From One Therapist to Another
Manipulation: Expressions of Ambivalence in Psychotherapy Part 2
Do you ever feel like a client is being manipulative in some way?
Do you feel like they aren't being fully honest or open?
Do you find yourself compelled to do things such as call or text more than you feel comfortable with?
Does it ever seem as though they are utilizing crises for secondary gain?
Do you worry that by giving them what they think they need, you are actually enabling them and even participating in a way that keeps them stuck?
As therapists we often hate to use the "M" word and we often resist talking about manipulation or feeling manipulated with our clients. However, another common manifestation of ambivalence is manipulation. Manipulation is defined as
1: to treat or operate with or as if with the hands or by mechanical means especially in a skillful manner as in manipulate a pencil, manipulate a machine
2a: to manage or utilize skillfully as in quantify our data and manipulate it statistically
b: to control or play upon by artful, unfair, or insidious means especially to one's own advantage
Thus, manipulation is not necessarily a bad thing. To manipulate is just to get something you need, such as manipulating a drawer to get a pen. However, when people experience ambivalence about their needs, they may feel that it isn’t okay to ask directly and thus resort to indirect means. Manipulation in relationships occurs when someone attempts to get their needs met without asking directly and frankly, we all do it at times. A very common manipulation is when a person puts on a sad or angry face in the hopes that someone will ask what’s wrong. In contrast, the direct form of communication would be to speak openly about their feelings. I educate my clients on the meaning of the word manipulation so that it doesn’t have such a negative connotation and so that we can discuss it directly. I help them see that the problem with trying to get your needs met indirectly through manipulating or controlling behaviors is that you never learn that you have a right to ask directly. Therefore, even if you get what you want in the moment, it only meets the need temporarily and is not truly satisfying.
One example of a patient manipulating a therapist is someone who spends session after session talking about a crisis that happened that week. By focusing on the crises, the therapy seldom moves forward. The manipulation is doing something to get the therapist to show concern because of a belief that the therapist wouldn't care otherwise.
Janie was coming to counseling for an anxiety disorder. We made a plan to work on skills for dealing with anxiety, but we had trouble spending time in this endeavor because each week there was a crisis that demanded our attention. These crises involved fights with her husband, disturbing calls from her mother, feeling slighted by her boss, etc. I felt concerned that, although the issues that she brought into our sessions seemed important, we weren’t making any progress on the initial topic for which she asked help. We would put out fires each week, but I felt like no real change was happening. I began to believe that this was a pattern that was not due to outside circumstances but had some deeper meaning for her.
Although I wanted to respond with concern about all her crises, I began to realize that it wasn't what she really needed. It can be very difficult though to know how to move away from this pattern. I asked her during one session what she thought we would talk about if there had been no crisis this week, implying that talking about crises is actually controlling the session in some way. After several probing questions, she shared with me that she didn’t think I would be interested in her if she weren’t in crisis. This was something that she had learned at an early age when her busy and sometimes depressed mother paid attention to her primarily when things were going wrong. (It should be noted that some people aren't this insightful and I have to take a stronger educational role. I may start by educating them about human needs and causes for indirect communication).
Until Janie became aware of her core belief that she wasn't important and how this belief was keeping her from communicating directly, she was in danger of pushing others away — they became overwhelmed by her chaotic lifestyle. The self-fulfilling prophesy here was that the very thing that she did to try to be important to others was pushing them away, which then reinforced her sense that she wasn’t important. She needed to learn that she was uniquely interesting with or without a crisis, but she would never find that out with her current behavior.
Although Janie was unaware of it, her pattern of having a crisis every week was a manipulation. I gently educated her on how children will learn ways to get their needs met indirectly if they don't feel that they are getting them met directly and that this is a source of resilience in childhood. However, now as an adult she could find more effective ways. For starters, I encouraged her to talk about the feelings of not being important rather than try to make (a manipulation) herself important to me every week. I then gave her the homework assignment to make a list of all the things that she would have difficulty asking for directly and consider ways that she may have unknowingly manipulated others in an attempt to get the need met.
Early in my career, I would be frustrated when clients utilized manipulative behaviors such as talking about crises every week or needing extra time between sessions because I believed we could never get to the real therapy. I have since learned to use my frustration as a signal that the client may be feeling ambivalent about something, which we need to address. This is the real therapy! I've often found that the thing I most wanted to shy away from talking about was the very thing that my client most needed me to address. Click here to read the first in my series of 10 posts where I poke a little fun at some of the common mistakes that therapists (including me) make.
My book A Clinician’s Guide to Pathological Ambivalence: How to Be on Your Client’s Side Without Taking a Side can teach you how to address this and other forms of ambivalence in psychotherapy by developing skills to work directly on resolving ambivalence and rewriting old narratives. I would love to hear from you. Please scroll down to the bottom of this page (past the banner of recent posts) to leave a comment.