 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 the next episode of The Therapy Show with myself, Jackie Jones, and I'm going to say it, the wonderful Bob Cook. Oh, I do like how you start that, Jackie. And in this episode, we're going to explore working with the challenging client. That is a great phrase. So I'm going to start by asking you a quick inquiry. And that is, what do you, as a psychotherapist, what do you define as challenging? When somebody says to you, oh, you know, I've got clients, which is so challenging. XXX, it's an interesting phrase. So what do you think of? Or how do you define the word challenging? Depends what day you ask me on, Bob, because it probably changes. Sometimes I find working with couples challenging because, you know, being in the middle and being a moderator to a certain extent. Yeah, there's lots of different degrees of what challenging is. And again, you know, I'm being completely honest here. It depends what day you catch me on. If there's a client that is very demanding of my attention and I'm feeling tired, then I would find that quite challenging on a certain day. If I'm going through something in my personal life and the client is going through something similar in theirs, I would find that client quite challenging. I couldn't put it in a box. OK, so I will attempt. Was that the answer you wanted? No. Yeah, no, it's a very, very authentic answer. And I think I understand where you're coming from. And I will put it in a little bit more of a structure for you and why that I think about it. I don't really like the phrase. It's the same. I don't really like the phrase when people talk about mistakes and so on, but I certainly don't really like the phrase when people talk about difficult clients. So so let's stay with challenging because that's the remit of this podcast. Now, I think it falls into a structure. So one therapist say that it falls into two roads, one where they haven't been trained and they haven't got the information or they haven't got here's how to work with particular clients. So an interesting one and all the counsellors on listening to podcasts might scream at me, but I'm going to say it anyway. I've a counselling courses can run from six months to six weeks to three years to four years and you get very good counselling courses. But one of the big drawbacks, I think in counselling courses, per se is they don't I don't deal with how to work with psychotic clients or disturb clients and psychotherapists tend to. So you see, I think that if if people come with strong personality disorders to counsellors, they would find that very challenging, mainly because they haven't been trained to deal with that type of person. So when people say, oh, this person is very challenging, it may well be because they haven't been trained to to know how to work with that client. Yeah, they have to go off and have some CPD training or some extra specialist training to have that information to work with clients. So I'm doing some training with some Slovenian therapists, actually. Next week, I think in is on how to work with specific personality disorders. Now, many people perhaps doesn't have the information. So if somebody comes from a personality disorder, they may they would find that very challenging if they haven't got the training to know how to work with that person. Yeah, yeah. If that makes sense. Yes, yeah, totally, which is why it's really important that, you know, we do do continuous professional development and go to supervision and all those sorts of things, definitely. That's one subset and the second one is is what you hit on, really. I think a lot of people term clients as difficult or challenging when the material that the client brings hits on the unresolved material of the therapist. Yeah, which is what you sort of 100% definitely when you said if you were doing certain personal issues in your own life and that person came with the same personal issues. So you had a lot of identification, which meant that you might term that person quite challenging because it's actually challenging for yourself. Yes, yeah, which, you know, the longer I am a psychotherapist, the more sometimes I think the universe throws me certain clients in order that I reflect on myself. Yes, so perhaps they should actually pay you. Yeah, you know, sometimes I do think that. You know, but I understand if we move away from that humor of that and and really in the business, they call what we're talking about counter transference. Yeah. And that's the client that comes along and they're actually, you know, as you talk to them, you're identified as a personal identification. So so, for example, if you have some parts of you which are depressed, that hasn't been resolved because of certain traumas in your own history and you haven't worked on that in therapy or you haven't dealt with those issues and a client comes along that is depressed. Yeah, then it might be quite challenging to work with that particular client because they may, you know, actually hit parts of yourself, which is very similar to them. And therefore you then both when the risk of ending up submerged in a co-dependent relationship instead of dealing with the feelings of the depression. Yeah. And that's called in the business counter transference. It's might be called a project of identification, which is type of counter transference where we identify with the content of the person's board, which then hits our unresolved processes in ourselves. Yeah. And then we will call that type of client or we might call that type of client challenging. Yeah. And there's no way of foreseeing that necessarily with clients in the early days. No, yes and no, I think. Yes, in the sense that we, you know, we can't always legislate for things that might actually hit on our own personal stuff, who can in some ways have good guesses. So in other words, if you have had a particularly traumatic history and you haven't dealt with things, which perhaps are to do with abandonment, neglect or trauma, whatever we're talking about, then I think of people that work, you know, I was thinking in your area of expertise, really, I was thinking people have been fostered or people have been adopted or people have had traumatic histories to do with abandonment, neglect or we sort of know that if we if we have had that in our own history, then there's a good chance that what they're talking about might actually, you know, we might actually identify with that. So instead of taking people to where we need to go to, which is to their feelings, we may intellectually talk about it instead. Yeah, so we might have good guesses that we don't work with certain people because that might happen unless we've done the therapy and resolved it inside ourselves first. Yeah, you are right, by the way, I also agree with you that you can work with many clients and suddenly as you go down the layers, things to pop up and expect and sometimes with certain clients' histories, I think it's important to think twice as a clinician if you haven't resolved those issues yourself. Do you work with them? And then the other side of it, of course, is you might think you've dealt with them and then actually you find out you haven't. Yeah, I'm thinking of life events, really, do you know what I mean, that can make it quite challenging for us to see people? Like if we, you know, are going through a separation that is kind of like in the present, it can affect us with certain clients if they're coming after going through a separation or if there's been a death in the family or, you know, a life event in the here and now, I get what you're saying about the past and unresolved issues, 100 per cent, but it can be that you've been working with a client for quite a while and then suddenly a life event happens that kind of puts you in a different place. Oh, well, if you've got a life event that was happening, I think I'm just thinking of what you might be talking about. So I don't know, you're part of the dyes. Yeah. Or I don't know, you've been made redundant to work or. Yeah, these are these are the issues you're talking about. Yeah. And then it's up to you as a therapist, I think, whether you take time off work, which then opens up a whole maybe different podcast that we can do at some point in the future, you know, as a therapist. What do we do if a life event happens? And we need to take time out. Well, it is another podcast, but all therapists should have in, you know, have people that they can refer to people who can take therapists. So, you know, you know, that's for I think that professional therapists to have organised, really. So they have got people they can refer to. But that is another podcast. It's a very good podcast. Yeah, yeah, yeah. So, you know, I just think a friend of mine, who's father died recently, they took three months off. I was thinking of another well-known therapist, his 21 year old son died in a motor car accident and he took a year off. So I think of those are the duty of care issues that therapists need to attend to. On other sort of perhaps, I don't know, milder issues that you're talking about, things like, you know, I don't know, somebody got a client who's been made redundant and you just made redundant or something of those sorts of things. Yeah, you have to make adjustments, I think, which is like, OK, can the supervision, I'm in therapy. Have I got enough support to deal with these things so I can move away from identification with the client? Yeah. And come from an adult to adult perspective. Yeah, which is kind of, you know, what we've been talking about now. The the other side of a challenging client could be one that is attempting to push the boundaries a lot of the time. Which, you know, I think that sometimes comes into the therapy session as well, where they try to extend the sessions or. Manipulation and things. Yes, but yes. And. If you've had adequate training and you have the information how to deal with these profiles and you have supervision. Then you. In most cases are able to to deal with the types of clients you're talking about, which are clients that are in napping out. They're passed on to the present. Now, there are certain clients who are pretty might be particularly disturbed or have a fragile adult that will act out in a way which you find personally hurtful. Yeah. Yeah. What you have to do is take into supervision. And if it's still, if there's still not enough resources there, have a second supervision in the week. And if still doesn't work, you'll have to go into therapy. And if you're still, you're still merged in sort of a mesh transference, then you need to defer on. Yeah. The reason why I brought that up, I was watching a television programme called New Amsterdam. I'm not sure if you've watched it, but I quite like it. There's a psychotherapist that works in a hospital and he had a client who was getting overly attached and he stopped seeing this client. But then this client kind of made contact through his family members. And, you know, he got a bit dark in places. But it's, it's that's keeping your boundaries. If, you know, you feel that the client isn't sticking to the boundaries, you know, for you to end the sessions. But there's also that other side of it that is that ethical to stop seeing a client. It got me thinking watching this programme. They're all different ethical dilemmas. Yeah. As well. I might be for the podcast. But you see, I don't necessarily define those as challenging clients. Okay. That's what I'm trying to say right at the beginning of this podcast. What are you called challenging? Yeah. No. I think the types of clients that you're talking about, we could put into particular if we wanted to, and we've talked about many podcasts narcissistic or borderline or any way we've talked about this before in podcasts. Now you would expect that type of behaviour from those types of clients. Yes. Yeah. You would be trained on to know how to do with that next. So the, the, the dramatisation if it's true or not new Amsterdam, I don't know what type of programme it is. But what you're probably talking about is a borderline client because that's the drama of these types of programmes, which then probably follows the therapist and you have these darker things that you're talking about. However, in the first place, any decent professional psychotherapist would have been having supervision to do, to, to talk about what to do next. Yeah. Yeah. And like you, you're saying it depends what we're defining as a challenging client. Yeah. Yeah. There's a wonderful programme by the wonderful, a wonderful DVD became a cult DVD called What About Bob. Now quite like the title, not, not quite like it. And it had the person, Bill Murray, who was in Grand Hock Day. Yes. And Richard Dreyfus, who's very well known as well. And Richard Dreyfus was playing the American psychiatrist. Now in the UK, we could say psychotherapist. And Richard, and that's Richard Dreyfus. Bill Murray was playing this paranoid schizophrenic client. And, you know, basically, I don't want to start, you know, take away the anticipation of the ending of all this lot. But the narcissistic psychiatrist took on this client, which is Bill Murray, and then he decided to go on holiday. And in America, of course, you go for a month's holiday, you go on vacation. And of course, what happens then is this paranoid schizophrenic client or borderline client, however we want to define it, then gets a complete flashback to his own life. And then he decided to go on holiday. And then he decided to go on holiday. And then he finally found it, then gets a complete flashback to his own trauma and can't hold the boundaries and follows Bill, follows Richard Dreyfus to his site, his home. And you've got all the dark things you're talking about here. But of course, in reality, the professional psychotherapist is trained to be able to work in a sensitive manner with these types of profiles. Now, if they are trained to be able to do that, they shouldn't be doing the job. Yeah. Yeah. I don't know what to say back to that. Except that I know what you're saying in the terms of people who are clients who are very pushy with boundaries, entitlement and all those things. And I know the therapist has to learn how to handle all these clients, but a very good training and some of the therapist that uses supervision can deal with most of these so-called challenging clients. Yeah. Because in the end, what is happening is they are enacting out their past into the present. And hopefully the supervisor, sorry, the therapist takes these people to supervision. So I'm going back to that. You've got two categories, I think. One is when you haven't had the information of the training to deal with these clients, and then you need to, I think, prefer or not take them on. Yeah. Then you get the clients who hit your buttons and talked about earlier on. And you've got counter-transference. And there's some of the experiences haven't been resolved in the therapist. And then it becomes quite difficult and the clients and the therapist gets merged together. How that can solve itself is through supervision and therapy by a therapist. If that doesn't work, then the therapist needs to, I think, prefer on. Yeah. So taking on board everything that you've just said then, I think it's really important for the therapist to reflect on the sessions and to be self-aware of what's going on, which links into the supervision and things. Absolutely. And I know I've just listened to myself and perhaps I'm being a bit too concrete here and there's blurred edges. I do realise that, especially if you're starting to build up your clinical practice and you're not that experienced and XXX. So perhaps I'm being a bit concrete and these things will happen. I really do want to emphasise supervision there and your own therapy. Yeah. And I was a therapist that always stayed in therapy or had access to therapy. So I was one that just did 160 hours of therapy and then just stopped. So I always had access to therapy and I always used therapy a lot for all many of the things that you're just talking about where clients who are talking about probably the most fragile or traumatic issues and may actually hit on some of my own stuff. I really do please or take a plea for encouraging therapists to have therapy, to have access to therapists and to use supervision very wisely. Yeah. Because in the end are there such things as challenging clients? That is a very interesting question. Yeah. Given what we're talking about here. Maybe there's such things as challenging therapists. Which is kind of my opening statement when I said to you it depends what day you ask me the question. We're going back to that very common sense answer of yours. You know, the many therapists are often very challenged because they have clients who actually are actually hitting their own buttons and then they transfer the word challenging onto the client. And in fact, perhaps their own history is very similar to the clients that have come through the room. They're the most challenged of their best of the client. So we're back to what you said right at the beginning and I said in a very sort of humorous way while perhaps the person should be paid is the client rather than you. But it's an interesting one, isn't it? Yeah, it is. And I think, you know, this podcast and other episodes as a whole, you know, for me, it encourages me to just be more curious and have self reflection, you know, after seeing a client and to look at how it went from my point of view as well. Obviously, I'm in the session for the client but when I come out, does anything stay with me outside of that room of the client? Because to me that's a bit of an indicator that there's something going on. That's right. So if we want to have indicators here that there's something going on for the therapist that's been stirred up by the content of the client, I'll give you some indicators. Number one, that you start thinking about the client outside the sessions in an obsessive way. Secondly, the client appears in your dreams. That sounds scary. No, I have many clients by the way have appeared in my dreams and my third is still my supervisor, both usually. That's two things. So somebody, yeah, a third one will be when you find yourself meandering, thinking about your clients and unable to concentrate on your work. Fourthly, when the clients start to come into your professional life and instead of focusing on the client in front of yourself, in front of you, you start thinking about this client. I suppose that's the obsession if you like. All these indicators are that the content of the client has an earth unresolved psychological quantum of yourself. Yeah. And that's when you need to go to supervision or therapy. Yeah. And as a caveat to that, I want to just say it's, I don't know, it's not like it's just a job and you do the job in that hour and you don't really give two hoots about your clients outside the therapy room. I didn't want to give that impression if that was the one that I gave. But, you know, there's a time and a place for the client to be in your head and that's in that therapeutic space. When I walk out of my therapy room, I don't think I'm going to be able to go back to being Jackie as opposed to Jackie the therapist. Yeah. Absolutely completely because otherwise you couldn't, you would not be able to do your job and your life, your life would be very difficult. Yeah. So absolutely on another level completely, I start working clinically after 38 years. And I was thinking the other day and I've actioned it and I'd like to write a sort of a book which would be quite existential about clients and about what we can learn from clients maybe in a metaphors symbolic way. And I started to reflect and think about lots of clients and actually I could think about many, many clients and that was quite nice because it meant that I was, those clients had stayed with me. Yeah. Quite nurturing and soothing. And I could think, oh, yeah, I think about how they've got on and quite a lot of professional satisfaction in my successes. And I think in my elder years and my retirement, that's very nice. Yes. Yeah. Yeah. And that's another level altogether. 100% and I get that in a nice warm fuzzy feeling in my stomach and I think I feel the same way with fostering to a certain extent. I've got a bit of those kids in me and I carry that forward. Yeah. Yeah. In an appropriate way. Yeah. In an appropriate way. So getting back to the title of this podcast, I don't know if we have challenging clients and I don't know if we have challenging purpose. I suspect they sort of go together. I think that is a lovely place to end. It's an exploration. That's what we're doing. We're pulling back the curtain on the therapy room. And I think we've done that well. Yeah. Thank you so much. Yeah. In a very relational way. Yes. Yeah. 100%. So what we're going to be looking at next time is the importance of boundaries, which kind of follows on quite nicely from this session. Yeah. Yeah. Yes. It follows on very well because we've been talking about boundaries a moment ago. Yeah. So we're going to do the next one on the importance of boundaries and the one after that about the use of the self and self disclosure in the therapeutic process. Well, you know, I'm looking forward to both those podcasts already. Me too. Me too. Literally. I can't wait. I will see you in the next podcast Bob. Yeah. Okay. Thank you. Take care. 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.