Resistance In Therapy: How Can It Be Solved?

Resistance in therapy refers to the client’s attitudes, behaviors or cognitions that may delay or prevent therapeutic change. Usually, it is present the first steps of the evaluation phase, because that is where the client can begin to ask questions during treatment. In addition to this, they may refuse to speak sincerely or answer the therapist’s questions politely. Sometimes they may agree to answer the questions, but choose to share very little relevant information. Furthermore, they may also contradict the therapist, or not believe in them, especially if the therapist is younger than themselves.

Resistance in therapy often stems from inadequate interventions in the motivational stage, which is a crucial part of the therapeutic process. Many therapists choose to put all the responsibility on the client’s shoulders, referring to passivity and stubbornness. This, as you can imagine, is very detrimental to the whole process.

Resistance is the therapist’s business

Therapists can undoubtedly stop the therapeutic process if they believe that it is no longer profitable or appropriate for the client. However, assessing the client’s resistance as the reason why treatment is not appropriate, or assuming that it means that they do not want to get better, is completely wrong.

We can see this problem from the approach to motivational therapy. The motivational interview, for example, is based on adapting the therapeutic style to the various stages of change that the client will go through. Through this one can see that the client’s resistance is the therapist’s problem, not just the patient’s.

Therefore, the therapist should not immediately feel convinced that the client does not want to receive treatment or to improve in certain areas. Instead, it is better to reflect on what may have led the client to construct these barriers. Maybe the type of therapy is not the right one for the client.

To prevent this from developing further, it will be most appropriate to address the issue in the coming hour. Sincerity and authenticity are incredibly relevant when establishing a good therapeutic relationship. It will also help to find solutions to the resistance that may arise along the way.

Possible causes of resistance in therapy: The age of the therapist

Resistance in therapy is more common than you think. A very common occurrence related to such resistance is that the client questions the therapist’s professionalism. Only because they do not have gray hair, a full mustache, a face full of wrinkles or because they are not wearing a suit. What may start as a simple comment at the beginning of therapy may develop into resistance later. This is when the patient will begin to doubt his psychologist in every way. Maybe they think their therapist is not in possession of the right tools or the information they need to help them. Another common situation that can arise is that the client believes that the therapist is too young to understand the problems they have.

Also, it is important to note that age differences between therapists and clients, for the most part, are a problem at the beginning of the process (on the client’s side). The reason for this will often be that older clients will most likely think that a young therapist will not be able to relate to their problems. However, it is important to solve the problem right away. Using the right strategies can turn the expectations of a seemingly meaningless treatment into an opportunity to strengthen the therapeutic alliance.

Labrador proposed important strategies in his handbook Difficult Situations in Therapy  (2011). For example, to solve the patient’s problems and to ask them directly about the resistance they are signaling and what skills they fear the therapist does not have. In addition to this, he also advises clients to focus on the positive side of having a young therapist.

To counteract resistance in therapy with self-reporting

During the evaluation and the intervention itself, the chances that the client does not do his homework are great. Even the most basic ones, such as self-report, are very important. They are very necessary for a functional analysis, as well as the preparation of a plan for treatment.

For this reason, it is extremely necessary to get the client to bring their own notes to each class. Some strategies to achieve this include:

• Do not assume that your client has fully understood your explanation of how they self-report. You may not have been clear enough, or adapted your language to the client’s needs. Do not hesitate to explain what the task consists of. You can also ask the client questions to make sure they understand the explanation you gave.

• Emphasize the value of the assignment. Insist that despite the fact that self-reporting is useful for you as a therapist, it is also valuable for the client. In addition to that, it is important that you mention that not completing the task is contrary to what they want to achieve.
• Be sure to request self-reporting in an appropriate manner. Try to avoid saying things like “You must complete self-report and bring the notes to the next class”. Instead, it will be much more convenient to motivate them. Be sure to emphasize that for the best possible treatment, the work must go both ways.
• Make sure that the material and media used to conduct the self-report are adequate. The client’s level of education, as well as their sociocultural status, can vary greatly. It is normal to think that paper and pencil are a tool that anyone can use. However, this may not always be the case.

• Allow external help. For example, if the client tends to forget to fill out the self-report, they can send them a text message as a reminder. There are also things you can plan for together in the therapy class. Help them set up a series of alarms or write reminders they can hang in places that are easy to see. This will make it easier to keep in mind.

Conditional therapy as the last option

Resistance in therapy can go very far. There have been cases where clients still do not take self-reporting seriously after going through all the adjustments we have talked about. The worst thing in these cases is that there does not seem to be any problem causing this. When this happens, you can confront the patient as a last resort. Tell them that if they do not complete the self-report, the next therapy session will be canceled.

To condition the therapy, call the client the day before the appointment and ask if they have completed the self-report. If the answer is no, you can cancel the upcoming appointment. Remember that you should always consider this as a last resort. Self-reporting is crucial for clinical practice, there is no doubt about that. However, it will not be possible for any clients to postpone or discontinue treatment due to the problems they are experiencing. This is important to keep in mind.

The ultimate goal will always be to offer your client the most appropriate, effective and useful therapy according to their issues. If it is possible to change the type of task, or to eliminate it in favor of other means that can achieve the same goal, do not hesitate to find and implement them.