Resistance in Therapy

As therapists, addressing resistance in therapy is part of the job. 

Even if a client has positively responded to interventions throughout the therapeutic process, they may have challenges they don’t want to face. Then, there are other clients who are resistant to change or progress altogether. 

When faced with resistant clients in therapy, the key is finding ways to meet clients’ where they are, focusing less on resistance and more on what the client needs to feel empowered in their situation. 

In this article, I’ll address signs of resistant clients in therapy, strategies and techniques to support families and clients experiencing resistance in therapy, and some first-hand clinician insight encouraging us to look underneath the cover of resistance.  

What is resistance in counseling?

Resistance in therapy is a complex topic. Its definition depends largely on your theoretical orientation and training. Theoretical orientations contribute to how we define resistance in psychotherapy and the potential implications it may have on the therapeutic relationship. 

For example, a systems theory approach might consider resistance as a self-protective attempt to maintain the system. 

Psychological and psychoanalytic perspectives may also view resistance as a defense mechanism used to avoid stress and change, which might look like:

• Unwillingness or non-compliance to participate in the therapeutic process
  
• Repressing unconscious memories (also called transferential resistance)
  
• Opposition to interventions and resistance to change

An anti-oppressive perspective, however, leans in to question resistance altogether, asking if the resistance could be, for example:

• An oppressed person asserting agency

• A response to the therapist’s rigid adherence to a protocol
• A poor therapeutic alliance

Janet Finn, PhD, Professor of Social Work at the University of Montana-Missoula, believes it’s important to consider alternative views about the meaning and power of resistance. 

In her book, “Just Practice: A Social Justice Approach to Social Work,” Finn writes: 

“A person resisting participation in the change effort may not be demonstrating pathology but may be actively asserting her right to protect herself, lay claim to her experiences and fears, and challenge those threatening to misinterpret her experience and silence her voice.” 

Finn goes on to explain the importance of “looking at the other side of the coin,” when seeking to address what we think is resistance. In other words, examining our own resistance and how invested we are in particular world views, theories, interventions, and expertise. 

It’s important to keep in mind that even if we try to center the client, there is an inherent power differential within the therapeutic alliance, with clinicians situated as the experts”  

When thinking about resistance, I believe it’s the responsibility of the clinician to gain better insight—through the lens of the client—into their survival strategies and find out the reason behind their resistance during the therapeutic process. 

It’s important to self-examine your role, as the therapist, in the client’s resistance. Evaluate the strength of the therapeutic relationship and consider any countertransference—your projection of personal experiences or judgements on the client—while finding ways to better meet the client’s needs. 

Types of resistance in therapy

If your clients show any of these signs of resistance in therapy, you may need to address it in your work with them: 

Lateness or cancellations 

If a client is repeatedly late or cancels appointments often, this could be a sign there is an unmet need or break in the therapeutic relationship. 

Verbal resistance 

Small talk, silence, indifference, or monosyllabic responses can all be a sign of resistance. In some instances, silence or withholding communication can be a sign of opposition to therapy—especially in response to being mandated to attend therapy.  

Avoidance 

In individual therapy, a client may refuse to participate in homework or engage in the therapeutic process. Avoidance can also be a type of resistance in family therapy, where one family member deflects attention from themselves or derails difficult conversations. 

Denial 

Clients may not want to acknowledge the seriousness of a situation or accept responsibility, or they blame others. 

Questioning or challenging the therapist 

This might look like questioning the clinician’s experience, but it may also be a sign of self-advocacy. It’s important for you, as the clinician, to refrain from taking immediate offense—instead, examine the reason behind their behavior and self-reflect on how you’re choosing to respond to the challenge.  

Self-censoring 

The client may limit or withhold information when asked—either to control the course of therapy, or due to a lack of trust. I’ve also had clients that want to establish rapport before revealing a painful history or things they carry shame around. 

Interrupting 

Talking over or interrupting the clinician can be seen as a type of resistance. Alternatively, it can be a response to disagreeing with an oppressive view, or microaggression. Interrupting can also be a symptom of ADHD—so it’s important to rule these out before interpreting it as resistance in therapy. 

Resistance to an intervention 

A client may not want to participate in an intervention or stall the intervention, which may indicate fear. This includes fear of confronting trauma, who they may become after processing their trauma, or fear of being present in their lives or accountable for themselves.  

Lack of progress 

Resistant clients in therapy can appear unmotivated and fail to engage in the process. However, clients who disengage may do so because of a break in the therapeutic relationship, inappropriate treatment modalities, poor preparation on the clinician’s behalf, or an improper assessment contributing to treatment failure. 

Tips for resistant clients in therapy

Some ways to deal with resistance in therapy include:

• Try to understand the client’s point of view with curiosity by asking them clarifying questions, like “I’d love to understand more about your point of view. Can you elaborate on [X]?”
• Cultivate the therapeutic alliance by providing a safe, accepting, and affirming space where the client feels comfortable to share feedback and address disagreements. I like to preemptively address potential discrepancies in the relationship by explaining that I am human and may misstep from time-to-time. I then ask how the client would indicate a disagreement or conflict. For example, If I am working with a teen, I might suggest something like “I noticed that you seem quieter today/when I said [X]. Is something bothering you about what we discussed?”
• View conflict as an opportunity to model repair. Some clients may have lived in dysfunctional homes where repair conversations never occurred, and punishment or silent treatment followed conflict. They may be frightened of losing the therapeutic relationship or being punished if they mention certain things. Therapy provides a great opportunity to model healthier outcomes in uncomfortable situations. 

First-hand reflections on resistance

On a final note, I’m sharing my personal experience of resistance as an invitation to fellow therapists to consider alternative explanations when tackling perceived resistance. 

A few years ago, I was experiencing difficulties in my marriage and navigating the challenges of graduate school. I found a therapist who shared some of my identities and favored a modality that used practical tools that were helpful in addressing my concerns. 

However, I struggled with the group sessions she conducted, feeling like the pace was slow. I couldn’t pay attention and became more dysregulated by the end of the session than when I arrived. 

I also experienced significant frustration by the categorization used in radically open DBT of “over controller” to describe many mental health conditions, like my ADHD. This concept of “over controller” felt deficit-based and pathologizing. 

Consequently, I switched to individual therapy and, while that helped initially, I began to experience discrepancies in the relationship during individual sessions too. 

A significant rupture in our therapeutic relationship occurred when the therapist sought to challenge my meaning of a situation in a way that felt unhelpful. Instead, it invalidated my experiences and left me feeling like there was something wrong with me. 

I tried to address this rupture in the relationship by explaining I felt like I was being pushed into a framework that didn’t fit. However, I experienced more rigidity and imposition of this modality from the therapist, rather than curiosity around my experience. I ended that relationship, but for a while asked myself “Why am I resistant to therapy?”

Following this experience, I was fortunate to find a more affirming therapist, who sought to understand my perspective. We later discovered that I am autistic. This explained why I found certain situations and environments incredibly dysregulating. 

Through an affirming approach, my therapist empowered me to make changes to my environment (and relationships) that support my sensory and capacity needs, instead of trying to change my autistic traits to fit into a neurotypical world. 

It is my hope, now, as a therapist myself, to continue to consider the meaning and experiences of my clients and empower them to use solutions that work for them. 

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