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?

You Catch More Flies With Honey

A few weeks ago, I wrote about accepting feedback, and part of what makes that difficult. However, it's also worth reflecting on what makes giving feedback also a challenge.

The most obvious answer, of course, is that many people are uncomfortable with conflict and fear that even well-meant negative feedback will be received with some degree of defensiveness, hurt, or anger. It's not really an irrational fear - any of those responses are definitely possible, while it is not possible to control what response you receive.

It's also true that most of us do not have the luxury to avoid giving feedback. We give feedback to our supervisees, sometimes our supervisors, and yes, even clients. In the case of clients, feedback may take the form of confrontation (e.g., highlighting discrepancies between a client's words and behavior), or redirection of inappropriate or detrimental behavior.

We provide feedback in order to be helpful: to facilitate growth and/or prevent harm. We may undertake it in the most nonjudgmental and kindhearted of mindsets...but the other person does not know what our mindset is, and many of our clients (and more than a few of us) may have insecurities that make them (us) vulnerable to criticism. Any sort of feedback can affect self-esteem, depending on how the receiver internalizes it. So, while one person may think, "Oops, she's right, I should have done that differently," another person may think "I should have known better than to make that mistake. She must think I'm an idiot."

Now, as I said above, it isn't possible to control the other person's reaction - to make sure, for example, that they think like person #1 rather than person #2. However, there are some strategies that we can use to make our feedback easier to hear. These strategies all seem to fall into the category: "You catch more flies with honey than with vinegar."

1) The feedback sandwich
Perhaps the most straightforward strategy is to "sandwich" a piece of negative feedback between two pieces of positive feedback: praise, criticize, praise. The positive feedback makes the negative feedback easier to hear, perhaps because it protects against a precipitous drop in self-esteem that might accompany negative feedback alone.

2) Empathic feedback
Any negative feedback is easier to hear when it is said in the kindest possible way, in an empathic and understanding tone, with explicit recognition of the person's best intentions, and assurance of ongoing positive regard (i.e., that you still respect the person and that their good qualities are not negated by the feedback).

3) Focus on concrete behaviors rather than personal qualities
We've all heard this advice when it comes to child-rearing: discipline should emphasize that a behavior is wrong, not that the child is "bad." The same principle can be applied to adults. Feedback is most effective when it focuses on a concrete behavior that the person can identify and change, rather than either vague feedback that does not suggest a specific change, or feedback focused on something that the person cannot easily changed (e.g., shyness).

4) The VCR technique
From the book Teens Who Hurt, this strategy suggests that feedback may be more effective when structured as follows: V - begin by validating, i.e. expressing understanding of the other person's perspective, and acknowledging a strength or positive quality (kind of like the feedback sandwich). C - next comes challenge, i.e. provide the corrective feedback, ideally building upon the information contained in the validation. R - finally, request, i.e. identify a specific behavioral corrective action.

How do you think about giving feedback? What strategies do you find make it easier for someone to hear and respond positively to feedback?

Accepting Feedback - The Role of Identity

It's impossible to do this work perfectly, so it's inevitable that we'll all sooner or later face criticism of one form or another from supervisors and clients (often more frequently than we'd prefer). Whatever euphemism we use (e.g., constructive criticism, feedback), these conversations are inherently difficult. Our responses, both internal and external, determine whether such conversations lead to positive results (professional and/or personal growth, mutual learning, improved rapport) or negative results (damage to relationships, self-esteem, and self-efficacy).

In the book Difficult Conversations, the authors argue that all interpersonally challenging conversations share a common structure, with three threads:

1) The "What Happened?" Conversation, which involves debate over what "really" happened (i.e., the Truth), what each person's intentions were, and where to place blame.

2) The Feelings Conversation, which involves whether and how each participant's feelings are addressed

3) The Identity Conversation, in which each participant determines what the current issue says about them, and how they see themselves in light of the current issue.

I tend to think the first two threads are easier to manage - after all, social workers have plenty of experience addressing emotions, and have practice (albeit with varying degrees of success) considering competing constructions of reality. Because the third thread happens deeper in the psyche, and plays on any lingering insecurities or self-doubts (we all have them!), I find it the hardest part of difficult conversations to manage. However, managing this third thread has a significant benefit, both in how we feel afterward, and in making the other two threads easier to navigate.

Criticism is hard to hear because it poses a threat to our sense of self - typically by causing us to question our own competence, goodness, or worthiness of love. To some degree, it is inevitable that feedback will challenge our identities. However, it's also possible to reduce our vulnerability to these challenges, and the intensity of the distress we feel as a result. 

1) Develop an awareness of your identity issues and vulnerabilities. Notice what elements or types of feedback unbalance you, and explore the feelings and thoughts you have during these moments to identify patterns - aspects of identity that are vulnerable to upset. 

2) Avoid all-or-nothing thinking. Our sense of self is more likely to be thrown off by feedback if we think we are either competent or incompetent, good or evil, worthy or unworthy of love - one extreme or the other, with no middle ground. We are more threatened by feedback if we're trying to hold onto a completely positive identity that leaves no room for flaws (which means we have to respond to negative feedback with denial to maintain our identity), or if we go to the opposite extreme, exaggerating the negative feedback so that it defines who we are - if I'm not perfect, then I must be worthless. The solution is to develop a more complex self-image that includes a range of both positive and negative qualities, and resist the impulse to make any one quality, positive or negative, the only element of identity that matters.

3) Accept that you sometimes make mistakes (we all do), your intentions are complex and sometimes mixed, and you have contributed to the problem in one way or another. Admitting these things requires a balanced, rather than all-or-nothing, self-image, and admitting them to ourselves makes it easier to admit them to another person. 

4) Put the current issue in perspective by asking yourself what significant this will have for your identity in the future - next week, next year, in ten years.

5) Remember that there may be identity issues at stake for the other person, too.

Of course, it's impossible to do these things perfectly (that would be another all-or-nothing expectation!), but working on them does lessen the intensity of distress we experience when we do receive feedback, and therefore allows us to respond more skillfully, and learn what we can from the encounter. 

How do you cope with the identity implications of feedback or criticism?