Is confrontation ever a good thing? – Lindsay Hall, MSW

*(the examples provided below are composite cases, synthesizing disguised information and not any patient in particular)

Many people seek out a therapist because they want someone to listen– to their concerns, stories, fears, and desires. While therapists certainly provide the listening ear, the most meaningful developments in therapy often come from confrontation. The word, confrontation, is often synonymous with accusation and defensiveness, but it is an essential tool in the therapeutic relationship.

The therapeutic confrontation differs from disagreements over a parent’s demands or the empty milk carton left in the refrigerator. It is an opportunity for patients to confront their own behavioral patterns – usually ones that they are unaware of. By drawing attention to habits in real time, the process allows patients to recognize the situations and actions that have occurred in the past and have led to unwanted outcomes. It is as if the therapist is asking, “Hey, remember that thing you do? You’re doing it right here, right now. Let’s consider what that’s all about.”

An illuminating example is Ramona, a woman in her early 30s. She began therapy because she felt stuck in a cycle of casual dating.  She was no longer speaking to her mother, whom Ramona described as “emotionally distant and highly demanding.” We met regularly for a few months when she began to cancel her sessions at the last minute. I was frustrated and confused by her behavior and sporadic attendance. Eventually, I challenged Ramona to consider why she was having difficulty in attending our sessions. Rather than shaming her, I invited her to explore the possible reasons she had for distancing herself at this point in treatment.

Initially, Ramona resisted the idea that she was purposefully sabotaging her treatment. With deeper reflection, however, she realized she felt guilty for prioritizing her own interests. As the oldest child in her family, Ramona was often enlisted to take on the caretaking responsibilities. Keeping her mother appeased and her siblings cared for, did not  leave much room to pursue her own interests. As an adult, Ramona feels guilty when she pursues her own needs and desires above those of other people . She also worries that others will place unrealistic demands on her, as her mother did. After my gentle challenges during sessions, Ramona realized that her fear and undue guilt has led her to withdraw from others who were “getting too close” –not just me, but also men she had dated.

Confrontation is intimidating for many people As in Ramona’s situation, clients might feel the urge to avoid or dismiss someone who initiates it. But when the therapist confronts the behavior, it is a sign that he/she perceives the obstacle and offers help in navigating it.

There are reasons behind each action, and they can be examined with the help of a professional who has earned the trust of the client.

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