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.

The Blame and Shame Game

When working with couples, I often run into a repeating pattern of behavior I call

“The blame and shame game.” It goes something like this:

They came in initially because they were arguing too much—at least every other day, they reported—about money, sex and children. Maryanne was concerned that hundreds of dollars had gone missing over the past six months and John pled innocence, claiming that she was “trying to pin everything on him.” He, in turn, accused Maryanne of having a secret affair with her ex-husband, which she also denied. Accusations continued to be thrown. They both began yelling and pointing fingers at one another. They were blaming one another for various unrelated incidents from the past and upping the level of each other’s transgressions in rapid succession, overlapping their voices such that the volume increased so significantly no one voice could be heard.

This pattern seems to be prevalent among couples that have not had good parental modeling for problem-solving or conflict resolution. It is within this framework that winning supersedes resolution. The result is predictably that they both hop on this treadmill that takes them nowhere, except deeper and deeper pain.

The interventions to this cycle are multidimensional in nature. That is, they overlap; they work together. In Respect-Focused Therapy, the specific needs of each individual or couple supersedes any formulated model or technique. This approach rather suggests that all known evidenced-based and reliable techniques, etc. to a therapist be utilized as best serves the needs of each client’s situation.

For example, in the case sited above, I was deeply aware that I need to gently interrupt the pattern of “blame and shame,” but I also knew that such a pattern was deeply entrenched in their style of communication over the long span of their relationship as well as the pattern each had grown up experiencing with their respective parents. This could and would not be an easy fix; to assume so would be to disregard these two people who sat in front of me. For me to assist them in effectively, I had to first acknowledge and positively regard/respect their perspectives on how and why they communicated in the fashion they did.

By asking more questions about how each had grown up, I found out that competing and never losing face in the process was a highly held value in both homes. This being particularly true in John’s home, unfortunately also meant “win no mater what the cost.” This included attacking his wife with a charge of adultery, which later it was found out he didn’t believe, in order to cover his gambling addiction.

In order to get a foothold into any meaningful resolution, I had to openly state my awareness of how much raw pain they each endured every day and how much energy and stamina that must require.

Once it was established that I truly understood how exhausting and frustrating it was for both always needing to win and yet no one ever winning, then I was able to begin offering some tools such as active listening and non-violent communication to slowly break up the long-standing pattern. Eventually, with months of trust-building, we were able to reconsider and reevaluate the value of winning an argument vs. the value of resolving conflict.

 

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/

 

 

 

 

 

What Respect Really Means

For many of our clients, there is little experiential connection with the concept of respect, because it feels contrived, obligatory or simply nonexistent—often from childhood. Predominantly, they don’t feel privy to getting any of its benefits, as it seems only to be for others, primarily “elders” or those in authority positions. Far too often the lack of genuinely feeling respected, honored by others authentically, can lead to lifetimes of never respecting oneself and therefore not having the grounding to be able to adequately respect others.

Our job as therapists, then, is to help clients realize that respect—in its truest form—is not contrived and is not hierarchical. In fact, to be genuine and grounded it needs to be mutual, shared symmetrically. To have high esteem for someone and that is unreturned by that person, it becomes at some point, meaningless for both. For example, if a child adores his father who is admissive or abusive towards his child, the adoration becomes unfulfilling and may, in fact, turn into resentment or despair. Respect needs to come from a place of authenticity and symmetrical balance to have any true validity.

Respect is more than a noun; it is also a verb. It is action. The Latin origin of the word is ‘respectare,’ which means to look back or look again. To reconsider. The realization that respect cannot be demanded or coerced in any meaningful way opens the possibility to a surprising new awareness of another person we thought we knew well, but upon intentional reconsideration, we find something wonderful we may have never noticed before.

Challenge your clients to take the next opportunity to “look again” at the person they most take for granted or get annoyed by, themselves first, or maybe a spouse or family member, a neighbor or coworker, and try assisting them to look through a lens of respect that can filter out the negatives enough to find one new positive perspective they may not have seen in the same way before. This may take some practice, but the more chances we take on this new path of interpersonal discovery, the more we may be delightfully surprised.

 

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.