Clients can wonder about the therapist's thoughts just as much as what is going on when a pet is staring at them.
What is going on in my mind?

Some clients wonder what is going on in their clinician’s head. What are the therapist’s thoughts? It is one of the mysteries that exist in the counseling room. In good sessions, it is not uncommon or the client to be talking most of the time, and the clinician only inserting into the conversation every so often. So what is the clinician thinking during all that time that the client is talking?

Client Focused Thoughts

Clinicians do a lot of thinking as part of their listening when a client is talking. The therapist’s thoughts will differ somewhat between therapists based on the individuality of the therapist as well as from their theoretical approach to therapy. It will also vary from day to day and client to client simply based on the fact that the therapist is human. Here are some of the things that could be going on in the therapist’s head:

  • what the client is saying
  • how the client is saying what they are saying
  • what the client is not saying and whether it is important
  • is there some detail here that needs to be remembered (like a name or date)
  • what is the client communicating outside of what they are verbalizing (body language, tone, pace, etc)
  • what are the emotions involved both at the time of what they are describing as well as as they are relating it now in session
  • how well did the client use the skills that have been worked on in therapy and is there more work to do in this regard
  • is there a meta story over the top of what the client is saying
  • how does what is being told relate to the client’s issues and what is already known in the therapeutic journey so far
  • what does this tell about our treatment plan and progress
  • is there a curve ball within what is being said that recommends re-evaluating what is going on in terms of diagnosis or treatment
  • is there a part of what is being said that would help the client if they were to hear it being repeated back to them
  • what of what is being said do I need to let the client know another person has heard
  • what part of what they are saying will be a good path to keep going down (could be to get more information, could be because it seems the client wants relief in a particular area, could be that it would be good in advancing the treatment, etc)
  • basic questions such as whether the client is making sense, whether thought patterns are coherent, whether the client is having problems with memory or orientation, whether the speech is indicative of the client possibly being under the influence, etc

Such a list could seem like there is a lot that the clinician is listening to and thinking about. It could even make you self-conscious if you were the client. It shouldn’t. What it really means is that the clinician is being an active listener, trying to hear what you are really saying and trying to put it into the context of your work together.

The Thoughts Behind the Thoughts

The therapist’s thoughts will not only be focused on the client. When I train clinicians, I teach them to be meta (thinking about the thoughts that are behind what is on the surface). Sometimes these other thoughts will influence what is heard when listening to a client. At times, it can even make it so that the clinician is not really listening but getting lost in their thoughts or just drifting. So, many therapists intentionally try to also think about the meta in order to help them be with the client. This leads to focusing on things like:

  • is what the client is saying creating an emotional response (of any sort) in me and why
  • how am I feeling as I am sitting here and is that getting in my way of listening
  • are there things that are distracting me right now (could be something seen for the first time like a client’s tattoo, could be a noise outside like a passing ambulance, could be anything coming into the room for the clinician)
  • am I not fully present because of being physically uncomfortable (something going on in my own body, the way I am sitting, the temperature of the room), where is that coming from and what can I do about it
  • am I judging myself as a therapist rather than really listening to what is going on
  • do I need to adjust my plan for working with the client
  • how are we doing on time, with the time left do I need to move the conversation to have time for us to address what is being said and/or will we come to a nice ending at the right time
  • have I gathered all the information I need to document this session (especially when there are things that are only periodically assessed)

Therapist’s Thoughts as a Human

Then there are things that go on in the clinician’s head that are just part of their humanness. Clinicians try to minimize out these just human thoughts, but clinicians aren’t perfect and still have them. Samples of these are:

  • who am I seeing next
  • haven’t I heard this story before (or even several times before) – can I hear it again in a way that helps me see something different or that things are reinforced rather than me tuning it out
  • what do I have planned later today after seeing clients, tomorrow, this weekend
  • did I lock the door when I left home to come to work
  • who is picking my child up from school
  • I went to the bathroom before coming into session, did I zip up my fly
  • Interesting music just passed by the window

So, hopefully this gives you an idea of some of things that are on the mind of your clinician while you are talking. Of course, you should also feel free to ask your clinician. Our counselors and therapists want you to feel welcome when you are in session with them. We are pleased to be with you on your journey to peace and wholeness.