I had just logged into a Zoom session for my Diagnosing Pathology class and my cohort was in deep discussion with one particular student as we all waited for our professor. This student in particular was already working in some sort of clinical setting, not yet giving therapy, but a new client profile had come across her desk with a diagnosis of borderline personality disorder. She didn’t know much about the diagnosis herself, but she was concerned because her boss said, “Whoa, good luck with that one. Borderlines are very difficult to work with.”
Difficult. It’s not the first time I’ve heard that word. Every time I hear a professional utter the word, “difficult” when referencing a client it stings. Is that how you really see us? As patients/clients that are stuck in a downward spiral whose struggles are too much for you to handle? Don’t you believe in what you do and that there is hope for us?
My heart breaks for whoever this person is that has borderline personality disorder because the cards have been stacked against them before they’ve even gotten started. One of my school assignments required me to write about working with a difficult population and this was my response:
“If we get the idea that a particular diagnosis or population is difficult to work with it feels like we are setting ourselves up for failure. Maybe we will treat them differently or have lower expectations or refuse to work with them because we have a negative perception.”
In 2022, I attended the Healing Together conference hosted by An Infinite Mind in Orlando, Florida. I was sitting in a session where I could hear and learn about lived experiences with dissociation and an excerpt from a book was read aloud as an example of how some clinicians view dissociative identity disorder. The presenter who read the excerpt was sad, the audience was sad, and I felt infuriated. The gist of the excerpt talked about how a clinician should be wary because clients with dissociative identity disorder are difficult to work with and that they bring unsolvable problems to therapy.
Unsolvable problems? Listen, if a client’s problem was easy to solve, they wouldn’t need therapy! Of course we are bringing our unsolvable problems to you. We believe in your ability to help us. We were trusting you enough to share our struggles. When we hear you call us difficult, challenging, resistant, and a myriad of other words, you break our trust and confidence.
My ask of you is that you reframe your perspective of difficult clients. My therapist always says that behavior is communication, so when you find a client’s behavior particularly difficult, ask yourself, “What is my client trying to tell me?” “What does my client need right now?” Seek out peer consultation or supervision without passing judgment on how difficult a client is for you.
I’ve always carried around my own judgment about myself as a client in therapy. I used to tell my therapist, “Thank you for putting up with me” and her response was, “There’s nothing to put up with.” When I had the opportunity to watch her present at a conference once, I went up to her just before it started to tell her she’d do a great job. She just smiled and said, “Everything I’m presenting today, I learned from you.” I thought about that for a long time. Not once, in our years of therapy had she ever shown any indication of frustration, feeling challenged, or felt I was difficult. She simply adapted her interventions as needed.
The NICABM posted back on June 11, 2022 on their Facebook page a quote from Pat Ogden, PhD; “When we call clients resistant or difficult, it’s because our interventions are not working and we feel incompetent.” As clients, we don’t think you’re incompetent. We think there’s something wrong with us and we believe you when we hear you say we’re difficult. So, please, choose carefully. Your words matter.
NICABM. (2022, June 11). What may at first seem like opposition or resistance can often signal a client’s deepest struggles. [Status Update]. [Image attached]. Facebook. https://www.facebook.com/NICABM/photos/10159170676011314
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