Working With Difficult Therapy Clients

Maybe you recognize that feeling—that sense of dread you feel in your stomach as a particular client’s appointment is approaching.

You start overthinking ways to say the right thing and make a difference. You start to wonder if there’s something wrong with you, or whether another clinician might be a better fit for this client. 

These feelings may arise when therapists work with difficult clients.

And, if we’re working with too many clients like this, it can contribute to burnout.

Many of us turn to private practice so we can better manage our work-life balance and lead healthier lives.

We want to be our best so we can show up for our clients and do the work we love. It’s important to recognize when we feel drained by difficult clients and identify what we can do to mitigate this type of fatigue. 

Difficult therapy clients you may encounter

It’s a client’s job to show up with all of their struggles. First, let’s keep in mind that a difficult client for you might be the easiest and most enjoyable client for a colleague.

To be clear, difficult clients are not to blame for their personalities and behaviors. However, they are responsible for making changes to those behaviors. And, it’s our job as therapists to use active listening skills, empathy, and motivational interviewing to help clients make those changes.

Here are two characteristics of difficult clients.

Clients who argue

These types of difficult clients always seem to know the answer before you say it—and they disagree with everything you say.

They’re coming to you for help and answers, but they never seem to let you do your job.

You get the feeling they’re either going to quit the process abruptly or they’ll keep coming forever.

Neither option feels good in your mind or body.

Clients who don’t follow through

This type of client never argues with you, but they also never follow through.

These clients are in agreement with everything you say, but each week they show up empty-handed.

They haven’t done their exercises or gained more insight into their issues.

You’re left wondering if this will ever work out. Because one hour a week isn’t enough time to improve their situation without them doing the work on their own as well.

What are our responsibilities to difficult clients?

Both of these types of difficult clients are in therapy for guidance and support, and it’s our job as clinicians to offer them the tools they need to manage their pain and successfully navigate their lives. 

Sometimes, the best support you can give a difficult client is a referral to a colleague who you know will be a better personality match for them.

Whereas, in other situations, you might find that attending a training or reading new research might give you the tools to better assist a certain client yourself.

In other words, sometimes it’s a matter of personality-matching, and other times it’s a matter of improving our own skill level.

Either way, the process of making this choice requires you to look inward and leave your ego at the door.

Remember why you entered this field—to help people, not to always be right.

How to navigate treating difficult clients

No matter what type of difficult client you may find yourself treating, there are a couple ways you can make sure you’re offering that client the best care possible—while also minimizing your own burnout. 

One of those ways is to join a peer consultation group.

In my opinion, all helping professionals should be part of a consultation group. We can’t do this work alone. We need the support of other professionals who know what we’re going through and who can offer both emotional support and clinical guidance. We need other people around us in order to form well-rounded, educated opinions, and peer groups are a great way to do that. 

Another thing you can do to help difficult clients and yourself is to see a therapist of your own.

As clinicians, our own concerns and triggers can—and often do—show up with our clients. Good therapists have their own therapists, and participating in therapy on your own will give you a way to navigate confusing and frustrating emotions. This process can also teach you to connect with different types of difficult clients in therapy instead of approaching those sessions with dread. 

Ultimately, working with difficult clients can actually make you a better clinician.

When you learn to work through your challenges, you have more empathy for your client’s challenges. Empathy is key in creating behavior change.

Most clients don’t need you to teach them as much as they need you to believe in them. When you believe in your own ability to overcome difficult feelings, like frustration and hopelessness, you learn to believe in your clients even when they don’t believe in themselves. 

There will be certain types of difficult clients in therapy who will make you feel like you are the worst clinician in the world, and the hardest part will be providing a space for that client to feel comfortable.

This comfort is what will enable your client to be open and honest with you, which aids in  their learning experience as well as yours. 

There is a time and place to refer your clients out to someone who is genuinely more specialized or skilled than you for this particular client’s needs. The only way you’ll be able to gain an intuition around this type of decision is by allowing yourself to feel uncomfortable, removing all judgements for yourself and for the clients, and surrounding yourself with other clinicians that you admire and trust.

Remember that your clients are here to teach you just as much as you’re there to teach them.

When you approach them with confidence in yourself and confidence in their ability to change, they trust you and themselves more.

The next time you find yourself hoping a particular client cancels their session, consider these three questions:

1. What can I learn about this client today?
2. What can I learn from this interaction?
3. Whose agenda is number one today?

Don’t give up when you’re feeling defeated. Lean into your feelings and be ready to explore those difficult emotions.

When you do that, you’re able to provide your clients with the care they need. 

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