Talking to Clients About Their Healthcare Experiences

As therapists, we have conversations with our clients about many aspects of their lives, ranging from their childhood experiences and personal relationships to workplace stressors. But there’s one topic that may sometimes be under appreciated: their experiences in the healthcare field.

Why talk to our clients about their healthcare experiences? Besides helping us to learn more about their background, this aspect of our clients’ history can yield many fruitful topics that can benefit the therapeutic relationship.

In this article, we’ll explore how it can be beneficial to discuss healthcare experiences, ways that we can bring up this topic, and some common themes and concrete steps that can arise from these discussions.

The Importance of Asking About Healthcare Experiences

At first, healthcare experiences may not seem too relevant to our work as therapists. We aren’t medical doctors, so why would we ask about this aspect of our clients’ lives?

But assessing clients’ healthcare experiences actually allows us to understand more about them:

• Physical health. By engaging in these discussions, we make sure not to miss out on any important information about our clients’ physical health, which has obvious connections to their mental health and sources of stress. We can also be cued into other aspects related to physical health, such as sleep and diet.
• Preferences in professional relationships. Why did our client pick this clinic, and not the other? What does our clinic appreciate about their healthcare provider? The answers to these questions can yield rich information about their preferences, which translate directly into our work with them.

For these reasons and many others, assessing healthcare encounters can not only enhance our understanding of our clients, but also build our rapport with them and enrich our work with them.

When to Discuss Healthcare Experiences

Like anything that we discuss in therapy, the timing of the discussion can be just as important as its content. Generally speaking, two timeframes will make the most sense for this conversation to happen: during the intake, and during a client’s active engagement with health care.

During The Intake

Most biopsychosocial intakes include a section about medical conditions or history, and I’ve found that this is a fitting place to ask about healthcare experiences more generally.

If the client has mentioned that they see a doctor regularly for a certain medical condition, we can ask them about their perception of their care and of their treating healthcare provider. Even if the client doesn’t endorse any significant medical history, we can still assess healthcare encounters by asking about any relationship with healthcare providers that stick out to them, or about their preference about healthcare providers more generally.

During Healthcare Experiences

Besides the intake, active healthcare experiences can also prompt discussions about client’s perception of healthcare. These can range from anything from simple yearly physicals to a lengthy treatment course or surgery.

Regardless of its nature, we may ask questions like:

• “What led you to choose this provider/clinic?” This can give us important information about the client’s preferences and values.
• “Has anything about this provider/clinic been disappointing/different than what you expected?” This is an open-ended question that provides the client an opportunity to reflect on what improvements could be made.

Common Themes

After having many conversations about my clients’ healthcare experiences, I’ve noticed common themes that tend to come up.

Strained Relationships

Many clients report that their healthcare providers don’t spend much time with them, or that they don’t adequately attend to their feelings during their appointments.

Our clients’ perception of their relationship with healthcare professionals can be a proxy for us to understand their preferences for their therapeutic relationship with us. Although medical and psychotherapeutic relationships are obviously different, there are overlaps that can give us important information, especially as we seek to deepen our relationships with our clients.

Invalidation

A person’s physical health is an intimate aspect of their life. Unfortunately, clients can have negative experiences when they believe that healthcare professionals haven’t adequately taken their concerns seriously or believed their reports about their physical health.

This can be a crucial factor in stress-related conditions like IBS, where the label ‘anxiety’ or even ‘mental health’ more broadly can be used to forego giving a medical diagnosis. In some cases, clients will tell us that they’ve had invalidating experiences with multiple healthcare providers, until they find the one who was able to give them the right diagnosis.

Unfortunately, some clients can generalize this phenomena to all healthcare providers, and expect to be invalidated by their therapist, too. Addressing this directly can lead to rich conversations that challenge fixed beliefs that clients may have about healthcare relationships more generally.

Access and Availability

Whereas the previous factors we considered involved the providers, this one is more systematic. Clients can sometimes have negative experiences related to the access and availability of healthcare, such as high costs, insurance coverage, or an inability to find the right healthcare provider for a specific population or condition.

This can be especially true for minoritized clients. For that reason, the discussions that emerge from this topic can be a great opportunity to open space for clients to talk about how their identity intersects with their access to health care.

Concerns about access and availability can be great jumping-off points to engage clients in solution-focused conversations. This leads us to our next section, which will review steps that can be taken after conversations about clients’ healthcare experiences.

Future Steps

Conversations about our clients’ healthcare experiences sometimes lead to concrete actions that clients can consider taking during therapy.

Articulating Needs

One of my clients scheduled an appointment with her primary care doctor after she began experiencing unexplained gastrointestinal symptoms. She was anxious about her symptoms and eager to get to the bottom of them, and had prepared many questions for her doctor. Between being shuffled between rooms, speaking to other providers, and being rushed in her conversation with her doctor, she didn’t get the chance to ask them.

Many clients have endorsed experiences like this one. Talking about them can lead us to have important conversations about helping clients to advocate for themselves and be effectively assertive. If clients can improve in their ability to handle minor confrontations and assert their needs during healthcare encounters, this can easily translate over to other fields of their life.

Finding A New Provider

Sometimes, the issues that come up related to healthcare experiences aren’t able to be managed. In these cases, the only solution is for clients to simply find a new healthcare provider.

Finding a new provider can be a difficult process for clients to navigate. First, there can be doubt about whether issues warrant such a drastic step. In addition, switching providers often involves a lot of paperwork and follow-up tasks, something that clients may even know from their experiences switching to a new therapist. This process can also be especially difficult for minority clients, who already have reduced access to healthcare.

Conclusion

In addition to other important topics we explore with clients, discussing their healthcare experiences can provide valuable insight into their health, therapy preferences, and actionable steps for support. Mindful conversations in this area also strengthen the therapeutic relationship and enrich their overall experience in therapy.