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Is Resistance Dead... - Page 2

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As an example of the flawed technique Rogers refers to, I once told a client too early in the process that she appeared to be quite angry with her parents. She didn’t readily accept this idea, since her conservative, religious upbringing had taught that she should "honor" her parents. Should her subsequent reluctance to accept her anger toward her parents be considered resistance or a result of my premature remark about something she wasn’t yet ready to embrace?

Around the time that Rogers was making his groundbreaking contributions, hypnotherapist Milton Erickson took the evolution of our perspective on resistance even further. Fascinated with the influence of language, Erickson pointed out that the specific words and phrases the therapist used contributed to both client resistance and its management. Like Rogers, he viewed a therapist’s dialogue as part of the resistance equation. For example, I could tell a client that, in certain situations, she reacts faintheartedly, or I could say that she’s searching for the courage to express her desires. The first phrase might make her feel belittled and arouse defensiveness, whereas the second might seed a new idea and promote movement.

In 1973, psychologists Stanley Strong and Ronald Matross added another layer to the concept of resistance by describing resistance as the "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." Thus, their view of resistance added the implication that it’s spawned not only by the precise words you choose, but also by how you choose to say them.

Many current therapeutic methods still view resistance as residing within the client. Cognitive therapists see it as resulting from clients’ distorted thinking. From a behavioral perspective, resistance results when the client is reinforced by the wrong thing—a concept once called secondary gain. Despite the advances we’ve made in many areas of psychotherapy theory and practice, too little attention is still given to the idea that clients’ "resistant” behaviors are just natural reactions to difficult situations, and should be seen as useful forms of communication.

Common Patterns of Resistance

Imagine one of your clients is a mother who comes to your office depressed and stressed over family issues that include a complacent husband, a withdrawn daughter, and an alcoholic son still living at home whom she sees as the center of the family conflicts. As you sort out the family system, you immediately begin to see a pattern of enabling behavior from the mother that includes providing her son with money that’s inevitably spent on alcohol, replacing vehicles wrecked in drunk-driving incidents, covering up and apologizing for his behavior, and bailing him out of jail while arranging another "second" chance for him. You listen, you empathize, you convey unconditional positive regard. The issues she presents sound similar to those of many other clients you’ve seen over the years. All the common patterns of rescuing, inappropriate reinforcement, and a lack of tough love are present in your client’s enabling of her son’s alcoholism. You feel you have something valuable and helpful to offer, and you’re ready to move forward into the next stage of treatment.

Once you’re satisfied you’ve established initial rapport, you take the next step and offer what you consider to be some sensible feedback about the client’s situation. You delicately point out a few flaws in her way of handling the family’s problems and supportively explain how, despite her good intentions, her actions are helping maintain the problems she’s there to address. Basically, you do your thing . . . and she listens and nods agreeably, but seems somehow unimpressed with the value of what you’re offering. Your suggestions are met with blank stares as she goes into momentary states of trance. When not leaving the room mentally, she replies with a host of "yes, but . . ." responses formed around cognitive distortions regarding her role as a mother and the need to be supportive. You offer some homework, but when she returns for the next appointment, nothing has changed at home.

You give some more homework, engage in more supportive dialogue, grow even more empathic, but the harder you work, the more it feels like you’re sinking deeper into the mud. Week after week, there’s only polite attention to the suggestions and explanations you provide and no sign of any change. You become frustrated and think, Why did she come here in the first place if she doesn’t want to try something—anything—different! Still you’re certain that you’re doing your best and following the appropriate treatment protocol faithfully. In your mind, the problem is clear: you have a "resistant" client on your hands.

Finally, your patience exhausted, you decide to pull out the big guns and deliver a blunt confrontation that you’re sure will jar her out of her denial. You aggressively explain that her actions are maintaining the problems and that she must radically change her approach if she wants any peace. You add, "In expressing a desire to change, you’ve been deceiving yourself and me." You wait for the walls to come tumbling down, but nothing happens. The enabling of the son’s alcoholism continues, and every session feels like you have to start over, redundantly explaining the promising alternatives she might try to the various dead-end coping strategies she’s currently employing.

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  • Comment Link Saturday, 25 May 2013 11:16 posted by James Lein

    The Eugene Gendlin interview you carried a while back fits well with this article. As I recall, he continually invites clients to correct his comments or interpretations, keeping the exchange at the client's pace. It is of course client-centered more so than therapist-centered.

  • Comment Link Monday, 20 May 2013 07:52 posted by Eugene Usner

    Excellent article on resistence. This article should be required reading for all therapists. Using all our listening skills and realizing that we cannot "fix" anyone is crucial. As you stated "slowing the pace" " getting more details" and establishing goals is paramount to successful therapy. Thanks again sharing you knowledge regarding resistence.

  • Comment Link Monday, 20 May 2013 02:46 posted by Plamen Panayotov

    Hi, Clifton,
    Thank you very much indeed for this very interesting and useful thread.
    Right now me and my friend and colleague Boyan Strahilov are trying to shape a brief text on 'From the Death of Resistance to the Birth of Assistance'.
    As in psychiatric treatment, where many patients resist their medical treatment, it takes one step to go from 'resistance' 'compliance', and yet another one from there to 'adherence'.
    As we see it now, resistance is mostly connected to untimeliness.
    Each and every question we ask the client can be on time, which results in assistance from her; or out of time, which provokes resistance.
    So, the main question for a therapist becomes: How can I fit myself to the time of this client now?
    One possible answer to this you can see here:
    Hoping we all can be on time some day,