When someone steps into a therapy room, one of the first steps a therapist should take is to establish expectations for the treatment they are about to receive.
This includes what a session is likely to involve, what they can expect from the therapist and what is expected of them. Helping a patient know what their treatment will involve will help soothe fears and help them to understand and define their own therapeutic progress.
However, therapy relies heavily on buy-in, and there are times when a treatment can be delayed by a patient’s behaviour or attitudes, such as not completing assigned pre-session tasks, do not respond well to recommendations or do not seem to be making any progress.
This is often known as treatment resistance, a term also used in psychiatry and to a degree in the wider medical world to refer to when an illness does not respond to an expected treatment.
In therapy, resistance can be more complex, because the reasons why people seek therapy are often complex and multifaceted, and in some cases, the resistance is itself a manifestation of the issues that a patient homes to address.
Therapy resistance can be frustrating because it can be seen as a sign that either a therapeutic approach is not working or that a patient is refusing to let themselves get better, neither of which are necessarily the most helpful conclusions.
Here are some top tips for how to face and take on therapy resistance.
Focus On Patient-Therapist Rapport
In many cases, the key to positive treatment outcomes is the ability to build a therapeutic relationship with a patient, treating them as an equal, being approachable and being a real person to your patient rather than a conduit for treatment.
Establishing a safe, non-judgement space is key to enabling patients to open up, so try to avoid framing subjects negatively, ensure that you step in and remain engaged as they talk to you, use their first name and recommend that they use yours.
Establish Goals
Whilst not every therapy treatment requires a full treatment plan, it is beneficial to set clear expectations and goals with the help of that patient. Ask what they want to get out of their treatment at an early stage, make notes of their answers and provide them with a copy.
This helps keep you both on track and motivates them to keep moving and progressing.
Ask Why
If there are certain tasks or goals that are not being achieved, it is beneficial to ask why that is, because the answer may be less about a lack of commitment on the part of the patient but instead not finding a particular task or assignment beneficial.
For example, whilst journaling can be beneficial to some patients as a mindfulness exercise or a way to translate unconscious feelings onto paper, it may be seen as dishonest busywork by others.
Engage with resistance with an encouraging, curious approach, as in many cases this lack of compliance can help reveal information that can help lead to a breakthrough.
