Psychological Portraits Of Difficult Clients

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

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Clients with psychological disorders

Clients with neurological problems or other chronic conditions that seriously impair their ability to concentrate, listen and communicate are classified as clients with psychological disorders. Donald is an energetic man of about 50 years old, at least he was like that before his right hemisphere stopped working after a stroke. In addition to left-sided paresis, he suffers from multiple deficits in cognitive functions, which is rather difficult to identify, since he does not want to demonstrate his incapacity. There is no doubt, however, that he repeats himself in his stories and has difficulty concentrating. Donald expresses extreme interest in changing his life, but he misses one meeting after another because he forgets what time they are scheduled. Periodically, a psychotherapist visits him at home to help him somehow cope with his problems, in particular various family troubles and serious financial difficulties that have arisen as a result of the illness. During home sessions, it becomes apparent that Donald is only able to hold his attention for a few minutes. Apparently, he feels the need only for a grateful audience, ready to listen to the sad story of life again and again.

Clients with secret scripts

Some people hide their true intentions when they go to a therapist. Sandor complains of depression and poor sleep. This had never happened to him before, it all started with problems at work. The boss accuses him of not coping with the work, and even officially reprimanded him. Can you help him cope with depression? And by the way, please contact his lawyer, who would like to know how this egregious injustice might affect his mental health. How many times does he need to come so that you write this letter to the lawyer?

Customers who tend to ignore the boundaries of acceptable behavior

Not knowing the rules of behavior during psychotherapy or being confident in their exclusivity, such clients tend to violate our sovereignty. “Is it okay if my kids wait in your waiting room while I run out on business? You see, they are safe here. Don't be angry if they make a little noise, but if you don't want them to paint the walls, please remove all markers from here. They lie right in plain sight. Next time I come, make sure that there is nothing superfluous here."

Customers who refuse to take responsibility for themselves

Some clients tend to be hostile, criticize everyone and everything, blaming other people for their problems. “It’s just awful how stupid my son’s teachers are. Unsurprisingly, he's in trouble at school. And who will not have them with such, if I may say so, mentors? And most importantly, I have to clean up the porridge they made. It's the same all the time. I already told you about my colleagues … Hey, are you listening to me? If you are listening, then why are you looking at the clock … Do you want to say that our time is up? What nonsense! You are like the people I told you about: take care only of yourself … Okay, I'll leave. But next time, I hope you won't waste time advising me to change. Keep in mind, dear, others will have to work hard for me to change."

Clients-disputants

Some clients love verbal skirmishes, seeing it as fun or a test of willpower. A client named Oni heads the Indian Reservation Council. By the nature of her work, she must be able to establish relationships with people in order to entrust them with public affairs, but she is at war with everyone. One gets the impression that she likes to push the tribal leaders against each other, sabotaging all the initiatives put forward. During psychotherapy, They behave in a similar way. She fiercely criticizes everything that is offered to her. However, Oni declares that he sympathizes with the psychotherapist and appreciates his efforts to help, but contradicts him in everything. As soon as the therapist agrees with what the client said, she immediately changes her mind to the opposite.

Clients afraid of close relationships

We are talking about clients who desperately seek intimacy with other people and at the same time fear their vulnerability. Crane was often rejected throughout his life. At first, these were parents who suffered from alcoholism, then older sisters who were forced to take care of him and considered him a burden, and, finally, childhood friends who treated him like a leper (at least in his words). Currently, he has no close relationship with anyone, of course, except for you, his therapist. It is strange that you do not feel this closeness at all. At the slightest your attempt to get closer to him, the offer to speak frankly, he in one way or another tries to prevent this. At times he is sarcastic, sometimes he clowns, and may even withdraw into himself. After rare moments, when minimal intimacy is planned, he "forgets" to come to the next meeting. If by some miracle you still manage to close the distance, there is a fear that he will simply run away. It immediately comes to mind that you are Crane's fourth psychotherapist in the past two years.

Psychological incompatibility between the client and the psychotherapist

The personality styles of the client and the therapist may not match. Maury is soaked with anger. He looks angry. He is harsh in communication. From the first minutes of the meeting, he said that this is his main problem. Maury suffered silently for years. His wife was diagnosed with schizophrenia, so there was no way to hold her accountable for her behavior. He was angry not so much with her as with himself, for having endured her antics for so long. And now he wants to fully express his anger. I suggested that it would be more appropriate to set a slightly different goal for yourself: to learn how to curb your anger and direct your energy in the right direction. Maury is clearly mad at me when I argue with him. It is clear to both of us that our relationship is not going well; some irritant prevents the establishment of contact.

Countertransference and related problems

Some clients bring extremely intense feelings into therapy sessions that the client and therapist cannot fully work through. It was only after I referred Maury, at his request (and to my relief), to a colleague that I was able to investigate the sources of the conflict between us. The fact is that many years ago I had a need (due to countertransference) to carefully monitor my actions when working with clients whose problems were fear of death or fear of failure, but my reaction to Maury was completely different, unfamiliar. In the end, I came to the conclusion that it is difficult for me to control the feelings of anger - both my own and that of others who are on the verge of exploding. I realized that over the years I often had to work with such people: if I could not understand the reasons for their anger and fully work out the problem, I usually switched to other topics where I felt more confident.

Client as an object of counter-transference

Individual clients resemble those people with whom we have had conflicts in the past. My first teacher called herself "Eagle Eye" because she was sure that she could read our minds and see everything we do. Once, with her back to me, I decided to test her phenomenal abilities and stuck chewing gum on my nose. The teacher, with a peripheral vision, noticed my trick and made me stand in front of the class with chewing gum on my nose for the rest of the day. Since then, I have not developed relationships with authority figures. When the gray-haired lady entered my office, I felt a thrill. It was not just a teacher - it was a real head teacher of primary grades. She behaved with royal dignity. Even worse, from the first words she called me "young man." It's time to take revenge. Fortunately, then my work was supervised by a supervisor who made me understand that the difficult thing in this case is not the client, but the psychotherapist.

Impatient customers

Some clients have illusions about the possibilities of psychotherapy, its duration and mechanism of action. Sang, a student and would-be engineer, turned to an advisory center with complaints about his inability to focus on his studies. He missed his family very much, as he studied far from home, had almost no friends and had difficulty adapting to the new climate and environment. His strong point was his engineering vein: he knew for sure that with the right tools and resources, he could build or repair anything. Sang believed that psychotherapy works in a similar way: as soon as the psychotherapist clarifies the essence of the problem, and he - a problem-solving specialist - will recommend a suitable remedy. According to Sang, the whole process should require no more than one or two meetings. In addition, he claimed that his suffering was so intense that he would not survive even a few days.

Clients with undeveloped verbal skills

Clients with undeveloped verbal skills or unable to describe their thoughts and feelings often come across as difficult to communicate with therapists.

Therapist: How can I help you?

Client: I don't know.

Therapist: Do you know why you came?

Client: Yes. That is, no. I want to say that I know why I came - for advice and help, but I do not know what my problem is and what you could do for me.

Therapist: Tell us a little about yourself.

Client: There is nothing to tell. I've lived here all my life. I just walked the streets. Is this what you wanted to know?

Therapist: Please tell us how you feel at the moment.

Client: I don't feel anything special.

Clients with overly specific thinking

Some people do not understand the figurative meaning of words, they have practically no abstract thinking. Stephen was an accountant by profession, and, in his words, pretty good. He held a notebook in his hands, and in his breast pocket he had a whole set of colored pens. He wrote down every word I said, and marked the most important points with a yellow marker. Using his notes, Stephen said, “So you think you are my consultant, kind of a brain accountant, haha, but I have to do most of the work myself? I assume you will give me written instructions and homework?"

Empty clients

Sometimes there are clients who are incapable of introspection and have no interest in self-knowledge. "Of course, I would love to help you, but to be honest, I don't think about the subject of our discussion in between sessions."

Clients with a sense of hopelessness in their situation

The most difficult category includes desperate clients who have lost all hope of a successful solution to their problems. Karin suffered from severe depression that was resistant to a range of drugs. Karin is crying every minute, sobbing sadly and looking at you, as if begging: “Do something! How can you calmly watch me die and do nothing?"

Obedient clients

There are also clients who pretend to agree with the therapy by showing their interest and responsiveness, but they do not change at all. Frida regularly attended sessions for many years. In fact, she came to the agency much earlier than most of its employees, and managed to talk to four of my predecessors, psychotherapists, who switched to another job. Although each of them applied their own tactics, the conclusions, judging by the notes, were similar: Frida is a pleasant and sociable client. She follows all the instructions of the psychotherapist and, apparently, is grateful for the help provided to her. However, after prolonged psychotherapy with the participation of four specialists, her marriage continues to be dysfunctional, she still works unpromising work and meets old friends who taunt her. Nevertheless, Frida faithfully attends her weekly sessions and looks forward to them!

Clients who tend to attack the therapist

Some clients abuse the therapist's trust, blackmail him, to the point of threats of physical harm, in order to dominate the therapeutic relationship. “Listen, I explained to you what needs to be done. I want you to call my wife and order her to return home. She trusts you. After all, it was you who first gave her the idea to leave home. Fix what you've done yourself, or I'll take care of you. I know where you live. If you do not comply with my request, you will have to deal with the state licensing committee and my attorney."

Clients unable to control their impulses

Clients who are unable to control their impulses are among the most difficult. Such people have a quick-tempered character, and they start with a half-turn; among them are often substance abusers. Nate was detained by the police four times for driving while under the influence of drugs and alcohol. He came to a psychotherapist by court order, which replaced his stay in prison with attending sessions until you, the psychotherapist, deem it necessary to release him. In addition to chronic alcoholism, Nate was distinguished by the fact that he easily lost his temper and often got involved in fights. The last episode that led to his referral to a psychotherapist happened on the freeway, when Nate thought that another driver, driving in the same direction, cut him off. Nate pushed the abuser's car to the side of the road, smashed the glass, forced the driver out of the car, and “persuaded” him to apologize. According to Nate, "It was not difficult, I was not going to touch him, I just wanted to teach him a lesson."

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