Do I keep coming in?

A client I have been working with for the past five years asked me last week: ‘Do I keep coming in for therapy?’ He is not the only client who asks me this question. Many clients want me to decide how often they need therapy. They will apologize if they cannot make it to a session for a valid reason. They will ask if ‘they are getting better.’ Most of my clients, despite being the ones to reach out for therapy, at some point in time make me in charge of the therapeutic process. Therapy is a relationship between a client and therapist and there is the psychology of two people in the room, and within the relationship is significant potential for the client’s journey of self-awareness, emotional processing, and transformation. So why does an adult make the therapist in charge of the most important journey of his life?
There are multiple reasons and all are significant and relevant. One reason is that most of the clients in Pakistan are confused about who the therapist is. Most perceive the therapist as a doctor and in a medical model, the doctor tells the patient what he needs to do. When he needs to come for the next appointment and if he is improving based on the patient’s feedback but also the doctor’s assessment sometimes based on physiological testing. I think that within this is also an inherent need in every individual to feel safe and making a trusted authority the caretaker of our well-being makes us feel safe.
Another factor is that the therapist becomes the parent in the room and the client unknowingly assumes a child position and surrenders control to the therapist. The therapist can become the good or the bad parent for the client but a perceived parent nonetheless in the therapy room.
My training makes me aware of these conscious and unconscious dynamics that play out within the therapeutic relationship. My work is to empower the client who has experienced helplessness in his personal life story and acts that out throughout his life be it his professional or personal relationships. I will mostly start a session by asking a client, ‘How do you want to use this time today? What do you like to talk about?’ Many will respond by asking me to take a lead and sometimes I do but again if the client continues therapy, I try to empower him by encouraging him to take ownership of therapy and most importantly to honour himself for his intention to continue the therapeutic process. Therapy is hard work. It’s painful. It’s not a client sitting and venting out his life story like reading out a fascinating story. It is week after week of understanding himself. Challenging himself and unlearning the coping skills he had learned to avoid pain in his life and taking the risk of experiencing emotional pain all once again.
For me, therapy becomes a parallel of the client’s attitude toward life. Do I keep coming in? Is the client asking this question specific to therapy only? It’s a deeper question in my opinion. I hear it as; ‘do I keep committing to life or can I take a break?’ Do I continue to take a risk to embrace and accept the life I have? Can I continue to take personal responsibility or can someone else step in and take it?
What is that commitment? It’s our relationship to life, isn’t it? A personal unique relationship that I need and want to take ownership of. To be fully present and show up for me in every aspect of my life. Understanding myself is a life-long process and continuing to evolve my relationship with life. Yet most of us let others dictate and decide for us if we can make that commitment how we see it.
Some of us are also put in such a position in our relationships that we keep answering this question for others and then are blamed for consequences that are not favourable. Stop answering this question for others. Let them decide how they want to use their time in this world. You and only you need to assume authority in your life. Only you should answer ‘if you can keep coming in’ and be responsible for what that means in your life story and it’s a question that will keep coming up for you. Therefore, do your best to choose today and every day to continue to come into life.

The writer is a BACP (British Association For Counselling and Psychotherapy) accredited individual and couple psychotherapist based in Islamabad. She can be reached at or her official website.

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