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Is Resistance Dead... - Page 3

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How can this client not respond to the compelling logic of your approach? Her life isn’t working, and you’re offering a promising set of new possibilities, carefully and thoughtfully pointing out behaviors she needs to change and the cognitive distortions she needs to challenge. You’re running out of things to try, but it’s not your fault. After all, you can’t help people who just aren’t ready to change.

But what might be called modern resistance theory offers you a way to pull back from your sense of being helplessly stuck to get a fuller picture of how you got there. Actually, the stagnation in the therapeutic relationship started the moment you began delivering information in a manner that your client wasn’t ready to accept. In reaction, she began trying to subvert your influence, and then in response to her reluctance, you pushed even harder—in this case, resorting to blunt confrontation. So she pushed back even more, missing appointments, fiddling with her phone in sessions, giving “yes, but . . .” responses to all your sage and helpful suggestions. Your frustration to her “resistance” increased, and your reactions and hers became a vicious cycle, fueled by escalating attempts not to be influenced by each other.

This is, of course, a common pattern in therapeutic stalemates. The key to finding alternative ways to proceed is to scale back your own expectations and sense of what’s possible at this stage of the therapy process. What you initially failed to recognize is that the client was only at the point where she’d accept influence in subtle forms of communication—an indirect suggestion perhaps, certainly not a blunt confrontation. Rather than honoring and embracing the client’s current state and then taking micro steps forward, you made the commonest of therapeutic mistakes: you got ahead of the client. Your approach didn’t mesh with her psychological state at that moment regarding the problems in her life. The harder you tried to help her, the more disconnected from her you became. Resistance? Perhaps. But who exactly was being resistant—the closed-off party, who failed to recognize that something needed to change, or you, who failed to recognize the therapeutic disconnect that was occurring?

Developing a Deeper Understanding

Perhaps the most important thing to recognize about the phenomenon we call resistance is that it’s always a circular pattern of interaction. As clinical psychologist and addictions expert William Miller and Stephen Rollnick reminded us in Motivational Interviewing: Preparing People for Change, “Resistance is something that occurs only within the context of a relationship or a system.” As therapists, we’re always prime components in the resistance equation: we push too hard, the client pushes back, and then putting the “resistance” label on the client usually only further interferes with the possibilities for doing something different.

So what do you do when you reach those stuck points when clients won’t embrace your ideas? In most cases, the most immediate and practical answer is: stop pushing. Don’t create more resistance as the client pushes back against your suggestions. Move to a position that provides clients nothing to push back against. How can they be resistant if you give them nothing to resist? I find it helpful to keep in mind the well-worn but still useful joke:

Question: How many therapists does it take to change a light bulb?

Answer: One, but the light bulb has to really want to change.

You can’t make people change, but if you’re a good therapist, you can inspire them to want to change.

We’re constantly reminding clients, “You can’t change other people; you can only change yourself.” How ironic, therefore, that we’re typically trained to develop a treatment plan and enter sessions with the intention of changing clients! How much frustration and wasted effort we might spare ourselves and our clients if instead of working to change them, we’d focus on our own contribution to the creation
of “resistance”!

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4 comments

  • 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: http://en.solutions-centre-rousse-bulgaria.org/files/simple_therapy.pdf
    Hoping we all can be on time some day,
    Yours,
    Plamen