So, Whose permission do you need to be happy?

This was a question I was asked well over twenty years ago by a counsellor when I was battling depression.  It was the light bulb moment that brought me back to a bright  life that I had forgotten existed.

I have listed this example here in response to the suggestion that therapists should be transparent to the outside world as to how the therapeutic process works. If I was a chef and wanted your attention to employ my skills there is little point in me uploading a photograph of my baked sweet potatoes with spinach, mushrooms and feta cheese with lemon and garlic dressing.  We can watch TV chefs prepare a dish, understand the processes and decide if this is the type of cooking we want to engage in. So, in this blog I wanted to give some insights as to how we work with clients and how the road to recovery starts as a slight glimmer which we can, over time, help nourish back to a full recovery.

Creating a light bulb moment for a client is not done by chance but by diligent listening, understanding and patience. So how does the process work?  Initial sessions may be mostly taken up by acquiring basic information such as does the client have siblings? Are their parents still alive and are they together?  This process is not just about building a background, it helps build trust and puts the client at ease. The therapist is always on the alert to see if any of these straightforward questions creates an emotional response. This may be the case for instance if they lost a sibling at an early age. The process requires the skill to create a useful and hopefully non-contentious setting for whatever issue the client wishes to disclose. It is learning to ask open questions and recognising that in communications only 7% of the message is in the words used, the rest is in the tone, facial expression and body language. Understanding this takes training, skill and practice. Lots of practice.

Once a level of mutual trust has been established the primary issue of concern may start to surface. Most often this comes as a series of what are sometimes known as door-handle questions.  This is where a client may take up 90% of their session with avoidance, masking or general conversations and then just on the point of the session ending surfaces some aspect of the real reason they are seeking help.  Questions such as suddenly disclosing being bullied at school or being involved in some trauma.  All too often it can take several sessions for key elements to be surfaced so a road to recovery can be mapped.

We, as therapists, might recognise at an early stage that the client has low self-esteem, but it takes skill and time supporting the client as they slowly unpack the core reasons for this condition.  Experience shows that anxiety generally comes from one or other of two causes. Or a combination of them. Has the client been exposed to trauma at any stage? And, has the client been subject to a dominant personality who stops them developing as their authentic selves?  

It takes skill, patience and experience to explore these areas without re-triggering a trauma or scaring the client into some form of regression or lack of trust.  Once key elements have been identified the reassurances and rebuilding can start. It is not the job of the therapist to teach the client how to live with feelings of insecurity, distrust or a sense of rejection. They have probably spent twenty years honing those skills. It is our job to help them learn and believe that they were born as wonderful, beautiful human beings, full of promise and fully entitled to be respected and happy.  Lessons they by-passed when learning to deal with alcoholic parents, being brought up in abusive situations or simply not being wanted. 

At an early stage in my training, I was shown a very simple demonstration where I was shown a crisp new £10 note, and I was asked to comment on its value.  “Ten pounds” I responded with confidence. My teacher then started to crumple up the note and again I was asked about the value. “Ten pounds” I replied. The process continued with the note becoming more creased and worn.  Finally, my teacher straightened the note out and said simply, “Remember whatever has happened to you, it has never taken away any of your value”.  That lesson stayed with me for a long time.

So, working with our clients is mostly about active listening, using open questions and having both patience and the empathy to gently help the client surface the issues that are troubling them Only then can a dialogue start of gentle inquiry to see what remaining barriers are perceived as being present to starting the recovery process. For me that simple, elegant question, posed at just the right moment, helped me bob back to the surface. I had skillfully been brought to the point where there was only one possible answer.

Please follow the blog and Choose Wellness as we write with no attempt to market, promote or sell, but simply to expose, with some transparency, the work we choose to get up for every day.

Ian McDonald

May 2025.