“Demanding” clients are often making legitimate requests. Therapists applying such a label should consider whether it is the client’s requests or the service’s lack of resources which is unrealistic.
“Demanding” is a label often applied to clients by therapists, although rarely within earshot of clients. The label influences the responsiveness of the service to the client’s stated needs by implying that their requests for assistance are in some way inappropriate or excessive.
The stereotypical demanding client is therefore one who places undue demands upon the service, seeking longer or more regular contact with their therapist than is usual or seeking access to medications and other resources which would drain the budget of the service.
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Unfamiliar co-therapists can use code phrases to transfer control of the session. Both they and the client can then focus on the client’s issues rather than the dynamics between the therapists.
While there should be no confusion in the mind of the client as to who is leading the session, there may be some stress for the therapists. Trainees may wonder if and when their supervisor will take over (or in some cases, may wish their supervisor to rescue them!). Supervisors may wish to ask a question or reinforce a point, but hesitate to undermine the trainee by interrupting.
The client’s focus should be on the issues they bring to therapy. Any awareness of unease on the part of their therapist may distract from this focus. Transfer of control of the session from one therapist to the other should be obvious to the client, but wrangling between the therapists should not.
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The newsletter of the American Psychological Association. Discussion articles and summaries of research which will be of interest and use to any therapist, be they American, psychologist or neither.
Online resources for therapists are relatively few in number and the authority of some is questionable. The decision of the American Psychological Association to make its monthly newsletter freely available online is therefore laudable.
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Therapists should encourage and support, not dread, “helpful patients”. Internet or other research by the client can indicate active involvement in treatment.
In 1978 JE Groves described four categories of “hateful” patient, ie: the patients most physicians dread:
- dependent clingers
- entitled demanders
- manipulative help-rejecters
- self destructive deniers
To this list a fifth category appears to have been added: “helpful” patients, who search the internet for details of their condition and treatment and provide these to their therapist. Comments from colleagues (in person and via blogs), as well as cartoons and the popular press, suggest that these folks inspire almost as much dread (or, at least, derision) as the other four stereotypes.
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Many therapists set explicit goals and use treatment contracts with their clients. Goal setting provides a focus for therapy: contracts indicate that both parties have agreed to the terms of the therapy (or should: the contract you use does bind the therapist as well as the client, doesn’t it?)
Some therapists aim to conclude this business by the end of the first session. While this gives a nice structure to therapy (1st session: agree goals, 2nd session: work toward goals), this may not be the best way forward.
Setting goals and signing a treatment contract is a big step for a client. Although clients may have been awaiting their first appointment for weeks, months, even years, the assessment process may bring to light new information and perspectives which could alter their aims significantly…given time to think things through.
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An accessible argument in favour of the scientific method. The book provides tools for discriminating science from pseudoscience and knowledge from speculation.
The late Carl Sagan was a strong proponent of science and the scientific method. The Demon Haunted World (subtitle: Science as a Candle in the Dark) revises a number of his magazine articles into a larger argument.
Sagan’s central thesis is that we should take nothing for granted. We should acknowledge that what we “know” is a collection of theories which have not yet been disproved, but which should continue to be tested in order that, if they fail, they can be replaced by more complete theories. There is no place for ego or privileged beliefs in Sagan’s world.
The highlight of the book is the twelfth chapter, entitled “The Fine Art of Baloney Detection”. The earlier chapters cover phenomena ranging from crop circles to demons, faith healing to alien abduction. In each case Sagan highlights the personal and cultural biases which permitted or permit these memes to thrive.
“The Fine Art of Baloney Detection” lays out a series of tools for sceptical thinking. Sagan advises us not to get overly attached to an idea, but to examine why we like it and to ask ourselves if we can find reasons for rejecting it (because if we don’t, others will: in our case, our clients!).
The chapter ends with a list of fallacies of logic and rhetoric for us to avoid. These include arguments from authority (“trust me, I’m a doctor”?) and considering only the two extremes on a continuum of intermediate possibilities (biological or psychological?).
The Demon Haunted World is an interesting read for scientist and lay person. Chapter 12 is highly recommended to both therapists, clients and anyone hoping to make sense of the “evidence base”.
Reference
Sagan C (1997) The Demon Haunted World: Science as a Candle in the Dark. Headline: London.
