How therapy can enable bad behaviors:

Dear Dr. Brilliant Cliché,

I am a therapist and I wrestle with the philosophy “the customer is always right.” It comes to mind again after recently running into an ex-client of mine. I thought this person would still be seeing me if I had given them what they wanted. At that time, this client was engaged in some unethical practices and felt mildly guilty and conflicted about it. The client kept pushing to explore early childhood memories and a lot of Freudian crap. My impression at the time was that this person just wanted an excuse for this behavior and would use any justification to continue without guilt- “it’s not my fault, my parents screwed me up.” I had no sense that the client was interested in changing the unethical behavior but rather wanted a diagnosis to use as an excuse to continue.

Despite the reality that the psychiatric field often enables just this stance, my personal opinion was that it was bullshit. I refused, and after the client got tired of trying to manipulate me, they left my practice. I can’t help being allergic to denial but everyone else in my profession seems to think that the client would still be in treatment had I been more cooperative.

What is your take?

-Denial ain’t just a river

Dear Denial,

The old cliché “You can bring a horse to water but you can’t make him drink” comes to mind. What you are describing is someone’s innate personality.

Life is like a pond and every behavior a person chooses is a like rock being thrown into the waters- the ripples touch everyone else in that pond. The definition of an adult is “one who takes responsibility for the rocks they throw.” Your client was an adult by age but a child by nature. Unless a person really has an investment in change you cannot create that change. Therapy is a tool not a solution, just as medication is a tool not a solution.

If you had been “more cooperative,” your client would still be an adult child and you would be planning your vacation while listening to them. They say there is someone for everyone. This applies to therapy to0. There are plenty of therapists out there who will give this client exactly what they want. This will make the client temporally happy…until they get caught and the game changes.

I am sure you have plenty of clients more open to change and I would focus on them.

Dr. Brilliant Cliché

Granny says: In a large scale study conducted in the USA, it was discovered that very few doctors will stress the importance of lifestyle changes, such as weight loss, because if they do, the patients simply leave and look for another doctor who will give them the pill or schedule the operation that they want. This is one of the aspects of our health care system and national consciousness that goes up my butt sideways, because a huge percentage of physical problems exist specifically because of obesity and other poor lifestyle choices. But does anyone get up in arms about that? No. Instead, people get on their freaking’ soap boxes and rant about how we need more affordable insurance and lower prices for pharmaceuticals.

The namby pamby physicians in this country are being held hostage by the HMO’s, the pharmaceutical industry and the whining a__holes who eat their way up to 400 lbs and then are surprised when their knees give out. I know I’m probably going to get flack for this, but honest to god- it’s about time people started looking at the REAL health crisis in this country; most of us are idiots who are suffering needlessly because we indulge ourselves and have no sense of the consequences of our behavior. Good riddance to the patient. You may not get to Tahiti as often as the apathetic money grubbers who look the other way, but at least you can look at yourself in the mirror at night.


About Dr. Brilliant Cliché

Dr. Brilliant Cliché and the Granny Dr. are a fictional web presence and advice blog. Together we offer a joint perspective that is deep but not academic, entertaining but not fluff, and educated yet street smart. By joining the internet community we hope to share thoughts and stimulate insightful conversation around pressing issues that affect us all. Looking forward to hearing your thoughts. (This is not a site for therapy nor does it intend to replace medical or other professional care. ) You can leave comments here or email The Dr. at and don’t forget to like us on facebook. Our facebook page is Dr. Brilliant Cliche
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3 Responses to How therapy can enable bad behaviors:

  1. Comment:

    I agree, one client I saw fired her family Doctor and actually lodged a complaint to the medical board about him. She was 350 lbs. He told her she was fat and was going to die. She was incensed! The crazy thing is the medical board gave this doctor a warning for being insensitive! Trying to motivate her into action was seen as negligence!

    Dr. B.C.

    Granny says: I would have lodged a complaint too! Look, it’s one thing for me to rant about a general trend in a blog- but a doctor who is sitting face to face with someone who probably has a lot of emotional issues tied up with their eating should NEVER slap them in the face with it in such a frightening and insulting manner. Such an approach can do nothing but put the patient in a defensive and unreceptive state of mind. Has the art of good bedside manners died?

    Additional Comments:
    In response one therapist Quoted a DBT saying: “ You might not have created the situation but now it is yours to solve.”

    Another wrote:
    The first step in having people take responsibility for their actions is to stop taking on the actions of others. The therapist ought not to feel guilty for the actions of their clients. The client doesn’t feel guilty because they don’t own their actions. If the therapist wants to be helpful then they must place all of the responsibility on the client’s shoulders. It is also not the therapists role to decide if or when a client changes. Instead shine a light that allows the client to better see where they are and how it affects them so they can choose whether to stay the same or change. If they trust you they may allow you to lead them. Supporting them in their decision to stay as well as being a guide down the path that leads to change is the ultimate goal for the therapist.

  2. Ken Bryant says:

    A therapist shouldn’t feel bad if a client stops coming. They also shouldn’t compare themselves to other therapists who may be more willing to give in to the client’s needs. Better to have one client who you really help and wants to change than six clients who want you to play their game. Your starting point is the clients mild guilt over whatever unethical practices in which he/she was engaged. Here, motivational interviewing may really help. Manipulation is sort of an addiction. Its a way of getting a lot of attention without taking any responsibility. Yet in the contemplative stage, MI really helps make a distinction between the advantages and disadvantages of a particular position or behavior. Be truthful to yourself and truthful to the client. If they have any interest in change, and only they can decide that, they will respect you and seek out your company.

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