I haven’t liked seeing every client who I’ve treated. For me, severely depressed clients or clients who aren’t ready to take an active role in their recovery are difficult. I usually don’t like working with them. The severely depressed clients can be a little triggering for me, and I often find myself feeling depressed after sessions with them. I struggle to disconnect from depressive material. That’s an area where I could use some improvement, but that’s a topic for another day’s introspection. Additionally, clients who aren’t ready to take an active role in their recovery are really just frustrating to to me. Sometimes I just want to smack them. I get irritated that they expect me to solve their problems for them. If I could, trust me, I would, but that’s not my job. I’m not a feelings wizard. I can’t make all of the bad things go away by myself. I can help you, but I can’t do it for you. I don’t dislike either of these types of clients as people, I just tend to dislike working with them.
Now, there are clients who you will not like on a personal level. Maybe they’re annoying or have really horribly racist or misogynistic views. Maybe they are really mean to you. Maybe they treat their partner or their children terribly and that doesn’t sit well with you. Maybe you just don’t like them because their voice reminds you of that bitch who went to your high school who tried to steal your boyfriend (JOKES ON YOU, LAUREN- WE BROKE UP AND HE STILL WOULDN’T DATE YOU!!!). Maybe they come to every session really smelly and you have a very sensitive nose. These things will happen.
When I was in college, I interned at a psychiatric intensive care unit and there were patients who I thought I could never learn to care about. Some of the patients were rapists, abusers, animal killers- all groups that I “hate”. However, that internship was one of the most enlightening experiences of my life. I learned something very important- you can dislike things that someone has done, but you don’t have to dislike them as a person. These people had complex life histories, severe mental illness, and wonderful little quirks about them despite having done some horrible things. Sometimes, especially as a therapist, you need to set your convictions aside in the interest of your patients’ or clients’ well-being.
Regardless of whether or not you like your clients, in order to help them, you have to care about them. You have to become personally invested in their wellbeing and recovery. You have to be invested for more than a paycheck, because no matter how well or poorly you do with a client in a given session, they will probably still pay you for that session (whether they come back is another story).
For whatever reason, some of my colleagues struggle to care about clients who they do not like on a personal level. Since becoming a therapist, I have not had this problem. I do not have to like someone or relate to them on a personal level to care about their suffering. I want to help people even if they aren’t the nicest or are extremely annoying or do not have the same political opinions as I do. We all have good and evil inside of us. Trying to decide who is “worthy” of our help as therapists is a slippery slope, and one that I am not willing to climb. In my opinion, even the “worst” people on this planet deserve relief from their suffering. Maybe this is what sets me apart from a lot of the other students in my PhD program? I am not the world’s best person. I have done shitty things, I have a chip on my shoulder, and I go into attack mode when I am feeling vulnerable, but I know that underneath all of that awfulness is a kind, warm, and tender person. I can be mean, but it’s usually because I am feeling hurt and that is how I learned to cope. I recently read on Twitter that part of overcoming abuse is unlearning abusive behavior that you developed as a way to defend yourself. I really identified with that.
Maybe this personal experience helps me to see past the flaws of some of the more abrasive clients. Maybe it helps me recognize that everyone is deserving of help. Whatever the case may be, other therapists struggle more than I do to become invested in the care of clients with whom they do not connect, and that’s okay. We all have our strengths and weaknesses as clinicians. What matters most is trying to improve and grow.
So, what do you do if you are working with a client and you find yourself uninterested in their care because you do not like them on a personal level?
Here are a few ideas.
- Try to find something you like about your client. Maybe they’re a total asshole to people, but they really like cats. Maybe they’re always late to sessions, but they do a great job on their homework. Maybe they can be a little rough around the edges, but they always have a great sense of humor. Trying to see the good in them (because there is good in everyone) can help to facilitate the therapy and it can make the experience more pleasant for all involved. And don’t give me that, “I just can’t find anything I like about them, sorry, that’s just how I feel,” bullshit. You can find something you like about anyone. If you can’t, you’re not trying hard enough.
- Similarly, try to find some common ground with your client. If you really are struggling to find some unique quality you appreciate about your client, try to look for some things you share with them. Is there a band you both really like? Are you both huge fans of RuPaul’s Drag Race? Did you both grow up with alcoholic parents? Do you also get depressed sometimes? Try to connect with them over that common ground, even if it is on a superficial level.
- Catch yourself and be more open. When you find yourself rolling your eyes at their excuses for not doing their homework again or start to think, “Great, that asshole comes in today!” take note of it. This behavior will not help you provide services to your client. With that attitude, you will only ever see the bad in your client. Let yourself learn more about your client. Don’t get stuck on your first impression and don’t cling to an overly rigid case conceptualization that you think somehow validates your negative feelings towards them. We all know about self-fulfilling prophecies and the confirmation bias. Try not to fall victim to these traps to the detriment of your client.
- If there is a certain therapy-interfering or inappropriate behavior driving you nuts, address it. Is your client’s consistently late? Do they make snide remarks to you and question your intelligence? Do they refuse to complete any homework? Of course these issues would foster and fuel resentment if you leave them unaddressed. Talk with your clients about the issue. Find out what is driving their behavior. Set boundaries with them. If necessary, you could set up a therapy contract. A therapy contract is a formal document that therapists and clients sign and are expected to respect, otherwise treatment will be terminated. For example, if a client has problems with lateness, they may be expected to show up on time for three consecutive sessions, or else therapy will be terminated. I usually like to save therapy contracts for when verbal agreements don’t seem to be working. Make sure you’ve first tried to talk to your client and understand what is going on before you whip out the therapy contracts.
- Try to understand why they are the way they are. Understand your client in the context of their history. Do they tend to doubt you and have trouble trusting what you are trying to teach them? One interpretation is that this client is just an antagonistic person and it’s a pain in the ass to work with them. A more helpful interpretation might consider the client’s past. Perhaps their father made promises to them but never followed through and this led to a tendency to doubt what others say to them. If you have a clingy client who won’t stop calling and emailing you, instead of immediately becoming annoyed, it may be helpful to remember that they have had a history of abandonment and abuse. This recognition of someone’s history can facilitate empathy, which is always a great approach to take. It can also help you to address problem behaviors, as recommended in point number 4.
- Recognize when you haven’t done your best. This is related to point number 3 and allowing yourself to be open to other interpretations. If you have a client who isn’t completing homework assignments, maybe it’s not because they’re lazy or unmotivated. Perhaps you didn’t explain the assignment clearly and they were confused. If your client is showing up late, it could be a cultural difference that you didn’t realize you needed to address. If your client is “mean” to you, maybe they are feeling unheard. If you cannot motivate yourself to care about your client, chances are they will pick up on this at some point, and that won’t help the situation.
- Care about them because you care about being the best therapist you can be and doing the best job you can do. This is self explanatory. If you cannot care about your client for their benefit, care about them for your own. Shouldn’t you want to grow and develop as a therapist? Take pride in your work. Mentally thank this client for the challenge and put forth your best effort, because that’s just what you do. Thinking about this case like a learning opportunity rather than a chore can really impact the quality of work you are able to do.
- Express your concerns in supervision or through consultation with other professionals. If you attend clinical supervision, bring up this issue. Try to talk with your group and/or supervisor about what the problem seems to be and why you are having such a hard time mustering up genuine care and empathy for this client. Maybe they will have some additional suggestions for you. If you do not attend regular clinical supervision, seek out consultation with another mental health provider. Talk things through with them. You may learn something important about yourself as a person and a therapist through this process.
- Do some reading on Carl Rogers and humanistic psychology. I recommend setting aside a few hours over the weekend to really dive into some of his work. Really try to get a deep understanding of unconditional positive regard. Once you’ve done the research, put it into practice.
- Last resort: refer them to another clinician. If you are not equipped to deal with what this client is bringing to the table or you simply cannot move past certain qualities about them, you would do a disservice to yourself, to your client, and to your profession if you were to continue to see them. Seek consultation and supervision on the case and try the above suggestions first, but if things really aren’t changing for you, it’s best to cut your losses and send them to someone else who can better meet their needs.
You don’t have to like working with every client who walks through your door. You don’t even have to like every client as a person. What you do have to do is your job. What you do have to do is care about them and their recovery. During this process, you may come to find that you’ve developed a fondness for this client, despite and possibly because of their flaws.
Often times therapy clients worry that we only care about them because it is our jobs to. To that I say, “So what?” Once you genuinely care about someone, the fact that it is part of our job to care about them doesn’t make the care any less real.