is it possible to be a client that no therapist wants?

I've got to admit amandalouise your post pushed my buttons. It's really unfortunate in my opinion that you would give up on clients in this way. Sometimes trust takes a LOT of time. Sometimes things are not what they seem. Sometimes you have to wait to feel the underwater currents. Slowly you become in tune with a person, knowing what they need, feeling for the faultlines, sneaking in. Resistance to therapy is an opportunity. Sometimes overcompliance is a problem. Listen with more than your ears and see with more than your eyes and you'll find yourself a better therapist...

When we get a call from someone or someone walking in to the crisis center asking for help we have them fill out papers. Name address that kind of thing and why they want to see us, what they expect to get out of coming to us.

then we schedule an intake appointment where they sit down with one of our therapists and fill out more paper work asking for more details about their problems. then their file is given to a supervising therapist.

The supervising therapist reads their intake forms and looks to see who has time available and what that therapist, intern, psychiatrist works best with. then they assign the person a therapist.

The first appointment with our clients we have more paper work for insurance and goal sheets. we talk with the client about their problem and the client and therapist make up goals together.

then for the next two months we work on accomplishing those goals. if after two months no goals have been accomplished and no effert has been put into trying to do the work ie the client keeps derailing the conversation off of the problems, the client doesnt try any of the suggestions, the client comes in complaining we3ek after week about this problem but when you ask them have you tried this that you agreed to try the last week or weeks ago answer no didnt want to didnt have time didnt think about it, dont think it will work anyway so why bother. excuses upon excuses instead of trying to work on the problems.

I cant help someone who doesnt want to help their self. We cant be in their homes making them do the work. we cant solve their problems for them.

its one thing to have a problem and decide to go to therapy because you think thats what is expected or someone tells you thats what you should do or thats what you think you should do,

and its another to actually want to get better, actually want to get rid of the problem. Actually want to make changes to your life.

therapists can be there and help show you how to fix the problems by helping you to set up goals and suggestions on how to accomplish those goals but the clients are the ones that actually have to do the work and want to get better.

Yes i know thats why even though it makes me cringe I take a deep breath and say to myself here we go. I get myself in the mind set that its time to go to work.

no we actually do get a lot of teenagers who learn one of their friends are coming in our door or seeing someone here so they come in just to be part of the in crowd. they don't have any problems they are just there because "Jane said she comes here" or they "saw David come in" they stick around for a bit most about 4 or 5 sessions so that they can tell Jane and David they come here too. it is actually quite normal for teen agers to want to do the same things their friends are doing. Think back to when you were a teen. didn't you want to wear the same clothes your friends were, do the same fun activities your friends are doing. Teens naturally want to do things their friends are doing. and in this case when a teen sees the guy or gal of their crush or a friend walking in someplace they want to be a part of it too. When a teen tells another teen I play chess at this place once a week the other teens want to be a part of it. Just natural teen behavior. I just wish some days theres a way to get through to teens that they don't have to wear the same clothes their friends are, they don't have to do the same things their friends are.

this is a joint effort right from intake. they take part in a structured intake process that allows them to tell us why they are here, what their problems are and they take part in the process of brainstorming and setting up their own goal sheets. The suggestions most times are actually their own ideas of what "they" are willing to try. We have set worksheets we use for this process with the suggestions on it and then they go through and mark off the ones they have tried, what ones have worked, what ones haven't worked and the ones they want to try, and there is a place for them to make their own suggestions. the goals are where "They" choose what they want to do. We dont force them into anything.

maybe so but we cant help them if they don't let us know what is going on. example can you go into a store and stand in front of customer service and they read your mind and know what your problem is and how to help you. no.

therapy is the same way therapists are not mind readers and we cant force someone to do the work, we cant force someone to want to change, we cant force someone to tell us why they are refusing to work on the goals and suggestions that they them selves have helped come up with.

All we can do have them be a part of their goal setting and therapy process of setting things up and if they don't put any effort into things then theres nothing we can do but transfer them to someone else and move on to the next person who may actually want to fix their problems, may actually want to make changes in their lives.

Im sorry. But we are not a long term therapy agency. we are a crisis center. Crisis centers are not for therapy thats going to take years. Its not that Im giving up on the clients that dont put in any effort. Top me it makes no sens to continue with a client who after two months has shown they dont wnat to do the work. maybe its me they arent comfortable with maybe they have deeper problems that take more time. the fact of the matter is we are a crisis center not a long term agency that can spend years turning the client therapist relationship into a friendship and then get to work. we have over 5000 clients and a waiting list and we get calls from the hospital and police.

to put it bluntly we cant waste time on the person that is obviously not putting in any effort when there is a 3 yr old battered brusied and tore up toddler in the er that needs us, a 16 yr old who walks in the door because her boyfriend committed date rape, being an avocate for a rape victim prosecuting their rapist, a suicidal person on the edge on the phones and a psychotic holding his neighbor at gun point and the police need a mediator from the crisis center.

which would you choose to do be in an office with someone shooting down every suggestion even those they themselves came up with, refusing to do talk about their problems, refusing to accomplish the goals that they helped set up

or be in court for the rape victim, be with the 3 yr old helping to calm the child so the hospital can get the evidence, be with the 16 yr old helping her tell her parents and the police and walking her through the process of arresting the guy, be a mediator for th e police.

our agency has to make hard choices every day and unfortunately we dont have the time to spend years on someone who doesnt really want to make an effort for what ever reasons. all we can do is be there for those we can and transfer those we cant help to other people who can take the time they may need or give them the structure they may need.

unfortunately one way does not work for everyone and you cant save the world. even therapists have hard choices to make. Like other posters have already experienced and if you read other posts here you will see sometimes therapists have to say sorry we cant help you.

the problems could be anything. wrong therapist, client and therapist not clicking, client not ready to work, client having deeper problems than the therapist can help them with.

Just like people trying to find a therapist they have certain kinds of therapists they don't like and cant work with. therapists have the same problem, every therapist has their own limitations, and preferences for what kinds of clients, what field of work they are comfortable with.

Its scary on both ends for both therapists and clients. they each have their own preferences what they can do what they wont do. Ask any therapist and they will tell you that yes at some point in their careers they have met up with a few clients they haven't been able to help, haven't been able to take the time needed and the therapist client relationship just didn't click.

Therapists are human just like you they don't like every person they meet.

Yes I know sometimes slow is better but unfortunately I work at a crisis center the work we do here is not long term. that is why protocol here says we transfer the client after two weeks if no progress is made no effort being put in. We deal with stabilization, suicides, rape and sexual abuse calls from police, hospitals schools, homeless people needing immediate shelter, Crisis centers are not for long term therapy. thats what transferring does. we transfer to other therapists in the agency or in the community that do deal with long term care. we cant help everyone and we dont have the time for endless handholding. If the person isnt ready to work with us from the get go then we are not the right people for them.

I feel I need to say something here. people are starting to get all worked up over how I do my job and the fact that there are types of clients that I dont like to work with and the fact that I am saying so.

The thread is about if there are clients that therapists dont like to work with so there is going to be posts in this thread that are going to be about therapists not liking to work with some of their clients. its what the thread is about. If it upsets you to read there are therapists that don't like to work with some clients I wonder if this thread is for you. Maybe a moderator could add a trigger warning on this thread so that people know some posts in this thread can be triggering for those who don't want to think about therapists not liking every person that comes into their lives?

Second theres a difference between working in a crisis center vs working in a county mental health agency and other private and public mental health places.

I work in a crisis center as an intern who has a CSW not a LCSW. and I work on rotations at a local mental health unit at the city hospital. what we do in these places are not like what is done in other private and public mental health agencies.

on the mental health unit we have 72 hours to access a person's problem and whether they need inpatient care, if not set them up with an out patient plan. If they need inpatient care we have only 2 weeks to work with these folks, to get them stabilized and on a treatment plan and develop an out patient plan with them or start transferring them to the state mental hospital for long term inpatient care.

Crisis centers are for immediate help and stabilization for immediate problems. its not for long term therapy. We don't get the luxury of working with someone for years and years. we have to assess the problem, stabilize, work up a plan and get to work. if the person needs more time we have to transfer them to another therapist either in the agency or in the community. Thats the way crisis centers work.

I know its upsetting to know there are such places that require you to get down to business but thats what crisis centers are for. Emergency help right now on this crisis problem

And I know its upsetting to find out that therapists are human too, that therapists have likes and dislikes of people just like non professional people do. Its a therapists likes and dislikes that is the deciding factor of what specialized field they want to work in. My therapist hates working with drug addicts but she loves working with dissociative s so she became a therapist for dissociative disorders instead of working with Narcotics anon.

When you are an intern you don't get the choice of what clients you get and part of internship is to see what kinds of clients you prefer to work with and those you know you cant work with or dont like to work with.

I know I don';t like to work the court mandated cases so when its time for me to branch out past internship I will be making sure that I don't have to work court mandated cases. I may not have a choice in some cases but given a choice I prefer not to.

Being an intern working at a crisis center I also don't have the choice of taking time with those longer term cases. someday when its time for my internship to be over and I have a choice then it will be up to me to decide. Right now at internship level I don't like working with those that don't put pout forth the effort. I cant find out if I like working with longer term or not because longer term isn't what this crisis center where I am working does.

Just to clarify, amandalouise, this thread wasn't "are there clients some therapists don't like to work with." I think it's fair to say different therapists have different preferences for who they want to work with. But this thread was "are there clients no therapist wants to work with." I understand about the crisis center and I also do not work in a long-term therapy center - I work in a place that does short-term intensive behavioral therapy for pediatric OCD. But I also always challenge the T's who say, "They must just not want to get better." That's the thing I didn't like and is such a judging stance to take on people with mental health problems! The way you expressed your frustration may have alienated those among us who couldn't jump right into therapy and fix their issues in the first few sessions. You suggest this is a failing on the person's part. I firmly disagree as I have discovered (finally) what actually works to help me get better, and it wasn't any kind of rigid system that expected immediate results. Maybe it's a failing of your system. I think saying, the crisis center isn't appropriate for those cases, is much more fair.

No, it isn't about you.

This thread asks, by the poster and about the poster, "Am I hopeless?"
And we are answering with a loving and resounding "No, you certainly are not."

sorry I should have been clearer. "Some" posters posting to me, in my opinion, seem to be getting upset at me for how I am working with my clients and because I have stated that there are clients here at the crisis center that we therapists do not like to work with and what types of clients "I" do not like to work with. So I wanted to clarify the type of place I work at and what we do here. Hopefully my doing that will make it easier to understand why I have posted the way I did.

wondering if you are mixing up another thread the post.

I was answering the first post in this thread is "is it possible to be a client that no therapist wants?" and the reasons for it. then my subsequent posts were directed to those asking me questions about how I work with my clients.

thanks Jexa I somehow didn't see that no in there. My reading abilities are sometimes off. I have had clients tell me they don't want to bet better. I wasn't assuming or judging these clients I have worked with that don't want to get better. Ill try to be more clear next time. I agree the crisis center system in the US does have its failings. unfortunately its not made for long term clients that need to go slow and long term care. I wish it was.

This is a crisis center? Is that what you do in a crisis?

There is a difference between expressing (and recognizing) clearly your emotions (dislikes) and attributing the problem to the clients themselves (THEY don't want to work on it). You might say "they don't seem (at first glance) to want to work on it..."

It is possible to feel that you are a client that no therapist wants. Being one is a different matter.

yes even crisis centers have to follow the state laws of documentation of who comes in and why. call or walk in any walk in crisis center in the united states and they will tell you if you walk in their doors the first thing thats going to happen is a receptionist or therapist is going to walk you through the paperwork of name address and whats your problem. Even when you call a crisis hot line while you are talking to the therapist or volunteer on the phone that worker on the phone is filling in the paperwork of time call comes in name if given address if given phone number on caller id and reason the client has called.

we ask the clients when they dont put forth the effort if there is a reason most times it is because they just dont want to do it. I dont assume they dont. I write exactly what they tell me.

no actually I have been with the same therapist now for the past three years and before that with the same one for 5 and the one before that for two. and all my therapists have never tried to get rid of me, they never said to me "I cant help you" they have all said and wrote in my files how easy it is to work with me because I am very open and receptive to their help. The only therapist that didnt want me was my school psychologist and then it wasnt because I was a client no one wanted. it was because I disclosed on going sexual abuse so by law she had to call in the police and the police asked her if she would continue to be my therapist. She said no because she wasnt comfortable with court cases and this was going to be a case where it was going to courtand she didnt have the time to spend on the case that would be needed for a 9 year old having to go through what was ahead. She did her part under her job as school psychologist now it was time for the officials out side the school to take over.

That method of "assembly line" therapy would never have worked for me, amandalouise. I don't do well with pressure and time lines. Everyone needs something different. For me, what I needed more than anything else was just for someone to hear me, be there for me and accept me. I needed the human connection. The rest just worked itself out. I would think losing sight of the human factor in this would make therapy much less effective for many. Therapy shouldn't be about clients conforming to therapist's needs/desires. I realize that you are on a time-limited basis with these clients, but sometimes simply being there for someone can be more healing than having all of the answers.

Yes and No.
It's depends on the therapists but not the clients.

I've had personal experience with the "crisis stabilization" mode of working with patients, so maybe I can clarify what Amandalouise is talking about. What she is working with really isn't "therapy" the way we see it. When admitted to the crisis stabilization unit in the hospital for instance, you are there for a very short time and the INTENT for the social workers working with you is to help you find a long-term therapist and pdoc if that is what you need. They really aren't there to do "therapy". They are kind of the go between guys I guess. They give you some support and work on very short-term goals while further arrangements for your future and care are made outside that environment (i.e. hospital or clinic). Where she works appears to be free-standing, not inpatient, but the work sounds about the same.

Patients in crisis situations are not always very willing to move forward into therapy. In fact, they are often very much in denial that there really is a problem, even when they've been beaten, they're withdrawing from drugs, they've been raped, etc., there is a huge amount of denial that can be going on. While the social workers try to get people to accept the help they need, as we all know, unless they are ready for it, it isn't going to happen. And even when arrangements are made, there's no guarantee that the patients will follow up.

All a crisis stabilization team can do then is to try to get through the initial crisis and the patients have to move on. This is not a long-term therapy situation at all. Is it a perfect system, absolutely not. Will these patients end up back in the system again, likely so if they didn't accept the long-term help that was offered to them.

Amandalouise, what you are talking about isn't "therapy" in the long-term sense that we are dealing with here in this forum, thus the confusion. It might be best to just let it go rather than to try to continue to explain what you do. It is really like comparing apples to elephants.

one thing i will add is that, having worked on crisis lines myself, there are many people out there who are more than willing to really listen & read between the lines of what a client may or may not be saying, who try to practice therapy without letting their frustration cloud the desire for this client to see improvement.

i am sad on your behalf, amandalouise. if one of my friends confided in me what you have been saying, (imo rather inappropriately to a forum populated by clients), then i would strongly suggest to my friend that they seek supervision and guidance on how to work through the frustration. i am upset that it seems like you have so many competing demands that you've somehow managed to convince yourself it's "ok" to work with certain clients in certain situations over others. i DO hope you'll talk this over with your supervisor - i'm assuming you have one as you mentioned you are an intern and thus not a fully qualified, experienced and mature therapist as yet.

i am not saying i am any better or worse because i've also "been there, done that". i only worked at the crisis line for a little over a year before i burnt out and needed to step away for my own sanity as well as for those people who required the line's services. yeah, it feels good to know you have helped someone step away from suicide, got a guy in the grips of florrid psychosis a hospital bed, help a child caught in a paedophile ring find the strength to tell someone and stand by him. of course results - fast and easy - feel good.

but there was this one guy - we all knew about him, were told about him on the first day of the job - he would call up at least 2-3times each week and had been doing so for the past 6 years. usually just to shoot the breeze, sometimes because he wanted to vent, but almost never to actually report that he'd followed through on any of the suggestions of the previous call. he was a regular on my shift, and i do admit there were occassions when i switched off (he liked to talk about railway systems around the world). but one day he called in from the pub - after 6years of having the counsellors not reject him - he'd finally found the strength to get into his wheelchair and go to the pub on the corner of the street and talk to two other guys there because maybe they wouldn't reject him also. he got the other two guys to say hi to me on the phone, and as i teared up i only then realised how important this guy's struggles were to me and how massive this was - how much more commitment he'd needed to make this small step than many of the other people (in more 'pressing' crisis situations) i'd dealt with. he promised to call back again later in the week, and he's probably still calling that line every week, but he's making small improvements. we all had a morning tea at work to celebrate when i got to spread the news.

now, i understand you may not have the same crisis set up i was blessed to work with - where we dont turn people away because they aren't making improvements - but it does concern me that this situation seems to have shaped your attitudes towards who is more worthy of help. there is a HUGE difference between a service not being able to provide certain services, and a therapist rolling their eyes because their current client has "less important" issues than the therapist thinks they should be working with.

again, i'd suggest talking to your supervisor. but as an intermediate step i also wonder if you might not benefit from practising more mindfulness so perhaps you can truly help the client in front of you and not all the hypotheticals competing for your time elsewhere.

edit: also there is a private social group for therapists/helping professions on PC - maybe you could post there if you don't want to bring this up with a supervisor yet. you can pm me & i'll figure out how to get you an invite so you can join if you aren't a member already.

thank you farmergirl yes thats exactly what Im saying. where I work we dont do long term therapy we do short term therapy and if the clients need longer term therapy we help them transition into a longer term situation.

to the one that said this kind of system would not work for them. I understand that. crisis center systems are not for everyone. just like in long term therapy one therapist doesn't work for all.

(((Solarwind)))

How are you doing today?

Do you accept that what they are saying -- is always what is true? No attempt to look beyond the original statement?

You may have to do as you say in your situation. I don't think that would work very well in therapy itself.