Clients can be resistant to therapy for a number of different reasons. In cognitive behavioral therapy, clients are encouraged to develop a secure and collaborative bond with their therapists. But how much does the therapist’s attitude influence client compliance or resistance? Researchers Henny A. Westra, Adi Aviram, Laura Connors, Angela Kertes, and Mariyam Ahmed, from York University, wanted to find out. “Strong empirical evidence indicates that higher levels of resistance are consistently linked to poor therapy outcomes, as well as premature termination of treatment,” they said. “Thus, resistance in therapy is important to prevent, identify, and minimize.” The researchers enlisted four trained therapists to provide eight sessions of CBT to 30 clients diagnosed with generalized anxiety disorder (GAD). Using the Ratings of Emotional Attitudes to Clients by Treaters (REACT), the team evaluated the emotional response of the therapists to the clients at various points throughout treatment. After the first and third sessions, the Penn State Worry Questionnaire, the Client Resistance Code and the Cognitive Therapy Rating Scale were also administered.
The findings suggest that the emotional reaction of the therapist is paramount in predicting client compliance or resistance. “In particular, therapist report of greater early positive reactions to clients, especially liking, fondness and affection for the client, enjoyment with the client, a sense of connection or attachment to the client, gratified in working with the client, and optimistic about the client’s future were consistently associated with lower levels of independent-rater observed client resistance at midtreatment,” said the team. “Moreover greater positive early reactions to clients were also associated with significant changes (reductions) in client resistance from early to mid-treatment.” The researchers believe their findings are extremely important, especially since there have been few studies on this dynamic. They said, “Although research on therapist characteristics has not commanded a great deal of attention in the context of CBT which has placed relatively more emphasis on technical proficiency, the present findings suggest that such effects may nonetheless exist and exert important influences on client engagement in the therapy process.”
Westra, H. A., Aviram, A., Connors, L., Kertes, A., & Ahmed, M. (2011, June 20). Therapist Emotional Reactions and Client Resistance in Cognitive Behavioral Therapy. Psychotherapy: Theory, Research, Practice, Training. Advance online publication. doi: 10.1037/a0023200
© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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