Client Voice

What does listening to client voice really mean? Some would say that it means they can let therapists know what symptoms, behaviors, and cognitions they are experiencing. This type of client voice guides the thinking of therapists into diagnostic labeling and exploration of irrational thinking errors. Thus, appropriate medication will be prescribed and thinking errors will be addressed. Another way to work with client voice is to focus on working together by engaging in a conversation that sets the tone for client voice to enter front stage. The therapist can explore (with the client's voice in the process to help guide what is discussed) what is wanted in therapy, what the client's thoughts are about change, and where the therapeutic interaction goes.

In order to explore these diverse utilizations of client voice, I will compare and contrast Cognitive Behavioral Therapy (CBT) to Solution Focused Therapy (SFT). The direction of therapeutic conversation and the intention are clearly different.

The crux of the CBT approach is perceiving the client as a cognitively distorted entity with irrational thought processes. The therapist carefully listens to the client and then makes an assessment about the errors in the client's thinking. Given this perspective, the therapist is put into an expert position to properly teach the client a new set of rational thinking skills that lead to appropriate behaviors. The client must conform to the therapists instruction and not resist.
The appearance of someone being resistant to CBT generates a confrontation that leads the CBT therapist towards diagnosing some kind of personality disorder. The personality disorder label often serves a function of drastically limiting the client's voice to a sound of a pin hitting the floor.

In contrast, the SFT approach perceives the client as a capable human being whose voice must be heard in order to get what they want out of the service. The therapist takes a non-expert position in the therapy room that invites curious questions. The client leads the therapist to the goal of treatment, how far they have come to that goal, and what is needed to take small steps towards the goal. The therapist may process with the client their thoughts about the client voiced story. However, the most important part of this therapy is to listen to the client voice while continously asking series of curious strength based questions that lead the client to the goals that they seek from therapy. Thus, resistant clients become very rare given that their voice is honored and the therapy becomes a mutual partnership between therapist and client. Since the focus is solely on what the client wants to work on, the use of diagnostic labels are rendered unnecessary.

According to best practice standards, it would appear that a mixture of SFT and CBT may be necessary for optimum positive outcomes. I am afraid that this mixture may lead to relative confusion on part of the client and therapist interaction with each other. How can a therapist switch from viewing the client's problem as an irrational thinking error and then suddenly switch to believe that the client can voice important rational thinking towards their goal? There seems to be a mixed message to the client and therapy becomes cluttered. Maybe taking an initial SFT perspective in therapy and then switching to a CBT perspective when SFT does not work? This answer may lead the client to believe that they are failing the therapist since the process was started with strength based inquiry and led to distorted thinking error teaching which may take the wind right out of the client voice sail. A better solution may be for the SFT therapist to refer to a CBT therapist and vice versa. Acknowledging that each therapists have distinctly different styles that may be useful for a different array of clientele.

In conclusion, honoring client voice may mean different things to different therapeutic approaches. I used SFT and CBT as an example to start defining the differences in approach in hopes that clients, students and professionals will be educated enough to ask well informed questions about the type of therapy that they are seeking, receiving, learning or providing. Thus, client voice can assist in the venture towards increased possibilities of quality mental health service.