How to navigate difficult clients in therapy

While there are numerous challenges therapists may face with clients, we’ll focus on seven common types and provide strategies for supporting each. By understanding these client behaviors and knowing how to approach them, therapists can foster a more productive and positive therapeutic relationship.

1. Resistant clients in therapy

Resistant clients often seem uninterested in engaging in the therapeutic process, or they may actively avoid addressing key issues. This resistance can manifest as silence, defensiveness, or deflection of the conversation. To support resistant clients, it’s essential to build trust and demonstrate empathy. Sometimes, it’s helpful to address the elephant in the room head-on and name the resistance. Try using reflective listening techniques and ask open-ended questions to gently explore their reluctance. Understanding the underlying fears or misconceptions that lead to resistance can help ease the client into more active participation.

2. Demanding clients in therapy

Demanding clients may expect immediate solutions or have high expectations of the therapist, leading to frustration when progress feels slow. These clients may frequently ask for advice or push for specific types of interventions. Asking a client what they want to get out of therapy is always a good idea, but particularly so when resistance is an issue.

In addition to setting collaborative goals, it’s important to set clear expectations about the pace and goals of therapy. While addressing their concerns, remind them that therapy is a process, and their active participation is crucial to achieving meaningful progress. Setting boundaries around what can be achieved in a single session is key to preventing burnout and maintaining a productive therapeutic relationship.

3. Silent or quiet clients in therapy

Some clients may not speak much during sessions, leaving therapists to navigate silence or limited communication. While this could simply be a sign of introversion, it may also indicate deeper issues such as fear of judgment or difficulty expressing emotions. Encourage silent clients with gentle prompts or simple questions that invite them to share at their own pace. It's also helpful to normalize silence in therapy, letting clients know it’s okay to take time to process their thoughts. Be patient and avoid rushing to fill the silence, as this can sometimes discourage clients from opening up.

4. Manipulative clients in therapy

Manipulative clients may attempt to control the direction of the session or manipulate the therapist’s responses for personal gain. These clients may shift blame, play on emotions, or attempt to sway the therapist's opinions. It’s important to maintain professional boundaries, assess for risk when needed, and stay focused on the therapeutic goals. Use clear communication to reinforce the purpose of therapy and avoid engaging in any behaviors that could reinforce manipulation, such as allowing them to violate a 24-hour cancellation policy repeatedly. Encourage honesty and self-reflection, but also be mindful of the potential for resistance or deflection. It is also OK to terminate sessions with these clients if boundaries are consistently violated.

5. Unreliable clients in therapy

Unreliable clients often cancel appointments at the last minute or fail to follow through with therapeutic assignments. This behavior can be frustrating and make progress seem slow. To support these clients, it’s essential to discuss the impact of their unreliability on the therapeutic process and set clear expectations about attendance and participation. Offering reminders, discussing barriers to consistency, and involving the client in setting goals may help address this issue. Building a strong rapport and showing that you care about their progress can also encourage more consistent engagement.

6. Highly knowledgeable clients in therapy

Highly knowledgeable clients, whether they have a background in psychology or simply extensive life experience, may appear self-sufficient or resistant to suggestions from their therapist. They may dominate conversations or present themselves as the expert in the room. While it’s important to respect their knowledge, it’s equally essential to guide them back to the therapeutic process. Reinforce the collaborative nature of therapy, reminding them that expertise comes from both the client’s self-awareness and the therapist’s guidance. Use their knowledge as a springboard to deepen the conversation and facilitate more insight into their behaviors and emotions.

7. Suicidal clients in therapy

Suicidal clients present one of the most serious challenges in therapy. These clients may express hopelessness or a desire to end their life, which requires immediate attention and a thorough safety plan. It’s essential to stay calm, non-judgmental, and supportive, while taking their feelings seriously. Acknowledge their pain and reassure them that they are not alone in their struggles. As a therapist, it’s important to conduct a thorough risk assessment, establish a crisis plan, and involve the necessary resources to ensure their safety. If necessary, connect the client with additional support, such as emergency services or a suicide hotline. Sometimes clients will need to be referred to a higher level of care if it’s deemed medically necessary. Ensuring a safe and supportive environment, even in difficult situations, can help the client feel seen and heard during their darkest moments.