“Not everyone who comes to counseling wants to get better.” Amanda, a mental health supervisor, told her intern. “Some are here because of a blown-up relationship, an employer who demands change, or there is a pending legal case mandated it. The key is to distinguish between those who want to improve from those who just want to be heard.”
Unfortunately for the therapist or the intern, this is not always transparent initially. Or can it be? In Gavin De Becker’s book The Gift of Fear, he identifies patterns of behavior that can be seen at a first encounter which help to discern the difference between a safe and unsafe person. The same concept can be utilized in a therapeutic setting.
That is not to say that every client who doesn’t want to get better is unsafe. Some are severely traumatized and need a longer time to establish a safe environment before they can begin a therapeutic process. But there are clients who don’t want to get better who are unsafe. An example of this is a person who uses therapy to manipulate or control another person. Or a person who uses therapy to escape responsibility for their actions and continue to blame or shame others can also be unsafe.
There are three types of clients who potentially fit this situation: those with a personality disorder, an abusive person, or an addict. They enter therapy with a misleading agenda, sometimes intentionally and sometimes now.
Within the definition of all personality disorders is a lack of an accurate perception of reality so their awareness is already misguided. This affects their opinions on morality, safety, authority, relationships, and laws. Some examples include sociopaths, narcissists, borderlines, histrionics, and obsessive-compulsives. Oftentimes, they are not in therapy to improve themselves, but rather to cast blame or shame onto their spouses, family, friends, or co-workers.
An abusive person, or sometimes an addict, attends counseling as a demonstration to others that there is nothing wrong with them. They frequently blame their victims with colorful stories of how they are the ones being abused. Then, they take the information gleaned from the therapist and use it to continue to abuse their victims or justify their abuse of substances. While the abuser or addict is usually honest about the reason for therapy (relationship issues), they intentionally withhold their abusive/addictive nature.
Understanding the motivation of these clients (we will call them misleading) can save hours of frustration during therapy and ironically makes future sessions more productive. Here are the concepts from the book that are applied for a therapeutic setting. Sadly, the examples given have occurred in our office more than once.
- PINs (pre-incident indicators). Before an action takes place, a person has the thought. Meaning, before the therapy session takes place, the misleading client thinks about it and rehearses it in their head. They might intentionally say something to get a surprise reaction from the therapist. For instance, one such client said, “The last time I heard you speak I almost died.” This line was clearly rehearsed beforehand and was designed to spark guilt in the therapist. If the therapist bit, and opened with what the client wanted (some sort of remorse), then the client has gained control of the session.
- Charm and Niceness. This is easy to spot in the beginning because the misleading client will come in smiling and extending compliments. It is not unusual for them to be slightly inappropriate and overly personal instead of remaining professional. For instance, they might compliment the therapist on what they are wearing or say how attractive the therapist is. They might seem very put together, with little to nothing wrong from an outward glance but they try too hard to hide their flaws.
- The Interview. This is apparent within the first few minutes of the session. The misleading client responds to the therapist’s opening remarks but then redirects the conversation to ask the therapist a couple of questions. Some questions are to be expected and part of the normal initial session, others are more personal in nature and have little to nothing to do with therapy. A client who has researched the therapist already knows general information so they usually go for a question that demonstrates this knowledge, goes beyond it, and might even be a bit intimidating. “I see you went to…” (therapist’s University), “Do you happen to know…” (they use the name of the therapist’s roommate), or “I know your spouse.”
- Typecasting. The misleading client makes some personal general statement about the therapist that is slightly insulting. This is done to engage the therapist, cause an emotional response, and see if they become defensive. If the therapist does, the misleading client learns an area of vulnerability about the therapist. This is useful to the client because they can return to the issue later whenever the therapist starts to confront them. This technique was done very well during several of the counseling sessions of Good Will Hunting.
- Forced Teaming. During the session, the misleading client begins to use the word “we” in reference to them and the therapist. For example, “I know you agree with me, we would never act that way. I can tell you and I are like.” First of all, the client should have no idea in the first session of what the therapist is thinking; this is not part of the best counseling practices. Next, there is no united front in therapy. It is not the client and therapist united against another person. This is triangulation.
- Loan Sharking. This technique is precisely why most regulatory boards strictly limit or prohibit gift giving from the client to the therapist. The misleading client offers something to the therapist such as a weekend at their condo on the beach or a connection to a famous person. If the therapist accepts, they owe the client on some level and this client intends to collect more than the offering of the gift. During the first session, the gift offering might be implied before it is given such as, “I have a lot of friends. If you can help me, then I will refer them to you.”
- The Unsolicited Promise. While the misleading client is telling an elaborate story, the therapist through their body language or an expression on their face reveals disbelief. The client immediately picks up on the signal and says, “I promise it happened this way.” This should signal back to the therapist that something is not right about the story. Otherwise, there would be no need to offer a promise. When trying to convince someone of a hard to believe matter, offering a promise is an easy way to put someone at ease and question their judgment.
- Discounting the Word “No.” This is not as difficult to test in a first session as it might appear. During a story or explanation, politely redirect the misleading client to another random subject. Almost always they will acquiesce initially. But a person who is unwilling to take “No” for a response (they have controlling tendencies) will go back to the previous subject. The misleading client is trying to control the session and cannot accept redirection. Another strategy is to tell the misleading client that the issue they came in for is not the one that needs immediate attention. If they refuse to accept the input, they most likely don’t take “No” in other environments.
- Too Many Details. This is easy to hear as the misleading client offers too many details before getting to the point of the matter. However, some anxious or obsessive clients naturally do this without having any manipulative intent. A misleading client whose intent is otherwise, offers the details as a distraction, not as further clarification. The details are more random in nature and have nothing to do with the story or the person. Asking the client to wrap up the story will not frustrate the anxious client as this has been said to them before. However, it will aggravate the misleading client.
- Rule of Opposites. Things are sometimes best viewed from their opposite. For instance, it is much easier to distinguish between the colors navy and black when placed on a white background. Likewise, a client who sits on the edge of their seat in forward position as if trying to get close to the therapist is very different from one who sits back comfortably in their seat. The same is true for a client who intently stares at the therapist without looking away even when answering a question instead of one whose gaze glances off to the side for a brief moment before returning back to normal eye contact. The misleading client is likely to sit aggressively and have “the stare” down pat.
If any of these concepts appear during the first session, just take note at the first instance. But if several emerge, then listen to your instincts that something might be off.