module 12;client resistance schedule Flashcards
explain what resistance is
Resistance is a protective mechanism and a way of coping with difficult emotions aroused in the process of change. At first, a client may appear unwilling or unable to change, and this can be very challenging for a therapist. It can raise their own anxiety, which can, in turn, lead to resistance. The resistance can be expressed by coming late, missing appointments, changing the subject of conversation, and may also account for drop out rates. It is important to remember, however, that this is different from reality-based constraints.
Resistance can have both a positive or negative impact on therapeutic relationship and needs to be worked with wisely. Is a normal response.
PSYCHOANALYTIC VIEW OF RESISTANCE
unconscious defense, designed to prevent painful feelings or ideas of the self from entering a person’s consciousness. Originally viewed as a nuisance, resistance was later considered an important source of information.
COGNITIVE VIEW OF RESTANCE;
normal and healthy protective mechanism. It is essentially thought that a person maintains their core beliefs or personal schemata, and that a confrontation of these core beliefs is what leads to resistance. However, this must be confronted to move forward.
outline some theoretical views on resistance
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describe common issues with resistant clients
Clients may be resistant because;
1.fear change
2. not changing holds some kind of appeal eg “I can’t stop being depressed because I am an intellectual and all the best writers were depressed”
3.Do not like being told what to do. View therapist as a dictator.
4. Are not actually ready to change, still in contemplative stage.
5.Change is driven by therapist and not by client.
6. Client views therapists as being like someone from past (transferance)
7.Other factors impede eg non sympathetic/abusive spouse, timetabling, ability to get to therapy etc
Characteristics of resistant clients include
-non compliance with homework
-argumentative
-responses of short non valuable utterances eg “I don’t know”
describe issues with resistant therapists
Therapists can be resistant in terms of not wanting to change their approach, not wanting to terminate therapy because like the client/worry about client after therapy. Need to be able to reflect on one’s own weaknesses and not view resistance as a direct personal challenge, but something that the client feels driven to do as a protective factor.
discuss resistance in relation to goal setting, termination and other key areas
need to be clear right from start what are the goals, why are we in therapy, finite time etc. Revisit notes and client agreements with them.
outline strategies for dealing with resistance.
“Resistance is a signpost that there is work to be done. Rejoice in it and empathise with the client because it is hard work, and so some level of resistance is perfectly understandable.”
“Resistance=some kind of threat is being experienced. Need to find it, soothe it, back up, and approach with less threat.” ie Titrate response. Smaller steps. lower goal.
“if encountering resistance, turn mirror on oneself. Are you demoralised/angry/feeling challenged/lacking in belief in client’s commitment?? Maybe normal responses but need to be acknowledged and worked through.
“We are all resistant because our old patterns were at some point adaptive. Needs to be spellt out-this is your old patterns, and we’re going to change it via this method.”
“People don’t actually want to resist, but they just don’t believe the healing can happen, so feel safer to keep people out. Be respectful of resistance because it has in the past, keep people safe. REspect it and find out about it and honour it.”
The protective factors such as resistance in trauma cases are always on high alert. Can be difficult to even breathe deeply. Some people resist even this little bit because when start ti experience something, get overwhelmed. So sometimes first step to overcoming resistance is just even getting used to being able to breathe deeply or blow a bubble or open arms wide etc.
Resistance exists for a reason. Some say it just means therapy is taking place. Sometimes resistance is because client fears being hurt or shamed or just needs to be adequately heard.
“Resistance should be welcomed, as it means client is doing something to “get in the game and engage the therapist”.
There are three ways to deal with resistance:
-Invite the client to speak freely. Be tentative. For example, ask questions such as, ‘can we talk about how you feel?’, ‘I noticed you were 20 minutes late …’, ‘maybe it doesn’t mean anything …’, ‘do any thoughts come to mind?’.
-Explore the danger or threat. Explore what your client fears in speaking openly. For example, ask questions such as, ‘can we talk about what might be preventing you from speaking?’.
-Interpret resistance directly. This should be kept as a last option. For example, raising assumptions like, ‘I’m wondering if you’re concerned I will judge you …’.
Psychological, social and biological factors interact, so a complex process is not a client’s fault. It is key to be aware that people are doing the best they can at the time, and that all clients are motivated to change in some sense.
Be tentative in your approach and remember that it is important to be determined to face your own resistance about dealing with resistance. During the process, focus on dealing with emotions by asking questions such as, ‘can we stay with that feeling for a moment?’.
You also need to always respect your client’s right to choose and go at their own pace. You can role model facing up to challenges by using here and now interpersonal process comments.
explore if client is fearful or lacking in self-confidence why this might be the case.
Allow clients to have some choice eg homework assignment of this, that or combination. allow choice of book reading etc.
Break down tasks into smaller components and try again. check explanations and understandings.
Socratic questioning can be very useful in that then client has come up with the idea and therefore has less resistance to it.
STAGES OF CHANGE
1.Contemplation: This is the high ambivalence stage. Here, the focus is first on problem clarification, then a review of expectations and previous successes or failures is carried out. Discuss what change means to your client and make a pros and cons list. It is crucial to not move too quickly during this stage.
2.Determination: Here, we generally see ambivalence, but also resolve. Help your client consider their options and the best approach. During this stage of support, feedback on progress and the overall relationship are all important.
3.Action: This is where you focus on putting everything into action, and breaking down tasks into manageable parts.
