For clinicians

The Settled Client Who Should Worry You

By Dr. Donetta D. Quinones, PhD, LMHC, LPC  ·  5 min read

A man of fifty-two, referred by his physician for insomnia. Asked about his father, he gives you four sentences and a shrug. He left. I was nine. I got over it.

You ask how long that took. About a year, I’d say. Then I was fine.

There are two readings available. One is that he is fine — people do recover, and not every absence is a wound. The other is that he is describing the third phase of a sequence and mistaking it for the end of one.

Distinguishing them is one of the more consequential judgements in this work, and getting it wrong in the reassuring direction is the more common error.

The sequence

Bowlby and colleagues described a three-phase response in young children separated from an attachment figure, and it has held up well enough to be worth teaching directly.

• Protest. Searching, calling, distress, anger. The system is doing its job: making noise until someone comes.

• Despair. The noise stops. Not because the need is met but because it has not been, repeatedly. This phase looks like sadness and is often mistaken for the whole picture.

• Detachment. The child re-engages with the world, appears settled, and is markedly less interested in the attachment figure when they do return. To an observer, this is recovery.

It is not recovery. It is the deactivation of a system that produced nothing. And in adults, the same three shapes are visible in how a person handles needing someone now.

How the third phase presents at forty-two

Not as flatness in general. These clients are frequently warm, competent, funny, and well liked. The deactivation is specific: it appears where dependence would be required.

• They can describe significant early absences without affect, and they notice you noticing, and they find that slightly amusing.

• They report the relationship as good and the sex as fine and cannot say what their partner is preoccupied with this month.

• They are extremely reliable and almost never ask for anything.

• They regard their own needs as logistical problems with solutions rather than as things that involve another person.

• Their partner, if you have them in the room, is the one who looks tired.

The reason this presentation should worry you is not that these clients are fragile. It is that they are the least likely to present, the most likely to be discharged early as improved, and the most likely to be sitting across from a partner who is quietly starving.

Telling settled from shut down

Three probes, none of which requires you to have decided in advance.

8. Ask about the body, not the meaning. When you say that, what happens in your chest? A genuinely settled client reports nothing much and moves on. A deactivated one frequently reports something and is surprised by it.

9. Ask what fine looked like. The client above said he was fine within a year. Asked to describe it, he described — without appearing to notice what he was describing — a boy who stopped mentioning his father entirely, stopped asking his mother when he was coming, stopped going to the window when a car slowed on the street, and who was praised at every stage for being the easy one.

10. Ask who noticed. Who in that house knew you were having a hard time? A settled history usually contains someone. A deactivated one frequently contains nobody, and the client has never thought about it as an absence because it was the water.

And listen for the sentence I have heard in some form several hundred times: my mother always said I handled it better than my brother. The praise for coping is often the exact mechanism by which the coping became permanent.

What not to do with it

Do not tell them they are not fine. You will be arguing with a defence that has been load-bearing for four decades, and you will lose, and you will have taught them that this is a place where their account of themselves is disputed.

Do not go after the affect. Trying to produce feeling in a deactivated client is the most common way to confirm for them that therapy is an intrusive activity conducted by people who need them to be sadder than they are.

What works better is description without conclusion. You lay out what they told you, in their own words, and stop.

“You stopped asking when he was coming. You stopped going to the window. And people told you that you were handling it well.” … “I don’t know what that was. But it was something.”

And the couples implication

In conjoint work this presentation is usually one half of a matched pair. A deactivated partner and an activated one, each confirming the other’s worst expectation: his composure proves to her that nobody is really there, her escalation proves to him that needing people is where things go wrong.

Which means the intervention is not to get him to feel more or her to feel less. It is to make visible to both that his flatness is not indifference and her volume is not instability — both are old solutions, arriving on time, aimed at people who were not there when they were built.

What moves it

Not confrontation, and not affect-chasing. What tends to work with a deactivated client is a slow accumulation of description that they cannot quite dismiss, offered without a conclusion attached.

• Reflect the behaviour, not the feeling. You stopped going to the window. A deactivated client will argue with an attributed feeling and cannot argue with their own reported behaviour.

• Use their own sentence back. Whatever they said in passing — I handled it better than my brother — is worth returning to three sessions later, verbatim. It carries more weight in their words than in yours.

• Ask what it cost, not what it felt like. Cost is a category they have access to. Feeling frequently is not, yet.

• Let silences run. These are clients who have learned that adults fill silences with reassurance. A silence you do not fill is new information.

The risk of getting this wrong in the other direction

One caution, because this article could be read as an instruction to disbelieve every calm client.

Some people are genuinely fine about a significant absence. Resilience is common, protective factors are real and under-asked-about, and a clinician who treats settledness as always suspect will spend a year excavating something that was not there — while the client learns that this is a place where their own account of themselves is not credited.

The three probes above are diagnostic precisely because they are cheap and non-committal. Ask them, take the answers at face value, and let the picture accumulate. If nothing accumulates over several sessions, the client was telling you the truth, and that is a finding rather than a failure.

From the book: “Who Are You Fighting With?” gives protest, despair and detachment a full chapter, with the adult forms laid out, the three probes above, and the reason a settled client is sometimes the most worrying one in a caseload.

Approx. 1147 words in the body above.