Are we asking for too much from our clients?

An Assistant Psychologist writes.

In recent months, I have come to realise some of the unrealistic expectations that therapists can have of their clients. I have witnessed some practitioners discharging patients because their client, who is severely depressed, has not completed their weekly mood diary. Not only this, but some therapists may refuse to continue with sessions because the client has not completed their homework, making it more of a challenge for the therapist to lead sessions.  

Although I agree with this mind-set, as to have successful therapy, the majority of the work should be done by the client outside of the sessions; I cannot help but think that we are asking for too much from people who are really struggling with daily living. I understand that as therapists we are more of a ‘trouble-shooter’ for our clients rather than a problem solver; however I do not find it acceptable that we should be turning our noses up at clients who cannot complete homework, or even tell us what their goals for therapy are. If someone with depression cannot function daily, shower, eat, get out of bed etc., how will they be able to create specific goals for therapy? Should it not be our job to help an individual understand what their goals may be, or what a goal even is, rather than expecting them to know this within their first session or even at the point of referral?

As the NHS becomes more stretched, resources diminish, waiting lists lengthen and staff become burnt out, this problem is only going to get worse and the expectations that therapists have of their patients is naturally going to become greater. To really help a population become well again, should we be dismissing individuals efforts who manage to turn up for therapy but struggle to complete their homework? Should we find alternative ways to ensure individuals feel able to complete such tasks away from the therapy room instead of expecting every individual to have capacity to do this?

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Hi, this was me at the beginning of my CBT course.  I was suffering with severe anxiety, fluctuating depression and CPTSD.  It was a living hell, so I grabbed the opportunity when telephone appointments of half hour slots once a week were offered.  I did forget to do the homework for the first three weeks, didn't even look at the homework.  But, the wellbeing practitioner stuck with me.  I reached my lowest point ever in the third week, terrified I was going insane.  That's when I committed 100% to the homework and the behavioural activation.  By my eighth session I was beginning to experience brief feelings of joy.