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How to Help 10 Types of Difficult Psychotherapy Clients

Dealing with the more challenging therapy clients

Being able to spot difficult client behaviours can help us avoid using the wrong approach to helping them engage with therapy.

Some clients are wonderful. They listen to our ideas, make the most of our reframes, and openly carry out our behavioural tasks. We might even find them interesting and likeable!

But we can’t simply hope and pray for nothing but delightful clients to cross our threshold (or grace our screen). Here I want to address 10 types of clients that I’ve found to be the most ‘difficult’. I offer, too, a few pointers for helping you deal with such clients.

I am not judging any of these patterns of behaviour, simply describing them. See if you recognize any!

1. The unreliable client

We’ve all had them. They show up half an hour late, or don’t show up at all. Cancel 20 minutes before the session, or forget you even had one. ‘Forget’ to pay, or somehow neglect to bring a means of payment with them.

It can be hard to get therapy going with such clients because all the initial practical hurdles need to be negotiated before you can even make a start on their issues. Mind you, helping them become more reliable may actually be the goal of therapy.

One unreliable client, when it came to payment time, told me he had to go to an ATM. He assured me a little too unblinkingly that he’d be back in 20 minutes. Three years later, when I’d long since forgotten about him, he surprised me by turning up at my doorstep, cash in hand. (Maybe I should have charged him interest!) I guess his conscience had been nagging at him.

Some people are so self-absorbed that other people’s needs and perspectives or a strong code of personal behaviour just don’t figure for them. Other people are just chaotic and lead jumbled lives. Some people may be so extremely anxious or troubled that they find it hard to plan and concentrate. I find, though, that most people can be reliable and honorable.

Sometimes unreliable behaviour may signal more than simple disorganization. For some, I suspect, it’s a way of resisting therapy or asserting control. Some people fear, consciously or otherwise, losing autonomy when they enter therapy. A part of them wants therapy; a part of them doesn’t.

Unreliable behaviour may signal more than simple disorganization. For some it may be a way of resisting therapy or asserting control. Some people fear, consciously or otherwise, losing autonomy when they enter therapy. Click to Tweet

Unreliability can feel deeply disrespectful. And, of course, if someone is chronically and continually unreliable, whether that be in your professional or your personal life, well, you have the right to refuse to be treated badly. But consider that their unreliability may simply be a symptom of the psychological problem they came to you for help with.

We can bring unreliability out into the open. Address it with our clients, ask them about it, and also ask them if they really want therapy from us given that they seem to be laying down so many trip hazards.

Of course, for some clients, the answer is clearly no.

2. The client whose relatives forced them into therapy

It can be invaluable sometimes to get the take of a well-meaning relative on your client’s problems, challenges, history, and emotions. And where really young clients are concerned, this can be vital. A parent or guardian might bring them in for help and offer us valuable perspectives and information.

If the client themselves is motivated too, well, all the better. But if the client is dragged in kicking and screaming, as it were, by (hopefully) well-meaning others, well, that can be a problem.

One woman manhandled her husband, a barrister, in for me to “sort out”. She was the dominant force in the relationship by quite some margin. All he wanted was a quiet life, so he had gotten into the habit of not even trying to present or negotiate his own point of view.

“I’m really here to please my wife,” he told me amicably once his wife had left us alone together. ‘His’ goals for therapy were, of course, her goals – in which he had no interest whatsoever! There was nothing much troubling him; the problem was that she wanted him to be more of this and less of that.

Needless to say, ‘therapy’ didn’t progress too far – although we did manage to talk about what he wanted (more peace).

If a family has many problems, sometimes there’s a kind of unconscious scapegoating. One member, the one brought into see you, comes to be seen as the one with all the problems. After a time you might fathom that this is far from how it really is, and that other family members are actually contributing to some unhealthy dynamic.

The ‘scapegoat’ client may be dragged from pillar to post by their relatives in an extended form of deflection and denial.

Sometimes, of course, a reluctant client dragooned into seeing you by loved ones may be genuinely in need. Perhaps they have stopped believing they can be helped, have given up and need help feeling that there is hope for them.

For our part, we do need to get their take on things and disentangle their needs from those of their loved ones. We need to talk to them directly, not through the veil of other people.

That’s if they can hear us.

3. The client who cannot listen

When therapy happens successfully, it is because learning has taken place. And in order to learn anything, we must first empty ourselves enough of our preconceptions, biases, and desire for control to be open to what is to be learned.

Some clients are so loquacious that it precludes learning. Now of course, some clients need to vent, and if you’re the first person they’ve had a chance to really talk to then this is a vital part of the process. But talking with you about their problems and possible solutions is not the same as talking at you about absolutely everything. After all, the meter is running!

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Your client may be so attention starved that they ravenously consume any attention paid to them. But as natural as this may be, we eventually need to help them meet these needs outside of the therapy room. Sometimes offloading – talking things out, perhaps repeatedly – needs to occur before your client is ready to adopt new ways of being, just as we sometimes need to put down what we are holding in order to pick up something new.

Ultimately we need to find ways to get our clients to truly listen as well as talk.

Mind you, with some clients we have the opposite issue.

4. The client who cannot talk

Some people are naturally not very talkative. That’s fine. The world is made up of different folk. Not everyone is outgoing or verbose. But some clients give us such a dearth of information, with nothing but monosyllabic answers, that it can be very tough to know where to go with the session. I’ve written a piece on this.

It may be that the non-talking client is deeply depressed, or it may be that they are simply shy or not naturally articulate. But once we give someone space to relax and talk, there is usually a topic of interest that will ignite words even in the most reticent of clients.

One client of mine didn’t seem to want to talk at all until I got him onto his favourite subject: football! After talking about that for 15 minutes, he then found it easier to talk about what was deeply troubling him. It was almost as though he had to get used to talking with me specifically.

But some clients just seem bent on not working with us at all.

5. The contrary client

You can usually spot this pattern fast. Some clients, possibly the unreliable ones (see above), tend to always want to say or do the opposite of what you suggest. This tendency is often so ingrained as to be automatic. Such people are sometimes known as polarity responders. The pattern of contrariness goes way beyond simple, honest disagreement.

One client, I remember, was really contrary. Our first phone call went something like this:

Me: “So shall we say 11.00 am then?”

Client: “No, let’s say 11.30.”

Me: “Okay, 11.30 then.”

Client: “Actually, can you do 2 pm?”

Me: “Err… I think so.”

Client: “Actually, no, I’ll come along at 11.00.”

And so it went on. Basically whatever I said, they contradicted it. They insisted on moving the chair around when they arrived. Asked me for a glass of water, then when it arrived enquired whether I had any coffee instead. During information gathering, they disagreed with whatever I said, even when I was simply summarizing what they had just said.

Fortunately, there are tried and tested ways of dealing with and therefore helping such people, but certainly if you are not used to this behavioural pattern it can be daunting.

As can the next kind of client.

6. The overanalytical client

Some clients like to analyze everything to the nth degree. It’s as though they have so overdeveloped one part of their mind at the expense of others that they are, in a sense, disabled by this lopsided mental hypertrophy.

Such people – like the scientifically-minded boy who cut up a fly and saw that he had all the parts of the fly but wondered where the fly itself had gone – splice everything down into detail, but miss the larger context. The wood is not seen for the trees. They may find it hard to let go and relax, be spontaneous, avoid excessive rumination, or in fact ever ‘switch off’. They may also lack a sense of humour. And humour, as we know, indicates a flexible mind.

Analysis is, of course, a fine tool, but it isn’t the only way the mind can work. If someone analyzes excessively they tend to get ‘paralysis through analysis’. Dissecting reality is a valuable part of human mentation. But it’s certainly not the only way to use the mind.

Sometimes shock reframing and confusional language and metaphor can help a client break free from constant plodding analysis to inhabit new, more spontaneous ways of being. I’ve written more about helping the overanalytical client here.

Some clients, though,might need more access to rationality.

7. The client who only emotes

As human beings, we have all kinds of potential faculties available to us. We are not just thinking machines, nor are we merely emotional energy processing factories.

But some clients seem to only emote. They seem to lack access to the rational, reasoning parts of themselves. It might be that they’ve been conditioned to feel therapy can only be about pain, anguish, or anger, or it could be a device for seeking highly concentrated attention from other people.

Of course, emotions are important in life; they inform almost everything we do. But when they rule completely, chaos ensues.

I want to make an important distinction here, though. There is a difference between the chronically emoting client and someone who is actually terribly traumatized or depressed. In the latter case it is, of course, important to recognize and respond with empathy to the genuine emotions that arise.

With some clients, however, you get a sense that they have become used to histrionically acting out. If you sense this you may have to be firm, to let them know that calm, clear thought and some rationality are also required in the therapeutic endeavour. We also need to help histrionic clients meet their needs for attention or status in healthy ways.

Sometimes – often, in fact – we need to help certain clients get out of touch with their feelings, as counter-cultural as that might sound.

Some clients, though, (think they) have heard it all before.

8. The expert client

Expert clients know all there is to know about how you should treat them. They are often prone to paralysis by analysis (see above).

Maybe they’ve been to many therapists and swallowed a lot of theory. They come in with all kinds of self-diagnosis and pre-empt everything you have to say. They’ve seen it all before and been so thoroughly ‘therapied’ that it may have all become a sort of mechanical ritual for them. Therapy has ceased being a live, fresh endeavour and degraded into chest-beating status confirming.

I’ve written specifically about dealing with and helping the expert client for whom therapy has become simply a way of life rather than a means to a better life and more autonomy.

Then there are the clients with whom we have to draw clear boundaries.

9. The boundary-bashing client

Some clients take an hour of your time even before they come and see you for paid therapy. They might then pull a no-show (see the top of this piece), yet still expect another (unpaid) hour of your time. Or they may call you all times of the day or night, or send you Russian-novel-length emails expecting you to reply to each point raised.

One therapist friend told me how a client staked her out on social media and raised issues about his therapy on her Facebook timeline. Another shared with me how he would receive online messages from multiple fake accounts, all of which he suspected belonged to the same client. People, not just clients, will often feel they can behave in all sorts of inappropriate ways if we are not clear with them.

Finally, what about those clients who simply seem to shirk all personal responsibility?

10. The client who shirks responsibility

Some clients take little responsibility for their lives. This can be a kind of learned helplessness, where the client has wrongly learned that they have little influence over their life, like a caged bird that doesn’t realize it can fly free when the cage door is opened. But with some clients you get the feeling they’re just used to passively consuming, to being given stuff, to having everything done for them, to projecting responsibility or blame outward.

People like this may feel that all their dissatisfactions are someone else’s ‘fault’. They never seem to want to make an effort. They may communicate that they want you to do all the work and feel generally that the world should adapt to them rather than the other way around.

Any sense of what they might have to do to improve their lives may have been lost, or perhaps never developed. This is disabling for them and can be infuriating for others.

We can remind them that this is a joint endeavour, a collaboration where we’ll be working together.

Finally, we need, I think, to meet people where they are at rather than simply worry that they are not acting as they ‘should’.

On not just wishing people were different

Some clients are a blend of the above, or – happily! – largely free of these traits. And there will be, of course, problematic types of clients that I haven’t included here. Certainly no therapist is obliged to see a threatening, intimidating, or abusive client. Therapist welfare is a thing!

It’s easy to fall into the trap of wishing our clients could be different rather than accepting what and how they present, and having strategies to deal with problematic behaviours.

But we need to be adaptive and creatively flexible with clients in order to begin to truly help them. We can only do this if, rather than requiring them to fit in with how we’d like them to be, we deal with them as they are. Sometimes this requires us to ‘go off script‘ with them.

We need to discern when not to take on a client as well as when to comfortably end therapy with a client. Ultimately a client has to be ready for therapy, not merely ‘window shopping’. You might be the most highly skilled therapist anywhere, but… well, to resort to a well-worn truism, it takes two to tango.

In almost three decades of doing therapy, I’ve found things to respect and like in almost all my clients. There are maybe one or two that I just couldn’t work with at all.

This piece may seem a little flippant, and I don’t mean it to be. I just think it is useful to recognize that these frustrating patterns of client experience are not just your personal cross to bear, but common to most therapists.

What we often find is that when a client begins to meet their basic emotional needs in sustainable ways, ‘difficult’ behaviours tend to evaporate.

It can be hard to see wider contexts when you’re depressed, terrified, and suffering greatly. And it’s good to remember that some clients may be on the autistic spectrum and therefore have some ‘context blindness’ (caetextia) when it comes to therapy and you.

I always try to see what people can be like or might be like once they are happier. Difficulties so often melt away when we connect with the heart of our clients – not just who they truly are, but who they truly can be.

Become More Artful With Your Language

Trickier clients demand more creative linguistic approaches. Mark’s course ‘Conversational Reframing‘ will show you many techniques and strategies of language to help get your message across. Read more about Conversational Reframing here.

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Mark Tyrrell

About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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