When Good Intentions Cause Harm
A reflection on empathy, control, and knowing when to let go.
Can I share a secret… Sometimes I have to fight getting annoyed with my clients.
Yes, I do my best to hold and maintain empathy, compassion, and an open heart and mind, but I’m still a regular human. And I’ve found that I’m not alone. Even the best therapists can become frustrated or annoyed with those that they serve. Personally, this shows up most often when I feel like my client is returning each session with the same challenges and consequences, yet they show an inability or an unwillingness to make the changes that could lead to better outcomes. After a while, it becomes hard for me to hold space for someone who has the tools and support to try something different, but fear or pain keeps them stuck in the same unhealthy patterns.
Good therapists engage in clinical supervision. These are meetings with other clinicians where we talk through our caseloads and receive feedback, insight, and accountability. We do this because we understand the limitations of our own thinking and value diverse perspectives to strengthen the care we provide. In these meetings, you might hear a therapist express frustration or disappointment in a client’s progress, or lack thereof. And in a high quality supervision session, the therapist won’t just be told to extend more empathy, but challenged by their peers to reflect: What is it about your client’s progress or lack of progress that’s bothering you? What feelings and emotions are being stirred up within you, that is fueling your frustration and annoyance?
There’s a shared understanding among clinicians that we are responsible for our own feelings and that feelings, such as annoyance with a client, often shines a light on the therapist’s perspective more than it speaks to the client's behaviors. Strong supervision invites us to ask: Why am I reacting this way? What’s being activated in me? And how can I regulate myself, instead of placing the responsibility of my frustration on the client who is moving at their own pace?
Most likely, my feelings of frustration have little to do with the client but is more closely linked to my own feelings of self doubt. The pace of my client’s progress stirs within me, questions about my own competence and I begin wondering if my client’s lack of progress is reflective of the quality of the care I’m providing. Other times, the client’s challenges mirror something within my own life or history, making it hard to hold space without becoming emotionally activated. When this happens, I have to be cautious not to try and soothe my own emotional reaction by pushing the client to make the changes I want them to make. But that would not be therapy - that would be control.
In instances like this, we are encouraged to refer the client out to another provider who may be better positioned to help. There have been several moments throughout my career when colleagues or supervisors have encouraged me to make that decision. Sometimes I listen. Other times, I’ve resisted the need to refer - often because I’ve cared too deeply about the client, the work we’ve done, and because referring out is hard.
