Navigating the Rift

A Therapeutic Rupture and the Art of Repair

Psychotherapy Networker

Thank you to everyone who responded to our June Clinician's Quandary. Here are some of the top responses! Submit to next month's Clinician's Quandary here.

June Quandary: In a moment of frustration, a difficult client recently told me I’m a bad therapist. I didn’t respond, and we muscled through the rest of the session, but the comment has really been weighing on me. I feel hurt and insulted, and I’m not sure how to proceed. A part of me doesn’t even want to work with this client anymore. What should I do?

1) Lean Into the Discomfort

This kind of situation is the ultimate challenge of your capacity to pull way back and approach it as an issue to process in therapy. It can sound cliché to say “this isn’t about you,” but it most likely truly isn’t. If you can believe that and respond accordingly, you’ll be using the opportunity to do good work with your client, no matter the reason for their comment. Here are some tips to help you get into that mental space before you approach the subject with your client.

Ask yourself what buttons of yours their comment pushed. If there are ways in which you doubt yourself as a therapist, a comment like that will bring them flying to the surface. Write down what comes to mind when you examine the areas in which you lack confidence. Then try looking at these “weaknesses” through a different lens. Is it perhaps true that you could improve in these areas? And could it also be true that your strengths balance out your shortcomings? Taking an honest look at the full range of your skills can decrease fear and shame.

Try doing a thought experiment in which you imagine anyone else besides you being on the receiving end of this comment. Run this scenario by a few friends, coworkers, or other therapists you know. Does the comment sting for them as well, or do you feel it differently?

In your next session, broach the subject by saying, “I want to talk to you about something that happened earlier. I know you were frustrated, and you mentioned being unhappy with our work together. I want to put that on the table, because an important part of therapy is being able to voice your feelings and reactions and talk about them openly.” The client might respond by saying it was a spur of the moment comment and they didn’t really mean it. This is a chance for you to model non-defensive openness and receptivity to input by saying something like, “Alright, but please know that if you ever do have concerns you should feel free to voice them to me. I won’t necessarily agree with you, but perhaps there are ways we can work together to improve our communication and your experience.”

If they express a genuine complaint about your work, remember that you don’t have to respond right away. Hear them, thank them for their honesty, and say that you’ll need to reflect. This will give you an opportunity to truly consider what they’ve said when you have time and space, rather than getting defensive. Form an honest and objective opinion, and be prepared with a thoughtful response before your next session.

Julie Borden, LCSW
Los Angeles, CA


2) Unexpected Paths

Ah, something every therapist can relate to! Competency challenges never feel good in the moment, and we as clinicians will invariably face questions regarding our skills, techniques, knowledge, and even our personal demeanor. Client critiques may be subtle or overt—sometimes even aggressive. But we can experience these as gifts of opportunity if—and it’s easier said than done—we take the personal out of it, get curious, and see what we and our clients can learn from these challenges.

Such comments may be the gateway to untapped material for deeper work. Channel your “objective observer,” taking the self out of it, and explore your client’s experience: What’s it like for them to be stuck with a “bad” therapist? What are they wanting out of therapy and not getting? Has the client had sessions that were helpful, and what was different about those? Have they had similar past disappointments in therapy or in other areas of their life? These uncomfortable spaces can provide unexpected paths to new understanding, problem-solving, and even aha moments.

Keep in mind contributions of transference, wherein the client's feelings about a significant person in their life are projected onto the therapist. Likewise, look at your own feelings of hurt and insult through the lens of countertransference—the natural, often self-informative responses of therapist to client. What might your own reactions be telling you?

This therapeutic rupture may well lead to repair and stronger collaboration between you and this client. And if it doesn’t? Our profession is largely relational, and no clinician can realistically expect to be the right fit for every client. At the very least, you’ll be learning something through the curious, open-hearted interaction to apply in future work.

Mary Garwood Yancy, PhD
Austin, TX


3) Get Curious

Working in a public mental health agencies sometimes exposes you to these types of provocative statements. There are several ways to address them, all of them very direct. One option is to ask the client what it is about your assistance that they’re unhappy with, and to explore whether that's something you can change. Another option is to ask the client what they consider to be an “ideal” therapist, which you could help them find if they continue to be unhappy with your services. Last, you could express curiosity and discuss with the client whether they routinely and bluntly let others who disappoint or displease them know that they’re doing so. Then, you might ask them whether and how they think it affects their ability to get their needs met.

You might elect to be even more direct. Why is the client running the show? After all, it’s your office, and what you do in your space is on your terms. You could try asking them to rephrase their statement in a way that's more conducive to solving their perceived problem, rather than simply assigning blame.

If nothing else, you’ve learned that this client is severely lacking in interpersonal skills. Perhaps you know enough to suggest another therapist or treatment. But you should be aware that this kind of statement isn’t one that’s made by a mature, well-adjusted adult, so don't take it personally. It says much more about the client than it does about you.

Lisa Volk, MS, LMFT
Aurora, CO


4) Get Some Distance

First, remove the label “difficult” from your client. The moment we label a client as difficult, it becomes harder to empathize with them. The client will sense this. Instead, start your next session trying to connect with them on a human level. Start with a light conversation. For example, talk about the weather or their favorite hobbies. When you’re ready, explore the meaning of what a “bad therapist” is and what made them say this. If you’re not ready to go there yet, then simply connecting on a human level can mend your relationship.

When you get to a place where you’re ready to explore this, listen openly to the feedback and try to put yourself in the client’s shoes. Don’t take anything personal. Ask yourself what this this client needs from you that they’re not getting, or what needs they have that aren’t being met. Their feedback might seem harsh, but it’s important to remember that it’s coming from a person who’s not in a good emotional place right now. Ask yourself how you can help them.

When listening to feedback, separate yourself from your emotions. You can do this by giving the client space to vent in the session and visualizing a protective bubble around you that no negative energy can penetrate. When you have a chance, process your own countertransference. This can be done in your own personal therapy or in supervision.

Another way to process emotions is through writing. It helps to get the words out of your head and on paper. Talking to colleagues who are trustworthy and supportive also helps. Remember, self-care is important to doing this work effectively and preventing burnout.

Alisa Ibragimova
Brooklyn, NY


5) A Therapeutic Opportunity

What this client said no doubt hurt your feelings, so first and foremost, be kind to yourself. First, make space for your own self-care and ways to center and calm yourself. Allow yourself to feel whatever you feel. Take your time.

First, I can understand your reaction. And it might seem like this interaction changed the therapy relationship. But what if there’s an opportunity here? The first opportunity may be within yourself—an opportunity to examine your own reaction to the client’s comment and the context in which it was said, taking into account what you know about the client and their defenses.

I’d also advise you widen your view. How do other clients respond to you? Is it possible this was an isolated incident, possibly saying more about the client than it says about you? Does this client continue to return to you for therapy? Assuming they do, that says something about the relationship you’ve built.

Second, this is a therapeutic relationship. So, use this interaction therapeutically! As hard as it may be, discussing this interaction could be very therapeutic. In object relations theory, we focus on how the residue of past relationships comes out in the present—often directed at the therapist. Use this interaction to learn more about the client, and to help them. Or, take a lesson from cognitive behavioral therapy, which also recognizes clients’ cognitive distortions as being rooted in past experiences.

Whatever your approach, this could lead to a fruitful conversation that allows the client—and you—to grow: you in feeling more comfortable having difficult discussions, and the client in having to examine his or her defenses.

In the end, this conversation might reveal that the client is looking for something different than what you’re offering—and that’s okay! If you feel mostly good about your skills and abilities, it’s okay to agree that this might not be the right fit. Just make sure you’re not coming from a place of defensiveness.

Christa Orfitelli, LISW
Davenport, IA


6) A Silver Lining

You might actually consider it a victory that your client trusted you enough to tell you what he or she was thinking. It may have been very difficult for them. In your next session, you might ask what it felt like to say that to you. Perhaps they’ve rarely or never been able confront their parents or friends when their needs weren’t being met, and finally being able to do this with you was a big step for them.

While comments like these can certainly sting, in psychodynamic circles, we welcome them as corrective emotional experiences, a sign that the client feels comfortable enough to say everything to their therapist. I would be proud that this patient felt safe in your presence and was willing to share their anger with you. After all, it's not about you.

I hope you’ll continue working with this client, for the sake of their progress and the sake of your growth as a clinician. If the comment continues to bother you, I might recommend talking with your supervisor or your own therapist about how this negative transference made you feel. It’s important to honor your feelings too, and to process them adequately. Trust me: you do not want clients to idealize you. When they do, there’s no direction to go but down. Best of luck!

Claudia Paradise, LCSW-R
New York, NY


7) Listen Differently

When clients tell us we’re “bad therapists,” it’s their way of saying that we’re not hearing something they want us to hear. I would start the next session by saying something like, “I thought about what you said last time, and would like for you to help me understand what has not been helpful to you.” I would listen carefully to the client’s response and explore why it may have been difficult for them to say something like this in the first place, and then find out if this happens in their other relationships.

Sometimes we get too close to client too fast and they need to push us away. Sometimes clients have unrealistic expectations of what we have the power to do. Sometimes they really just want us to take their side and not challenge their beliefs. And sometimes clients create situations so we can experience what they experience on a regular basis.

Regardless of why this client said what they said, uncomfortable moments like these can be used to help them understand how their interaction patterns impact others and aren’t helpful in terms of meeting their needs. For the therapist, it may mean disclosing the impact their hurtful words had. Then, reassure the client that you won’t take it personally, as you realize this was something said in a moment of self-protection.

Babs Schmerler, LCSW, CAC III
Montrose, CO

***

Photo © iStock/shironosov

Topic: Business of Therapy | Challenging Clients & Treatment Populations | Ethics | Professional Development

Tags: anger | Clinician's Quandary

Comments - (existing users please login first)
Your email address will not be published. Required fields are marked *

*
*
*
3 Comments

Monday, July 12, 2021 4:36:32 AM | posted by Lynn Lichtenstein
In Navigating the Rift, the patient tells the therapist that she, the therapist, is a bad therapist. I thought therapists encouraged patients to talk about their feelings about the therapist and regard an expression of the patient’s feelings towards the therapist as an opportunity to explore the patient’s behavior patterns and past incidents that may be influencing the patient’s current behavior. So it would be a good thing for the patient to bring up negative feelings about the therapist.

Saturday, July 10, 2021 1:02:26 PM | posted by Georgia johnston
Sometimes therapists are bad -perhaps consider that you actually did do something wrong. Or recognize that your profession is such that clients have no way to rate you people or know what it is you are actually doing to deserve payment. The client is not always wrong,

Saturday, July 10, 2021 12:35:52 PM | posted by Pamela Thacher
I might encourage the client to read the notes you've taken once you reach the "halfway" point, and then again at the end, and help you add to them what they felt was missing. Or, alternatively, have them read each note at the beginning of the next session. Or, they could keep a series of notes themselves and then you could compare your reaction/memory to theirs and see what comes up, after a few weeks go by. They might take a look at the note and decide that's not such a big deal, especially if your notes just indicate the topics you've discussed. In any case, I would invite the client in. If your notes being taken in session aren't insulting, or ungenerous, they can certainly be read by the client. If your notes indicate your frustration or your anger (hey, it happens!) then maybe those kind of notes should be written after the session is over, when the client isn't sitting right there. Taking notes in session is, I believe perfectly defensible. After a few sessions reading them, the client might actually just say, "You know what, I don't really need to see what you're writing anymore ... it's not that critical", once their curiosity is satisfied. I think it's a very natural reaction to want to see what someone else is writing, presumably about them. It's not pathological; it's quite expected. I'd treat it as such for sure.