Rick Hanson’s recent book, Hardwiring Happiness (2013), provides a wonderful resource for understanding human beings’ tendency to focus on the negative and ignore or minimize the positive. As therapists, we are often challenged to be cheerleaders for the latter – reminding clients of their accomplishments and successes, encouraging them to reframe how they are thinking, sitting with and modeling compassion in the hopes that they can internalize this experience so that it will somehow transform their limiting perspectives.

In Hardwiring Happiness, Hanson (2013) suggests that the human brain has a negativity bias. For survival purposes, the brain evolved to learn quickly from bad experiences but not so much from the good ones. This evolutionary negativity bias is wired into the brain. According to Hanson, this negativity bias is an ancient survival mechanism that was helpful in the past but no longer serves us and is instead the root of much depression, anxiety, and general unhappiness.

With this apparent genetic predisposition for negativity, it can seem daunting at times to help clients make a shift in thinking and experiencing. For those suffering from anxiety, the constant attention to potential negative events has become a way of life and a coping strategy that feels too threatening to lose. For those mired in the depths of depression, the energy required to notice and savor even the simplest sign of beauty seems impossible to muster. Hanson’s (2013) recommendations for overriding the brain’s default program suggest that we can build a brain that can balance out and even limit this negativity—and in so doing, allow contentment and a sense of well being to become the new normal. Yet helping a client who is entrenched in pain and suffering embrace this possibility can seem overwhelming and sometimes impossible.

I worked with a client I will call Judy.[1] Now in her early 60s, Judy had been suffering from a Major Depressive Disorder most of her adult life. It seemed as if she had tried every type of medication, therapy, and even electroconvulsive therapy. When she came to see me, she was still so depressed that she had many days in which she could not even get out of bed. She was too depressed to work and was living on social security disability and a small spousal support payment from her divorce. Her expenses were greater than her income and she had exhausted her savings. Multiple friends and family members had suggested she sell her unused piano or take in a boarder, which would enable her to stay in her small house. Judy always countered these suggestions with a reason why this wouldn’t work (e.g., the piano needed repair; she couldn’t tolerate potential noise from a boarder), therefore resigning herself to a hopeless situation.

As a therapist, it is difficult to sit with a client like Judy. It can elicit hopelessness or annoyance or even anger. Some therapists feel pulled to help a client like Judy who seems to be so helpless. Judy told me about a previous therapist who had actually helped her grocery shop! Other therapists will give up on clients like this and refer them to the next therapist or another treatment modality. It is easy to get pulled into a tug of war with clients like this—trying to get them to change while they resist. It is also easy for therapists working with such a client to feel like they have not done enough or that they are somehow inadequate. It becomes more and more difficult to find anything positive to savor in such a therapeutic relationship, let alone help the client be open to finding the positive in his or her life.

Managing our countertransference response is tricky, but quite important. How do we work with our own negativity bias in order to see the good in our client and to stay hopeful when working with a difficult client? In essence, how do we resist the pull toward seeing the world as the client does and also resist pathologizing the client to protect ourselves? Our countertransference reaction can be informative and help us to understand how other people may respond to these clients or how the clients’ negativity may keep them isolated, possibly perpetuating beliefs that other people do not care for them or that they are alone in the world. Yet can we be of assistance to clients when we have negative or complicated feelings and thoughts about them ourselves?

In my own experience the people who had the greatest influence on me were people who saw me as more than my problems: teachers who saw the potential in me or therapists who believed in me. How do we as therapists see beyond the presenting symptoms of clients, see them as greater than their issues and help them reach their potential? How do we work with our own “negativity bias” so that we can maintain hope for our difficult clients and assist them?

New research has indicated that the person of the therapist is an essential factor in successful psychotherapy (Norcross, 2002). It seems that it may not be so much what we do in therapy but it is instead who we are. It seems that the presence or state of mind of the therapist influences the psychotherapy process. Yet how can we maintain a state of mind that has positive benefits with clients as depressed as Judy? Most therapists go to therapy themselves and many therapists seem to have a regular practice of meditation, presence, or mindfulness. Rick Hanson’s work, focusing on the positive and building new neural pathways, seems like it may hold additional promise for therapists who deal with difficult clients.

In the first part of his method, Hanson (2013) suggests a process of having a positive experience, enriching it and absorbing it so that it becomes firmly encoded in our brains. Taking the few extra seconds to savor those experiences will generally help therapists approach work with their clients from a more positive place. In the second phase of his method, Hanson suggests a process that seems particularly useful when working with difficult clients. He encourages a practice of visualizing a positive experience and spending time feeling it and experiencing it inside us. When we have a strong connection with the positive experience, it can then be linked with a negative experience. This pairing of a positive experience with a negative can rewire the brain towards the positive according to Hanson. Or, as Hanson suggests with a quote from neuroscience, “neurons that fire together wire together” (p. 10). This does not occur quickly, but rather through a gradual accumulation of these positive experiences—drip by drip.

So, if we used this approach with a client like Judy, we might spend some time outside the therapy office visualizing and having a felt sense of a positive experience, such as an experience of compassion or competence. When we felt fully aligned with this experience we could then introduce a thought of Judy’s depressive comments or a moment in therapy that was negative. By pairing the positive experience with the negative one, we could theoretically rewire our therapist brain to have a positive bias toward Judy and with our clients in general.

The attitude of the therapist is important in the therapy process yet it is sometimes difficult to maintain a constructive attitude, particularly when working with difficult clients. Hanson’s approach may provide a method for shifting our attitudes from negative to positive. By utilizing a practical method for hardwiring therapist happiness, we may be able to sustain work with difficult clients and improve the quality of psychotherapy.

[1] All identifying information has been disguised to protect client confidentiality.

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Barbara L. Vivino, Ph.D.

Barbara L. Vivino, Ph.D. is a licensed Psychologist with over 20 years’ experience treating clients and training/supervising therapists. She is currently in private practice in Berkeley, CA where she sees a broad range of clients from anxious students graduate students to clients facing the end of life. She has served on the Board of SAP for the past six years in the role of Domain Representative for the Professional Practice Domain. She received her Ph.D. from the University of Maryland and completed a clinical postdoctoral fellowship at the University of California, Berkeley. She worked as an Associate Professor at The California Institute of Integral Studies, where she also served as Director of Clinical Training. She continues to be actively involved in Psychotherapy Research. She is an avid hiker, averaging 4 miles a day, a daily haiku writer, a regular meditator, and has been learning French on Duolingo continuously for 1695 days.