top of page

Managing Difficult and Sensitive Conversations in Therapy

Cory Newman

7 Mar 2024


Among the many tasks that therapists need to perform in their work with clients is to serve as positive role-models for effective communication. For example, therapists often have to provide clarity about diagnostic issues and treatment planning to clients who sometimes enter therapy in an unsettled state. Therapists also help their clients to remember important details about interventions (including homework) by being clear and organized in the process of teaching them. Perhaps most challenging for therapists are those times when they have to give their clients feedback that may be difficult for them to hear and accept. This webinar will describe how therapists can enact their best interpersonal and verbal skills in having difficult and sensitive conversations with their clients. These skills have multiple components, including a mindset that embraces facing challenging situations, an optimistic outlook about interpersonal problem-solving, the capacity for tact and diplomacy, sufficient self-awareness to refrain from contributing to escalating power struggles, and a manner that allows for confronting a patient with empathy.

The event will be equivalent to 2 hrs of CPD.


This webinar will address some of the many situations in which therapists have to bring a high level of interpersonal and verbal skill in talking to their clients about important matters. Examples of such situations include: (1) discussing differences of opinion about the client’s diagnosis and/or targets for therapeutic change, (2) setting limits with clients who are engaging in therapy-interfering behaviours, (3) addressing strains or ruptures in the therapeutic relationship, (4) needing to give their clients a “reality check” when the clients’ views (and resultant behaviours) are hazardously off the mark (including being “in denial”), and (5) navigating sensitive cultural matters, including times when clients express hateful, prejudiced views. Having difficult, sensitive conversations of this sort with clients starts with the therapist’s recognition that giving the clients feedback is necessary, along with a willingness to engage, even though it may be quite uncomfortable, and the outcome uncertain. The process of having difficult, sensitive conversations with clients is assisted by therapists being good listeners who can accurately summarize (or otherwise take into account) their client’s viewpoints as a foundation for expressing their own (likely differing) viewpoints. Additionally, the therapist has to make a decision about “if and when” to introduce the challenging conversation, seeking a middle ground between avoiding the conversation and rushing in impulsively. The process of having difficult conversations with clients is furthered by the therapist having a repertoire of statements that demonstrate good will and tact, in essence taking the “brutality” out of the “honesty,” and being able to enact “empathic confrontation.” Numerous clinical vignettes will be presented to demonstrate these skills in maximizing the chances that a difficult conversation with a client will have a constructive result.

Learning Objectives

1. Adopt a positive mindset that looks at a difficult conversation as an opportunity to improve a situation, and that takes pride in trying to prevent or repair an interpersonal relational strain.
2. Express opinions that have both validity and utility, while having the patience and awareness to refrain from expressing opinions that are lacking in these qualities.
3. Practice the skill of empathic confrontation.
4. Utilize well-attuned listening skills to assist in eliciting maximum collaboration in the midst of an otherwise tense or awkward conversation.

Training Modalities

Didactic presentation with slides.
Vignettes that illustrate the clinical methods being described.
Q & A.

Key References

Eubanks, C. F. (2022). Rupture repair. Cognitive and Behavioral Practice, 29(3), 554-559.

Newman, C.F. (1997). Maintaining professionalism in the face of emotional abuse from clients.
Cognitive and Behavioral Practice, 4(1), 1-29.

Newman, C.F. (2007). The therapeutic relationship in cognitive therapy with difficult-to-engage
clients. In P. Gilbert & R.L. Leahy (Eds.), The therapeutic relationship in the cognitive behavioral psychotherapies (pp.165-184). Routledge-Brunner.

Scott, A. M. (2022). Difficult conversations between healthcare providers and patients. In T.L.
Thompson and N. G. Harrington (Eds.), The Routledge handbook of health communication
(pp. 179-193). Routledge/Taylor & Francis Group.

Stone, D., Patton, B., & Heen, S. (1999). Difficult conversations: How to discuss what matters most.

Zilcha-Mano, S., & Barber, J. P. (2018). Facilitating the sense of feeling understood in patients with
maladaptive relationships. In O. Tishby and H. Wiseman (Eds.), Developing the therapeutic
relationship: Integrating case studies, research, and practice (pp. 105-131). American
Psychological Association.

About the presenter

Cory F. Newman, Ph.D. is Director of the Center for Cognitive Therapy, Professor of Psychology, in Psychiatry at the University of Pennsylvania Perelman School of Medicine (in Philadelphia, Pennsylvania, USA), and Adjunct Faculty at the Beck Institute for Cognitive Behavior Therapy. Prof. Newman did his postdoctoral training under the mentorship of Prof. Aaron T. Beck, and he is a Founding Fellow of the Academy of Cognitive and Behavioral Therapies. Prof. Newman has maintained a full clinical caseload and has extensive experience as a CBT supervisor, having supervised over 350 professionals-in-training, both at the University of Pennsylvania, and through the Beck Institute’s international training programs. Prof. Newman was recognized by the Association of Behavioral and Cognitive Therapy with the Outstanding Clinician Award for 2019. Prof. Newman is an international lecturer, having presented approximately 300 cognitive-behavioural therapy workshops and seminars at home in the U.S. as well as in twenty-three other countries. Prof. Newman is author of over 100 articles and chapters on cognitive-behavioural therapy for a wide range of disorders and clinical issues, and he has authored or co-authored six books, including two with Prof. Aaron T. Beck. On the side, Prof. Newman is an avid classical pianist.

Who should attend

This presentation is suitable for mental health practitioners across disciplines and substance use counsellors. Therapists who practice low-intensity CBT as well as standard-course CBT will benefit from this presentation, as will clinicians of all levels of experience.

Low Intensity clinical contact hours survey - BABCP Low Intensity Special Interest Group

Please click below if you are interested in contributing to the survey.


The BACP Low Intensity SIG are interested in the impact of clinical contact hours on Low Intensity/Wellbeing Practitioner wellbeing. This questionnaire contains six multi-choice questions and a free text box for you to share your experiences. The answers to these questions will help the BABCP SIG plan how to meet CPD topics and other developments within the SIG.  The SIG hope to produce a write up of the answers to this questionnaire to be shared with SIG members and to be used in training.

View Survey

This FREE conference is for Psychological Wellbeing Practitioners working in Talking Therapies for Anxiety and Depression services and is brought to you by Bespoke Mental Health in collaboration with the NHS England Talking Therapies National PWP Leads Network

bottom of page