As therapists, we are natural healers and helpers. We build a strong alliance, set goals, implement interventions, and achieve positive outcomes. More than anything, we want our clients to make consistent gains toward their therapeutic goals. Marriage and family therapists (MFTs) are acutely skilled and interested in shifting negative patterns in their lives and relationships. We are holistic in our approach and want our clients to connect with their strengths and make desired changes in their lives.
MFTs treat individuals, couples, and families and view problems in the context of relationships. We meet a range of clients in our practice and face various issues. One of the most challenging therapeutic presentations is resistance. When a client resists therapy, it leaves the therapist feeling discouraged. Even a seasoned therapist will tell you that resistance can make them feel deskilled, stuck, and unsure of what to do next.
There are, however, other ways to frame this experience. While uncomfortable, resistance provides essential information about what is happening in the client system. As MFTs, our training tells us that this is an isomorphic moment. Resistance is a standard defense mechanism activated in response to fear. It may serve an adaptive purpose to the client but feels like a barrier to the therapist.
Therapeutic resistance can be covert or overt, showing up in several different ways. Clients may come in for therapy with their spouse and announce that they don’t believe treatment works. In this instance, the resistance is manifest. Another client may resist therapy due to a cultural norm according to which accepting outside help cannot solve personal problems, or at any rate is embarrassing. Yet for others, resistance may be a symptom of another problem. It may be the discouraged or fearful surface response of someone who is feeling depressed or anxious. Either way, we need to have some strategies for recognizing and handling resistance so that we don’t miss the opportunity to connect clinically with our clients.
Here are some ways to work with resistant clients:
- Use it as an opportunity to join and build trust with the client: If a client announces that therapy is not for them, do not try to convince them otherwise. Instead of making a sound argument for the benefits of therapy, be agreeable and curious. Our job is not to persuade anyone to believe in therapy but rather to validate their perspective and gain more understanding of their narrative about therapy.
- Check-in and ask for feedback: It is important, in the first place, to notice the resistance which may be masked by broader cultural beliefs. You may think your alliance is strong and your connection with your client is close. However, the client may still be harboring resistance and concealing it from you. Therefore, check-in and ask specific questions and invite direct feedback. For example, you may let your client know upfront that the therapeutic process takes time, and the therapist might miss something important to the client. Encourage the client to ask clarifying questions and to give candid feedback about what is and is not working for them.
- Keep an eye out for underlying causes of apparent resistance: If your client is in a cycle of “help-rejecting complaining,” remind yourself that it is not personal, but it may be a symptom of underlying depression or anxiety. Clients who present themselves as high functioning may appear to be resistant when in fact, they are experiencing inner turmoil. We need to be sure that we check-in and are screening for any underlying conditions before concluding that the client is being “difficult” or not open to help.
Our work as therapists can be rewarding and challenging. When you find yourself overwhelmed or puzzled by resistance, seek professional supervision. The objective feedback of another MFT can relieve the stress of working with resistance.