When hope seems lost, finding new ways to motivate clients can feel futile
The sound of the doorbell hit me like an electric charge. Why had she come?
Was there really any point to this? And was I really helping? I fought back the tide of reluctance and went to let her in. I vowed to shake myself down. Maybe this time it would be different.
She sat and studied the floor as always. Head sunk, Denise peered at my mottled carpet as though seeking some lost thread of hope.
She was firmly stuck on the inside of her experience, and me, being part of the immediate and external world, barely registered for her. Or so it seemed.
Prefer to watch instead?
This was our fourth session. I’d had to tone down my natural ebullience because she was so unresponsive. I felt like I’d been trying to light a match underwater.
Her first language was not English, but she understood everything I said and spoke perfectly. That is, when she actually did speak. She seemed to have no desire to engage with me at all.
But it was worse than that.
I was feeling hopeless about her. And if I felt like that, then what in the name of lost souls did she feel like?
Constant, silent tears
I have never seen anyone who could produce so many tears. They slid silently down her expressionless face. I had to encourage her even to wipe them away. It was as if she cared nothing about anything.
Denise had been dragged along to see me by her friend. She herself felt it was hopeless and pointless, that much was clear. I’d hardly gotten any response to my questions. The little I knew about her had come from her friend over one email.
Denise’s friend’s electronic missive had informed me Denise was originally from a place called Buoux, in France. This proved to be significant.
Climbing out of depression
In all this time Denise had not, as far as I was aware, actually looked at me. Our eyes hadn’t locked once. But though she didn’t look at me or speak to me, I looked at her. And I wondered about her.
She was lithe and slim, but looked strong. I knew Buoux in France was famous as a climbing destination. So I took a chance. If she wouldn’t speak, I would just talk gently to her.
I evoked, in really general terms, the climbing experience. I spoke evenly and slowly.
A climb can sometimes look impossible at first glance. But bit by bit the way upwards can become clearer. You can test the rock and find a way to progress.
I continued.
Sometimes one way looks like the way to go but then you may have to go down a little ways again to try a new way until you find a way that works.
Was it my imagination? Or had Denise’s attention become more focused on my words?
Some people can ‘daydream a wonderful climb’ and can even ‘close the eyes’ and ‘start to relax a little’.
I overlapped the senses in my description of climbing, describing how the outside air might warm the skin, how the hands feel when they are strong, finding out the secrets of the rock and so on. And then something wonderful happened.
Denise settled back. She had closed her eyes. Her face had relaxed and her eyeballs were dancing as though deep in some supreme dream beneath her lids. She was totally listening, and totally engaged.
We climbed that rock wall together. I suggested that there can be a wonderful sensation of ‘almost triumph’ when you reach the top of a difficult climb. She nodded minimally and unconsciously. I suggested the landscape looks different when you have risen high. I described how you can see so much in context you couldn’t see before and how new horizons and possibilities and perspectives appear from this new vantage point.
Again, there was a subtle nod of her head.
I talked of how the muscles of the arms and legs can relax and rest after a really intense climb. Denise sighed deeply and I noticed her hands were no longer clenched into tiny balls of tension. In fact, she now looked restful. I had demanded nothing from her. All I had done was ‘think out loud’ about what climbing might feel like.
Of course, I hadn’t just been talking about climbing.
Learning from clients
I later learned Denise had been a highly respected climber back in France.
This session taught me all kinds of things. Firstly, never, ever give up on someone. Secondly, when they don’t talk, we can – and we can use metaphor. And thirdly, we need to stay out of our clients’ destructive trance states. If someone is drowning in a torrent, don’t jump in with no plan. Find a way to keep yourself safe and get them to safety.
There may sometimes be clients you feel hopeless about. Maybe they’ve infected you with their hopelessness. This is one of the inherent risks of doing therapy. Of spending time with people trapped inside a bubble of seemingly intractable negativity.
The rise of the mood viruses
Along with infectious pathogens, we evolved to infect one another with our moods.1 You can catch bad moods, just as you can colds, from those around you. Even via social media!2
Low or high morale can spread; and charisma, the extent to which someone can and does instil or prompt emotional states in others, can come in negative or positive forms.
Denise’s totally bleak mood, for some reason, had got to me. It pulled me in. I’d also suffered a failure of imagination. I just couldn’t imagine how she could get better. But I hadn’t been trying hard enough.
I felt she wouldn’t communicate. But of course, she had been communicating. Tears, head shakes and sunken gaze are clear words in the language of defeat.
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A terrible thought
And maybe my burgeoning hopelessness about her had in some way started to speak to her in a kind of ‘another person who feels I’m a hopeless case!’ kind of a way. That’s a terrible thought.
If you sometimes feel hopeless about a client, maybe because they don’t respond as you feel they should, or because they are simply captious and contrary, or ‘resistant‘, then perhaps these ideas can help you stay out of the quagmire of what seems like hopelessness.
Tip one: Stop doing what ain’t working
Einstein famously defined insanity as doing the same thing over and over and expecting different results.
Asking questions hadn’t worked. Denise just sat there. I could have been a phantasm on some distant planet.
I had one last shred of a clue as to what might engage her. I had to forget me. I had to rise out of myself and throw my feelings of struggle far away. I had to see and think through fresh eyes.
If you are despairing over a client, look at what you’ve been doing and try something different. If it doesn’t ‘take’ with the client then nothing is lost, because what you were doing wasn’t working anyway.
Over the years I have found that whenever I’ve started to feel hopeless about a client (and it’s really a rare event) I look at what I’ve been trying to do that hasn’t worked. I call to mind Einstein’s maxim.
And I’ve also learned to do the following.
Tip two: Don’t (overly) blame yourself
It’s sometimes said that there are no bad clients, only bad therapists. And it’s true. If we are inventive, creative and flexible, we can do some amazing interventions with many or perhaps most clients.
But it might be that the situation and time are all wrong. We can do a lot to motivate our clients even when they don’t (think they) want to change, but perhaps we and they are not a good match.
Certainly, when we are trained in establishing and maintaining rapport, and decent and sociable people anyway, then most people we work with will be a good match. But sometimes, for whatever reason, the therapeutic chemistry just isn’t there.
So often when we find ourselves despairing over a client’s lack of progress we are taking it personally. But if you feel there’s really no effort or engagement coming from your client you can do something quite dramatic. Cue tip three!
Tip three: Use negativity positively
One client, Robert, said “yes” to my “no” and “no” to my “yes”. More than honest disagreement, this was, I eventually noticed, automatic contrariness.
If I said “up”, he said “down”. When I breathed in, he breathed out (well not really, but it felt like that!). He was almost obsessively oppositional, and it started getting to me. It seemed more important to him to control the session than to get the actual benefit he had said he wanted from therapy.
Everything I said was automatically wrong.
I worked with his resistance by encouraging it, and that worked quite well… but he was still dragging his feet – and mine too!
One day I decided to try a different tack.
“Robert… what is this, your sixth session?”
“Thereabouts… no, wait… it’s my seventh.”
“Okay, well I have decided I’m not sure I can help you. Maybe I’m just the wrong guy. You might well suit a number of… many… other therapists. But I feel we are not getting anywhere.
“But maybe I’m wrong… is there anything you can think of that we can constructively work on? Maybe something I’ve missed? Otherwise, I think we need to call it a day.”
He was thunderstruck. He then earnestly told me how valuable he was finding our sessions. How he felt we were making progress. And you know what? From that point on, we did make progress. But it needed that kind of fuel injection to get it going.
I wasn’t really giving up on him, but I didn’t want to take his money for no purpose and I wanted to see whether he really wanted my therapy. In this way we can be open about whether they are really happy to continue. That would have been a harsh approach for Denise, but for Robert it worked beautifully.
Tell them you’re not sure you can help them any further and ask if there is anything they can think of that you are not doing. And come back to it if necessary. We don’t want clients to waste their own time.
Positive use of negativity to motivate the client can be surprisingly powerful when they and even you had started feeling a bit hopeless about it. But you should also remind yourself regularly of the next point.
Tip four: Remember that people are surprising
To my shame, I had forgotten that people can surprise us. Resources can be hidden below the surface even when that surface may look like arid desert or lifeless crystalline iced tundra.
This is exactly the kind of imagery I used with Denise. I talked about how in winter trees and shrubs appear lifeless, but underneath, even beyond awareness, changes can be happening that will soon start to break free, bringing life back to the world…
Now, on the rare occasion I start to feel even a tad hopeless with a client, I remember Denise and how she surprised me, and how faithless I had been to doubt her.
And remembering that people surprise can help you inhabit fully the next and final tip.
Tip five: By your very being, transmit your positive expectation
I expect my clients to get better and become happier. I sometimes sit down before they arrive, relax, and hypnotically see them happier and healthier in the future. I want my expectation to influence them, and I think it often does.
New drugs were once tested in mere ‘blind’ trials. This meant the patient didn’t know whether they were getting the real deal or not, but the doctor administering the drug or placebo did know. And there’s a huge problem with this.
It was found that the doctor’s (non-verbally expressed!) expectation influenced the client’s responsiveness to both the drug and the placebo.
Nowadays well-conducted drug trials are ‘double blind’, meaning neither the patient nor the doctor knows whether the patient (or trial participant) is getting the real drug or the placebo. Expectation of the healer matters for the patient and can have a positive or negative impact on the outcome for the patient. Even when real drugs are used!3
So the expectation of the therapist may be a key factor in the outcome of the therapy. It’s worth letting that sink in for a moment.
Sunk in?
Okay! And you can also self-hypnotically rehearse your client getting better. What will they look and sound like and how might they be living their life in this better future? We need to give our clients a template for health, an alternative to dysfunction and a blueprint for change, but we also need, as the practitioner, to have our own template as to their future progress.
At the end of her inner rock climbing experience Denise was ready, seemed finally happy, in fact, to talk.
She looked more relaxed. She marvelled at how I’d known that rock climbing had been so dear to her (I hadn’t known) and that she really enjoyed revisiting this passion. A passion from her “forgotten life”, as she called it.
Slowly, and without tears now, she started to tell me of her fears, terrors, and traumas, and finally her rediscovered hopes.
At the end of that fourth session she transformed herself and the world in general with a smile. For a moment, it cut through the darkness – and my perception of her and her potential.
It was long and hard, but we climbed her rock together. At last, she could see further and better than before.
Chronic pain management client
Just added to UPTV, this client comes in for her third session for chronic pain management. She has had some good results from the hypnosis and recently had a whole week of no pain whatsoever, although when she went back to work she did have a two day migraine.
During this session she still has a lingering migraine although Mark does manage to relax her and make more suggestions for comfort and a sense of leaving the pain behind in the future. This is a short session with almost three quarters of it consisting of hypnotic therapy. Click here to be notified when UPTV is next open for booking.
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About Mark Tyrrell
Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.
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Notes:
(1) http://journals.sagepub.com/doi/abs/10.2307/3094912
(2) http://www.pnas.org/content/early/2014/05/29/1320040111.short
(3) http://www.ebiomedicine.com/article/S2352-3964(17)30385-7/fulltext
