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Our clients show up to therapy in all stages of readiness. Sometimes, they’re ready to act, while others are more contemplative. Therapy asks people to change and be vulnerable, and resistance is often a protective response to that process.
Client resistance is a universal experience, but can manifest in many ways. The circumstances that bring your client to the session and cultural values can determine how and when you’ll encounter resistance.
Whether you’re meeting virtually or in person, you can use many strategies to prevent and work through client resistance while maintaining a strong therapeutic relationship.
Understanding client resistance
A client may resist the therapeutic process as a whole or put up defenses in response to tough topics.
Common forms of resistance in therapy
Cancellations happen, but consistent missed appointments could indicate that your client is experiencing resistance, even though they may not see it that way.
Another common form of resistance is cynicism and defensiveness. Your client might express attitudes like “This sounds great, but it won’t work for me” or a sense of hopelessness: “Nothing can help, nothing can change.” Or, your client might spend time intellectualizing as a defense against difficult emotions.
Your client may experience progress regression. When this happens, it’s important to remember that therapy isn’t linear. Regression and resistance are natural steps as your client works to change things they’ve been doing for years or decades.
Underlying reasons for resistance
When we experience resistance, there is always an underlying reason. Identifying the cause is key to moving beyond it.
Fear of the unknown
Fear of the unknown is the biggest cause of resistance that I see. People across cultural and geographical boundaries all experience hesitancy towards what is risky occasionally. This is a biological response—fear is a mechanism in our brain that keeps us safe.
Guilt or shame
When resistance occurs around specific parts of our client’s lives, guilt or shame is sometimes the underlying experience. Every therapist knows that a client may not willingly go towards the topics that can bring up uncomfortable feelings, and moving into that vulnerable space can trigger some resistance.
Preservation of their identity
As we grow up, part of our individuation involves looking at our value system and deciding what’s important to us. That process can push up against our cultural upbringing, and we might experience a loss of identity. When our client is attempting to do something that might contradict their family values, resistance can occur when that loss of connection is felt.
Even the things we want to let go of, like anxiety, can cause us to experience a loss of identity, and this can catch the client off guard and result in resistance.
Identifying the signs of resistance
Recognizing resistance as a common part of the therapeutic process will help you anticipate it.
Behavioral indicators
- Frequent cancellations or no-shows
- Non-compliance with therapeutic tasks
- Minimal participation
- Hostile or defensive attitudes
Emotional indicators
- Hopelessness or an overly positive attitude
- Withdrawal or lack of engagement
- Doubt or skepticism about therapy
- Regression in progress or symptoms
Strategies for working through resistance
I once had a client who was a working mom. She was struggling with overwhelming stress and high anxiety, and she was feeling out of control in a lot of places in her life. While she was very verbally motivated, she was immediately quite resistant to the therapeutic process. Much of our first session was spent on intellectualization.
After our first session, I focused on changing the language of therapy to her language. For example, she hated the word homework. Then, I moved into motivational interviewing, which allowed her plenty of open-ended space to meander in our conversation. I noticed she began feeling more comfortable and in control of our session.
I also checked in with my sense of pacing—we were limited in time, and I felt pressure to move fast. I pulled back to match her pace so that she could continue to feel in control of the process. By our third session, she showed up ready, and we could move forward.
A strong therapeutic relationship is essential to working past resistance
Our therapeutic alliance was strengthened when I adjusted my pace, language, and clinical approach to meet my client in her comfort zone.
Here are some guiding principles for maintaining your therapeutic alliance as you navigate resistance:
- Practice active listening
- Adjust your language to fit the client’s comfort zone
- Practice empathy and compassion
- Validate and normalize the client’s experience
- Explain what’s ahead
- Circle back to the client’s goals
- Educate the client on how the brain works and how the therapeutic process works
- Get informed consent to share and make suggestions
- Get curious about defensiveness
How to create a safe, non-judgmental space for your client
Part of creating a safe space is simply cutting out distractions and listening with all my senses. What do I hear? What do I see? What is going on with this person? It’s important to ensure that I’m fully present, especially in virtual sessions.
Another imperative practice is to do what I say I will do. In my practice, I rely heavily on the “Plan” part of the notes I share with my client. Even small actions like sending a book recommendation can help to establish safety.
Addressing resistance in in-person sessions
Handling missed appointments
When a client is missing sessions, we want to approach them from a place of concern. An attitude that says, “Help me understand what’s happening for you,” can help the client feel safe addressing their resistance.
Consent and permission are very important parts of this conversation. You may ask the client for permission to share an observation about participation-related resistance. This can be very diffusing, as the client can consent to hear you out or simply say no.
Managing cynicism and defensiveness
Curiosity is one of my favorite tools in the therapy room because it is absent from judgment and expresses interest in the client’s experience.
Approaching the client from a curious space may look like:
- “I’m noticing X”
- “I’m curious about X”
- “This is how it feels to me…am I sensing that right?”
If cynicism or hopelessness arise, it can be helpful to normalize the experience. Let your client know that it’s okay to feel challenged or even uncomfortable by what is being asked of them.
The client must understand that sometimes, our depression, anxiety, and trauma responses are our body’s way of trying to help us do what it thinks will be helpful. Normalizing the experience of resistance as something shared by everyone engaging in the therapeutic process can help the client see it as a stretch of the road rather than a roadblock.
Handling progress regression
One of my favorite questions I ask my clients is this: “If you look ahead three months, six months into the future—what is going to look different for you to know that our work together was helpful?”
The answer my client provides can anchor us when we encounter resistance later. I might check back in, remind my client what they said they wanted to see change and ask if that’s still what they want. What has changed?
Addressing resistance in virtual sessions
Some of the challenges of virtual sessions are the same as in-person ones, like missed appointments and defensiveness, but there are some experiences that are unique to virtual sessions.
Getting control of our environment
In virtual sessions, you don’t have control over the room your client is in. They might be in their bedroom, an office, or even their car. Distractions, too, can happen on your end.
I structure virtual sessions by checking in at the beginning and the end. Initially, I ask them about what’s going on in their lives in real time. What do they want to discuss before we jump in?
Then, I check in again at the end to be sure we’ve talked about everything they wanted to. Is there anything we didn’t touch on?
Ensuring that technology is easy to access and use
Technology that isn’t intuitive or accessible can activate fear of the unknown, creating resistance before the session even begins.
One of the things I hear from my clients all the time is that Spring Health’s platform is easy to use. Many have been looking for therapists for a long time and have had trouble identifying available providers. The Spring Health platform is set up so that if they see someone online, it’s only because they’re available.
Having intuitive technology sends a message to the client that says, “We’re here, we’re ready for you.” Our members in over 100 countries can see a provider in under 3 days on average globally. With wait times around the world varying between 3 months and up to a year, this can make all the difference in the lives of my clients and their families.
The seamless user interface makes it more likely for members and their families to access care, and as a result, they see a reduction in turnover and absenteeism in as little as six months.
Maintaining a strong therapeutic relationship
Universal, client resistance is highly individualized—and so must be our response. Localized care and the ability to understand the unique cultural, linguistic, and environmental factors in your client’s life are essential to establishing trust and moving beyond resistance.
A strong relationship with your client and their ability to trust the process directly impacts client outcomes. Empathize with your client, validate their experience, and provide basic education on the therapeutic process.
Foster a collaborative and empowering environment
67% of people feel that being given a voice—to ask questions and voice concerns—is essential to success in changing a behavior. When clients participate in goal setting and planning, they’re more invested, and resistance is easier to manage.
You might have a great goal that you feel is perfect for your client, but if they want to set a different goal, go with theirs. If you can work through their goal first, they build confidence and trust. Often, they’ll become open to hearing suggestions from you.
Practicing informed consent, you can suggest goals, and if your client chooses them, they carry more importance in the face of resistance.
A healthy perspective on resistance
- Client resistance is a natural part of the therapeutic process
- Anticipating resistance and identifying the sign can help you get ahead of it
- Resistance can manifest as missed appointments, defensiveness, cynicism, and progress regression
- Empathy, curiosity, and normalizing the client’s experience are key to moving past resistance
When you encounter resistance, remember to be patient. Understand that change can take time and that resistance isn’t a reflection on you as a therapist. More often, resistance is simply a part of the process. Stay patient, stay supportive, and have self-compassion.
Unlock seamless mental health support with Compass, Spring Health’s clinician-designed intuitive, and efficient client platform.
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