The secret to undoing resistance is simple.
Like stupid simple.
Like, I’m going to tell you the answer and you’re not going to believe me because it’s going to sound stupid. Because it really is that simple.
Let’s return to this video from last week.
What is resistance in psychotherapy?
First, what makes this resistance?
Well, resistance is whenever a client opposes a direction set by the therapist.
In the above video Dr. Phil is basically saying, “there’s a connection between your mental health and your daughter's,” and the mom is basically responding, “I don’t accept blame for her mental health.”
This moment is important because resistance is therapy poison. The more resistance you have, the more the therapy is poisoned. That’s rule 1 of motivation.
That doesn’t mean if you do therapy “right” you won’t have resistance. Even in the smoothest sessions you’ll have some resistance. But when you see it, you have to deal with it immediately.
In that sense resistance is like a poisonous mold. It’s normal to find mold under a kitchen sink or behind a bathtub. Once you spot it, though, you have to deal with it quickly. Otherwise it will destroy what you’ve built. This is the second rule of resistance.
Rule 1: Resistance is therapy mold.
Rule 2: Resistance is normal. But deal with it quickly.
Even though Dr. Phil is right, his way of dealing with the problem is increasing resistance and poisoning the therapy. This is because he keeps pushing for mom to acknowledge her role in her daughter's mental illness. When we see resistance and keep pushing our agenda we increase resistance.
Rule 3: When you see resistance, if you want to increase it, keep asking the client to change.
It’s hard to change tactics in these moments, mostly because we truly feel we are right. In this case it’s obvious that this mom’s issues have impacted her daughter. In situations like these, when the problem is so obvious, it's easy for us to keep pushing for our agenda and feeding the poisonous mold of resistance.
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How do you defuse resistance in therapy?
How should you defuse resistance in therapy?
The most evidenced-based way to defuse resistance in therapy is to demonstrate empathy, which we do through reflection.
It’s that simple. I know. It sounds dumb.
But it works.
Now there are some caveats. First, your reflections don’t need to be super amazing or long. In fact shorter tends to be better. It does help if you reflect the implied message, not just parrot back the client’s words. Let’s look at the Dr. Phil transcript (lightly edited).
Dr. Phil: At age 15 you had multiple hospitalizations for bulimia and anorexia at age 15. At age 15 your daughter is struggling with bulimia and wishing she was anorexic because she's wanting to get down. And you see no connection at all.
Mom: I see a connection because I know that there is a genetic background and I put a lot of emphasis on health and fitness. I don't really remember putting so much of an emphasis on food.
What’s the implied message from the mom?
It’s some version of, “I see a connection, but I’m not to blame. I’ve worked really hard for my daughter to be healthy.”
Dr. Phil could reflect by saying something like:
“You’ve worked really hard to help your daughter.”
“Her health is important to you.”
“For you, it was never about the food with her.”
Now, people aren’t machines, so simply reflecting isn’t like pushing a button and turning off resistance. It’s a process. Sometimes you reflect and the resistance instantly vanishes, other times you have to work the process for 10, 15, 20, 30 minutes.
But what’s pretty consistent is, if you work the process, just keep reflecting the underlying meaning, once they feel heard and understood and trust your nonjudgmental presence, the resistance softens.
Rule 4: Reflect and trust the process.
I think that for many of us this feels like we’re not doing anything. I would argue that we are. Clients—heck, people—find it really hard to work with someone they don’t trust. When we reflect we’re demonstrating empathy, and that builds trust, which is the foundation for any and all work we do in the future.
Still, if I’m honest, when I first started learning this I was skeptical. I had to watch tape after tape of therapists reflecting resistance and see how that lead to the client giving up their resistance. By this point I’ve seen it work so much that, now, when I see resistance, I’m comfortable reflecting for entire sessions. Rarely does it take that long, but occasionally it does.
If you want to defuse resistance in therapy, avoid this at all costs.
As we saw earlier, when you see resistance, if you want to increase it, push the client to change. Anything you say which implies the client should change will only increase resistance.
This means no judgment. It sounds obvious. But it also means don’t problem solve. Don’t give advice. Don’t even cheerlead your clients. Even though cheerleading is kind and it sounds supportive, you're likely only going to increase resistance.
This doesn’t mean you can’t ever problem solve or help the client think through their options. You certainly can. It’s just all about timing. If you push for change in a moment of resistance you only increase the resistance.
Rule 5: Resistance teaches us timing matters.
If you use these secrets, here's what can happen.
Imagine working with this mom and you're just reflecting and demonstrating empathy and at some point, say three sessions later she says, “You know, I’ve known part of this is the message about food I told her. It’s just so hard to acknowledge that despite my efforts I’ve done the same thing to my daughter that was done to me.”
That, I think, would be magical.
And that totally happens. You just got to know the secret to defusing resistance in therapy.
Best,
Jordan (the counselor).
Paul Peterson and Jordan Harris are co-founders of Private Practice Incubator, a consulting firm dedicated to:
Helping clinicians earn more money.
Helping clinicians help more clients.
If you'd like to learn more about launching your practice, visit us here.
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