“Help-rejecting complainers”

Help rejecters?
What a load of horse crap.

I think this discussion is interesting, I didn't realize however how sensitive the topic is, I apologize if it upsets people.
I think I didn't take from the article what some others read. I think it talked about help-resisting people. And it's not a myth, that there ARE people in therapy who are not willing to work, who complain a lot and who can not get out of that mode easily or don't want to. These people do exist. I was one of them. I have no problem to admit that. And I have an extensive trauma history too. I have PTSD. And yes, for me that approach absolutely worked. So generalizing for what group of clients this works is pointless in my opinion. It's not like the therapist is always pushing or is ever mean to the client. It doesn't mean that there is no validation, patience, understanding. On the contrary. I had just as much warmth and fuzziness and validation and encouragement as I had some tough love and as I said before, for me personally it was life-saving. So I think it depends on the client as well as the T. I am glad I had some tough T's in my past. I would have never gotten out of my misery without it.

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I think there are certain types of responses from the therapist that can inadvertently encourage more of the complaining behavior. Someone who is stuck in constantly complaining and resistant to suggestions for change might do well with a therapist versed in motivational interviewing techniques. In this approach, "resistance" is seen as being at least in part created by the therapist. If the therapist keeps getting "yes, but..." responses back to his well-intentioned advice on how to change, then it might be time for the therapist to change his approach with this client. Motivational interviewing helps the client engage in more "change talk" than "yes, but I can't do it, yes, but I have no time, yes, but that won't work for me" type responses. I think a therapist who can't think of any way to help a client like this beyond "come back to me when you're ready to work" might benefit from expanding his repertoire of techniques. There are a lot of good trainings out there. (I learned recently that the "come back when you're ready to work" approach was very popular in the 80s but not so much now.)

There have been times I was stuck on something in therapy, and my T will comment, "that's' the 3rd time this has come up..." and I realize I am repeating the same story again and again. My T can see this stuckness as a sign of trauma, perhaps minor or perhaps not, and he sometimes offers a trauma technique to help me get over it. "Would you like to do EMDR on this?" I think my repetition of the story is an attempt at processing, and that can indeed get stuck or derailed in trauma so something like EMDR could be helpful to shake that loose and let me move forward.

About 5 months ago I saw my therapist and was very much complaining about the same thing practically the whole session--my job. My T did try to get me off the topic to something else--I'm not sure why--but the problem was so huge, simply dominating my life, that I had nothing else to talk about. I couldn't talk about some minor thing in my life that wasn't bothering me. It really had to be "the job" or nothing. I probably appeared to be someone who was complaining, complaining, complaining... But I had never voiced my dissatisfaction to anyone before, I had just stewed in my unhappiness. I took T's attempt to change the topic as an indication he couldn't help me on where I was at with the job. I had to reach a point in my life where I was ready to do something about the problem, and I wasn't there yet. So I didn't go back to therapy for almost 5 months and I worked on this problem in my own way, part of which was just "holding still" and doing nothing. I think returning to therapy regularly and complaining about my job would have made things worse for me, made me feel more dissatisfied and unhappy with something that I had to accept couldn't be changed at that moment. It would have created or made worse a tension in my life that I didn't need at an already stressful time. I am very happy to now be through this impasse.

Information on Motivational Interviewing:
Motivational Interviewing

I don't look usually to the therapist for advice and the times she has tried to give it unbidden, I have told her to stop. I have once or twice gone in and asked if she could try to be useful on a concrete level, and then she has given her opinion. Usually it has not been particularly helpful or different from what I already knew were the options. I don't have much difficulty knowing I have choices in matters. Sometimes I don't like the choices, but I fully believe I have them. The problem I have with this is the idea that the therapist somehow knows what someone is doing and that they are rejecting help because the client is wrong. It is quite possible the help is being rejected because it is the wrong kind of help for that client.

It is also possible that I am not as bothered by constant complainers because I usually just quit listening after a few minutes and I never try to get them or help them change. If they ask for something specific and I don't mind doing it, then I will help, but I have to make sure I have no real investment in the results.

I am reminded of a joke about MPD (DID): You don't like me?! Just wait 15 minutes.

My T has given me some tough love. I kind of like it (so long as I know it's tough love and not criticism).

If my thoughts start going off track, she'll tell me to hush and that we're not going there.
If I try to distract her from something, she's more than happy to point it out.
She has called me out on "B.S." a few times.

Sure there's more, but my brain isn't functioning very well atm.

I prefer honesty over "fluff". People don't need to be rude or mean, but it's better to know what reality is than to live in a delusion...least I think so. So if my T sees me going some place mentally I need to not go, I more than welcome the redirection/halt.

My therapist likes to kick things in the butt, I like it this way.

I think this is where there is so much room for interpretation.

My T doesn't get in my space and say "You have to do X" or "We've talked about a million times", but I would never say he responded with "fluff" or that our relationship was based on "fluff".

Just because your T isn't "pushing" you or showing you "tough love", it doesn't mean that it's not a healthy, positive relationship that fosters change. Honesty doesn't have to equal something that is negative.

Everyone needs something a little different.

I thought I was the type of person who needed someone to push her to do things, push her to talk about certain issues....but that type of therapuetic relationship fostered a more chaotic life.

If you're only changing because someone is pushing you, guilting you, or making you feel like you don't have a choice, that isn't change. That's manipulation. To me, the article wasn't about tough love (which I'd consider to be honesty within a supportive relationship, absent of the treat of termination because you're not changing), but about a therapist's own frustration with a certain type of clientele.

True change should happen because you WANT it to and it's your decision. Telling a client that they need to stop therapy until their ready to do the work doesn't equal creating a safe place where you want to change.

That's why I don't think this is a practice that could be blanketed over everyone (like any approach).

I do agree with you. I was merely saying how I prefer honesty over anything. But that doesn't mean I don't like being comforted. My T does both. When I'm really upset, she doesn't make me feel bad or tell me get over it. She lowers her voice, talks slowly, maybe puts her hand on my knee, supports me.

Just "tough love" isn't always a bad thing. A T wouldn't be doing their job if all they did for your entire relationship was stroke your ego. But then again...there are many different T's out there. I had one that loved to stroke her own ego...lol.

i haven't read the article or all the comments yet but i do remember reading somewhere that chronic complaining doesn't actually help the complainer but actually does them harm in the long run. i would hope a good T would be able to redirect the complaining client, but if a client isn't willing to do any work to change, then i don't think a T needs to feel obligated to see the client. i have had friends who have been chronic complainers at times and one friend because of not taking any action in her stressful situation ended up making herself quite ill. i guess i see chronic complaining as a dysfunctional behavior that needs to be dealt with rather than tolerated because it does do damage to the sufferer, not to mention how it effects others.

I don't want anyone else deciding what harms or helps me.

I can't fully grasp the context of an adult who is an extreme whiner or complainer. I'm sure they've been in my life before but not for quite a while .

It is definitely a matter of ethics though. My Therapist and I have had general conversations about clients and ethics and decision making in treatment plans. She mentioned she always terminates and refers out clients who "lack the fight" and are not willing to be helped out of that victim role, work hard, stay dedicated, and start healing. This decision is mostly because she feels she cannot help them and will begin to cross the ethical line by continuing to see them, knowing she cannot help.

It's sad really because there ARE therapists who will continue to go along with it, being completely aware they are no longer helping their client. Some of them do it to bank off of these clients too! Therapists are doing their jobs when they tell you what they're observing and point out patterns. That's truly the only way to make progress.

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I completely agree. There's also a difference between complaining and venting. As clients we are usually there to work on a variety of issues such as anxiety, depression, trauma, PTSD, communication, behavioral patterns, and so much more. These issues require venting and discussion but there is definitely a difference in repeating the same issue every week due to resistance, and repeating the same issue often because the previous solutions did not work or stopped working.

In my personal experience, my T knows there are certain situations I am in currently where I really am temporarily "stuck" because of certain things being out of my control (lacking necessary tools to make the change). In these instances she will absolutely allow me to vent OR complain as much as I want so it doesn't add to my depression at all.


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It died with the advent of Managed Care.

Therapists get what are called CPT codes which are codes from managed care companies (in behavioral health companies like Magellan, MHNet, etc.) that determine how many session you get (and how long each session is in terms of 15 minute intervals) in a given period of time. Once that time has expired or the number of sessions is up, a therapist MUST re-justify to a managed care company why it is you need more sessions. It is THEN up to the managed care company to look at their obligation under your policy; your medical history; your diagnosis; etc, etc, etc. and decide whether or not to authorize additional sessions.

If the managed care company says NO, then it's between you and them to work it out. Or you, them, and Stopdog.

Treat your sessions as PRECIOUS (if you live in the USA). The number you get for any given policy are largely NOT within the control of your therapist but your insurance provider.

"It takes as long as it takes" is a myth of the psychoanalytic age. Those days are GONE.

Therapy today is SOLUTION FOCUSED, not problem. If you're not looking for ways to deal then you're probably not a good candidate and wasting your time and the medical industry's limited resources.

"It takes as long as it takes," does exists. It's called "self-paying clients." If it's your nickle, feel free to take forever. The INSURANCE INDUSTRY won't mind.

Haven't ever had insurance limit my sessions. They've been quite cooperative actually. I know there are plans out there though that do so.

I am self pay now but when I had insurance my sessions were definitely numbered, even with my diagnosis. There was no time that I could "waste" because I wanted help and it took quite a bit of work in a short time.

But are you familiar with the healthcare reform laws that went into effect as of January 1st? They actually work more in favor of mental health treatment by considering it a medical necessity.

What you are claiming was absolutely the case before 2014. Low income insurance like Medicaid only covered Psychologist visits and Psychiatric medication management. MFTs were unable to accept Medicaid; however my therapist is an MFT and said she was surprised when she realized Medicaid clients were being authorized to see her because it was never the case before.

I only know all of this because the insurance I have now goes through Magellan and I asked a lot of questions about mental health to make sure I could still see my T and pDoc. They said visits do not need authorization and are unlimited.

This is all referring to the states though.

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I think it is against the whole idea of therapy to just send away clients who are unable to do what you think they should be able to do. To me it seems some therapists are not willing to work with difficult cases, whether it is unwillingness or a realistic assessment of the limits of their competence I don't know.

Couldn't agree more. Therapists terminating clients for being difficult really reflects more on them than the client.

I had my therapy covered under managed care for years even before 2014 and my sessions never had to be authorized; they were covered and I just paid my copay, no questions asked. Did you not say you were a therapist in another post? I find it very odd you are so misinformed.

I haven't had a limit on my sessions for the whole 3 years I've been going, and I go more than once a week.

That doesn't obviate the reality that "medically necessary treatment" under Medicare, Medicaid, or the Affordable Care Act still require CPT codes and authorization. You have "access to care," but it is still managed care.

Ask your social worker or MFT what company manages your mental health benefits and you will likely find it is Magellan or some other company hired by your state to provide blanket services to all persons under Medicaid if that is how you receive services. If through Medicare, much the same. Through a private insurance company, again... the same.

What you consider "medically necessary" and what the managed care or other service which administers mental health services will authorize are often two very different things. "Medical necessity" can be argued and oftentimes additional services will be granted, HOWEVER the Affordable Care Act isn't an open door policy or a "right to unlimited services."

I saw my therapist for seven years. My sessions were never limited. He always said it takes as long as it takes even though I guess somehow he stopped believing in me somewhere.

Amazingly for here (sarcasm) you missed the part where I said subject to policy review as well as the part where I said your therapist gets authorization for X services and then X more. If your therapist never had an issue getting your provider to authorize more services, depending on your COVERAGE, your DIAGNOSIS, your MEDICAL HISTORY, etc. etc. etc. then it would appear seamless to you.

I am sufficiently familiar with the backside of medical billing and getting paid to have knowledge of the subject. Your attempt to drag me back into a "Stopdogg-ian" tit for tat regarding the profession or my knowledge of it isn't going to work. Your attempts to "blame the messenger" merely show YOUR bias not mine.

I'm talking reality. You're talking ********.

Enjoy the talk.

I'm done.

Well, that was nice