I’ve been thinking about problem clients recently, as it is something I get asked about quite often by fellow therapists, especially those just starting out. “How do you deal with problem clients?” is a common question so I thought I’d write it up as a blog entry so I have something to refer people to in the future.
The first thing to consider is just what is a problem client. “Problem to whom, specifically?” is an important consideration point.
We need to differentiate between those clients who, despite all the help they are offered, fail to change, and those clients who are a royal pain-in-the-ass for other reasons.
It is common, especially amongst brief therapists, to view clients who fail to change, or who reject our methods, or argue with us as being a “problem” – they do not fit into the models of understanding of the therapist and thus not only damage our own fragile ego states, but also bugger up our success rates (or at least the success rates that we claim!) My advice in these situations is that maybe the therapist ought to change their view on things a little. Maybe from the client’s point of view, the therapist is a problem therapist, i.e. inexperienced, uncertain, lacking the relevant skill base and so on. Or maybe, the client simply isn’t going to change, because that is just how they are. NLPers hate that – “Everyone can be changed!” is something they like to claim. I disagree. I have met many people that are unlikely, or indeed are unwilling, to change their behaviour despite all the therapy, training and change work in the world.
I don’t see these situations as a problem, it is mainly a function of time. The majority of people do change over time, clients as well as therapists. And of course, experience can only be gained with time. I tend to be very wary of people who like to hold someone’s lack of age and lack of experience against them. I think it is a way of maintaining a fragile status position over other people. I know a number of trainers who do this, and it isn’t a nice thing to do.
Now, I am not talking about the classic, “You are not what we are looking for, we really require someone with more experience, maybe come back in a year or two” type of thing. But I am talking about the, “You weren’t there back in 1984, you young whipper-snapper, so don’t try and tell me that….” Where the speaker uses the person’s age and experience level as a direct criticism of the person. Age and experience are a function of time (and effort) and to a large degree are outside of the control of the person, so isn’t something that they can do much about.
For some difficult clients, much of the difficulty may result from simply a lack of experience. Young, recently affected schizophrenics can have a very hard time in understanding and dealing with their symptoms. They can become very confused, frightened and helpless quite easily. Older, more experienced schizophrenics handle things quite differently, primarily owing to their level of experience. This is true for so many psychological problems and conditions.
Thus, for me, a problem client is not a person who fails to conform to the therapist’s wishes and intents.
Here is a little list of things I see as a problem:
Incessant midnight phone calls
Mad or abusive text messages/answer phone messages
Turning up on the doorstep outside of appointment times
Blaming the therapist for their own behaviours, alcohol/drug consumption etc.
Threats of violence, threats against property
Given the client group that I tend to work with, and the volume of clients I tend to see, I average one ‘serious’ problem a year and three lesser issues per year also. These are rarely “serious” in a life threatening kind of way, but can prove problematic. Over the years I have developed a number of strategies which prove effective in both minimising the number of problems but also dealing with them when they arrive.
Without any shadow of a doubt, the clients that generate the most problems are the drinkers/alcoholics. Some will arrive slightly edgy and act as if they are simply looking for a reason to take offense at something I do or say. I wondered if this was just me – after all, I’m not exactly known for my love-and-light approach to change work – but I have seen exactly the same behaviours in support group and other change work sessions I have observed. The pattern, though, is consistent.
The drinker who behaves in this way is the drinker who is not interested in giving up alcohol, but rather wishes to “control their drinking” – abstinence is not an acceptable outcome for them. Now, others may well disagree, but personally, I think getting a problem drinker to a position of “controlled drinking” is not much different from trying getting a heroin addict to a position of “controlled heroin use.”
Now, at the first point of contact (usually email/’phone) I will put this proposition to the client with the drink problem, and the potential client who rejects this and demands that they get a service which enables them to have “controlled drinking” is not accepted as a client. I wish them luck and move them on. This reduced the number of problems significantly. If I am not connected to the outcome that the client requests and the client is not willing to reconsider their outcome, then clearly it is foolish for me to try and work with them – I am the wrong therapist for them.
Another thing that reduces significantly the number of problems is demanding that the assessment form be filled in correctly. The forms that get returned to me with only token information in the form of one-word-answers and no real information get rejected. The client is sent the form back and asked to fill it in fully and correctly. It interests me how one or two people will refuse to do this and simply either get angry or take a “oh, I can’t be bothered, forget it” type of attitude. It is good to know this early on. Those clients do not get an appointment.
And another much less common thing is how many people do not put their address or contact details on the form. Everything else gets filled in well, but not these parts. Small detail, but important. OK, I already have their details because I have sent them the form in the first place, but still, I send the form back asking for the form to be completed.
Most people are happy to comply. One client responded with, “Why didn’t you do this for me?” Whilst I don’t wish to `thin slice` here, but when I hear this, I suspect this attitude might extend into other contexts.
Alarm bells also ring when people reject all available appointments that are offered and instead insist on a time or day that is unavailable. And I must say, I am pretty flexible with my appointment times. Without an exception, every single time I shifted my schedule to suit a client in this way, I regretted it. These are the clients who are either late or simply don’t show up, and then expect another appointment.
In the last 18 months only two clients have failed to show. Both were people who wanted appointments on evenings where they were not offered and both were clients who I volunteered to see for free. So, I booked out evenings for people who aren’t paying and then they don’t show up. Not my preferred thing at all.
I am clear with my clients that if they are late, or fail to show up, I never offer a second appointment. Both those clients complained about my lack of “caring.”
Two other indicators that I have found prove to be a 100% predictor of a “problem” client. (i.e. problem to me, not to themselves in terms of chronicity).
They arrive bearing a present and I have never met them before.
They reject the offer of tea/coffee/water.
People who arrive bearing presents or songs of praise for me on the first time we meet tend to make me nervous. A pendulum will swing both ways and at the same speed. People who buy favour will often withdraw it at the same speed.
Now whilst it isn’t common, some clients will arrive with a present and offer it at the end of the session. Whilst they are paying a fee, some people will still feel a degree of debt. So this isn’t the same as people who offer a gift at the beginning – it creates a mutual degree of appreciation and for many will help balance things out. At workshops, it isn’t uncommon for people to arrive with biscuits or cake to add to the refreshments table. This is a good thing and, I’d just like to add, homemade fruitcake is my favourite.
Thus the client who arrives offering the gift puts me in a position of gratitude to them before we have even started. It’s an interesting dynamic and from experience isn’t a good one. It is difficult to maintain an attitude of gratitude and act in a therapeutic manner at the same time. Gifts offered at the beginning of a session tend to act as a Trojan horse. Be aware.
This has only happened once in the past two years, and the individual who did so went on to make numerous late night phone calls, abusive text messages, threats against property and unpleasant emails and Facebook messages.
My advice to anyone on the receiving end of such action is to respond only once asking what the problem is. This gives the person an opportunity to properly record what their grievance is. For some people there is no reason, they just enjoy being aggrieved – it’s their thing – and so are unable to tell you exactly why they behave in this way.
Cease all further communication and simply record in hard copy where possible all evidence of the abuse. I keep impeccable records of such actions.
Therapists tell me that they worry about being sued by such individuals – maybe as a therapist they did or said something wrong during the session to provoke such a reaction. Well, it would make for an interesting court case, don’t you think?
“You see, it is like this your Honour, I didn’t like what the therapist said to me, so yes, I threatened him, send abusive messages, harangued and generally acted like an asshole for the past 6 months. Now, I want you to award me some compensation.”
The other predictor is whether the person accepts the offer of “tea or coffee?” when they arrive. I’ll save this for another blog entry, but basically, at the first offering the person receives, they reject it. It tends to set the precedent for how the session will go subsequently.
Time is pressing. The sun is shining and I have a busy day off ahead of me so will add more later.