This interview/article appeared in Counseling Today, Feb. 2010
Managing Resistant Clients
Lynne Shallcross, senior writer for Counseling Today magazine
You can't change anyone else; you can only change yourself. Many counselors have used this common bit of wisdom to help clients overcome problems, but it's crucial that counselors internalize that idea themselves, says Clifton Mitchell, a professor and coordinator of the community agency concentration in the counseling program at East Tennessee State University.
"We tell our clients things like, 'You can't change other people; you can only change yourself.' Then we go into a session trying to change our clients. This is hypocritical," says Mitchell, the author of Effective Techniques for Dealing With Highly Resistant Clients, which is in its second edition. "I teach, 'You can't change your clients. You can only change how you interact with your clients and hope that change results. That's all you get.'"
The concept of counselors focusing exclusively on their interactions with clients and letting change happen on its own is key to the successful management of resistance and the pivotal point of effective therapy, says Mitchell. For 10 years, the American Counseling Association member has studied and presented seminars on dealing with resistance in therapy. "Although most therapists have been trained extensively in theoretical approaches, few have had extensive training in dealing with resistance," he says.
Conventional thought defines resistance as something that comes from within the client. In other words, says Mitchell, "If you're not buying what I'm selling, you're resistant. Those definitions have existed for years in the mental health literature. The problem with that is it makes it difficult to do something about it."
But times and definitions of resistance have changed, he says, removing the blame for resistance from the client and putting the responsibility squarely on the shoulders of counselors. Modern definitions come from social interaction theory, Mitchell says, and indicate that resistance doesn't exist until a counselor and client have a conversation; resistance is borne out of the interaction style. "This says if what you're doing with the client is not working, then do something else because your interaction is creating resistance," he says. "The beauty of viewing resistance from a social interaction theory is we're empowering ourselves to do something about it." Mitchell defines resistance as something "created when the method of influence is mismatched with the client's current propensity to accept the manner in which the influence is delivered."
When counselors label a client's behavior as resistant, typically, one of two things has occurred, Mitchell says. "Either we do not have a technique to manage what is going on in the interaction at the moment, or we do not understand enough about the client's world to understand why they are responding the way they are. So, we label them as resistant as a result of our inability and lack of therapeutic skills. There is always a reason the client is responding the way they are. Our job is to understand the client's world to the degree that we see their behavior for what it is and not as resistance."
Another shift in thinking that can benefit counselors? Accept that resistance isn't always inappropriate, says Robert Wubbolding, director of training for the William Glasser Institute and director of the Center for Reality Therapy in Cincinnati. "It is a client's best attempt to meet their needs, especially their need for power or accomplishment," says Wubbolding, an ACA member and professor emeritus at Xavier University. "Resistance is a universal behavior chosen by most people at various times. Sales resistance is helpful for the purpose of practicing thrift and saving money."
Clients are sometimes resistant because the counselor is asking them to deal with an undesired agenda, Wubbolding says. "Resistance means we're working on the wrong problem a problem that the client doesn't care to work on. Counselors need to connect with the client in order to find the right problem. I suggest connecting on the basis of clients' perceived locus of control. Many clients resist because counselors focus too quickly on the clients' feelings, behaviors or sense of responsibility. If a client resists because they feel everyone else has the problem, then focusing on the client presents a miscommunication."
A dose of reality
Wubbolding uses a reality therapy approach to reduce resistance. "The counselor needs to help (clients) see that their resistance is not to their advantage," he says. "As a teacher and practitioner of reality therapy, I suggest that the counselor begin by asking clients what other people in their environment are doing to them, how they oppress them, reject them, make unreasonable demands on them and control them. It is important for counselors to connect with clients on the basis of the client's reality rather than putting emphasis on the counselor's agenda. In other words, the counselor may want the client to make better choices, but without connecting with the client's perceptions in the beginning of the counseling process, the counselor might facilitate more resistance rather than less."
"Then," Wubbolding continues, "the counselor can help clients explore what they've done to get people off their back and to do what they want them to do. The key here is questions focusing on self-evaluation such as, 'Have your efforts been successful?' Clearly, they have not been successful, so when clients decide that what they've been doing is not working for them, they are more inclined to make alternative choices. Thus, self-evaluation is key in dealing with resistance." Wubbolding offers the example of a teenager who is flunking out of school, taking drugs and being rebellious toward school personnel and his parents. "Connecting with this individual on the basis of perceived victimhood and external control is often effective and serves as a basis for asking crucial questions: Have you tried to tell these people to leave you alone? How have you tried? Is what you're doing to get them off your back working? Is there any chance that telling them one more time is going to do the trick?"
"It seems to me," Wubbolding might tell this resistant client, "that you have two choices" to continue down your current path or to choose a different path. "You can continue to do what's not working, or you could try something different. One road maintains the misery you (currently) have and will probably make it worse. The other road will more than likely help you if you're willing to give it a try."
"After connecting with the clients' perceptions, their sense of external control or sense of being controlled," Wubbolding says, "the counselor can proceed to inquire as to whose behavior the client can control, what choices are available and whether making a change is either possible or desirous."
A two-way street
Newer definitions of resistance empower counselors to exert more control and influence over the situation, Mitchell says, but these definitions also place great responsibility on practitioners to keep things moving forward. "If you feel your client is resisting you, you also must be resisting your client," Mitchell says. "Resistance goes two ways. The challenge is having to find more creative and different ways to interact."
It's a task worth tackling, Mitchell contends, because the degree to which a counselor effectively manages resistance can determine whether therapy is successful. "Therapeutic outcomes are determined by how well we manage the places in therapy where 'stuckness' appears to occur," he says.
The counselor-client relationship is key to helping the client move forward, Wubbolding says. "Clients are less resistant if they feel connected with the counselor. If counseling is to be successful, the client must be willing to discuss the issue, examine it and make plans. If clients will not disclose their inner wants, actions, feelings and thinking, change is very difficult. But in the context of a safe, trusting relationship, they are more likely to disclose such information. After clients lower their defenses, they can then more freely discuss their inner thoughts and feelings. After this occurs, the counselor can help them conduct a more fearless self-evaluation."
Also important, Mitchell says, is having a mutually agreed-upon goal. It's all too easy for counselors to put themselves in situations where they have a goal in mind for the client, but the client either isn't aware of or doesn't agree with that goal. If the client-counselor relationship is key to good outcomes, Mitchell says, a mutually agreed-upon goal is the key to a good client-counselor relationship.
Mitchell admits that receiving "I don't know" answers from clients can be frustrating and make counselors feel as though they aren't getting anywhere in session. But he advises counselors not to grow discouraged or to waste time fighting the client's response.
Responding, "Oh, yes, you know the answer," will only create resistance and force the client into a defensive position, Mitchell says. "The safest way to respond to an 'I don't know' response is to accept it, embrace it and empathize with it," he says. "If you do that, you will decrease the defensiveness that comes with fighting it."
If a counselor empathizes with the client and agrees that the problem is difficult to figure out, the counselor is indicating that he or she is joining the client in the attempt to find a solution, Mitchell says. Too often, he adds, counselors make the mistake of treating an "I don't know" answer as a barrier rather than an opportunity to work with the client. "Use it as a doorway into the struggle," he says. "Most people don't realize it's a great place to get to." Assuming the role of "expert" can also get counselors into trouble with resistant clients, Mitchell says. When a counselor gives ideas or suggestions related to a client's problems and starts hearing "Yes, but ..." answers, it's time for the counselor to vacate the expert seat, he says. "You need to stay in a naïve, puzzled, unknowing, curious position. You need to not have knowledge; you need the client explaining to you. We want them talking, not us talking. If you're not buying what I'm selling, I need to quit selling." Encouraging clients to analyze their situation and explain it to the counselor is important, Mitchell says, because in the process, they might discover insight for improving the situation.
Mitchell also exhorts counselors to do the unexpected. "Typical responses beget typical answers, and typical reactions keep clients stuck in their situation," he says. "Resistance is fueled by the commonplace. The client is likely expecting the same type of response from you and already has a rebuttal waiting. If socially typical responses were effective, we would not need therapists. Why do the unexpected? It disrupts patterns of thinking and responding a key to creating change."
Perhaps the best way for counselors to avoid resistance with clients is to allow change to happen on its own, Mitchell says. If a counselor enters the therapeutic relationship and pushes the client to change before that person is ready, resistance will be the likely result, he says. Instead, he advises counselors to simply listen to the client and focus on not creating resistance and not fostering defensiveness. Then, step back and let change happen, he says. "If you go in there and make not creating resistance your first priority and let the change come as a second priority, with highly resistant clients, you're more likely to get change."
Counseling Today asked Mitchell and Wubbolding to weigh in with their best recommendations for managing resistance in the counseling relationship.
•"Stay out of the 'expert' position," Mitchell says. "The more resistant the client, the less knowledge you should profess to know. The more motivated the client, the more knowledge you can express."
•"Don't collude with clients' excuses," Wubbolding says. "Don't buy into and encourage feelings of victimhood and powerlessness. Discussion of these perceptions are useful in the beginning of the counseling session, but the counselor needs to move beyond them and lead the client beyond them. There is a French saying, Qui s'excuse s'accuse. Whoever excuses, accuses. Facilitating feelings of powerlessness only communicates to clients that they are powerless. This is a disservice to them." Empathize, but don't sympathize, he says. "Try to see the client's point of view without communicating a sense of victimhood."
•"When you encounter resistance, slow the pace," Mitchell says. "Trying to go too fast is a perfect way to increase resistance. Only take baby steps with resistant clients."
•"Don't argue," Wubbolding says. "This creates more resistance."
•"Focus on details. The devil is in the details, and so are all solutions," Mitchell says. "Details create options. If you do not have enough options, you do not have enough details about what is occurring in the client's situation. All therapeutic breakthroughs come from addressing and processing a detail in the client's life that no one has ever discussed and processed before."
•Leave blame out of it, Wubbolding says. "Don't blame the client, and don't blame the people they think are creating their problems."
•"Always treat the resistance with respect," Mitchell says. "The client has a reason for what they just said, (so) respect it."
•"Seek emotionally compelling reasons for change," Mitchell says. "Do not waste time trying to create change through logic. If people changed because of logic, nobody would smoke or drink and everyone would have an exercise program and get eight hours of sleep. When people make major changes in their life, they don't do it because of logic. They do it because they have an emotionally compelling reason."
•"Stay out of an excessive questioning mode of responding with resistant clients," Mitchell says. "Questions are micro-confrontations with resistant clients that invite unproductive answers. Excessive questioning is the primary means by which therapists get sucked into the client's 'stuckness.' Learn to dialogue without questions."
Ultimately, all therapy comes down to the successful management of resistance, Mitchell says. "Most therapists approach clients from the perspective of creating change. They would benefit themselves greatly if they would approach clients from the perspective of not creating resistance and let change occur as a natural result of the client exploring his or her own world."
Lynne Shallcross is a senior writer for Counseling Today. Contact her at firstname.lastname@example.org. Letters to the editor: email@example.com.