Saying "No" is Progress in TherapyAs an educator and clinician, I spend a lot of time teaching beginning and seasoned therapists how to do “trauma informed” therapy.  This includes taking the time to build a safe and trusting therapeutic environment and relationship before jumping into assessment questions that are emotionally loaded and re-triggering.  It means consciously modeling and sustaining healthy boundaries.  It means knowing how to help clients pace their work so they don’t get flooded or overwhelmed in or after sessions.  It relates to establishing internal and external safety, teaching clients strategies for self-soothing, and connecting them to external resources for comfort and support.

In terms of actual treatment approaches this means not limiting the work to “talk therapy” but rather continually inviting clients to work with expressive modalities that allow them to access both visual and body-based sensations, memories, and experiences.  This is because trauma is often not stored in the part of the brain that handles language.  Many memories are stored and later retrieved through visual and visceral experiences. But as we discuss the idea of using art techniques therapeutically, incorporating movement, music, sand tray, psychodrama, yoga, breath work, and other expressive paradigms, a question I am often asked is, “What if I invite the client to try one of those approaches and he or she says “no.”  Then what do I do?”

Many clinicians interpret a client saying “no” as a negative response: a sign of “resistance,” or the client being “uncooperative or difficult.”   “No” feels like a roadblock that creates tension and even a potential power struggle in therapy.  I believe that when a client says “no,” it’s actually positive and a true breakthrough in treatment.

  • It means they have found the courage to use their voice to advocate for what feels safest and best in that moment.
  • It’s a protective way to pace the work so they don’t prematurely open a door that will cause them to become emotionally dysregulated.
  • It ‘s a way to communicate anxiety or a fear about “doing something new- wrong.”
  • It means they’re moving beyond the well-worn but historically necessary coping strategy of being compliant, acquiescent, or silent, and not rocking the boat by disagreeing.

When a client says “no,” they are connecting with an empowered part of who they can be and it’s a moment to celebrate.  In all likelihood, they are saying no because they feel safe enough to be honest with the therapist: a good sign that trust has been established.  A traumatized client needs to practice saying “no,” especially when they’re asked to do something they don’t want to do or that they find initially scary.  This is a right that often gets taken from them by their perpetrator.  Therapy can be the first place where they can get comfortable using their voice and advocating for their right to be safe.

When therapists recognize the reparative value of clients being able to say “no” and take the time to celebrate the courage and trust that it takes, it means that invitations to try new strategies can never “fail.”  It’s win/win.   If the client says, “yes” and tries a new approach, it’s a great act of courage and can potentially create safe new openings and avenues for insight, growth, and healing.  If the client says “no” it’s also a great act of courage, as well as the beginning of gaining mastery over self-protection and self-advocacy.  And it can help both therapists and clients alike to realize that saying “no” doesn’t have to be a permanent answer.  When it’s acknowledged and honored in the present moment, and trust and confidence continue to be enhanced in therapy, many clients do eventually find the courage to go out of the “talk therapy” comfort zone.  With the unconditional support of a therapist, clients can begin experimenting with more expressive techniques and discover the ways in which it can deepen their healing process.

How have you responded to a client who says “no?”

2 thoughts on "Why Saying “No” is a Sign of Progress in Therapy"

  1. Tuula Koraska, LCSW says:

    Wonderful points in this article. First, I validate, validate, validate – respectfully – the client’s resistance. The fact that they have shown up in my office, is all by itself, a significant act of courage that I think should be acknowledged.

    I agree that saying ‘No’ to a therapist can also be empowering, even life-altering. My stance is to meet the client where they are, and begin to walk with them, at a pace acceptable to them.

    In the early stages of rapport-building, I find that many clients are comforted by psycho-ed about the different trauma therapies I offer. EMDR is not a good choice for clients who are very dissociative, or have a seizure disorder, or are on a benzo, etc.

    I have had success offering CPT-C (without the trauma account), as one alternative with such clients. Each person presents with unique needs. I do spend.time in pre-treatment, ferreting out what would best suit each person, e.g. Grounding techniques, Safe Place, Distress Tolerance skills, and a million other interventions. Well, dozens.

    Thank you for always presenting us with powerful new ideas, important research findings, and especially, your positive belief in the human being’s innate ability to heal.

    1. lisaferentz says:

      Thanks Tuula for sharing your words of wisdom, and for the wonderful work you do with your clients.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

More from Lisa's Blog