Dr. Tarra Bates-Duford
Dealing with Difficult Patients: 9 Tips
Although, a lot of psychologists and therapists might not like to admit it, there are times when you don't click or “mesh” with particular clients—or worse, you just don't like them. Unfortunately, there may not be one specific reason or an obvious reason a therapist and patient are unable to develop a deep therapeutic bond. Failure to bond during therapy can be stressful for both the therapist and the patient/client. Failure to connect during the therapeutic process can lead to delay/interference with symptom stabilization and progress.
Clients often seek counseling and other mental health services for a variety of reasons, are referred to treatment, or mandated by a court to attend treatment. Some clients enter therapy willingly, open, and receptive to treatment, however, others may enter treatment resistant, angry, suspicious, or profoundly depressed, making it difficult to develop a bond with his/her treating therapist.
Therapeutic bonding can be challenging for many different reasons as the person present with overly critical or negative behaviors and attitudes, or you find your personalities are not a good match. It is important to note, you do not have to like a person to do a good job as a therapist. However, if you actively dislike your client/patient, it is much harder to identify the root cause of what is creating and maintaining the client problems/distress or perform the role of therapist appropriately.
It may come as no surprise, the stronger the therapist-client relationship, the better the outcome of therapy is likely to be. As difficult as it may sound, there are good clinical reasons for not treating people you don't like or are unable to establish a bond with. Unfortunately, some therapists tend to feel guilty about their feelings of dislike for a client and are reluctant to refer the client to another therapist, or seek supervision to resolve their negative feelings associated with the client.
Of course, what starts out as a rocky connection can improve over the course of the client-therapist therapeutic relationship. Not surprisingly, there will be moments during the course of the therapy when you may find yourself disliking your client’s attitudes, behaviors, or the position they are taking, fortunately, this is usually a momentary thing. There are going to be many instances where initial dislike turns into regard over time and that a difficult beginning does not preclude a positive working relationship.
Helpful Tips That Can Help You Deal with a Difficult Patient Include:
Separate your personal feelings about the clients attitude/behaviors from the reason treatment is needed or sought
Therapists are encouraged to identify what behaviors exhibited by the client produce a negative emotional response
Ask yourself specific questions, i.e., whether you can provide competent/unbiased service, does your personal reactions affect your work with the client, etc.
Consider whether you'd be able to overcome your antipathy
Use your feelings to move therapy forward
Consult with more experienced therapists or colleagues
Protect the integrity of your practice
Refer the client
Don't view referral as a failure
Interestingly, we should realize that it is a virtue that a therapist can recognize, acknowledge, and accept that they have negative feelings towards a particular patient. Realistically, we cannot expect therapist to like, engage with, or develop a therapeutic bond with every client. If the feelings are minor it should not create a barrier/interference with the treatment process. By establishing awareness of negative feelings, the therapist can keep these feelings in mind while providing treatment to the client. The trick is to check in with yourself and a more experienced professional to determine if these feeling are interfering with, or creating a barrier to the therapeutic process.
If the awareness of the dislike for the patient comes during the initial consultation and the therapist is not inclined to work with the patient, it may be relatively easy to refer the patient to a colleague. A therapist not uncommonly will refer a patient to another therapist after the initial consultation if a therapist with special expertise might be better suited to treat the patient or if the therapist and the patient’s schedules don’t mesh for setting up ongoing therapy.
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