When Values Collide in Therapy

How do I provide care for clients when we don’t think similarly about really important things, and they use language that goes against everything I believe in? When I allow them to express misinformation, am I doing harm—not just by enabling something like this within an individual session, but as a dynamic perpetuated in a larger community? 

Square Peg, Circular Hole

The potential for both therapists and clients to be matched with someone with vastly different values systems is high. Most mental health counselors, approximately 68 percent, according to research published in the journal Behavioral and Brain Sciences, identify as liberal or very liberal, while only about one quarter of the American population would describe themselves as such. This creates a chasm between the number of Americans that might need mental health support who don’t identify as liberal or very liberal and the number of counselors who do.

Most counseling programs offer classes and trainings that address the challenges of managing differences in cultural identities, belief systems and values. However, in today’s increasingly polarized political climate, building a strong therapeutic alliance with someone whose values are different from yours is becoming increasingly challenging. Counselors who, as a foundation of best practice, address differences in the counseling relationship can struggle to broach a disclosure of values differences for fear of creating a barrier to care, or worse, doing harm to their client. Additionally, counselors may be left feeling like they must deny the very beliefs that led them to the helping profession in the first place, when stark differences in value systems arise between them and their clients. Clinicians might worry about isolating clients, influencing clients by detailing their belief systems, or appearing critical, ultimately breaking down the therapeutic alliance, a widely agreed upon key factor in successful therapeutic outcomes.

Conversely, clinicians could feel as if they’ve abandoned a part of themselves in their sessions when they bracket beliefs and values core to who they are—as if they’re not showing up authentically because the way they present in the therapeutic relationship is incongruent with who they are. Or they may feel incompetent, given that the therapeutic relationship, in addition to being nurturing, is intended to challenge clients. At a time when Americans are worried about high prices, paying bills, employment, and various social issues, the likelihood of needing increased mental health support is high. How can the support therapy offers remain accessible in a polarized country to all amid glaring differences that sometimes separate families and friends?

In my work with supervisees, I addressed this issue using one of the foundational models of person-centered therapy: Rogers’ Core Conditions.

Necessary and Sufficient

In 1956, psychologist Carl Rogers wrote that for a person to experience therapeutic change, six core conditions must be present: two people are in a relationship with one another, the person who is the identified client is in distress, the person who is the clinician is “freely and deeply” themselves in the relationship, the clinician experiences unconditional positive regard for the client, has an empathetic understanding of them, and is able to effectively communicate these things to the client, and the context of the therapeutic relationship, the client is able to accept this understanding and regard. Using these conditions as a guideline, clinicians can address differences in values that could create barriers to therapy. Once conditions one and two have been met, condition three asks the clinician to be genuine—meaning, they must avoid an outward appearance that doesn’t accurately reflect what they think and feel. I might ask a supervisee who complains of working with a client who has radically different values, “When your client expresses something that conflicts with your values or beliefs, how do you respond?”

In my experience, many supervisees will say something like, “I try hard to contain how upset I am and strive to present myself as objective.” Counselors have this response for a variety of reasons and while those reasons are understandable, they depart from what Roger’s proposed to be a necessary condition for supporting a client: that they be “freely and deeply” themselves within the therapeutic relationship. I might then work together with a supervisee to craft an alternate response in which she’d allow herself to reflect her feelings in a way that was concise enough to keep the focus on the client. This might entail saying, “I’m surprised to hear you say that” while looking surprised, or “Ugh, hearing this makes me feel really sad,” while looking sad. It could also mean saying, “I think differently about that, and it’s hard for me to hear that from you,” while allowing one’s face to exhibit frustration.

When a clinician honestly (albeit mindfully) expresses themselves, they avoid putting on a façade, allowing them to be authentic about the interaction happening in the room. This can lead to deeper discussions along with opportunities for clinicians to better empathize with the client.

Clinicians work on developing the skill of empathy early in their career. Coursework focuses on understanding a client’s awareness of their own experience. Many supervisees who face this challenge believe they’re being asked to empathize even with thoughts and feelings around values-related topics they disagree with, such as a client’s beliefs about women. This attempt to outwardly express feelings that are incongruent with her inner experience falls flat for both the clinician and the client. As an alternative, it’s best for clinicians to focus on their feelings related to the subject matter, not the description of the value. Here are a few examples:

Client: I don’t trust women, they’re liars.

Therapist: [Looking sad] I’m sad to hear you say that. It seems like you’ve experienced some women not being forthcoming with you and that makes you distrustful of them.

Client: Illegals are stealing our jobs. They shouldn’t be here!

Therapist: [Looking frustrated] I’m surprised to hear you say this. I’ve found you to be a tolerant/kind/generous person and this statement doesn’t match up with that. Tell me more about your concern about undocumented people being in the United States.

Client: Gay people are ruining everything in this country.

Therapist: [Looking surprised] Wow, I’m really surprised to hear that. What worries do you have about this country being ruined?

As these examples demonstrate, a clinician can express their genuine emotion but still reflect empathy by working to understand the emotions associated with the topic, thus inviting an exploration of a client’s worldview. By focusing on understanding their own reaction as well as on how the client thinks and feels, we can shift the discussion away from values discourse to a shared understanding of emotions related to various topics.

It’s also important to keep in mind that clients have likely experienced exchanges with others regarding values and beliefs that haven’t gone well, which may have left them feeling misunderstood. If a clinician can reflect genuine empathy during these values disclosures, it can lead to the client experiencing the therapist’s unconditional positive regard, which deepens the relationship and supports ongoing exploration and self-understanding.

Without Conditions

Rogers believed unconditional positive regard is achieved when a clinician can experience feelings of warm acceptance toward a client during expressions of negative emotions, thoughts or ideas that conflict with the clinician’s worldview, and other experiences that don’t typically evoke positive feelings. According to Rogers, it’s in “caring for the client as a separate person, with permission to have his own feelings, his own experiences,” that we can see a way through to effectively supporting them even when difficult values disclosures occur. If a clinician can embrace a client as autonomous within the therapeutic relationship, then they have permission to experience all things, positive and negative, and the therapist can trust that they’re showing up authentically—just as we are. Additionally, we can notice feelings of admiration, appreciation and curiosity for the therapy process while also accepting that some of the information the client shares may be difficult and even cause us discomfort and distress.

One supervisee I worked with was strongly pro-life and struggled with a client she disagreed with who frequently made statements like, “Women should be able to have full control of their bodies! I shouldn’t have to carry a baby if I don’t want to.” This clinician worked on appreciating that her client had the bravery to express an opinion that’s socially tricky, particularly in the conservative state where she lived. Over time, this supervisee was able to respond with a gentle head nod to this client’s views, even though they differed from her own. With an empathic expression, she said, “I can see how important this is to you. Can we talk about what it means to be made to do something you don’t want to?” She and her client were able to explore the ways her client felt powerless, a feeling this supervisee could also relate to.

When a client expresses beliefs that go against a therapist’s personal values, the key is to focus on the process of what’s happening in session, as well as on the feelings a client experiences. This allows the clinician to feel genuine feelings, experience unconditional positive regard, and most importantly, reflect this positive regard toward the client. Positive regard, after all, isn’t just saying, “I like you.” It’s the therapist’s ability to experience and express a robust understanding of the client and to allow them space to express their own feelings without internalizing them or confusing a client’s feelings with their own.

When a clinician is truly able to grasp a client’s worldview and lived experience, they have more compassion for clients’ distressing thoughts and feelings about a subject—and yes, even for values they may disagree with. This allows clinicians to genuinely express understanding regardless of whether they agree with a client and to create an opportunity for clients to explore the underpinnings of their values, which transforms the therapeutic environment into a safe place where clients can take risks, examine their values and beliefs, and work through difficult feelings.

Over time, when we’re able to talk through our clients’ histories, piece together experiences that have contributed to harmful, intolerant, or judgmental views, and empathize with the feelings associated with those experiences, we come to regard our clients in a positive light even though they sometimes say things we disagree with or find distressing. We can be more authentic in our responses when clients state something that dings our own value system by responding with a “yes and” statement that models disagreement along with a desire to connect and understand. By repeatedly showing up genuinely while focusing on clients’ feelings and lived experiences, we stay true to who we are while supporting clients in aligning with who they want to be.