Understanding Client Criticism: 5 Things to Consider

I've written in the past about challenges in giving and receiving feedback. I want to reflect more specifically today on feedback/criticism from clients. For most of us, our work is important to our identity, provides us with a sense of purpose, and (ideally) feelings of competency. It makes sense, then, that criticism of our work can feel threatening, and elicit a wide range of distressing emotions. Yet, how we respond to clients' criticism or anger toward us can significantly influence the quality of our treatment relationship.

Responding to criticism or anger from clients is not a simple or straightforward matter, however, because there are several variables at play.

1) First, it's important to regulate my own emotional reactions in the moment so that I can continue to function therapeutically and remain focused on the client's needs. I keep breathing and subtly relax my body in the session, keeping my own defenses from rising. Afterward, I may seek supervision or consultation to work through any emotional reactions that linger.

2) If a client is expressing criticism and anger, I have to assume that there has been some kind of empathic failure. I think it's important to hear the client's message and begin by demonstrating that I've heard them (using empathic reflection), validating their feeling, and considering the possible truth to what they're saying. This process begins to restore the empathic connection. It also requires sifting through what has been said (including excessive anger and hurtful words) to find the bottom-line message.

3) Sometimes the feedback is valid and there is some shift I can make in response, to better meet their needs. While it may be difficult, it's important to acknowledge when I've made a mistake (not to mention it's good modeling). Sometimes the feedback is accurate, but not something I can or am willing to shift. In these cases, I explain why I can't do what they're asking. For example, occasionally a client will become frustrated that I'm not "telling them what to do." I know that if I try to tell them what to do, however, I run the risk of telling them something that doesn't resonate with their own perspective, or something they're not ready to hear. Both of those possibilities would also be significant empathic failures. Since I value self-determination and think the process of clients coming to an answer themselves is often the real work of therapy, I can't in good conscience "tell them what to do." When I explain that, most clients respond with some version of: "I know you're right, but I still wish you could just give me the answers." I validate their frustration with the slowness and discomfort of the process - which is really the issue, rather than my withholding my expertise, as they originally suggested.

4) It's also important to consider the role of transference. Clients may be critical and angry not because of any mistake or misstep on my part, but because of their own transference. When I have listened for the bottom line message and genuinely don't believe it's consistent with what's actually been happening between us, I wonder whether the client's other relational experiences, anxieties, and patterns of interaction may be coming out in the transference. In these cases, the client's words/actions and my reactions are both sources of information about how the client experiences the world, and relates to important others. Once these patterns appear, good therapeutic work can be done by naming and exploring them together.

5) Another possibility when the feedback doesn't seem to match up with reality is that it is a defense mechanism. It may be that the work has come uncomfortably close to deeper issues, threatens to open painful issues, or is moving a client toward a change he or she feels unready to make. It is understandable that the client may subconsciously defend against these threats by reacting to me with anger, often employing displacement, projection, or projective identification. Responding to defense mechanisms is a very delicate matter, because "breaking through" defenses can seriously destabilize a client. I generally find it preferrable to gently lean into them, and back off if the defenses intensify. Whatever the issue is will resurface when the client is ready.

As you can see, there is a lot to think about and untangle when responding to a client's feedback - your own emotions, the possibility that you've made a mistake or had an empathic failure, whether or not the underlying request is clinically appropriate, and whether transference or defense mechanisms are contributing. There may even be other things that I'm missing. How do you think about and respond to feedback, including criticism and anger, from your client?