy often involves observing for indirect communications of distress or dis-ease with the therapy process.  Often clients come to me because they recognise they have an insecure attachment style and want to change this.  Insecure attachment develops because childhood caregivers have been unable to offer unconditional acceptance of emotional distress.  As a result, a child learns to either bury their distress (leading to avoidant attachment style) or ramp up their hurt to be seen by a caregiver who is inconsistently emotionally available (resulting in a preoccupied attachment style).  They learn that stating their needs doesn’t work, or perhaps can make things worse, so they innately learn to bury them.  But we rarely give up on communicating our needs – we just do it indirectly.   

A big part of my learning over the decade or so I have been a psychotherapist has been to really listen for these indirect communications.  Missed sessions and clients regularly turning up late might be two such examples.  I might wonder aloud if these are indirect communications that the work feels overwhelming to them in the ways I have described above, adding, “It’s a hunch, and only a hunch, but what do you think?”

If I am beginning to wonder if the therapy feels overwhelming, I listen for indirect communication via the material a client brings.  Listening for this, I might hear stories that suggest life feels out of control, perhaps precariously so.  For instance (and this is a fictional example), a client might report she was rushing to the bus stop, carrying heavy shopping.  She tripped, and the shopping went everywhere, but people only jostled her to get on the bus and no one stopped to help. 

I might wonder if the shopping is a metaphor for her emotional distress (which feels heavy, cumbersome and slows her down), and that our work is ‘rushing’ her along at a pace that makes her unsteady.  Perhaps I am like the people who don’t stop to help, unconcerned and perhaps irritated that her distress (shopping) is uncontained and getting under their feet.  Perhaps that I am only interested in my journey, not hers.  Again, I tentatively put these out as a theory, and I am prepared to be wrong.  But I think the aspects of a client’s week that they choose to share in therapy can be a powerful communicator and that we (the client and I) need to try and understand what is being communicated.

There is so much more that can be said on this topic, and I really interested to hear what people think. Perhaps you are a client in therapy, a therapist, or just interested in the subject, but do share your thoughts!