In Consultation

In Consultation

It's Not About You: Matching your clinical style with your clients' needs

By Steven Shapiro

January/February 2009

Q: I'm sometimes unable to form an alliance with "difficult" clients, and therapy fizzles out before it's gotten started. How can I reach these hard sells?

A: As you've undoubtedly discovered, when we genuinely connect with clients, therapy usually goes smoothly and effectively, and the work is rewarding. We tend to ascribe our successes to our clinical skills and our clients' motivation. Like­wise, when things don't go so well—when we sit with passive, sullen, unengaged, unforthcoming clients for session after session—we often think it's because we lack the necessary skills, or the clients are unmotivated or resistant. We may even begin to resent such clients for putting up barriers against our best efforts to help them.

What stands in the way of connecting effectively? I've found that the major difficulty stems, paradoxically enough, from trying too hard! Many clients, even if they're highly motivated to get into therapy, have only limited tolerance for emotional connection, interpersonal closeness, and sympathetic concern—actions that most therapists assume are central to the alliance and to therapy itself. The harder you try to reassure such clients and show how much you care, the more fearful, defensive, and withdrawn they become.

What's happening here is a failure to match our self-presentation and efforts to connect with our clients' emotional capacity to respond. To put it bluntly, our song hurts their ears, and the more they…

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