Case Study: Overcoming the Fear of Losing Clients

Moving Past the Fear of Losing Clients is Necessary to be an Effective Couples Therapist

Ellyn Bader and Peter Pearson

Working as a couples therapist, I’ve become adept at helping partners connect in the office and take their connection home with them. But I can still blunder so badly that I risk losing clients, and for the couple dropping out of therapy without having faced basic issues in their relationship, the stakes are much higher—more potentially damaging—than losing clients is for me.

I’d been working with Richard and Tina off and on for about four months. During their 11-year marriage, Richard had done a slow disappearing act on his family responsibilities, which had caused a grinding tension between them. But we’d started to make progress on this front.

Then one morning, as the couple walked in and took their seats, I saw their faces were tight with misery. Tina began the session by telling me that she’d caught Richard on the Internet looking at porn. “You need to stop and stop now!” she hissed at him. “I will not allow that filth in my home!”

Richard nodded. “I won’t do it again, I promise. I know it was wrong,” he said, sounding like a severely scolded child.

I now had two problems. First, I knew that Richard would be unlikely to keep a promise made in the hot seat. Second, Tina’s edict left no room for discussion. What now?

I could go along with Tina’s demand and Richard’s promise and pretend the issue had been tolerably managed, or I could risk going further and try to open up a fruitful discussion of a taboo subject.

I wanted to know whether Tina was upset about the porn itself, about the fact that Richard was looking at it in their home, or about the frequency of his use. Knowing I had to bring this up in a way Tina could hear—or risk losing clients—I felt as if I were about to walk through a minefield.

“Tina, I’d like to ask you a question,” I began. “I know that the issue of porn upsets many people, but the often differ as to why. Can you say why it’s so charged for you?”

She looked at me for a long time. “Of course you’d try to make it my problem,” she said. “You’re a man.”

I’d just exploded a landmine. Four months of goodwill suddenly vaporized and it never returned. We met twice more, but the sessions had lost their spontaneity and energy, and Tina and Richard became excruciatingly polite to each other. They ended therapy with Richard repeating his promise never to watch porn again.

After they left my office, I felt sadness and guilty relief as escaping a case with such an uncomfortably high level of tension: I no longer had to sit in the presence of so much unresolved emotional pain, but I felt that I’d failed. One of the devilishly perplexing facts of life for a couples therapist is that, sometimes, no matter what you say or do and how skillful you become, there still will be troubled endings and the risk of losing clients.

Topic: Couples | Aging

Tags: couples therapist | emotional pain | emotionally focused couples therapy | losing clients | therapist

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Saturday, March 22, 2014 12:03:09 AM | posted by Linda Churchill
The message I get from Bader and Pearson's article is that of accepting ambiguity. I respect their humility; their willingness to tell the truth about a foiled therapeutic relationship. I'm sure we can all relate and be given pause to reflect. I also appreciate that indeed, no matter how skilled we may be, outcomes may not be what we intended or hoped.

Monday, March 17, 2014 6:42:13 PM | posted by DEBORAH BRAUTMAN
So true-- a good reminder.

Monday, March 17, 2014 5:52:49 PM | posted by Colleague Last Name
I like the way you've posed this question. Thank you for the example.

Monday, March 17, 2014 5:51:00 PM | posted by Colleague Last Name
It's easy to blame the therapist (or oneself as a therapist) for a poor outcome. I feel it's equally important to look at the client for responsibility in outcome. What is their motivation for change? How compliant are they being to interventions? Why is it so important to save a marriage if one to two people have to change who they are in order to make it work? Sometimes, it's ok that it doesn't work, and they need permission to move on.

Monday, March 17, 2014 5:25:36 PM | posted by laura carite
Interesting to hear the male side of the story. As a female therapist, I often feel as though the man in the relationship feels now he has two woman to nag him. Conversely, Many women expect I will side with them and that together we will "fix" her husband. After some years of experience, I am no longer jarred by this dilemma but it is very uncomfortable and porn is a perfect topic to set the stage especially when "as a woman" I am not blindly supporting her wish to ban porn from her home.

Monday, March 17, 2014 4:52:52 PM | posted by DEBORAH BRAUTMAN
I have a similar case. The male spouse goes to SAA. The spouse going with the addiction says that he likes the counseling because he feels it is a safe environment ... When I ask the wife how she is feeling about the treatment, she says that I am just one more therapist who will see her as the " big bad wolf." Even though her husband says that he has not been acting out, she is terrified of being disappointed again. It is not only his addiction. He has seriously let her down in other ways. We have had some interesting discussions about her fear if being present to experience potential joy in the relationship with him as well as in her nuclear family. For me the bottom line is to go slowly and continue to check in with what they are experiencing in the moment. I have worked with couples where I have felt under attack. Fortunately , this is an easier case in that sense. I'm sure at some point that I will unwittingly say something that causes the wife to bail. Of course, I'm hoping to be that therapist that will make the difference, but obviously , that is my issue. This is such tough work.
Thank you for posting.

Monday, March 17, 2014 3:31:45 PM | posted by debf
so? I wonder if you reflected on why you chose the approach you did? Was there a wish to have this couple gone - so you could 'disappear? How was the porn possibly another 'disappearing act on family responsibilities" on Richard's part? Did he know it would upset Tina ? Was this already an agreement they had? It seems even if you would have started setting 'equal ground' with " I would be interested in what this means to each of you - who would be willing to start?" minimizes 'blame' which in the 4 months with them, I would bet Tina had expressed before.

Monday, March 17, 2014 3:16:27 PM | posted by Colleague Last Name
Yea, so what did you do?