Transcript for Edge of the couch

Episode title: When you dislike the client

Speaker 1:

This podcast is not training or supervision. This is an invitation to delve into these really big topics. When we are talking about clients, please know it is not you. It is a weaving together of stories that come up over and over again.

Speaker 2:

With Edge of the couch, we are here to create a space to delve into the topics that were either shied away from or dismissed because they were too big, too nuanced, too risky, or too uncomfortable to discuss in school or even supervision. We are two passionate therapists sharing our personal opinions about the therapeutic process.

Alison:

Hi everyone. I am Alison McCleary.

Jordan:

I'm Jordan Paquel, and we are Edge of the couch. Today, we are talking about when you dislike your client; it feels like a juicy topic.

Jordan:

Yes, a little bit vulnerable, a little bit 'what are our peers going to think about this?' For me, am I going to say something wrong or bad where a client's going to think about this; those are just some of the things that are in the back of my mind right now.

Alison:

I definitely notice more than any other recording that we've done before, a bit of a sense of, I hope my clients know I'm not talking about them and there's a worry that I have that clients might go, Alison dislikes her clients? Does she dislike me?

Jordan:

Yes.

Alison:

But also realizing that we have to talk about it because it happens, so we have to name it.

Jordan:

That deep breath when you see your schedule and go, ooh, should I have such a big day? Those are tough subject matters, or we don't gel as well. Then I think about, oh no, does my therapist think that of me? See me on the schedule and then go...

Alison:

Oh God, here comes Jordan.

Jordan:

Yes.

Alison:

There are all these layers to it now that we're peeking behind the curtain. It's not always pretty back here being a therapist. 

Jordan:

We're human. That's the ultimate thing, and the idea that we're this blank slate is untrue. We need to acknowledge what is here.

Alison:

As people, we don't like all people. I don't love a hundred percent of the people that I meet in my personal life either. I don't get along with everyone, or there are people I meet organically, and I dislike them. There are clients that I meet, and we work together, and I don't like them.

Jordan:

Yes, let's get into it.

Alison:

Okay. It does happen super rarely of the many clients I've had, and it's a lot. The clients that I have disliked, I can only really think of three.

Jordan:

Yes.

Alison:

So it isn't happening a lot because it hasn't happened again. It's not happening now. It hasn't happened recently. But in hindsight, I should have asked myself these questions, and I just didn't know to ask them back then. But now I know to ask a question like, is the fact that I dislike this client clinically relevant? Does it feel connected to something bigger that is going on for the client, a pattern they're familiar with in relationships, or is it countertransference? Is the presentation of this person scratching at some stuff that I have in my own life, wounds or relationships? If you can ask yourself those questions and reflect, I think then you have a better sense of what the next step should be.

Jordan:

Yes. It rarely happens. Rarely do I go; I dislike this person because that's a global judgment. That's not something that I think or feel. It's more about parts of me that pop-up. Moments, so common.

Alison:

Is it common to have moments or slices of it? Yes.

Jordan:

It's rare to have that sense of, I don't like this person, but very common to have these moments of feeling frustrated or feeling irritated or my own stuff is coming up, and I can feel a little bit of heat here.

Alison:

What's a common time that you notice that?

Jordan:

This is usually in the first few sessions. So it's not something that happens on an ongoing basis or maybe it does. I don't know. I'm not thinking of anyone in particular when I say this, but I know what it feels like. I am in session with somebody. They bulldoze me because I'm pretty good at interrupting. If somebody is continuously talking, I know that I need to interrupt, so I will interrupt, and they just bat it away. Then at the end of the session, say, this wasn't very effective.

Alison:

Right, because they treated you as if you were just like a sounding board.

Jordan:

And then they are frustrated with me.

Alison:

Right.

Jordan:

To me, that's also therapeutically relevant.

Alison:

Sure.

Jordan:

That's something that they probably do in other relationships.

Alison:

Yes.

Jordan:

I mean, there's a little bit of my stuff. What's coming to mind is a story of a colleague of mine. When she told me about it, I said to her, hmm, there's some energy around this. Then she came back to me and said, I thought about what you said, and I think it's ageism because I grew up in a culture where you respect your elders. Being younger than the client, she is bulldozing you because you're supposed to respect your elders. That's why she wasn't listening to me. If this were coming from a younger client, it would be fine. We could work through it. Those are things to be aware of and to name.  

Alison:

Sometimes you don't know they're a thing until they're a thing.

Jordan: 

Yes. 

Alison:

Yes. This isn't going to irritate you until you're with a client who's doing it. Then you're noticing how irritated you feel.

Jordan:

Yes.

Alison:

I do have these distinct three clients in my mind, all of whom mistreated me, so I feel like that's a huge part of it. I think it comes up more like that slice that you're talking about, like these moments versus a global dislike of a person. I'm just learning about this in psychodynamic psychotherapy. The course I'm in right now has a defense that is about help avoidance and helplessness - that kind of helpless sense of nothing will work. It doesn't matter what you say or what suggestion you offer. I've tried everything, and nothing has helped. The first time it happens. The second time it happens. The third time it happens. I'm rolling with it. I'm in empathy. I'm saying it's hard to change. It's hard to shift, but when you're in, say, session nine and a client has refused to do anything. I've had a session like this; again, I think it's clinically relevant, so it's good to name. I named to the client that I'm feeling so frustrated with you right now because I realize that everything that I'm suggesting to you, you're shutting down before you've even had a chance to consider it. What are you getting out of this?

Jordan:

You named it with the client and that immediately takes some power out of it and power to it in terms of therapeutic power.

Alison:

It's a delicate dance, right? When we're in therapy, we're always being of multiple minds - present and hearing where the client is at and then also backstage; what is going on here? Should I name it? When do I name it? How do I name it? That has always a bit of a delicate dance, but there's so much power in naming. This is what it's like to be in a relationship with you to the client. Do you know that?

Jordan:

The relationship is the vehicle for change.

Alison:

A hundred percent.

Jordan:

The way we relate with our therapists is often how we show up in our other relationships. So it's very clinically relevant. You bat me away when I try to connect with you; that is something that probably comes up in other relationships. We should talk about that.

Alison:

Then you're tasked with the next step, which is, do I bring it up in therapy because it's relevant and useful? Or is it really about, I can't work with this client? I can't serve them well.

Jordan:

Yes.

Alison:

Because there's something there, whether I find them frustrating, I feel dismissed by them; there could be no one in this seat. You're not doing therapy with that person.

Jordan:

I like to name there, that there's a part of you that keeps coming. So I'm so curious about what's going on with that part of you. They're also frustrated. That's another piece - that it's easy to ally with them when you're both frustrated versus somebody who really is completely unaware of the fact that they're bulldozing you and then feeling frustrated with you.

Alison:

Naming that takes me back to the situation I had with a client who to this day, when I think about them, I have an embodied, visceral dislike. I'm going to name it. I probably wouldn't know them if they walked by me in the street because it was seven years ago. I was in practicum. It was more about the feeling and just how, first of all, they treated me like garbage. When you're a practicum student, you don't have a lot of say necessarily. I talked to my supervisor about it, but there was no option. I had to keep seeing this client and every session, the client would say, I'm not getting anything out of this. Why are you coming back? We would have this conversation, like, what are you getting out of this? Nothing. Well, then please don't take advantage of your 12 free sessions. This person attended every single one of those 12 sessions and wrote me horrendous feedback on the feedback form. I felt like he was coming to therapy just to have an outlet for being mean to someone.

Jordan:

Which is clinically relevant, but you don't have to take that.

Alison:

Now, I would not. I would say, I can't be your therapist, this isn't working. But when you're in a practicum, you're not giving me what I want and I'd be like, great; here are the resources that will, but it wasn't that he was; there was something kind of sick that he was getting out of it. If you have power over that, don't keep seeing that client just because it's clinically relevant.

Jordan:

Oh, I just have so much compassion for practicum student you, who's really trying her best.

Alison:

Yes, but let me tell you what, by those last couple of sessions, I was not serving that client well. I had surpassed the place of empathy and taking it. I got combative, essentially. He would call me stupid and I would just say, okay, well, I'm too stupid to understand what you're saying. I definitely got to a place where it was not good therapy. It was not me and my best self. Also, a good reminder. If you are showing up in a way that is not consistent with how you show up, there's something about the client and you need to slow down and go, what is going on here? I did not show up as my best self in that relationship. Do I regret that? Not at all. I think that the well had run dry in terms of patience with that. But check in on yourself, if you finish the session and you're like, oh, that tone I was using is not normal for me. How insistent I was about something; my mind wandering how annoyed I felt. That's data.

Jordan:

Yes, and knowing which populations you can't work with, like you said, you learn as you go. Oh, I'm learning that this is something that brings up stuff for me. For me, one of the only things is working with misogynist men who aren't coming to therapy to work on that. If they're coming and saying, I have stuff with women, and I really need to work on this, then I love doing that work. But people who are depressed or anxious and clearly hate women, and I can feel it in our relationship, which does not happen anymore to me. I mean, one, I'm not taking on new clients, but also my profile is no longer on Psychology Today. On Psychology Today, people would see your picture and go, oh, she does CBT, according to this list. During the consultation, they would say something like, I saw something about your profile that resonated with me. But you know, I don't know about this feminist stuff. I can be really clear about who I am and the way that I work, and they can decide whether or not they want to work with me and those folks; there would be a problem here. They don't book.

Alison:

There's something that can sometimes happen. A client will fire themselves because they'll get to a point where they don't want you anymore, and they've gotten to a point where they're sick of you. However, you have to say, oh shoot. Okay and then they fire themselves, and you have an embodied sense of relief, like, oh, that's nice. 

Jordan:

That sucks. 

Alison:

Does it? What's lucky about that?

Jordan:

I know that feeling, but I don't like that, that is the thing that has to happen. You know? I feel bad for those clients. Even just thinking about if I knew that my therapist felt relief because I stopped being their client. Oh, that feels sad.

Alison:

To defend that a little, because I don't feel the same ickiness around it. Rarely have I had the experience with those of the clients who are doing the work. Almost always, they are clients where it's not clinical stuff that is problematic. It's how they treat me or how they talk to me. I would love to be able to serve every client who walks through my door, but if you're going to treat me like I'm stupid, then I'm not going to be sad when you leave.

Jordan:

It's interesting because you're a pretty straight forward blunt person, but to like feign, Oh no; feels like, huh, what is that about and so I wonder about boundaries.

Alison:

I think that, oh no is about how back when that used to happen to me; because again, it has been a long time, the ethics around it is that you can't do a good 'get out!' or bridge them to the next referral source, but if they fire themselves, you don't have to do that.

Jordan:

I guess now I'm thinking of someone where that happened and there was a relief. Usually, it's because I don't feel like it's safe enough that they wouldn't be able to hear it and then it would be damaging. As we get more experience, it's easier for me to say earlier in the beginning, I don't think you're getting what you need to get. I'm wondering if I can connect you with another counselor to maybe do the work you're trying to do. 

Alison:

That's such a nice way to do it.

Jordan:

Early on, I wasn't getting clients that were the right fit, I was just taking on whomever. There's that whole sense of being a beginner counselor and feeling like I was always at the client's whim. Oh, I'm coming in on weekends, when I don't want to be; Oh, if you don't show up, I'm just going to be like, okay, fine. Let's rebook and not charge you the fee. Somebody is bulldozing me or mistreating me. There are steps that we can also take ourselves so that doesn't happen.

Alison:

Everyone has to go through that stage, I think, to some degree of when you're bending over backward, because you're trying to build your practice and then you end up with all these clients who are not the type of client that is on your list of ideal, presenting problems. Maybe it's not just a rookie mistake because I still know therapists who've been in the game for years and are doing stuff like that. Don't take that client. Don't do it.

Jordan:

Well, you're in a rural setting and so I think that's important too. In Vancouver, the city, there are so many different niches and micro-niches. It's really easy, well, maybe not so much right now with the pandemic; everyone's so full. There's such a high demand. I can just refer you on to three other people and they would take you on and maybe it would be harder right now knowing that it would be really hard for them to get services.

Alison:

Two of the clients I'm thinking of live here locally. One of them, I would have actual fear of seeing them around town because of how everything went down. I usually celebrate seeing my clients but then there are these specific people where I'm saying, I hope to God, I never, and I haven't, I don't even know if they live here anymore.

Jordan:

Violence against therapists is a real thing.

Alison:

Yes.

Jordan:

Just because we have this therapeutic container and can talk about everything does not mean that we are protected from harm.

Alison:

Yes, and the one client that I disliked was the only time that I've ever had to say, get out of my office. You have to leave.

Jordan:

Didn't you feel physically?

Alison:

Yes. I felt very scared. Suddenly it dawned on me, there was no one else in the building. I didn't have a panic button. No one will hear me if I scream and this person had already gotten into legal trouble for assault. I definitely had this moment standing behind my desk. This is not a safe situation.

Jordan:

And see to me dislike, you felt in danger.

Alison:

But I disliked this client even before that moment.

Jordan:

Yeah.

Alison:

The fact that that happened made me scared of them but even before that happened, I had a gut sense that there's something about this person. Then, I've had more people storm out of my office than any other therapist that I know.

Jordan:

I love how you wear that as a badge of honor.

Alison:

It's a stylistic thing. I (inaudible) to the here and now very intentionally and none of those clients are the people that I'm thinking of. Storming out of my office doesn't even make me dislike you. It just makes me go; good for you.

Jordan:

When somebody says, I am not getting something from this, or I don't agree with that where I'm like, yes, that means you feel safe with me. That means we're getting somewhere and it's therapeutic growth for you to say this to me. So I wouldn't say that if somebody is not completely deferential, I don't like it. No, it's not that at all. It's fundamental disrespect as a human being.

Alison:

Sometimes it's the clients that you get referred to based on what they're coming for. For example, I think about my teenage clients a lot whose parents will say, Oh, they're a handful, and so I expect, ooh, am I going to like this client? Then they show up, and I adore them.

You're right. It's not even presenting problem. It's not them calling me out that I dislike because I like that. It's something else; it's countertransference. It's personal. It's something that is unnamed, I don't know, substance or element or energy but I also just want to normalize therapists disliking their clients.

Sometimes from time to time concerning unconditional positive regard (this is so controversial) I just don't know if we can always unconditionally have positive regard. That person in my practicum who treated me like I was actual garbage. I'm sorry, I do not have unconditional positive regard for that person. The day that he left, I said, thank God.

Jordan:

That person shouldn't have been your client.

Alison:

No, obviously not. Other people could have unconditional positive regard for him and that's great, but now that I'm many years into this, I don't hold myself to that same standard of unconditional positive regard.

Jordan:

I only take clients where I can feel some element and when we talk about gut sense, there are times where the first impression is, hmm, I don't know if this is going to work for whatever reason. Whether it's something that they said that I'm extrapolating, that it's going to be this issue or there's just this gut sense of we're already out of sync and then three or four sessions later, Oh wow, I really enjoy being with this person. So I also don't want to completely write off someone because they made one offhanded remark.

Alison:

Sure.

Jordan:

I'm cautious or curious and we'll see how it continues to go. Most often, the relationship evolves where I really enjoy this person or at least I can recognize that the parts that are challenging, I can understand. 

Alison:

Then there are clients where, when you named them, hey, this is what I feel like is going on in our dynamic; they can go there with you and do the work and go, oh, I've heard that from other people before and then you can get underneath whatever it was that was on the surface that was pushing you away. What you disliked, you can swim through or get under and come over to this much more tender version of them.

If the client won't go there with you, knowing yourself is huge, as the therapist. Knowing what feels safe, what feels comfortable, how you know if it's been a good session or a weird session, how much time you're willing to invest in someone's counseling, when you feel like it's not working, all of those things are going to be different for each client. You think about some therapists who work with really challenging populations, where they expect the first 20 or 25 sessions to be rocky. That's normal. In a private practice like mine, I expect session three, session four, to feel closeness.

Jordan:

You deserve respect as a human being. You shouldn't have to work with disrespectful people or somebody that something comes up and you paint them. You have that global judgment of you're a bad person. You don't want to work with that person.

Alison:

Yeah.

Jordan:

That's something to notice. There's something like, I really don't like this person. They rubbed me the wrong way or there's something about them that is bringing up stuff and disrespectful. Those are all things that maybe you could work with. You don't have to, but can. I get super triggered. I feel unsafe or I think that they're a bad person as a whole.

Alison:

These three people I'm thinking of are the only people that I have ever had the experience of being like, I don't know if they're a good or nice person, because generally, I work from a place of believing that there aren't bad people. Everyone is just responding to whatever life has handed them and then I have this situation with these three individuals.

Jordan:

Yes. Can you look at it through a trauma lens? Is there any trauma there?

Alison:

Yes.

Jordan:

That's where I went automatically.

Alison:

This person that I'm talking about from my practicum met the criteria for delusional disorder. So he was already struggling with that. Then this separateness just believed women were stupid. Maybe you learn that, but that almost feels like trauma to some degree. Oh, he had stuff. I was not equipped to handle his stuff. He also treated me like garbage. The person who attacked me in my office verbally attacked me and I had to say, get out, definitely had stuff. I was trying to be aware of their stuff because they were in their stuff. They flew off the handle and it got unsafe for me, but this other person. So in those two, I can go like, yeah, they had stuff. This third person though, it was the only time where I felt they were using me to some degree to kind of play out this very strange dynamic. They would constantly say things like, I know you have feelings for me and I wanted to say, you literally repulse me. I had the opposite reaction to you where I hate when you come in here. It got to a point where I had to say, if you're going to continue to do sessions, I have to record them. I don't feel comfortable with how stuff has gone down here and he's saying stuff like, I know so much about you. Then say these things that were not true about me and it put me in this place either defending it or couldn't do the work when I would go under it to say, something's going on here? What is this? Well, you have feelings for me and it's so obvious and I was just, no.

Jordan:

For me, coming from anti-violence, to me that feels unsafe and maybe that's unsafe situation. Maybe it's vicarious trauma working with so many people who have been harmed by men's violence. That kind of stuff is immediate no, for me.

Alison:

Yes.

Jordan:

For some people that is a therapeutic issue. There are probably people that could work with that person. I'm just not that person. I would feel unsafe with that person. Yes. I wouldn't be able to work with that person.

Alison:

No, me neither. I recently had to go back through some client stuff to send an email and I saw their name pop up just because I had to go back into my client files and I literally had a bad feeling, which is not good.

Jordan:

Yes. No, it's not good, but it's something to be aware of and acknowledge.

Alison:

Super vulnerable in today's episode because I know that I'm naming things in a really distinct and big way. This is how I felt and there's no nuance in those moments. I'm not being like, and I kinda, I was like, no, I only felt this way. But if we don't normalize these experiences as therapists, these experiences just go underground and then people feel shame about it.

Jordan:

Yes.

Alison:

Am I bad for disliking my client who is making me feel X, Y, Z and so for me it feels...

Jordan:

You feel that now?

Alison:

No. I don't feel that.

Jordan:

Okay.

Alison:

I don't feel I should. Maybe I should feel more of it, but I worry that new therapists have that sense of, am I allowed to dislike my client? I feel bad if I do. I think if older therapists and therapists who've been in the game longer can name when it happens because I never remember a time in my training or early experience where an older, more experienced therapist was telling me about a time when they disliked a client. Yes, so when I disliked a client, I didn't know what to do. I felt bad.

Jordan:

Yes.

Alison:

I probably stayed longer in some of those dynamics than I would have if someone had normalized to me that you're allowed not to like your client and explore it and what it means and find out if you should end that relationship earlier.

Jordan:

Yes.

Alison:

I just wish someone had said that to me. So I'm naming it because I'm hoping there are people out there who need to hear it.

Jordan:

I need to learn how to do this as a therapist. I need to work on my unconditional positive regard.

Alison:

It's easy to internalize.

Jordan:

Hmm, no, you're human and there are some important information here, whether it's therapeutic or just this direction or it's my own stuff that I need to look at it or it's some decision-making that I need to come up with about your safety plans or to refer this person on.

Alison:

Totally.

Jordan:

We're naming gender misogyny and as women therapists, that's something that comes up. We're talking about with men. It does come up with women, but the dislike only comes up when I'm talking to men who are misogynists.

Alison:

Me too. Yes, it's mostly men. What is that? So interesting.

Jordan:

I'm a woman and it feels personal. As somebody who is a woman of color and a mixed-race person; somebody who is white-passing to some people, I will have white clients try to collude with me in their racism.

Alison:

Yes.

Jordan:

That is my disgust rage feeling. I just feel hurt. I feel rage. I feel disgusted. I feel frozen. That is not a good situation for me to be in and if you're a white client working with a BIPOC counselor, we live in a white supremacist society. I understand that that's something that comes up, but it's the colluding, for example, you know, Brown people, right? Then I want to burn everything down. It makes me angry and so that's something that for me, I have learned that I want to identify myself early on to situate myself so that people can know who they're talking to so that when their racism comes up, this is the relationship that's happening and we can talk about it. You know, we're talking about race, we're talking about gender. I'm sure that there are other pieces around how we show up.

Alison:

That absolutely happens as a white therapist, white clients saying things to me that they assume I'm going to agree with them about because I'm also white and I also feel disgusted in those moments. That's where like again, split-brain listening to the client speak, then also be in the back. Do I circle back to that? Do I make it clear that I disagree being cisgender, being straight-passing, being white? The things that white clients, CIS clients, straight clients will think that you're going to agree with them about are sometimes shocking. How do you know that I'm not that thing? It's just very bizarre, repulsive and disgusting.

Jordan:

That's the rage, disgust or dislike where anytime it feels like the client is not treating me like a person; maybe they know that I'm a woman of color and they're still talking about women of color in these fetishized ways, there's misogyny and racism. That's when I'm like, oh, you don't see me as a person and the way that you're treating me is like, I'm not here. That is a moment for me that I need supervision. I need to look at my own stuff and I need to decide, do I bring this up? Is this a therapeutic issue? Do I need to refer this person on?

Alison:

I'm so glad that you brought up supervision. I hope that whoever's supervising you is a safe person that you can go to and say, I'm feeling these things about my client or my clients had these racist things and I don't know what to do. I need to talk about it. I felt rageful, or I felt fill in the blank. This is where peers can be so huge. Looking to peer support and talking to other therapists who are not your supervisors, but in your network, whatever they are, because this is where we need to do our work and know our stuff. We need to know what is acceptable to take on in therapy. What is not, what our boundaries are and I think by talking through it with other people, we get so much better at knowing ourselves and how to show up. Private practice is like you're floating on a little island by yourself and you can get so stuck in what you do and what you take, what you accept from clients. Then you speak to another person, another therapist who is saying, don't do that. You don't have to take that. Speaking to other therapists, speaking to your supervisor is huge.

Jordan:

There are some therapists that may say, oh, you feel dislike, refer out. We're saying it's so much more complicated than that. It's either refer out or I never disliked my clients.

Alison:

What?!

Jordan:

We have the full range of human emotion towards our clients because we are full human beings and that's how it should be. It's more about, okay, what do we do with these feelings? But to cut ourselves off from any emotion that comes up with another human being is probably going to be a therapeutic issue for us in our own counseling.

Alison:

Yes. Is that a thing that comes up for you in other relationships? Talk about patterns. How often are you pretending like you are not upset with people in your personal life? I lean so heavily to the other side where I'm saying, I want to be able to talk about disliking my clients in that moment, disliking them again in totality; super rarely, but yes, frustrating moments. We want to hear what people think.

Alison:

Yes.

Jordan:

I feel like this is going to bring up stuff, so yes, let us know. Send us an email or a DM and we'd love to hear what your perspectives are. We know that it's unique to our own personal histories and the populates we work with and the setting we work in.

Alison:

Orientation.

Jordan:

Theoretical orientation, that's right. Let us know and we will talk to you next time.

Alison:

Yes, we'll talk next time. Bye.

Alison:

Thanks for listening. We'd love to hear from you. Send us an email at connect@edgeofthecouch.com to tell us what you think, ask the question or let us know what type of episode you'd love to hear. You can even send us a voice note for us to play in a future episode.

Jordan:

You can support us by giving us a review on Apple podcast, sharing the show with a friend or supporting us on Patreon. Join us next time at the Edge of the couch.