Building a therapeutic relationship when a client seems difficult

“There is no resistant client. It is only that we have not found a way to work with them.” – Karl Thom

Most therapists learn a framework for working with “difficult” clients, but so often, in the moment, experiencing the difficulty, knowing what to do doesn’t seem so obvious. Reflecting after the session or in a supervision conversation, it often becomes obvious, but by then it is too late.

This is probably one of the commenest issues a therapist brings to supervision, and one of the most obvious areas where deliberate practice has a chance to improve effectiveness.

But what to practice?

At The Centre of Effective Therapy, we teach that the most useful beacon to alert you to a problem with the therapeutic relationship, is your own response. The best thing about that is that it is hard to miss.

There are 3 common responses that we have to clients.

The first is that we like them. We are aware that the client is collaborating, responsive and willing, and the work flows. This reminds us why we do this work and we enjoy the interaction.

The second response is that we find ourselves feeling overwhelmed, inadequate or anxious. Our heart sinks and we feel the sudden need to refer this client to someone better than us. We might look at the clock, wishing the session was over. This client seemingly has a huge problem and the difference is that they want us to fix it. They are not invested in a collaborative process, and while we might see that there is something they personally could do differently to ease the problem, they are not ready to see yet. When we see their name in our appointment book for follow up, we might even hope they don’t turn up. But they always come! Steve de Shazer called these people complainants, but if you have learned a different framework, you will likely identify with the feeling, and know where you are in your frame.

The third response we have is frustration. We get a disturbing desire to shake our client. We might feel irritated or annoyed that they are wasting our time and unwilling to look at their issues. We think they are avoidant. When we see their name in our appointment book for follow up, we know they likely will not turn up. Steve de Shazer called these clients visitors, but again, in different frames the response is still the same, and is the easiest thing for us to identify in the moment.

Rob McNeilly takes these responses to the extreme and says that we fall in love with our customers, we feel suicidal with our complainants, and we feel homicidal with our visitors.

We all want to enjoy our work and be effective. We know the alliance is pivotal, and when we call a client difficult, it is usually because we are either feeling frustrated or inadequate. This is our cue to restore the relationship. We could say simply, that we need to do something so that our response changes from irritation or inadequacy, to liking the client. It is our job to do this, and not our client’s.

In our programmes, we teach students that if they have either of these two responses, they simply need to down tools and validate the client”s experience.

That’s it. Simple.

You’ll notice though that the validation is a bit different in the two categories when you get it right. If we feel inadequate, we will likely find ourselves  validating the client’s experience of their problem and how huge it is. If we feel frustrated we tend to validate the client’s experience of not wanting to be here. We may even engage them in the idea of how to get out of having to come again, and find at this point we have a willing collaborator!

If we do this sufficiently we will then be able to engage them in looking at what they might be able to do differently, and as we do this, we notice our response shifts and we start to enjoy the work and we start to like the client.

We restore the relationship by fixing our response.

Next time you find yourself feeling suicidal, or homicidal with your client, try downing tools and validate, actively working to restore the relationship by focusing on their experience, not yours. If you then find yourself enjoying the work and liking the client, you know it is fine to proceed. If the unhelpful response recurs, down tools again, validate, restore and move on.

Other ways that I have noticed help when I am disengaging, is to ask the client what they like to do. A different version of them appears as they talk about what they like, and I find it much easier to be interested and engaged, discovering their resources and knowing that bringing those resources to the problem area will later be fruitful.

I remember reading that Erickson liked to find something about every client that he could appreciate. In one instance he was struggling to find anything with an old man who seemed to have little concern for anything other than himself, and just when it seemed there was nothing, the old man smiled revealing a mouth full of decaying teeth, but one of them was gold. The one gold tooth!

What do you do to engage a so called difficult client? Please leave a comment.

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One thought on “Building a therapeutic relationship when a client seems difficult

  1. I love this: ” down tools and validate the client”s experience.”
    I guess it makes sense to me now! I’m not that good in always using the tools :-)
    I’m not familiar with ‘difficult’ clients like you describe them, but I notice being most of the times ‘on my guard’: is it the right time to use a tool, or do you (client) want to have more ‘stage/podium/time’?

    Like

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