Why are my clients unwilling to open up?

Communication is necessary when it comes to establishing an excellent patient-therapist relationship. When patients come to trust their therapists, it opens up different, diverse channels of talk that are beneficial to their progress. Communication is a two-way street and requires equal effort on the part of both parties. Dr. Ili Rivera Walter, a marriage and family therapist, writes, "Success as a therapist is not found in doing something for the client, but rather in being something for the client." It is their responsibility for all the therapists out there to be a cushion for feelings and emotions. A safe space where patients can lay their souls bare and be commended for it. 

However, things don't always go as perfectly as you would want them to. The ability to communicate how we're feeling to other people is not something we're born with but something we learn as a part of life. Different people grow up with different experiences, and not everyone is comfortable sharing their feelings. It can be challenging for certain patients to open up, even to a therapist they decided to see. This conundrum is not because they aren't looking to get better, but more so, they don't know how to convey whatever they're saying. 

Why Is Communication Important 

You may already have experienced this yourself, but expressing our thoughts and desires can often soothe us. We tend to feel lighter once we share our anxieties. Call it a sense of camaraderie. Maybe even because it's nice to know someone understands us and doesn't find our feelings crazy. As human beings, we feel safer with other people that know what we have done, what we have been through, and they still don't judge us for it. Unlike other people, therapists are trained in keeping an open mind and creating a judgment-free environment for their patients. 

There are different types of communication, all of which are equally important for therapists to pursue. Verbal communication is dominant in psychotherapy sessions. However, therapists also need to look out for other cues such as body language, posture, facial expressions, etc. All of these need to be taken into account to track a patient's progress and move on to the following stages of treatment. 

In psychotherapy, otherwise known as talking therapy, the level of communication determines the outcome and pace of the treatment. Hence it is essential to understand all the reasons why a patient might not be talking freely, despite coming to the session in the first place. We will discuss how patients and therapists can both work together to overcome this hurdle. 

Difficult Patients and What They Do

When we say the word "difficult," we usually follow up with our plans of action that help us overcome the situation by working harder. In some cases, when therapists talk about a patient being difficult, it can mean different things. Before we move on to why patients tend to clamp up, we need to discuss what constitutes being tagged as difficult.

Difficult patients are not the same as patients who have trouble talking and should not be treated. They can represent them in two ways:

1. Resistance

Resistant patients are those that may not think therapy is for them. Treatment may be court-mandated, or they might be being forced into it by loved ones. By that metric, not speaking isn't a form of resistance. Instead, it's the persistence of behavior that clients engage in when they don't feel safe or lack the abilities to discuss what's going on in session vocally.

2. Rejecting Treatment

Rejecting treatment might be a sign that the form of therapy being used isn't correct. There might be a possibility that the patient may respond better to another type of psychotherapy, so the therapist must persist at it. Our efforts should not be focused solely on verbal discourse as a form of involvement. Instead, we should focus on deciphering the meaning of the client's nonverbal communication.

What Does the Silence Mean

A patient's refusal to talk can mean the following things:

Fear: The client may be terrified of your judgment, rejection, or inability to maintain confidentiality. If a court-involved client speaks up, they may face legal ramifications. A teen who grownups have wronged does not comprehend why you are different. A partner may be concerned that everything they say in session will be used against them in their next conflict.

Burnout: Therapy can elicit intense sensations of anguish, loss, and rage. It can also bring about feelings of relaxation, fulfillment, and even joy. It might be difficult for patients to control their emotions, and it is even more challenging to put them into words.

Inability to Articulate: Not everyone is comfortable with verbal communication. Not everyone grows up in a household with dynamic dialogue, English is the primary language, and it is acceptable to express oneself. Such clients will require some time to think about what they want to convey.

Introverts vs. Extroverts: Introverts make up a portion of our clientele. It is not their favorite thing to be the center of someone's attention and expected to interact. They've had a lifelong habit of avoiding new interactions with people they don't know well. Introverts are also different from extroverts in the sense of how they communicate. As we said before, communication is verbal, and sometimes introverts will use other methods of expressing their emotions. 

One-way Communication: This is just another indication of the power struggle. In interactions, the patient has a two-position switch, believing they are either in command or too vulnerable. Another factor here is that essentially you are talking to a stranger. The therapist knows a lot about you, and you won't get to know anything about them. In the patient's mind, it might be giving way to feel not like an equal. The solution is to maintain control by not saying anything.

Incompetence: The onus is not always on the patient. It might be the way a therapist is choosing to talk to them. They might not appreciate it. Hence, maybe sometimes re-evaluating the treatment can make a big difference in getting someone to open up. 

Journaling, a Way Out of the Silence

There are numerous methods you can find suggesting what to do if a patient is clamming up in therapy. Be more empathic. Create a safe space. Meet the patients in a mental area of their preference. However, all those methods are standard and already researched upon. One method that we are going to discuss is journaling. 

The impact of writing as therapy for mental health has been studied for years, and the results are astounding. Therapeutic journaling has been shown to improve mental health in numerous studies. It provides you with mindfulness skills. Writing therapy is a low-cost, easily accessible, and adaptable treatment option. It can be done alone with just a pen and paper or with the help of a mental health expert. It can be done in a group setting, with group discussions centered on writing. It can even be used in conjunction with another type of treatment.

Journaling is a good self-soothing coping method that also teaches you how to be aware. It also assists you in releasing the intensity of your feelings. When you express your anxiety verbally, it loses part of its force. As you continue to journal, you will notice that you are becoming less worried.

This is an excellent technique that therapists can apply for patients that have difficulty opening up in sessions. Journaling can allow them to articulate their feelings, their emotions better and recount past traumatic events. There are many prompts that the therapist can provide them with each time they have a session to prepare for the next one. The patient will find writing easier than talking, even remembering more stuff they have been holding on to. 

When we talked about introverts and them, they have their preference of types of communication. One mode of them expressing themselves is through writing. Hence, this is something that they will be accepting of and be great at it. 

One step further includes patients sharing these notes and copies with their therapist on a sessional basis and work from there. The therapist can read it and decide what the essential points that they can then discuss are. This, however, requires excellent mutual trust between the patient and the therapist. For the patient, the therapist needs to take it slow and be mindful of these writings. They might be even rawer than saying things out loud and hence requires a safe space. For the therapist, it is a must that the patient is writing things down in their most accurate form. 

There will always be patients that might not open up first, but with the right kind of mindset and determination, both patient and therapist can work together to make things better.