About Alien Clients

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

In the practice of each therapist, sooner or later, the same "terribly difficult client" appears. Someone is lucky at the very beginning, and then you can get very scared and either quit the profession, or perfectly pump your therapeutic resistance. He comes to someone in an already established practice, clearly standing out from the background of other clients as if inexplicably strong, sometimes very difficult for the therapist to tolerate experiences next to him in contact. Therapists are more likely to carry the cases of such clients to supervision, and often the first thing they do is diagnose them as "borderline".

Each therapist has a different type of “difficult” client that may not resonate as strongly in another colleague at all. According to my observations, this difficulty primarily lies in the exact hit of the client's request in the deficit zone of the therapist. Hence - such a strong resonance for both. The feeling of borderline, which is often talked about in such cases, does not always correspond to the organization of the client's psyche, but in one form or another accompanies the quality of the contact, reproducing the client's borderline situation in the transference, which the therapist can unconsciously enhance by the response of his own, often polar borderline experience (which is Every person). That is why the client becomes so "difficult" and the more motivated he is to work, the more demoralized the therapist may feel in the process. And vice versa. Supervision of such cases is not always sufficient, sometimes clarifying the situation for himself, the therapist finds that he needs to study his own reactions to the client in personal therapy. On the one hand, such a client becomes a source of tension and headache for the therapist. On the other hand, it is a powerful stimulus for strengthening the therapeutic identity and recognizing oneself from those sides that were not available for research before. The main difficulty in the work is the constant overcoming of the clinch (latent or explicit) that arises in the interaction. The therapist is tempted to hand over the responsibility for shaping the client, thereby exacerbating PTSD and often creating unnecessary stress.

What I had to face. 1. All comfortable and normal for the therapist ways of interaction the client rejects or perceives with hostility. The feeling that you need to look for a special approach, to develop a new common language. And there is. 2. Transference or countertransference is full of terrible expectations. You and the client can switch places in an intolerable sense of your own vulnerability. At the same time, nothing terrible happens in real contact. 3. It is often easy to associate this feeling with traumatic events in the client's life, but over time, the volume of experienced feelings of trauma increases, and the quality of contact does not change. 4. The need for introjects. The client often looks very bad at understanding you, at the same time there is a suspicion that he is just mocking. He often has similar feelings. If you slow down enough, you can find out that a person needs to explain to him some absolutely elementary steps in self-regulation, which he does not know how to do due to insufficient sensitivity to himself and simply the lack of a suitable narrative in the experience. One of my clients was constantly angry and attacked me in session. We have been working for a long time and I, knowing about this way of asking for something for myself, patiently contained the reciprocal irritation, although at the beginning of our work I experienced this method as quite traumatic. I tried to find out the reason for her anger, to which she responded with interest. In response to my proposal to turn to bodily experiences, after a while she was able to notice that she was thirsty, but remained sitting in her place and was going to continue working. When I asked if she would like to go and fetch herself some water, she was very surprised and did not even immediately follow her. She was surprised not that at the session you can go out and take water, but that if she was thirsty, she could immediately get up and quench her thirst. In her experience, it was normal to endure the discomfort for a while, leading it to intolerance and being angry with others for it. Unbearable thirst was a good reason to take care of yourself. It was just that thirst was not perceived by her as a need. This episode allowed the client to reflect on being attentive to her body's signals and to connect her anger with finding the source of discomfort and discovering a need. Such meticulous, painstaking and slow work on clarifying at first glance the little things, allows you to restore the picture of how the client has formed the mechanisms of self-regulation and to compare with the protective destructive behavior that the therapist encounters. At this point, it usually becomes much easier to countertransference, and there is enough energy to interest the client. That is, the tension that causes the client's behavior can be enough to contain and help him form a different way of dealing with himself and others. And in this place, personally, my experience with my clients is rather successful in enlarging, slowing down and explaining the incomprehensible, than in lengthy long conversations about the existential. There is nothing shameful in the fact that sometimes the therapist is simply required to be a "mother" who will explain the incomprehensible, even if the client cannot formulate the question himself. It is more difficult to find that this request is also packaged in hostile behavior. The important difference between such a request and narcissistic hostility for me is that the client is able to be grateful, build on the experience, and grow.