NYC Psychotherapist Blog

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Saturday, March 23, 2013

Psychotherapists Need to Stop Labeling and Stigmatizing the So-Called "Help Rejecting" Client and Be More Creative Instead

One of the most unhelpful labels that a therapist can pin on a client is the so-called "help rejecting client" or, worse still, "the help rejecting complainer."

Stop Labeling and Stigmatizing the So-Called "Help Rejecting" Client

No matter how a therapist tries to qualify these labels by saying that he or she understands that the client isn't intentionally rejecting the therapist's recommendations or that the client is responding this way out of fear, there's no way around it, these labels are pejorative and damaging to the therapeutic work.  And I can't help feeling that using these labels is a way of blaming the client, making him "wrong" and making the therapist "right."

Generally speaking, clients who are referred to as "help rejecting" are often seen as finding reasons why interventions the therapist attempts in treatment won't work or responding to the therapist's treatment recommendations with, "Yes, but..."

No doubt, when this happens, it's frustrating for the therapist and the client.

Reconceptualizing the So-Called "Help Rejecting Client"
I think it's time that mental health professionals reconceptualize these outmoded labels and begin to "think outside the box."

Better yet, I think we should "retire" the terms "help rejecting client" and "help rejecting complainer" in much the same way we retire certain baseball uniform numbers.  Let's agree to stop using these labels.

I'm not saying that therapists are actually calling clients "help rejecting" to their faces.  It's more of a term used in psychotherapy literature, although I've also seen it written about in certain therapy blogs for the lay public.

Many people might disagree with me, but I think that even if a therapist never utters the words "He's a help rejecting client,"just thinking about the client in this way has the potential to sabotage the therapy.  After all, if the client is "help rejecting" and the therapist's job is to help, what's left to do?

The Client's Fear and Ambivalence
There are clients who are ambivalent about treatment and about making changes.

If you've lived your entire life relating in a certain way and engaging in certain behavior, even if behaving in these ways has caused a lot of emotional pain, it's scary to venture into unknown territory to change.

If a client is afraid to make a change, it's up to the therapist to help the client to feel safe.  The old maxim of "starting where the client is" comes to mind.

This could mean that the therapist might need to get out of his or her "comfort zone" to try something different.  It could mean working in a different way from how he or she would.  This is why it's important to have many different ways of working because therapy can't be a one-size-fits-all endeavor.

It could also mean seeking a consultation with a more seasoned therapist.

In some cases, the therapy might take longer than the therapist and client anticipated.  At times, it might be frustrating for both the therapist and the client.  But the therapist can't go any faster than the client is willing to go.

Engaging the Motivated Part of the Client That Wants Help
Most people understand that, as human beings, we're complex.  Even when we say we want to change, there's often a part of us that doesn't want to change at all.

It's up to the therapist to understand the part of the client that fears change and to engage the part of the client that came in wanting help.

At the start of therapy, the more dominant aspect of the client might be rejecting what the therapist has to offer.  But, usually, underneath the fear and ambivalence there's an aspect of the client that wants to change but doesn't know how.

After all, if a client spends the time and money to come to therapy every week, there must be some aspect of him or herself that wants to change or s/he wouldn't be there.

Therapists Need to Be Creative
Gone are the days when the therapist can take a "neutral stance" with the client.  Good riddance to the days when the therapist sat back and just said, "Uh huh," retraumatizing the client as he poured out his problems!

Therapists need to learn to be creative in their work to help the work come alive.  They need to be a presence in the therapy room rather than being neutral.

Clinical Hypnosis and Somatic Experiencing
There are many creative ways to overcome therapeutic impasses with clients who are ambivalent and/or fearful about change.

I often find clinical hypnosis and Somatic Experiencing to very useful in helping clients to soothe the part of themselves that fears change and connect with the aspect of themselves that wants to change.

Talking about these aspects of self without helping clients to connect to where they're feeling these emotions in the body is very limited.  Talking about it often becomes an intellectual exercise that doesn't lead to actual change.

Helping the client to have a "felt sense" of these conflicting aspects of him or herself makes the therapy come alive in a way that regular talk therapy often doesn't.

Helping Clients to Use Their Imagination
Helping the client to use his or her imagination in an embodied way can open the door for the client to have a "felt sense" of internal and external resources to invoke.

Over time, clients can learn to use these resources to have a corrective emotional experience that wasn't available to them before.  At that point, the client has access to more of him or herself to do the work to make changes.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.  

I work with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.