Is "Resistance" in the Therapy Room Really Dead?

Using Resistance as a Chance to Improve Your Therapy Skills

Clifton Mitchell

By Clifton Mitchell

If you’re like most clinicians today, you can guide your clients in reframing their life story, enhance their experience of being intensely in the moment, reprocess their past traumas, time travel with them to redesign their future, locate and tend to their abused inner child, tap their body at strategic points---all of which, as we know, can sometimes lead to powerful moments of insight and healing. Nevertheless, that nasty, old resistance still gets the better of you more than you’d like to admit. When clients give weak excuses for missed appointments, stare blankly into space when you offer suggestions, and ask that you “fix” them without any effort on their part, in spite of all the techniques and approaches in which you’ve received training, you still feel prickly with frustration.

After many years, I’ve learned that rather than seeing our clients’ frustrating reactions as obstacles that we need to overcome, we can use them as valuable information with which to steer the therapeutic conversation more skillfully. In fact, our clients can always be seen as cooperative, giving us clear signs of how they’re experiencing the issues at hand. Without question, taking on this perception of client resistance has increased my understanding of the therapeutic process, as well as my job satisfaction, peace of mind, and, I believe, my clinical effectiveness.

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is a mother who comes to your office depressed and stressed over family issues that include a complacent husband, a withdrawn daughter, and an alcoholic son still living at home whom she sees as the center of the family conflicts.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. You listen, you empathize, you convey unconditional positive regard.

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. Your suggestions are met with blank stares as she goes into momentary states of trance. 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. You add, "In expressing a desire to change, you’ve been deceiving yourself and me." 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.

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.

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 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.

Too often therapists give too much importance to the role of reason and logic in the early stages of the change process. In fact, most people aren’t motivated to change by logic: they change only when they have emotionally compelling reasons to do so. If people changed because of logic, no one would smoke, no one would drink, and no one would overeat. We waste a lot of therapeutic time on logical reasoning that’s met with rebuttals mislabeled as resistance. So if you want to break through resistance, uncover the client’s emotional motivators.

The best tool for discovering clients’ emotionally compelling reasons for change is to deliver well-phrased, high-level, empathic statements that label their emotions and bring them into greater awareness. This tool should be used consistently during the quest for the details of a situation. As you bring forward clients’ emotions, monitor their reactions in a search for what will trigger strong incentives and motivations.

I once heard about a dependent female client in treatment for addiction whose therapist kept encouraging her to make changes for herself, not for those around her. When she suddenly began making significant improvements in her life, however, she said she was making them for God, not for herself. Her therapist was troubled by this statement, interpreting it as displaying dependency. He tried to disrupt this motivator and promote more self-focused reasons for change, failing to accept that her emotionally compelling reason might not meet his preconceived ideal. Who was being resistant in this case? When dealing with resistance, don’t fight the client’s motivators when they’re working!

Radical Change
After 100 years of the existence of this profession, it’s time to reexamine both the possibilities and the limits of psychotherapy. The concept of resistance is central to that reexamination. Like so many other people in this field, I’ve spent countless hours going to workshops and lectures trying to learn ever more powerful techniques for producing change. But no matter how seemingly powerful the methods I learned were, I wound up regularly experiencing “resistance” from my clients. It’s only recently, as I’ve grown more aware of how much of that resistance was created by me, that my experience as a psychotherapist has undergone a fundamental transformation.

This blog is excerpted from "Is Resistance Dead?" by Clifton Mitchell. The full version is available in the May/June 2013 issue, Tough Customers: Is It Them or Us?

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Illustrations © Dave Cutler/Stock Illustration Source

Topic: Professional Development | Anxiety/Depression | Creativity

Tags: resistance | therapeutic conversation

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Tuesday, December 8, 2015 7:14:15 PM | posted by Kaleel
Great article! I wish she had given examples of what she means by , "well-phrased, high-level empathic statements." Without these critical examples, I'm left needing more. But many thanks

Saturday, December 5, 2015 5:12:20 PM | posted by Kaleel
Mitchell's article is very solid and honest. I like the tone and the observations, and applaud his willingness to admit to complicity.

I wish he'd give an example or two of what he calls "well-phrased, high-level empathic statements."