Case Study

Case Study

Whose Therapy Is It Anyway? When Your Client Is Uncommitted to Change

By David Johnson

March/April 2014

In my several decades of practice, one skill that’s served me well in this field is my ability to leave work at the office. But every once in a while, I see clients whose situation intrigues, moves, or confounds me in a way that keeps them in my thoughts in between sessions, even if I’m often not sure what it is about them that continues to haunt me. Such was the case with Matthew.

The first time my secretary ushered him into my office, all I knew about Matthew was that he was 20 years old and had been referred by his primary-care provider. When he first took his seat across from me, a quick scan revealed an obese, unkempt, and (by the smell) unsanitary young man with a pimpled face. Large flakes of dandruff salted his uncombed hair, stains colored his ragged T-shirt, and his well-worn tennis shoes had no laces in them.

I usually start off a first session with small talk, asking questions such as “Where did you grow up?” “What about this weather?” “How did you hear about me?” “Do you enjoy sports?” Matthew stopped me after my first foray into the gulf between us.

Brushing back a greasy lock of hair from his face, he said, “Look, I’ve probably been to 20 therapists in my life and none of them have done me any good. I know what you’re going to say before you even say it. So just save your breath.” In a flat tone of voice, he continued, “I’ve been diagnosed with PTSD, ADHD, bipolar, major depression, panic attacks, and social anxiety. They’ve had me on all…

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1 Comment

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