What is Resistance?

Resistance refers to behaviours, emotions, or cognitive patterns that prevent therapeutic progress. It often protects the client from painful feelings, uncertainty, or perceived threats (loss of control, identity, or relationships).

Types of Resistance

• Avoidant Resistance — avoiding topics, missing sessions, changing subject to reduce discomfort.
• Active/Overt Resistance — arguing, confronting the therapist, openly refusing homework or techniques.
• Passive Resistance — silence, minimal response, agreeing without engagement, superficial compliance.
• Cognitive Resistance — rigid beliefs, counter-arguments, intellectualising emotions (e.g., “I don’t believe therapy works”).
• Emotional Resistance — strong affect (anger, shame) that blocks processing, or emotional numbing/detachment.
• Transference/Countertransference Resistance — repeating relational patterns with therapist (idealisation, mistrust) that recreate past dynamics.
• Systemic Resistance — family or cultural pressures that undermine change (partners discouraging therapy, stigma).
• Motivational Resistance — ambivalence about change (wanting different outcomes but not the work required).

Why Resistance Appears — Common Functions

• Protects from overwhelming emotion or trauma.
• Masks fear of change, loss, or failure.
• Maintains identity or relationships tied to old beliefs.
• Signals mismatch between therapist approach and client readiness.

Implications for Therapy

• Slows progress if unrecognized, but can be a therapeutic signal when explored.
• May lead to dropout without careful engagement.
• Offers clinical material — understanding resistance uncovers core beliefs and fears.
• Requires therapist flexibility: technique + relational stance.

Practical Strategies to Work With Resistance

• Normalize & Validate: Explain resistance as understandable and expected.
• Collaborative Stance: Use curiosity — “Help me understand what happens for you when…”
• Motivational Interviewing: Explore ambivalence, evoke change talk, roll with resistance.
• Adjust Pace & Dosage: Use smaller steps, reduce an exposure’s intensity, add stabilisation.
• Use Socratic Dialogue: For cognitive resistance — gentle questioning rather than direct confrontation.
• Increase Experiential Work: Role-play, behavioural experiments to shift stuck patterns.
• Address the Relationship: Check alliance, repair ruptures, explore transference gently.
• Systemic Involvement: With consent, involve family or refer to community supports.
• Set Clear Boundaries: For dangerous or obstructive behaviours — be firm, ethical, and transparent.
• Supervision & Self-Reflection: Therapists should seek supervision to avoid countertransference-driven responses.

Short Case Example

Client: 29-year-old male avoiding conversations about a past assault. Misses sessions and diverts when asked about the event.

Approach: Therapist normalised avoidance, used motivational interviewing to explore ambivalence, introduced a 5-minute imaginal exposure as manageable homework, and scheduled shorter sessions to build trust. Over time, client increased attendance and reported reduced avoidance.

Practical Therapist Script Samples

• Validation + Invitation: “I notice you change the topic when we get close to X — that makes sense. Would you tell me what feels risky about talking about it?”
• MI Elicit-Provide-Elicit: “What do you think makes therapy helpful? May I share a short idea? — What do you make of that?”
• Boundary & Structure: “I hear you’re not ready for that homework. We can postpone — what small step feels doable this week?”

When Resistance Signals a Need to Change Approach

• Persistent non-attendance despite engagement attempts.
• Escalation in risk (self-harm, substance use) — consider crisis interventions.
• Severe dissociation — require stabilization before trauma work.
• Therapeutic impasse despite multiple strategies — consider referral or different modality.

Key Takeaways

• Resistance is meaningful clinical data — explore it with curiosity, not punishment.
• Match interventions to the type and function of resistance.
• Prioritize safety, alliance, and gradual change — small gains compound.
• Use supervision; therapist self-awareness prevents enactments and burnout.

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