Demanding clients make legitimate requests

“Demanding” clients are often making legitimate requests. Therapists applying such a label should consider whether it is the client’s requests or the service’s lack of resources which is unrealistic.

“Demanding” is a label often applied to clients by therapists, although rarely within earshot of clients. The label influences the responsiveness of the service to the client’s stated needs by implying that their requests for assistance are in some way inappropriate or excessive.

The stereotypical demanding client is therefore one who places undue demands upon the service, seeking longer or more regular contact with their therapist than is usual or seeking access to medications and other resources which would drain the budget of the service.

Groves (1978) listed amongst his four sterotypes of “hateful patients”: the entitled demander. He noted:

Demanders evoke a wish to counterattack; such patients need to have their feelings of total entitlement rechanneled into a partnership that acknowledges their entitlement–not to unrealistic demands but to good medical care. (Groves, 1978)

While there may well be clients with a feeling of “total entitlement”, they are unlikely to be as common as the use of this label. “Demanding” is actually defined as “making others work hard or meet high standards”, neither of which is necessarily a bad thing.

Therapists are (usually, but by no means always) comparatively well paid and can be held to rigorous codes of conduct, but the reality of healthcare provision is that services tend to be over-subscribed and underfunded. No amount of hard, high quality work on the part of the individual therapist can compensate for a referral rate double the capacity of the service.

Faced with a client requesting time or other resources the service does not have (but which the therapist’s training and judgement say should be available), the therapist has three choices: explain to the client that their requests are unreasonable given the size/funding/etc of the service; work even harder or fight for greater resources.

For overworked junior therapists, without the time, energy or power to fight successfully for resources, blaming the client is the easier option. To paraphrase Groves (1978), such therapists need to have their feelings of total helplessness rechanneled into a partnership that acknowledges their clients’ requests as good therapeutic care, not unrealistic demands.

The test comes when a member of the therapist’s family (or the therapist themself) falls ill: suddenly the waiting list no longer seems so reasonable, the prescription cost so cheap; the therapist becomes yet another “demanding” client.

If you feel inclined to label a client as “demanding”, first ask yourself:

  • can I distinguish genuinely unrealistic demands from good care that we don’t have the resources to provide?
  • would I accept our lack of resources as a reason why I couldn’t have the care I need?
  • what steps am I taking to improve our ability to meet clients’ needs in future?

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