 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to Episode 102, I can't believe we're this far ahead now. And this one is all about how to confront clients. That's an interesting title, Jackie. He says, I don't like confrontation, Bob, I never have. Okay, so we change the, let's reframe the word confrontation to challenge. Okay. I mean, no, you can use confrontation, but I think when I think of confrontation, I think that perhaps like a, I know it's a psychoanalytical word when you talk about things, when we talk about things, but I prefer the word challenge because I think it has a softer sort of feeling to it. Yeah. So when you talk about confrontation, I tend to think of challenge. So how do we confront stroke, challenge in psychotherapy? Well, it's an interesting one because if we go back to the contract, now I'm not sure if you do this, I'll be a good, I'll enjoy asking if you do. As you know, non-tracks is pretty central to TA from an adult to adult perspective. So when somebody comes into therapy with me, in the contracting stage, I usually will say, how are you in terms of me challenging you if I feel you're sabotaging yourself or some of your goals and aims are scripted. Okay. I don't do that. No. So usually I get some sort of permission in the process so that they are, well, not the more more they're ready for that, but they also agree from that, from an adult place. So it means that in the challenging, if somehow they, I don't know, they act out, I can say, well, do you remember at the beginning, we were talking about in psychotherapy sometimes, there's a necessity to challenge if I see the therapy going away, which is sabotaging your health or not what you want. Yeah. Which is a very good point. Yeah. Maybe I should do that. One of the things I do say to clients is, how will I know if you're angry with me, which is kind of along the same lines, do you know what I mean? What will I see if you're angry? So are you linking anger with challenge then? Yeah. Okay. So you're linking things like irritation and frustration to the impact of confrontation and challenge from you then? Yes. If I had questioned them or if I've done something to upset them, I would imagine that is a challenge or a confrontation in some way and they would have a response or a reaction to that. Okay. So we sort of, it's in the same ballpark. Yeah, kind of. Yeah. So I always do that so they, because obviously I think part of psychotherapy will demand challenge. Yeah. Because if that wasn't there, it's almost like why do they come to therapy in a way? Yeah, because when they're stepping out of the comfort zone, it is going to be a challenge. It is going to be difficult for them. So yeah. So I always get that sort of contract and you know, the only way really to bear in mind around challenging with clients, the several tips, number one, I think, if you spend some time hearing their story first. Okay. Reminds me of a book that somebody lent to me when I went on holiday recently and it was written by, and I can't remember a name, but it was written by a forensic psychotherapist and she worked with people who really were either murderers, serial killers, people who really were inverted commerce, had really times in their lives. So she was working with those characters and she said quite frequently, which was heartening for me to hear, because I come from the same framework in terms of therapeutic technique, is that you really need to hear their story first, not only out of curiosity, respect and integrity, but as important to build up a relationship where there's some aspect of trust. Yeah. Before you do anything else. Yeah. And I suppose no-indo story and how conflict or challenges were dealt with when they were growing up is also going to be helpful, because for some people, being challenged isn't that bad of a thing, whereas for others it can be a really difficult thing to cope with. To be questioned or anything like that can be uncomfortable. That's right. In TA they call that process script analysis, where you're looking at how the script was started, formed, formulated and ended, if you like, or still going. Either way, I think build up a working relationship is so important when we talk about the timing of challenge. Now you are correct in terms of how a person takes challenge. I often think in terms of personality adaptations or personality theory, so for example, somebody who comes from a narcissistic place, find challenge more difficult than perhaps some other personality profiles, because they'll feel or could feel narcissistically wounded by any challenge against what they say, for example. Yeah. I think the different personality adaptations or disorders often are a guide to perhaps how a therapist will challenge or seek to challenge somebody when they are perhaps acting out destructive behaviors or acting out processes, which means that their goal or their contracts will be achieved. So I do think that's important to think about personality formulations. Yeah. And even people pleasers, like me, I'm a people pleaser, for me to be challenged or confronted in my mind means that I've not got it right, something's wrong, and that impacts on me because I'm a people pleaser. Or they try hard, do you know what I mean? When we're trying to just make everything into a Chinese puzzle. So there's lots of different things that play out when there is a challenge or a confrontation that needs to take place. Yes. You're correct. And it's not that therapists are not in the game of challenging people. In fact, I'll go back to my first statement at the beginning of this podcast and that is I think if a therapist doesn't challenge a person when they are sabotaging their healthy goals or they continue to get destructive behaviors, then the therapist isn't doing their job. It's not that you wouldn't have therapy without, you know, there's always be challenge in a therapeutic process. So that's taken us where it's how you do it. Yeah. And number one, I think, as I said, is building a working relationship, hearing their story. Now, you can be thinking of, like you've just said, posting adaptations, personality formulations and how you might propose this value by build up to challenge a person in front of you. So it's how you do it, not, no. I think you do it or not. Yeah, that's the question. So I said, build up a working relationship, get trust, do script analysis. Building a working relationship is so important in terms of trust and having the fertile ground which enables you to make the tentative challenges you're going to make. Another really, really crucial bit about the whole process of challenge in psychotherapy, the process is the idea of timing. In other words, when you do it. Yeah. That's almost as important as building up a relationship is the timing of the confrontation stroke challenge. That is absolutely important. Timing, I think. When in the therapeutic process, do you start to challenge? Well, yes. I mean, there's different types of challenges, aren't there? When you say start to make a challenge, I was thinking, oh, there's different types of challenges, sort of like a continuum of health. You can challenge in a way which might, the other person might perceive as a very abrupt or feel that being demeaned or whichever way you want to look at this. So start, yeah, if you want to put it that way, start in the challenging process. Yes. Now, the timing comes very, very crucial. Number one, again, it needs to be when trust has been established. Without trust, you aren't going anywhere. It has to be when the working relationship is being established. And I think it has to be, and this is, I think a fourth tip now, and it's a TA words again. So forgive me, people who perhaps don't know TA that well. It is when the child trusts you, not the adult, not the parent, but the child, the younger self, needs to feel safe with you before they can tolerate challenge, I believe. Yeah, yeah, absolutely. And I think, I'm thinking back now at the times where maybe I have challenged clients that that child, the way that it responds and reacts to that is interesting because I've had clients that kind of go into that rebellious younger self where they kind of get the hump with me. And then there's also the one where, you know, the more adaptive and apologetic when, you know, that's happened in a session. Which probably is the flip side of the adaptive child, you know, the compliant child on one side and maybe the angry or even the free child on the other side. But it's definitely the younger self. If you've got the younger self on board, in terms of them feeling safe with you, regardless of whether they become compliant or whatever, you've got a chance of the timing of the challenge being received in a way which the other person can tolerate not only hearing you, but reflecting on what you said. Yeah, yeah, without thinking it's a judgment or a criticism. Yeah, yeah. Yeah, that's it. If you're going to make a challenge about their destructive behaviors or the way they're acting out or the fact they're going, they're still keeping to their script or whatever it is, then they have to be able to hear that in a way that you're on their side and not against you. Yeah, which is why the word challenge is a lot nicer than, you know, conflict or confrontation. Yeah, it's a softer word. Yeah, definitely. And I think, again, I was reading this book on yesterday, this is where I remember it, and she was talking about, the author was talking about another person she was working with who was quite damaged. And she had to spend quite a long time building up a working relationship before she could even or how the receiver could tolerate her even speaking to him in the first place. So I think timing really is crucial in terms of the continuation of trust, the establishment of safety and the younger self believing or feeling safe that the therapist is on their side. Yeah, so once we've done that, once we've given it time and, you know what I mean, with the relationships formed and all those sorts of things, what if it's taken the wrong way? Well, let me just carry on. Yeah, that's a good question shall I get back to. I just want to just carry on a moment and talk about a concept in TA called strokes, which is a unit of recognition, and even more specifically, what is called a ball-sized stroke or a ball-sized transaction. And that's where the transaction hits all three eager states at the same time. In other words, it's accepted by the parent, heard by the adult, and believed by the child. So it's a really important transaction and it usually will provide reflection and insight by the other person. Yeah, I just wanted to say that because that ball-sized transaction is usually only really possible after working relationship and time is spent. Now, in answer to your other question is, which I think I'm hearing this right, what happens if the receiver, that's the client, either doesn't hear the transaction or the timing is inaccurate or the timing isn't the way that the therapist hoped it would be or the client acted out in some way. Is that what you're asking? Yeah, yeah. Well, I would actually say usually that's a mistake of delivery by the therapist or a mistake in timing by the therapist. Yeah. Yeah. Now, we did a podcast not longer, I think, on mistakes in psychotherapy, I believe. Yeah. They can be immensely valuable. Yeah, and can be something a therapist can really use only if the client feels safe enough to tolerate the mistake. In other words, the client feels, okay, that was a mistake or that was wrong or you hurt me here or this was said at the wrong time or whatever it is, but they can allow that to be part of the process if a working relationship has been established and trust has been established and the client at some level knows the therapist is on their side, even if they got it wrong this time. Yeah. And then of course, the therapist needs to take ownership of the mistake and say something like, oh, were you not ready to hear that at that moment or did you feel overwhelmed or was it the wrong time for me to perhaps have said this or was reflection of what I've said so painful and maybe we can come back to that. So they take ownership. Yeah. It's another psychoanalytic term. It can be seen as a relational term in therapy. They take ownership of the misattunement because if the therapist is attuned to the client, then mistakes are going to be less frequent. Yeah. Especially in delivery of transactions. Yeah. Absolutely. But there are some clients that I can think of that potentially wouldn't even let me know that I have upset them or the timing wasn't right. Do you know what I mean? Because yeah, they wouldn't bring it up. They might just disappear. They might just not come back again. Or what? Or if they stayed with you, what might they do instead? Not sure what you mean. Okay. So for you to have said that, you must have some thinking about either previous clients or even a hypothesis that you wouldn't know. I think that's what you said. If the time had been inaccurate or that they were hurt or there was some mistake in delivery that they would either adapt or go away or something else would happen. And I was thinking, well, I wonder what would happen then if you didn't know they were hurt or whatever it is. Yeah. Yeah. I think it's more that they would know that they were hurt, but they wouldn't bring it up with me. They wouldn't say anything. And then what would you do? Well, hopefully I've noticed a change in behavior. There'd be a disconnect there. And I would notice, do you know what I mean? That disconnection between the two of us. And let's follow this through. And then what you might do when you see the disconnection? Question them. Have I, have I said something that's upset you? Yeah. You'd account or take ownership of what happened. Yeah. That's what I meant earlier on. That you would take ownership and account for the misattunement, for the transactions, for the hurt, or even you would take account by querying or asking questions or reflecting. But what I suspect you wouldn't do is let it just pass. It wouldn't just at the moment pass. You'd probably inquire, even if it was by asking questions or reflections. Yeah. I guess. Yeah. Yeah. If you were given the opportunity, I was thinking that there might be some clients who don't give you the opportunity. They kind of, after that session, they just leave because what you've done has hurt them in challenging them. And it's not what they wanted to hear. Because it's difficult for some clients. But in order to make change, we need to take action. And that sometimes can be difficult. So challenging a client is part of that taking action or making a change. And that in itself can be quite challenging. Absolutely. That's absolutely true. So let's just follow what you just said about somebody with doors or leaves. Yeah. Yeah. If that happens, I mean, we have talked in earlier podcast, but let's just take through what you're talking about here. If that happens, what usually happens then? There's many options for the therapist. Now, knowing you, I don't think the option I'm going to say next you would take, but I'm going to say it because this is one of the options. You could just say, oh, well, it was too much for them. Goodbye. And that would be that. Yeah. I don't think you take that one. I think you would think about this. You would reflect on what's been happening with therapy. And you'd find some way to complete the process and take account, even if it's only a way of finding a way to say goodbye. Exactly. Yeah. To have an appropriate ending. Yeah. Yeah. Absolutely. And that is taking account of the process. Now, usually if you take account of the process, even if somebody leaves, so you phone them up or you leave a voicemail or send them a text or in the days of social media, you can do many other things. If you take account, take ownership and also remind them of the contract they had at the beginning, which was with you, to have permissions to challenge them if you see some of the behaviours which is unhealthy like withdrawing or passive behaviours or whatever it is. By reminding them, they will feel accounted for. Yeah. Absolutely. And from that, you may get a completely different beginning in therapy. Yeah. I think, yeah, absolutely. Yeah. But I think it opens up a whole new area for discussion, you know, being challenged and bringing that back into the room and how that made them feel. And, you know, did you feel like you were being criticised or judged or, you know, did you understand that it was coming from a well-meaning, loving place and just, yeah, opening up a whole different conversation. Yeah. Staying in relational dialogue. Yeah. Yeah. Sometimes you are correct. They're so uncomfortable, the challenge or the reflection or taking ownership of their own scripted behaviours, that they may, for the moment, withdraw. Usually when people don't come back, as I said, if you take account of the process, I'm thinking one card here particularly, and invite them back to discuss what has happened in the process and remind them of the contract you had at the beginning around challenge and everything else. Mostly if you've got a working relationship which is good and they know that you're on their side, they often will come back. Yeah. Yeah. I think the only time really where I've had to challenge a client, I want to say quite strongly, is when a client's broke and I were contract, which I felt really, really uncomfortable about doing because it's only ever happened once and it was in the early days and I took it to supervision because, I mean, they didn't know what to do because they broke in the contract. And the bit was you cared about them enough to take them to supervision. You didn't just wash your hands at them. No. It's true. So I think this goes back to something I would give to the podcast listeners as a tip, is to put in their contracting procedures, if they do contracting procedures, and to talk about one of the duties, if you like, to use that word, or one of the roles, if you want to use that word, for psychotherapist, is to challenge a person if you see them moving towards unhealthy patterns or destructive behaviors, or keep putting a script on the road which isn't healthy for them. Yeah. Because you've always got somewhere to go back to. Yeah. Because you just saying that then quite succinctly or whatever, it is part of our duty to challenge the clients really. And why is it not doing our job there? We really aren't. Yeah, exactly. In fact, we're doing, we are doing something far more unhealthy, which is to collude with a unhealthy script or destructive behavior, which will mean usually a repetitive cycle and the client will just continue in that process and repeat history. Yeah, absolutely. And paying us to challenge them. That's not the main question for me. That's why I put it in the contract. It's how we do it. Yeah. I said three things, one, build up a working relationship, two, make sure the child feels safe with you. Three, are safe enough to tolerate mistakes or misattunements. And thirdly, and I think this does need to go here, is that you challenge gently. Yes. Not from a parent position. Yeah. Or if it does come from a parent position, you need to be fairly safe with the process that the person is going to hear it from a positive parent setting boundaries or whatever it is. Yeah. And not to repeat history for them, where they feel judged, demeaned, put down, dismissed, whatever ways we want to put this. Yeah. Which is possible. We can come from a parent's place without it coming across as being condescending or judgmental or any of that sort of stuff. It can be done in a nurturing way. Well, I think we have to, if we're talking about setting boundaries, helping with emotional regulation, helping with helping the person have a place to reflect on what's happening in the process, we often have to come from a positive, you know, nurturing, if you want to put it that way, parent. Now, I think what you're hitting on, you said it earlier on in the same sort of ballpark again, which is that maybe what you do, but the client still hears it negatively. Yeah. Because that's their history. Yeah. The question is what you do then. Now you can do many things. One of them is say, you know, I'm thinking, are you hearing this as negative against you or you're hearing this judgmentally? And if you are, who in your history spoke to you in this way negatively with dismissing the meaning you, because this is not my intention. Yeah. You really unusual for you to hear. So let's just discuss this for a moment. Yeah. It's not that we need to come to parent, because quite often, they haven't had a dependable, consistent, protective parent looking out for them. So it's very unusual for them. They're in an alien world. They've had the opposite usually. The toxic narrative. So it's, it takes a while for them to find a new calibration if you like. Yeah. And they can stand in a different way. Yeah. And I agree with what you said, you know, that it's kind of unusual for some clients in a therapy situation to be challenged because they kind of, I don't know, somehow think that you're always on their side and you're not going to pick them up on anything, even if you see it as being detrimental to moving forward or, you know, well-being or anything. It's like, yeah, it can be disruptive in the relationship somehow. If you have a sniff of them redefining and hearing the negative parent rather than your positive parent, you need to reflect and think, am I coming in a positive position in my voice tone, my inquiry, my, you know, you have to think about that. But if that is all lining up for you, then you need to inquire with the other person what they're actually hearing. Yeah. How does that fit in their history? Because it's not my intent to fit into your history. In fact, it's my intent to provide you a different experience. So you then have a space for relational dialogue. Yeah. Now that leads us on to another thing. Sometimes the positive parent, which I'm talking about here, just often nurturing, though quite firm, often accounting, and all the things I've just been talking about, may be too painful for the person to hear because it reminds them of what they didn't have. And then they might act out in a different way and push you away. But the job of the therapist then is to be like a terrier, if you want to look at this way, is to make every inquiries. I hear that you seem to be withdrawing or perhaps even feel a bit angry. Could you tell me a little bit about what's going on for you at the moment when I'm reacting to you this way? Yeah. So you search their subjective experience, rather than assuming something? Yes, that's the danger without the inquiry is that we do, well, I do make assumptions. Yeah. So it is important to inquire. And I think that's a really good point that you're saying, you know, the fact that they can reflect on something and the feelings that they didn't get from their parents, and that that in itself can be quite upsetting. Yeah, absolutely. And often is, and it's the end of mistake, if you would have put mistake and inverted covers here by the therapist would be if they stopped there without inquiring the extra step. And what's happening inside? Yeah. It's happening for you as I'm talking to you this way. You feel overwhelmed or I see that you've moved back a step or you seem quite ex and it's happening for you. So your voice goes down a bit. There's an increase of nurturing process. If they're so overwhelmed, they'll step back even more. Yeah. You need to inquire about what's going on for them, not to assume. Yeah. And this for me is the beauty about therapy because, you know, in a session, we get sidetracked or, you know, we have to take a sidestep to work on something that's come up in the session, not necessarily about the topic, but the reaction or the relationship in the room. Do you know what's most important, Jackie? It's the content of the session. Yeah. It's the process of the session. Yeah. It's what's happening in the process between two people, not necessarily the content. I'm not saying the content's not important, but what I am saying, what is far more important in my professional opinion is the process and what's underneath the content. Absolutely. But we do get caught up in the content sometimes. Yes, especially, you know, in the early days, I did. Yeah. And often if we're contract driven, because, you know, it's important that we have contracts and goals. And we, I think it's important to put that in the therapy car park, if you like. That's a phrase of my therapy car park. How long back? Yeah. But what's more important is the process beneath the contracts. Yeah. But you are right. We, you know, and if we do do that, and it's very, very straightforward, lots of therapy students, we do get so caught up on the content or focus driven in the achievement of contracts, we can miss the process. And I think the process, if we stay with the process, we get there in a much, we get there on the end, and we also get there in a much more subject, we get there taking account of the client's subjective history. Yeah. Yeah. Rather than our own assumptions. Absolutely. And with a much more robust, resilient client at the end of the day as well. Yeah, I, absolutely. So it's not that we aren't in the game of not making, you know, challenges or confrontations. It's, it's how we do it and what we do next. And what we do next usually, especially if there's misattunements, we take account of those misattunements and we inquire what's happening with the other people. Yeah. The other people, I mean, and their subjective experience. Yeah. With that, the building up of the working relationship and the therapeutic process means they're much more likely to be able to reflect, have the space, the relational dialogue to look at what is being put forward in terms of a challenge, if you want to put it that way. Yeah. I really enjoyed this, Bob. Thank you. It's an interesting subject, isn't it? It is. It is. And again, you know, the process of it all and the different layers and everything. It's, yeah, this is why I love my job. Can I just wait one other point? You certainly can. Yeah. Yeah. Again, it's for transaction analysts. Well, it's for anybody listening, of course, but I'm using the TA model again. And I think you talked about timing early on. I talked the importance of timing. I talked about bullseye transactions. I think it's important to think about which ego state or part of the self the challenge is aimed at. Now, if you make the challenge to the parent part of the self, you risk competition. In other words, you risk the parent part going into competition with the parent part or what they perceive as the parent part of the therapist. Yeah. Absolutely. Yeah. I can say that because it's really easy. Very easy. I'm very almost commonplace for therapists. If the challenge is made to the parent part of the client to go into the troubled waters of competition or at least to invite competition by the dysfunctional parent. Yeah. So what I'm suggesting is that the challenge needs to be aimed at the child ego state or the younger part of the client. Yeah. That's the last thing I wanted to say in the podcast, but a very important part because I've seen it many, many, many, many times in supervision when therapists get caught up with parental battles when they challenge the parent. You need to bypass the parent to get to the child ego state where they feel safe enough to reflect about their younger self in the surface of that relational dialogue. Yeah. Because I see that part of it is getting into the playing games, but if you do do that, there's a danger of getting into the parent competition. Yeah. Yeah. Yeah. Definitely. Definitely. Another way of looking that of course is the Cartman Triangle. If you get caught up in that sort of persecutor rescue of business, which comes usually from the parent, you go around that triangle and repetitive processes or you need to keep off all that lot. Yeah. And the best way is to head towards the vulnerable child ego state. Brilliant. Okay. To stop. I just wanted to say that last bit. And it was a very important bit to say though. So until next time where we'll be talking about how to promote resilience in the therapy process, which I think follows on from this quite well. It does. And I thought about that when you mentioned the word earlier on, you were talking about resilience. It does really, really follow on from this. So I look forward next week talking about that. Okay. Thank you. Until next time, Bob. Bye. Bye-bye. You've been listening to the therapy show behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.