The Unspoken Truths of Being a Therapist: When You Don't Like Your Client
This is the third installment in our series examining the complex realities of therapeutic practice. Today we address one of the most challenging aspects of clinical work: navigating poor therapeutic chemistry.
The Reality of Therapeutic Fit
Every therapist faces this uncomfortable truth: sometimes, despite professional competence and genuine effort, the chemistry with a client simply isn't there. Research shows that therapeutic alliance, the quality of the relationship between therapist and client, is one of the strongest predictors of treatment outcomes, making this challenge particularly significant.
Unlike the warm connection we experience with some clients, poor therapeutic fit might manifest as chronic irritation, difficulty accessing empathy, feeling drained after sessions, or simply not "clicking" despite both parties' engagement.
Understanding the Dynamics
Poor therapeutic chemistry often stems from:
Communication style mismatches: Fundamental differences in how therapist and client process and express information
Value conflicts: Worldview differences that create subtle but persistent tension
Personality clashes: Incompatible temperaments or interaction styles
Cultural gaps: Differences requiring specialized competence the therapist may lack
Triggered responses: When clients activate therapists' own unresolved material
The Professional Challenge
When therapeutic chemistry is poor, several clinical issues emerge:
Reduced therapeutic presence as therapists manage their own reactions
Impaired empathy and attunement affecting the quality of interventions
Increased countertransference that may cloud clinical judgment
Client sensing of disconnection, which impacts their sense of safety and trust
Research consistently shows that when alliance is weak, treatment outcomes suffer regardless of the therapist's skill or the intervention's evidence base.
Clinical Assessment Framework
When you notice poor connection with a client, consider:
Is this workable? Some disconnection can be addressed through direct alliance work and therapeutic exploration.
Is this informative? Sometimes our reactions mirror what others experience with this client, providing valuable clinical information.
Is this a competence issue? Cultural differences or specialized needs may require referral to better-matched providers.
Is this personal material? Our reactions might indicate our own triggers requiring supervision or personal therapy.
Intervention Strategies
Direct Alliance Work
Openly discussing the therapeutic relationship
Collaboratively exploring what would make therapy more helpful
Adjusting therapeutic style based on client feedback
Supervision and Consultation
Processing therapist reactions without shame
Exploring whether disconnection carries clinical information
Determining if referral would better serve the client
Professional Development
Building cultural competence for diverse populations
Developing skills for different personality types
Expanding therapeutic flexibility and approaches
When Referral is the Intervention
Sometimes the most therapeutic action is connecting clients with better-matched providers. Ethical referral involves:
Honest assessment of whether the relationship can serve therapeutic goals Collaborative discussion with the client about the therapeutic fit Appropriate resource identification for alternative providers Smooth transition planning to ensure continuity of care
Research shows that clients often do better with therapists who are genuinely engaged rather than those going through professional motions.
Training Implications
Academic programs can better prepare therapists by:
Normalisng that not all therapeutic relationships develop strong chemistry
Teaching alliance monitoring and repair skills
Developing cultural humility and competence awareness
Practicing difficult conversations about therapeutic fit
Reframing Professional Identity
Effective therapists aren't universal fits for all clients. Professional competence includes:
Self-awareness about your therapeutic strengths and limitations
Ethical decision-making about when to refer
Cultural humility recognizing when others might serve clients better
Relationship skills for working through alliance challenges when possible
Conclusion
Poor therapeutic chemistry isn't a professional failure—it's a human reality that requires skilful navigation. The goal isn't to like every client, but to work ethically with the reality of human connection.
When we can approach these situations with curiosity rather than shame, we serve our clients' needs more effectively. Sometimes that means working through the disconnection therapeutically. Sometimes it means making an ethical referral to someone who's a better match.
Both responses can be deeply therapeutic when done with integrity and care for the client's wellbeing.
Resources for Further Learning
Assessment Tools:
Working Alliance Inventory (WAI)
Session Rating Scale (SRS)
Recommended Reading:
The Heart and Soul of Change by Duncan, Miller, & Sparks
The Therapeutic Relationship by Gelso & Hayes
Next in our series: "The Weight of Holding Others' Pain: Understanding Secondary Trauma"
About the Author: link