Therapy isn’t just tough for clients. It’s also tough for therapists, especially when they have to deliver difficult feedback to their clients. For instance, clinicians might need to challenge their clients’ denial or self-destructive habits. They might need to tell them things they don’t want to hear.
But while challenging, this is vital work. “I believe some of our most powerful work as therapists occurs through the ability to tolerate very uncomfortable or difficult news, moments or feelings and continue to stay present and empathically connected to the client,” said Joyce Marter, LCPC, a therapist and owner of the counseling practice Urban Balance.
Difficult feedback comes in many forms. For instance, Marter had to help a client realize that her husband, who admitted to an “emotional affair” with a colleague, was still hiding a big skeleton about the relationship. According to Marter:
I certainly didn’t know the truth of the matter, but as therapists, we can tell when stories don’t make sense and there is missing information. I asked several questions to try and get a more complete picture.
When my nagging suspicions remained, I said to her, “Have you considered the possibility that his story is not the full truth?”
She was quiet and visibly displeased and we sat in some discomfort for a few moments. I had to tolerate the discomfort and not sweep it all back under the rug again.
I felt worried that I pushed her too far, but she came back the next session and said she confronted her husband and learned he had been sleeping with that woman for many years. Our conversation was a difficult but necessary part of her growth and recovery, and she is doing fabulously without him!
Another time Marter had to tell a self-conscious client that his lack of luck with women stemmed from his grooming habits. Not wanting to hurt his feelings, Marter skirted around the issue for several weeks. But, ultimately, she decided to be straightforward. (He started a relationship three months after this session.)
This kind of candor helps clients become more self-aware and encourages growth. Plus, it fosters the relationship between client and therapist.
“Being honest and direct with clients is a very genuine, authentic, intimate experience. The initial discomfort of the tough feedback will pass, the client will see that you are invested in them and care enough to be real, and the therapeutic relationship will deepen,” Marter said.
Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression, had to deliver difficult feedback in the form of a diagnosis. She vividly remembers having to tell a young couple, who was in deep denial, that their son has autism.
There was a great deal of heartache at the moment of the diagnostic disclosure. Their grief, confusion and shock shifted them into a true crisis state. Though I felt great sadness delivering this news, I also felt hopeful and confident that early detection and early intervention would offer significant help for this little boy. It’s never easy for a psychologist to deliver a diagnosis – nor is it ever easy for a parent to receive it.
John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens, regularly shares difficult feedback with parents. Recently he talked with a couple about whether the high school they chose for their son was really in his best interest.