Resistance is an age old issue in psychotherapy. The argument that resistance doesn’t exist and is only caused by the therapist is also an old one. Here is how I experience this issue in my practice.
It’s clear that whenever the therapist has either a belief or agenda that you can easily encounter resistance.
For example, if I believe that if my client can only experience anxiety if they have negative thoughts, then if my client says “I’m not having negative thoughts but I’m still having anxiety”, that will often be labeled resistance.
If I have an agenda that my client ought to recognize that his relationship with drugs is harmful and that he ought to consider stopping, and my client doesn’t follow my agenda, that will also often be labeled resistance.
In my practice, I don’t do agendas (for the most part). I do not see it as my job to fix the client, help the client, or change the client. Rather I work for the client. The client decides where he wants to go, and my job is to help the client get there. I might suggest some ideas of good places to go, but that’s all they are. Ideas and suggestions for the client to consider. Ultimately it’s the clients choice and I wouldn’t have it any other way. And so if my client doesn’t want to stop taking drugs or doesn’t want to change her relationships for the better, that’s fine. It’s not resistance, rather it’s something the client isn’t hiring me to help them with. I find that I can’t do therapy without knowing first what the client wants.
Another helpful piece is the fact that my beliefs are flexible and have breathing room. While I believe that for the most part communicating openly is helpful for relationships, I’m open to the possibility that it isn’t always the case. While I believe that for the most part emotional avoidance isn’t helpful, I’m open to the possibility that it isn’t always the case. And so when my client challenges my beliefs and says “When I communicate more openly things get worse”, that isn’t resistance. It’s simply the client reporting back to me on what they experience in their own life and relationship. And I’m open to the possibility that they are correct.
In essence, both the destination and the way to get there are both in the clients hands. I might offer suggestions and ideas based on my experience, but ultimately the client is the one who gets to make the decision.
At the same time, I do not hide what I think. If I think something is unrealistic or won’t work, I will tell the client. But I recognize and say explicitly that it’s only my opinion and that I might be wrong. At that point, it’s the clients choice as to if they want to pursue that course of action or change directions.
This process of choosing a destination and a course of action is not a one time thing. Rather it happens over and over as we collect data on what is or isn’t working.
So let’s see how this plays out in practice…
A client comes to me complaining about anxiety. I take a detailed history, and then ask the client what he wants to accomplish in our work together. The client says that he wants to live a life with no anxiety ever.
So far so good.
At this point, in my own mind, an alarm bell is going off. It’s saying “unrealistic goal”. And so I share that with the client. I say:
“I’m hearing that you want to live a life with no anxiety ever. I have to say, that in my experience I don’t really know anyone who never ever has any anxiety. I’m not saying it can’t be done, but I would be very very surprised if we were able to pull it off. Now I might be wrong, this is but my experience and opinion. What do you think?”.
Sometimes the client will pull back and say “ok, so what is something we can pull off”.
Sometimes however, the client will say “that’s what I want and I don’t care if it’s unrealistic”. In either case, at this point I respect the clients choice. I believe that they might know something I don’t and therefore I might be wrong. And so I’m willing to go with the client and try it out.
And so we try. And we try for a few weeks. And after a few weeks the client might feel stuck and frustrated that “it’s not working”. And the client might even get upset at me for being such an incompetent therapist! And all this is a good thing. It’s data that is piling up that will help the client make his next decision.
So when we have that conversation, the one where we talk about how we aren’t making progress towards the clients goals, I will ask the client what he thinks is going on. And he might have ideas, and we might use some of them to experiment further. He also might have no ideas and he might ask me for my opinion. And I’ll tell him.
“So we have been trying this ‘no anxiety ever’ thing. And it doesn’t seem to be working. Now of course, this doesn’t mean it’s impossible. It can just be because I’m not a great therapist, or because we haven’t tried long enough, or because of some other reason. My guess is that it’s because ‘no anxiety ever’ isn’t very possible. But of course, I might be wrong. What do you think?”
And back we go, round and round. The key here is to notice the process.
1. I find out what the clients desired destination is.
2. I give ideas and suggestions based on my knowledge, observations, and experience, and the client can either use them or not.
3. I find out how the client wants to get to the destination.
4. I give ideas and suggestions based on my knowledge, observations, and experience, and the client can either use them or not.
5. We try it!
6. If it’s working, great! If not, I point it out to the client, and with this new data in hand (the fact that we tried and this is what happened) we go back to step 1.
This process can happen every few session or even as often as every session. It doesn’t have to take long. As clients get used to it (many of them aren’t used to being in the drivers seat), it starts taking quicker and quicker.
As you can see, using this process there is very little opportunity for resistance. Since I have no agenda and no beliefs set in stone, there is very little for the client to push up against.
In the next installment of this series I will talk about exceptions, as well as what I do with clients who often use the term “I don’t know”.
Please post your questions and comments down below,
JYK
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