Resistance in therapy
Anyone who has ever performed therapy such as psychotherapy has run into resistance. When you have a resistant client, you often leave the session feeling like you just spent the therapeutic hour banging your head into a wall. Put simply, it can be highly stressful and frustrating. Let’s explore resistance and what you can do when you run into it.
What is Resistance?
The idea of resistance in therapy is complicated. It was originally created as a psychoanalytic concept by Sigmund Freud, who believed it was an unconscious opposition to revealing memories in psychoanalysis (Psychoanalytic Terms & Concepts Defined, n.d.). In more general terms, resistance is thought of as anything that stops therapeutic change. It has traditionally been thought of as an unwillingness (either consciously or unconsciously) of the client to grow. More current definitions, however, posit that resistance is not just the fault of the client, but is a product of the therapeutic relationship (Shallcross, 2010). If the client is exhibiting resistance, it is the job of the therapist to assist in reducing it as much as it is the client’s responsibility to change their behavior. Whatever your definition, one thing is sure, resistance is negatively related to treatment success (Beutler, Moleiro & Talebi, 2002).
Common Signs of Resistance in Therapy
Not Talking
Every therapist fears the silent session. Although complete silence is a rare occurrence, it is not unusual to find a client that gives short answers and has difficulty opening up.
Small Talk
Some clients will talk extensively, but it is about their weekly activities and other inconsequential information. When guided to talk about thoughts and feelings, they tend to avoid and distract.
No Homework/Don’t Use Suggestions
In many forms of psychotherapy it is popular to give homework. A telltale sign of resistance is a client who does not complete their homework or follow up on your suggestions. In order for therapy to be successful, a client needs to at least think about what was discussed in session in their daily life. Not doing homework is a sign they are forgetting about the session as soon as it is over.
Canceling Sessions
Almost all clients cancel a session from time to time, but when a pattern develops it is a worrisome sign. Someone who is motivated to change will make attending sessions a priority.
Spinning Your Wheels
When you feel like a client is not making progress, it is a sign of resistance. They may come in regularly but they keep having the same experiences and don’t show improvement.
You Are Trying Harder Than Your Client
When you feel like a client is not much making much progress it is natural to feel frustrated and a bit guilty. You want to make sure you are providing them with the best therapy possible so you spend extra time on their case, planning new strategies and interventions. Unfortunately, the client does not seem to be making much effort other than showing up for treatment. Therapy is a two-way street. If you are working harder than your client, it is probably not going anywhere.
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How To Address Resistance in Therapy?
Go With The Resistance: Paradoxical Intervention
One of the most effective methods to deal with resistant clients is to use a paradoxical intervention. When you use a paradoxical approach, you don’t try to fight the resistance, you actually support it. For example, say a client is having trouble sleeping and you have recommended some changes in their sleep hygiene. You find out they have not changed any of their behavior and are still complaining of sleep. Instead of chastising them for their non-compliance, you tell your client that they should not change any behavior and just keep on taking the same approach to bedtime. Because certain clients are oppositional in nature, it is hoped they will defy your recommendations and actually do the opposite behavior (which is what you wanted them to do in the first place). Numerous research studies have supported the use of paradoxical interventions for those with highly resistant behavior. (Beutler, Moleiro & Talebi, 2002).
Confront the Resistance, But Don’t Fight It.
Actively fighting resistance is an approach that rarely works in therapy (Beutler, Moleiro & Talebi, 2002). Instead, this strategy involves noting the resistance so you can explore what is causing it. Pointing out that a client appears to be exhibiting some resistance allows you to process it and move beyond it (Austin & Johnson, 2017). For example, a therapist might simply remark that they noticed a client did not do their homework. An open-ended question or non-judgmental statement can produce a discussion that may help to break down walls. Ultimately, you want to address the resistance and help the client feel like you are joining them rather than criticizing their actions.
Establish Goals
It is much harder for a client to exhibit resistance when you have set concrete goals with them (Mitchell, 2006). Take the time early in treatment (and on an ongoing basis) to have a discussion of what they want to accomplish. Although a structured treatment plan may not be required, it does help to write the goals down and give your client a copy. When you have established goals, you can easily revisit them, especially when you feel therapy may have veered off course due to resistance. This will remind the client what they are working towards and spur internal motivation, helping break through the blockades of change.
Work on Client-Therapist Rapport
There is no bigger resistance buster then having a good relationship with a client (Shallcross, 2010). When you have a positive rapport, the client will be more engaged and try harder to make a change. A strong therapeutic relationship also allows clients to be honest with the therapist in case they do not agree or believe in a suggested intervention. Your relationship with a client should be a focus of the first session and be a part of every session after. It is important to prioritize your relationship, even if it means putting a planned intervention on the back-burner.
Dealing with resistance in therapy can be exasperating. Despite the difficulty, it often shows you what areas need to be addressed. Resistance is a normal part of the therapeutic process and therapists should be prepared to deal with it. By establishing a positive relationship, using paradoxical interventions, and working toward mutually created goals, you can tear down the walls of resistance and help your client make the progress they desire.
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Sources
Austin, S. B., & Johnson, B. N. (2017). Addressing and managing resistance with internalizing clients. Retrieved from: https://www.societyforpsychotherapy.org/addressing-resistance
Beutler, L.E., Moleiro, C. & Talebi, H. (2002) Resistance in Psychotherapy: What Conclusions Are Supported by Research. Journal of Clinical Psychology, 58, 207–217.
Burns, D. (2017). When Helping Doesn't Help: Why some clients may not want to change. Retrieved from: Society for the Advancement of Psychotherapy
Mitchell, C. (2006). Resistant clients: we've all had them; here's how to help them! Retrieved from: Addressing and Managing Resistance with Internalizing Clients.
Psychoanalytic terms & concepts defined (n.d.). Retrieved from: http://www.apsa.org/content/psychoanalytic-terms-concepts-defined.
Shallcross, L. (2010). Managing resistant clients. Retrieved from: https://ct.counseling.org/2010/02/managing-resistant-clients
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