Preparing for Difficult Clients

Working with clients productively isn’t always an easy road. Clinicians frequently run into clients who are challenging, frustrating, maddening or otherwise pushing our emotional buttons in some fashion.

For example, there are clients who have their own anger issues and come in ready to pick a fight. They simply want to argue with us, and question our knowledge or expertise. There are clients who are passive-aggressive, are in denial of their addictions or simply don’t engage in therapy the way we would like in order to make the progress we wish for them. Then there are clients we just don’t like for some reason; they don’t share our values and don’t respect our time or our boundaries.

Often, the rule of wisdom is to refer such clients out so that they can find a better fit and get better care. But before you do that, I have a few suggestions for preparing yourself for your next session.

To begin with, check yourself. How are you feeling? Tired? Anxious? Hungry? Already dreading this appointment or preoccupied with something you’d rather be doing? What buttons are being pushed inside of you by this client? Spend some time slowing down and acknowledging your feelings. Breathe and try divesting yourself from feeling graded (even pass-fail) on the outcome of this session. This is your client’s session, not yours.

Then spend some time thinking about where your client is emotionally and cognitively. As I frequently say to interns, try going behind the curtain of the stage your client occupies to see the stagehands at work. What’s going on behind the behavior or attitudes you’re seeing and experiencing? Behind the anger is there fear or doubt? Behind the bluster is there insecurity or sadness? Is there a traumatized child puppeteer behind the puppet you see?

As you go into your session, attempt to drop all negative pre-conceptions, judgments and expectations into the trash can. Work with the person in front of you who is scared, sad, lonely or vulnerable from a place of authentic respect.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Respecting Our Differences

Human differences are infinite. We have different ethnicities, cultures, religions, family backgrounds, appearances, interests, and abilities. We each look different, sound different and act and think differently. Many variations of human experience, appearance, and expression shape our unique positions in life.

Williams and Levitt (2007) studied the differences between the values of therapists and clients as they relate to multiculturalism. They found substantial evidence supporting that real value differences exist between therapists and clients and that “therapists cannot be value-neutral and that they routinely convey their values with clients.” (p. 256). Therefore, they say, “the potential exists for therapists to consciously or unconsciously influence clients to become more like themselves.” They point out that most therapists are unaware of the potential negative effects of sharing such values with the client because they do so intending to benefit the client. Especially within a multicultural context, there is a higher probability of alienation, shame and/or indoctrination for the client in ways that either shut down the treatment or is counter-indicated for real progress to be gained.”

To widen our lens, to be able to experience the fuller personhood of our clients, means to be more aware of all the components of their uniqueness and to find a means to fully embrace that which is unique. In order to do this effectively, we need to be able to notice differences without engaging the filters of our own bias.

Respect-Focused Therapy (RFT) recognizes that the highest quality of the therapeutic relationship is necessary in order to create a process that is truly effective for enduring positive outcomes. To nurture these relationships, they need to be grounded in the most genuine sense of acceptance and respect. Using the terminology of Martin Buber, it is in the “I-Thou” relationship, the total realization of the other person as wholly distinctive from oneself and yet wholly valued as a human being, that we are then able to more safely and effectively enter our client’s world and assist in improving his or her experiencing of that world.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Williams, D., & Levitt, H. M. (2008). Clients’ experiences of difference with therapists: Sustaining faith in psychotherapy. Psychotherapy Research, 18(3), 256-270. Slay-Westbrook, S. (2016). Respect-Focused Therapy: Honoring Clients through the Therapeutic Relationship and Process. Routledge. https://www.ncbi.nlm.nih.gov/labs/articles/18815978/