Therapy Resistance

[Peanut]

So I was reading through my text book for my upcoming class and I found something that is really interesting to me. It shocked me because it was like reading about my own therapy sessions. Here is an excerpt from Counseling A Comprehensive Profession by Samuel T Gladding

I was curious if anyone else experienced similar therapy sessions or techniques or had any thoughts about it.

The first part says:

A resistant client is a person in counseling who is unwilling, unready, or opposed to change (Otani, 1989; Ritchie, 1986). Such and individual may actively seek counseling but does not wish to go through the emotional pain, change in perspective, or enhanced awareness that counseling demands (Cowan & Presbury, 2000). Instead, the client clings to the certainty of present behavior, even when such action is counter productive and dysfunctional. Some resistant clients refuse to make decisions, are superficial in dealing with problems, and take any action to resolve a problem (I.e., do anything a counselor says). According to Sack (1988), "the most common form of resistance is the simple statement 'I don?t know'". Such a response makes the counselor's next move difficult and protects the client from having to take any action.

And then it discusses methods that can be used to deal with it, and the part that sounds like exactly what happens in my therapy sessions is:

Counselors can also use language, especially metaphors, to soften resistance or reluctance. "Metaphors can be used to teach and reduce threat levels by providing stories, by painting images, by offering fresh insights, by challenging rigid thinking, by permitting tolerance for new beliefs, and by overcoming the tension often present between a counselor and the resistant [or reluctant] client" (James & Hazler, 1998). For instance, in addressing a client who keeps repeating the same mistake over again, the counselor might say, "what does a fighter do when he gets badly beaten up every time he fights?" (James & Hazler 1998).
Finally, Sack (1988) recommends the use of pragmatic techniques, such as silence (or pause), reflection (or empathy), questioning, describing, assessing, pretending, and sharing the counselor's perspective, as ways to overcome client resistance. These techniques are especially helpful with individuals who respond to counselor initiatives with "I don't know."

This is really fascinating to me because that is exactly what my psychologist does. He uses metaphors, stories, his own life, etc when he's talking to me. He also stops and takes these long pauses all the time! I have told him how much I hate conversational pauses yet he continues to take these 10 second pauses to think and I'm left there squirming for what seems like an eternity. The other thing that caught my eye was the "I don't know"...I say that to him all the time (unintentionally). This is making me wonder if I am a resistant client.

Do other people's therapists use metaphors and stories and silences??


(OK I always get mixed up with how to cite things, so in case I need this...)

Gladding, S. T. (2004). Building A Counseling Relationship. Counseling A Comprehensive Profession (pp. 121-144). Upper Saddle River, New Jersey: Pearson.

 

[Cat Dancer]

That is interesting.

I've only had one session and I said "I don't know" a lot. :yikes:

Do you think his metaphors and stories are helpful?

 

[Peanut]

I've only had one session and I said "I don't know" a lot.

Hmmmm...I wonder if it is typical to say that a lot.

Do you think his metaphors and stories are helpful?

The long stories, no. He told me this drawn out story about monks, I did not know what he was getting at but I pretended like I did so we could stop the story. The next week he launches into the same story mg: and I had to stop him and tell him that I had already heard that story and that I had no idea what he was talking about. So then he asked do you remember it, and I said yes (I really did not remember it) because I didn't want to hear it again and then he told me what it meant which I cannot remember now at all. Sometimes the stories are about him and I like those better because they are more interesting, we seem to have some things in common from the stories he tells. I don't know if he's just trying to relate to me or if he really is relating or what. Or maybe there is no difference between the two.

 

[Daniel E.]

Sometimes the stories are about him and I like those better because they are more interesting, we seem to have some things in common from the stories he tells.

My favorite, real-life story by a mental health professional was by my psychiatrist, who was from Haiti. He mentioned that his father was assassinated and that he fled to Latin America. It was a great, heartening story that is certainly memorable.

 

[Peanut]

Interesting. In my opinion personal stories and experiences are a good way to cultivate respect from the client (and actually I like it when teachers do it too). I, of course, do realize that there are limitations on what should be shared, but it's just a personal preference of mine. A lot of times it's easier for me to learn from someone that is speaking about something from personal experience.


Why do you think he told you that story?

 

[Daniel E.]

Why do you think he told you that story?

I don't remember, exactly, but it was in response to something I said. I talked a lot about death and suffering at the time (9 years ago). Also, not surprisingly, I tended to take everything positive in life for granted. So the story could have served many purposes.

 

[Lost]

When my therapist asks these deep, provocative questions, that's when I say "I don't know." And the more she asks things like that, the more I say "I don't know".

Then, she'll make suggestions... for me to think about. Either I'll say, "no, that's definitely not it" or I'll say "maybe... I understand what you're saying hypothetically, but it's not really resonating with me," like one of those 'aha!' moments... or, sounding like a broken record, I'll say "I don't know" again.

With me, I know there's definitely a huge part that resists. My whole set-up, the way I programmed myself from childhood, was to ignore my own thoughts and feelings, so it's really really really hard to undo all of that, and just try and think about what's going on inside me.

And with you Toeless, I'm just wondering why you didn't like the monk story, and why you didn't remember it? Maybe you're subconciously understanding what he's getting at, but you don't want to 'go there' so you're refusing to listen and understand???

I know that there are times when she talks about things like my jealousy, my competetiveness, my hatred, my insecurities... and all the bad things I may feel, which makes me feel ill, and I don't want her to be saying it, and I don't want to talk about it... and I don't want to listen... and I want to talk about anything else but that... (and she will let me change the topic if I want to... but I'm always angry with myself afterwards for copping out...)

then i go home and eat and eat and eat and eat anything and everything in sight... but deep inside I'm thinking about what she's said, and over time I'm slowly understanding her better, and more importantly, I'm understanding ME better...

 

[Lost]

And to answer your relating issue - there's just 'relating' a story which could be purely 'relating' - as in saying over a story to a listener... but as a therapist, I'd hope that he'd be relating the story in order to RELATE TO YOU and help you connect with the point of the story, identify with it, and maybe learn something about yourself - from the story ...?

That's if he's any good, this therapist of yours!

You could always just say, "Why are you telling me this story? What's the point?" - if you're brave enough!

My therapist does rarely tell me a story - not like about monks or anything exotic, (it's not fair! why don't I get any exciting stories?!?!) but just about herself or her family - only in order to make a point, and enable me to understand something, or change my perspective on something. And it works!

 

[Halo]

Hi All,

Toeless I thought that your original post was great and it really made me think of my present situation and past ones as well. I know for me when I say "I don't know" it is usually just a cover because I do know but just don't want to divulge that information or don't know how to say it and don't want to sound stupid. I use to use that saying alot with one particular psychiatrist that I had because I really didn't like her and didn't want to answer anything she said.

As for the telling of stories by a therapist I personally like it. It helps me see that they are real people with real lives outside of therapy. Sometimes I like to live in a fantasy world and think that my therapists are not "real" people. I have found in the past that by hearing stories from them it helps me to be more open and free with talking.

Again, great post Toeless!!
Nancy

 

[Meg]

If a client had all the answers to the tough questions they wouldn't be asking a therapist to help them work it out . I reckon that sometimes saying "I don't know" could certainly mean that the client either doesn't want to, is scared to, or isn't ready to discuss or do something, but really sometimes it means just that: they don't know, or they've become confused. I don't think that there's anything there to judge yourself over. If someone says "I don't know" there is a reason for it, and maybe figuring out that reason is the issue to be dealt with first? You're not going to get as far with an intervention if your client doesn't think you care about them, is worried about being judged for saying what they really think, or if they don't understand why they're being asked to do something.

I know I certainly said "I don't know" a lot for the first 5 months or so of therapy! I was just a bit scared and confused and learned to be more open over time. I made much more progress when I was open, but it took a while to get there . I liked it when my therapist told me stories about herself, too. It took the pressure off me a little and they were usually funny ones. It helped me to know that I could trust her, so I agree that it certainly has a place.

Oh, and I also was thinking that often brief pauses in conversation while your therapist thinks are actually a good sign. Who wants a therapist who responds to something important without thinking it through? I can see how it would be uncomfortable, but you're getting a more carefully considered response that way.

Meg

 

[Peanut]

Wow, thank you guys for sharing your experiences and thoughts about this. It's really helpful for me. Every single one of you have given me something to think about and I really appreciate it. I don't know that I have anything to add at this point, but definitely a lot to think about. Thanks.

 

[Into The Light]

this is a very interesting topic and it has me thinking about how i do. i do pretty well for the most part in session but as i've posted elsewhere today the last few times i have not been able to bring up something that i want to bring up. so the question is why do we resist? i think i'm scared, but i'm not sure why. scared that it will sound stupid, but that's on the surface. there is a deeper fear and i can't quite figure out what it is.

 

[Peanut]

Oops! I almost wrote my three favorite words, "I don't know" That is a great question though. For me personally, the reasons that I say "I don't know" vary...with the most notable being when the session opens up with "Where should we go today?" and I always say, "I don't know", even if there is something that I want to talk about. I guess that doesn't really answer the question why, but it is an example of the type of thing that I say "I don't know" to, when I really do know. I think that part of me is afraid that what I want to talk about is too trivial and that maybe he has more important things that we should talk about...maybe?

I also say "I don't know" when he asks a really broad question like "Why do you keep doing xyz?" ...there are usually so many reasons that I don't really know where to start.

 

[Lost]

Reading some other posts - I realised another reason why I say "I don't know" and that's because I don't want the therapist to think that I'm petty, or say stupid things, or feel stupid things... When the truth is, at the end of the day, we're all human. We all have thoughts and feelings that we're embarrassed about, and the therapist is human too!!!!
I think it's a very common theme running through many posts here.

Why don't we all try and say to our therapists - instead of saying "I don't know" why don't we try and say, "Well.. I think I may know the reason why.... but I feel really stupid saying it..." or "I don't want you to think that I'm stupid" and see how the therapist responds to that!!!

If he / she's a good therapist, they'll say something like, "nothing that you think or feel is stupid. you're a valuable human being and it's important that you can express your thoughts and feelings, even if they seem to you to be trivial"

And then we'll feel better about talking about things!!! And we'll say "I don't know" less!

Easier said than done, but I think it's something we should try and do. I'll be trying when I next see her...

 

[Cat Dancer]

Why don't we all try and say to our therapists - instead of saying "I don't know" why don't we try and say, "Well.. I think I may know the reason why.... but I feel really stupid saying it..." or "I don't want you to think that I'm stupid" and see how the therapist responds to that!!!

Lost, I think that is a really, really good idea! Thank you for suggesting that.

 

[David Baxter PhD]

Of course, sometimes when a client says "I don't know", it's because s/he really does not know at that moment.

Sometimes, I'll ask a question and specifically say I don't want or expect an answer to this on the spot - it's just something I want you to take some time over the next few days or a week to think about - how would you answer it? does it have any relevance to you and your life at all? In doing so, I'm acknowledging that it may be off the mark and have nothing to do with the client's situation.

Part of the reason I'm posting this is to remind all of us that therapists are not gods or superhuman. We may have specialized training and knowledge and in some cases yeqars of experience but that doesn't mean we're infallible. Sometimes a question is a question, and the correct answer is "I don't know" - adding "I'll think about it" if only in your mind is usually a good idea.

 

[Lost]

Thanks Janet... now lets see who has the courage to actually say it...

 

[just mary]

I'm posting this is to remind all of us that therapists are not gods or superhuman.

Really Dr. Baxter, I thought they were!!! (sorry, couldn't resist)

Anyway, I think this topic is interesting also. The description of the resistant patient was informative. I always pictured a resistant patient as someone who was forced into therapy by someone or something else. I never thought that they would actively seek therapy. In fact, it reminds me of my own situation.

This post also helps to make sense of some of the things my old therapist did. He would tell me stories about himself and I could never figure out why. I guess I was always under the impression that therapists were never supposed to divulge personal things about themselves. For example, he once told me had a fear of water and couldn't swim. I could not understand why he told me that. Maybe it was to show me that we all have fears and sometimes we never get over them, even if we're a trained therapist.

Sometimes, I'll ask a question and specifically say I don't want or expect an answer to this on the spot - it's just something I want you to take some time over the next few days or a week to think about - how would you answer it? does it have any relevance to you and your life at all? In doing so, I'm acknowledging that it may be off the mark and have nothing to do with the client's situation.

Okay, that's interesting, my therapist did that with me a few times also. That makes a lot of sense.
Thanks.

Bye for now,

 

[David Baxter PhD]

Maybe it was to show me that we all have fears and sometimes we never get over them, even if we're a trained therapist.

Quite likely, or to normalize the behavior a bit. For example, I think many people including me have some obsessive or prefectionistic tendencies or traits - it's not necessarily disadvantageous in all situations and we don't call it OCD until it's at a level that interferes with ones day-to-day functioning. Similarly, I think many of us have idiosyncracies in how we process certain types of in formation or in our ability to hyperfocus - it doesn't necessarily make it a full blown learning disability or ADHD because we figure out ways to compensate for those quirks.

I will give examples of that from my own life to some clients to illustrate things like this.

 

[Peanut]

I always pictured a resistant patient as someone who was forced into therapy by someone or something else.

Right above the resistant client description the book says:

A reluctant client is one who has been referred by a third party and is frequently "unmotivated to seek help" (Ritchie, 1986). Many school children and court-referred clients are good examples. They do not wish to be in counseling, let alone talk about themselves. Many reluctant clients terminate counseling prematurely and report dissatisfaction with the process (Paradise & Wilder, 1979).

The way I read the text, it looks like the techniques can/are used for both reluctant and resistant clients.

Of course, sometimes when a client says "I don't know", it's because s/he really does not know at that moment

I could not agree more. The majority of the time I answer "I don't know" it is because I really don't. A lot of times the questions are really challenging and it takes some time, at least a day to figure out the real answer.