Difficult Personalities in Online Text-Counselling

Greetings,

This morning as I peer sleepily at my screen over a steaming cup of sweet chai tea, the first of eight for the day *grins*, I consider what challenges I've faced in online therapy over the past five years. I thought to myself, 'what type of client has proved to be the most difficult?'

It seems obvious that someone with a difficult personality would be challenging to work with through any medium whether that be face-to-face, online, telephone etc, but I think that the online medium intensifies the difficulties faced by therapists with this style of client. I'm reminded of a few cases, which I can not talk about in specifics, but they certainly had a few things in common. (And boy did I learn some lessons :))

1. The clients were demanding.
2. The clients were highly reactive to all their emotions (often threatening to self-harm).
3. The clients were unpredictable and attention seeking.

Your first thought might be 'well, set some boundaries then?' And this would be an excellent point, but when those boundaries conflict with deeply established maladaptive patterns of behaviour (patterns now firmly a part of the personality) this requires time and awareness on the clients part in order for those patterns to be altered.

The obvious question to ask now, is 'how does online counselling (in text) creates further difficulty for this style of client?' The first thing that pops into my, now awake, mind is emailing. The client has a constant link to you, your email.

In a physical setting, you most likely have a receptionist or an answering machine, something you probably won't check several times a day (Well maybe you do?). My point is, email makes getting in contact with you ethically questionable. The difficult client can send you emails about ending their life, self-harm, or anything else that goes on in their day that they deem necessary for you to know about. With messages like this in your inbox, you may be left feeling a little concerned or worried -- well, I would certainly hope so! Of course, your training may have taught you that you should call the police or contact the client directly. What happens if they're overseas? Do you call their phone (if you have that number)? If they're anonymous, how much are you responsible for if something happens to them and you were the last to be informed?

These are all challenging questions to answer.

As I said in my previous blog, you do what you can. The only way clients learn boundaries, is through consistency. Supportive consistency. Address the issue with the client, establish consequences for the continued behaviour in the next session.  I don't mean you should threaten to withdraw your support, even if the client is making it difficult for you to help them, the threat of withdrawing support is not helpful whatsoever. I have dealt with this style of client by bringing up a modified version of "The Boy who Cried Wolf." Clients are usually aware that they go through emotional crises which are not always life threatening, make a plan for them that doesn't involve sending you emails (coping skills!). If the client doesn't use these coping skills then that needs to be addressed also. Finally, the best way to ensure you do not put yourself in this situation in the first place is to Screen your clients. And I say it again, Screen your clients! In the few instances where I have agreed to work with these types of clients, I made sure that they would work on their issues and that they would do their homework -- and they did. They demonstrated great enthusiasm to change, and this is the first thing I look for in my clients before I take them on. Deeply ingrained maladaptive coping skills, with hard work, can be changed. The client is more likely to change if they are willing to change. Sometimes these types of clients have terrible living conditions with little social support, and in this case you can make a huge impact on this persons life, whether they are difficult or not.

Know your limitations in this online context. Set your boundaries. Take your time testing whether you can help your clients. Lastly, risk/reward. Will you be putting yourself at risk for a client that you will probably not be able to help? Then don't do it. Helping others requires that we as therapist give so much of our own energy, if you exhaust that energy supply, you and your clients will be affected.

Now, time for a refill.