When clients are resistant in therapy, it can be discouraging. Therapists want nothing more than for their clients to make the best use of their time, and advance consistently toward their goals.
But since resistance invariably occurs, we need to be prepared for it so that we don’t panic or make the situation any more challenging than it needs to be. Remember, it’s all part of the therapeutic process, and we can handle it when we know what to do.
What’s Behind the Resistance?
Resistance, like so many other defense mechanisms, is generally an unconscious psychological response that originates in the amygdala, the almond-shaped part of the brain that is the home of the autonomic reaction to fear. Humans develop responses to fear and reactive mechanisms that help mitigate and control feelings of anxiety that are often triggered by harmful or unpleasant stimuli.
It’s important to remember that these defense mechanisms are designed to help us; they protect us from upsetting situations and help to keep us safe and happy. The problem arises when this resistance morphs into unhealthy or maladaptive behaviors that prevent us from engaging in ways that will be helpful, such as actively participating in therapy.
How to React to Client Resistance
1. Don’t Resist the Client’s Resistance
It is important to keep in mind that it is perfectly normal for a client to resist in-person or virtual therapy! Looking for ways to avoid doing things that are unpleasant or difficult is a very common defense mechanism. Perhaps we developed this trait as young children to avoid being mistreated, or perhaps it was learned as a way to distract our parents or teachers, to cope with their disappointment in us.
When you find the client to be resistant, don’t avoid it. Instead, quickly normalize the behavior by talking openly about it. Being candid often puts the client at ease as many people believe that they are being bad or unusual for being resistant. But don’t stop there, for while resistance may be normal, it isn’t helping your client to move any closer to his/her goals. That can only be done by navigating these defense mechanisms.
2. Calm Yourself
When you are faced with a challenging client or situation, you don’t want to escalate the situation any further by reacting to it in kind. Instead of fighting back, do what you can to become aware of your own emotional and physical state, such as a racing heart, surging adrenaline, confusion, or any other unpleasant sensations.
“Don’t resist resistance,” says Fred J. Hanna, Ph.D., who directs the counselor education and supervision program at Adler University in Chicago and is also a faculty associate at Johns Hopkins University in Baltimore. “When the client is resisting the therapist and the therapist starts getting irritated with the client, then you have two people resisting each other,” he says. “That’s not therapy; that’s called war.” And doing battle may set you off!
3. Practice Mindfulness Meditation
“Mindfulness meditation can help psychologists prepare for the anxiety, frustration, and anger that challenging clients provoke,” says psychologist Mitch Abblett, Ph.D., executive director of the Institute for Meditation and Psychotherapy in Boston.
By practicing mindfulness daily, clinicians learn to identify sensations arising in the body and thoughts arising in the mind without judging themselves. They can also reconnect with the core values that guide therapy. “If you connect with those values, it can pull you through some of these charged moments,” says Abblett.
4. Make it a Habit to Express Empathy
Practice reflective listening. This is not the time to argue or debate. Rather, you need to validate the client’s feelings and show empathy by saying, “You’re feeling upset now because …” And even if the client is blaming you unfairly, it is best to tell your client you’re sorry that something you did has made him/her upset. This will not only help de-escalate the situation but will invariably further the ultimate therapeutic goals.
5. Cultivate Patience
“Psychologists should strive to be patient not only with challenging clients but also with themselves,” says Sarah A. Schnitker, Ph.D., an associate professor of psychology at Fuller Theological Seminary in Pasadena, California. She has discovered two strategies in her research that can help psychologists cultivate more patience.
The first strategy is called “loving-kindness meditation.” This is when practitioners direct well wishes to themselves, friends and family, even their enemies. The other strategy is “re-appraisal,” or thinking about situations in new ways.
“If your client is frustrating you, remember the bigger picture — that therapy is helping to bear the burden of another person’s pain,” says Schnitker. You might think, “This is helping to test me as a clinician” or “This is helping me develop patience, a virtue I can use in my own life.”
6. Manage Silence in Counseling Sessions
For some, tolerating silence is natural, but for others it is intolerable; they feel compelled to fill the silence. Becoming skilled in this area could be beneficial to your client as it will provide comfort in those frustrating or difficult moments. Your silence may hold an empathic space in which your client can become mindful of what he/she is experiencing, and create the opportunity to work through those thoughts and feelings.
7. Seek Support from Your Peers
“Psychologists can feel a lot of shame when they’re having trouble with clients,” says Seattle-area private practitioner Kirk Honda, PsyD. “A big reason for that is because people don’t talk enough about their difficulties,” he says. “They think they’re the only ones.” Sharing stories about challenging clients with other therapists in a confidential way both mitigates isolation and may also pave the way for constructive suggestions.
“It can also be helpful to get a second opinion by consulting on specific cases with colleagues who are ‘outside the fray,’” says Matthew J. Sullivan, Ph.D., a private practitioner in Palo Alto, California. “You can touch base with them when you’re feeling rattled or insecure about something you’ve done,” he says. “Even a quick phone call with a colleague can help.”