Our expert says:
What I dislike, are cruel people ; people like Jen in the instance you quote, who seem to take pleasure in making ugly and hurtful comments to someone already distressed and asking for help. That's despicable behaviour for any human.
But you're asking a broader and very interesting question. Now, Nic-key makes a vital point --- I don't have patients online. When any of us form a "patient-doctor" relationship with someone, generally both patient and doctor have a relatively free choice in the matter. OK, in a very small town, it may be the local GP or nothing --- or travel to the next town, but generally you have some choice. A wise patient wouldn't try to be deliberately offensive to the doc, and a wise doc would be adult about not easily taking offense.
Sometimes there are surprizes. I remember when I worked in London, being called in by my friends the haematologists, to help deal with a 15 year-old boy with severe leukemia who was not expected to last long. We got on well ; so well that one afternoon while we were talking, he lay back and enthusiastically told me how he was a member of the British Nazi Party, and started mouthing the sorts of hate speech then being promoted by the part followers. That was a major surprise. I was able to handle it, concentrating on his needs, and to recognize the horrible things he was saying about people, as arising from his immaturity and the way his parents had brought him up to hate anyone slightly different from him.
Back in the archives, you'll find a very relevant sory of mine, too, about the young guy who attempted suicide by injecting a particularly nasty weed-killer into his belly. Up to then, nobody seemed to have survived this slow poison, so I was in the odd position of treating someone who had probably kiled himself, but wasn't dead yet.
I devised a form of treatment, with my colleagues, and he survived and was given the "probably all clear" after we'd laboured over him day and night for a week or so. That afternoon he disappeared, and was brought back into casualty a few hours later. I was called, and as I approached the stretcher, he just pulled up his T-shirt, and I could see three oozing wounds on his stomach where he had injected himself again.
He looked up at me, and said : "God, but you must hate me !" I thought a moment and replied : "No. I hate what you have done, but not you."
This is often a crucial point --- people do hateful things, but without usually being themselves deserving of our hate. ( I'll make a few exceptions for the Milosovic's, Saddams, and Osama's of this world, perhaps ; but whatever they may need, they're unlikely to seek psych help !)
Bu the other issue you seem to be raising is about confrontation, rather than butering up. It's easy for a therapist to be liked. Indeed, playing on someone's vulnerabilities, it's not hard to become loved, undeservingly, and to take advantage of that. But if you only tell people what they want to hear, and if a therapist so badly wants to be liked that they avoid all the unpleasant truths and challenging ideas the person really needs, they become useless as a healer. As you say, one needs skill and tact where possible, to try to keep the person close enough to encourage them to face what they need to face. But sometimes, when the person refuses to do what they need to do, and wants only that you pander to their likings rather than their needs, one may have to end therapy, and recommend that they try to find someone else from whom they may find it possible to hear what they need to hear.
And further to Nic-key's sensible comments, we all need to learn that disagreement is not hostility or an attack --- we can disagree respectfully.
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