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Therapy

The Ideal Psychotherapy Client

Are you a YAVIS?

Key points

  • A older study once showed that therapists prefer clients who are married women, age 20-40 with post-high school education and a professional job.
  • A more recent study shows therapists prefer clients who are motivated and open-minded above all other qualities.
  • Several therapists in a recent study shared characteristics with those they described as their ideal client.

In the '60s, the perfect therapy client was described as YAVIS: youthful, attractive, verbal, intelligent, and successful. Do therapists still believe this?

In 1964, University of Minnesota professor William Schofield (1921-2006) wrote Psychotherapy: The Purchase of Friendship presenting his views on the state of the mental health profession. It's a we're headed in the right direction, but have a long way to go sort of commentary with recommendations for better training for therapists, more rigorous selection of therapy candidates and clearer distinction between "mental illness" and the normal problems of human experience.

Schofield's Psychotherapy is a bit dated, but the many illuminating, critical research findings and insights make this a fine addition to any "paid friend" library. It's peppered with cutting tidbits such as this from his introduction to the 1986 edition:

Can it be that we are training a cadre of professionals who are especially adept at curing fears of snakes and spiders and peculiarly inept at treating conditions of demoralization after they have been carelessly diagnosed as affective disorders? (p. xii)

Take that, CBT. Schofield pointed his critical spotlight on the entire field of psychotherapy and researched many biases and inconsistencies within the profession. For example, he surveyed 377 psychiatrists, psychologists and social workers and asked about traits of their ideal client, defined as: "the kind of patient with whom you feel you are efficient and effective in your therapy" (p. 130). The majority stated a preference for married women, aged 20-40 with at least some post-high school education and a professional/managerial occupation. Hence his formulation of the "YAVIS syndrome," critiqued here:

What is there in the general theory of psychodynamics or psychotherapy to suggest that the neurosis of a 50-year-old commercial fisherman with an eighth-grade education will be more resistant to psychological help than a symptomatically comparable 35-year-old, college-trained artist? ... It seems more likely that there are pressures toward a systematic selection of patients, pressures that are perhaps subtle and unconscious in part and that, in part, reflect theoretical biases common to all psychotherapists. These selective forces tend to restrict the efforts of the bulk of [therapists] to clients who present the YAVIS syndrome—clients who are youthful, attractive, verbal, intelligent and successful. (p. 133)

The YAVIS syndrome points to the biases therapists hold about rewarding, successful psychotherapy. Therapists tend to want to work with clients with whom they can achieve success, and these characteristics seemed to lend themselves toward a better prognosis in therapy.

What therapists want from clients today

So what about today? Are therapists still looking for YAVIS? I decided to tackle this myself, on a much smaller scale. Schofield did his research 45 years ago and I did mine last month. He surveyed 377 psychotherapists and I surveyed 20 psychologists (mostly), social workers (one), marriage and family therapists (a couple) and psychology graduate students (a few). I'm sure his sample was fairly representative of the population at the time. Mine is not, consisting of some friends and colleagues from my address book. I won't even pretend my friends are representative of therapists as a whole.

Schofield had a detailed questionnaire, but I simply asked 20 colleagues for three adjectives describing their ideal client. Here's what they said (combining synonyms):

  • Motivated, ready to work (x13)
  • Open-minded, flexible, adaptable (x9)
  • Introspective, contemplative, curious about self (x7)
  • Consistent (with payment & appointments) (x5)
  • Verbal, communicative (x4)
  • Honest (x4)
  • Trusting (x4)
  • Creative (x2)
  • Sense of humor (x2)
  • Intelligent
  • Enough symptoms to keep things interesting
  • Spiritual
  • Non-resistant
  • Cash pay
  • Gracious
  • Tolerance for ambiguity
  • Will tolerate pain for growth
  • Neurotic
  • Sparring

As you can tell, it's not quite Schofield's findings. Youthful, attractive, and successful aren't even mentioned, intelligent gets one vote, and verbal barely cracks the top five.

I'm not terribly surprised by these results. They point to a theme I often hear from therapists: We want clients to be as invested in the process as we are. We like it when they're motivated to work in and out of the session, ready to try new things and willing to look deep inside. When these ideal elements are in place, therapy tends to progress nicely. Pulling teeth to motivate, collaborate, and communicate is much harder work. But that's why we go to school and earn a paycheck.

A large part of our job is helping clients learn what motivates and discourages them, what rigid beliefs and harmful paradigms they cling to, and how to become curious about the self. So there's good news: Motivation, open-mindedness, and introspection can develop over time, which gives everyone the potential to be the ideal client. At least these qualities are easier to achieve than YAVIS.

On a final note, after I sent my bulk email a few therapists wondered if I was sneaking them a projective test. Shrinks are paranoid like that. I didn't have that goal in mind but did observe that several therapists shared characteristics with their ideal client. Or maybe they were reporting their own ideal traits, the qualities they wish they embodied. Why would a therapist want to work with their own ideal self? A question for another post.

Apparently, therapists aren't looking for YAVIS. We want clients who invest in the process and share the traits we highly value: motivation, openness and introspection.

Forget YAVIS. We're looking for MOI.

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