{"id":39553,"date":"2018-11-19T06:00:12","date_gmt":"2018-11-19T14:00:12","guid":{"rendered":"https:\/\/www.goodtherapy.org\/blog\/?p=39553"},"modified":"2018-11-16T10:07:44","modified_gmt":"2018-11-16T18:07:44","slug":"how-to-address-client-resistance-in-therapy","status":"publish","type":"post","link":"https:\/\/www.goodtherapy.org\/blog\/how-to-address-client-resistance-in-therapy-1119185","title":{"rendered":"How to Address Client Resistance in Therapy"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-39560 alignleft\" src=\"https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2018\/11\/frustrated_man_in_therapy-300x200.jpg\" alt=\"A therapist sits in the foreground, listening to a man discuss his frustrations.\" width=\"300\" height=\"200\" title=\"\" srcset=\"https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2018\/11\/frustrated_man_in_therapy-300x200.jpg 300w, https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2018\/11\/frustrated_man_in_therapy.jpg 724w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/>Have you ever met those clients who are resistant to change?\u00a0 Do you have clients that are noncompliant to your recommendations and never complete assigned homework? Or do you find that your work in therapy with one of your clients has stalled and become stagnant?<\/p>\n<p>Many clinicians experience resistance from clients. In general, a therapist will have one of two responses:\u00a0 (1) to blame the client; or (2) to blame the self.\u00a0 Neither is appropriate. Blame never brings any type of positive result \u2013 especially in the mental health profession. Instead, it is recommended that a clinician address the following six reasons for client resistance:<\/p>\n<p><strong>1) Therapist&#8217;s inability to develop rapport with the client.<\/strong><\/p>\n<p>Oftentimes a therapist will assume that client resistance is 100% based on something within the client. In reality, the therapist&#8217;s inability to build a strong <a href=\"https:\/\/www.goodtherapy.org\/blog\/psychpedia\/definition-of-therapeutic-relationship\">therapeutic relationship<\/a> with the client may be a contributing factor.<\/p>\n<p>Building rapport requires:<\/p>\n<ul>\n<li>Managing eye contact appropriately.<\/li>\n<li>Helping clients feel a sense of relatedness to you. You can do this by trying to match the client\u2019s initial demeanor, disposition, and rhythm.<\/li>\n<li>Keeping negative topics neutral\u2014avoid framing statements using negative connotations.<\/li>\n<li>Using the client\u2019s name.<\/li>\n<li>Setting the tone.<\/li>\n<li>Letting clients get to know you\u2014that is, being a real person.<\/li>\n<li>Being approachable and engaged.<\/li>\n<li>Acting interested. Even if you feel bored, step in toward the client and help them feel seen, heard, and important.<\/li>\n<\/ul>\n<p><strong>2) Therapist imposing their agenda onto client.<\/strong><\/p>\n<p>Therapy needs to be conducted by developing client goals based on collaboration between the client and the therapist. If a client is being resistant or otherwise \u201cnoncompliant,\u201d then the issue should be directly and honestly discussed.\u00a0 If a client is not accomplishing certain tasks in therapy, then perhaps these aren\u2019t important to the client and the therapist is simply imposing their own agenda on the client.<\/p>\n<p><strong>3) Therapist inflexibility.<\/strong><\/p>\n<p>If a therapist lacks a client-centered approach, then the client will notice (if not consciously, then unconsciously) that their therapist is inflexible or rigid. If a client has issues from childhood resulting from a controlling parent or has problems with authority figures, then they may unconsciously resist what is being perceived as external control from the therapist.<\/p>\n<p><strong>4) Failing to realize that noncompliance is part of the \u201cpathology\u201d that needs to be treated.<\/strong><\/p>\n<p>If goals for therapy have been arrived at collaboratively between therapist and client and there is still noncompliance, then resistance can be addressed as part of what needs to be focused on in treatment. The resistance should be actively discussed with the client, without judgment or surprise. Issues contributing to client resistance may include fears of failure or the fear of terminating therapy. One question a therapist can use to address these types of fears is, \u201cWhat would happen if you were successful?\u201d or something else along those lines. Always explore topics of resistance with curiosity and encouragement.<\/p>\n<p><strong>5) Need to process fears and early life \u201cschemas\u201d or experiences.<\/strong><\/p>\n<p>A therapist can explore a client&#8217;s fears and early life experiences by using the Socratic questioning method. Determine what the client\u2019s underlying beliefs about life are. For example, does the client have a strong need to manipulate others or have power over them? Unmasking and revealing underlying maladaptive schemas, along with addressing their protective factors, should be addressed in the treatment plan.<\/p>\n<p><strong>6) Therapist fears of engagement.<\/strong><\/p>\n<p>A therapist needs to be willing to fully engage with their clients, even if it puts them out of their comfort zone. When a therapist tries to keep the relationship with their clients at a distance because of fears, such as fear of <a href=\"https:\/\/www.goodtherapy.org\/blog\/psychpedia\/countertransference\">countertransference<\/a> issues, the clients may sense this distancing. The effectiveness of therapy might then be diminished. A therapist can benefit from taking emotional risks with their clients. Client relationships aren\u2019t so fragile that mistakes can\u2019t be dealt with and overcome.<\/p>\n<p>To address therapist anxieties, a therapist needs a good support system, including people with whom they can discuss their fears. It is also good for a therapist to reframe their fears with anxiety-reducing strategies, such as:<\/p>\n<ul>\n<li>Challenging unrealistic performance expectations placed on the self<\/li>\n<li>Reminding oneself that it\u2019s okay to make mistakes<\/li>\n<li>Focusing on the client rather than on the self<\/li>\n<li>Realizing that no mistake is fatal and that part of good therapy involves the concept of \u201crupture and repair.\u201d When ruptures in the therapeutic relationship occur, repairing of the relationship can be healing in and of itself.<\/li>\n<\/ul>\n<p>It is always helpful for therapists to realize that everyone has limitations \u2013 including therapists and clients. It is important for therapists to understand when they are placing unrealistic expectations on clients based on the therapist\u2019s own experiences. Remember, clients have their own personal experiences that may or may not be conducive to certain treatment outcomes.<\/p>\n<h2>Treatment Plan<\/h2>\n<p>The best way to ensure effective therapy is for clinicians to formulate a well-thought-out case formulation and treatment plan, including the following:<\/p>\n<ul>\n<li>Determine client\u2019s core problem(s).<\/li>\n<li>Examine client\u2019s developmental contributing factor(s) to core problem(s).<\/li>\n<li>Evaluate client\u2019s relationship wants\/needs in the therapeutic relationship:\n<ul>\n<li>What does the client want from me or others?<\/li>\n<li>What does the client expect from me or others?<\/li>\n<li>What is the client\u2019s experience of self in relationship with others?<\/li>\n<li>What are the client\u2019s core beliefs?<\/li>\n<li>What are recurring themes in the client\u2019s relationships?<\/li>\n<\/ul>\n<\/li>\n<li>Establish best therapy interventions to incorporate into treatment.<\/li>\n<li>Address client self-sabotage.<\/li>\n<li>Assess and evaluate effectiveness of current strategies, and make adjustments as necessary. Remind yourself that therapy is supposed to be a fluid enterprise rather than a stagnant one.<\/li>\n<\/ul>\n<h2>Concluding remarks<\/h2>\n<p>The best approach to coping with client resistance or noncompliance is for the therapist to look in the mirror. If all efforts at treatment have apparently failed, then the therapist can step back, regroup, and assess the problem(s) in the treatment protocol. In fact, if the therapist finds themself frustrated with the client\u2019s effort, they may be best-served to \u201clet go\u201d of expectations, as this is a sign that the therapist\u2019s personal agenda is not being met.<\/p>\n<p>Realistically, most of the \u201cwork\u201d\u00a0 is in the hands of the client in between sessions.The therapist is simply one \u201ctool\u201d in the \u201ctool belt,\u201d and time spent in therapy is limited. Ultimately, the\u00a0client is the one who is responsible for their own recovery.<\/p>\n<p><strong>References:\u00a0 <\/strong><\/p>\n<ol>\n<li>Lang, E. (2012). A Better Patient Experience Through Better Communication. <em>Journal of Radiology Nursing, 31<\/em>(4): 114\u2013119.<\/li>\n<li>Shapiro, F. (2018). <em>Eye movement desensitization and reprocessing therapy, third edition: Basic principles, protocols, and procedures<\/em>.\u00a0 New York, NY: The Guilford Press.<\/li>\n<li>Smith, A. (n.d.) <em>Building (and maintaining) rapport in the classroom<\/em>. Retrieved from: https:\/\/www.depts.ttu.edu\/tlpdc\/Resources\/Teaching_resources\/TLPDC_teaching_resources\/Documents\/Building_Rapport_new.pdf<\/li>\n<li>Teybor, E., McClure, F. H. (2011). <em>Interpersonal process in therapy: An integrative model.<\/em> Belmont, CA:\u00a0 Cengage Learning.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Sometimes people in therapy resist professional recommendations. Learn why noncompliance occurs and what strategies you can use to address the issue.<\/p>\n","protected":false},"author":3035,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[542],"tags":[31,1408,1407,1409],"class_list":["post-39553","post","type-post","status-publish","format-standard","hentry","category-featured-articles","tag-psychotherapy-practice","tag-client-resistance","tag-noncompliance","tag-therapeutic-impasse"],"_links":{"self":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/39553","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/users\/3035"}],"replies":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/comments?post=39553"}],"version-history":[{"count":0,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/39553\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/media?parent=39553"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/categories?post=39553"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/tags?post=39553"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}