Treating the Help-Rejecting Complainer

Recently, a friend posted on a social media website about problems he was having with his computer. He listed what he had tried and asked for help in figuring out what might be wrong. After some people asked clarifying questions about the problems, some started suggesting things to try. And the friend started shooting down every suggestion, giving ample reasons why the suggestions wouldn’t work. 

I was reminded that patients often come to therapy with a long list of grievances that they imply they want help to change. The less experienced therapist might be tempted to begin making helpful suggestions of what the patient could try, only to have each suggestion shot down. It only takes a few rounds of, “Why don’t you try…?” “No, that won’t help” for the therapist to become frustrated and wonder why the person has come to therapy. 

But most of us have encountered someone, either in our professional or personal lives, who is what Jerome Frank termed the “help-rejecting complainer.” (1) This type of client is difficult to treat in psychotherapy.   

A “help-rejecting complainer” complains as a way to seek help and support but then rejects any help that’s offered. When anyone tries to make a constructive suggestion—“Why don’t you try…?” or “Could you…?”—the help-rejecter insists that the advice is useless. In fact, help-rejecting complainers sometimes seem proud to be beyond help.

People outside of therapy often find help-rejecters annoying because the help-rejecter appears to want help but constantly refuses others’ attempts to assist, which is very frustrating. 

There are several ways to work with this dynamic. First, of course, the therapist should bring the pattern to their awareness. Many people are not aware that they do this and will be surprised and even disbelieving. 

Second, agree with them. For example, if your patient, who is in a new relationship and says her dream is to get married and have a family, then goes on to say, “I’ll probably scare away this guy just like the last one,” say, “Yes, I can see that with that idea in mind, you just might.” 

The most important way to work with someone who complains but doesn’t make any changes, though, is to resolve not to offer advice or solutions, and not to try to solve the person's problems. And that comes back to why someone who chooses to practice psychotherapy would feel compelled to solve patients’ problems rather than giving them the tools to solve their own.   

We like helping others; it makes us feel good, and it offers tremendous rewards. Why else would someone choose to listen to painful stories for a living? But if you keep trying to help people who refuse to benefit from your help, or people who reject or condemn your help, you need to ask yourself some questions. 

• Why do I do this?
• What do I need to learn from this?
• What am I getting from this dynamic? 

Although we may look forward to the day when formal clinical supervision comes to an end, it is actually very helpful to continue with a colleague or small group of colleagues who can “catch” us when our desire to be helpful gets in the way. 

However, we should keep an important caveat in mind: the appellation ‘help-rejecting complainer’ does NOT apply to a group of women friends. In that case, the complaining serves a bonding purpose and no one expects the others to offer solutions, just support. Researchers from UCLA have found that when women gather with other women to complain or commiserate, it can actually chemically counteract the harmful effects of stress (2). When a woman is under pressure, the calm-inducing hormone oxytocin is released, causing her to seek and nurture relationships with other women. This "tend and befriend" reaction is the female equivalent of the "fight or flight" response, and the woman is not looking for suggestions, a fact that women wish more men understood. 

In your practice, how do you handle the “help-rejecting complainer”? 

References 

1. Frank, JD, et al.  Behavioral patterns in early meetings of therapeutic groups. Am J Psychiatry.1952;108:771-778. 

2. Taylor SE, Klein LC, Lewis BP, Gruenewald TL, Gurung RAR, Updegraff J A. Female Responses to Stress:Tend and Befriend, Not Fight or Flight. 

Leslie Durr, PhD, RN, PMHCNS-BC is an advanced practice psychiatric-mental health nurse with a private psychotherapy practice in Charlottesville, Virginia.

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.