13. Liking... Not Liking Clients - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Why does the therapist like particular clients?  Does the therapist like Carson?  Does the therapist like Vee?  Which one does the therapist like more?  Does the therapist need to like clients to do effective therapy?  In individual therapy, there is only one relationship to manage- that between a single client and a single therapist.  It is relatively easier except in the most triggering cases for the therapist to bond with and like an individual client.  It is significantly more difficult to manage the four relationships in couple therapy: the therapist with one partner and with the other partner, the therapist with the couple as an entity, and the relationship between the couple.  The first three relationships are critical to, but also subordinate to the relationship between the couple, which is the point of couple therapy.  What if therapists like one partner but not the other in a couple?  Family therapy with potentially even more participants has more relationships to manage, and more members to potentially like or dislike.  Theoretically, the behaviorist or psychoanalytically oriented therapist may be able to claim that liking or not liking clients is not important to the work.  However, the humanistic existential therapist conduct therapy based on sharing his or her humanity with their clients.  But what if the therapist does not like the client's humanity!?  Humanity has many expressions that may be positively familiar or benign, or negatively familiar.  Humanity has a great diversity of cross-cultural expressions that may be not only unfamiliar but may trigger negative feelings or reactions based on cultural experience or ignorance.  There may be ways clients express similar values that are misinterpreted. Client's expressions may push not just another, partner, or family member's button, but the therapist's buttons too!?  The challenge is to connect to client's core feelings that create the behavior.

There may be different ways that people express their core feelings.  Expressing with strong anger verbally, emotionally, physically, or socially may be culturally approved or discouraged.  Or, approved or discouraged in the family-of-origin.  The therapist must be aware of and understand personal experiences and comfort with intense feelings- also known as counter-transference such as anger, and especially allowance for and comfort level with it.  Individual's anger is normally not the primary emotion, but at least the secondary emotion to more vulnerable feelings.  Anger is the emotion that often ignites hurtful (or self-destructive) behavior.  The behavior can be impulsive, thoughtless, cruel, vicious, and even sociopathic.  It may be amoral or outside of expressed cultural or family standards, but still hypothetically within the standards that the aggressor grew up in or exists in currently.  Negative aggressive behavior may immediately draw the attention and energy of everyone, including the therapist who recognizes the harm to individuals, couples, and families.  The therapist may see, experience, or intuit both the perpetrator and the victim- the protagonist and antagonist.  In individual therapy, the abuser or betrayer of therapist's clients is not in the room.  Joining with the individual client "against" the other may build rapport but runs no risk of harming the non-existent relationship with the other person.  In individual therapy, the target of the client's anger, aggression, or other inappropriate behavior is not in the room suffering it.  Whether it seems that the target "deserved" or was unaffected to traumatized by the actions of the individual's actions, depends on the reality he or she presents to the therapist.  In couple or family therapy, almost everything can happen in the room.  Cruelty, insults, hurt, and anger happen in front of the therapist.  Experiences from the real world or home are brought into the room, but there are also individuals, couple, or family's actions in the room.  All relationships are in play.  How the various relationships are prioritized and managed is critical to the therapy.  

Boundaries must be set, but the therapist needs to know if the boundaries are for the therapist's comfort or to facilitate healthier functioning.  There hypothetically is a fifth relationship- that of the therapist with his or her own self.  If that relationship takes primacy, therapy will be compromised.  In couple or family therapy, if maintaining a close relationship that favors one partner or family member takes precedence, therapy will be compromised.  In a comparable sense, favoring one persona over another within an individual may be problematic.  Integrating the various personas much like integrating partners or all family needs may be a goal of therapy.  However, if keeping all partners or family members happy with or liking the therapist becomes more important than the relationship, therapy will fail clients.  The therapist needs to recognize which are personal moral boundaries versus ethical/professional boundaries versus cultural boundaries versus legal boundaries.  If one partner or family member engages in inappropriate behavior in or outside the therapy room, the therapist must set boundaries that validate the harmed person's right to decent treatment.  However, the therapist does not serve the relationship by protecting one individual and pathologizing the other person.  The therapist who identifies as rescuers or advocates of the oppressed will align with one individual while demonizing others in the room or in the individual's life.  When the therapist asserts such boundaries, he or she needs to also express compassion for transgressing individuals and their initial igniting emotions.  The therapist needs to conceptually hold that problematic behavior often comes out of individual's anger.  Anger often or usually comes from harm, betrayal, violation, or loss through depression, fear, or anxiety.  The harm, betrayal, violation, or loss is often symbolically re-experienced family or cultural patterns that no one, including the transgressor in the therapy room or in the outside world is aware of.  Conceptual understanding leads the therapist to having compassion for the wounds within the transgressing individual that have led to the poor behavior.  When the therapist or when the process of therapy sets boundaries against harmful behavior, it must be done such that they do not dismiss or unintentionally diminish the aggressor's fundamental pain.  Everyone experiences pain, but not always the same way or for the same reasons.  Pain comes from innumerable multi-cultural and family variations.  The therapist, especially in couple and family therapy need to be aware of personal emotional and behavioral variations in personal ability to integrate client's emotional and behavioral variations effectively in therapy.

When children are involved, problematic behavior can be so sensational and harmful that the drive to manage and create safety often loses track of the underlying pain.  This happens with children's behavior, but also with parents' behavior within the couple.  The denial of anyone's pain re-traumatizes him or her and the cycle of negative behavior repeats itself.  Often individuals in the couple or family are able to express behavior, sometimes able to express anger, but quite unable to express the underlying root of the pain to other people.  Some of this may be developmental, because of being developmentally stuck or not having developed the sophistication to express themselves well.  It may be partially a cultural issue where the expression of pain with a family, group, or society may be more or less acceptable and practiced.  The therapist have to be comfortable or comfortable enough with anger and aware of variations of the cultural role of anger for the clients in order to begin to investigate individuals' personal inhibitions or freedom.  The unaware or inhibited therapist may try to eliminate or suppress anger out of hand.  The therapist needs to honor anger as a survival mechanism that individuals learned from a time of vulnerability and sparse options within their cultural or family context.  By honoring the anger, the therapist can reach and honor the deeper pain within clients' experiences.  The therapist may fear his or her own and others' anger as unbounded rage that leads to abuse.  This is a consequence probably of personal experiences.  As such, the therapist cannot honor anger.  Through their empathetic connection of hurt to anger to behavior, the therapist can then criticize the behavior as currently dysfunctional in the relationship without demonizing the transgressor.  Criticism and subsequent boundaries and behavior changes will be more likely taken and considered. The therapist may find it easy to feel sympathy for one individual, especially if the other person is particularly harshly emotive.  "EFT therapists typically avoid this mistake by concentrating on the patterns of interaction as elements of the couple's overall attachment styles, which are healthy and adaptive, but become problematic at times.  Assessing the cycle of interactions which clearly delineates that each partner's response and behaviors in the dyad are a direct result of their experience of their partner clarifies that there is no one to blame and no one position is 'better' or less 'pathological' than the other; a dance is a dance and both partners are intimately tied to the movements of the other" (Peluso, 2007, page 263).

One individual, often a male such as Carson may be relatively crude and less conversant in the language of emotions and intimacy.  Trained by society to stuff feelings, men may stuff it until they cannot stand it anymore.  Holding it in may create frustration that becomes anger that becomes bitterness with resentment.  When such men are a part of a couple, they can present nicely in public.  Everyone at church thinks Carson is a fine fellow, and Carson's wife, Vee is a total sweetheart.  They don't see what happens at home.  When they arrive in therapy, both of them present as fairly decent people.  Both seem to want to connect with the therapist.  Vee seems to stay calm and pleasant throughout most of the session.  Carson, although initially very calm shows more agitation. Symonds (2004) says "…it may be important to consider the complexities that arise when the therapist has a stronger alliance with either the male or female partner. It also seems probable that male and female clients experience alliance differently. Further, because one partner is the same gender as the therapist, and the other partner must form a relationship with a therapist of the opposite sex, the therapist's gender may be an important consideration...Which partner's alliance matters most, when, and to what effect?" (page 444).  

Carson talks about having some time to visit his parents without his wife criticizing him.  He proposes that he visit them Sunday mornings, but will be back by noon to spend time and do things with her and the kids.  He asks, "How about it?  That work for you?"  Vee turns her head and says, "Whatever… I don't care." (her aggressive/defensive response to harm and pain).  Carson (there are any of the number of cultural backgrounds that supports male aggression and anger to handle vulnerability) flies into a rage, "You f—king, b----!  That's it!  You see how long you make it without me…and my paycheck!"  (Pardon the allusion to profanity… the therapist is going to hear it.  If the therapist is too easily sensationalized or worse, become judgmental the therapy will be negatively affected). Two injuries, two hurt and angry people, and two counter attacks.  The therapist has seen this, has experienced it, and may have been even personally traumatized by this before.  It becomes easy for the therapist to not like the abusive spouse… actually it's easy to hate Carson!  And, to identify or pity or align with the poor "victim".

Not all women or men have these stereotypical behaviors.  In addition, there will be individual nuances from individuals' specific life experiences, cultural backgrounds, religious upbringing, and social treatment (including for example, gay and lesbian individuals or couples who have to deal with homophobic or heterosexist messages and actions in society).  Who in the couple started "it?"  Unless their therapist has taken a side, therapeutically it does not matter anymore.  Both members of the couple are continuing it.  It is an old dance between them.  "As therapy progresses, each partner may attempt to enlist the therapist to understand the ''story'' sympathetically from his or her perspective.  To the extent that each partner feels that the therapist accepts his or her version of the problem and preferred outcomes as the goals of treatment, an alliance is built.  However, this process may replicate the dynamics that brought the couple into treatment.  The attempted co-opting of the counselor may explicitly or implicitly lay the blame for the problem on the other partner and damage the allegiance that the couple has toward one another.  In this case, the partners would experience the alliance as unbalanced and disagree about its strength.  The therapist would then need to balance the desire to build a strong alliance with each partner against the strain that it might impose on the allegiance between the partners.  The therapist's ability to resolve this dynamic by moving from an either/or to a both/and position could result in an increase in the strength of the alliance for both partners, and in stronger agreement between them" (Symonds, page 452).

In this scenario, Vee is quite adept at "letting" Carson make the case that has always backfired on him.  Eventually, she would be able to enlist people on her side.  She expects to enlist their therapist on her side too.  The therapist should address the angry husband first, but not necessarily addressing his response, which may be culturally determined.  The partly culturally determined response, which is angry and aggressive, comes out of the normal human response of being hurt along with male training.  Emotional or psychological injury often evokes anger.  Anger then is an empowering self-protective emotion.  Anger often triggers aggressive behavior, which is considered acceptable for men.  The aggressive behavior, which was insulting and profanity laden can distract the therapist from Carson's underlying pain.  If there were physical danger in this therapeutic exchange, the therapist would need to quickly assert clear boundaries to protect the wife.  At this point, danger is to feelings, spirit, and the relationship.  All such dangers can be handled eventually, if the therapist productively manages the couple's process.  The other significant danger is that the Carson's vulnerability will be ignored again.  His vulnerability can be easily missed amidst his roaring verbal aggression.  This becomes an opportunity for the therapist to connect with Carson, which may be crucial to a positive outcome for couple therapy.

"…when the male's alliance was greater than the female's and when the male's alliance was improving over time, the correlations between alliance and outcome were strong.  In a related finding… found gender differences in a study of 63 couples in marital skills training.  They determined that the strength of the males' alliance was a more powerful determinant of outcome than that of their female partners.  It is possible that the male clients were more reluctant to come to therapy.  If the therapist successfully fostered the necessary engagement of the less motivated male partner, the chances for a positive outcome were enhanced.  These men could have been more reticent because they did not feel that they were sufficiently skilled at communicating their personal thoughts and feelings.  This interpretation is consistent with the conceptualization of marital power that suggests that although men often hold more ''positional power'' based on their control of resources and status, they are often disadvantaged in ''relational power,'' or the ability to exert their influence within the context of an intimate interpersonal relationship" (Symonds, page 453).

Verbal and sometimes, physical aggression may be cultural or family training to more or less effectively hide or overcome vulnerability.  However, it does not draw normally empathy from others, including intimate partners.  The therapist can directly address the husband being hurt. "Vee really hurt you there, didn't she?  She's all quiet and everything, but her dismissing you with 'Whatever…' got you good.  Makes you like…you don't matter, doesn't it?"  The "doesn't it?" inquiry invites him to expound on the invalidation.  His response was "Yeah, she does that all the time.  It makes me so f—king mad!  And, she knows it!"  While still animated, the intensity drops a notch because Carson is finally getting some acknowledgement of how his wife's actions diminish him.

ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
(510) 614-5641 or (510) 582-5788
fax: (510) 889-6553
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