There are moments in therapy when you feel it in your gut: it’s time to be direct- even confrontational - with a Client. Your hands sweat. Your throat tightens. A quiet fear sets in. You dread these moments. And your mind isn’t always your ally: What if I damage the relationship? What if I’m wrong? What if they don’t come back? What if they sue?
This dilemma is familiar to most therapists, and it can come at almost any point in therapy, the first session or 10 sessions in. Ultimately, it will happen with every Client at some point. Therapy, at its core, involves challenging the way people think and feel about themselves and the way they live their lives. That challenge can’t happen without some form of confrontation.
Confronting the Narrative not the Person
First, let’s look at what confrontation shouldn’t be. It’s not about being rude; judgmental; defensive; or dismissive. It’s not about teaching the Client a lesson or giving them corrective feedback.
Ultimately, everything we do is about changing what is toward what could be. We are confronting the psychological system that has the Client trapped, we are not confronting the Client as a human being.
So, exactly what are we challenging? We are challenging the Client’s pull towards unhelpful behaviors; we are challenging the identity they’ve constructed based on who history told them they had to be; we are challenging the way they conduct their relationships; we are challenging how they have settled for a life that gives them less than they deserve.
Confrontation as a Therapeutic Move
Confrontation in therapy has a complicated history. Some models lean on it heavily, others refuse to allow it at all. But generally, when therapists reach a moment of necessary challenge or confrontation, there is little guidance on how to do it. This is often left to supervision after the session, instinct, or personal style. This uncertainty leads to some therapists avoiding confrontation entirely, whilst others take risks they’re not equipped for; in most cases the therapist delivers the challenge and has really no idea how it will land. In these cases, the confrontation was critical but its delivery lacked direction and guidance.
Not a Blunt Instrument
In Process-Based Behaviour Therapy (PBBT), we’ve made room for confrontation when it serves a clinical purpose and is the most effective and appropriate way to achieve a specific clinical outcome. We’ve built confrontation into the fabric of the therapy itself. Not as a blunt instrument, but as a carefully crafted move within a broader clinical pathway. So, when you’re doing PBBT, confrontation is just the best delivery vehicle for the very precise clinical move you want to make. You want to go from A to B and confrontation seems to be the most reliable way to get to B. We don’t rely on guesswork about what exactly to say, or how to say it. We know what we want to achieve from each clinical move we make and knowing the Client, we calculate the costs and benefits of making that move through confrontation.
Imagine, for example, a Client who persistently jokes when the conversation gets close to any emotional pain. After a few sessions, the therapist gently says:
"I notice that whenever we touch on something vulnerable, you immediately shift into humour. I think you’ve got a great sense of humour, I really do, but this just isn’t the place for it. And, that’s what you do, isn’t it, being funny, being funny anytime anyone like me gets near a sore spot, such as your fear? It’s ironic, your humour is like a weapon you use to keep me away in case I get too close. Could I ask you to put your weapon down, because you don’t need it in here. I won’t harm you.”
Confrontation, when done thoughtfully and purposefully, such as is in the weapon analogy here, is a way of making the Client feel seen even as they are right now. It’s an act of appreciation and care for the person who needs to have a weapon when anyone gets close. Precise confrontation, such as this, can challenge the Client's stuck system, reveal what’s been hidden, and ultimately enable change. But it must be done with precision, timing, and a deep respect for the Client’s right to hide, deflect etc.
You’re Protected
Everyone feels nervous when they’re about to confront another human being about a specific issue. Feeling nervous or afraid as a therapist doesn't mean you're doing something wrong - it often means you're about to do something clinically important and you’re willing to make yourself uncomfortable to achieve a clinical aim for your Client.
When confrontation is needed, a good therapeutic model can’t make you feel safe or comfortable, but it can give you reassurance that this is the best way to make the move you need to make. In PBBT, confrontation is not risk-taking, but a skillful, necessary step that will serve your clinical aims. As with all moves in PBBT, confrontational steps are guided, rehearsed, and clinically justified. When a therapist makes a bold move within this framework, they are not leaping, they are stepping forward on solid ground.
So if you’re a therapist who has ever hesitated at the edge of confrontation, know this: your fear is not a failure. Your fear is an important indicator that you care about your Clients, you value their transformation, and you’re willing to make yourself uncomfortable for it.
Want to Learn More?
Join us for an informational webinar on the Professional Diploma in Process-Based Behaviour Therapy (PBBT).
You’ll learn how the programme equips therapists with a structured, clinical framework for making bold, compassionate, and effective therapeutic moves, like confrontation, safely and confidently.
Date: 16th June 2025
Time: 16:00 (Irish Time)
Register here: https://us06web.zoom.us/meeting/register/OIWsDRnUQwGsHbfLU6btCg
Whether you’re new to PBBT or ready to deepen your practice, this session is a valuable opportunity to explore how the diploma can support your clinical development.