Friday, January 21, 2011

Start Where the Client Is At: My Client/Myself

“Start where the client is at.”

Believe it or not that was the defining sentence in my clinical courses in social work school 4 decades ago (yikes!).   It can always be counted on to elicit a chuckle in a contemporary who attended social work school around that time as well.  We all remember this.

As ungrammatical a sentence as that might appear to be—and maybe even impenetrable to the un-initiated, it turns out to summarize a great deal of clinical wisdom, wisdom that has stood the test of time.

What does it mean to start where the client is at?  It means that at least initially the clinician must eschew judgments, must listen carefully to discern what the client is feeling and thinking and not to step either too far away, or move too quickly ahead to where you think the client needs to be "at."

In reviewing my own long career as a clinician I am very aware of how hard this is, and always was, to implement, and how often I failed to do so.  If anything this got harder as I gained experience and thought I knew where the client was going.  I often was too far ahead, not putting enough effort into being in sync with people.

I sit down to write this now,  not because I need to discuss basic clinical social work principles,  but because I have just realized that this principle underlies a certain kind of mindfulness meditation training that I am pursuing with myself.  And in general, I think it is a wholesome practice for all of us

Here in the DC area I have the very good fortune to be attending weekly meditation sessions and talks with the internationally regarded insight meditation teacher, Tara Brach (  Tara has written a book Radical Acceptance,  and she teaches “radical acceptance.”  By radical acceptance Tara means we must accept where we are at, in order to even begin mindful practice.  Mindful practice is not just about the formal meditation practice,  but it extends to being mindful of other activities,  paying attention to whatever you are doing: cleaning the bathroom,  eating mindfully, taking care of children mindfully, all manner of daily life.  And this extends to where we are at emotionally.

One of my mindful practices is to try to catch myself when I feel unhappy when it is not for any obvious reason.  Just stopping, allowing myself the feeling makes it easier to know where I’m "at."  Once I know where I’m "at,"  I can start the acceptance part.

So I feel yucky becomes,  "I’m really very jealous of so and so,  or angry,  or disappointed or afraid."   And those feelings are automatically judged by me.  You know the drill:  I shouldn’t be jealous, angry, afraid.  Its probably the judgement, more than anything that creates the "yucky" feeling, not being a good person because I have this feeling.  But that's how it is.  And that is where I am at right now.  Its okay.  A gentleness,  a compassionate acceptance is in order.  And then we go from there.
What I found, when I was able to do this, was that my body “sighed”,  there was an easing of my breathing,  a release and a relief.  Maybe I didn’t feel wonderful,  but it all passed by more quickly and was less likely to ruin my day.  And as a little time went on, my understanding of these feelings deepened.  Starting where my “inner client” was and is "at,"  allows a spaciousness and a creativity in problem solving that is otherwise not there.

So once again:  start where the client is at.  And these days,  the client is me.

 P.S.  Dear Readers, 
Come visit  me on a recent Scientific American blog: 


  1. My experiences included daily meditation readings on areas I was working through (such as anger, fear,etc) and combinations of support groups and 1:1 counseling. I walked away knowing that I will look at 'it',feel 'it', and choose to let go of 'it' - for in the end it is I who will be holding on to it and the cause or whoever, will not be impacted at all. I know to say it is a choice sounds a bit too easy- but I do believe working things through and than choosing how we will go on through our days, is a choice. thanks for the post.

  2. Some things don't change -- "starting where the client is at" is still one of the main tenets taught in social work graduate programs today!

  3. I tend to view all things through parenting lenses these days, so I guess it's not surprising that this seems to apply well to my very young, very easily frustrated "clients." It's hard to always start where they are at, but usually worth the effort.

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