The Way To Say It…

This article first appeared in the May/June 2010 issue.

Q: I often find myself flustered when clients challenge me or are critical of me. I never seem to know what to say right at that moment. Any suggestions?

A: There are ways to deliver profoundly effective, on-the-spot responses during difficult encounters—ways that can mobilize you and restore the receptive, flexible, and empathically attuned you. I’ve chosen a small sample of a long list of examples that colleagues and trainees have shared with me over the years, including my own personal favorites.

You’ll notice that many of the suggestions call attention to nonverbal tips and scripts. I call those “The Way to Say It,” because it takes so much more than clever insights and keen conceptualizations to make a difference during challenging moments with clients. It takes awareness of how you communicate your message, the desire to explore your stumbles and falls, and the ability to attend to your inner core and mend the tattered places within you to make sense of your “hot buttons.”

What’s Come Over Me?

For example, when responding to a (possibly narcissistic) client who’s in his angry/critical mode, the first step is to identify what part of you is getting in your way. If you’re a person who has problems with anger and confrontation because of unsettled experiences from your own early years, you may find yourself shriveling in the face of anger. You press yourself deeply into the back of your chair, let your posture collapse, wring your hands, and begin to apologize for his upset, nervously making excuses and promising to try harder to make the goals and strategies of therapy clearer for him.

Don’t get me wrong—it’s okay to apologize and clarify points when it’s warranted. But let’s not forget the issue of his unacceptable tone and abusive criticalness. If fear and intimidation engulf you, and you resort to old familiar coping responses, you may lose opportunities to help the client understand the impact of his self-defeating behavioral style. The same is true if your coping tendency is to get embroiled in an argument.

To retrieve the competent you, you’ll need to sit upright in your chair and enlist an internal messenger to remind you that you’re not only an adult who has rights and is entitled to respect and consideration, you’re also a trained professional who understands the complexities of this client. You tuck your “vulnerable self” safely away and conjure up an image of your client as a faultless child who possibly feels shameful and unlovable. You then fix your eyes gently but solidly upon him, and say slowly and clearly in level tones: “Listen, I know it’s hard for you to simply ask for what you need when you feel confused or frustrated with this process. I know this comes from early experiences of being deprived and confused by the people who couldn’t meet your needs, which made you feel ashamed and alone. So now, when you get upset, you feel entitled to put people in their places if you think they’ve let you down. But when you speak to me in those loud, cynical tones—saying mean and critical things about me and my work—it’s very hard to care about you. Your approach is harsh and unacceptable, and what you end up doing is reenacting scenes from your past and producing the same outcome: loneliness.

“I’m sure this is what it’s like for your wife and your colleagues who’ve gotten fed up with you. While I can report honestly on how it feels to be the recipient of your anger, I’m also a trained professional who understands your makeup. We might consider this an opportunity for some important work, because without the willingness on your part to communicate your needs more authentically and respectfully, you’ll lose the people who matter most to you.”

He’ll probably buck and battle a bit more, but don’t let go of the interchange until he agrees to look more deeply at his reactions and the links to his emotional themes. Don’t let him off the hook. Continue to hold him accountable for his actions, set limits, and reinforce the leverage—pointing out the consequences of his behaviors—throughout the session.

“I Am How I Am”

I’ve come to know a common set of phrases from clients, which often show up in their relationships, too. You probably hear these as well: “I am who I am.” “This is just me: take it or leave it.” “I’m not changing.”

There’s a useful twist that I’ve developed in response to this moment in treatment. It goes something like this: “You know, Joe, I can fully understand how annoying it is that Carol keeps asking you to be more emotionally open with her, especially since you feel that you already do so much to show your love. You often tell her that you’re just a typical ‘guy’ who doesn’t show a lot of emotion. ‘I am who I am,’ you say. And, while it may be true that you’ll never be as expressive as she’d like, I do think that you aren’t being exactly who you are.

“You say you have a lot of love for her, but you only express a portion of what you feel. You aren’t fairly representing all of you—in some ways, the best parts of you. Do you think the ‘how you are’ is a true match for your feelings? She only gets to see the ‘how’ but not the entire ‘who.’ That’s too bad, because the ‘who’ of you has a lot of really good stuff inside.”

Of course the same holds true for you, the clinician. It’s moments like these in which you want to be sure that how you communicate delivers the intended message of who is sending it. If you want to let the forever-disappointed and avoidant client know that her inner Eeyore—”Nothing makes a difference.” “I can’t do that.” “I don’t know how I feel.”—is really becoming a problem for you, besides pointing out the pattern and linking it to her life themes, you might share that those statements have become off-putting to you. They demotivate you, even though you’re fully aware of where they come from, and if she wants you to continue to be an advocate for her frightened side, she’ll need to promise to be more conscious of the use of language like this.

Zingers, Jibs, and Jabs

Therapists in training programs frequently approach me asking, “What do you say to clients who say that their childhood issues are resolved and they see no point in looking back?” I usually respond to such clients with a question: “How uncomfortable is it for you to look back at your early experiences?” This is a tad provocative, but it inserts a concept I like to call the “implicit assumption.”

This concept suggests that certain feelings are reasonable: it makes sense that we may want to find ways to steer clear of the past. When a client balks and proclaims “I’m not uncomfortable; it’s just a waste of time,” you can follow with: “It’s not that I’m saying that your feelings are wrong or that you aren’t being honest. It’s just that I know that most of us feel uncomfortable with the experience of looking back at painful moments in our lives—even when we’ve done it before. There are many reasons for the discomfort: family loyalty, embarrassment, not wanting to feel our negative emotions. I wonder which of these might be true for you. I also propose that if these past experiences were truly resolved, you probably wouldn’t be stuck in the self-defeating patterns that keep you from getting your needs met.”

Here’s another classic: “You just don’t get me.” This client may be characterized by a profound lack of empathy from caregivers during her childhood, along with a high degree of manipulation and control from them throughout her life. She’s known to be a fighter when she feels misunderstood or used. So here you are, trying to be your empathic and caring self as she tells you, from her most vulnerable core, “I know I need to work on these issues. It’s so hard (tearful). I just get so triggered when . . . .” You’re sitting tall, clipboard on your lap, taking copious notes, while nodding, and “um-humming,” and you say, “I’m beginning to understand how hard this is. I really get how when you . . . .” But, before you can finish your thought, she’s grimacing with arms folded. “No you don’t! You don’t get me! No one gets me! No one ever will! Please don’t pretend to understand and be nice to me.”

This time, with arms comfortably resting on the sides of your chair, hands gently placed on each thigh, both feet on the floor, posture straight with face tilted forward a bit, you say: “I wonder what would make you feel the need to become so defiant and self-righteous with me just now. I’m aware that whenever I offer my understanding—the very thing that I know you long for—you seem to immediately negate and dismiss any empathy that may be resonating for me. Can you see that, too?” The discussion that follows can be very revealing. Links to fear of control or shameful exposure are among the themes that may be discovered.

This is hardly a complete list of examples. But, hopefully, it affords a glimpse of how to use expressive integration within the moment-to-moment challenges in the treatment room. In addition to competent assessment, interpersonal skills, and general therapeutic techniques, healing your own maladaptive life themes is an absolutely necessary component of effective therapy. This isn’t so you won’t feel the jab when a client crosses a line, but so that you can feel it just enough to be able to confront and correct self-defeating patterns, instead of becoming ineffectively numb or overwhelmed.

And remember—it’s not just what you say. It’s the way you say it!