What do you do in your practice when a client begins insulting you personally and professionally, especially if they do this to you over and over again?

by Paul Vereshack M.D.
(Notwithstanding his M.D. Dr. Vereshack is not a licensed physician)

The Abusive Client

Nowhere in all of Psychotherapy is there a greater test of a therapist's balance and wisdom than there is in this issue. Many therapists ask the client to leave their practice.

And yet, there are some very simple guidelines to untangle this painful event.

There are two main streams or kinds of verbal attack that clients make against their therapists and possibly a third which we will discuss at the end of this talk.

The first and I believe completely acceptable kind of verbal attack on a therapist is one which the client recognizes to be connected to an old feeling.

Recently a woman said to me, "Paul, I have some very powerful negative feelings toward you and I want to bring them up and throw them at you directly. I sense they are left over from feelings I had toward my father but they feel like they are also connected to you."

My response in the face of this insightful request, to begin insulting me was, "Let's have them. Throw every last negative thing you can find at me. Don't forget to use the tone that exactly matches the feeling. Be as mean and as powerful in this as you can. Do not spare my feelings one inch. Go for it."

And so it began session after session. "You stupid blind god damn fucking son of bitch. How could anyone trust you. You don't know what you are talking about and your therapy is pure shit and so are you." And so it went on and on hour after hour after hour, until it started to sound like this. "You know Paul, the more I do this, the more I realize that this hatred I have been expressing to you is exactly to the tiniest nuance what I feel toward my father. He really was an ass hole and I can't tell you how much help it has been to get this stuff up and out directly at you, this way. My last therapist just wouldn't let me do this at all."

This story happens to be a true one from within the last few years in my work. What a pleasure it is to see such growth and to be a part of it.

Then there is a second kind of therapist abuse. It sounds the same but it comes from an entirely different place. It comes from the client who simply does not realize that they are in an old feeling. They really think that the feelings of distrust that are coming up belong solely to the therapist's inadequacies. ( We will pursue this thought in a moment.)

This second kind of abuse although it usually begins in a milder form, "I just don't think I can trust you", can degenerate into real verbal abuse if left completely unchecked..

It is up to the therapist, assuming that the therapist is competent and doesn't really deserve this negativity, to point out to the client that their attitude may be an old one. It can be asked whether they have ever have had these feelings before, in their current or any previous relationships. This is one time that contrary to the advice in my book, I will attempt to stitch together an insight as follows. "Lie down and stay inside this feeling. When you have completely soaked yourself in it, drift back in time and see if this same feeling occurred anywhere in your childhood."

I will work in this directive a manner under these circumstances because if this situation isn't corrected the therapy will end anyway. Who knows? Perhaps this is an early warning sign that it should end. Clients who proceed into deep feelings without a firm understanding that these feelings are over determined by other events are as dangerous to a therapist and everyone else as an undiscovered land mine.

If the shift toward this realization does not occur after a reasonable period of time, say a month or so, then some serious boundary setting is in order.

The client needs to be told that they are not looking underneath these feelings for their true source and that unless this happens the therapy will in fact have to end. I am fine with saying to a client, "I need you know that I do not find this attitude either productive or respectful of the therapy. I am not available to you for use as a target where no real understanding of what you are doing exists."

Now in fact, I am sometimes quite casual in my work and at one point a few years ago after much discussion with a client I finally said this. "I'm completely tired of this shit. Either lie down and get to work, get the hell out of my practice." She stared at me in surprise. Lay down, focused deeply and proceeded to do years of excellent therapy..

In truth situations are never clear cut and usually, in the beginning months of therapy, float around somewhere in the in between. One judges the essential good will of the client and makes allowances, not however to the point of damaged self respect.

Now it needs to be said, that if a therapist is inaccurate in his/her work, either in the ability to reflect or in the use of intrusive directions etc., then the client's insights must be respected. If there is one mistake that I have been exposed to continuously over the last thirty years it is the sophisticated defenses of therapists in situations where they are challenged.

Phrases such as, "that is a projection", are all time favorites. I happen to believe that disallowing client's highest intuitive functions with this golden oldy is mind killing and worthy of the utmost disrespect. I have heard therapists go so far as to tell their clients that all thoughts and feelings about anyone outside of our selves are projections. How very convenient for the therapist.

When a client says something to you about yourself, honor it, and if they are correct let them know how great their accuracy and intuition really is. This honesty and validation will usually create huge levels of trust for you. It is the opposite of anything they have ever heard. It is the opposite of what crippled them in the first place.

Paul Vereshack

Other pages on this website about Dr. Vereshack's writings include:

Book Review of Help Me -- I'm Tired of Feeling Bad
The Primal Page's Favorite Quotations from Help Me -- I'm Tired of Feeling Bad
The Primal Psychotherapy Page Interviews Paul Vereshack, M.D.

Return to Index of Dr. Vereshack's Questions

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