The Most Difficult Client

Dr. Judith Beck describes the challenges she experiences working with clients with pre-existing therapy experiences. Dr. Beck also explains some of the techniques she utilizes to increase the likelihood of the client buying into therapy.

[dustinsanchezmusic]

I am a student that is going to start my internship next spring. Being an addict in recovery and having gone through many treatment centers, I realize that it's actually up to the individual client if they really want to change. Even though my previous experiences at a recovery center were unsuccessful, each time I learned something I didn't know from the previous time. So for some it may take more than one time in treatment to "get it." Thanks for sharing this video.

[gaynorevans]

It's possible that these clients suffer from Structural Disassociation which leaves them with 2 distinct parts and creates a tug of war i.e. a wanting/not wanting, a push and a pull. The 'adult' part wants help, (this is the part that seeks help ) the child part is fearful and resists change. In my experience, naming and exploring these parts compassionately, allows the work to continue.

[some-cool-guy]

I would like to see more videos like this on engaging clients. I believe the relationship is so crucial to the success of therapy, as well as the skill of the therapist. I'm glad to hear that I'm not the only therapist that doesn't get it right every single time! -Dr. Frank Diak, The Happiness Psychologist

[travislebreton]

As a patients prospective and trying all of the other thearapy listed as well as a few others I can truthfully say what's kept me going to see my clinician is the relationship and amount of trust I've built with her.. the other thing is she is extremely good at reading my body language and can tell usually within minutes what should and should not be covered in that meeting weather it be that the topic would be to triggering to me causing a hospital trip or that it's somthing that I am trying to move on from focusing on one thing all the time makes us feel like we will never recover. So for me with my trauma some weeks we talk about the trauma directly while other weeks we talk about other bits and pieces of the trauma that help me make the connections to realise what had truly happened to me.

[ThatsY]

I was that client. It's an inability to be completely honest with one's self. To admit weakness rather than failure is extremely vulnerable. AND that is where the resistance hides.

[tracygiven]

Love what you’ve just said at the begging of this vid. I’m in 2nd year off degree, lacking confidence at the min, but I know I can do this and become a helpful counsellor. As a person in general I will hopefully be a better more knowledgeable person 5years from now. Hopefully a successful counsellor 🙏🏻

[dianabowen]

Being kind to self is very hard at times when it feels like the world hates you

[sliceofbreadyrago]

Just a suggestion but perhaps if a patient comes to after trying many types of therapy and yet the patients remains unwell, it could be because the patient dosent want to get better.
It sounds unusual, but for some patients I believe there is an underlying hidden desire to remain sick. When the patient is sick he can then blame the world and play the victim card.
And no amount of therapy can help the patient, it is only when the patient truly wants help.

[dbawab]

I think CBT alone won't be sufficient with such client (other approaches, especially existential or humanistic, may be better combined with CBT in that case). You may explicitly explains what kind of help and resources you can offer and ask them how s/he thinks these may particularly support her/him. This is while doing it in a relaxed, open and gentle manner, and while being careful not to show frustration (because it may make them feel like a hopeless case). Before taking a decision to refer them to another therapist or terminate, listen very well and try to understand what may underlie their interest in CBT now as well as what may underlie what seems to be resistance. Usually it is best to act from the premise that the clients are the best experts of their life and experience. Usually they have the answers, but the therapist may facilitate the exploration of these answers and provide resources that are in line with the client's agenda -while being flexible to experiment with different methods-. The client should have the ownership and agency (and need to be gently reminded with this -which may include exploring and playing at the client's strengths-).

[dianabowen]

As someone you just explained I'm looking for self compassion and nurture in a world that feels hostile greedy and ruthless and always wanting something from me . An unbalanced idea of self that needs recalibrating

[sabrinaabdelhamid]

I think he needs to listen to a lot of lectures with his private sessions... Sometimes we lack new information about ourselves. I think group coaching with a coach who has studied CBT, DBT, positive psychology and other forms of therapy so that he can explore more about himself and this will allow him to express himself more.. Because sometimes we have limited beliefs because this is all what we can remember but when we listen to lectures from a really good coach who is talking about healing ideas, we we start to remember more, more situations that we need to heal from, more good memories that we need to remember... This is what Ihave been trying for 3 years now and it is working thank God

[kwiaxxxkwiaxxx]

I'd think about trauma and / or dissociation

[patriciaanndemello]

I think technique is overrated. Sometimes you just have to click personally and in being your authentic self you end up helping the client. It's like hearing the same thing over and over but someone says it in a certain way that finally resonates with you and you have an " Aha" moment. That's happened so much with me. It's like I was ready to hear it.

[lgfish]

I wonder if part of it may be illuminated for some clients by investigating their past experiences with all those sorts of providers listed that they had in the past .. transference happens in both directions, and perhaps this "difficult" client was unlucky enough to chance upon a provider, well meaning, but going through their own difficult time, and there was some (negative) transferance - undiscovered by both parties - from provider onto client in the past. Unresolved, this would make it hard to start anew.. I think, as in many things, the answer is "get curious" rather than assuming much based on this client's past efforts.. after all if s/he was willing to give it another go, in spite of past attempts not working, the least we can do as practitioners is be curious and extend the benefit of the doubt ..

[Smashachu]

I feel like I'm going to fall into this category, whatever I'm suggested I've either tried or have read studies on why that's not effective and worth my time. I think a large issue is the narcissistic traits associated with myself and others who have "been there done that". I think really getting through that inability to self reflect on this defence mechanism is the issue, that's what i'm telling myself atleast. For example, i was suggested to do mindfulness meditation. My response was "well I've read a few studies on how it's mostly a placebo effect, but i'll try it anyway".

[edbrown]

You sure said "He" a lot. I know it's human but it sounds like you view the toughest clients to be men. Good point though just had to point that out.

[liam.]

I genuinely don't find talking and therapy helpful at all, I've tried it numerous times and always felt worse

[mp-plrw]

Dr. Beck, since you asked, my opinion is that such people need philosophy, not psychology. If they're deep thinkers, CBT cannot help them, for their problems are more philosophical than psychological and they need a philosopher to talk to. CBT may be rooted in philosophy (Epictetus and the Stoics) but it's not really a philosophical practice and therefore it has its limits when dealing with deeper questions concerning epistemological & moral issues or a quest for meaning. Existential psychotherapy could be an option for such clients, but better yet I suspect that philosophical counselling (with a serious philosophical counsellor that holds an advanced university degree in philosophy of course) is the answer.