Resistance in therapy often appears as an obstacle, reflecting a client's reluctance to engage with the process. But what if we viewed it differently, acknowledging it as valuable information about our clients' experiences?

When we see resistance as meaningful feedback rooted in fear, ambivalence, or self-protection, we find new opportunities for therapeutic growth and change. This change in perspective can significantly alter how we handle challenging moments in sessions.

This article aims to provide clinicians with tools to recognize, interpret, and work with resistance—not against it. Let's explore how to use resistance for deeper understanding and progress.

What Is Resistance? Defining It Clinically and Relationally

Resistance involves any behavior or thought process that delays or disrupts therapeutic progress. It can appear as silence, missed appointments, intellectualization, defensiveness, or excessive compliance.

Resistance can be conscious or unconscious, and identifying its nature requires therapeutic attunement. When therapists pay attention to the relational dynamics, they can better understand and address resistance.

Underlying Drivers of Resistance

Resistance in therapy often arises from a mix of emotional, cognitive, relational, and neurobiological factors. Knowing more about these drivers can help clinicians approach resistance with greater empathy and effectiveness.

• Emotional factors, such as fear of vulnerability, shame, and past invalidation, can play a significant role in resistance. Clients might worry about the intensity of emotions that therapy could bring up or feel hesitant to share deeply personal experiences. Past experiences of emotional invalidation can also make it difficult for clients to trust the therapeutic process.
• Cognitive factors, including fixed beliefs, identity threats, and internalized stigma, can also contribute to resistance. Clients might hold rigid beliefs about themselves, others, or the world that feel threatened by the idea of change. Internalized stigma around seeking help can also make clients hesitant about engaging in therapy.
• Relational factors, such as mistrust of authority, insecure attachment styles, and prior negative therapy experiences, can create barriers to engaging in therapy. Clients who have had negative experiences with authority figures or past therapists may understandably be wary of the therapy process. Insecure attachment styles can also make it challenging for clients to form a trusting alliance with their therapist.
• Neurobiological perspectives provide additional insight into resistance. The brain's threat detection system can be highly sensitive to perceived risks, leading clients to unconsciously resist interventions that feel emotionally unsafe. Creating a sense of emotional safety and attunement is important for addressing this form of resistance.

Looking at resistance from these various angles allows therapists to develop a deeper understanding of their clients' experiences and adjust their interventions accordingly. In the next section, we'll look at how to recognize signs of resistance in a session.

Recognizing Resistance in Session

Resistance in therapy can appear through various verbal and nonverbal cues. Noticing these signs helps therapists address resistance effectively and collaboratively.

Key indicators of resistance include:

• Recurring patterns: Clients might repeatedly avoid certain topics, revert to familiar narratives, or display consistent behaviors that hinder progress. These recurring themes can signal underlying resistance.
• Changes in emotions: Sudden shifts in a client's emotional state, such as becoming more guarded, disengaged, or irritable when discussing sensitive subjects, may indicate resistance. Monitoring these emotional changes helps therapists identify potential barriers.
• Physical signs: Signs like fidgeting, tension, or changes in posture can reveal discomfort or resistance. Therapists should be attentive to these nonverbal indicators and gently explore their significance with the client.
• Avoidance of key topics: When clients consistently steer conversations away from important issues or provide vague, superficial responses, it may suggest resistance to deeper exploration. Therapists can note these patterns and work to create a safe space for addressing avoided topics.

Therapist countertransference can also provide valuable insights into emerging resistance. Feelings of frustration, boredom, or disengagement during sessions may signal that resistance is impacting the therapeutic relationship. Therapists should reflect on their own reactions and consider how they might relate to the client's resistance.

Using rupture-repair models and staying aware of the moment can help track resistance gently. By paying attention to subtle shifts in the therapeutic alliance and addressing them with curiosity and empathy, therapists can navigate resistance and strengthen the relationship. This approach prioritizes collaboration and understanding, rather than confrontation, when working with resistance.

Approaches to Working with Resistance Collaboratively

When addressing resistance in therapy, a collaborative approach is key. This means focusing on validation and curiosity rather than confrontation, working with the client to explore their experiences and concerns.

Motivational Interviewing can be particularly helpful, as it highlights ambivalence without forcing change. This method allows clients to examine their own mixed feelings about the therapeutic process, fostering a sense of autonomy and self-determination.

Narrative techniques can also prove useful when working with resistance. Therapists can explore client language and meaning-making, helping them reframe their experiences and see new possibilities for growth.

Here are some additional strategies for collaborating with clients to navigate resistance:

• Open-ended questions: Encourage clients to reflect deeply on their thoughts, feelings, and the roots of their resistance.
• Goal-setting: Collaborate to establish specific, achievable objectives that align with the client's values and aspirations.
• Solution-focused approaches: Highlight client strengths and resources, encouraging them to envision a desired future and identify steps to get there.
• Adapting interventions: Stay flexible in tailoring techniques to the client's needs and preferences, based on their feedback and reactions.

Throughout the process, therapists can use process comments and meta-conversations to identify the therapeutic dynamic, bringing awareness to patterns of resistance and exploring them openly with the client. This transparency builds trust and allows for a shared understanding of the challenges and opportunities in the therapeutic relationship.

A collaborative approach to resistance is rooted in empathy, cultural sensitivity, and a commitment to empowering the client as an active participant in their own growth and healing. Working together to navigate resistance can strengthen the therapeutic alliance and create meaningful, lasting change.

When Resistance Reflects Readiness — or Lack Thereof

The Stages of Change model, also known as the , Transtheoretical Model (TTM)  offers a useful way to understand resistance in terms of a client's readiness for change. This model includes six stages: Precontemplation, Contemplation, Preparation, Action, Maintenance, and Termination.

Resistance tends to be more noticeable in the Precontemplation and Contemplation stages, as clients might not yet recognize the need for change or feel uncertain about it. Therapists can use this insight to adjust their approach, focusing on building rapport, raising awareness, and exploring ambivalence without judgment.

As clients progress into the Preparation and Action stages, resistance may lessen as they commit more to change. However, it's important to differentiate between normal hesitation and resistance that disrupts treatment. Some hesitation is typical as clients prepare for major life changes, but ongoing resistance can impede progress.

Therapists can adjust their pacing and goals based on the client's readiness and ability. Key strategies include:

• Collaborating on goal-setting: Work with clients to set realistic, achievable goals that align with their current stage of change.
• Adjusting interventions: Select techniques suited to the client's readiness level, such as using Motivational Interviewing in earlier stages and action planning in later stages.
• Providing stage-appropriate support: Offer guidance and resources tailored to the client's current stage, such as psychoeducation in Precontemplation and relapse prevention strategies in Maintenance.

Regularly assessing a client's stage of change can help therapists manage resistance more effectively. Resistance that continues despite appropriate interventions may indicate a need to reconsider the therapeutic approach or investigate underlying issues more deeply.

Therapist Reflexivity and Ethical Practice

Therapist reflexivity –defined as the ongoing self-examination of one's beliefs, biases, and emotional responses– plays a key role in managing resistance in therapy. It involves being mindful of one's own expectations, urgency, and need for control during the therapeutic process. Reflexive practice helps therapists stay aware of their reactions to resistance, ensuring they prioritize the client's needs and autonomy.

Regular self-reflection allows therapists to:

• Identify personal biases: By looking at their own beliefs, assumptions, and emotional responses to resistance, therapists can avoid pushing their own agenda onto the client.
• Maintain cultural humility: Reflexivity helps therapists understand when what seems like "resistance" might actually stem from cultural differences in worldview, values, or communication style. This awareness encourages cultural sensitivity and reduces the risk of misinterpreting diverse experiences.
• Prioritize client autonomy: Through self-reflection, therapists can ensure their approach to resistance respects the client's right to make their own choices, even during challenging moments in therapy.

Practicing ethically  in the face of resistance also means seeking consultation and supervision when necessary. Discussing difficult cases with colleagues can offer valuable insights and help therapists recognize blind spots in their approach. Ongoing professional development, such as training in cultural competence and motivational interviewing, can further enhance therapists' ability to handle resistance effectively and ethically.

Therapist reflexivity and ethical practice are vital for building a therapeutic relationship that can endure the difficulties of resistance. By remaining curious, empathetic, and aware of both their own reactions and the client's needs, therapists can create a safe, collaborative environment for growth and change.

Resources for Building Clinical Skills with Resistance

Handling resistance in therapy requires a complex skill set that involves ongoing learning and reflection. Therapists can enhance their understanding and ability to work with resistance through various resources, including:

• Recommended readings: Explore key works on resistance, such as "Overcoming Resistance: A Rational Emotive Behavior Therapy Integrated Approach" by Albert Ellis and "Motivational Interviewing: Helping People Change" by William R. Miller and Stephen Rollnick. These books offer foundational knowledge and practical strategies for addressing resistance.
• Continuing education opportunities: Attend workshops, webinars, and conferences that focus on resistance and motivational interviewing. Look for CE credits offered by reputable organizations like the American Psychological Association (APA) or the National Association of Social Workers (NASW). Interactive training can help therapists practice skills and receive feedback.
• Reflective prompts for supervision: Engage in regular supervision and peer consultation to discuss challenging cases involving resistance. Use prompts like, "What are my own emotional reactions to this client's resistance?" or "How might cultural differences be influencing our interaction?" to foster self-awareness and identify potential blind spots.
• Sample scripts and sentence stems: Create a toolkit of reliable phrases and questions for addressing resistance with compassion. For example, "I sense some hesitation around this topic. What are your thoughts on exploring it further?" or "It's understandable to feel uncertain about change. Let's talk through your concerns." Practice these scripts to build confidence and fluency.
• Role-playing and practice: Participate in role-plays with colleagues or peers to simulate resistant clients and try out different approaches. Receive feedback on your tone, body language, and overall effectiveness in handling resistance. Regular practice can help develop skills and increase therapeutic flexibility.

Resistance in therapy is a natural part of the change process. Ongoing learning and skill-building can help therapists view resistance as an opportunity for growth and strengthening the therapeutic alliance, rather than a hindrance to progress. Approach the challenge of resistance as a pathway to providing more empathetic, client-centered care.