â€œManipulativeâ€ clients may be reacting to overly controlling therapists. Before using such a destructive label, it is worth asking why someone would need to manipulate their therapist if they have agreed common goals.
â€œManipulativeâ€ is one of a therapistâ€™s most damning criticisms. While not as bad as â€œmalingeringâ€ or â€œpersonality disorderedâ€, both of which have their place in formal diagnoses, the label has similar power to influence the clientâ€™s future treatment as it implies that there is something bad about the clientâ€™s behaviour or the client themselves.
â€œManipulativeâ€ is defined as â€œtending to control or influence others cleverly or unscrupulouslyâ€. â€œUnscrupulouslyâ€ is, in turn, defined as neither honestly nor fairly. The stereotypical manipulative client is one who misrepresents their symptoms to obtain extra medication for abuse or resale, or who exaggerates their symptoms or situation in order to obtain financial benefits they donâ€™t deserve.
Some clients will be deemed â€œmanipulativeâ€ when they give different accounts or responses to different professionals. I have observed therapists respond to a client sympathetically or supportively in the session, then speak critically or dismissively of the same client in supervision or at a multidisciplinary meeting.
Many therapists are wary of manipulation by their clients. To have been manipulated would seem to be shameful, indicating that one was too naive or gullible when exposed to the clientâ€™s wicked wiles. This wariness can lead to a â€œguilty until proven innocentâ€ attitude to clientâ€™s apparent manipulation of their therapists.
Manipulation can represent a failure on the part of a therapist. It is difficult to imagine why a client would seek to control their therapist if the clientâ€™s true goals had been identified and an agreed plan to achieve these goals was being followed. Possible reasons might therefore include a lack of faith that a therapist would work with the client towards their true goals or even dismissal of the clientâ€™s goals by a therapist.
The failure may not have been on the part of the current therapist. Clients may feel (with some justification) that to reject a therapy or service may prejudice their access to or support by other services. They may therefore feel that they have to keep everyone â€œsweetâ€.
If you feel inclined to label a client as manipulative, ask yourself:
- do I really understand what it is that they want from me and the other services they receive?
- have we reached a genuine agreement or is the client merely paying lipservice to my treatment plan whilst pursuing their real goals with others (or outwith the service)?
- would I be prepared to work towards the clientâ€™s true goals?