What do you do if your therapy clients are resistant to engagement?

When we use the term 'resistant' it brings in a sense of judgement, like something is happening that shouldn't be happening or the client is unwilling. When we change the lens and therefore the label, we see 'resistance' as just a protective part or mechanism within the client. Something in the client is becoming protective. We then inquire with what is protecting, really wanting to know what's the fear and meet with the underlying fear. It is very often kindness, non-judgment, a sense of safety and gentle inquiry that melts what we call 'resistance'. Isn't that true, when something in us feels understood and safe, there isn't a need to defend.

Building trust is more than listening. Depending on the client, building trust can look like relatability. Do you share interests in common things, like sports? Activities? Communication style? What does your office say about you, or your care as a provider? Is it a safe space? If so, how do you verbalize that in session? Incorporate care into disclosures and consents. Verbal validations like “your business belongs to you. I’m privileged to share this space and your experiences”, or “I’m on your team, and we can make it through this” can make a big difference. When appropriate (AND WITH PERMISSION) hugs, high fives, or shoulder pats can also be affirming. Leading with your humanity can make, and build lasting trust with client engagements!

Attending therapy often involves confronting difficult emotions, memories, or experiences, which can trigger our natural defense mechanisms. These defenses serve to protect us from perceived threats or discomfort, but they may also hinder the therapeutic process by blocking access to deeper feelings or insights. Therapy is a collaborative process, and it's common for clients to initially have walls or defenses in place. A skilled therapist understands this and creates a safe and supportive environment where clients can gradually lower their defenses and explore their thoughts and feelings more openly. This is usually done by building safety, rapport, and empathetic reflections.

Talk about the resistant. Use their hesistancy as a tool to engage and build rapport. Normalizing feelings helps others feel understood. Feeling understood leads to a more willingness to talk and share.

When facing resistance, build trust by showing genuine interest in clients' perspectives and acknowledging their feelings. Validation reduces defensiveness and fosters collaboration. Trust building requires consistency, patience, and celebrating each small step forward as a victory. ???? #BuildingTrust #TherapeuticRelationship #PatientCare

Reflective listening allows the client to see that you’re listening and paying attention to them which in return builds trust as they see someone is creating space for them.

Use reflective listening with resistant clients by restating their words to confirm understanding. This makes clients feel heard and valued, encourages self-reflection, and may reduce resistance over time. ??? #ReflectiveListening #ClientSupport #CommunicationSkills

Employ reflective listening with resistant clients by restating their words to confirm understanding. This makes clients feel heard and prompts self-reflection, potentially reducing resistance over time. ??? #ReflectiveListening #ClientSupport #ReducingResistance

Tanto la escucha reflexiva como la escucha activa son herramientas poderosas para abordar la resistencia al compromiso en la terapia, ya que permiten una conexión más profunda con los clientes y facilitan un ambiente de apoyo donde se pueden explorar y abordar sus preocupaciones con mayor comodidad.

Address client resistance by exploring ambivalence about change. Discuss the pros and cons of current behaviors versus potential changes to clarify values and goals, fostering intrinsic motivation. Understanding ambivalence aids in guiding clients toward positive change. ????? #AmbivalenceExploration #IntrinsicMotivation #PositiveChange

Resistance is a normal part of the therapeutic process. There are many forms of and reasons why clients are resistant. Hence different ways to deal with it for each client. One's theoretical approach often determines how a therapist responds to resistance in sessions. Way I see it, when resistance (unconscious kind) is observed , it can in fact be taken as a good thing - as now the client is closer to a break through (in time) but how and manner in which, we as therapists, make the client aware of it, is crucial.

Address client resistance by exploring ambivalence. Encourage discussion on the pros and cons of current behaviors versus potential changes. This helps clarify values and goals, fostering intrinsic motivation and assisting in resolving ambivalence towards positive change. ????? #ClientResistance #Ambivalence #IntrinsicMotivation

I would be careful with how you approach this one. Often, when we explore ambivalence with clients, we do so with implicit judgment as to the "correct" choice. Instead, I would recommend a motivational interviewing approach.

Es común que los clientes experimenten sentimientos encontrados acerca del cambio, por lo tanto, es esencial alentarlos a explorar los aspectos negativos de sus comportamientos actuales en contraste con los cambios que desean llevar a cabo. Es importante discutir cómo estos cambios positivos van a tener un impacto constructivo tanto en sus propias vidas así como en su entorno.

As someone who primarily works with children (Ages 5-12), creativity and flexibility in approach is essential in building therapeutic rapport. I have played Uno, done art projects, had races, competed in soccer and basketball, made crafts, and joined Roblox to create that initial connection. While it may make billing and goal development more complex, I have found that some of the most insightful moments occur during these less structured sessions.

If a method isn't effective with resistant clients, try different strategies, tailoring to each client's unique needs. Incorporate creative activities or adopt a more direct approach based on what resonates best with the client. ????? #ClientEngagement #FlexibilityInApproach #TailoredTherapy

Adapt your approach to engage resistant clients by trying different strategies tailored to their unique needs. Consider creative activities for expression or a direct, structured approach, depending on what resonates best with the client. ????? #ClientEngagement #FlexibilityInApproach #TailoredTherapy

La flexibilidad en el enfoque terapéutico puede ser fundamental para comprometer a clientes resistentes. La clave está en mantener una mentalidad abierta y estar dispuesto/a a ajustar el enfoque según sea necesario para promover un progreso significativo en la terapia.

Flexibility is key when working with resistant clients. Drawing upon my years of experience, I adapt my therapeutic approach to meet clients where they are, whether it's through psychoeducation, experiential exercises, or culturally relevant interventions. By tailoring interventions to clients' unique needs and preferences, we can enhance engagement and promote meaningful progress.

I would also remember that as social workers, we believe in radical self-determination. That means that even if we don't agree with a choice, it is a client's right to make it (within certain parameters of course).

Para mi la psicoeducación desempe?a un papel crucial en la reducción de la resistencia al compromiso por parte de los clientes de terapia. Al proporcionar una comprensión más profunda de la naturaleza del proceso terapéutico, los beneficios asociados con la terapia, y al desmitificar los conceptos erróneos que pueden existir, así como al aclarar las expectativas mutuas, la psicoeducación ayuda a reducir la incertidumbre que a menudo conduce a la resistencia por parte de los clientes.

Reducing resistance involves empowering clients to make choices in their therapy. Offering options for session conduct and discussion topics makes clients more engaged, motivated, and invested in their therapy journey. ???? #ClientEmpowerment #TherapyEngagement #ChoiceInTherapy

Try to understand the reason behind their resistance. Is it due to fear, skepticism, or past negative experiences ? Understanding their perspective can help tailor your approach. Make sure you acknowledge and validate their feelings of resistance without judgement. Lastly, involve the client in setting therapeutic goals that are meaningful and relevant to them. This may motivate them to engage in their treatment process.

When you've done everything like listening, reflecting, normalizing, building trust, acknowledging and all the things we are trained to do, it might be time to consider that the therapeutic relationship isn't a good fit. There might be a myriad of reasons and you're client may never share them but continuing a relationship that isn't progressing from the client's perspective or yours isn't helpful for either of you. Having that conversation with the client may bring about a change in the relationship or bring a natural end and you can support them in finding someone else to work with.

Meet clients where they are at! Normalize the resistance. Let clients know that resistance is a natural part of the therapy process. Understanding that their feelings are common and expected can help clients feel less isolated or defensive. Provide opportunities to explore the Resistance rather than pushing against resistance, and invite discussion about it. Ask open-ended questions that encourage clients to explore what might be contributing to their hesitancy. This exploration can uncover underlying fears, beliefs, or past experiences that may be impacting their engagement. Examine and reflect on power dynamics within the helping relationship and how that may be impacting the therapeutic alliance.