Observations from thousands of hours of both individual and couples therapy sessions:

The patient that monologues, gives speeches, and answers their own questions (and/or dictates to the therapist how they want the therapist to do her job):

Th: Do you notice how you are doing both parts of the relationship and there is no real room at this point for me to be a therapist with a separate mind from yours?

The patient who launches into really long-winded explanations and background information: 

Th: I can see you are about to launch into another long explanation. If you do that the session will soon be over and you won’t have gotten much from me. Can we look at why you do this? Are you not used to being heard and understood?

The patient uses therapy like it is social hour, trying to get social needs met:

Th: This seems to be one of those days when you are looking to get from our relationship what you are not getting from your life, instead of trying to get to the bottom of why you are not getting it outside of here. 

Combative behavior — includes scolding, lecturing, shaming, and using a tone that suggests the other has done something egregious:

Th: You are on the attack right now — that leaves you alone and embattled. I cannot help you when you push me away like this (repeat as long as necessary, and do not engage in content). 

The patient who goes through the empty motions of therapy, disengages:

Th: You are going through the motions, and I can’t pretend you are not. Maybe you want me to pretend that we are really doing therapy, but we are not. Maybe you are looking for someone where you can go through the motions and they are not going to bring that to your attention.

The patient who talks about positive things or problems that were in the past:

Th: I wonder why you are here — you seem to be moving to happy talk or talking about problems that you have turned a corner on. Is there anything currently that is not going well that you would like to focus on? 

The patient who makes it clear he wants to be served, coddled, and taken care of (and/or for others to be able to read his mind):

Th:  I am guessing you didn’t get enough of those things as a child — they’re all things a child is supposed to get. Do you want to face that you didn’t get those needs met and grieve that out, or do you want to take the edge off that pain by burdening your adult relationships with your unmet childhood needs, pressing people to be an extension of you and your needs, to rearrange themselves so you don’t have to face your past traumas? 

Or:

Th: So you pressure people to give up their free will and be an extension of your will. Do you know anyone who likes being around you and you do that? Is this working out well for you?

The people-pleasing patient:

Th: You can certainly continue to be compliant if you wish to, but have you considered that it’s hard work to try to figure out what I want from you and then deliver on that? Eventually I would probably become a burden to you. Do you ever experience people in your life as burdens? Also, this mode seems to leave you alone, in that your actual feelings go on the back-burner when you’re complying. 

The compliant patient who experiences the therapist’s questions about their will as simply more expectations piling on:

Th: We have to acknowledge that it’s not clear what your will is right now. I have my hopes, I have to be honest with you, I am not neutral, but it just isn’t clear what you actually want. Maybe we will get clarity on that, or maybe we won’t. …And maybe even your response now is to try to accommodate my expectation. It’s not clear, and maybe we need to accept that for now. 

The patient who jerks you around:

Th: Do you always jerk people around like this, or is it just something about me that you don’t like?

The patient who continuously waffles and engages in contradictory narratives:

Th: You are being noncommittal and contradicting yourself. What is it like for you to be hurting your own credibility in here, ensuring that I can’t take anything you say seriously? 

Or:

Th: We both know that is not a solid position, and that a minute from now it will change. You keep changing your position, so the ground between us keeps shifting — and as long as that remains in operation I cannot help you. 

The patient who wants help changing others:

Th: I am sorry, I have no influence over those people. Do you want to try to find another therapist who might be willing to try to do that for you, or would you like to give up this project of trying to get others to change and see if there is anything about yourself you would like to change? 

The patient who externalizes:

Th: I notice that you seem to see the problem and the solution as outside of yourself, you talk about your husband as if he is the source of all of your pain and if only he was different, you would not need to be here. This condemns you to being a victim of external circumstances. Is that OK with you, or would you like to focus on your own role in your own pain? 

The patient who deals with her anger by treating people like they are not important, with manifestations in the transference:

Th: So we established that when you are angry with your boyfriend, you treat him like he is not important. And do you notice in here that you are chatting with me like we are friends having coffee, like I am not important to you as a therapist? Could we look at your feelings with me, since we have seen the connection between your anger and treating people like they aren’t important?

The patient in couples therapy who treats his wife poorly, neglects his health, and wants his wife to be his mother:

Th: Do you know that you are treating her like she is your mom? That you can say and do anything and she will still be there for you. That’s what mothers do, you can be mean, rude, push them away, and they will still be there for you. That is what you are looking for – someone you can treat any way you want and she will still be there for you.

Him: You could be right. 

Th: Even if she was, the fantasy is that if you can just get that as an adult, you wont have to face how painful it was to not get that as a mom. 

Her: And he will load up on sugar even though he is diabetic, so we are in the hospital twice a month.

Th to him: When you don’t take care of yourself, you are looking for a Mom to scold you, ground you, feed you good food. You are looking for someone to be your mom, but those days are gone, that ship has sailed — your childhood is over.

Him: Yes I really want her to make me yummy meals. 

Th: If you could only get it now you think you wont have to face how enraged you are at your mom and how painful and scary it was that she abandoned you.

Your wife, she can be a partner, but if you are looking for a Mom, even if she was there and did everything for you and took all the abuse and insults,  even if she just took all that, you would still have to face that you never had a mother.

The wife who takes the abuse:

Th: Set me straight if I got this wrong, but you seem to keep thinking – as long as I do what he wants, everything will work out OK, that as long as you are extension of him, which is what a mother is (an extension of their children), things will be OK. Do you really want to be an extension of him or any other man?  Is that your goal? 

…Sounds like you are not very good at expressing your anger, and instead you go into the mode of trying to manage the relationship to meet his needs.

A part of this comes from you being genuinely compassionate person, and there are some people who would cherish that, and there are some people who would exploit it, and your husband exploits it.

The patient who feels chronically slighted, ‘unsafe,’ and victimized, claims his wife ‘silenced’ him when she simply chimed in with her opinion (alternates with self-attack): 

Th: This is it. This is what I was trying to describe — what you are doing right now. Not feeling safe is being a victim. She did not silence you, nor could she unless she physically assaults you and covers your mouth with her hands. You see yourself as the injured party, and you talk to her as if she has done something egregious, when in fact all she did was chime in with how she remembered that event we were discussing. 

Or:

Th: How are you not safe? What was the danger here? What do you think is going to happen?

Pt: You are attacking. 

Th: Where is the attack?

Pt: you are questioning my experience. 

Th: I think you definitely experience yourself as a victim, but I don’t see that that is happening, even now as we talk about it, you experience yourself as being attacked, but I don’t see anyone attacking you. It’s a horrible way to feel, to feel victimized, and it is not necessary if you are not really being victimized. Do you see how you’re actually a victim of the thought that you are being victimized? 

Pt: My wife should not be triggering me.

Th: So there is a lot she does that brings up a lot of pain from your past, when you really were a victim, as a child. 

Pt: Yes. 

Th: You seem to be assuming that rather than resolving that trauma inside of you, you are thinking that people, your wife specifically, should treat you differently, should try to avoid triggering you — as opposed to you resolving that in yourself and letting people be themselves. 

Pt: OK, keep going.

Th: If you do the latter, then you can just have your feelings without feeling unsafe, victimized, or feeling like you are bad. 

Pt: Hmm. 

Th: So you are wanting the world to accommodate you and your trauma triggers rather than you resolving the trauma so you can just have your feelings be commensurate to what is actually occurring at present. 

Did you come in here to get me, your wife, and the rest of the world to accommodate your trauma, or did you come in here as part of the process of resolving your trauma?

The fighting couple:

Th: Notice how when she does not agree with you, you talk to her as if there is something very wrong with her. And do you notice that you talk to him with an attitude of, ‘here is what I think and want, end of discussion, as opposed to, ‘here is what I would like, but what about you?’

The couple at cross-purposes with the therapeutic task, the husband’s criteria for success is to get the wife to do what he wants her to do: 

Th:I think we are working at cross purposes here. I see the two of you being emotionally distant, I see it as painful for of you, I see it as a horrible thing to role model for your children, and I imagine it’s not just between the two of you.

Husband: Say more.

Th: I am working on helping the two of you connect, to feel closer to each other, feel heard and acknowledged by each other — and you (husband), you are trying to get what you want, you are using the therapy as a new skill-set to help you make sure she is an extension of you and does things the way you want her to do them. And I am not telling you that you can’t do that, I am just telling you that we are working at cross-purposes. Because even if she does what you want, you are still alone and not closer together. You live your life alone behind a wall of being a loner, by being prickly, stand-offish, avoiding each other, and manipulation — trying to get what you want. And to me that sounds miserable, but you may be fine with it. I encourage you to be honest.