Dealing with client resistance is a normal part of practicing therapy. If you have been in the field for any length of time, I’m sure you have experienced this.
Today I want to explore the question of how to navigate client resistance in therapy. To do that, I want to consider a few different therapeutic approaches.
I’m not an expert, per se, in any of the therapeutic approaches I’m going to touch on. But, I do know a thing or two about these approaches. These are approaches that I’ve received some amount of specialized training in, and I use in my practice on a weekly basis.
So hopefully my thoughts feel like informed representations that will help you navigate dealing with client resistance.
What Is Client Resistance?
Let’s begin by defining what client resistance is. One article I found explained client resistance as, “anything the patient does to impede the progress of psychotherapy.” (Leahy, 2001)
Basically, in my mind, it’s any time a client rejects or refuses suggestions from their therapist.
It’s a good idea for us to take a benefit-of-the-doubt approach towards our client. Rather than take it personally, or blame our client and see them negatively.
All of that said, when a client responds with what looks like resistance in therapy it can feel really tough as the therapist to know what to do. You’re trying to lead them in the direction you thought they should go, and they don’t want to go there. So, you feel like your hands are tied behind your back.
But, I’d like to propose some other approaches that help navigate client resistance.
There are so many wonderful therapeutic approaches out there! There’s no way I’m going to cover them all in this article. The ones I will cover today are approaches that I’m personally familiar enough with to feel like I can present them here.
I hope that I can equip you with some tools in your tool belt to help if you are dealing with client resistance.
Approach #1: Cognitive Behavioral Therapy (CBT)
The first approach we’re going to explore when dealing with client resistance is cognitive behavioral therapy (CBT).
The core concept of CBT is: our thoughts, feelings and behaviors all influence each other. So, in CBT, the hope is to target our thoughts, and sometimes our behaviors in order to allow our whole self to move towards an outcome that we desire.
The APA has a series of books called The Essentials Of Deliberate Practice. And, in the book, Deliberate Practice In Cognitive Behavioral Therapy, they have an entire exercise for how to navigate resistance with your therapy clients.
I find it interesting that it leans pretty heavily on motivational interviewing strategies to help clients find their own intrinsic motivators to move forward.
So, with this approach, whenever a client presents some amount of resistance then the idea is to:
- Take a step back from CBT agenda
- Validate the client’s experience
- Identify client’s internal motivators for change
An example of what this might sound like in practice:
Client: “I’ll be honest, I didn’t do last week’s homework. I just didn’t see how anything in there was actually going to make a difference.”
Therapist: “I’m glad you told me. Maybe we can take a step back from our plans for a moment (step #1). I definitely don’t want you to feel like you’re just doing a task because I asked you to when you don’t think it’s going to help (step #2). So, I’m curious to revisit what you think you’re looking for from our sessions (step #3) and where you’d like me to support you. That way we can make sure we’re on the same page and I can really help in the ways you need.”
Approach #2: Dialectical Behavioral Therapy (DBT)
The next approach to help when dealing with client resistance is Dialectical Behavioral Therapy (DBT).
DBT focuses on striking a balance of validating and accepting a client’s current challenges while also embracing change by building up skills that help clients regulate their emotions.
When a client is resistant to something in therapy a DBT therapist will:
- Ask the question: “What is it that’s pushing my client to avoid doing things?”
- Then, according to Marsha Linehan, the developer of DBT, it’s really important to act as a “salesperson” in these moments.
- Finally, validate your client’s pain.
- Essentially, therapists are advocating for how effective these treatments are while simultaneously validating the client’s pain. Both the pain they are experiencing now and also the amount of pain they will need to go through in order to move forward.
Using DBT with a resistant client might sound like:
Client: “Oh, I’m definitely not doing that.”
Therapist: “I wonder what you’re concerned that will be like for you if you did it?” (step #1)
Client: “If I practice that skill, it’s just going to remind me of my grief and I’m going to fall into a deep pit of sadness that I’ll never get out of. What’s the point of that? Aren’t I trying to get out of my sadness?”
Therapist: “I understand how it can feel backwards to run back into the burning building of your emotions when you’re just trying to get to safety. The creator of DBT has this imagery that many of my clients find useful to hear. (step #2) It’s like you’re in hell right now, and you keep trying to get out by climbing up a ladder. But the ladder is made of metal. So every time you climb up a little bit, you burn yourself, so you drop back down into hell. It is an option to hang out in the misery you’re in, but the only way out of hell is to get burned while climbing up that ladder. So even though this exercise is extremely painful and you’re already dealing with an excruciating amount of pain, it’s designed to help you move through and out of the pain you’re in. (step #3)”
Approach #3: Internal Family Systems (IFS)
The next approach for dealing with client resistance is IFS, or Internal Family Systems Therapy.
IFS sees each person as having multiple inner parts led by their core self. Internal Family Systems sees that some of these inner parts may have wounds that require healing. The goal of IFS is to help people access their protective or wounded inner parts and heal through understanding those parts.
According to Dr. Schwartz, the developer of IFS, “…resistance is the protective parts of a person. They see it as their job to keep people — therapists, or any threat of danger—out of the client’s system.” (Schwartz, 2017)
In IFS, the therapist:
- respects the resistant part of the client as a valuable protector from feared outcomes
- seeks to understand the client’s fears
- lets the client know they are fully in the driver’s seat
- names the future benefits of letting the therapist in
Using IFS with a resistant client may sound like:
Client: “Oh no, I really don’t think I’m ready to go there.”
Therapist: “Certainly, you’re in charge here. (step #1) We don’t ever have to go there if you choose not to. I’m curious, I wonder what you think might happen if that protective part of you lets its guard down and lets me see more of you? (step #2)”
Client: “I’ve just been hurt by so many people. Every time I let my guard down, people judge me or disappear. So I prefer to keep my guard up to avoid that.”
Therapist: “That makes total sense. I would really need to earn your trust in order for that protective part of you to let its guard down and let me in. Let me be clear: we won’t go down that path without your express total permission to do so. (step #3) But I’ll say for now, if there comes a time when we build enough trust that you feel safe enough to let your guard down, so we could help the other parts of you find healing, I imagine that protective part of you wouldn’t have to spend so much energy protecting you all the time. (step #4) But whether we ever cross that bridge would be completely up to you. We don’t ever have to go there if you don’t want to.”
Approach #4: Psychodynamic Approach
The last approach I’m going to take a look at is a psychodynamic approach to resistance in therapy.
In general psychodynamic theory sees clients as being heavily influenced by unconscious forces, like motivations and drives.
A primary goal of psychodynamic treatment is to make those unconscious forces conscious. As well as navigating the clients’ relationship with the therapist (called “transference”).
So when a psychodynamic therapist sees resistance coming up for their client they may be keeping in mind that there are some unconscious variables influencing their client. They may want to check in to see if there is anything about that client’s relationship with the therapist that may also be influencing the resistance.
Here is what a dialogue with a resistant client may sound like:
Client: [after showing up late] “Oh my gosh, I completely forgot about our session!”
Therapist: “You know, last time we met we touched on some heavy topics, it seemed like we left off on a rough note. I wonder if it’s possible that some of that may have contributed to our session today slipping your mind?”
Client: “Oh no no no, not at all! Actually I’ve been doing really great lately. You’ve been so helpful and I’m doing so much better. Maybe I don’t really need to keep coming.”
Therapist: “I’m glad to hear you’re feeling so much better. I can’t help but also remember the note we left on off last time. You ran out of my office crying before our session was over. It seemed like you were experiencing something pretty intense. It’s great to hear that you feel better now, but I’m also concerned for how you were doing when we ended last time. Is there perhaps something more to the story here that I’m missing?”
Client: “Oh yeah, I almost forgot about that. I guess I might have been trying to avoid what we were talking about last time. I don’t really want to go back to that place.”
Remember All The Tools In Your Tool Belt
Honestly, it was hard to choose just four therapeutic approaches to highlight in this article. There are so many wonderful approaches to therapy. That’s the beautiful thing! All of these approaches can be effective. If you’re in a situation where you’re dealing with client resistance you have a lot of different tools to pull from.
I hope you feel encouraged that there are a lot of options for you when dealing with client resistance. Also, I hope that I was able to validate that resistance is a completely natural process in therapy. It’s not personal, and it doesn’t mean you’re doing something wrong.
If anything, it’s a signal that you’re probably going in the right direction! Because, if a client is resisting a direction you’re trying to take them, they’ve probably resisted going in that direction for a long time. So if there’s any compassionate, gentle way that you can take their hand and safely walk in that direction together maybe you can unlock some new things that they haven’t been able to access yet.
More Therapy Skill Resources
If you appreciated this article on approaches to use when your client is resistant, then you may find my article on what to do when you’re not sure how to help your client who feels stuck helpful.
Or, what should you do when your clients quit therapy? I have a video all about that.
If you are interested in more, I have a whole section on my blog with articles that cover a variety of therapy skills.
Until next time, from one therapist to another: I wish you well!
-Marie
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