In our therapeutic careers, we will undoubtedly encounter clients who are challenging, difficult, or hard-to-reach. This article examines how we can support such clients in counselling.
“Difficult” is a word that therapists try hard not to use when talking about the people they work with. It doesn’t feel right, to call someone “difficult”. But what do therapists actually mean when they do use the D-word?
Well, it can mean a whole range of things, such as how difficult it can be sometimes to form a working alliance with someone, or when the therapy never seems to get off the ground and fizzles out quickly. Or sometimes it might mean those people who it feels difficult for us to reach. Yes, we don’t like to admit this but there will always be people with whom we find it professionally or personally difficult to emotionally connect with. This might be because of our own resistances, or what the person themselves is bringing usually unconsciously to the therapy relationship.
And then there are those people who really struggle in a therapy session, and perhaps continuously struggle, and are often passive or silent or very unforthcoming. Perhaps they seem unmotivated or it feels like they are putting up barriers to us trying to be helpful. So many times in clinical supervision a supervisee has said to me “I just feel like I can’t reach them”.
Trying harder may be counterproductive
Therapists are always wanting to do their best by any client they see, and so often when sitting with someone who seems far away, or who is struggling to engage for whatever reason our tendency can be to make more interventions, to keep the conversation going, to try to find out what’s going on for the client. Basically, to work our socks off to make the situation work.
Again, as a clinical supervisor I find myself so often saying in supervision “can you work less hard?”, so paradoxically I encourage therapists I work with to do less work and to back off from trying to fill in all the gaps when working with clients who appear to be hard to reach in therapy.
There might be a variety of issues going on in the therapy room, and the quieter we can be the more capacity we might have to hear them. I’m not suggesting being punitively quiet, but just holding back sufficiently to hear our client rather than tend to our own anxiety or feelings about the lack of engagement in the room.
There will be some people who come to therapy to learn how to be emotionally connected and who struggle with too much intimacy. Imagine how intrusive we might be if we don’t respect this and try to approach the situation with a great deal of gentleness. The more we try to encourage their engagement, the further they are likely to pull back and withdraw.
Reaching the hard-to-reach
So how can we approach working with people who on the surface seem reticent to engage with us?
We might first of all assume that someone who appears distant or unforthcoming, is actually anxious or feeling very uncomfortable. They may even be feeling very frightened. They may not even be able to name their feelings, they just know that something is compelling them to stay inside themselves. How they present may give you some clues about their personal history and their experiences in their family-of-origin, so be curious about that.
They have, after all, brought this way of being into the consulting room because it’s what they know and what has kind-of worked for them over a long period of time in their personal relationships. They have probably come to therapy because this way of being is blocking them too, stopping them from being who they want to be.
There will be times when it is just too hard and too raw for someone to own their emotions, and our attempts to connect or discuss their emotions might be very firmly, even vehemently, batted away. It may be tempting to think you are a ‘bad’ therapist for being unable to encourage your client to discuss their feelings with you, given the battering you get when you try to go there.
Find another way to connect
There will always be another way in, so to speak. A back door, to use the language of fiction writers. We are in the business of being emotional detectives, so creative writing is not a bad place to go for clues to help us on our journey with people who stop us in our tracks. Again, in situations like this perhaps we are better serving our clients if we ‘back off’, if we respectfully and gently attempt to engage them in ways that are not so directly emotional, but that perhaps talk about what they wants to achieve in their therapy or what goals they have.
Find out what your client is interest in. Be interested in that too. It doesn’t matter what it is. I once worked with a young teenager who struggled to engage. We spent three sessions talking about her pets. She came alive, there was a lively spark in her eyes, and she was animated and engaged. I learnt more about her internal work from those sessions than any other session where we tried to speak directly about her emotions.
Monitoring anxiety in the therapy room
At all times we really need to stay tuned in to the levels of anxiety in the consulting room, both ours and our clients’. Our anxiety may inadvertently push us to say more than we need to or be more intrusive than is helpful. Our client’s anxiety levels will be one of the indicators that can help us monitor the pace of the therapy work.
It’s probably true to say that clients who are not anxious at all are not motivated to do therapy and those that are too anxious will easily become overwhelmed by their feelings and find it difficult to engage in therapy. We need to find a balance of engagement that avoids being intrusive but is not so distant and potentially punitive that it increases the client’s anxiety.
Be present. As present as you can be. And respond in a human way. Sometimes it can be helpful to forget ‘being a therapist’, just for a moment.
You can find out more about some of these issues in Dr Maggie Turp’s workshop with Brighton Therapy Partnership.
*Working with ‘Hard-to-Reach’ Individuals in Counselling and Psychotherapy* takes place on Saturday 3rd November, and tickets are still available on the Brighton Therapy Partnership website.