Is there any hope for this client?

[Natalia]

I have a client who is a very difficult case. I've been working with her for several years and I'm convinced she just does not want to get well. She's addicted to her pain and her health problems. She would have nothing in her life without them. She's been to multiple doctors and practitioners for her ailments and chronic pain issues. She is always very defiant and will not take anyone's advice or treatment. I am the only practitioner she sees that will just do what she asks me to do. She orders how she wants the session to go and I oblige. (Understand though, its pretty much a basic full-body massage, I'm not doing anything painfully deep or dangerous.) She just needs to be in charge of the session and I know that this is her personality, so I just deal with it.

Her other doctor's are not so willing to bend and take orders from her so she gets very defensive and angry with the medical and alternative health professions in general. Some days she comes to see me and she is very uptight and angry and even takes her frustrations out on me. She will not follow any doctor's advice, even specialists because she knows best. She won't even try anything new, so I'm not sure why she visits so many practitioners in the first place?

I'm pretty much drained by her. I know I can't help her, but she feels that I do. I really think she just likes being able to order me around, and that is in some way therapeutic to her, not the treatment. I can't take it anymore and I've decided that its time to dismiss this client. The thing is, I am genuinely concerned for her wellbeing. She's becoming progressively more reclusive and self-absorbed and obsessed with her health problems. I want to refer her to another pracitioner, but I don't want to subject anyone to the abusive I have tolerated from her. I just wonder if there is any hope for this person or should I dismiss her and forget her and try not to care?

Also, I have to be very gentle with how I dismiss her. If I imply that its her "negativity" or "bad energy" or anything of that sort, it could throw her into a nasty depression. I'm not sure how to approach her about terminating our relationship? I need a good "excuse" basically, that won't put any blame on her. She can seem very tough and rude at times, but I think she's really very fragile.

 

[ffl04122007]

Is there any hope for this client?

Bottom line - if she's saboeforum.xxxing her own wellness that's on her hands, not yours. This is no longer a healthy therapeutic relationship, and ethically you need to let her go.

If I imply that its her "negativity" or "bad energy" or anything of that sort, it could throw her into a nasty depression. I'm not sure how to approach her about terminating our relationship? I need a good "excuse" basically, that won't put any blame on her.

You approach the situation professionally, WITHOUT making up excuses, and how she decides to deal with that information is HER responsibility, not yours. It's also not your job to find her next therapist for her either. If you know someone who you think would be a good match for her that would be one thing, but unless you have a good reason to refer, then don't.

There are a few examples around here of letters people have used to "fire" clients. You may want to search those for ideas, but your best bet in the end is to keep it simple. You don't need to explain all the ins and outs and open the issue up for discussion. There is no discussion. You've decided to no longer see her as a client, wish her the best of luck, the end. If she calls you and tries manipulating her way back, again - be professional and to the point, tell her no, and move on.

While many people who get into massage therapy do so because they have a caretaking side to them, you can not allow those feelings to overstep your ethical and personal boundaries. If you're having these feelings, it's ethically responsible to let her go. How she conducts herself beyond that, is her responsibility, not yours.

 

[Yep]

Is there any hope for this client?

I think that if you decide to refer her to anothr practitioner, the main thing is to be up front with them and let them know that she is a difficult case. Tell them what you told us and see if they are interested in taking her on. If they are, you have a referral. If not, look some more.

I don't know exactly how you run your sessions, but personally, I don't have any qualms with letting a patient run the session if they like. I'd like to tell you what I do, and you can see if it fits with how you do it. Maybe there is a difference that would be useful to you, since I get the feel that the way she runs the session is generally frustrating for you. Forgive me for putting words into your mouth, but that is what the post sounded like. If you can find a better way to allow this, her "running" the sessions may begin to run off you like water on a ducks back (at least until you get her out of your practice).

When I have a client who wants to run the session, I have a few of my own boundaries that make this easy for me. The first is that I don't take it personally. I am now here to complete a job with my skills and a little artistic style. I take the client into their room. Something to get you a little peppier: "Your relaxation zone awaits you..." with a flourish of the hand. It helps me to get in art-mode, sometimes.

Next, I stand at the door while they are moving around, settling into the chair, or taking off their jewelry and ask: "So, what's my job today?" Of course, this would be a regular and consistent client we are talking about. Therefore, I basically already know. But, I ask to make sure. After they tell me, I lay out my plan. "Well, in that case, I think we'll start you face down for about 30 mins. for your back and arms, then turn you face up and do some extra work on your neck, work your arms, legs and feet for about 40 mins., -- then, turn you face down again for the last 20 mins. and work those legs and glutes before finishing up for about 7 mins. on the back and arms to pull it all together. How does that sound?"

"Oooooh, ahhhhh, great! But don't forget I need extra time on my feet."

"No worries Mrs. X. I've got it covered."

That seems to work pretty nicely.

If you want to dismiss her from your practice, I'd suggest coming up with a general letter, and letting us tweak it for you. Maybe we can come up with something useful.

Possibly this thread will be helpful. Within it, I added some links within it of other termination letter threads from the forums. I bet there is something in the thread or those links that will help give you a few ideas. Need Help with "Dismissal" Letter

 

[RaTz]

Is there any hope for this client?

Having had a family member live with my parents for three years, I saw how depression acts. And, honestly, no matter how gentle you are, you can't be assured that someone who is depressive is not going to drop into a depressive state in a case like this. You really can't hold yourself responsible for that, if it happens.

 

[Aditya]

Is there any hope for this client?

Pueppi,

That is pretty much how I handle all my sessions with my clients. I don't mind them "running" the session in that manner. This one is different, and I didn't want to go into too much detail, but it goes way beyond her just "running" the session. (The fact that she can't run the sessions with the MD or the PT's is why she stops seeing them and continues to come to me.)

She's abusive. She pushes boundaries. She's miserable and has bad energy. I've allowed it to roll off my back long enough, but her derogetory comments are too much to take. She seems to think we are similar and almost "friends". We do have some similar hobbies and interests, but other than that, we're not alike. I don't dispute the things she says (regarding her strained relationship with her family and friends) to be sympathetic and "the customer is always right", or I stay silent. She seems to think I have the same attitude toward my family as she does. She's a man-hater and makes snide remarks about men and implys things about my husband. She's just a miserable person and she's gone too far with me. She asks me why I would want to spend holidays with my family, rather than alone (like her) and has called my mother crazy and my sister a Female Dog! She has said these things about HER family, I've NEVER said them about mine, but when I sympathize and say things like "Well we all have problems in our families. Or, no family is perfect...." just generalized statements regarding relationships in general, she paraphrases and assumes I hate my family the way she hates hers! (I'm sorry, I didn't mean to go into this much detail, but I'm frustrated and angered by this woman.)

I have to let her go for my own health and well-being. She's really killing me. If she were a friend I'd have told her off a long time ago, but because she's paying me, I bite my tounge. I also know that this is probably the reason she has no real friends or relationships in her life, she treats everyone this way. I feel sorry for her, but I'm burning out emotionally and I can't do this to myself any more. I just wonder what is going to happen to this woman now that she's planning early retirement (which will only make her more of a recluse) as well as buying herself a motorized wheelchair for her heel spurs? I guess I shouldn't care?

I'm actually thinking of writing her a nasty letter and then burning it. Then I'll write her a cordial dismissal letter.

 

[Boo Boo Kitty]

Is there any hope for this client?

I agree Elliemare you have to let her go for your own health & well-being.
It's dragging you down. Fire her as a client and make room for the change you've been wanting in your life and your practice! Indulge in a bit of energetic spring cleaning!
Let her go... and move forward toward your dreams!
Onward & Upward! You can do this!

 

[Gerik]

Is there any hope for this client?

Well, I think with that response you pretty much answered that you don't have to be gentle in how you dismiss her. I agree... she's got to go. And, you don't need a good excuse. Fragile or not, you have to let her know that you can't see her anymore.

Let us know what your letter looks like. It will surely help others in the future.

Oh, and if it helps any, I recently had a weekly client who was very high-maintenance, though not nasty like yours... and she really got manipulative with me. When I called her on it, I figured she wouldn't be back and naturally (for me), I was a little stressed about it. It ends up I had three wonderful new clients replace her within a week!

 

[mango1cecrm]

Is there any hope for this client?

I am having a really hard time even begining a dismissal letter for this client. At this time, my feelings toward this client are so emotionally charged that I'm finding it hard to remain professional. The issues with her run so deep and are so vast that its hard to really pin-point the core issues too?

I'm thinking of wording things from my standpoint, that I have to do what is healthiest for me. I'm planning on overhauling my practice, including my techniques so I won't be offering this clients preferred "method" of treatment any longer, so maybe I could use that angle? I'm just not even sure where to begin?

 

[Pompal 09.]

Is there any hope for this client?

I'm thinking of wording things from my standpoint, that I have to do what is healthiest for me. I'm planning on overhauling my practice, including my techniques so I won't be offering this clients preferred "method" of treatment any longer, so maybe I could use that angle? I'm just not even sure where to begin?

Are you actually doing this, or is it an excuse that you're thinking of using? You don't have to make excuses or sugar coat anything. Own the situation, and be straight forward, simple, and professional. Taking some cues from this thread http://www.massageplanet.com/forum/viewtopic.php?f=31&t=4654 I'd probably send...

Dear XXXX,

I'm writing to inform you that I will no longer be providing massage therapy services to you. As a professional, I am required to terminate this relationship as I believe I can no longer effectively provide for your needs.

I thank you for your business, and wish you well in the future.

Sincerely, Me.

If she already had an appointment scheduled, you can throw in the line from the other thread re cancellation of future appointments... the end.

NOW, since she has a history of pushing boundaries and you have a history of bending, I'm guessing you'll probably get a phone call from her trying to get back in. Decide now how you're going to handle that. Again, simple is best. "I'm sorry XXXX, but as I stated clearly in the letter, I will not be able to provide services any longer. Good bye." and hang up.

I'm betting you'll feel stronger once this is over with .

 

[Pompal 09.]

Is there any hope for this client?

Here's another version of a termination letter (dismissal letter) I've mixed from a few posts which were in that same thread JaeMarie mentioned above.

• Dear Client X,
  
  After much consideration, I am writing to inform you that I will no longer be available to provide massage therapy for you.
  
  After a recent session where you ordered me around, implied unacceptable things about my husband, were angry and took your frustrations out on me, I have found that I must terminate our relationship in the interest of my personal and professional well-being.
  
  Please know that your appointment on has been cancelled, as have all future appointments.
  
  I wish you good health and peace.
  
  Sincerely,
  
  (Your Name)

03/08/11: edited to correct some sentence structure and typos.

 

[Pompal 09.]

Is there any hope for this client?

I'm sure I will feel much better after this is all over with.

I really am overhauling my practice and changing my technique as well as letting go of more clients than just this one. Most of my clients who are draining me to this day (just a small handful, some which I don't see that frequently) came to me when I was an employee. I allowed the employer to push boundaries with me and she required me to take a lot of crap from clients just to keep them happy and coming back. I really do think its time to make a clean break from these people since the foundation of our relationship was established at a time when I was being a door-mat.

I'm ready to move on to better things these days! I'm leaving the past behind me and starting over with (hopefully) new clients, a new outlook, a new focus and some new modalities! I'm long over due and if I want to stay in this business, I have to make these changes before its too late and I'm emotionally burnt out for good!

I think I'm going to have to start with a long letter to this client and just shave it down and down until I'm just left with the core issues. Its one of those things that I'll have to write and then come back to it again and again when I'm in a better state of mind so that I don't do anything hasty or unprofessional. Thanks for the suggestions, I've found some threads on here that have been helpful too.

 

[The Oracle]

Is there any hope for this client?

Ellie, this and the other clients you're wanting to get rid of wouldn't happen to be in the "old" location, would they? THAT would have been EASY to fix....

 

[renaisance festival]

Is there any hope for this client?

Ellie, this and the other clients you're wanting to get rid of wouldn't happen to be in the "old" location, would they? THAT would have been EASY to fix....

No and yes, theses are clients that now come to my home, but are holdovers from my "old" location. The select few that have chosen to drive to my new location. Not all of them are bad, but most of them met me during my "doormat" days. The client in question is one of the few who actually live nearer to my new location than most of my "old" clients. Its still a long drive for her, but not long enough apparently!

 

[Pooky]

Is there any hope for this client?

Another option is to stop working like your doormat days, and the rest will come naturally. Tell them what you are doing in your practice, tell them when they do something that is not allowed and tell them what you won't be doing anymore. They'll either shape up or ship out.

Easier said than done, I am sure... but here's a little nudge if you need it. *hug*

 

[A G]

Is there any hope for this client?

Another option is to stop working like your doormat days, and the rest will come naturally. Tell them what you are doing in your practice, tell them when they do something that is not allowed and tell them what you won't be doing anymore. They'll either shape up or ship out.

Easier said than done, I am sure... but here's a little nudge if you need it. *hug*

That is an idea. I am trying to get a job outside my home. I think that working from a professional office setting may help me to maintain better boundaries too. I would only continue to see the respectful clients from my home office.

I have a second interview at a spa near me, but far from most of my "old" clients, so I could lose some of them due to the added distance... IF I get this job, and IF the situation is a good fit for me.

Back to the client in question though. I know I shouldn't concern myself but do you think that some people just don't want to be well? They really truely want to hang on to their pain, misery and illness? Is there any hope for these people? I feel bad "giving up" on this person becaue I know so many other practitioners have given up on her, or never tried to help her in the first place. The problem is, she doesn't want to help herself. I can't do it for her, so I guess I've "helped" as much as I can? I just hate to think that some people will never truely be happy or healthy. That's just sad.

 

[Imran M]

Is there any hope for this client?

Back to the client in question though. I know I shouldn't concern myself but do you think that some people just don't want to be well? They really truely want to hang on to their pain, misery and illness? Is there any hope for these people? I feel bad "giving up" on this person becaue I know so many other practitioners have given up on her, or never tried to help her in the first place. The problem is, she doesn't want to help herself. I can't do it for her, so I guess I've "helped" as much as I can? I just hate to think that some people will never truely be happy or healthy. That's just sad.

Yes, I think some people really don't want to get well. They do truly want to hang on to their pain, misery and illness. I hope there is hope, but I think for the most part, if soft love doesn't help them, sometimes they just need a swift kick in the pants.

We had a family member in their 60's who let himself completely go. He asked for help and was given the help plus three years to get back on his feet, get some medical care and possibly find just a part time job to help out with his living expenses and burden he placed on the family. It's a terrible thing to say, but he just ... didn't. I don't know why. I don't get it. I really don't understand. But, there you have it. And, in the end he had to be evicted from my parents home. At 60! t009 It was terribly disheartening and the family was torn over how to deal with it. In the end they did what had to be done. We all hope he eventually gets it together.

If's she's like this for so long now, and doesn't understand that everyone has to suck it up at some point and move on or listen, then I'm not convinced you'll be able to help her either. Possibly the swift kick will give her the jolt she needs to move on and change her life. If so, maybe then she'll come back a new person. Then again, maybe not.

 

[Mirroboy Nick]

Is there any hope for this client?

I agree- some people, for whatever reason, simply will not or cannot fathom what "healthy" looks like-- physically or emotionally. As massage therapists and not qualified counselors, we cannot determine what "healthy" is for any individual other than our own selves. However, we *can* and *must* accurately judge "healthy" for ourselves, and kowtowing to clients who are manipulative and damaging to ourselves or our practices (and it's really all one and the same) is decidedly *not* healthy. Well, going back to "I can only decide for myself what is healthy or not", I have to admit that it would not be healthy *for me*.

You *could* just give her the pink slip without stating a particular reason. "I'm incorporating some changes in my business, and from X date will not be able to work on you any longer." Remember that sign we should all have hanging in our offices: "We reserve the right to refuse service to anyone." Sometimes, we actually have to stand back and quietly point to that sign. With a straight face on.

 

[Hello K]

Is there any hope for this client?

The problem is, she doesn't want to help herself. I can't do it for her, so I guess I've "helped" as much as I can?

Yes, and that's why you can move forward and feel alright with dismissing this client. You have done everything you could. She has to want to get better. Just like an alcoholic in recovery, they have to want to go for treatment or it's all for naught.

At one point does "helping" become enabling? You can see this particular client/therapist relationship is not healthy for you. Take steps for your own health. Cut the cord. Terminate the relationship with this abusive client and move in the direction of your dreams (goals).
You said you wanted to change the types of work you do. Plan it, save for it, do it!

I think getting a new place to practice would help you set up firmer boundaries. Many people take advaneforum.xxxe of therapists who work out of their homes... and moving your MT practice would probably give you a great chance to re-establish your professional boundaries.

And while you're chasing your dreams... know we're here... cheering you on. t026 t026 t026

 

[Villain]

Is there any hope for this client?

Thanks for the support and encouragement. I will be seeing this client one more time this week and I think this will be our last appointment together.

I just hope I don't fall into this trap again with another client. I knew many years ago that I could not help this particular client unless she was ready to help herself. I stopped "trying" so hard to help her and just started going through the motions. I allowed her to make the call as to if she felt I was helping her. She seemed to think the sessions were beneficial, so I continued to book her appointments. I had to pull back mentally and emotionally for my own sake since I know I can't "fix" her. I thought that would be enough... but continuing to work with her under these circumstances has been detrimental to my health after all.

I've referred her to other therapists and practitioners in the past. Most of them sent her back to me. No one else will deal with this woman the way I have. I guess my only option is to cut her off. Finding a new therapist will have to be her responsibility, I can't refer her to anyone new.

I know that I'm going to feel so much better when this is all over with!

 

[Pompal 09.]

Is there any hope for this client?

I am trying to get a job outside my home. I think that working from a professional office setting may help me to maintain better boundaries too. I would only continue to see the respectful clients from my home office.

Many people take advaneforum.xxxe of therapists who work out of their homes... and moving your MT practice would probably give you a great chance to re-establish your professional boundaries.

It's your home, your santuary. It's the last place clients should be allowed to take advaneforum.xxxe of or push you. Consider it in these terms and I think your professional boundaries at home will improve dramatically.

They should not bring bad energy into your dwelling - you work and live there. The home most definitely needs to maintain good energy.

Thanks for the support and encouragement. I will be seeing this client one more time this week and I think this will be our last appointment together.

Suggestion for a re-phrase: "This will be our last appointment together." No, "I think" allowed. Or, call her and cancel it now.