Seek Details. People say that the devil is in the details, but so is the way out of most therapeutic stalemates. Take a moment and look back on any case in which you were particularly successful. Chances are that the clients’ general insights about life made less difference than more fine-grained shifts in their way of approaching life challenges. Much of what’s labeled resistance is the result of a therapist’s failure to move the conversation from broad strokes to specifics.
I once had a suicidal client who was alarmingly close to killing himself. Although he was divorced, unemployed, and alcohol addicted, all of which could be motivators for suicide, it turned out that none of these things was the driving force behind his suicidal tendencies. After a detail-seeking discussion in an emergency session, he revealed that he’d been told as a child that bouncing his baby brother on his knee had caused his brother’s autism. Overwhelmed with pain and guilt, my client had never revealed this information to anyone. After we discussed why there was no link between bouncing a baby and autism, he began wanting to live again. Had I assumed the typical motivators for suicide needed to be the focus, I likely would have experienced continued “resistance” from the client, but that resistance would only have been my failure to ascertain this client’s true concerns and motivations.
Find the Emotionally Compelling Reasons for Change. 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!
Establish Mutually Agreed Upon Goals. A prime component of a therapeutic relationship in which resistance is kept to a minimum is the establishment of mutually agreed upon goals that both you and your client can state clearly. Such goals can be ranked in two tiers. The first tier is mutual agreement on what the overall goal of therapy is. What would constitute a successful outcome? The second tier is mutual task agreement, best characterized as agreement on the goal of the immediate conversation at hand. Combining these tiers, a good therapist will constantly try to determine whether what’s being discussed at the moment feels like something worthy of discussion from the client’s perspective.
So how do you uncover goals to agree on? Rather than finding them in a packaged treatment-plan program, seek goals that emerge from conversations with the client, especially clarifying why the presenting problems are problems from the client’s perspective. To do this, direct the client with a statement such as, “Tell me how this is a problem for you.” I have yet to meet a human being who wouldn’t get absorbed in the task of describing exactly why his or her problems are problematic. As you listen, it can be helpful to focus on both what the client wants and what he doesn’t want. Clarifying the opposite of the undesired is a useful way of cultivating goals based on a client’s perceived needs that gives therapy concrete direction.
The bottom line in our profession is that we can’t change people; we can only aid people in creating the changes they desire. Therapists who impose goals on clients are like salespersons who try to sell products that people don’t want. Recall the last telemarketer who called trying to sell a product for which you have no desire and you’ll get a feel for the client’s experience when we impose goals. Most mental health professionals abhor sales work. Nevertheless, we often allow ourselves to move into a position of selling treatment plans to clients who have no desire to buy. This is a surefire way to manufacture “resistant” clients.