When clients are particularly difficult, a therapist may need to decide whether to work it out or cut professional ties.
For therapy to work, the client and therapist need to establish a good rapport. There should be a foundation of trust, respect, and good communication.
Sometimes, when things don’t go well, it’s simply a mismatch — perhaps there are differences in personalities or philosophies.
Other times, clients can make things quite difficult either accidentally or on purpose. Things can become pretty uncomfortable if a client doesn’t want to be there, is argumentative, or pushes the therapist’s boundaries.
In these cases, a therapist may need to set firmer boundaries or even ask the client not to come back.
We often think of therapists as wise and peaceful experts — immune to experiencing negative reactions like the rest of us.
But while they’ve certainly been trained to solve problems and help people, they’re also human. Therapists do get frustrated with clients from time to time, but some can handle difficult clients better than others.
This may be due to training or inherent personality traits.
“Relatively passive therapists who are committed primarily to reflection, clarification and empathy techniques have the most trouble with difficult clients,” says Stanley L. Brodsky, PhD, a clinical and forensic psychologist.
“Active, highly involved therapists with focused and energetic techniques often have the best payoffs.”
There are several types of clients who can make a therapy session more difficult.
“Clients coerced by family, work supervisors, and situations (like being in prison) can be very difficult, but this rule hardly applies to all coerced clients,” says Dr. Brodsky. Instead, this situation often produces difficult clients if the client has no motivation to improve and does not believe there is a problem to begin with.
According to Mark Tyrrell, a hypnotherapist and the co-founder and owner of Uncommon Knowledge, Ltd., a psychotherapy training company, the following situations tend to cause the most problems:
- Clients who’ve been forced into therapy by others. Clients who’ve been coerced into therapy by well-meaning friends, partners, or relatives may feel resentful to be there. While clients must “want” to change, Tyrrell notes that therapists can often help them get to that point. Helping the client become motivated can also be a therapeutic focus, he says.
- Clients who are argumentative. Some clients will automatically refute everything the therapist says. They may do this to feel in control or simply because they enjoy arguing.
- Clients who need emergency help. If a client is chronically intoxicated, physically ill, or experiencing psychotic symptoms, they need to be stabilized first. These clients need the help of other professionals before they start therapy.
- Clients who think their therapist is fully responsible for their wellness. Some clients want to take a passive route and expect the therapist to do all the labor. They don’t want to put in the necessary work for healing.
- Clients who cross boundaries. It can be difficult for empathetic therapists to set boundaries with needy or aggressive clients. Some clients will call their therapist to speak for a “couple minutes,” only to continue talking for 40 minutes during the therapist’s personal time. In these cases, it’s important for the therapist to set firm boundaries, says Tyrrell.
Therapists may choose to work through conflicts with their clients, but if the client is particularly difficult, resistant, or toxic, they may ask them not to come back.
In less-than-toxic cases, however, this decision often depends on the therapist, their personality, and their policies.
Here are Tyrrell’s “three golden rules” on how therapists can respond to difficult clients:
- Never take any difficult behavior personally. It’s important not to take the client’s resistance personally, but instead turn it around and use it as fuel. For instance a therapist might say, “I totally get that you don’t want to be here, and that’s OK.”
- ‘Difficult behavior’ may represent an unmet need in the client’s life. If a client only talks and doesn’t listen, they may desperately need to be heard, because they’ve been starving for attention. If a client resists attempts for help, it may be an expression of an otherwise unmet need to feel in control.
- It’s human and OK to get annoyed at times. In fact, sometimes showing a client a little frustration can be a useful wakeup call and promote self-awareness.
However, if things aren’t going well, then perhaps finding a new therapist may be the right choice.
Dr. Brodsky suggests either clearing the air with your therapist or start looking for another one.
“When asked by acquaintances who are unhappy clients, I tell them to confront their therapists or to move on. If something worthwhile has not happened in the first 5 sessions, try another therapist,” says Dr. Brodsky.
According to Tyrrell, recognizing that your therapist is frustrated with you might be a good thing, as it can allow you to see yourself more objectively.
But if you’ve earnestly examined your own behavior and found nothing wrong, and if the therapist’s conduct “seems excessive and unreasonable…then it might be time to ditch the therapist in question,” says Tyrrell.
Tyrrell notes that the therapist should not take the client’s behavior personally. “They need to have their own emotional house in order, at least to the extent they can help their client.”
Therapy should be a positive experience for everyone involved. But if it becomes toxic or hostile, it’s likely not going to work.
While therapists do get frustrated with clients from time to time, it’s not typically enough to call off therapy. The situation is often resolvable.
In the end, communication is key. If both the therapist and client are open, honest, and kind then therapy becomes a healthy and productive space.