2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43
Manipulation can be defined as "arbitrarily influencing or controlling other people in order to gain benefits through persuasion, deception, seduction, coercion, induction or guilt." This term is almost always used to describe the client's attempts to control the relationship; if it is done by the therapist himself, it is called "skillful management of the client's behavior."
Clients can manipulate in many different ways, directly or indirectly, consciously and unconsciously. Direct manipulation includes an attempt to dictate your own terms, forcing the therapist to make promises or guarantees. Indirect manipulations can be much more difficult to recognize, and clients show remarkable ingenuity. Some of the more common forms of manipulation are described in the work of Murphy and Hughes. I will present them below, accompanied by relevant examples.
- Unreasonable demands. Sorry to bother you at home, but I can't sleep. Can you help me somehow?
- Control of the conditions under which psychotherapy is carried out. You never told me that you should warn me about the cancellation of a meeting due to my poor health 24 hours in advance. I thought you were referring to the time when I want to stop therapy altogether. I would still like to agree on the next session, of course, only if we remove this misunderstanding.
- Begging for promises. You said that I could call you if I feel worse. I would like to know if a headache is a dangerous symptom?
- Requiring special attention. I know you don’t usually work on Wednesday evenings, but would you exceptionally meet me this Wednesday?
- Self-condemnation. I don't even know why you treat a person like me so well. I don't deserve that kind of attention at all.
- Expression of dissatisfaction. And I was hoping that you are not like all the other psychotherapists with whom I happened to communicate. But you can be cruel too.
- Threatening to harm yourself. I hope I will be all right within the next week. If I decide to commit suicide, I would like to thank you in advance for everything you have done for me.
Entering the office and not having time to sit down, the first thing she did was turn the clock so that the dial was not visible. “I don't like it when they look at the clock. It makes me nervous. I would just sit and count the minutes."
Then she outlined her demands: she would pay no more than a certain amount; and will do this only after receiving medical insurance; I will not under any circumstances meet with her husband; She can only see me on Wednesday or Thursday at five in the evening. Does this suit me?
- Why can't you talk to your husband? - I was so dumbfounded that I could not think of a better question.
- Because he does not know that I am here, he would not let me come if he knew. And one more thing: you shouldn't call me at home, so I won't give you my phone. The invoices will be sent to the office address.
After that first meeting, things got better. I decided not to contradict her. (She reminded me of a cocky classmate: I was always afraid that she would beat me.) I showed unprecedented patience and complaisance, which is usually difficult for me - I do not like when the situation gets out of control. But I was patient and decided to wait it out. Perhaps that day I was very confident in myself.
In the interval between the second and third meetings, I received a message on the answering machine with a request to call her. After waiting for another break, after a few hours I called her.
- Hello.
- Hello. I'm Jeffrey Kottler, you asked me to call.
- Do you always wait that long before calling?
- Sorry, I did not understand?
“I mean, does it always take that long before you make a phone call back?”
“This is my first break,” I replied more meekly than I would like.
- This is an excuse. What if an accident happened to me?
- Apparently it was not an accident. How can I help you?
- I would like to know if it is possible to postpone our meeting from Wednesday to Thursday? Just this week,”she hastened to add.
- I'm sorry, but I have no free time. - I didn't want to make concessions.
“If you’re so stubborn, I’ll have to look for a more accommodating therapist.
(Compliant? She accuses me of a lack of flexibility? This woman could not even come to terms with the fact that I hung a new picture in the office - she immediately commented on it, and she still claims that I am stubborn? This is a projection!)
So I answered:
- You are probably right.
I immediately regretted what I said. After all, I knew that she was testing me, but I could not answer the way I should … At that moment, I just wanted to get rid of her.
She went to meet me and hung up. A few days later, the client called again and left her message. I called her back immediately, although a client was waiting for me in the waiting room. None of us said a word about the past incident, but each apologized in his own way - she called me again, I immediately paid her attention.
After a few months, she moderated her demands. This client taught me to turn the clock, but one day I forgot to do it. I realized that I had made a mistake, only an hour later and decided not to correct it. I was walking my client to the door, when she suddenly smiled, touching my shoulder: “Well, how? Don't you think I noticed? I guess my condition has improved, hasn't it? I smiled back.
Customers who are in control of the situation feel they deserve special treatment. As a child, they tended to throw tantrums to get their way; As adults, they devise more sophisticated ways to dominate others. They are ready to whimper, make endless demands, or get into the position of the offended - depending on the situation, to insist on their own.
According to some authors, the need to control the situation is mainly due to the lack of freedom. When a person feels his own powerlessness in various areas of his life, he tries to take tight control over the course of psychotherapy. In the absence of inner strength, people tend to manifest external strength in order to create the illusion of freedom.
Brehm and Brehm called their theory the theory of reactivity: according to it, the motivation to control the situation in small doses can be quite justified, since it allows you to maintain a certain autonomy. Other authors developed this theory and began to highlight situational and characterological reactivity. The latter is a hallmark of difficult clients, for whom control, coercion and manipulation become a way of life. With situational reactivity, which, according to the authors, is nothing more than resistance in the usual sense of the word, the client tries to protect himself from temporary helplessness.
There are other benefits of being in control. Discussing the dynamics of control-prone clients, Fiore describes some of the more primitive defenses these people use to get their way while maintaining close relationships: externalizing conflicts to keep their surroundings at a safe distance, using the therapist as a container for fearful impulses. The most common defense is projective identification, through which the client gains the ability to dissociate himself from unacceptable feelings, attributing them to the therapist, and he himself enjoys denying them in himself. Fiore gives an example of how the client himself describes this process, who is inclined to control the situation:
When I get close to someone, I begin to attribute negative traits to him. Even knowing that these qualities are inherent in myself, I sometimes think that the other person manifests them in relation to me. At times, we seem to exchange blows, so I lose the idea of what is happening and in what sequence. Finally I get completely confused. Now that you have pointed this out to me, I understand with my mind what is happening, but it does not change anything. People around me are irritated mainly by the tendency to control the situation. This is because I attribute bad intentions to another and have to keep everything under control in order not to be deceived.
Thus, the task of the psychotherapist is to calmly relate to the client's need to act out a controlling scenario and contain the client's experiences, without taking what is happening to heart. The secret to being a good container, according to experts on the subject such as Winnicott, Bayon and Kernberg, is to maintain an empathic attitude while simultaneously changing the parameters of the psychotherapeutic environment until the client no longer needs to use defense mechanisms. Of course, the therapist still cannot get away from the age-old problem: to take a hit without feeling anger and disappointment!
Ashley at the first meeting started a conversation about how unlucky she was with previous psychotherapists. “You can't even imagine how stubborn people can be. I am not always that late, but one therapist stated that he would not communicate with me more than the time allowed for the session, even if the next visitor was not waiting for him in the waiting room. That's why I like you so much. It's not my fault that today there were traffic jams on the roads, and I appreciate that you allowed me to stay longer than the allotted time."
This was no doubt a warning. She practically laid out her plan, according to which she was going to test the patience of the therapist. He fell into a trap, but his position was not hopeless; he retained the opportunity to change the already established norms of command. These preventive actions are most effective when dealing with dominant clients: Intervene before thathow unwanted customer behavior becomes habitual.
It is extremely important for clients to retain some ability to influence what is happening in a threatening situation. Particularly vulnerable people try to establish much tighter control than is necessary or justified; our task is to help them gradually loosen their control so that they do not lose their sense of their own dignity. This therapeutic task requires a skillful combination of a high tolerance for individual differences, on the one hand, and the ability to establish rigid rules of behavior when the situation calls for it on the other hand. The dominant client eventually learns one of our main commandments: the ability to control a situation is more related to the internal state of a person than to external manifestations. It reflects a person's confidence in their ability to function in difficult situations and the ability to maintain stability at the same time.
Dowd ET, Seibel CA A cognitive theory of resistance and reactance: Implications for treatment. Journal of Mental Health Counseling, 1990
Fiore, R. J., Toward engaging the difficult patient / Journal of Contemporary Psychotherapy, 1988
Jeffrey A. Kottler. The compleat therapist. Compassionate therapy: Working with difficult clients. San Francisco: Jossey-Bass. 1991 (lyricist)
Murphy, G. E., Guze, S. B. Setting limits: The Management of the Manipulative Patient / American Journal of Psychotherapy. 1960
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