Navigating Difficult Clients in Therapy

Dealing with various types of difficult clients in therapy settings can be a challenging journey. For many therapists, it’s the most daunting aspect of the job. Your clients come to you for help, but they may not know exactly how to deal with it. 

Navigating tough sessions with demanding, silent, or resistant clients in therapy requires more than just professional expertise — it involves patience, understanding, and a strategic approach. 

If you’ve been struggling to cope with a client, keep reading for effective strategies and tips that will help. Understanding and implementing the right techniques can enhance your effectiveness and ensure you maintain a positive therapeutic relationship.

1. Resistant clients

A quintessential example of a resistant client would be someone who’s nudged or forced into seeking help. Characteristics of a resistant client might include someone not believing they need therapy or resisting help because they fear vulnerability and want to avoid delving deep into painful emotions or past trauma.

Resistant clients in therapy can be skeptical of therapeutic methods, which makes progress difficult since successful treatment requires active participation from both ends. Research demonstrates the importance of identifying and understanding the root cause of resistance. 

Tips for working with resistant clients

• Nurture trust: Fostering trust is crucial when dealing with resistant clients. Creating a safe space where they feel understood rather than judged paves the way for better communication and cooperation.
• Use motivational interviewing techniques: Motivational interviewing can enhance motivation and improve the therapist-client relationship. Here, you explore ambivalence about change, which can lead to increased willingness to participate in the process over time.
• Practice patience and persistence: Last but certainly not least comes patience. It’s not uncommon for people to have past experiences that shape their attitudes toward therapy. Engaging clients in therapy may take some time. Your job as a therapist is to be patient and exhibit empathy, coupled with persistence, as you work to break down the characteristics of a resistant client and eventually help them find meaningful change.

“Allowing clients to tap into their own emotional motivation, creates opportunities for change. Begin with respect and trust to foster more interest in a therapeutic alliance. I often let my new clients start us off to encourage rapport, “I know it’s not easy to open up to someone unfamiliar-tell me how I can best support you with what might be causing stress?”

– Talkspace therapist Elizabeth Keohan, LCSW-C, LICSW, LCSW

2. Demanding clients

Demanding clients often have high expectations or expect immediate results from their sessions. A typical scenario might involve a client insisting on all their problems being solved within one therapy session or hoping you will provide solutions without them having to participate. This behavior can undermine the therapeutic relationship and hinder progress toward your treatment goals. 

Tips for working with demanding clients

• Set boundaries: The first step when dealing with demanding clients is immediately setting clear boundaries. This step is crucial to managing expectations by communicating what therapy can achieve.
• Open communication: Fostering an environment where open communication is encouraged helps alleviate tension and promotes better understanding between you and a client.
• Keep boundaries in place and practice self-care: Self-care for therapists plays a vital role in managing the stress of challenging clients. Taking regular breaks between appointments and engaging in relaxing activities outside of work significantly reduces the potential for therapist burnout. Develop strong support networks within your professional community so you have an opportunity to share experiences and get advice as you navigate difficult situations and clients. 

“Demanding clients deserve no less empathy and understanding but it sure can be tough when someone is not respecting limits and boundaries. Keep an eye on goals and a clear path to get there, otherwise it can be easy to feel like sessions are usurped by tension or unreasonable demands. Highlight understanding, identify goals and be honest about the timeframe to get there-bear in mind, that therapy can be a great place to practice respect for personal relationships.”

– Talkspace therapist Elizabeth Keohan, LCSW-C, LICSW, LCSW

3. Silent or withdrawn clients

Dealing with silent or withdrawn clients can be particularly challenging. It can help to remember that quiet clients may find it hard to express their thoughts and feelings, leading to minimal interaction during sessions.

The reasons behind this behavior could range from anxiety or depression to a history of trauma — it might even result from personality traits. It’s important to understand that silence might indicate deep internal processing.

Tips for working with withdrawn clients

• Create a safe place: Safety and trust are paramount when working with quiet clients. Showing patience and empathy helps them feel understood on their terms, eventually encouraging communication.
• Use open-ended questions: Rather than asking yes-or-no questions, open-ended queries are generally more effective. They allow space for self-expression comfortably without feeling pressured into immediate responses.
• Try alternative therapy techniques: Don’t be afraid to think outside the box. While more needs to be done to determine the extent of efficacy, research suggests that art therapy can reduce adverse psychological outcomes — thus, incorporating innovative techniques like art therapy or role-play might provide opportunities for self-expression, which can be especially beneficial when dealing with withdrawn clients.

“It is human nature to need comfort in order to feel at ease with someone but therapists can’t read minds. It’s important to explore feelings, and examine the possibility of something changed or triggered within the therapeutic space if a client withdraws. It’s ok to say, “Let me know what you’re feeling about what we are talking about”. It can be easier for someone to process if they can acknowledge an active listener who is there to support the hard stuff.”

– Talkspace therapist Elizabeth Keohan, LCSW-C, LICSW, LCSW 

4. Manipulative clients

As a mental health professional, you will commonly encounter clients who try to control or steer the therapeutic process in their favor — these are often termed “manipulative” clients.

Manipulative motives can make progress in therapy extremely challenging. A manipulative client might consistently change topics the second an uncomfortable issue arises, or they might try to gaslight you.  

Tips for working with manipulative clients

• Share your observations: A good starting point when dealing with manipulative behavior is openly communicating observed patterns without being accusatory. Try using statements like: “I’ve noticed our discussions tend to veer away from the main topic.” This encourages self-awareness without putting anyone on the defense.
• Set expectations: Prioritize clear expectations at the start of every therapy session to keep conversations focused.
• Be prepared to refer them to someone else: If the manipulative behavior continues despite your efforts, you might need to refer a client to another therapist who specializes in this behavior.

5. Unreliable clients

Unreliable clients can be self-destructive and thwart progress. They may frequently miss appointments or show up late without any notice. They also might fail to complete tasks assigned between sessions. 

The erratic behavior exhibited by these clients offers unique counselor challenges. It can disrupt flow and make establishing a consistent treatment plan difficult, hindering progress toward achieving mental health goals.

Tips for working with unreliable clients

• Create clear expectations: Outline expectations when scheduling, showing up, and completing assignments.
• Leverage digital tools: In an era where technology is so accessible and affordable, sending reminders about upcoming sessions or tasks that are due is simple. Email notifications or text messages can be helpful — for Talkspace providers, this is done for you. We’ll send your clients automated reminders before sessions.
• Communicate effectively and often: Establishing an environment where open communication thrives is essential when dealing with unreliable clients. If you’re trying to cope with a client’s irregular attendance patterns, have a conversation with them about what’s causing the disruptions.

6. Knowledgeable clients

This personality type comes to sessions prepared with vast — often self-taught — information about mental health and therapeutic methodologies. Their knowledge base is typically gleaned from extensive reading or internet research.

This deep dive into self-education can sometimes create an imbalance in the therapist-client relationship. The client’s knowledge may lead them to question your expertise and recommendations.

Tips for working with knowledgeable clients

• Use tact and respect: Navigating sessions with well-informed clients requires tactful communication and mutual respect. As a mental health professional, acknowledging your client’s understanding can be a balancing act while maintaining your role as a guide through their healing journey. Affirming statements like “Your investment in learning more about this issue shows great initiative” might help.
• Take time to explain the process: If they resist specific interventions based on prior knowledge or misconceptions, explain why you recommend the strategies.  

“Being professional does not mean being perfect and sometimes compassionate care requires some level of humility. It is more than ok, to offer perspective and space for clients to gain a better understanding of what they have self taught; this allows a space for learning and a growth mindset both as a therapist and a client.”

– Talkspace therapist Elizabeth Keohan, LCSW-C, LICSW, LCSW 

7. Suicidal clients

Dealing with clients who are having thoughts of suicide is undeniably one of the most challenging aspects of any therapist’s job. These clients often grapple with intense emotional distress and may feel a sense of hopelessness that can be difficult to navigate. Their thoughts might be consumed by ending their pain, making it difficult for them to focus on therapeutic strategies that can ultimately improve mental health.

The unpredictability associated with these clients adds another layer of complexity to treatment. They might show up inconsistently or exhibit erratic behavior during sessions. This unpredictable nature makes establishing trust and building a therapeutic relationship even more challenging.

Tips for working with suicidal clients

• Have a crisis plan in place at all times: When working with a client who’s having thoughts of suicide, safety takes precedence above all else. You must ensure they have an updated crisis plan that outlines steps to take if there’s a sudden deterioration in condition and you need to get them immediate help. 
• Create a safe place for expression: Encouraging them to express their feelings freely without fear might help alleviate some of the immediate pressures they’re experiencing.
• Have local resources readily available: Familiarize yourself thoroughly with local resources, including emergency psychiatric services or hotlines that offer immediate assistance outside therapy hours when needed.

Improving Your Practice Overall

Even though it can be hard in the moment, remember that the challenges you face with some clients can be overcome with the right strategies. From working with resistant clients to demanding clients, to silent, withdrawn ones, you are sure to encounter a tough case at some point — but remember, every difficulty is an opportunity for growth for you and your client.

If online therapy is your platform of choice, don’t let these challenges deter you from significantly impacting people’s lives through virtual counseling sessions. Our platform makes it easy for you to navigate even the most difficult patient dynamics effectively so you can enhance therapeutic relationships and outcomes for every client you work with. Learn more about becoming a Talkspace provider today.