I’m closing my private psychotherapy practice after 20 years. How many conversations have I had with clients over that time? Thousands, and each one different. Sometimes delightful, exciting and energising; often frustrating, disappointing and exhausting. There is no template: the dialogue is minted fresh every time the door opens. So what have I learned?

Getting started: learning to say less

I began my training the week after conducting my father’s funeral. We hadn’t been particularly close, although I suspect we loved each other deeply without being able to express it. I felt in exactly the right place to have discussions about life, death, love, loss and everything that matters deeply but isn’t always easy to express. In healthy, worthwhile therapy we give ourselves permission to go to the risky, shadow side of our lives, client and therapist both.

When I began, I’m sure I used to spray words about unnecessarily. I remember wittering on at my first session with Pedro – a real live client! – about my training and background, taking up far too much time. Pedro waited politely but had no need for my waffle. He trusted me to listen to his concerns; trusted me more than I trusted myself.

But I soon learned to say less – much less. Silence is a rare commodity in most of our lives and for a client to sit without the necessity to speak can be a luxury. There can still be meaningful psychological connection. The longest time I spent with a client when neither of us spoke was 18 minutes. It was, he said later, “such a refuge”.

Honesty is the best policy

“Tell the truth” has to be my mantra. Maybe not the whole truth, the whole time. There’s often an internal monologue (Is it too cold in here? She said Brian – is that her husband or her son? How many minutes are there left? Is it better to pick up on that reference now, or shelve it and come back to it later?) but mostly the concentration is total and the process all-consuming. In that space, it can be surprisingly straightforward to tell the immediate, unfiltered truth. To say, “I don’t understand” or, “I’m shocked” or, “Isn’t that different from what you said last week?” Or even: “I’m not sure I entirely believe you.”

Which is very different from accusing someone of lying or, worse, being a liar (one is a comment on a single statement, the other a judgment of their character). I might add: “I wonder why that is. What are your thoughts?” or, “Perhaps there’s something else you’re not telling me,” which opens up an inquiry rather than shutting it down. Such a comment can be accepted or easily batted away by the client. It can feel risky, but without risk there will probably not be progress.

My turn on the couch

On 31 December 2015, I was involved in an accident on a dark country road. My car hit a pedestrian. The man died. I was shattered by the event, profoundly traumatised. Disabled by shock, I craved a tenderness and care that I couldn’t define. I tried going for massages; there was a silent therapeutic conversation in the physical contact, a soothing of my soul. But to help me find a path to recovery, I knew I also needed long-term talking therapy.

I had a shortlist of potential counsellors, all of whom looked suitable in theory. The reality was a revelation. One had left her phone on, so it rang during our meeting, with me in a torrent of tears. She didn’t apologise, and I felt worthless. Another sat in front of a wall covered in framed certificates. “That’s quite a display of power,” I said. She shrugged it off without addressing the issue, and I felt dismissed. At the end of my meeting with another, she said she couldn’t stand up as she was in extreme physical pain brought on by hearing about my accident. I had needed her to offer strength, not vulnerability; I felt cheated.

In one consulting room, there was clear glass along the base of a wall, so the feet of strangers could be seen passing in the corridor. I felt exposed and unsafe. I met another therapist on the 27th floor of a smart block in London. When I commented on the view and asked, “How long have you lived here?” he twisted and squirmed, trying neither to acknowledge nor deny my assumption that it was his home. I felt angry: just tell the truth.

The final person on my list, Caroline, was gentle, kind and patient. As I sank deeper into an anguished account of my story, I knew this was where I could expose my pain. While allowing me to relate the details of my ordeal, Caroline helped me filter what I needed to say from what I didn’t, to assert some slight degree of control after the chaos. But her empathy was the decisive element. As we parted I said, “I feel warmed by you.” We worked together for a year and, with her support, I began to function again.

Is it OK to hug a client?

I’ve made some mistakes I cringe to recall. I once said to a client, “That’s the third time you’ve interrupted me.” It was factually correct, but there were so many gentler ways I could have opened up a line of inquiry about communication. She fled after that session, never to return. I’m not surprised.

Physical contact is an area fraught with potential danger. Most clients don’t expect any touch. Some offer a hand as they arrive or leave. William, a few years younger than me, would ask shyly for a brief hug at the end. Fair enough. But over time the hugs became tighter, the contact longer. Gradually they melted into an embrace that contained the subtle tremor of sensuality; of sex. I was confused, yet flattered. I felt myself being silently, surreptitiously seduced. A session would focus on William’s marriage, children, childhood, career. Then came the writing of a cheque, arranging our next appointment, the walk to the door… and that hug.

For several weeks I failed to address the issue. I was in two minds: reluctant to let the state of affairs continue but wary of damaging the good work we’d done with a false accusation. Agonies of guilt gnawed at me. Was I complicit? How should I respond? Eventually, I told him I felt uncomfortable about the physicality we’d developed. I shared my own confusion and remorse, and he was generous, absolving me of blame. He also filled in the missing parts. “When I was a little boy and wanted to sit on my dad’s knee, he would push me away.” His features crumpled into those of the rejected child. “I’ve come to see you as the loving father I wish I’d had. When we part, I’m terrified to let go. I’m scared you won’t be there next week.” Then he turned his sad face to me and said: “If I ask to sit on your knee, will you push me away?”

I didn’t hesitate. “No, William,” I said. “I won’t push you away.” There was challenge and acceptance in our eyes. William was a tall, strong man and I wondered if my Ikea chair would bear the weight. And my knees, come to that, as well as our relationship. But it felt vital not to reject him. He perched awkwardly on me and we shared another hug, briefer this time, without the layers of sexual need. He cried a little. It felt just right, for both of us. William didn’t look for erotic connection any more. Even hugs weren’t necessary. He knew I’d be there next week. And the next and the next, until he was ready to end therapy.

Expect the very unexpected

In training, so many hypothetical scenarios are discussed. What would you do if your client made racist comments, said they loved you, told you they’d raped someone? (And, yes, all of these things happened.) There aren’t correct or incorrect responses; it’s the airing of the possibilities, and often the discovery of one’s own prejudices, that matter. That’s the theory, anyway; then comes real life. There have been countless moments when I’ve heard a voice in my head whispering: “We didn’t cover this at college…”

Sara, who had been a client for several weeks, stood up at the end of one session and looked down with horror at a saucer-sized stain of blood on the cream fabric of the chair. Her period had started. “Oh, I’m so sorry,” she said. “What shall I do, take the cover home? I can wash it and bring it back tomorrow?” I felt it incumbent on me to be as matter-of-fact as possible, full of reassurance. It was a simple thing for me to wash and bleach it and dry and iron it for the morning. Sara did disappear for a while but then returned to therapy for another year. The incident was only briefly referred to, in terms that suggested nothing further needed to be discussed. We had managed it successfully between us.

What would you do if a client behaved like a dog? Lucy was a highly qualified professional who had talked for several sessions about her family, childhood and current partner. She often mentioned her pet labrador, Buddy, and their relationship of trust and love. Once she even brought him to a session. The whole dynamic changed with a third breathing creature in the room; I confess I resented his presence.

One day, in a tough session with many tears and much pain, Lucy told me she wished she could feel as safe and loved as Buddy, and said I would be a wonderful master. She slid from her chair, got down on all fours and crawled over to me, curling herself around my ankles. At first I did nothing ; then I reached down and laid my hand on her shoulder. She shuddered and pressed herself against my touch. For several minutes we didn’t move or speak. Then she stood up, returned to her chair and said, “Thank you for allowing me to do that. It felt wonderful.” The simplicity of the gesture is often out of all proportion to the effect.

Years earlier, as a client in training, I had occasion to benefit from a therapist’s confident improvisation. I arrived on my motorbike for a session soaking wet and furious. “I’m not staying!” I said. “I’m so pissed off with myself for not wearing my waterproofs. I’ll pay you and go. I need to dry out.” My therapist, Vernon, was having none of my self-indulgence. “Would you like to borrow some sweat pants and a jumper? You can put those wet things on the radiator for an hour.” I gazed at him; could it be that straightforward? It was. “And we won’t even begin to think what Freud would make of this,” he said with a twinkle.

Keeping an open mind and an open heart

Time spent with clients can be frustrating and unsatisfactory. But the conversations have, mostly, been good for the client and rewarding for me. As I close my practice after 20 years and browse through some of the comments I’ve received, I’m reminded of this.

Bobby was a young man I worked with on and off for eight years; he would attend a few weekly sessions, then fade away for months. In the consulting room, he would tentatively approach the core of his pain and always sidestep at the crucial moment. Only when we were faced with our imminent ending did he summon the courage to tell me about sexual abuse in his childhood. All he needed me to do in those final sessions was to witness his story, to meet him just where he was.

Later, Bobby wrote to thank me: “I’ve been thinking of your capacity to hear what I was trying to say, to swim alongside, to let me meander but gently steer me towards a moment of clarity, honesty and safety. I see now how extraordinary this was, how rare.”

He spoke of feeling loved. Carl Rogers, creator of the person-centred approach to therapy, called for “unconditional positive regard” but also spoke of “non-possessive love”. That, for me, is the core of the best therapeutic work. My job has been to accept each client, to welcome them with an open mind and open heart.

To all the clients from first (1999) to last (2019), the briefest (one session) and the longest (299), the most engaging and the hardest to encounter, your integrity and courage have enriched my life. I will miss the tears, the laughter – and the silences.

All names have been changed.

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