Breaking Through Therapeutic Gridlock
How to Respond When Clients Resist Your Advice
Q: What should I do when the response to anything I suggest to a client is, "I've already tried that and it doesn't work"?
A: Those moments can feel like you're caught in Chinese handcuffs—the more suggestions you make, the more stuck you and the client feel. Sometimes, a therapist's suggestions aren't so hot—fair enough, we are human. And sometimes clients obstinately resent our attempts to move them out of their problems because they are resistant to change. But more often than not, when clients repeatedly respond to my suggestions with "I've already tried that and it doesn't work," what I hear them expressing is not resistance or criticism of me, but feelings of helplessness and hopelessness about the possibilities for change. Instead of trying to come up with more clever suggestions or getting into a power struggle over their "resistance," I respond to that subtext.
I recently saw a woman in her thirties, Martha, who had gone through a difficult divorce and was having a hard time feeling good about herself again. She came in one day distraught because her mother was planning a visit, and she worried that her dog, an excitable terrier, would misbehave, which would cause her mother to criticize her. I suggested, "Maybe you can try saying, 'Nanu, no barking' and then offer him a cookie as a bribe." Martha said, "I tried that. Nothing works." I said, "Maybe you can let your mother and Nanu work it out between themselves and you stay out of it." She told me again that she had tried that, and nothing worked. Stretching for some solution, I said, "You could put your dog in the kennel for the weekend." Again, she said, "I tried that, and my mother still criticized me about how I am treating my dog."
I realized that "nothing works" was a refrain I often heard from this particular client and that it was as much my own sense of helplessness as hers that had driven us down this path of therapeutic gridlock. So I said, "I wonder if this is how you are feeling about your life: no matter what you try, nothing works?" She took a deep breath and nodded. Instead of staying in a fix-it mode, her stuckness—no, my stuckness—created a space where I was able to grasp how her situation felt to her. From there, I was able to empathize with her about how hard it is to feel helpless and out of control. Life is always barking, I pointed out, and no one can control life. Once she felt that I supported her and understood her, Martha began to talk about how feeling out of control was a theme of all her relationships—with her mother, her ex-husband, her friends. The therapy began to move to a deeper level. At the end of the session, a solution to her dog problem became clear to her: she would warn her mother that her dog was a handful, and ask for her mother's support and advice, rather than wait to hear it as criticism. This experience made me reflect on my own tendency to rush in and make suggestions rather than be more present with clients' discomforts and help them find their own solutions.
Usually I find that I am most drawn into giving suggestions when the solution seems obvious to me and I decide that, for whatever reason, the person has not thought of it. But I have come to realize that when I begin to view my clients as empty vessels awaiting my font of knowledge, I am just as stuck as they are.
As therapists, one of the most therapeutic experiences we can offer our clients is how we use ourselves. We need to be open to feedback, even criticism, as a means of deepening the therapeutic relationship. Establishing trust by moving beyond the reflex action of offering a solution and creating a context in which the possibility for transformation is greater than the pull of old patterns is hard work both for clients and for therapists.
This blog is excerpted from "Been There, Done That," by Jay Lappin in the May/June 1999 issue.
Photo © Kaspars Grinvalds/Dreamstime
CategoriesClinical Skills & Experience