Communicating with Challenging Clients

  • Pauline Irving
  • Diane Hazlett
Part of the Community Health Care Series book series (CHCS)


The issue of working with challenging people is one which will be familiar to all community nurses. It is a truism that some clients are more difficult to help than others, due to diagnosis, personal characteristics or poor interpersonal skills, but it is surprising that there is very little in the literature that directly addresses this issue. The guidance that does exist tends to be rather anecdotal in nature and focuses on two areas: first, types of difficulties are delineated and, second, the communication skills thought most appropriate are identified and discussed. This approach is typified, in the business context, by Markham (1993, p. 9) who states:

‘There is no way you can make difficult people change and suddenly become sweet and amenable. Such change can only take place when the individuals concerned desire it and work towards it. So, if you can’t change them, the only thing you can do is change your own reaction to them.’


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Andrews M.L. (1995) Manual of Voice Treatment. San Diego: Singular Publishing Group.Google Scholar
  2. Andrews, M.L. and Schmidt, C.P. (1995) Congruence in personality between clinician and client: relationship to ratings of voice treatment. Journal of Voice, 9(3), pp. 261–9.CrossRefGoogle Scholar
  3. Brumfitt, S. and Clarke, P. (1983) An application of psychotherapeutic techniques in the management of aphasia. In C. Code and D. Muller (eds), Aphasia Therapy. London: Edward Arnold.Google Scholar
  4. Burnard, P. and Morrison, P. (1991) Client-centred counselling: a study of nurses’ attitudes. Nurse Education Today, 11, pp. 104–9.CrossRefGoogle Scholar
  5. Chamberlin, J. (1988) On Your Own. London: MIND.Google Scholar
  6. Coid, J. (1991) Interviewing the aggressive patient. In R. Corney (ed.), Developing Communication and Counselling Skills in Medicine. London: Routledge.Google Scholar
  7. Dalton, P. (1994) Counselling People with Communication Problems, Counselling in Practice, 3. London: Sage, pp. 6–8.Google Scholar
  8. Dickson, D. (1989) Interpersonal communication in the health professions: a focus on training. Counselling Psychology Quarterly, 2(3), pp. 345–66.CrossRefGoogle Scholar
  9. Egan, G. (1990) The Skilled Helper: A Systematic Approach to Effective Helping, 4th edn. Pacific Grove, Calif.: Brooks/Cole Publishing.Google Scholar
  10. Egan, G. (1994) The Skilled Helper: A Problem-Management Approach to Helping. Pacific Grove, Calif.: Brooks/Cole Publishing.Google Scholar
  11. Elliot, R. (1985) Helpful and non-helpful events in brief counseling interviews: an empirical taxonomy. Journal of Counseling Psychology, 32(3), pp. 307–22.CrossRefGoogle Scholar
  12. Fletcher, J. (1997) Do nurses really care? Some unwelcome findings from recent research and inquiry. Journal of Nursing Management, 5, pp. 43–50.CrossRefGoogle Scholar
  13. Gordon, N. (1991) The relationship between language and behaviour. Developmental Medicine and Child Neurology, 33, pp. 86–9.CrossRefGoogle Scholar
  14. Haber, L., Fagan-Pryor, E. and Allen, M. (1997) Comparison of registered nurses’ and nursing assistants’ choices of intervention for aggressive behaviour. Issues in Mental Health Nursing, 18, pp. 113–20.CrossRefGoogle Scholar
  15. Hall, B. (1991) Attitudes of fourth and sixth graders towards peers with mild articulation disorders. Language, Speech and Hearing Services in Schools, 22(1), pp. 334–40.CrossRefGoogle Scholar
  16. Hargie, O., Saunders, C. and Dickson, D. (1994) Social Skills in Interpersonal Communication, 3rd edn. London: Routledge.Google Scholar
  17. Heppner, P. and Rosenberg, J. (1992) Three methods of measuring the therapeutic process: clients’ and counselors’ constructions of the therapeutic process versus actual therapeutic events. Journal of Counseling Psychology, 39(1), pp. 20–31.CrossRefGoogle Scholar
  18. Hermonsson, G., Webster, A. and McFarland, K. (1988) Counselor deliberate postural lean and communication of the facilitative conditions. Journal of Counseling Psychology, 35(2), pp. 149–53.CrossRefGoogle Scholar
  19. Hill, C., Thompson, B., Cogar, M. and Denman, D. (1993) Beneath the surface of long-term therapy: therapist and client reports of their own covert processes. Journal of Counseling Psychology, 40(3), pp. 278–87.CrossRefGoogle Scholar
  20. Hopson, B. and Scally, M.(1981) Lifeskills Teaching Programmes: No. 1. Leeds: Lifeskills Associates.Google Scholar
  21. Howell, P. and Bonnett, C. (1997) Speaking clearly for the hearing impaired: intelligibility differences between clear and less clear speakers. European Journal of Disorders of Communication, 32, pp. 89–97.CrossRefGoogle Scholar
  22. Irving, P. and Dunne, A. (1994) An empirical basis for the formulation of strategic communication objectives at a local level. Health Services Management Research. 7(1), pp. 56–65.Google Scholar
  23. Irving, P. and Long, A. (1993) Counselling in health promotion: a nursing perspective. Journal of the Institute of Health Education, 31(4), pp. 126–32.Google Scholar
  24. Knox, S., Hess, S., Peterson, D. A. and Hill, C. (1997) A qualitative analysis of client perceptions of the effects of therapist self-disclosure in long-term therapy. Journal of Counseling Psychology, 44(3), pp. 274–83.CrossRefGoogle Scholar
  25. Ley, P. (1988) Communicating with Patients. London: Chapman & Hall.Google Scholar
  26. Lindlow, V. (1992) Just lip-service? Nursing Times, 88 (December 2), pp. 49–63.Google Scholar
  27. Luft, J. and Ingham, H. (1955) The Johari Window: A Graphic Model of Interpersonal Relations. Los Angeles, Calif.: University of Los Angeles Press.Google Scholar
  28. Markham, U. (1993) How to Deal with Difficult People. London: Thorson.Google Scholar
  29. Newell, R. (1978) Interviewing Skills for Nurses and Other Health Care Professionals. London: Routledge.Google Scholar
  30. Norton, R. (1978) Communicator Style. Beverly Hills, Calif.: Sage.Google Scholar
  31. O’Farrell, U. (1988) First Steps in Counselling. Dublin: Veritas.Google Scholar
  32. Oldfield, S. (1983) The Counselling Relationship: A Study of Clients’ Experience. London: Routledge & Kegan Paul.Google Scholar
  33. Parkinson, K. and Rae, J. P. (1996) The understanding and use of counselling by speech and language therapists at different levels of experience. European Journal of Disorders of Communication, 31, pp. 140–52.CrossRefGoogle Scholar
  34. Pettigrew, L. S. (1977) An investigation of therapeutic communicator style. In R. Ruben (ed.), Communication Yearbook 1, New Brunswick, NJ: Transaction Books, pp. 593–604.Google Scholar
  35. Read, J. and Wallcraft, J. (1992) Guidelines for Empowering Users of Mental Health Services, London: MIND.Google Scholar
  36. Rinaldi, W. (1991) The meaning of moderate learning difficulties at secondary school age. CSLT Bulletin, ISSN 0953–6086.Google Scholar
  37. Rogers, C. R. (1957) The necessary and sufficient conditions for therapeutic personality change. Journal of Counselling Psychology, 21, pp. 95–103.Google Scholar
  38. Salvage, J. and Buxton, V. (1997) Assessing the health of community nursing, Health Visitor, 70(2), pp. 56–7.Google Scholar
  39. Symon, A. (1997) Improving communication: apologies and explanations. British Journal of Midwifery, 5(10), pp. 594–6.CrossRefGoogle Scholar
  40. Thomas, S. (1997) Angry: let’s talk about it! Applied Nursing Research, 10(2), pp. 80–5.CrossRefGoogle Scholar
  41. Wheeler, S. and Turner, L. (1997) Counselling problem drinkers: the realm of specialists, Alcoholics Anonymous or generic counsellors. British Journal of Guidance and Counselling, 5(3), pp. 313–26.Google Scholar
  42. Windahl, S., Signitzer, B. and Olsen, J. T. (1992) Using Communication Theory. London: Sage.Google Scholar

Copyright information

© Pauline Irving 1999

Authors and Affiliations

  • Pauline Irving
  • Diane Hazlett

There are no affiliations available

Personalised recommendations