How can you communicate with a client who resists therapy?

1 Understand the reasons

The first step to communicate with a client who resists therapy is to understand the reasons behind their resistance. Resistance is not a personal attack on you or a sign of failure. It is a natural and normal reaction to change, uncertainty, or vulnerability. Resistance can also be a coping mechanism or a defense against painful emotions or memories. By empathizing with your client's perspective and validating their feelings, you can show them that you respect and care about them. You can also ask open-ended questions, reflect their statements, and summarize their concerns to demonstrate your interest and curiosity.

2 Establish trust and safety

The second step to communicate with a client who resists therapy is to establish trust and safety in the therapeutic relationship. Trust and safety are essential for any effective therapy, but especially for clients who resist therapy. They may have been hurt, betrayed, or marginalized by others in the past, and they may fear being judged, rejected, or abandoned by you. To build trust and safety, you need to be consistent, reliable, honest, and transparent with your client. You need to set clear boundaries, expectations, and goals for the therapy. You need to respect your client's autonomy, preferences, and pace. And you need to use trauma-informed and culturally responsive practices to avoid re-traumatizing or alienating your client.

3 Collaborate and empower

The third step to communicate with a client who resists therapy is to collaborate and empower them in the therapeutic process. Collaboration and empowerment are key principles of client-centered and strength-based approaches that recognize your client as the expert of their own life and the agent of their own change. Collaboration and empowerment mean that you do not impose your agenda, opinions, or solutions on your client, but rather invite them to share their views, needs, and goals. You also help them identify and leverage their strengths, resources, and values to overcome their challenges and achieve their desired outcomes. You use motivational interviewing techniques, such as affirming, eliciting, and supporting, to enhance your client's readiness, confidence, and commitment to change.

4 Address ambivalence and discrepancy

The fourth step to communicate with a client who resists therapy is to address their ambivalence and discrepancy. Ambivalence is the state of having mixed or contradictory feelings about something, such as changing a behavior or attending therapy. Discrepancy is the gap between one's current situation and one's ideal situation, such as one's values, goals, or aspirations. Both ambivalence and discrepancy can cause resistance, as well as opportunities for change. To address ambivalence and discrepancy, you need to help your client explore and resolve their conflicting emotions and thoughts. You also need to help them recognize and increase the discrepancy between their current and desired states, and the consequences of maintaining or changing their status quo. You use reflective listening, scaling questions, decisional balance, and pros and cons exercises to facilitate this process.

5 Manage conflict and feedback

The fifth step to communicate with a client who resists therapy is to manage conflict and feedback. Conflict and feedback are inevitable and necessary aspects of therapy, but they can also trigger resistance if they are not handled well. Conflict can arise when you and your client disagree on something, such as the problem, the goal, or the intervention. Feedback can be positive or negative, but it can also be perceived as praise, criticism, or manipulation. To manage conflict and feedback, you need to use effective communication skills, such as active listening, assertiveness, and empathy. You also need to use constructive feedback techniques, such as sandwiching, framing, and eliciting, to deliver feedback that is specific, timely, relevant, and respectful.

6 Adapt and modify

The sixth and final step to communicate with a client who resists therapy is to adapt and modify your approach and interventions. Resistance is not a static or fixed phenomenon, but rather a dynamic and fluid one. It can vary in intensity, frequency, and form, depending on the client, the therapist, the context, and the stage of therapy. Therefore, you need to be flexible and responsive to your client's changing needs, preferences, and responses. You need to monitor and evaluate your client's progress, feedback, and satisfaction, and adjust your strategies and techniques accordingly. You also need to be open to learning from your client, from your colleagues, and from your own experience, and seek supervision, consultation, or training when needed.

7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?