Understanding the Difficult” Client – How Do We Move Forward
Heidi Reznick OT Reg. (Ont.), and Veronica Takes OT Reg.(Ont.), have been featured in the March 2016 edition of Litigator Magazine, with their article entitled “Understanding the “Difficult” Client – How Do We Move Forward?”
The Litigator is a magazine by the OTLA which is available to its membership, along with members of the Judiciary, politicians and others in the legal field.
Understanding the “Difficult” Client – How Do We Move Forward?
by Heidi Reznick and Veronica Takes
If the title of this article has caught your eye and you’ve started reading this, then odds are that you’ve had some experiences with “difficult” clients. Maybe these “difficult” client scenarios have kept you up at night or distracted you during personal time with friends and family. Difficult clients can be one of the most stressful aspects of the workplace. The reality is that we’ve all been there. In an industry where we are working with people going through major life transitions, it is inevitable that some might leave us feeling exhausted, frustrated, and stressed. It’s not just our emotional health at stake with these clients. If the legal and therapy team are feeling at odds with the client and struggling to engage with them, then the client’s recovery from their injuries will be negatively impacted. The client might quickly be labeled as “unmotivated” or “non-compliant” and denied services, and their true level of current and future need might be grossly underestimated. There could also be miscommunications or unmet expectations from the client’s perspective, leading to conflict and potentially firing of some or all of the legal and therapy team.
What is a “difficult” client?
This might seem like an obvious question, but how do we really define a “difficult” client? Other articles on this subject have identified difficult clients as “hostile”, “dependent” or “non-compliant”1. It can be argued, however, that what seems difficult to one person is a walk in the park to another. Or that an “easy” client can become more difficult as circumstances change over time. While many factors might come into play when identifying a “difficult” client, the truth is that clients don’t exist in a vacuum. The legal and rehabilitation team are key players in defining whether interactions with a client become difficult. Further to this, the connection the team has with the client is instrumental in diffusing difficult situations (more to come on this later). When we start labeling our clients as “difficult” you can probably bet that they see us as “difficult” too. If we focus solely on the client as problematic and ignore our influence on the situation, then we are working with blinders on to the potential solutions.
I invite you to take a step back and rather than trying to figure out how to manage the “difficult client” take a look at possible solutions to the “difficult relationship” you are in with your client. Specifically, we can describe these relationships in a few ways. The first type of difficult relationship is one I like to call Stuck in the Mud. This is when you have a client that never seems to progress despite the best efforts of the legal and rehabilitation team. The client inconsistently follows through on recommendations no matter how much support they receive. Over time it gets harder and harder for the rehab team to justify continued service as no objective progress is being made and the client’s level of disability does not reflect their injury severity. In this relationship, every time you try to dig your client out of the mud, they just seem to sink in deeper. The second type of difficult relationship feels like you are Pushing Against a Wall. This client goes against every recommendation put forth by the legal or rehab team. The client may seem to agree with you in the moment but their actions tell a different story. The more you try to push and convince this client of something, the more they pull away or push back. Finally, there is the relationship where you feel like you are Walking on Eggshells. You are never sure when this client is going to get angry or explode. You feel like you are constantly bending over backwards for this client yet you could be fired at any moment.
Resistance is Normal!
No matter how you feel in the relationship, the key to moving forward is to first realize that these types of breakdowns are totally normal. Feeling stuck in the mud, like you’re pushing up against a wall, or like you’re walking on eggshells are all forms of resistance, which is a natural and necessary phenomenon when a person is going through a major life change. In fact, established theories, such as the Transtheoretical Model of Change, have described that there are many stages a person must go through before they get to the point where they are actually ready to take action on their goals.2 You can probably think of a time when you were trying to make a change and no matter how logical the change was or how much you wanted to do it, you experienced some resistance in yourself to moving forward. This change might have been a big one, like taking a new job, or could have been smaller like trying to cut sugar out of your coffee. No matter how big or small, we have all encountered resistance in ourselves and this is something that all of our clients go through to varying degrees.
Recognizing that resistance is a normal part of any change process lets you sit back and breathe a little easier. Your difficult relationship with your client might be easier to understand than you at first thought. Encountering resistance might be your clue that something pretty big is going on for the client in their life, their recovery or in their relationship. You now have the opportunity to take a step back and try to decipher why this resistance and relationship breakdown is occurring.
Here are some questions you can ask yourself:
- Are you truly recognizing or understanding your client’s needs or wants? What are their expectations with regards to their medical recovery? The outcome of their legal case? The manner in which the rehabilitation and legal team communicates?
- Are there different cultural values at play which might strongly influence the client’s understanding of the situation, how they make decisions or how they interact with the legal and rehabilitation team?
- Is the client ready for change? What changes are they encountering in their personal recovery and in the legal components of their case? Is the rehabilitation team asking them to accept a piece of equipment or new life role? Was it a difficult decision for the client to retain legal counsel in the first place or is there an aspect of the legal case which is emotionally triggering for the client?
You can also engage the team and client in this discussion. While it might be difficult for a client to explain exactly what’s underlying their emotions or behaviours, reflecting back to them what you’re feeling can be a good place to start. I’ve started a number of these challenging conversations with something like: “Hey, I’ve been feeling like we are really stuck here … is it just me or have you been feeling like this at all? Help me understand what’s going on for you right now.” You might be surprised what you learn from your clients by opening up the door for them in this way.
The Difficult Relationship Toolbox
Once you’ve recognized the presence of resistance in the relationship, reminded yourself that this is a completely normal phenomenon and reflected or had some discussion with your team and client around possible underlying factors for the relationship breakdown, there are a few tools you can use to help your client and relationship move forward in a positive direction.
- Express empathy
This might sound overly simple, but empathy is one of the most powerful tools you have in your tool box. To understand why this is, it’s important to clarify the difference between empathy and sympathy. Dr. Brené Brown explains this best in her animated short on the subject3 (which I highly recommend if you haven’t seen it). She describes empathy as “feeling with people”; being able to take the perspective of another person without judgment. This shared perspective serves to foster trust and connection between people. Sympathy on the other hand is feeling caring or concern for someone, but without that shared perspective. Sympathy can make a person who’s in a vulnerable state feel even more isolated. Empathy is about being present with your client, really listening to their story, and not watching the clock when they are with you. It’s about mirroring or reflecting back what they are feeling in a genuine way. As emphasized in Dr. Brown’s video, “rarely does an empathic response begin with ‘at least’”. If you find yourself trying to paint a silver lining for your client, or trying to convince them that things could have been a lot worse, then you are likely not expressing empathy. Empathy is so powerful that research has shown that a therapist who expresses high levels of empathy has a much higher chance of influencing change in their clients compared to non-empathetic therapists.4 Why is this so important? As legal counsel, you are in a unique position to offer advice which will significantly affect the outcome of your clients’ lives. The more your client feels connected with you, the more they will be able to trust you and the more you will be able to understand them and help them make decisions which are in their best interests. For those difficult relationships, a lack of trust or not feeling understood by the team could be a driving factor in the relationship breakdown. Empathy can be expressed in a single sentence or in the silence of just listening and being present. It is a simple yet powerful tool to create connection and fuel change in your client relationships.
- Roll with resistance
When we are determined to get a point across our instinct is often to thoroughly explain all the reasons why someone should agree with us. In many situations this is a highly effective strategy, for example, in a courtroom or with a client who wants you to take control. However, with our clients who are on the fence about making a decision, who don’t fully trust us, or who are in a vulnerable state, listing out all the reasons to do something could have the exact opposite of the desired effect. Research has shown that when clients are on the fence about making a change and a counsellor uses a confrontational style of communication, the client is significantly less likely to talk about change (and talking about change is highly predictive of actual behavioural change).5 It’s human nature to become resistant when you feel like you are being pushed into a corner. When we are in a difficult relationship, it might not take much for our clients to feel this way. Instead of confronting, over-explaining, or fighting the resistance, try rolling with it. Ask the client to explain the pros and cons of the situation to you. Be genuinely curious about their opinions and the reasons for their actions or behaviours. Even if in your head you completely disagree, try and see things from their point of view. Validate the legitimacy and importance of their opinions and make sure they feel heard. Once this foundation in the conversation is established, you may then have an opportunity to review the discrepancy with the client, in other words, help them link how certain actions or decisions either move them towards or away from their stated goals. This could sound something like, “So on the one hand you want ‘x’. But on the other hand you are doing ‘y’.” In these conversations it’s important to reflect ideas back to the client in a curious rather than confrontational manner, using the client’s own words and explanations. Getting to a place where the client can start explaining and hearing their own reasons to pursue a certain desired action or behaviour is foundational to resolving a difficult client relationship.
- Create a secure and cohesive team
The importance of team communication and a shared understanding of the situation cannot be underestimated. When you feel you are in a difficult relationship with a client it’s often the case that the rest of the legal and rehabilitation team is struggling as well. As you build your client’s rehabilitation team, consider putting on service providers who have very strong communication skills and are tuned into more subtle psycho-emotional aspects of client care. Coordinate regular team meetings to ensure that everyone is on the same page. Encourage the rehabilitation team to document their understanding of the situation in their reports using research (e.g. Transtheoretical Model of Change) to normalize why your client may be getting stuck and to advocate for increased time to reach client goals. Implementing these proactive communication strategies will strengthen the team and enable the client better manage the peaks and valleys of recovery. This will in turn minimize the likelihood of the client having services denied due to misperceptions that they are “non-compliant” or “unmotivated” or having a complete relationship breakdown where the team is fired.
Taking a step back and employing your Difficult Relationship Toolbox can turn a potentially negative outcome into a positive one. Whether you’re stuck in the mud, pushing against a wall, or walking on eggshells, the path of resistance can be navigated successfully with the right outlook and tools. By expressing empathy, rolling with resistance, and creating a secure and cohesive team you can positively strengthen your relationship with the client, maximize the team’s efficacy, and improve your client’s recovery and their overall experience with the legal process.
Endnotes:
1 Curtis, C. (2003). Dealing with the Difficult Client. http://www.practicepro.ca/practice/pdf/DealingDifficultClientCaroleCurtis.pdf
2 Prochaska, J. O. and Prochaska, J. M. (1999). Why don’t continents move? Why don’t people change? Journal of Psychotherapy Integration, 9, pp. 83-102.
3 RSA (2003). Brené Brown on Empathy https://www.thersa.org/discover/videos/rsa-shorts/2013/12/Brene-Brown-on-Empathy/
4 Moyers, T.B. and Miller, W.M (2013). Is low therapist empathy toxic? Psychology of Addictive Behaviours, 27(3), pp. 878 – 884.
5 Miller, W.R. and Rose, G.S. (2009). Toward a theory of motivational interviewing. American Psychologist, 64(6), pp. 527-537.