How to Engage People Who Don’t Want to Work With You

Posted on: May 21, 2024

This interview has been taken from the Context Magazine; issue April 2024.

An interview with Ged Smith and Jeff Young, No Bullshit Therapy

Ged: Hi Jeff. Can I start off by saying that it was a pleasure to meet you in Melbourne, and to read your book No Bullshit Therapy which really connects with me and my own practice. You have a very clear way of speaking with clients, and of writing about it which really speaks to me. Therapy can be so complex sometimes and so can writing or talking about it, so it was great to see this book which simplifies complex ideas beautifully. I’d like to know first off, however, how did you manage to get that title agreed? I mean, some people would have avoided the BS word for fear of offending some or having the book hidden in bookstores.

Jeff: Thanks Ged. I have quoted your work because it resonates with much of my own thinking.

Routledge US agreed to publish this book back in 2014, but stipulated that I couldn’t use the term, bullshit. ‘No bullshit therapy’ (NBT) had started to gain a following in Australia and I felt loyal to the people who had embraced it, and to no bullshit therapy itself, so I didn’t accept the offer of publication. I’m pleased I took, what was an obvious but hard decision at the time. Once you call yourself a ‘no bullshit therapist’, it does propel you to be honest with yourself.

Routledge UK didn’t question the title, so I think it is partly cultural. A few years ago, a person in New Zealand asked The Bouverie Centre, where I ran regular NBT workshops, if we could change the name because her organisation wouldn’t
give her professional development money to attend, but lots of therapists and even more people in the general community love the name. It’s somewhat refreshing and disarming. I think the name signifies a critique of (or alternative to), how
help is conceptualised (or not) for clients who are not keen on therapy. I think this because the first NBT workshop was oversubscribed three months prior to the event – which had never happened before.

The title No Bullshit Therapy goes a long way to create a context for mutual honesty and directness, but of course, there is a lot more to it. And there’s no need to use the term bullshit, I only use it in extreme situations, maybe with 5% of my clients, but these clients used to provoke 95% of my worry time. Some practitioners use ‘no bull therapy’, or NBT and there are lots of ways to convey the underlying ideas of honesty, directness, and authenticity, such as being on the level, being upfront, talking from the heart etc.

Ged: Yes, it certainly comes across as fresh and authentic, and appealing to so many people including reluctant clients. For me, I have found myself using NBT or “cut the crap” therapy as I’ve written about myself partly out of the growth of experience and confidence over years of doing this work, but also, I confess, out of impatience. I want to get on with it and do good therapy from the start. What would you say has influenced your move to no bull therapy Jeff?

Jeff: I have always been so enthusiastic about helping people that in my early days I took on too much responsibility for the client’s change. It took me decades to realise that not everyone in the community shared my love of therapy. I had to find ways to help people who appeared to not want my help; people who did not agree with the definition of the referrer’s description of their problem, did not accept the role of clienthood, and hence, understandably, didn’t accept or trust me as their therapist.

Family therapy helped me to acknowledge and make a feature of the constraints, including the client’s lack of trust, that got in the way of establishing a good working relationship, but the strategic or paradoxical ways family therapy at the time typically used to address these constraints, did not fit with my ethics. Jay Haley’s warning, “Don’t be the most enthusiastic person in the room” was helpful. Single session therapy (SST) helped me create a context to cut-to-the-chase, by approaching the first session ‘as if ’ it was also the last. SST provided a safe frame for getting down-to-business quickly, but again, it didn’t work with non-voluntary clients. I started saying that I practise no bullshit therapy with angry, defiant, non-voluntary clients strategically, often men, and it worked. I could see the client’s suspicion soften a bit. But I wasn’t happy with the strategic nature of this approach, and so over time, I developed NBT into a philosophy of authenticity. Striving towards mutual honesty and directness may have also been informed by my distaste for the obfuscation I saw in a psychiatric hospital where I first worked, when a defiant client’s views did not fit with the treating team’s view.

I started to explore what a model of therapy that suited clients who did not like therapy or me, would look like. NBT attempts to make therapy fit ‘resistant’ clients rather than expecting ‘non’ clients to fit our traditional therapeutic approaches.

What I love about NBT is that it allows me to convey my hopes for a reluctant client and at the same time, make overt that I can’t make the person engage or change. I have discovered through role plays I’ve conducted with reluctant clients in my NBT workshops, that saying something as outrageous as, “I don’t want to waste your time, and to be honest, I don’t want to waste my time” is strangely empowering to a client who is extremely distrusting of me. It conveys that I am here for ‘them’ not for ‘me’. And it is very different to what I was taught as a student therapist.

Growing up in the country, where there is a healthy suspicion of professional therapists, and coming from a non-academic farming family, probably also helped me challenge the orthodoxy of engagement.

Ged: Thanks Jeff, that is all so interesting, and answers other questions I had in mind. I know you did your PhD on working with people in Victoria who suffered from the drought a few years ago, and this partly influenced your practice. I wonder if
you think NBT is particularly Australian? I also wonder – even though I love it – how you think it might be received in the UK, or perhaps elsewhere like America?

Jeff: Good question. To be honest, I’m not sure about the universality of NBT. It certainly has a cultural congruence with Australian and New Zealand populations. During my PhD study (2006-2011), which was titled, A ‘no bullshit’ approach to counselling in drought-aff ected rural communities, a title which got a great laugh at my graduation, a drought counsellor remarked, rural people are suspicious of counselling until you put ‘no bullshit’ in front of it. I suspect it will be an easy transition to the UK, especially for disenfranchised communities. Maybe it may need to be soft ened to no BS, for a broad American audience. Although I have talked to a group about it in Hong Kong and Malayasia, I’m not sure how NBT would go down generally in Asian countries, but again, the underlying concepts, I imagine would be transferable. Colleagues in Israel, Holland, Sweden, America and UK love it – but that’s not a very scientific response to your question. I was surprised but delighted that NBT has been embraced strongly by our First Nation students at Bouverie. In short, I think any community or group or person who feels done over by mainstream structures will find it restorative.

Ged: I agree that anybody who feels disadvantaged, unjustly labelled, or sometimes just plain confused by how mainstream structures respond to their struggles will welcome this approach. In the UK context this will relate to all the things you mention, very much including race issues which are so important. This links for me with another feature of your approach which you really stress in the book, and this is the importance of linking your approach of honesty and directness with warmth and care. This human, caring stance is a crucial feature of NBT isn’t it?

Jeff: Yes, it is but human caring is a complex beast at the best of times, let alone when a person doesn’t want your help.

Tension in client-therapist relationships oft en occur when the wounded helper’s care is not accepted or seen as genuine by a suspicious client. NBT provides a way of conveying warmth and care that ‘non-cooperating’ clients are more likely to
accept. If a client is not feeling in control of their experience, direct expressions of concern and care can be experienced as condescending, infantilising, or psychologising. I personally don’t like having my nose rubbed in my vulnerability when I’m
feeling bad, even if the concerned person has good intentions.

You need a nuanced approach. Mark Furlong’s quote, “you can be overt about emotions if not overtly emotional” captures it nicely. Mark was talking about working with men, but it is true for a range of people. Following Mark’s advice, a therapist can be very direct about emotions, but cognitively direct, especially if the therapist has negotiated an agreement upfront to be honest and direct. I might get myself into trouble here for making stereotyped assumptions, but one thing I like about NBT is that
it draws on how decent Australian blokes oft en provide care to each other. For example, You’d be in your rights if you dropped your bundle given what’s happened to you mate (acknowledging the misfortune or unfairness and acknowledging but not dwelling on the pain), but if you don’t pull it together, you might not have a job tomorrow (direct advice or tough talk, conveying care but not in a disempowering way), which might be a bloody good outcome if you ask me (humour to soften or normalise the situation).

We know from working with couples and families that just caring about a person is not enough – the person needs to know you care about them. If you want to convey your humanity to people who don’t trust or like you, I’ve found it also helps to be parsimonious with warmth initially (otherwise they see it as a strategy to get them to do what you want), and to convey it cognitively not emotionally, and ultimately be prepared for the client to not accept your warmth and care, or a working relationship of any kind.

What I like about NBT is that the approach allows you to be make overt your human care, as you put it, whilst realising that warmth on its own is unlikely to work – you need to convey warmth in combination with tough talking, having created a
context for mutual honesty and directness. Marrying honesty and directness with warmth and care is the art and heart of NBT.

Ged: Art and heart, I like that. Moving on Jeff, beyond individuals, I also wonder about using this approach with families, and all the complexities we family therapists know so well, of facilitating therapeutic conversations with several people at the same time. How have you found people respond to NBT not only for themselves, but seeing this “tough talking” as you put it with others in their family?

Jeff: As family therapists we often see the full range of clients along the therapy lover – therapy hater continuum, in one family. We often get one person who is very keen driving the referral and some family members who would rather be anywhere other than seeing a family therapist. Family therapists will have their own strategies for engaging reluctant family members. NBT can help not only engage the reluctant family member quickly and in the process reassure the family member driving the referral (great the therapist is engaging the person I was worried wouldn’t co-operate or contribute) but also create a context for everyone in the family to have respectful and honest conversations with each other, not just with the therapist. I usually engage the reluctant family members first, knowing that the keen family members will be more forgiving than the therapy hater. The family member driving the referral often organises family therapy to get the therapy hater into therapy, or at least  involved in the family’s emotional world.

Ged: As with so much of this Jeff, and so many of your answers, it resonates with my own practice, and you have such an articulate way of expressing it. I know that some therapists find these approaches difficult, even if they want to be more direct. With trainees I often have conversations about them being “too nice” or “agreeable” and most agree and strive to break free of this constraint but feel disrespectful in using more straightforward language. Sometimes I have to remind myself that it takes years to find the confidence, and perfect the language, to use more direct language. I also wonder about issues of power in this approach, and if you ever find that it can be experienced as too direct, or even attacking?

Jeff: Interestingly, therapists are more likely to worry about directness than clients. Most clients what to know what their therapist really thinks, but maybe due to the power or role differential, don’t feel they can ask. Moshe Talmon’s (1993)
second book (Single Session Solutions) focused on how clients can get the best out of their therapist, and I think there is a gap in the field helping clients to direct therapy. But that is another story.

In my NBT workshops, I ask participants about what their family of origin would say about honesty and directness, and about warmth and care. Some participants report family scripts such as, if you can’t say something nice don’t say anything,
or be honest and if it causes offence, it’s their problem not yours. Finally, I ask who in their relational field naturally combines the two and could act as an inspirational blueprint for their NBT career.

I’ve also had participants come to my workshops almost thumping the table confidently reporting that they tell clients exactly what they think; that’s aggressive therapy not NBT. NBT is a nuanced integration of directness and warmth, which
is possibly best taught by an invitation to embrace Susan McDaniel and Judith Landau-Stanton’s (1991) philosophy of both/and or Heraclitus’ unity of opposites. I encourage participants to embrace these philosophies and then to let their heart and their own words enact these views. Another practical way to inform greater directness is to share the single session therapy approach: “what would I want to say to this client if I knew I’d never see them again?”, or to redefine direct feedback as a gift, if it comes from a good place and in the interests of the client.

I also think that having a range of safety strategies in your back pocket, such as ensuring all four NBT clinical guidelines are enacted, talking about the talking, apologising, and starting again, helps create the confidence to be more direct. Creating a context for mutual honesty and directness is also a safety strategy and it helps address issues of power in the work, as it invites clients to say what they think too. Finally, in relation to a part of your question, wouldn’t it be great if we could combine our later career experience, confidence and wisdom with our early career enthusiasm, naivety, and hard work.

Ged: I agree that we worry about it more than clients Jeff. I find that people want us to be robust, challenging, take some control of the process, and talk in straight, no bullshit ways. And as you say, the nuance and the warmth and care are what  makes it so collaborative and in no way attacking or aggressive. However, it takes time and experience doesn’t it, to find both the language and the confidence!

Jeff, it has been a real pleasure, both to meet you in Melbourne, and to talk more here about your work and your book which I find inspiring and a great contribution to our field. Thank you so much for this.

Jeff: Thanks Ged, it has been an absolute pleasure.

References

McDaniel, S.H. & Landau-Stanton, J. (1991) Family of origin work and family therapy skills training: Both and. Family Process, 30, 459-471.

Talmon, M. (1993) Single-session Solutions: A Guide to Practical, Eff ective, and Affordable Therapy. Boston, MA: Addison-Wesley Publishing Company.