Although therapists might not like to admit it, there are times when you don't click with particular clients—or worse, you just don't like them.
Perhaps the person is overly critical or negative, or you find your personalities are not a good match. "You don't have to like a person to do a good job as a therapist," says June Wolf, PhD, assistant clinical professor of psychology at Harvard Medical School. "But if you actively dislike somebody, it's much harder to do a good job."
She and other experts stress that the stronger the therapist-client relationship, the better the outcome of therapy is likely to be. Karen Maroda, PhD, a Milwaukee psychologist and author of the forthcoming book, "Interactive Psychodynamic Techniques" (Guilford, 2009), takes a different position, emphasizing that there are good clinical reasons for not treating people you don't like. Maroda says that therapists tend to feel guilty about deciding not to work with a particular client and are reluctant to do so. But she adds that "recent research has shown that the empathy required for therapeutic success is only possible when the therapist basically likes the client."
Thought of this way, taking on clients you may not warm up to can actually prevent them from getting the therapy they need. In these instances, Maroda recommends "gently referring the disliked client to a colleague who you believe will work better with him or her than you will."
Of course, what starts out as a rocky connection can improve over the course of therapy, points out Christopher Muran, PhD, chief psychologist and director of the psychotherapy research program at Beth Israel Medical Center in New York, who studies difficult moments, or ruptures, between patient and therapist.
"There are certainly plenty of moments when you dislike your patient or dislike the position they're taking," he says. "Very frequently that is a momentary thing."
Muran says he's seen many instances where initial dislike turned to regard over time and that a difficult beginning does not preclude working together.
"Early struggles could be a bad prognostication, but therapists could also turn these struggles into transformative experiences for their patients, depending on how they negotiate them," he says.
So how should you deal with a client you don't like?
• Reframe the question. The issue is not whether you like someone but whether you can provide competent service. Ask yourself how your personal reactions may affect your work with the client, says Stephen Behnke, JD, PhD, director of APA's Ethics Office. Your job is to determine whether you and the client are a good match, he says
• Consider whether you'd be able to overcome your antipathy. Washington, D.C., practitioner and APA Board of Directors member Jean Carter, PhD, says she has experienced an occasional clash with clients who have values that are "irreconcilable" with her own. For example, she is more likely to end treatment with clients who have a view point of "'The world owes me, I should be getting everything I can get,'" she says.
• Use your feelings to move therapy forward. Muran advises using metacommunication -- communication about the communication -- when your client is obnoxious or aggressive. "It's important to explore the experience of dislike and try to figure out what's going on,"" he says. "The only way to resolve it is to engage the other in open conversation about what's going on." The psychologist might raise the problem in one of three ways, he says: As the patient's experience ("You seem angry with me"), as an observation ("It seems we're playing cat and mouse") or your own experience ("I feel like you're taking shots at me"). That conversation becomes part of therapy. Don't let difficult moments build, but raise concerns as they happen, Muran says.
• Consult with colleagues. If your feelings toward a client are getting in the way of providing good treatment, seek help. Are you having a tough time with this client because of something in your own history? "Ask, 'Is there a way I can use my personal feelings to more deeply understand the client's challenges?'," suggests Behnke.
• Protect the integrity of your practice. Some clients may be so taxing that they deplete your energy for the rest of your clients. Limit the number of emotionally exhausting clients you take on.
• Refer the client. Far better to refer the client after one or two sessions, says Wolf, than to decide well into treatment that you really are a poor match. "I think it would be a toxic experience for a patient, unless the therapist were super-humanly able not to express it, to sit with a therapist who didn't like you," she says. Be careful to refer the client in a way that is not damaging to the patient. "The right way is to acknowledge that you're having trouble giving them the therapy that you think they need," says Carter.
• Don't view referral as a failure. It's impossible for psychologists to help every client who comes through the door. Finding a therapist who is a good match, as soon as possible, is in the client's best interest. "It's hard to accept the fact there may be some people we are simply not that well-suited to treat," says Behnke. "But that's part of our growth as clinicians."
Beth Baker is a freelance writer in Takoma Park, Md.
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