I recently wrote a book about how to provide couples counseling to couples that are caught in a power struggle. Since I first started working on the book, the concept of there being a power struggle between two people has really intrigued me. Once I became more familiar with the concept I started to notice these power struggles everywhere. Seemingly, the petty and unnecessary struggles that take place between two people often come down to a struggle for power of control. And yes, this struggle can take place between client and therapist.
What power struggles ultimately come down to is a need for personal control. It’s a need we all have, although some may have a stronger need than others. We need to feel like we have some control in our lives, if not, we feel unhappy. It’s interesting to note this because so many of our clients come into therapy because their lives are “out of control”. They also express a desire for the therapist to, at least initially, take over control and “fix it”. So, we do. We give some initial suggestions, advice, and homework. More often than not, we then feel some “push back” from the client. The client tells us that they didn’t do the homework. Instead they did their own thing. They then tell us that the results turned out terrible, but that’s our fault not theirs; we should have given better suggestions.
This experience of the client begging us to take control, only to rebel against us when we do, is often mystifying to the therapist. I believe that what we are witnessing here is a conflict of needs: A need to be taken care of and satisfied, and a need to have personal control. Ultimately what we therapists learn to do is to make the client believe that our suggestions were their own idea. We carefully lead them down a path with only one destination, wellness and functioning. In this manner, we help the client get better, but they get to take all the credit for it.
However, this is not where the story ends. Every now and then we encounter a client who has a stronger than average need for control. Obviously the client wont outright tell us this about themselves, but their behavior gives them away. They pointlessly argue with you over your office policies. They constantly cancel and reschedule appointments. They insist on getting “special treatment” and “exceptions to the rule”. The client may even act out in a childish manner such as by mocking you or making fun of you. When they are not being confrontational they are being passive aggressive. These are often the clients that therapists dread, but the solution isn’t to just get rid of the client unless they are being so difficult that you really can’t even work with them. So what’s a therapist to do?
When dealing with such a client, eliminating the power struggle should be treatment goal #1 and should be the sole focus of treatment until the issue is at least manageable. What the client is showing you is what it’s like to be in a relationship with them. The client is showing you what it’s like to be their spouse, family member, neighbor, and co-worker. As problematic as it is for you, you can imagine how difficult it is for your client to navigate through their life when they treat other people in this manner. This is why this issue becomes the primary focus in therapy. The best way to work on this issue is to be really firm with the client. You’re going to need to confront the client on their behavior and point out the difficulties that it causes for them in their life and how it makes other people feel. Find out where the need for power and control ultimately comes from and then work on it.
You never want to get caught up in a power struggle with the client. Remember, there’s no need to because there really is no struggle here; the client will either drop out of therapy or you will have to let them go because they are too uncooperative. It’s not a struggle, therefore there is no need to argue with the client or get mad in your sessions. Just take an approach to therapy of “this is the way it is” and if the client doesn’t like it than that’s okay. I’ve found that when working with such clients if you remain totally calm and don’t let them get you worked up then they usually stop the struggle after a few sessions. The last thing you want to do is to get caught up in it with them.