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Is Resistance Dead...

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PNMJ13-1Or Have the Rumors Been Exaggerated?

By Clifton Mitchell

With all the recent developments in research, theory, and practice, we have more treatment options to choose from than ever before. Why then do so many practitioners still find client “resistance” a regular companion in their consulting rooms?

In 1984, after it was rejected by several mainstream journals, the late Steve de Shazer, a pioneering brief therapist and an acerbic critic of therapeutic orthodoxy, published a now-legendary article titled "The Death of Resistance," declaring that psychotherapy had entered a new era. Rather than an objective phenomenon, de Shazer proclaimed that "resistance"—clients' seemingly illogical attempt to thwart the well-intentioned efforts of their therapists—in fact, existed only in the eye of the therapist-beholder. According to him, psychotherapy was moving into a more enlightened age of more effective treatment in which the concept of resistance would become obsolete.

So why then, if de Shazer was right, are you still struggling with so many of your cases three decades later?

If you’re like most clinicians today, you have a toolbox crammed with even more therapeutic theories and techniques than de Shazer could have imagined. 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.

Many years ago, a particularly grueling session with a client left me feeling so beaten up and irritated that it pushed me to embark on a study of resistance that’s continued for more than two decades. Through this journey, 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, as de Shazer brilliantly pointed out, 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.

The crucial shift comes in seeing situations you once labeled as resistance as marking critical junctures in the therapeutic dialogue providing crucial opportunities for you to make adjustments to your role in the conversation. Rather than becoming frustrated, you can use those moments to assess what’s occurring—both for you and for the client—and change your own behavior. After all, aren’t we always advocating that our clients make mindful changes? If you fail to recognize and respond effectively to the signals your client is sending moment by moment, it doesn’t matter what kind of approach you’re using—cognitive-behavioral, Gestalt, Neuro-Linguistic Programming, Somatic Experiencing, or any other method­—it just won’t work.

A Brief History of Resistance

Sigmund Freud was the originator of the concept of resistance, along with so much else that’s shaped the development of psychotherapy. Of course, given the challenging perspective he was offering clients about their unconscious desires to have sex with their parents, I assume he must have regularly felt compelled to account for his patients’ reluctance to accept his theories. He wound up defining what he labeled resistance as the client’s attempts to avoid anxiety-provoking, psychologically threatening information. In Freud’s view, if the client wasn’t "buying" what he was "selling," the client was being resistant. Resistance was something in the client and, for much of psychotherapy’s history, therapists were not encouraged to look at their own contributions to it.

Fortunately, by the mid-20th century, several figures rose to prominence within the field who challenged this prevailing view, and new perspectives began to evolve. In 1951, humanistic pioneer Carl Rogers stated in Client-Centered Therapy that “Resistance to counseling and to the counselor is not an inevitable part of psychotherapy, nor a desirable part, but it grows primarily out of poor techniques of handling the client’s expression of his problems and feelings . . . out of unwise attempts on the part of the counselor to short-cut the therapeutic process by bringing into discussion emotionalized attitudes which the client is not yet ready to face.” With this, Rogers placed the problem squarely on therapists: if they move too far ahead of the client too quickly, they’re sure to evoke resistance.

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4 comments

  • Comment Link Tuesday, 18 June 2013 09:19 posted by Eugene Usner

    Excellent article and subject. As a Social Worker, the basic tenent of the therapeutic relationship has always involved focusing on "where the client is". You have sucinctly stated and give exambles that resistence is produced by the therapist for not really listening to the client. The therapeutic journey does involve focusing on our client's goals..not ours or an referring agency. A great deal of education needs to be disiminated to the public regarding our abillity to "fix" our clients. Thanks for a clear understanding of client resistence.

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