Exploration of Therapist Characteristics and Therapeutic Models for Work with Difficult Clients

Keywords: difficult clients, resistant clients, therapeutic skills

Abstract

Throughout a therapist’s career there will be some clients who challenge clinical skills more than others. For example: these clients may appear to not want to change, they may continue in maladaptive patterns of being in the world or may dispute their responsibility in management of their life. These individuals are often referred to as difficult or resistant clients. These clients challenge the skills and patience of the therapist in ways which can cause the clinician to break or to grow. It is beneficial to explore both the influences of the therapist’s characteristics, such as their preconceived ideas, lack of knowledge or understanding, which may elicit or perpetuate the resistance in a client, as well as effective clinical approaches to address such situations. This paper demonstrates with a case study the application of five theoretical approaches. The difficult client in the case study struggles with external locus of control and unrealistic expectations which are addressed through the therapy.  

References

Asmundson, G. J. G., Thorisdottir, A. S., Roden-Foreman, J. W., Baird, S. O., Witcraft, S. M., Stein, A. T., Smits, J. A. J., & Powers, M. B. (2019). A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder. Cognitive Behaviour Therapy, 48(1), 1–14. https://doi.org/10.1080/16506073.2018.1522371
Berger, M. (2004). Motivational Interviewing: Preparing people for change/ therapy with difficult clients: Using the precursors model to awaken change (Book). Journal of Psychiatry & Law, 32(2), 229-231.
Captuo, A. (2004). Client’s perception of resistance in counseling (0-612-96249-0) [Doctoral dissertation, University of Alberta]. Library and Archives Canada, Published Heritage Branch.
Cladder-Micus, M.B., Becker, E.S., Spijker, J., Speckens, A.E.M., & Vrijsen, J.N. (2019). Effects of mindfulness-based cognitive therapy on a behavioural measure of rumination in patients with chronic, treatment- resistant depression. Cognitive Therapy & Research, 43(4), 666-678. https://doi.org/10.1007/s10608-019-09997-8
Claiborn, J.M. (2001). [Review of the book Treatment for Chronic Depression: Cogntiive Behavioral Analysis System of Psychotherapy, by J. P. McCulloh & M.R. Goldfried]. Journal of Psychotherapy Practice and Research, 10(2), 136-139
Clark, D.A. (2014). Cognitive restructuring. In Stefan G. Hofmann and David Dozois (Eds.), The Wiley Handbook of Cognitive Behavioral Therapy (1st Ed., 1-22). John Wiley & Sons, Ltd. http://doi.org/10.1002/9781118528563.wbcbt02
Evans, J., & Parry, G. (1996). The impact of reformulation in cognitive-analytic therapy with difficult to help clients. Clinical Psychology & Psychotherapy, 3(2), 109-117. https://doi.org/10.1002/(SICI)1099-0879(199606)3:2<109::AID-CPP65>3.0.CO;2-U
Griffith, L.F. (2003). Combining schema-focused cognitive therapy and psychodrama: A model for treatment clients with personality disorders. Journal of Group Psychotherapy, Psychodrama & Sociometry. Winter, 128-140
Hanna, F. J. (1996). Precursors of change: Pivotal points of involvement and resistance in psychotherapy. Journal of Psychotherapy Integration, 6(3), 227-264.
Hannah, F. (2001). Therapy with Difficult Clients: Using the precursors model to awaken change. American Psychological Association (APA).
Kottler, J.A. (2013). Compassionate therapy: Working with difficult clients. International Psychotherapy Institute E-Books.
McCullogh, J.P., & Goldfried, M.R. (1999). Treatment for chronic depression: Cognitive behavioral analysis system of psychotherapy. Guildford Press.
McCullogh, J.P., Schramm, E., & Penberthy, J.K. (2016). CBASP as a distinctive treatment for persistent depressive disorder. New York University.
Melaero Centorla, A.R., Yela, J.R., Crego, A., & Cortes-Rodriguez, M. (2020). Effectiveness of a mindfulness-based cognitive therapy group intervention in reducing gambling-related craving. Journal of Evidence-Based Psychotherapies, 20 (1), 107-134. http://doi.org/10.24193/jebp.2020.1.7
Mueser, K.T., Rosenberg, S.D., & Rosenberg, H.J. (2009). Treatment of posttraumatic stress disorder in special populations: A cognitive restructuring program. American Counseling Association. http://dx.doi.org/10.1037/11889-003
Norcross, J.C., & Wampold, B.C. (2011). What works for whom: Tailoring psychotherapy to the person. Journal of Clinical Psychotherapy, 67(2), 127-132. http://doi.org/10.1002/jclp.20764
Otani, A. (1989). Client resistance in counseling: Its theoretical rationale and taxonomic classification. Journal of Counseling & Development. 67(8), 458-461. https://doi.org/10.1002/j.1556-6676.1989.tb02117.x
Probst, T., Schramm, E., Heidenreich, T., Klein, J., & Michalak, J. (2020). Patients’ interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness-based cognitive therapy and a group version of the cognitive behavioral analysis system of psychotherapy in chronic depression. Journal of Clinical Psychology, 76(7), 1241-1254, https://doi.org/10.1002/jclp.22931
Shelton, J.L., & Levy, R.L. (1981). Behavioral assignments and treatment compliance. Champaign, IL: Research Press.
Sperry, L., Griffith, J., & Powers, R.L. (2006). Psychotherapy and medication: Mind-brain strategies for optimizing treatment with difficult clients. Journal of Individual Psychology, 62(1). 70-76.
Taylor, P. J., Perry, A., Hutton, P., Tan, R., Fisher, N., Focone, C., Griffiths, D., & Seddon, C. (2019). Cognitive Analytic Therapy for psychosis: A case series. Psychology & Psychotherapy: Theory, Research & Practice, 92(3), 359–378. https://doi.org/10.1111/papt.12183
Published
2021-11-01
How to Cite
Quaranta-Leech, A., & Zaporozhets, O. (2021). Exploration of Therapist Characteristics and Therapeutic Models for Work with Difficult Clients. Herald of Kyiv Institute of Business and Technology, 48(2), 45-51. https://doi.org/10.37203/kibit.2021.48.07