Yeah, being more straight to the point, even somewhat confrontational. Also depends on the patient. Some people are very sensitive so therapists don't seem to challenge them. Can backfire. Others might need a little more confrontation or if are in a dangerous situation, perhaps a kind of a wake-up call. A person who was abusing drugs and showing up at his therapist's office high, once had such a session, when the therapist confronted him and was very "real" with him, as he said it. It did not involve yelling at him, using insult, or anything else. Just a kind of intensity, facing reality about consequences of his actions and his failure to do anything to help himself, in a way that shook him up.