Difficult Persons in Therapy

A number of times I was on the receiving end of William’s threats of suicide and expressions of anger during in-person sessions.

To worsen things was his premature termination of his therapy. Only days after, he got rushed to the ER of the city hospital for attempting suicide.

Dr. Jeffrey Kottler, psychologist and author, noted the concern of “problem client” therapists experience in their work.

I surmise he means hard cases, where prognosis is poor or progress if any is often slow.

Here are some in Dr. Kottler’s list of “problem clients” or difficult persons in therapy:

• those with serious medical illnesses like strokes or head injuries

• those who ignore boundaries such as chronic lateness or missed appointments 

• those who refuse responsibility (“you fix me”)

• those who fear intimacy (avoidant or seductive)

• those who are incompatible for wanting something you cannot give 

• those with hidden agendas 

• those who are impatient and want quick fixes 

• those who are unable to access internal states 

• those who feel hopeless or actively suicidal

• those with poor impulse control like offenders and and substance abusers 

Therapists are called to “pick up the pieces” after losses, disappointments, trauma, or death.

It’s a helping profession privy to the deepest, most secret hidden selves of our lives that we may be healed and redeemed.

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