By Ndoumbé Fall
This blog was originally published on March 15, 2022.
As a therapist, it is important and crucial for me to empower my clients to have a voice within the therapeutic relationship and the therapeutic process by ensuring that they have full autonomy and access to their self-energy (their wiser self). This in my opinion, starts from the beginning stages of therapy. It is important to me that my clients are active participants in treatment planning and are consenting to the interventions being utilized.
There is an inherent power dynamic that exists within the therapeutic relationship that could make the concept of consent/autonomy difficult to grasp. However, the more a client grows attached to the therapist and is in need of the therapist, the more their ability to have a voice and a sense of autonomy becomes necessary for the success and health of the therapeutic relationship. To simply say that clients are allowed and welcome to say no and to push back is not enough, because that is operating from the assumption that all clients are capable of saying no or setting boundaries. It also does not take into consideration whether the therapist has created an environment where the client can say no in the first place. Not all clients have access to their fight response (this is a survival defense response that’s responsible for creating safety by fighting back when feeling attacked, unsafe, or intruded upon). Thus, it is the therapist’s job to create an environment of consent from the onset of the therapeutic relationship and to support the client in finding their voice by creating opportunities where a client can have space and agency.
To simply say that clients are allowed and welcome to say no and to push back is not enough, because that is operating from the assumption that all clients are capable of saying no or setting boundaries.
There are clients who may not yet be able to verbalize their need to push back and say no. However, through attunement and close observation, a therapist can get a sense of the client’s ambivalence and hesitation. This may show up as tension in their body, or you may be able to observe traces of hesitation in their facial expression. It is the responsibility of the therapist to notice how a client’s internal conflict shows up in their body, and then bring it into the client’s conscious awareness. Once this tension or internal conflict is brought into the client’s conscious awareness, then the therapist can support the client in verbalizing the need or boundary that may be present. It can create a powerful corrective experience for the client to be able to verbalize their needs and boundaries, and then be met with respect and tenderness from the therapist. The therapeutic space can provide a wonderful opportunity for clients to regain access to their natural ability to set boundaries and to practice boundary setting within the therapeutic relationship.
It is the responsibility of the therapist to notice how a client’s internal conflict shows up in their body, and then bring it into the client’s conscious awareness.
I believe that, as therapists, we do a disservice to our clients when we assume that all clients can say no or set clear, firm boundaries. Clients who have dominant submit, freeze, and shut down responses may have limited to no access to their protective fight and flight responses that are needed to assert their needs, set boundaries, and get out of unsafe situations. This is where it can be significant for a therapist to lean into their intuition and attunement with the client. Even if the client is signaling a yes either verbally or nonverbally, the no might be present somewhere in their body. For a client who has limited access to their survival responses, it is crucial to look for the potential no when seeking consent from them. This could also be an opportunity for therapists to support clients in nurturing self-attunement and reconnecting with their own internal senses by guiding them to find the answers in their bodies. By tuning into their own body, they can get a sense of whether a yes truly feels like a yes (this might show up as excitement, enthusiasm, curiosity, calmness, neutrality, etc) or whether something in their body may be indicating a no (this might show up as tension, tightness, queasiness, restlessness, etc). When they find that place in their body that’s indicating a yes or a no, then we can help the client to give it a voice. This way, you are slowly nurturing a space where the fight response can be reactivated, and the client can once again access and reconnect with their innate ability to assert their needs and their boundaries. By doing this, we could balance the power dynamic in the therapeutic relationship and create a more equitable, collaborative experience.
About the Author
Ndoumbé is a licensed mental health counselor of Senegalese origin. She graduated from Queens College with a Bachelor’s degree in psychology and sociology, and received a Master’s degree in mental counseling and wellness from NYU Steinhardt. Ndoumbé’s work mainly focuses on relational trauma, attachment, and esteem building. Ndoumbé utilizes trauma-informed integrative approaches, culturally sensitive approaches, and incorporates Islamic spirituality to guide her work. Ndoumbé has always been passionate about advocating for the importance of mental health within her community as well as advocating for the importance of culturally sensitive and trauma-informed care for BIPOC individuals in mental health spaces.
We Want to Hear from You!
Join our blog community! Share your mental health expertise, research, or resources with us. Email your article to blog.editor@muslimmentalhealth.com