The 6 Most Challenging Issues in Therapy: NP0021 - Session 1

Welcome to “The 6 Most Challenging Issues in Therapy…And How Therapists Can Overcome Them.” In this series, leading innovators in the field will explore specific kinds of cases and clients that can stump even veteran therapists—narcissists, resistant clients, individuals with borderline personality disorder, and more. Each session will focus on concrete, practical strategies that’ll help you when facing these kinds of difficult cases.

In this first session, marriage and family therapist William Doherty highlights some techniques to follow when a client isn’t following the treatment plan, continues to follow a self-destructive path, or simply isn’t making progress. Learn how to avoid sounding like a disappointed parent or threatening to abandon the client when therapy stalls.

After you hear this presentation, please take a few minutes to comment about what you found most interesting or relevant, to ask any questions you have of the presenter or your colleagues, or to share any experiences. If you ever have any technical questions, please feel free to email support@psychotherapynetworker.org and our Support Team will help you.

How We Can Solve Our Most Challenging Cases

The desire to keep growing and improve our skills is a good part of what brought many of us into this demanding profession.  But once we’ve acquired some experience and achieved a certain level of competence, we may begin to fall into a routine, just repeating ourselves over and over again. After all, getting to the next level—transcending our own current performance—often requires us to leave our normal comfort zone, not something many of us relish doing. Nevertheless, getting to that next level of mastery doesn’t just improve our performance—it can make us feel renewed as human beings.

Let me give you an example from my after-hours life as a pick-up basketball player.  I’ve been playing basketball for close to 50 years now—thousands of hours dribbling, running up and down basketball courts, working on my jump shot, pushing and shoving complete strangers. For a 63 year-old considerably beyond the usual age for a viable basketball career, I’m not a bad player. But over the last few years, I noticed that I was just repeating my old tricks, doing the same things I know how to do, over and over again. I still loved basketball, but there was getting to be a certain sameness about my game. I felt stale.

Last year at this time, I got inspired watching the Dallas Mavericks, one of the oldest teams in the NBA with a roster of geriatric 30-somethings, win the league championship. I was drawn to try for my own basketball breakthrough and see if I could get out of my benign rut.  I found myself a coach—a 25-year-old named Andrew who loved basketball even more than I do and seemed to have studied everything there is to know about the game. Since then, he’s become my basketball guru and taskmaster. Every week, I have a session with Andrew, who keeps pushing me to expand my game, after which I take notes and practice what I’ve learned. Andrew’s very nice, but very tough. Instead of telling me how great I am at stuff I already know how to do well, he relentlessly points out the limits of my game, and then shows me how I can improve.

A few weeks ago, for example, after observing how predictable my offensive repertoire was, he announced, “You always drive right, never left. You gotta expand your game.”  As a right-handed person, I naturally tend to dribble with my right hand, make jump shots to my right, pass to my right, and so on. So he started pushing me to focus on dribbling with my left hand, driving to my left, and hitting left-hand lay-ups. It felt unnatural, awkward, hard to do, but I practiced the moves he showed me again and again and again. One day, after a couple of weeks of this, I found myself playing one-on-one with a familiar rival who had the annoying habit of beating me. I was determined that, regardless of how awkward it felt, I’d make myself drive left. Quite familiar with my right-wing basketball tendencies, my opponent kept overplaying me to move to my right. Instead, I kept hitting left-handed lay-up after lay-up and won easily. But not only did I feel the fleeting joy of victory, I had that incomparable sense of suddenly discovering a new self, not bounded by my old limitations. It was thrilling.

As therapists, we all face situations and cases that tap into our particular limitations, make us feel frustrated and incompetent. We all tend to get into our ruts, avoid certain kinds of clients, or feel off-balance and uncomfortable in the face of clinical challenges that press our particular buttons. And in a sense, the presenters in our upcoming webcast series The 6 Biggest Challenges Therapists Face are like Andrew. They recognize what keeps us limited in our effectiveness and how routinized our practices can become. But, like Andrew, they have highly practical suggestions—offered in the context of very vivid case examples—for helping us get beyond our limitations.

Without Andrew, I’d still be avoiding what I didn’t feel fully competent doing. But he’s opened up a whole new range of choices for me on the basketball court. I hope you discover some new choices for yourself in our new webcast series and up the level of skill and excitement of your “game” in your consulting room.