Resistance in Therapy: What to Do about It

August 3, 2019
A great part of therapeutic change has to do with the client doing their homework. However, when they decide not to, the therapist often assumes they simply don't want to change. In this article, we'll be talking about resistance in therapy and how to address it.

Resistance in therapy refers to patient attitudes, behaviors, or cognitions that may delay or avoid therapeutic change. Usually, it’s present during the first stages of evaluation because that’s where the client may begin to question the treatment. In addition to this, they may refuse to speak sincerely or answer the therapist’s questions politely. Sometimes, they may agree to answer them but choose to share very little information. Something else that can happen is that they may contradict the therapist or not believe in them, especially if they’re younger than them.

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

Resistance Is the Therapist’s Business

Undoubtedly, therapists can put a stop to the therapeutic process if they don’t think it’s profitable for the client anymore. However, considering the client’s resistance the reason why they can’t be treated or assuming they don’t want to get better because of it is completely wrong.

We can see this issue from the approach of motivational therapy. For example, the motivational interview is based on adjusting the therapeutic style to the different stages of change that the client undergoes. Through this, one can tell that the client’s resistance is the therapist’s problem and not the first’s.

Therefore, the therapist shouldn’t immediately feel convinced that the client doesn’t want to undergo treatment and or improve in any way. Instead, it’s better to reflect on what could’ve made the patient set those barriers. Maybe the type of therapy isn’t appropriate.

In order to avoid this going further, the most appropriate thing would be to expose the problem in the upcoming session. Sincerity and genuineness are incredibly relevant when establishing a good therapeutic relationship and finding solutions to the resistances that may come up along the way.

A woman facing her therapist during a session.

Possible Reason for Resistance in Therapy: The Therapist’s Age

Resistance in therapy is more common than you think. One very common resistance-filled occurrence is that the patient questions the therapist’s professionalism for not having gray hair, a lush mustache, a face full of wrinkles, or not wearing a suit. What may start as a simple comment at the beginning of the treatment can become a resistance later on. That’s when the patient will begin to doubt their psychologist in every way. Perhaps they think their therapist doesn’t have the right tools or information in order to help them. Another common circumstance is that the patient may think that the therapist is way too young to understand their problem.

Moreover, it’s important to note that age gaps between therapists and clients are, most of the time, an issue at the beginning (on the client’s end). The reason for this is that older patients are most likely going to believe a young therapist won’t be able to relate to their issues. However, it’s important to address the problem right away. and using the correct strategies can turn expectations of apparently pointless treatment into an opportunity to strengthen the therapeutic alliance.

Labrador, in his Difficult Situations in Therapy manual (2011), proposed important strategies. For example, clearing out the patient’s problems and asking them about their resistances and the skills that they don’t think they have. In addition to this, he also advises clients to focus on the good side of having a young therapist.

Beating Resistance in Therapy with Self-Records

During the evaluation and the intervention itself, the chances of the client not doing their homework are high. Even the most basic ones, such as carrying out self-records are very significant since they’re necessary for the functional analysis and elaboration of a treatment plan.

For this reason, it’s of extreme importance to get the client to bring their self-records every week. Some strategies to achieve it are:

  • Don’t assume that your patient fully understood your explanation of how to make a self-record. You may not have been clear or perhaps your language didn’t go well with the needs of the individual. Therefore, don’t hesitate to reexplain what the task consists of.
  • Emphasize the value of the task. Insist on the fact that, despite self-records being useful to you as a therapist, they’re valuable to them as well. In addition to that, it’s important that you mentioned that not doing them goes against what they want to achieve.
  • Make sure to ask for self-records in an appropriate way. Try not to say “You have to make a self-record and bring it to the next session”. Instead, it’d be much more convenient to motivate them and emphasize that the work goes both ways.
  • Make sure that the material used to make the self-records is adequate. The educational and sociocultural levels of your clients can be very different. It’s normal to think that a pencil and paper are tools that everyone knows how to use. However, that may not always be the case.

Now, some people aren’t able to take a piece of paper with them everywhere they go. Others may not be too fond of writing, which could give them anxiety and therefore not want to do it. On the other hand, others may be so forgetful that they don’t even remember to write down anything during the day, so when they start writing at night, they’ve forgotten everything.

For this reason, it’s important that you keep an open mind and remain flexible. Give them the opportunity to make the self-records in a different way. We all know technological advances have been on the rise for a while now. For that reason, don’t be afraid to encourage your clients to write them on their smartphones. They could also record them or use apps such as Mentalcheck or Self-Monitoring. They can be very useful to help the therapy move from incomplete self-records to outstanding evaluation sessions.

  • Allow external aid. For example, if the patient forgets to fill in their self-records, send them a text reminding them. There are also things they can do during the therapy session. Help them establish a series of alarms or make reminders they can place in easily-seen spots so they never forget.
A therapist and his client discussing a topic.

Condition Therapy as the Last Option

Resistance in therapy can go a very long way. There have been occasions where the patient still doesn’t bring the self-records to therapy even after having carried out all these adjustments. And the worst part is that there doesn’t seem to be any issue causing it. When this happens, as a last resort, you can confront the patient. Tell them that if they don’t do their self-records, there won’t be a therapy session the following week.

To condition the therapy, call the patient the day before the appointment and ask if they completed their self-records. If the answer is negative, cancel the session for the following day and so on. Remember that you should always consider this as a last resort. Self-records are essential for clinical practice, there’s no doubt about that. However, many patients can’t postpone treatment due to the nature of their difficulties, so keep that in mind.

The ultimate goal will always be to offer the client the most appropriate, effective, and useful therapy according to their issue. If there’s the possibility of changing the type of task or eliminating it and finding other means to reach the goal, don’t hesitate to look for them.

  • Labrador, F. (2011). Situaciones difíciles en terapia. Madrid: Pirámide.