Takeaway: Taking a “learn something” approach to a client’s treatment reflects a true partnership between therapist and client, and creates the potential for constant personal and professional growth for both parties.

“Please tell me you won’t give up on me,” she implored. I must have looked a bit stunned at her statement.

This client had struggled with a very difficult musculoskeletal problem for months before coming to see me. Through that process, she had endured a substantial amount of pain and far too much invalidation from health-care providers and family.

Her challenge was revealed in our first session, which was part history, part explanation of the anatomy of her issue, and part hands-on treatment. The results after our first sessions were nothing short of remarkable as she had little to no pain for the next two weeks. Given her long struggle with unrelenting pain, this was astonishing to her.

After two weeks with no symptoms, she felt good enough to push the boundaries of physical activity. At the same time, there were some additional life challenges that increased her stress level. The aggregate effect of the increase in stress and increased activity led to an increase in pain, but nothing approximating her previous level. This was, however, understandably disturbing, as she had acclimated to the idea of a pain-free existence. Her reaction mirrors what pain research literature reveals: Losing control of pain that was once effectively managed is far more distressing than struggling with pain that was never under control.

Please tell me you won’t give up on me kept echoing in my brain.

“I’m here for the long run,” I responded. “Having done this for decades, I can tell you it is almost never a straight road; there are always twists and turns that are part of the process.”

“But I was doing so well,” she replied.

“You absolutely were, but setbacks are to be expected,” I said.

Since my client was a psychotherapist, I decided to frame the process in her world.

“Consider a parallel to your own work,” I suggested. “You have a client who struggles with their relationship and feels powerless to change a difficult situation. In the first session, you give them some helpful strategies to manage their emotions and deal with conflict. These tools work marvelously for the next two weeks or so. The client is understandably thrilled. At some point, a new challenge happens that surpasses the client’s ability to navigate it effectively. The strategies initially employed after the first session do not fully address the new challenges. Sound familiar?”

“You bet,” she replied.

“In your second and subsequent sessions, new strategies for addressing conflict are explored and employed. While you as a therapist can never fully anticipate the challenges your client might face, the task is to give them additional capacity to handle whatever might come their way. When new challenges arrive, you are there to provide both comfort and counsel.”

“I totally get that,” she said. “As obvious as this sounds when you explain it, I realize that I had a different model in my mind for this kind of work.”

“How so?” I asked.

“In all the health-care environments I have experienced, the approach has been more like a ‘fix-it’ model than a ‘learn something’ model. I guess I applied the same to my work with you. In a way, that’s surprising, because as you pointed out, my own work with people is much more process-oriented,” she said.

“I think that’s a great word to describe what happens—it is about a process, not an event.”

From that point, my work with this client changed; or perhaps shifted is the better word. There have been some ups and downs, a few twists and turns, but the overall trend is markedly in a much better direction. By her account, her symptoms have improved about 80 percent, and she no longer gets discouraged when there are minor setbacks.

This process mirrors the overwhelming majority of my clients who present with difficult musculoskeletal issues. There are improvements and setbacks. Conveying this process to clients is vitally important; expecting miraculous and lasting results from one or two sessions is far from reality. Few things in life are like that.

In the “fix-it” model, the client is the passive recipient of ministrations from the therapist. Perhaps the most important benefit of the “learn something” model is the potential for full engagement, commitment, and empowerment from the client, reflecting a true partnership between the therapist and the client. This model of treatment also creates the potential for constant personal and professional growth for both therapist and client. We become not only better therapists, but better people as well.