Treatment Resistance: Client Issue or Counselor Challenge?

DEBRA E. ORR-BROWN, MSW, CAP

CORRECTIONS CORPORATION OF AMERICA (CCA)

Why Talk about It?

After completing this workshop, the participant will be able to:

1. Identify and describe the forms of resistance.

2. Understand the importance of the therapeutic alliance in

reframing resistant thoughts and behaviors.

3. List effective communication and behavioral skills to increase motivation for

change in difficult clients.

Who Are We Talking About?Involuntary Clients

Clients who talk excessively or are quiet and withdrawn

Clients who overwhelm themselves

Clients who blame others

Clients who deny needing help

Clients who are overly dependent on you

Clients who manifest passive-aggressive behavior

Clients who rely primarily on their intellect.

Clients who use emotion as a defense.

Contributors to Resistance: Client-Based

Feelings of Hopelessness

Fear of Change or Fear of Success

Self-Punishment

Perfection and Grandiosity

Reactance and Rebelliousness

Secondary Gain or Hidden Agendas

Resistance created by fear or discomfort

Fear of Disclosure or Shame

Pessimism, Depressive Outlook, and Lack of Risk-Taking

What Behaviors are We Likely to See?

Arguing: challenging, discounting, hostility

Interrupting: talking over, cutting off, defensive manner

Denying: blaming, disagreeing, excusing, claiming impunity, minimizing, pessimism, reluctance, unwillingness to change

Ignoring: inattention, no reply, inaudible reply, sidetracking

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How Do We Define Resistance?

Behavior designed to avoid exploring personal conflicts or painful feelings.

Reluctance to bring to conscious awareness threatening material that has been previously repressed or denied.

Any client behavior that shows a reluctance or unwillingness to comply with treatment interventions.

Contributors to Resistance: Counselor Induced

Counselor's Moralistic Attitude

Client-Counselor Mismatch

Love-Hate or Transference Problems of Counselor and Client

Counselors' Countertransference Problems

Transference

Examples of transference situations include:

Clients who make you into something you are not

Clients who see you as a super person

Clients who make unrealistic demands on you

Clients who are not able to accept boundaries

Clients who displace anger on you

Clients who easily fall in love with you

Countertransference

Signs of potential countertransference effects:

You become irritated by certain clients

With some clients you continually run overtime

You quickly take pain away from a grieving client

You regularly feel depressed after seeing a particular client

You are aware of typically working much harder than your client

You become aware of giving a great deal of advice and wanting to have clients do what you think they should do.

You find yourself lecturing or debating with certain clients.

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Reactive Counselor ResponsesArguing, disagreeing, challenging Judging, criticizing, blamingWarning of negative consequencesSeeking to persuade with logic or evidenceInterpreting or analyzingConfronting with authoritySarcasm or incredulity

Resistance Reframed

Outdated Coping Strategy

Ambivalence About Change

Counselor-Client Struggle

Signal of important client issues

Therapeutic Alliance

The relationship between the therapist and a client; particularly the collaborative aspect of the relationship that includes three components:

The emotional bond that allows the client to make therapeutic progress.

Agreement about the goals of treatment

Agreement about the therapy tasks to accomplish the goals

Collaborative Communication

Use empathic understanding

Express nonjudgmental understanding

Avoid "hierarchical" dialog

Encourage process discussions

Tolerate ambiguity

Use appropriate self-disclosure

Reactive vs. Reflective Responses

Arguing, disagreeing, challenging

Judging, criticizing, blaming

Warning of negative consequences

Seeking to persuade with logic or evidence

Interpreting or analyzing

Confronting with authority

Sarcasm or incredulity

Simple Reflection

Amplified Reflection

Double-sided Reflection

Agreement with a Twist

Shifting Focus

Reframing

Therapeutic Alliance

Ruptures

Reenactments

Resistance

Activity

References Corey, M. S. (2007). Becoming a Helper (5th ed.). Belmont, CA: Thomson Brokks/Cole.

Ellis, A. (2002). Overcoming Resistance: A Rational emotive Behavior Therapy (2nd ed.). New York: Springer Publishing Company.

Horvath A. O. & Luborsky, L. (1993). The Role ot the Therapeutic Alliance in Psychotherapy. Journal of Consulting and Clinical Psychology, 61(4), 561-573.

Miller, W. R. (2002). Motivational Interviewing: Preparing People for Change. New York: Guilford Press.

Mitchell, C. (2015, January 30). "You Can't Make Me": Effective Techniques for Managing Highly Resistant Clients. Retrieved July 13, 2015, from http://www.continuingedcourses.net/active/courses/course036.php

Teyber, E. &. (2011). Interpersonal Process in Therapy: An Integrative Model. Belmont, CA: Thomson Brooks/Cole.