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Fundamentals of Resistance Management

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Don’t Read This Introduction, Skip to the Meat of the Article Instead



Okay, so now you are reading the introduction. Was it something I said? Or, are you one of those oppositional therapists that if I suggest you do this, you do that? If I had titled the introduction “Conquering Resistance,” would your urge to read have been the same, or would you have skipped to the next section? At least I got you reading a few lines! Oh no, now you’re feeling like you have been tricked into reading. You’re sure I am using reverse psychology and you hate it when someone does this to you—you’re a counselor, you’re supposed to know better. 

 

But, how else am I to figure out what to say to engage you? What an enigma. Oh no, now I fear I have a new problem. In my efforts to create some movement, I now fear I may have created more resistance through my trickery than you originally had. Now what do I say to get you to continue? I’m really trying hard here. What is it about people that makes it so difficult to get them to try something different in their lives that really could be for their own good? I really want to help you with your resistance problems, but what a pain the ass you’ve become. God knows it’s not my fault; I’m a good person. This is starting to feel like the position I have gotten into with my clients so many times. Yikes! You’re just like my clients, and you’re supposed to be a mental health professional. Yet here you sit with an internal struggle as to whether or not to read more. Worse yet, I, at the least, contributed to it. In my zeal to help, I fear I have created a mess. 

 

Can you feel the bind? Is a similar pattern of interaction too often a part of your treatment experience? Read on. Or, if you are resistant, don’t read on. 

 

By the way, this is how you get people to read the introduction.

 

Perhaps We Need a Change of Perspective

 

As a whole, the therapy business is quite confused regarding resistance, and rightfully so. The concept is defined differently by almost every new therapy that comes along. Freud got us started on this idea. I assume he must have encountered so much of it that he was compelled to try explain it—just not in a manner that put any of the responsibility for it on him. Freud defined resistance as clients’ attempts to avoid anxiety-provoking, psychologically threatening information—more specifically, his peculiar theories. Can you believe that people would resist the idea that their current marital problems are a result of never getting over their desire to have sex with their parents? Or that their current bad habits are the result of childhood potty training or what they experienced from their mother’s breast-feeding techniques? It’s easy to understand why his clients would resist these ideas. Yet, to Freud if clients were not buying what he was selling, the clients were being resistant. Freud put resistance on clients and for decades therapists never looked at their own contributions to the problem.

 

As a result, many therapeutic approaches that followed continued defining resistance as something in clients. The cognitive therapists view it as a result of cognitive distortions in clients’ minds (i.e., not the therapist’s mind). The behaviorists view it as a result of secondary gain from clients’ perceived reinforcers. The Gestalt therapists define it as conflicting parts within clients, not a result of our conflicts about how to proceed. 

 

Fortunately, as therapeutic knowledge grew, perspectives began to evolve. When the approaches of Milton Erickson and Carl Rogers gained attention, the focus shifted. These therapists were much more interested in exploring the world from clients’ perspectives. Erickson was fascinated with the use of language and both emphasized communication styles and the interaction with clients. Thus, we moved from the if-you’re-not-buying-what-I’m-selling-you’re-being-resistant perspective of Freud to the how-do-I-adapt-and-utilize-the-client’s-perspective approach. We stopped selling and became consumer advocates. Simultaneously, definitions of resistance started including therapists’ contributions. 

 

Although rarely credited with influencing our definitions of resistance, Rogers stated that, “ . . . resistance to counseling and to the counselor is not an inevitable part of psychotherapy, nor a desirable part, but it grows primarily out of poor techniques of handling the client’s expression of his problems and feelings . . . out of unwise attempts on the part of the counselor to short-cut the therapeutic process by bringing into discussion emotionalized attitudes which the client is not yet ready to face” (1951, p. 151). Rogers placed the problem rather squarely on therapists: your technique is flawed, you moved too quickly, you’ve gotten too far ahead of the client, and you’re not with the client. 

 

Similarly, Strong and Matross defined resistance as “ . . . psychological forces aroused in the client that restrain acceptance of influence (acceptance of the counselor’s suggestions) and are generated by the way the suggestions are stated and by the characteristics of the counselor stating them” (1973, p. 26). 

 

Such perspectives of resistance are broadly referred to as a social interaction model of resistance. Here, resistance is not viewed as something in clients; rather, as something cocreated in the interaction between clients and therapists. The social interactionists have taken resistance out of clients and, figuratively speaking, placed it squarely between clients and therapists. Motivational interviewing (MI) founders Miller and Rollnick accentuate this point when they remind us that, “Resistance is something that occurs only within the context of a relationship or a system” (2002, p. 45). Thus, we, as therapists, are a necessary component of the resistance equation. 

 

I am fond of explaining this perspective by pointing out that whenever two people are interacting, there is an exchange of influence. This is especially true of therapeutic conversations that inevitably include the push-pull struggles of clients as they work to avoid the difficulties that change requires. Nonetheless, you are influencing clients and clients are influencing you. There is always an exchange of influence.

 

Out of a desire to add greater practicality to the social interaction model of resistance, I teach that, “Resistance is created by the therapist when the method of delivering influence is mismatched with the client’s current propensity to accept the manner in which the influence is delivered” (Mitchell, 2010, p. 10). If you try to influence clients in a manner that they are not willing to embrace, resistance is inevitable. For example, if your level of rapport is such that all clients are willing to accept from you is an indirect suggestion and you decide to approach them with confrontation regarding their inconsistencies and hypocrisies, your method of delivering influence will be out of sync with what these clients will accept. Resistance is the result. 

 

Such notions would have likely aroused resistance in Freud. He might turn in his grave if his theory had to play “second fiddle” to clients’ mental readiness to accept his interpretations. “You mean that what I said spawned resistance? It’s my characteristics and not theirs that are the problem? It can’t be me; I’m a caring person. Isn’t therapy hard enough as it is without the added responsibility of making resistance my problem?” Well, it’s not all your fault. 

 

Moursund (1985) noted that there are two types of resistance. The first stems from the internal struggles of clients. The second comes from the therapist’s mode of influencing. The key is to recognize what we are doing that may be promoting resistance and let our clients’ struggles be theirs. The good news is you can do something about your contributions to resistance a lot easier than you can do something about clients’. Further, this is a circular relationship, and when we tend to our contributions to resistance creation, we have maximized the potential for our efforts to pay off. 

 

I consider the above paradigm shift a major turning point in counseling theory and a significant step forward for therapy and therapists. We now understand that there are two sides to this resistance coin and to manage it effectively we had better look at therapist contributions. It’s just not that complicated. Clients say something; you say something. What you say either decreased resistance, kept things about the same or increased resistance. We’ll take either of the first two. If your words resulted in the third outcome, it may not be that bad; however, you had better be on your toes. Your words have created a critical juncture that requires careful management.

 

From this perspective it becomes apparent that the management of resistance is not about learning the latest treatment approach. It’s about learning to meticulously negotiate the therapeutic conversation at those critical junctures when clients are having difficulty embracing what is occurring or what was just said. At these points, clients are sending signals that we often fail to pick up and respond to appropriately. Fail to recognize and effectively respond at these junctures and it doesn’t matter if you’re doing cognitive therapy, Gestalt therapy, NLP, kiss the sky or zip-a-dee-doo-dah therapy, it won’t work. 

 

From this theoretical foundation I would like to offer some fundamental approaches and techniques regarding our interactions with clients that move toward a practical application of these ideas in the management of resistance. 

 

Respond Out of the Ordinary

 

Overall, the therapist’s job is to strive to disrupt the clients’ common patterns of thinking, feeling, and behaving. To this end therapists should work hard to respond in an unexpected manner to clients and avoid socially typical responses. Clients who have talked to non-mental-health professionals (and some professionals) have likely heard the standard how-to-fix-your-situation advice commonly dispensed. Most frequently, this advice was not well received. If socially typical responses were effective, we would not need trained therapists—clients could talk to anyone and get better! 

 

From a social interaction perspective, typical responses beget typical reactions, and typical reactions keep clients stuck in their situation. Resistance is fueled by the commonplace. This is one reason why the brief therapists argue that problems are maintained by attempted solutions that are ineffective (Walter & Peller, 1992). Our typical responses and reactions are likely to be incorporated into established, ineffective, attempted solutions. The more we respond in a typical manner, the more likely we are to become part of the system and patterns that maintain resistance and problems. 

 

In order to avoid the pitfalls of typical responses and the resistance that follows, you must consistently strive to avoid the commonplace—you must avoid typical verbal and nonverbal responses. In doing this, you surprise clients, confound their anticipation of your response, and you begin disrupting the patterns that are inherent to their thinking and problems. 

 

Yet, the unexpected does not have to be complex. The better techniques taught in training programs are unexpected by most clients. The empathic response, the avoidance of questions with preordained answers, the lack of criticism, the nonjudgmental posture, all possess these qualities. Perhaps one of the most basic ways to respond in an unexpected manner is to deliver a Rogerian empathic response when the urge to argue or counter clients’ positions is felt. By displaying empathy, you respect and honor the resistance and, whenever you move to a position of understanding with clients, there is nothing for clients to resist. Keep in mind that regardless of how illogical, bizarre or foolish clients’ positions are, there is a reason in their world for saying what they said. Do the unexpected: respect and learn the reasoning behind their comments. Once mutual understanding is established, clients are more willing to consider alternative approaches.

 

Maintain Goal Alignment

 

One of most fundamental ways therapists promote resistance is by failing to establish mutually agreed-upon goals with clients. The key word here is “mutually.” Clients should be active participants in goal establishment, particularly resistant clients. People do not resist what they want; they resist what they do not want and what is imposed upon them. If we start by first seeking what clients want, we build a foundation for mutually agreed-upon goals. When the goals of therapists are not aligned with those of clients, resistance is inevitable.

 

The significance of mutually agreed upon goals was expounded by Asay and Lambert (1999) who reported that agreement between clients and therapists on the goals of therapy was foundational to the therapeutic alliance. This agreement appeared at two levels. First, there was agreement on the overall goal of therapy. That is, what would constitute a successful outcome? In addition, there was what was referred to as “task” agreement. This is best characterized as agreement between clients and therapists on the momentary goal within the session. More precisely, do clients and therapists agree that what is being discussed in the session at the moment is important to a successful outcome? Thus, the critical question therapists should consider is: Do clients perceive that what is being discussed at the moment is something that is important to their perception of a successful outcome? Therapeutic interactions where clients do not view the issues addressed as important are likely to produce resistance.

 

Manage the “Yes, but” Response by Avoiding the Expert Position

 

One of the most common critical junctures in therapy occurs when clients deliver a “Yes, but” response to therapists. Almost inevitably, the therapeutic context from which the “Yes, but” response develops goes something like this. Clients tell their story regarding a host of problems. In your discussions, you learn that they are very narrow in their choice of options. Because there are so many changes that may bring improvement, possible solutions appear abundant from your perspective. As you become aware of the myriad of possible solutions, you become more certain that your ideas can help. Because of your certainty, you begin talking more and more as an expert regarding the problem at hand and possible solutions. 

 

But here’s the catch. The more of an expert you become, the more you provide clients something definitive to resist against. “Yes, but” responses most commonly follow advice and suggestions, or leading questions that are intended to convey alternative behaviors clients might try. Such responses almost universally occur when you have moved into the position of expert regarding clients’ problems. Unfortunately, your expertise is not welcomed at this juncture and, thus, is not working therapeutically. You are delivering influence in a manner clients are not willing to accept—from an expert position. How do you know? You know this because clients are pushing back through the not so subtle “Yes, but.” As the brief therapists are fond of telling us, the message is in the answer received. And “Yes, but” answers are a sure sign you have moved to a position that is not working—in this instance, the expert position. 

 

So, what do you do when you are “yes-butted”? 

 

Reverse the paradox. Present yourself as less knowledgeable, uncertain, and puzzled. In short, dumb down and honor and respect clients’ positions with great understanding and acceptance of their internal struggle regarding the issue. When done well, clients are offered nothing to resist against (and they have no awareness that this is precisely what you are trying to accomplish). 

 

It should also be considered that the more of an expert you become, the less psychological freedom clients have to explore possibilities on their own. Thus, your expertise results in clients losing the sense of freedom that is necessary to embrace change willingly. When clients’ experience is that they must defend their position and actions, they narrow their focus. Clients are freer to accept new ideas that arise when they have not been moved to a position of defending. You can take this so far as to completely surrender to clients’ extreme position. 

 

Moving to a position of naiveté and unknowing is sometimes difficult because you really do think your ideas could help. The expert trap is often fueled by our desire to help in combination with our frustration with clients’ refusal to try alternative actions. However, it is not how much you know that matters. It is not how much you want to help that matters. What matters is what is occurring in the relationship between you and your clients at any particular moment. If clients are rejecting your suggestions with “Yes, but” responses, they are signaling that they are not buying what you are selling. It’s not working. When this occurs, stop selling and return to gathering information about what clients might accept. Remember, if what you are doing is not working, change! This is a classic example of a mismatch between our method of delivering influence and clients’ current propensity to accept the method by which the influence is delivered.

 

Alternatively, if clients are accepting your ideas and suggestions, and are willing to run with them, don’t resist their openness by holding back on what you have to offer. To manage resistance the rule to keep in mind is this: The more resistant the clients, the less you know; the more motivated the clients, the more you know. Ironically, this is the opposite of what often transpires in therapeutic interactions.  

 

Slow Down to Go Faster

 

When most people and many therapists encounter resistance, too often they unconsciously increase the pace in an effort to break through the current struggle. This is a mistake. Instead, slow the pace. Increase the space between your words and increase your use of silence. This results in a unique therapeutic environment. First, it creates pressure to fill the space and provides time to think and feel—two things resistant clients avoid (Gerber, 2003). Keep in mind that the real therapeutic work is done in the time between the words, during the quiet moments when new perspectives are examined and embraced. Thus, to diminish resistance you should increase the space between the words to allow more time for the inner work to be done. 

 

Another benefit of slowing the pace is that it keeps the therapeutic tension within clients and does not place the therapeutic tension between clients and therapists (Mitchell, 2010). The therapeutic tension should not be between therapists and clients as if therapists are trying to pull their clients along or coerce new perspectives. The therapeutic tension should be within clients as they face their inner struggles. Increasing the pace places the therapeutic tension between therapists and clients. 

 

Remember the last time you were in an argument. The faster and louder you presented your points, the greater the tension between you and the other person. When you slow the pace, you are able to keep the therapeutic tension within clients where it belongs. Tension between clients and therapists increases resistance. The issues presented are not your problem and clients’ internal tension to resolve their struggles should remain within them. Why do you want to shoulder this tension? There is an art to keeping the therapeutic tension in clients and not between clients and therapists. When resistance is encountered, the first step is to simply slow down. 

 

Please note, however, that slowing the pace does not mean to become passive and slow the therapeutic work. To the contrary, slowing the pace intensifies the therapeutic work. You slow the pace in order to focus on and magnify clients’ internal struggles and search for answers. A pace that is too quick does not allow time for thorough processing. Resistance is overcome with an emphasis on direction, not speed. 

 

 

Here’s a therapeutic tip: Sometimes clients become nervous and reluctant as they approach difficult material. In such instances, you might directly instruct clients to slow their pace by making statements such as, “In order for you to help me fully understand your world, let us go over this in slow motion” (Mitchell, 2010, p. 40). 

 

Getting the Correct Focus

 

The more I study resistance the more I realize that most of us are working too hard at the wrong things. Primarily, we enter therapy with an agenda to accomplish some change within the client rather than to simply understand and clarify. I approached therapy this way for years. I went to numerous seminars (I still do) to learn the latest techniques that were promoted as the new revolution in creating therapeutic movement. Yet, resistance remained. After studying resistance ardently for over twenty years I gradually made a right-turn in my approach. Now, I enter sessions not trying to accomplish anything other than not creating more of what I formerly labeled as “resistance.” I carefully monitor client reactions and constantly gauge the level of acceptance. When I detect clients’ reluctance to accept my last statement I immediately process the momentary hesitancy that emerges. I let go of anything that is not working and focus on processing. I have no problem going east to reach west and, to my gratification and enjoyment, I get there more often.

 

If all of this rings true for you, you are showing your years of experience. Veteran therapists almost universally reach these conclusions. If these adjustments strike you as far-reaching and you find this degree of change a bit difficult to swallow, check your resistance. When I find myself slipping back into my old ways, I keep in mind a great truth noted by and adapted from King (1992): All a client has to do to thwart your efforts is nothing. With this is mind, I don’t work so hard.  

 

 

 

 

 

References

 

Asay, T. P., & Lambert, M. J. (1999). The empirical case for the common factors in therapy: Quantitative findings. In M. A. Hubble, B. L. Duncan, & S. D. Miller, (Eds.). The heart and soul of change: What works in therapy (pp. 23–55). Washington, DC: American Psychological Association.
Gerber, S. K. (2003). Responsive therapy: A systematic approach to counseling skills (2nd ed.). New York, NY: Routledge.
King, S. M. (1992). Therapeutic utilization of client resistance. Individual Psychology, 48(2), 165–74.
Miller, W. R., and Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York, NY: The Guilford Press.
Mitchell, C. W. (2010). Effective techniques for dealing with highly resistant clients (2nd ed.). Johnson City, TN: Clifton Mitchell Publishing.
Moursund, J. (1985). The process of counseling and therapy. Hoboken, NJ: Prentice Hall. 
Rogers, C. R. (1951). Client-centered therapy: Its current practice, implications, and theory. Boston, MA: Houghton Mifflin.
Strong, S. R., & Matross, R. P. (1973). Change process in counseling and psychotherapy. Journal of Counseling Psychology, 20(1), 25–37.
Walter, J. L., & Peller, J. E. (1992). Becoming solution-focused in brief therapy. New York, NY: Brunner/Mazel.
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