The difficult patient

I believe 'difficult' is just another name for unconscious resistance when it comes to therapeutic work. Instead of perceiving the client as 'difficult' I reframe into resistance and work at reducing the resistance and encouraging the client to acknowledge how it manifests.
The client is sitting there preparing to release some long held beliefs and strategies they have used for life often for decades, there is no surprise that they can become tense, uncomfortable and resistant.
Once this is gently communicated it is time to focus on the goals the client has in mind and spend a little time witnessing how fear and resistance have held the client back.
With this knowledge of their own strategies for sabotage and confidence that they are working with someone who understands them I have always found it easy to move forward having benefited from the experience.

I am Julia Rhodes of West London Colonics.
Difficult clients are those I learn most from.
Not that I like it at the time. But just to say, they are often a mirror.

The most important thing with any client is to listen to them. And listen hard. The 'difficult' client is often fearful which is why they put up a defence. It is the training and professionalism of the therapist to find the end of the thread to help start pulling that defence down with respect and understanding.
Mirror their actions and use their speech patterns to gain confidence. Use eye contact and don't forget to smile!

I find coaching manuals help here ~ you can figure out what the client's representation system is and use wording that matches it. For example, if they are more of a visual person (you can tell this if they say things like "I see what you mean" or mainly talk in pictures), and you talk more from a kinesthetic perspective ("I know what you mean"), then it may be difficult for them to see things from your perspective. Figure out how they perceive the world and talk in line with that. You also have the "rapport ruiner" who disagrees with everything you say, so you have to change the way you say things and include 3 negatives in each sentence ("no, you wouldn't want to do that then, would you not")