Choosing to End Therapy with a Difficult Client
I recently concluded working with a therapy client* because I did not like working with her.
I agonized over the decision for a long time - MONTHS.
Who was I to conclude just because I found her to be an abrasive, difficult client?
I sought supervision.
I consulted with fellow therapists.
I spoke with my own therapist.
I took additional continuing education on subjects related to the client.
I gave it time and patience.
When she started therapy, I noticed she had an intense presence. Her intensity increased over time and oppositional behaviors emerged. She would mock me, use unkind sarcasm, make passive aggressive remarks, directly criticize me, and more. I knew these behaviors had nothing to do with me, but they were still difficult to weather.
I sought counsel and education from multiple sources. I tried many different strategies and methods for therapeutically addressing her behavior, which sometimes involved strategies of ignoring the behavior. It became a marathon of deciding when to address and when to let something go.
Every effort I made to improve our therapeutic work together failed. Her behaviors became worse with time. It was exhausting.
I knew some therapists would say that she just needed more time, patience, and understanding to experience growth.
However, I did not want to be the therapist to do that work. I did not want to subject myself to more of her behavior. As a therapist, my needs also matter.
I questioned the validity of ending therapy for such a reason.
To end therapy to protect myself.
To end therapy for my benefit.
I tried to improve, in all the ways I previously mentioned.
But it just got harder and harder.
I finally decided I had enough.
And, that it was ethical to do so.
The number one predictor of therapeutic success is the therapeutic relationship.
If I did not like working with the client, I knew that had to impact the quality of the relationship, no matter how much I tried to hide it.
Furthermore, I was clearly not helping. It was in her best clinical interest to work with someone with a different set of skills.
And so, I finally had the concluding conversation with her. I was terrified.
I even debated providing a therapeutic lie (lying because it is in her best therapeutic interest).
However, that was not in alignment with my values and I decided to tell her the truth: I did not have the skills to help her reach the goals she wanted.
I am proud of myself, for it was a very difficult decision to make.
As a therapist, situations such as these are some of the most challenging aspects of being a therapist. In conjunction with the cultural therapy norms of martyrdom mentality and the invisible therapist myth, it can be easy to slip into shame for centering my needs.
In contrast, as I wrote this essay, it became clearer and clearer that I acted with integrity and made the best possible decision. Furthermore, I am choosing to share this experience because I think these are the kinds of topics we need to discuss more openly in the mental health field.
*I have altered information to protect the identity and confidentiality of this individual