Why Clients Reject the Care They Need

In this conversation, Richard Erskine explores one of the most subtle and clinically important concepts in relational psychotherapy: the juxtaposition reaction. Why do some clients reject the very care they have longed for? Why can empathy, tenderness, and attunement evoke mistrust, withdrawal, or even rage instead of relief? Drawing on decades of clinical experience, Richard explains how a therapist’s attuned presence may become a painful contrast to a client’s early relational history. Together we discuss the relationship between juxtaposition, early affect confusion, borderline adaptations, and the delicate balance therapists must maintain between offering corrective experiences and respecting a client’s capacity to receive them. Rather than focusing on techniques, this conversation highlights the artistry of psychotherapy—slowing down, making relational inquiries, and remaining sensitive to what unfolds between therapist and client in the present moment.

Richard G. Erskine, PhD, is an internationally recognized psychotherapist, clinical psychologist, and the founder of Integrative Psychotherapy. His work has profoundly influenced Transactional Analysis, Ego State Therapy, and relational psychotherapy through his emphasis on attunement, relational needs, and the healing power of therapeutic contact. If this conversation resonates with your clinical work or personal reflections, consider subscribing to the Harmony channel for more interviews with leading figures in psychotherapy.