What were the needs of the client in this case? The needs of the therapist?

Question

Debra Masters, a social worker in private practice, conducted an initial interview with Stephanie Railsback, a young woman also working in the helping professions, who was conflicted about her sexual orientation. Debra was a lesbian herself, open, but discreetly so. As the interview proceeded Debra was increasingly distracted by the question of whether she should disclose her sexual orientation to this client and, if so, when. Her anxiety intensified to such a degree that she had to leave the interview to compose herself and decide what to do to resolve this dilemma.

Answer 1

Stephanie needed to believe that her therapist was able to understand her current conflict, that she was competent to help her explore the potential relationship between her current conflict and her sexual abuse history, and skillful enough to help her resolve the problem definition they would formulate together in this exploration. She was likely very sensitive to whether her therapist was knowledgeable and skillful enough to be effective with this particular problem topic. She was also, at least initially, seeking unconditional positive regard and validation from her therapist. Because trust had not been fully developed in the relationship, the question of how Debra responded to her presenting problem was critical in this first meeting. She was presenting a problem that was clearly not typical and was exceptionally value-laden. In presenting this problem to any therapist, Stephanie risked the potential of a value conflict with the therapist. Any value conflicts might have precluded establishing a contract, or if therapist and client did form a contract, value differences might have prevented the progress and resolution the client needed. Stephanie needed a sense of trust and confidence that this therapist (or any therapist) would be able to help her. This need paralleled her need for relief from the stress and dysphoria stemming from her current conflict—the presenting problem. She needed a sense of relief and confidence that she could and would find resolution of her conflict.
Debra needed to feel and believe that she was practicing competently, that she was doing the right thing for the right reason. She was very conscious of this from the sense of her general ethical responsibilities as well as in considering the specific consequences of making poor choices in this meeting with Stephanie. Some of those consequences involved potential harm to Stephanie, but Debra was also aware of the potential harm to her professional reputation and the reputation of her practice colleagues. The increased awareness of these potential negative consequences was the source of Debra’s anxiety which led her to take a break in the session. Debra also wanted to avoid revisiting the pain of the disastrous outcome of her disclosure to Dan Corley, She wanted to continue to strengthen the congruency between her public and private selves and a negative outcome from another disclosure threatened to increase her conflict and stress about her identity.