Resistant Clients: We've All Had Them; Here's How to Help Them!

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• Whose Goal Are You Working On?
• The Who, Where, and When of it All
• When the Solutions are Terrifying
• The Columbo Technique
• Is Rogers Still Right?
• Baby Steps are No Joke
• Recognizing When Resistance Has the Upper Hand
• Some possible dynamics of resistance
• The Plus Side of Client Resistance
• Resistance: Something Besides Stubbornness?
• References

If you inwardly cringe when a client becomes resistant to the counseling or psychotherapy you're providing, take heart. Encountering resistance is likely evidence that therapy is taking place. In fact, several studies indicate that successful therapy is highly related to increases in resistance, and that low resistance corresponds with negative outcomes.¹ There is an upper level of resistance (too much) as well as a lower level of resistance (too little) that are counterproductive. Getting to moderate levels of resistance is important to successful therapy, especially when followed by effective approaches and techniques.

The most effective therapists are prepared to encounter their clients' resistance—they know how to deal with it, and how to help their clients break through it. They do this by understanding what resistance represents psychologically, and they have developed a way of conceptualizing and reacting to the resistance that allows them to remain emotionally comfortable or centered.

We can deal with highly resistant clients effectively when we:

1. learn to avoid common errors that unnecessarily create or foster resistance;
2. recognize when resistance has gotten the better of us; and
3. are able to consider the positive side of resistance.

Resistance has been defined from a number of perspectives. Traditional definitions have their roots in Freudian theory and usually place resistance inside the client. Such definitions view resistance as representing the client's efforts to repress anxiety-provoking memories and insights, or efforts to fight the therapist's influence. For example, Bischoff & Tracey define resistance as "any behavior that indicates covert or overt opposition to the therapist, the counseling process, or the therapist's agenda." Although common, such perspectives leave therapists lacking control and too much at the mercy of other influences when attempting to foster change.

The social interaction theorists view resistance as being the result of a ''negative interpersonal dynamic between the therapist and the client."² Here, resistance is seen as something that results from the interactional style of the therapist and the client. The therapist allows the client to form a mutual communication pattern that hinders counseling and the change process. The interactional view of resistance forces the therapist to remain aware of what he or she may be doing that actually promotes resistance. The great benefit of this perspective is that changing your interaction style results in changing what has been deemed resistance. This perspective empowers therapists in managing resistance in therapy.

Whose Goal Are You Working On?

When we experience resistance, we say that the client is "not going anywhere." We feel stuck. Central to these statements is the question: Where is the client supposed to be going? The client is showing no progress toward what? One of the primary therapist errors that causes resistance is failure to establish a mutually agreed-upon objective. If you and your client are not in agreement about a desired outcome, problems are inevitable. Furthermore, you and your client should be able to clearly state the mutually agreed-upon objective. If a mutually agreed-upon objective has not been established and reasonable time has been devoted to establishing rapport and understanding the client's situation, then it is critical to focus session time on the creation of such an objective.

The next time one of your colleagues complains to you about a particularly difficult client who does not want to change, ask them, "What is the goal?" If they begin stuttering or go into a vague, rambling explanation, you will know that a mutually agreed-upon goal has not been established. Then inquire, "If your client was asked what the goal is, would the client's response agree with what you just stated?" It is mind-boggling how many times this essential therapeutic component is not properly formulated.

Such goals do not have to be complex. For example, a simple goal may be for the client to spend at least 15 minutes each day in a discussion with their partner about their day before any other activities are begun. Another could be for the client to plan one night a week where they do an activity together with their partner. Such goals could be smaller components of an overall objective to increase communication and connection in the relationship.

The Who, Where, and When of it All

We are not helpful to our clients until we have reached a point where problems can be defined around a specific person, place, and time. David Burns, author of Feeling Good, taught me this concept and I have yet to prove it wrong. Sometimes the person, place, and time are obvious—e.g. a spouse at home, when the children need disciplining; or a boss, previously dealt with at work, in the past. Or maybe the problem is the client's traumatic experience at an earlier age with a family member. Sometimes it is the client and you, dealing with the conflict, at the present moment in the session!

Regardless of the case specifics, the person, place, and time components are present in solvable problems. Being clear on the person, place, and time of your client's problem brings clarity to the process and avoids ambiguity that hinders progress. For example, a client who enters therapy with a goal to "not be nervous" has yet to reach a point in problem clarity where help can be provided. The brief therapists would say that this problem has not been defined in manner that makes it solvable. As a result of the therapeutic discussion, such a vaguely defined problem would be transformed into a more specific goal such as to be "calm, relaxed, and assertive when discussing needed changes in the department with the boss." With this level of specificity, the definitive steps can be taken toward resolution. Skilled therapists most often move the discussion to a level of specificity almost without conscious awareness. However, clarity in understanding the essential elements of solvable problems can enhance the process. It is also quite helpful for beginning therapists who have difficulty figuring out exactly what they are trying to do.

When the Solutions are Terrifying

We all know the familiar axiom that our clients have the solution to their problem inside, and that it's our job to help them find it. What experienced therapists know is that

one of the main reasons clients come to therapy is not because they don't know the solution to their problem, but because they find the solutions terrifying. From this perspective, one of the therapist's primary jobs is to normalize the fears surrounding the solution and support the client's courage to move forward in the midst of the perceived impending terror. In cases where fear of the solution is great, focusing too strongly on the solution may increase fear. In such instances, focus on dealing with the fear that accompanies the solution before moving the focus forward toward actions to be taken.

For example, I once counseled a woman who repeatedly discussed how much she hated her husband and how badly she wanted a divorce, but she was not proceeding with the divorce. As we addressed the issues further, we discovered she was filled with fear about the divorce—fear because she and her children were financially dependent on her husband, fear because she felt she had no marketable job skills, fear because returning to school for training was costly and scary. At this point the counseling session changed from focusing on whether she should divorce to the more pressing issue—addressing the fear that accompanied the divorce.

The Columbo Technique

An interesting paradox occurs with highly resistant clients. The greater the resistance, the more likely it is that they are refusing to consider any of a host of possible solutions. Typically, as we become aware of the myriad possible solutions to a client's problems, we become more certain that our knowledge can help them. As a result of such certainty, we begin talking more and more as an expert regarding the problem at hand.

But here's the catch: The more of an expert you become, the more you give the client something definitive to resist against and the less psychological freedom clients have to explore possibilities on their own. Thus, being too knowledgeable about obvious solutions may actually create resistance. A sure sign that you have become too much of an expert is getting, "Yes, but ..." answers.

The way out of this situation is to reverse the paradox. The more obvious possible solutions become, the more naïve, inexperienced and uncertain your displayed attitude toward these solutions should be. The principle at work here is that your client cannot be resistant if there is nothing to resist. My students have dubbed this approach the Columbo technique because it is similar to the approach taken by fumbling television detective Columbo as he hoodwinked his suspects into revealing key information necessary to solving murders. Columbo apprehended his suspect by constantly appearing to not understand the basic components surrounding the murder and by asking questions that forced the suspect to clarify his or her actions. Although Columbo always appeared to be two steps behind the murderer, in reality he was two steps ahead.

A therapist I know explained to me that he used to get sucked into lecturing, argumentative discussions with alcoholic clients that expounded to them the many reasons not to drink. After reading my book, he says that he now avoids such vain, pointless conversations. Recently, in a first session with an alcoholic client, he inquired as to the client's reasons for drinking. Expecting a flood of reasons not to drink as a response, the client proceeded to build a case for drinking in which he explained how drinking help him to relax, deal with stress, manage his chronic pain, etc. After hearing the strong case for drinking, the therapists stated that he had no knowledge of any pill or therapeutic discussion that could substitute for the benefits received from continuing to drink. Almost immediately the client began to state something to the effect, "But, you don't understand, I have a fifty-dollar-a-week alcohol bill that I can't afford, my wife is threatening to leave me, my kids don't respect me, and I really don't like myself for drinking." In this instance, in order not to provide something to resist against and avoid the typical "Yes, but..." response, this therapist selectively became uncertain and naïve as to any solutions to the drinking problem.

By becoming naïve to the obvious, he quickly received from the client motivations to stop drinking, and the discussion proceeded from there. My therapist friend explained to me that, in similar situations in the past, he would have immediately provided information and knowledge for the client to resist against. However, he has since become much wiser and goes to great lengths to avoid providing a position for his resistant clients to oppose.

Is Rogers Still Right?

Many experienced therapists become lax in consistently showing empathy throughout their sessions. When we conduct sessions excessively loaded with questions without a foundation of understanding, our clients lose the feeling of psychological support necessary for them to proceed safely. An essential component to breaking through resistance is maintaining a foundation of understanding through a dialogue that engages the client's experience with empathic comments.

An equally important reason to consistently use empathic statements is to get clients in touch with the emotional energy they need in order to initiate change. People rarely change because of the logic of the situation; people change when they have an emotionally compelling reason. Yet, because emotions are often linked to uncomfortable feelings, clients have blocked awareness of or are in denial of their own emotions. Empathy is the tool that fosters the emergence of emotionally compelling reasons for change, and thus it ignites and fans the fires of change.

For example, I have often dealt with people who desire to quit smoking. One of the things I have learned is that people very rarely quit smoking because of the possibility for cancer, emphysema, heart attacks, bad breath, high costs, etc. People do quit when these issues directly affect them as a result of a medical checkup or in some other manner. I once worked with a man who wanted to quit smoking, where I initially struggled to get to the underlying emotional reason behind this life change. He appeared reluctant to offer up or get in touch with the real reason for breaking the habit. However, through continuing to respond in an empathic manner and to pull to the forefront all of the emotions I was sensing, I struck gold when I indicated that I sensed he was a very responsible person who cared for children. From this revelation, the underlying force for his habit change emerged in the conversation: His wife was pregnant! He was going to be a father! Now, he had an emotionally compelling reason to change. Therapists seeking to mine the compelling reasons for change should consistently use empathic statements that include specific reference to the emotions present. This is the most efficient avenue to discovering the emotionally compelling reasons that fuel the desire to change.

Baby Steps are No Joke

A considerable amount of resistance comes from poor timing. If you find that you are offering explanations before the client is ready to accept them, confronting the client too soon or moving too fast, then slow your pace, back up, and take smaller steps. Therapy is clearly one area of life where it pays to slow down to go faster. In fact, taking small steps is often a central part of effective therapy, including brief therapy.

In order to not rush your client, I suggest you constantly ask yourself, "What could I say that might move my client the smallest step possible toward where they need to be to resolve their problem?" This approach solves two problems for the therapist. First, it does not push the client and thereby create resistance. In fact, if you slow down to the point that you are behind your client, then you can actually have the client pulling you along toward their solution. Second, this approach takes an enormous amount of pressure off of you. The task at hand becomes manageable, and you will find that you are more able to remain balanced in sessions. Learning and practicing this skill can be an enormous stress reducer for therapists.

For example, to ask a person in denial over the loss of a loved one to fully accept the loss may be too threatening or inconceivable to them. This is simply too big of a step to take at the moment. To ask the same client to come up with ways to honor their loved one in his or her absence will likely appear much more palatable. In this way, perhaps some of the underlying emotions related to loss, meaning, closure, guilt, etc. can begin to be addressed. By suggesting smaller, more acceptable steps in moving through the grieving process, the therapist circumvents the resistance that the client would have experienced as a result of moving too fast toward closure.

Recognizing When Resistance Has the Upper Hand

Significant client resistance leaves psychotherapists feeling insecure, incompetent, frustrated, hopeless, stressed, and burnt out. When these feelings are indirectly communicated to clients, more resistance occurs and a negative spiral develops. Less-experienced burnt-out therapists are most vulnerable to the negative effects of resistance. One of the keys to dealing with resistance is to recognize that resistance is not personal. Resistance is a fact of therapy.

Watch for signs that resistance has gotten the better of you:

• You feel like you are fighting or arguing with your client. Many times you may have felt like you were trying to convince your client of something and were not making headway.
• You feel stressed and drained in an unhealthy manner after a session.
• You are working harder in your session than your client is. If, after finishing your sessions, you have more work to do than your client, then you should take a close look at what you are doing. Something is likely amiss.
• You are feeling burnt out with your work.

Typically, resistance conjures up ideas of stubbornness, obstinacy, and defiance. Beware! Once you place these labels on your client, you are generally just as stuck as your client. To avoid getting stuck, you may want to consider other perspectives on resistance.

Some possible dynamics of resistance

• Resistance may be a reflection of the developmental level of your client.
• Resistance may be a signal that the client is dealing with a very important issue that has multiple conflicts.
• Resistance may be a result of the way the therapist and the client interact. Consequently, changing your interaction style will change the resistance.

(See Something Besides Stubbornness below for other reasons a client might be resistant.)

The Plus Side of Client Resistance

To fully understand resistance, the many positive benefits of resistance need to be examined. Resistance has a purpose; otherwise, it would not exist. When we understand the many benefits of resistance, we begin to realize that it is just as essential to mental health as it is a problem in therapy. The following purposes and benefits of resistance are compiled from the writings of Anderson and Steward.³

• Without resistance, all social systems would dissolve into chaos and confusion, changing with every new idea presented.
• Resistance is what prevents us from buying every product presented to us in commercials and infomercials.
• Without a certain amount of resistance, we would have no stability, predictability, security, or comfort.
• Resistance provides us with a sense of being right. Can there be a sense of right and wrong without an awareness of the opposition of one position against another, or without a resistance to certain positions?
• Resistance can be a sign of good mental health and judgment; people often want new alternatives to problems before giving up old ways.
• Understanding resistance—including its possible positive purposes—and knowing effective means for dealing with resistance is not merely intellectual enrichment. This knowledge can reduce therapist stress and burnout.
• Resistance in therapy is a natural, necessary part of every client's problem. It is neither good nor bad, and the effective therapist neither abandons, rescues, nor attacks clients because of their resistance.
• Resistance is the problem at hand. Many clients are ambivalent about change, and the decisions they make are typically not clear-cut—that's why they have come to therapy.
• People resist difficult change because of the underlying conflicts. The therapist's job is to provide an environment where internal conflicts can be addressed.

When we have a plan for dealing with resistance before we encounter it in therapy, we won't get trapped in a futile battle with our clients. Instead, we will be able to remain objective and have a clear perspective about what is occurring. Hopefully some of the techniques for responding to resistance that I've suggested here will help you with resistant clients and keep yourself grounded in the process.

And if you find yourself feeling discouraged by resistant clients, think about this: Which is more troubling: a client who does everything you suggest, or one who takes time to assimilate and adjust to new ideas? Or if that idea doesn't buoy your spirits, then consider the following: "Without resistance, we would all be out of a job."⁴

Resistance: Something Besides Stubbornness?

Have you considered any of the following reasons clients might be resistant to therapy? Resistance could be a sign of:

Fear of failure. Client does not know how to be a client and has a high need for success or perfectionism and thus resists as a result of the fear of failure.

Fear of taking risks. Client sees counseling as a highly risky behavior and client is actually very conservative in his or her life approach.

Manipulation. The client enjoys manipulating others and, by not "moving" or responding therapeutically, they experience power in recognizing that they can manipulate the therapist.

Passive-aggressive behavior. Client is angry with the therapist or some other adult/authority that the therapist represents (transference). The resistance could be a reaction to authority figures in general.

Shame. The client may have feelings of shame because he or she has not been able to resolve the issues or because of the social implications of the issues.

Jealousy or desire to sabotage the therapy relationship. "If I get better, then I will not be able to come to these sessions and get all of this attention and maintain my relationship with my therapist." In this instance, an unhealthy dependence has developed between the client and therapist.

Exhaustion. Resistance could be an indication that the client is psychologically drained and does not have the energy to take on the tasks that will lead to change. Here, the therapist needs to back off and allow for replenishing of energy. Take a therapeutic break.

A personality style. Many people instinctively respond to change with resistance.

A client who enjoys resisting. Some people simply enjoy the battle of resisting, the stimulation of arguing, and controversy long beyond the initial reaction to change. These people often switch positions if they find others agreeing with them to keep the stimulation going (Kottler, 1994).

References

¹Bischoff, M. M., & Tracey, T. J. G. (1995). Client resistance as predicted by therapist behavior: A study of sequential dependence. Journal of Counseling Psychology, 42(4), 487-495.

²Otani, A. (1989). Resistance management techniques of Milton H. Erickson, M.D.: An application to nonhypnotic mental health counseling. Journal of Mental Health Counseling, 11(4), 325-334.

³Anderson, C. M., & Stewart, S. (1983). Mastering resistance: A practical guide to family therapy. New York: The Guilford Press.

⁴Pipes, R. B., & Davenport, D. S. (1990). Introduction to psychotherapy: Common Clinical wisdom. New Jersey: Prentice Hall.


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