Cort Curtis and I belong to an email group of internet therapists. Here is an extract from one of his messages. I think every counselor or therapist should read it and think about it.
I discard all notions of diagnosis at least from a DSM point of view. Diagnosing implies a perspective where I must determine what is "wrong" with the client and then through my "expert knowledge and skills" go about trying to "fix" the client by constructing and following through with a "treatment plan" (kind of like an auto mechanic). The perspective that there is something "wrong" with clients because they are seeking psychotherapy or because they are troubled or struggling is rampant in our profession (so let's give them a pill or perform this or that technique to try and make them "better").
My point of view is that there is nothing "wrong" with my clients; I don't care how intense their struggle or how "crazy" their behavior appears to be. The problem, as I see it, is that THEY think there's something "wrong" with them and that THEY believe that they must be fixed. I come from the perspective that my clients are already "well", "healed", "whole" and "OK" just the way they are. They don't need to be in therapy nor do I need them to be in therapy. To me there is only one diagnosis and that is that the client is not in touch with their true self which is ALREADY whole and complete. The fact that someone is struggling with a particular situation, thought or emotion does NOT in any way mean they are not whole and complete the way they are.
Therapy, to me, is more an OPPORTUNITY for clients to explore, express and experience themselves in an environment of absolute non-judgement or agenda for their lives. Indeed, I believe all therapists would agree with this notion but the fact is that our own "stuff" often gets in the way. Because we believe we know what is best we then begin to develop our own agenda for the client. When they don't show up or don't want to come anymore we label them as "resisting" (the whole notion of resistance is a very important issue to elaborate on but we need to distinguish WHAT the client is resisting. Are they resisting MY need or "professional recommendation" for them to be in therapy or are they resisting THEIR OWN experience (feelings, thoughts, etc). If they are resisting ME then I've got an agenda. If they are resisting themselves then they need to evaluate how far they want to go).
Bob Rich has said that he considers every session as the last. I agree: if the client chooses to continue or not, it is THEIR choice and responsibility. I have no need to "keep" my clients in therapy nor do I assume that I know what is best for them. I tell them that they will know when it is time to stop before I will and I do ask that when they make the decision to stop that they simply acknowledge it and complete it with me rather than never showing up or just fading away. That way we can bring to closure the unit of time that we have spent together.
When the client is clear that they are NOT in therapy "because the therapist believes it is best for them" then therapy becomes an autonoumous decision for them where my function is to make myself available for them to work on themselves as long as they need (or even want) to. I give them what I've got during the unit of time that I work with them and they take what they get as a function of their own responsibility. I bless them in whatever decision they make for themselves and for whatever little or alot they have gotten out of the therapy experience.
The result for me in my work as a therapist is that therapy is a joy and a privilege. I get to be "present" to many people as they struggle with their own existence. I am free because I have no agenda nor do I feel burdened by assuming responsibilty for another's existence. Some people (from their own acknowledgement) get a lot from therapy, some people get nothing and some people APPEAR to get very little because they didn't do any "in-depth" work. I know that I may not be the best therapist for everyone who comes through my door. But it's happened on occasion that I will hear from a client thanking me for simply "being there" during a difficult time when I, myself, have thought "I failed" and "this client didn't get anything". Sometimes, we just don't know what impact we have when we fail to take into account our tiny (but often significant) place in the total fabric of the client's life.
You may reach Cort at email@example.com. His new website is http://www.achangeinthinking.com/