Being in denial: How to address this defence mechanism

It is not uncommon to encounter denial (or that river in North Africa as it is referred to in AA) in client work. As such it is, for this counsellor, an aspect of client behaviour/attitude that I find certain ways of approaching as being particularly effective.

If I try to tackle denial head on then I am more likely to reinforce the denial and cause the client to shelter behind it. The denial takes me straight to Carl Rogers and the core conditions, i.e. unconditional positive regard, the client's frame of reference and the practice of being empathic and supporting the client.

In the therapeutic relationship, my goal is to establish a relationship where the client experiences being heard, not criticised, and where their existence is acknowledged as being important. Having established this, the client is able to feel they can trust me as their counsellor, to feel safe enough to explore issues that have been part of their life for sometimes decades. 

Denial as a defence mechanism 

Denial, being a defence mechanism, serves the client therefore the issue seems, to me, to be more about what is the denial protecting as opposed to just the denial in isolation.

To use an analogy, sunscreen can be used to prevent sunburn but perhaps the issue that really needs addressing is the need to obtain a suntan at the risk to health. In client denial, the issue that is being denied can be seen as the issue that when adequately dealt with will obviate the need for the denial. The self-acceptance of paler skin can obviate the need to put health at risk by getting sunburn.

What has caused the client to use denial? Is it a sense of shame or perhaps it is a previous response to the client's actions that has caused them to feel guilt? Perhaps it is caused by the client being unwilling or unable to deal with the vulnerability that comes with the issues that the client is using the denial to protect. Is it the associated loss of control felt by the client when the client feels the need to deny? It is used to protect themselves from all of these feelings and undoubtedly many more also.

The role of the counsellor 

By establishing a healthy therapeutic relationship with the client, the counselling sessions are experienced as a safe and accepting place. A place where the client understands they are able to go to places where they would previously use denial. When a client reveals issues, in my experience it is unusual for it to be a 100% reveal of all details – unusual but not exceptional. Commonly, the client reveals details in dribs and drabs. When a small aspect is revealed and the client experiences acceptance and not criticism they often feel safe to reveal in more detail and more extensively. Thus in increments, as trust in the counsellor is built, more is revealed.

With clients, the denial is often not accepted or even acknowledged, so a part of the counselling journey is walking alongside the client until they begin to perceive that they are actually in denial. When the client can see the denial then an opportunity to explore why they are using denial is present. Getting to this stage may take a long time, and considerable patience, but is that not a skill that defines the counsellor?

When a client is denying that they are perhaps responsible as an abusive partner for the loss of their relationship, or that they were victimised by a bully or abuser, that they caused harm to come to a loved one or other person (or themselves) by inaction, that their parenting could have been different, then I ask what would be the purpose of confronting that issue head on? If the denial was effective would I even be allowed to know that issue? I think no positive purpose would be served nor a positive result would be achieved. Therefore when the client is enabled, by a skillful counsellor, to acknowledge the denial, when they are willing to address the denial and its causes, only then can work on the defensive mechanism of denial be addressed.

As a counsellor, when I experience a client at this stage, I feel immensely satisfied. Satisfied because a client has made a move from rigid, fixed responses to a more fluid acceptance of external events and thus moved closer to Carl Rogers' ideal of the fully organismic person. 

Having been able to realise that denial no longer adequately serves them, the client, in my experience, will seek out different ways of dealing with life. Ways that serve the client's needs better. The client may not find them at the first attempt but we learn from our mistakes. The counselling room is a safe place for the client to make these mistakes. The positive thing is that the client has moved from being stuck (in denial) to being freed to explore other ways of being. 

Is that not therapeutic change, the purpose of counselling?

Finally one more reference to Carl Rogers: "A person will do whatever they need to, in any circumstance, to ensure survival of the person". The client in denial illustrates this just as much as the client who is able to move through and past the denial.