"You Can't Make Me!" - Effective Techniques for Managing Highly Resistant Clients by Clifton Mitchell, Ph.D. 6 Credit hours - $89 Last revised: 02/20/2008 Course content © copyright 2008 by Clifton Mitchell, Ph.D.. All rights reserved. ContinuingEdCourses.Net DBA SocialWorkCoursesOnline.com is approved by the Association of Social Work Boards (ASWB) to offer continuing education for social workers, through the Approved Continuing Education (ACE) program. ContinuingEdCourses.Net DBA SocialWorkCoursesOnline.com maintains responsibility for its courses. ASWB provider #1107. ContinuingEdCourses.Net DBA SocialWorkCoursesOnline.com is approved by the National Board for Certified Counselors (NBCC) as an NBCC-Approved Continuing Education Provider (ACEP) and may offer NBCC-approved clock hours for events that meet NBCC requirements. ContinuingEdCourses.Net DBA SocialWorkCoursesOnline.com solely is responsible for all aspects of the program. NBCC provider #6323. ContinuingEdCourses.Net DBA SocialWorkCoursesOnline.com is approved by the California Board of Behavioral Sciences (CA-BBS) to offer continuing education for MFCCs (MFTs) and LCSWs. CA-BBS provider #3311. ContinuingEdCourses.Net DBA SocialWorkCoursesOnline.com is approved by the Ohio Counselor, Social Worker, & Marriage and Family Therapist Board (OH-CSWMFT) to offer continuing education for counselors, social workers, and MFTs. OH-CSWMFT provider #RST080501 & #RCX010801. Take the Course Take the Test Buy your Certificate

LEARNING OBJECTIVES

This is an introductory to intermediate level course. Upon completion of the course, mental health professionals will be able to:

1. Develop a personal philosophy for understanding and managing resistance.
2. Describe five errors therapists make that foster and promote client resistance.
3. Apply five principles for dealing with resistance in clients.
4. Describe two critical concepts in formulating therapeutic language.
5. Develop goals based on client motivations that are more likely to be effective in producing change.
6. Discuss three problems that arise with asking too many questions in therapy, and use alternate linguistic approaches to avoid these pitfalls.
7. Identify the multiple meanings of "I don't know" responses from clients and apply techniques for managing these responses.

COURSE OUTLINE

0. Foreword "Do Not Read This"
1. Developing a Personal Philosophy for Handling Resistance
2. Understanding Resistance
   1. Conventional Definitions
   2. Alternative Perspectives: The Social Interaction Theorists
   3. Resistance and Influence: Breaking the Negative Cycle
   4. Client Dynamics Often Mislabeled as Resistance
   5. The Positive Side of Resistance
3. Common Errors Therapists Make That Create and Foster Resistance
   1. Your Client is Not Making Progress Toward What?
   2. Why Most People Come to Therapy
   3. The Essential Ingredient Necessary Before We Help Anyone
   4. The Perils of Assuming a Knowing Attitude
   5. Rogers is Still Right and Why People Change
   6. Timing is Everything and "Baby Steps" are Not a Joke
   7. Accepting the Invitation to Take the Pain
   8. Failure to Recognize and Respond to the Client's Stage of Change
   9. Cognitive Distortions of Therapists That Foster Resistance
4. General Principles for Dealing with Resistance
   1. Averting Resistance By Honoring It
   2. Basic Principle #1: Do the Unexpected
   3. Basic Principle #2: Slow the Pace, Focus on Details, Process Feelings Relative to Meaning
   4. Basic Principle #3: Treat Clients' Resistance with Respect
   5. Basic Principle #4: Maintain an Attitude of Naïve Puzzlement
   6. Basic Principle #5: Never Label Clients with Terms That Imply Resistance
   7. Basic Principle #6: Focus Where Clients are Stuck
   8. Basic Principle #7: Frame All Desires in the Positive
   9. Basic Principle #8: If They Are Not Confused, Confuse Them
   10. Basic Principle #9: Resist the Urge to Confront Initially
5. Words: The Fundamental Tool of Therapists
   1. Two Fundamental Rules of Language Every Therapist Should Know Lessons from Aikido
   2. Why it is Crucial to Develop the "Desire Side" of the Motivation to Change
   3. The Influence of Words on Mental Processing: Why the Words You Choose are so Important
   4. The Compelling Power of Priming
   5. Summary Points Regarding Language and Therapy
6. Goal Creating Language and Techniques
   1. Always Take Time to Establish an Answer to This Inquiry
   2. Enhancing the "Desire Side" of Change
   3. Goal Creating Dialogue for Resistant Clients
   4. Goal Creation Through Enhanced Empathic Responses
   5. Ask the Miracle Question
   6. A Few Points on Creating Viable Goals
   7. Critical Points for Viable Goals/Problem-Solutions
7. To Ask or Not to Ask, That is the Question
   1. The Problems with Questions Lie Just Beneath the Surface
   2. Generally, Do Not Ask Questions Under the Following Circumstances
   3. What to do if You Have the Urge to Ask a Question
   4. How to Convert Questions Into Curious Commands
   5. Voice Tone
   6. Generally, Use Questions for These Purposes
   7. Do Not Assume Clients Are Not Asking Themselves Questions in Their Own Minds
   8. Advantages of Avoiding Questions
8. Managing and Using "I Don't Know" Responses
   1. What Does "I Don't Know" Mean?
   2. Responding to "I Don't Know"
   3. How to Avoid "I Don't Know" Responses
   4. Inquire of a Wise Friend
   5. The Classic Pretend Technique
   6. Using "I Don't Know" to Open Therapeutic Doors
9. Putting It All Together: Concluding Thoughts
10. References and Suggested Readings

The course was created from, and is based on, the book, Effective Techniques for Dealing with Highly Resistant Clients. The book addresses additional areas of resistance beyond those included here. Some of these additional areas of study include dealing with silence, responding to challenges from clients, additional linguistic techniques and language nuances, as well as an assortment of additional approaches such as paradox and reframing. If you would like to order the book or view the resistance topics not contained herein, please go to www.CliftonMitchell.com for more information.

Do Not Read This

One day, after feeling worn out and emotionally "beaten up" by a client, I searched every text I had for information on dealing with resistance. What I discovered is that most texts had nothing, and a few had less than a paragraph addressing the subject. Over the next eight years, I continued to search for material on resistance. I found numerous ideas and approaches scattered throughout the literature as well as a few excellent books that addressed resistance exclusively.

As a result of my own struggles and search, I began leading training seminars on resistance. Immediately, I realized the need for a comprehensive course that succinctly compiled ideas and techniques for the working therapist who does not have time to read lengthy, detailed books and articles that often include a great deal of theoretical discussion and only a small amount of practical how-to. I wrote this course in an effort to fill this void in the literature.

Before studying resistance, my basic skills as a counselor were reasonably well developed. Like most therapists, I could skillfully empathize and build rapport. Conceptualizations of client's problems were readily formulated. I could analyze and present logical reasons for change for any client. Along with these positive skills, I was adept at stressing over my clients. When I did not perceive client movement, I was burdened by the lack of progress. I could carry tension regarding a session with me for days. Moreover, when clients did improve, I did not always know why. This aroused the unsettling question that so many therapists ask themselves—Do I really know what I am doing? I was like many of the therapists I meet at my trainings—stressed out and approaching burnout without a definitive plan to resolve the predicament. The study of resistance is vital to therapists desiring to get out of this state.

There are a few things you need to know before reading this course.

The purpose of this course is to present a compilation of ideas, techniques, and approaches from a host of sources. Some of the ideas will be new to you. Some of what you will read focuses on basic skills that we seem to forget easily when caught up in exceptionally difficult client problems. These basic skills are presented with a focus on resistance. However, this course is by no means complete. As I kept compiling and writing material, I realized that I had to stop writing somewhere, even with many ideas still available about which to write.

This course will not solve all of your resistance problems. It will provide techniques that effectively handle resistance in many instances. It will provide you with a host of approaches that will greatly improve your therapeutic skills and subsequently enhance movement in your clients. However, you will still have some clients who make little progress. In the midst of its shortcomings, there is an important ancillary benefit that comes from the study of this course—it will reduce your stress levels. This, in and of itself, is a meaningful reason to undertake a serious study of resistance. Even if your clients don't get better, you will.

In the chapters that follow, you will find an emphasis on practicality. I have tried to write this course in somewhat distinct sections so that the reader might turn to any page and discover a helpful idea or technique. However, in order to fully understand resistance and ways to deal with it, you will have to read all of the sections and bring the material together in your practice.

There is no step-by-step, linear way to present this material. I have rearranged the order of what I want to say many times, and I am never completely satisfied. Thus, there is repetition and there will be references to ideas in some sections that are explained in later chapters. You just cannot say it all at once. Those who have attended my workshops have indicated that the order of presentation used is practical, and they have recommended that I retain the order presented here.

Historically, there has been a line drawn between what has been deemed counseling and what has been deemed therapy. However, in the midst of what I see all mental health workers dealing, I view this distinction as archaic. The distinction between the more serious problem that warrants a diagnosis and the less serious problem that is viewed as more developmental is just not that clear. To clients, all problems are serious. The experience of many school counselors is that they are managing small, community mental health agencies in their schools. The elementary school counselors that I supervise have very serious mental health issues in some young children. Even though they may not always be warranted, diagnoses are necessary for services in most community mental health centers and most therapists appear to find ways to accommodate the system with minimum adjustment. Thus, I do not make a distinction between the terms "counseling" and "therapy." I do not know where to draw the line. Further, I do not desire to lessen the significance of the work of any mental health workers by labeling their work as "counseling" and not the more severe "therapy." Therefore, I use the words interchangeably and deliberately alternate their use in discussions.

What you have just read is taken from the foreword to the second edition of my book. Most people never read the foreword. Rather than fight this reality, it is easier to instruct people not to read the foreword. This is how you deal with the resistance against reading the foreword.

Chapter 1: Developing a Personal Philosophy for Handling Resistance

The effective management of resistance is the pivotal point of good therapy. Consequently, it is recommended that all mental health professionals take time to develop a personal philosophy for dealing with resistance. Your personal philosophy of resistance should provide you with techniques for dealing with resistance that are built from an understanding of the dynamics of resistance.

Thus, the foundational component of your philosophy should be an understanding of what resistance is—what it represents psychologically. Resistance is not one thing. The word "resistance" is actually a very limiting term utilized by mental health professionals that represents a host of reactions and interactions. In order to deal effectively with resistance, you should have an understanding of its many possible psychological interpretations. One of the purposes of this course is to expound upon this point, and thereby, provide an understanding of the many meanings of what is commonly referred to as resistance.

Your understanding of resistance should then lead you in developing approaches to managing resistance. As a result, your personal philosophy will include a wide variety of approaches and techniques for directly managing resistance. These tactics should equip you with several alternative responses to virtually any client position. Your toolbox of techniques should provide you with approaches that gracefully and eloquently manage client reactions. You should have a balance between responses that are too passive and responses that might appear to be too confrontive. Ideally, you should be able to react in a situationally appropriate, yet decisive, manner when resistance is encountered.

Thus, your personal philosophy should include theories for conceptualizing resistance, and techniques that allow you to maintain your emotional comfort as you deal with resistance. Further, your theories and approaches should aid you in conceptualizing the resistance in a manner that avoids futile battles with your clients. You should easily circumvent being pulled into the stuck state that your clients are experiencing, and you should be able to remain objective as you establish a clear perspective about what is occurring.

Ultimately, your personal philosophy should equip you with the skill to see resistance coming well in advance, so you will not be surprised when it presents in therapy. Interestingly, as your skills develop, your knowledge will help you to remain at ease as you bring to the surface the internal struggles of clients. Because of your increased comfort, you will allow yourself to arrive sooner at critical issues. Thus, you more quickly reach the place in therapy where you can be helpful. Your understanding and comfort with resistance will also decrease treatment time.

In summary, you should have a plan for dealing with resistance before you encounter it in therapy. You should be able to articulate to other professionals your position on resistance and your methods for dealing with it. If you were asked to state your theoretical position on resistance and your approaches and techniques for dealing with it, could you? If not, it is likely that your therapy is not as productive as it could be and that your highly resistant clients are quite frustrating to you.

Here are some indications that resistance may have gotten the better of you:

1. You feel like you are fighting and arguing with your clients. Many times you may have felt as if you were trying to convince your clients of something and not making headway.
2. Your clients are "Yes, but-ing…" you to death.
3. You are sitting on the edge of your chair, leaning toward your client with your neck stretched out while the client sits there relaxed! Our posture can be very revealing with regards to our comfort with resistance.
4. You are working harder in your sessions than your clients are. If, after finishing your sessions, you have more work to do than your clients, then you should take a close look at what you are doing. It is likely that something is amiss.
5. You are worrying more and carrying more tension about clients' problems than clients are. You take your clients' problems home with you on your weekend while your clients go home relaxed and confident that their therapist has the situation under control. The therapeutic tension should stay with the client, not the therapist.
6. You are feeling compelled to say "we" as you discuss client problems.
7. You dread the session before it begins.
8. You dread the session after it ends.
9. You feel stressed and drained in an unhealthy manner after sessions.
10. You are feeling burned out with your work.

Resistance Control = Stress Control

"Resistance feels personal to therapists" (Anderson & Steward, 1983, p. 2) rings true because of two interrelated realities. First, the desire to help others is strong in those who choose to work in mental health. This trait is observed when prospective students are asked why they seek a degree in counseling. The most common response is, "I just want to help people." Second, mental health work is fraught with difficulties. It is understood that most therapists who work in community mental health frequently deal with unmotivated clients with little desire to make serious changes. These clients are treated in a cumbersome bureaucracy that is filled with questionable paperwork and utilizes approaches that often feel as if they are, in part, contributing to the problem.

The strong desire to help others, coupled with the difficulties inherent in promoting client change, can result in resistance feeling personal. We often think it is our fault that our clients do not change. Resistance can result in feelings of insecurity, incompetence, frustration, hopelessness, stress, and burnout. When these feelings are indirectly communicated to clients, additional resistance results and a negative spiral develops. Novice therapists are especially vulnerable to the negative effects of resistance and the downward spiral that can develop.

The reality is that there are hosts of variables over which we have no control that contribute significantly to therapeutic outcomes. Indeed, Hubble, Duncan, and Miller (2006) concluded that approximately 40% of improvement in clients comes from extratherapeutic factors. More recent research estimates the influence from extratherapeutic variables to be as high as 87% (Scott Miller, personal communication, March 12, 2007). Such factors include the client's own personality characteristics as well as social support and chance events. Most likely, you were never taught these particulars. If your coursework included this data, it is unlikely that you will remember it when things are not going well. For some reason, we tend to think that our weekly one-hour conversation is going to override the impact of the 167 hours per week of influence from outside factors. Sounds like a cognitive distortion to me! I should point out that Hubble, Duncan, and Miller's research does indicate that our one hour of therapy is quite significant in its influence. It's those highly resistant clients that burst our bubble and arouse our stress.

Thus, one of the keys to dealing with resistance is to recognize that resistance is not personal. Resistance is a fact of therapy. All therapists experience resistance. All therapists go through periods where resistance gets the best of them. All therapists have to learn to manage resistance. There is nothing personal about resistance, other than that which we allow to be personal.

The mistake is letting yourself get sucked in by the alluring nature of resistance. Most commonly, you may personally take on clients' struggles and try to fight their internal conflicts for them. When you begin fighting clients' internal struggles as if they were your struggles, you allow the resistance to snare you in its trap. You allow clients' resistance to become personal and, in your zeal to help, you become helpless.

An extremely beneficial byproduct of understanding resistance is an accompanying reduction in therapist stress. Stress and burnout among mental health workers is well documented. Much of this stress comes from high therapist expectations coupled with minimal client progress; both of these factors are intimately tied to resistance. A comprehensive understanding of resistance and effective methods for dealing with resistance is essential to controlling therapist stress and burnout. This course was written to teach counselors how to avoid the frustrations of resistance and the accompanying stress. You owe it to yourself to study resistance if for no other reason than to help you deal with the stress inherent in mental health work.

Chapter 2: Understanding Resistance

Conventional Definitions

I do not like the word "resistance." It conjures up precisely the image that I wish to eliminate. Indeed, this course was written in order to overcome the outdated and useless ideas that the word typically conveys. Yet, I am stuck with using the word. This is because "resistance" is so commonly used that it provides a starting point from which to discuss the most serious frustrations encountered by therapists. Moreover, I have no alternative words to adopt in its place for which the meaning is commonly understood among therapists or that does not carry the same pitfalls. Further, given the choice of attending a seminar on "fostering client movement" versus "dealing with resistant clients," the great majority of therapists are much more responsive to the latter. This is because "dealing with resistant clients" carries with it the added appeal of solving therapists' problems as well as those of clients.

Thus, throughout this course and in my trainings I use the very word that I wish to redefine and, ultimately, eliminate from the minds of therapists. Such are the binds in which language places us. In the chapters that follow, you will learn some techniques that use similar language binds in ways that greatly benefit the therapeutic process. For now, I am compelled to use "resistance" in order to begin with a common language.

There have been numerous definitions of resistance. Traditional definitions have their roots in Freudian theory. Freud conceptualized resistance from two related perspectives. The primary position of Freud was that resistance represented the client's efforts to repress anxiety-provoking memories and insights (Otani, 1989). In other words, resistance is an attempt to control anxiety. In this sense, resistance protects clients from frightening discoveries about themselves. If we use this understanding to guide us in presenting ideas to clients, there is merit and utility in this definition.

Freudian theory also postulated that clients who do not accept the interpretations of their problems as conceived by their therapists are resistant. The idea that the therapist was wrong, that the therapist presented the issues in an unpalatable manner, or that there may have been other factors that resulted in the client's rejection of the interpretations does not appear to have been considered. Further, Freud also believed that resistance resides in the unconscious. Depending on the client's ability to access and disrupt unconscious processes, this position could make change even more difficult to accomplish. Overall, Freud conceptualized resistance solely as a client problem. It is this aspect of Freudian ideas that renders them outdated and counterproductive. As will be explained, the more we view resistance as a client problem, the less we empower ourselves to do something about it.

The following are representative of outdated definitions found in mental health literature. Such definitions still carry the influence of Freud, and are limiting in that they portray resistance as something that has its origin within clients. Figuratively speaking, resistance is seen as "residing" in clients.

"Any client behavior that exhibits a reluctance, on the part of the client, to participate in the tasks of therapy as set forward by the therapist,"
or
"…any behavior that indicates covert or overt opposition to the therapist, the counseling process, or the therapist's agenda" (Bischoff & Tracey, 1995, p. 488).

"Resistance refers to the client's unwillingness to change" (Ritchie 1986, p. 516).

"…ways utilized by the client to deter the counselor from his purpose of helping him to change can be called resistance…" Kell & Mueller, (1966, p. 12). (It should be noted that these authors also discuss the therapist's resistance to the client.)

The next definitions offered have much merit and utility when used to conceptualize and understand clients. When compared with the characterizations above, they expand the perspective and meaning behind resistance. Yet, they are incomplete in that they fail to include the therapist's contributions as a component of the resistance. To varying degrees, each of the following descriptions still tends to view resistance as something that resides within clients. Such perspectives leave therapists lacking control and too much at the mercy of other influences when attempting to foster change.

Cognitive: The cognitive therapists view resistance as a result of negative cognitions. Although the source of resistance is still seen as internal to clients, there is some truth in this logic. The therapeutic mistake that arises from viewing resistance as resulting solely from clients' cognitive distortions is that therapists can become overly focused on trying to change clients' thinking, rather than on changing their therapeutic approach. As will be addressed later, some resistance is a result of therapists' cognitive distortions that lead to unproductive approaches.

Behavioral: Some behaviorists see resistance as noncompliance with behavioral assignments. Similarly, resistance may be a result of a failure to find the right contingencies, reinforcements, punishments, etc. Kahn (1999) saw resistance as a good measure of secondary gain inherent to the problem. From this perspective, resistance occurs because of the benefits gained from maintaining the current behavior. These perspectives do have the benefit of taking the source of the resistance out of clients. Unfortunately, they require considerable control over the environment before anything can be done to overcome the resistance, a luxury most therapists do not have.

Typically, resistance conjures up ideas of stubbornness, obstinacy, defiance, hardheadedness, rigidity, and opposition. Even with useful conceptualizations, negative labeling is common. However, there is little benefit from conceptualizing resistance in this way. When you place negative labels on your clients, you move into a position of "stuckness" with your conceptualization. In order to avoid the consequences of negative labeling, you may want to consider other perspectives on resistance. For instance:

• Resistance is a reflection of the developmental level of your client.
• Resistance is a signal the client is dealing with a very important issue (Moursund & Kenny, 2002).

Unfortunately, perspectives that view resistance as solely a client problem have lingered in modern counseling literature. New, more insightful perspectives have been presented, but have been slow to emerge as a dominant school of thought. Likewise, these new perspectives still do not appear to be taught in many training programs.

Alternative Perspectives: The Social Interaction Theorists

The most insightful and useful definitions of resistance come from the social interaction theorists. From this perspective, resistance occurs as a result of a ''…negative interpersonal dynamic between the therapist and the client" (Otani, 1989, p. 459). Or, as Strong and Matross (1973) more specifically state, "Resistance is defined as psychological forces aroused in the client that restrain acceptance of influence (acceptance of the counselor's suggestion) and are generated by the way the suggestion is stated and by the characteristics of the counselor stating it" (p. 26). Here, resistance is seen as something that results from the interactional styles of the counselor and the client. The counselor allows the client to form a mutual communication pattern that hinders counseling and the change process. This view of resistance forces the counselor to remain aware of what he may be doing that actually promotes resistance. The great benefit of this perspective is that changing your interaction style results in changing what has been deemed resistance. This perspective empowers therapists.

This position is primarily what is expounded upon in the Solution-Focused Brief Therapy literature. Solution-Focused approaches never label clients as resistant. The concept of resistance is eliminated from conceptualizations of clients and their problems. No matter how much reluctance may be displayed, all responses are simply viewed as information regarding how clients perceive and proceed with change (Walter & Peller, 1992). Taking a position counter to traditional views, Brief Therapy models replace resistance with the idea of cooperating. Clients are not resistant; they are cooperating in ways that are not always understood by most therapists. Indeed, de Shazer (1982) presented arguments that the terms "resistance" and "cooperation" are really two sides of the same coin, suggesting that their differences are a matter of perspective.

Replacing traditional views of resistance with the idea of client cooperation is a major paradigm shift for the field of therapy. Do we react to clients' responses in a manner that views their behavior as resistant, or do we react in a manner that implies cooperation? This course presents approaches that avoid the trap of interaction styles that interpret client responses as resistance. Such pitfalls are likely to create resistance where none may have existed previously.

There are numerous ways in which the perspectives and interaction styles of therapists foster resistance. A number of these will be addressed later. At this point in the discussion, in order to help shift your perspective to a more therapeutically empowering stance, the following ideas are offered. By seeing the source as the therapist, these points of view take a different approach to resistance. Read through the statements below and notice how resistance is defined around therapist behavior and not as something that resides within clients. As you read, perhaps you will become aware of your own reticence toward what is being suggested. Are you resisting or just conveying that these ideas are a bit difficult to accept at this time? Perhaps the writer should present these ideas in a more palatable manner?

• Resistance occurs when the counselor fails to recognize that all clients are ambivalent about change.
• Resistance sometimes occurs when the counselor wants more for clients than clients want for themselves. In this sense, resistance can be a values clash between the counselor and clients in which the counselor's values are overly present.
• Resistance is a result of the therapist being too intent on her own agenda.
• Resistance = counselor expectations.
• Resistance occurs when the counselor starts trying to solve the client's problems.
• Resistance occurs when the therapist is going too fast.
• Resistance occurs when the counselor does not know what to do.
• Resistance occurs when the counselor asks the wrong question or makes a poorly worded, unacceptable statement. To the client, the statement is unfathomable and unrealizable.
• Resistance is "...anything the client does that makes the therapist feel inadequate" (Pipes & Davenport, 1990).
• Resistance occurs when the counselor fails to cooperate with the client.
• Whenever you feel that your client is being resistant, you also must be resisting your client's position. From this perspective, you are being resistant. When considered in this context, resistance is a counselor problem.

Moursund and Kenny (2002) suggested that there are two types of resistance. The first has to do with what the client is struggling with inside. The second is resistance that results from therapist error. When you closely examine personal struggles, you discover that resistance is a natural, necessary part of every client's problems. It is neither good nor bad, and the knowledgeable counselor does not abandon, rescue, or attack the client because of her resistance. Resistance is the problem at hand.

In the case of therapist error, the counselor is trying to get the client to do what she is not ready to do, or is afraid to do, or does not even understand. In this case, the counselor's own impatience creates resistance and is the counselor's greatest enemy. In many cases, the counselor is trying to proceed in a manner that is not suited to the client. Perhaps the counselor has used language in a way that does not promote movement. Regardless, you cannot push or verbally bludgeon your client into genuine change. Approaches different from the commonplace must be learned and applied in order to promote change.

You cannot change your clients; you can only change how you interact with your clients. Perhaps the key point that emerges from studying the social interaction theory is that change results from interaction style. Hence, we do not and cannot change our clients. Our clients change when they decide to change. To think that we have the power to change anyone is a cognitive distortion. We change how we interact with our clients in the hope that our interactions result in clients making decisions to change. When we view therapy from this perspective, our approach and techniques take on a new purpose and meaning. When we focus on how we are interacting, we empower ourselves to make needed adjustments when resistance is encountered. When you think about, this is the only legitimate way we overcome resistance.

Resistance and Influence: Breaking the Negative Cycle

In order to further clarify and expand upon the social interaction theories of resistance, the following model is offered. This model conceptualizes and defines resistance as being a mismatch between the therapist's mode of influence and the client's current willingness to accept that influence. The approaches and techniques presented in this course are based upon this model.

There are many ways to influence people and promote change. If you were to create a rough hierarchical list starting with the least forceful and moving toward the most forceful methods to influence people, it might appear something like this:

Each method of influencing has its benefits and drawbacks. Further, the benefits and drawbacks vary depending on the situation at hand. Effective therapy hinges upon therapists using an appropriate level of influence with regard to the client's current state of mind. With highly resistant clients, it is critical to be on target with the method of influence you use relative to their current degree of acceptance of your approach. Resistance is created when the method of influence is mismatched with the client's current propensity to accept the manner in which the influence is delivered.

For example, although there is definitely a time and place for direct confrontation, it is usually not in the initial stages of counseling. Confrontation delivered early in the process will likely be incongruous with most clients' initial inclinations toward accepting such a forceful method of influence. To be effective, direct confrontation should only be employed after considerable rapport and respect have been established and other approaches exhausted.

This is not to say that therapists are not to influence clients. Indeed, it is impossible not to influence. The key is to understand the benefits of each method of influence and to then maximize the use of diverse methods of influence at various times during the therapeutic process. More specifically, in order to manage resistance, you must incorporate the most fitting method of influence relative to the dynamics that are present in the therapeutic relationship at a particular point in time. Effective therapists are constantly adjusting and matching their method of influence with their client's current state of mind. This is perhaps why research continues to support the idea that the therapeutic relationship is the most critical factor in successful therapeutic outcomes. When the method of influence used is incongruous with the client's current state of mind, what is commonly labeled as "resistance" occurs. If you deal with clients who display much reluctance to change, it is important to understand the relationship dynamics at work.

Clients who display what appears to be resistance do not, for some reason, want change in the manner prescribed by their therapist. Here, the method of influence utilized is likely mismatched with the client's current inclination to accept that method. In order to subvert therapist influence, clients must expend energy as they focus on not coming under another's control (i.e., resistance). In reaction to clients' reluctance to accept their influence, most therapists try even harder to influence. As therapists' attempts to influence increase, so do the clients' rationales and inner needs to circumvent this influence. A vicious cycle is formed that is fueled by the escalating attempts of therapists and clients to not be influenced by each other. Often, what originated from an inappropriate method of influencing intensifies into an arduous battle of wits.

In such relationships, it is as if the client and the therapists are in a tug of war with each pulling harder on his end of the rope in order to drag the other across the line into submission. Each is exerting considerable effort to force the other to give in and agree with the opposing perspective. The result is that clients are reinforced by the secondary gain of not having to face their struggles and change, and therapists are exhausted and approaching burnout in their work.

The way out of this cycle is to avoid directly fighting clients' positions. Stop pulling the rope and join clients on their side of the line. Upon doing this, there is no reason for clients to focus on, and expend energy to oppose, therapist influence. This same energy is now free to be used for other pursuits. Once this is accomplished, a more suitable method of influence can be established. Typically, at such junctures, therapeutic influence that is indirectly presented has a much better possibility of shifting perspectives and behavior.

Clients only have so much energy to focus on the difficult struggles before them. Therapists do not need to do anything that diminishes the amount of energy available for the therapeutic work at hand. When therapists apply mismatched methods of influence with clients, they increase resistance and decrease the energy available for change. For those seeking additional study of models of resistance from this general perspective, I suggest you begin by reading Cowan and Presbury (2000).

Client Dynamics Often Mislabeled as Resistance

The redefining of resistance has two interrelated components. The first component is to understand resistance from a social interaction perspective. The groundwork for this was presented in the previous discussion. The second element is to learn to replace conceptualizations that inaccurately label client dynamics as resistance with more precise conceptualizations that provide a useful framework from which to proceed.

When you view resistance from the perspective of these two components, you quickly realize that the word "resistance" is frequently used when one of two things is occurring. The first is that we, as therapists, do not have a technique or approach available at the moment to use with a particular client situation. If we had a technique to deal with every interaction, would we need to label clients as resistant? The second is that we use the word when we do not fully understand the world of the client and, thus, we do not understand why the client is responding in the manner in which she is. If we fully understood the world of our clients, would we need to label them as resistant? Or, in such instances, would we simply comprehend and understand their reactions relative to their world? From these perspectives, it becomes apparent that resistance has become a catchword—an excuse, if you will, for our lack of skill in dealing with clients and our lack of understanding of our clients' worlds.

With this understanding, it becomes apparent why therapists are strongly cautioned against labeling any behavior as resistant. Such labeling moves therapists into a position where they stop looking for alternative conceptualizations of client reactions and for alternative approaches. Thus, labeling creates stuckness. Further, as will be discussed later, we create what we talk about. If we talk about clients' reactions as being resistant, we are creating the very thing we want to avoid. The more you study what is commonly labeled as resistance, the more you will recognize that such labeling is of little therapeutic benefit. Indeed, it is most likely harmful. Before any behavior is deemed resistant, the counselor should rule out a host of alternative conceptualizations.

There are a multitude of possible explanations and meanings for what is often labeled resistant behavior. Below are some of my own and some from various sources. These ideas are offered in an effort to be thorough and to add utility to this course by increasing the understanding of the many client dynamics to which therapists must adjust. These ideas are not presented as a definitive list nor are they assumed mutually exclusive. Many have overlapping components. They are presented to stimulate ideas about what may be occurring within clients that may appear as resistance to therapists.

When you find yourself frustrated with a client's lack of progress, read through this list and assess whether any of these ideas may be legitimate conceptualizations of the underlying factors resulting in the lack of movement. Typically, after a client dynamic is understood, it is less likely to be perceived as resistance. Subsequently, you can adjust your approach and deal with the dynamics at hand.

• Resistance could be a sign that the client does not want to be there—that the client came to counseling to satisfy demands of someone else.
• Resistance could be an adjustment reaction to the novel situation of counseling, of actually talking to someone about problems, or of being in the office of a "shrink."
• Resistance could be a reaction to the openness of the therapist. Such openness may be experienced by the client as very strange behavior.
• Resistance can be an indication that the client does not know how to be a client. For example, they may not be skilled at "going inside" and assessing and experiencing their own feelings (Moursund & Kenny, 2002). Thus, when feelings are suggested and stated by the therapist, the client may be perplexed and bewildered.
• Resistance could be an indication that the client has been hurt in previous close relationships. In order to prevent additional pain, they stop moving forward to guard against the perceived hurt that may arise in the client-therapist relationship (Moursund & Kenny, 2002).
• Resistance could be a sign of an underlying fear of failure. This fear of failure may be related to making changes in one's life. Alternatively, this fear may be from the client not knowing how to be a client and, at the same time, having a high need for success or perfection. Thus, resistance may be a result of the fear of failure at being a client.
• Resistance may be a result of feelings of shame that exist because the client has not been able to resolve issues (Teyber, 2000), or because of the social implications surrounding the issues.
• Resistance could be a result of the fear of taking risks. It might be that counseling is seen by the client as highly risky behavior whereas the client is actually very conservative in his approach to life.
• Resistance may be an indication that the client feels as if she is "…having familiar things taken away or tinkered with in ways that do not yet feel safe" (Murphy & Dillon, 1998, p. 126).
• Resistance could be a sign of social fear that emerges as a result of poor social skills.
• Resistance could be a desire from the client to flex his individuality.
• Resistance may be a sign that the client enjoys manipulating others and, by not "moving" or responding therapeutically, she realizes that she can manipulate the therapist. Opposing the therapist may be one of the only empowering elements of the client's life.
• Resistance can be passive-aggressive behavior. The client may be angry with the counselor or some other adult or authority figure that the counselor represents (i.e., transference). This anger is expressed as resistance.
• Resistance could be a result of life experiences. Perhaps the client has learned that parental or authority figures are not to be trusted. It may be that he has learned that to survive you should not trust authority figures. What appears to be resistance may be a survival mechanism in reaction to authority figures in general (Kaplan, 2001).
• Resistance can be an indication that the client is psychologically drained and does not have the energy to take on the tasks that will lead to change. Here, the therapist needs to back off and allow for replenishing of energy. Take a therapeutic break.
• Resistance can be a personality style. Some people enjoy the battle of resisting. In such clients, the stimulation that results from arguing and controversy may reinforce resistant behavior. They often switch positions if they find others agreeing with them in order to keep the stimulation going (Kottler, 1994).
• Resistance may be a reaction to the loss of personal freedom inherent in the counseling relationship (Anderson & Steward, 1983). "Entering any form of psychotherapy constitutes the formation of a dependent relationship and therefore a loss of personal freedom" (p. 30).
• From an Adlerian perspective, resistance is the client's way of avoiding personal responsibility and of gaining respect and sympathy from others (King, 1992). Adler viewed all behavior as purposeful, and concluded that these two justifications explained the underlying purposes behind what is deemed resistance and its related symptoms.
• Resistance can be an act of jealousy or sabotage in order to maintain the counseling relationship. "If I get better, then I will not be able to come to these sessions and get all of this attention and maintain my relationship with my counselor." In this instance, an unhealthy dependence has developed between the client and therapist.
• Resistance may be a healthy response to bad counseling (Hammond, Hepworth, & Smith, 1977). Therapists who lack empathy, dominate discussions, lecture to clients, move too quickly, or offer advice from a know-it-all stance will likely arouse resistance in healthy clients seeking someone with better counseling skills.

The Positive Side of Resistance

Resistance has a purpose, otherwise, it would not exist. When you understand the many benefits of resistance, you begin to realize that it is essential for mental health. Drawing from the work of Hycner (1988), Cowan and Presbury (2000) remind us that, "…the counselor must be able to appreciate the wisdom of resistance as the client's way of preserving some important aspect of self or identity" (p. 414). To fully understand resistance, we must recognize and study its many positive aspects. The following purposes and benefits of resistance are compiled from the writings of Anderson and Steward (1983) as well as my own analyses.

• Without resistance, all social systems would dissolve into chaos and confusion, changing with every new idea presented.
• Without resistance, families would not have the stability necessary to provide the structure required to raise healthy children.
• Resistance is what prevents us from being victims of charlatans and sociopathic con artists.
• Resistance is what prevents us from buying every product presented to us in commercials and infomercials.
• Without a certain amount of resistance, we would have no stability, predictability, security, and comfort.
• Without resistance, there would be no sense of self.
• Feminists regard resistance as an indicator that the client is fighting against unjust systems and as a sign of power in the face of oppression (Brown, 1994, as cited in Corey, 2001).
• Resistance provides us with a sense of being right. Can there be right and wrong without resistance?
• Resistance can be a sign of good mental health and judgment. Without resistance, there would be no mental health.

Food for thought: Would you rather have a client that does everything you suggest, or would you rather have a client that takes time to adjust to new ideas? Which is more frightening?

Chapter 3: Common Errors Therapists Make That Create and Foster Resistance

The purpose of this chapter is to take a hard look at what might be occurring in the counseling relationship that may inadvertently create resistance. Many of these points stem from the distinction between what we are trying to accomplish in therapy and what we are doing at present with the client. One of the keys to becoming a master therapist is to develop a keen awareness of what we are doing, literally, at the present moment with the client. Too often, mental health professionals know, and focus on, what they are trying to do with clients. However, these same professionals are not always aware of what they are actually doing with clients—what is happening with the relationship as they speak. Understanding this distinction is critical to managing resistance. When the focus is on what you are doing in therapy, the chances of success are increased.

This chapter examines what we are doing and the potential impact it can have on creating resistance. Although the initial points presented here are highly interrelated, they are presented as separate issues for clarity.

Your Client is Not Making Progress Toward What?

Among other things, when we experience resistance we say that our client is "not going anywhere." The client is not "invested in changing" and is "showing no progress." We feel stuck. Central to these statements are the questions, "where is the client supposed to be going?" and "the client is showing no progress toward what?" One of the primary therapist errors that causes resistance is failure to establish a mutually agreed upon objective.

The key word here is "mutually." Clients —particularly resistant clients—should be active participants in goal establishment. People do not resist what they want; they resist what they do not want and what is imposed upon them. If we start by first seeking what the client wants, we build a foundation for mutually agreed upon goals. Our initial conversation should set an atmosphere of understanding wherein ideas are not imposed upon the client.

Counselors who impose goals on clients without regard for clients' desires are like salespeople who try to sell products that people do not want. We have all experienced the irritation of a pushy salesperson trying to get us to buy something we do not desire or need. When therapists create goals without client input, they often find that they have inadvertently moved into the role of salesperson. In most of these instances, therapists are trying to sell the client on a particular treatment plan. Ironically, most people enter the counseling profession because they do not like sales work. Yet, they frequently experience therapy as trying to sell treatment plans to clients who are not interested in buying. In order to prevent moving into a position where we are trying to convince clients to "buy" our treatment goals, we should strive to stay in a customer service mode where we aid clients in finding what they desire. This mode of interaction is also considerably less stressful to therapists.

The significance of a mutually agreed upon goal is substantiated in the insightful and informative research of Hubble, Duncan, and Miller (2006). When factors within the therapist's control are examined, the therapeutic relationship/alliance emerges as primary to successful outcomes. This should be of no surprise. When the therapeutic relationship/alliance itself is factored in, it turns out that agreement between the client and the therapist on the basic goal of the therapy is one of the three critical components that make the therapeutic relationship/alliance work. Thus, of the factors we control, a commonly recognized goal is essential to successful outcomes. (One of the other two factors that form a successful relationship is agreement on the therapeutic processes that must be carried out within the sessions. In other words, agreement on the therapeutic work to be done. The final factor is, of course, the presence of Rogerian core conditions. What did you expect?!)

If you and your client are not in agreement about desired outcomes, problems are inevitable. For therapy to be successful, you and your client should be able to clearly state mutually agreed upon objectives. If mutually agreed upon objectives have not been established and a reasonable time has been devoted to establishing rapport and understanding the client's situation, then it is critical to focus session time on the creation of such objectives.

The next time one of your colleagues complains to you about a particularly difficult client who does not want to change, ask, "What is the goal?" If she begins stuttering or goes into a vague, rambling explanation, you will know that a mutually agreed upon goal has not been established. Then inquire, "If the client was asked what the goal is, would the client agree and could he state it?" It is mind-boggling how many times this essential therapeutic component has not been formulated.

Why Most People Come to Therapy

Understand this: Most people do not come to therapy to find solutions to their problems. Most people come to therapy, "…because they realized what the solution was and were terrified" (Walter & Peller, 1992, p. 100). Although there may be exceptions to the above statement, more often than not, it is true. Perhaps you have heard the commonly stated axiom that all clients have the solution to their problem inside; the job of therapists is to help them find it. The reason people are unable to come to grips with a possible solution is that the solution is terrifying. Making the changes necessary to resolve issues in their lives scares the hell out of them. Thus, it becomes much easier not to recognize possible solutions at all.

From this perspective, one of the primary jobs of therapists is to normalize the fears surrounding the solutions and support the client's courage to move forward in the midst of the perceived, impending dread. In cases where fear of the solution is great, focusing too strongly on solutions and goals may actually increase fear. To break the impasse, focus on dealing with the fear that accompanies the solution before moving the focus forward toward actions to be taken. The primary point is that therapists may inadvertently create what appears to be resistance because they have focused the discussion on the wrong issue, or on an issue that should not be approached until other issues are addressed and, at least, partially resolved. In such instances, therapists have gotten ahead of clients in problem resolution.

The issue of defining the problem and thus, the solution and goal, is often directly tied to the "horror of the solution." The more terrifying the solution, the more likely clients will be to dance around the real problem. They will discuss a series of seemingly disjointed incidents or never actually present a clear picture of why they are seeking help. In these instances, the problem is not clearly emerging in the dialogue. Generally, such dialogues are unfocused, scattered, inconsistent, contradictory, and just do not add up and make sense. If this occurs, it is likely that the discussed problem is not the primary problem that needs to be addressed.

Clients that dance around the central issue often feel as if they are resistant. The real issue facing such clients is only discerned from the overall impression of what is going on in the session. The therapist must step back and look at the session as almost an abstract work of art. You must look at the big picture and then find the primary underlying theme that prevents clarity in the dialogue. As noted, this is typically an impending fear or dread that is linked to the problem. As a picture of this theme emerges, the therapist's next task is to find a way to present the theme to the client in a supportive, palatable manner. From this discussion, a coherent problem definition can be developed.

In our clinic we once had a woman who talked for four sessions about how much she hated her husband and how badly she wanted a divorce. We were dumbfounded that she was not proceeding with the divorce. As we addressed the issues further, she began discussing her financial dependence on her husband and the fact that she had no marketable skills to use toward getting a job. This was compounded by the fact that she had children to support, and returning to school for training would be costly and scary. At this point, the entire session changed from focusing on the desire to divorce to focusing on the fears that accompanied the divorce. Hence, we began dealing with the real issues.

As will be explained in future sections, clients that greatly fear solutions to problems are typically said to be in the precontemplative stage of change (See Chapter 3, the section entitled, Failure to Recognize and Respond to the Client's Stage of Change). With such clients, therapists must learn to focus on the immediate struggles and not on distant goals. This is often challenging because it does not place emphasis on immediate problem resolution and quick action. The ability to recognize that there is much groundwork that must be laid before direct attempts at resolution are implemented requires much skill and patience on the part of therapists. The ability to understand the dynamics of change across time is a must. The ability to be content with small steps will also go a long way toward making meaningful progress.

The Essential Ingredient Necessary Before We Help Anyone

Here is a simple but powerful premise that was taught to me by Dr. David Burns, author of Feeling Good: The New Mood Therapy, at a seminar he conducted. Dr. Burns stated that you can never help your client until the problem is defined around a specific person, place, and time. I have contemplated and tested this assumption numerous times and have yet to disprove it. If your discussion with your client has not reached the point where the problem can be formulated around a specific person, place, and time, then there is clarifying yet to do.

This is a very interesting idea. Sometimes the person, place, and time are obvious. It might be a husband or wife or boss or child. In other instances, the person, place, and time is the client at an earlier age in a traumatic experience with someone. Sometimes it is the client and you at the present moment in the session. This is because what is occurring between you and the client is often a microcosm of what is occurring with others in his life. Thus, there is no need to seek an outside example when the pattern of behavior is occurring right there in the session.

In most instances, something needs to change in the interaction with the particular person, place, and time. Something must be done to interrupt the current modus operandi. At other times, the client needs to "return" to a point in time in her life, and discuss and reframe events and emotions. Regardless of the case specifics, the person, place, and time components are always present in solvable problems. If you and your client cannot readily state the person, place, and time of a problem, then the problem definition is too vague and progress will be hindered.

What actually happens is that clients have a series of problems. These problems have to be sorted through to determine which one the client wants to work on presently. The problem chosen has within it a series of person, place, and time events of significance. Most likely, there are similar patterns of interaction within each of these person, place, and time events. In order to be helpful, one of these person, place, and time events must be selected and processed in great detail in regard to emotions and alternative approaches. It is at this point that we, as therapists, become helpful. Person, place, and time events are the nuclei of most problems. These core components are only reached when the issues are funneled down to a singular person, place, or time event. Until this level of clarity is reached, clients may appear resistant. When clarity is lacking, establishing specificity is the first step to dissipating resistance. However, as will be addressed, there is a time for generating confusion, also.

The Perils of Assuming a Knowing Attitude

An interesting paradox occurs with highly resistant clients. The greater the resistance, the greater the likelihood that the client is refusing to consider any of a host of possible solutions. Because there are so many changes that may bring improvement, possible solutions appear abundant from the therapist's perspective. As you become aware of the myriad possible solutions, you become more certain that your knowledge can help. Because of your certainty, you begin talking more and more as an expert regarding the problem at hand.

But here's the catch. The more of an expert you become, the more you provide the client something definitive to resist. Furthermore, the more of an expert you become, the less psychological freedom the client has to explore possibilities on her own. Thus, your expertise results in the client losing the sense of freedom that is necessary to willingly embrace change.

One sure sign that you have become too much of an expert is "Yes, but…" answers. "Yes but…" responses most commonly follow advice and suggestions, or questions that are intended to convey alternative behaviors the client might try. The problem with such comments is that they communicate your expert knowledge. With highly resistant clients, the more knowledge you present about solutions, the greater the likelihood of resistance. Conversely, when you present yourself as less knowledgeable, uncertain, and puzzled, the less you provide a position against which to resist. In addition, when you present yourself as unknowledgeable, you give clients more psychological freedom to "move" therapeutically.

Moving to a position of naiveté and unknowing is sometimes difficult because you really do think your ideas could help. However, it is not how much you know that matters. It is not how much you want to help that matters. What matters is what is occurring in the relationship between you and your client at any particular moment. If the client is rejecting your suggestions with "Yes, but…" responses, he is signaling that he is not buying what you are selling. When this occurs, stop selling and return to gathering information about what the client might accept. This is a classic example of a mismatch between our method of delivering influence and the client's current propensity to accept the method by which the influence is delivered.

Hence, the way out of this situation is to reverse the paradox. The more obvious possible solutions become, the more naïve, inexperienced, and uncertain your displayed attitude toward these solutions should be. In other words, your highly resistant clients should experience you as more uncertain when possible solutions are obvious. You want to avoid creating a situation where your knowledge of solutions emerges in such an overbearing, know-it-all manner that you increase the motivation of your highly resistant clients to try to prove you wrong. You can avoid this dilemma entirely by assuming a naïve position toward solutions. The principle at work here is that your clients cannot be resistant if there is nothing to resist.

My students have referred to this approach as the "Columbo technique" because it is very similar to the approach taken by detective Columbo as he fumbled yet cleverly hoodwinked his suspects into revealing key pieces of information necessary to solve the murder. Columbo apprehended his suspect by appearing unable to understand the basic components surrounding the murder and by asking questions that forced the suspect to clarify her actions. Although Columbo always appeared to be two steps behind the murderer, in reality he was two steps ahead.

It should be noted that there are certain pseudo therapeutic statements that convey a knowing attitude without substantiation and invite challenges from clients. To make such statements is a classic error that should be avoided. Gerber (1986) provided examples of two such statements—"I know how you feel" and "I understand." If you suspect you know how clients feel or you understand their situation, then say it explicitly; do not just expound that you know it. (Can anybody really know how another feels?) The problem with such statements is that, if the client challenges your knowledge and you are forced to explain what you think you know, the client can always say you are wrong, and you have no grounds from which to defend your position.

Rogers is Still Right and Why People Change

A long-standing maxim in counseling is, "Clients do not care how much you know until they know how much you care." Yet often, after some therapeutic experience is gained, counselors forget the powerful impact and importance of empathic statements. We become lax in consistently including empathy throughout our sessions. Commonly, sessions become loaded with an excessive quantity of questions without a foundation of understanding. What typically follows is that clients lose the feeling of psychological support necessary to proceed safely. Much of the time, the decreased use of empathy is more of an unconscious than conscious progression on the part of the therapist. You have slowly moved away from the basics as your job has become routine. Subsequently, sessions begin to stagnate. An essential component to breaking through resistance is to maintain a foundation of understanding through a dialogue that consistently includes empathic statements.

In addition, there is an even more important reason to consistently use empathic statements. Many times therapists discount and limit the consistent use of empathy once rapport has been established. The logic here is something like, "Now that I have rapport, I will build a logical case for change." However, people do not change because of logic. People change when they have an emotionally compelling reason to change. The energy and drive for all change is derived from an emotionally charged base. Logic alone is not enough. If people changed because of logic, no one would smoke, no one would drink, everyone would exercise, we would not eat the vast majority of the food in vending machines, we would never try to outrun a yellow light or a train, or engage in a host of other stupid human behaviors. Yet, people continue to do these things on a regular basis.

I am not saying that logic is not present in change; it almost always is. Most of the time, it is presented as the reason for change. However, when you closely examine the underlying forces that actually move people to change, they are not logically based. They are emotionally based. You must look below the surface to understand fully the dynamics of change. Logic provides the socially acceptable, sensible reason to change; emotion provides the underlying motivation to initiate and implement the change.

Compelling reasons are compelling because they arouse strong emotions. Yet, because emotions are often linked to uncomfortable feelings, most clients have blocked awareness of, or are in denial about, their own emotions. It is through the use of empathic statements that therapists get clients in touch with the emotional energy needed to initiate change. Empathy is the tool by which therapists get and keep clients in touch with the emotions that ignite and fan the fires of change.

Highly resistant clients need to experience consistent empathic responses in order to build a compelling emotional foundation on which to motivate their logical reasons to change. For most resistant clients, logic without an underlying emotional charge is just talk. Failure to consistently include empathic statements in counseling dialogue inevitably makes the task of overcoming the client's ambivalence to change much more difficult and will likely be experienced as resistance by therapists. Interestingly, it is the highly motivated client that is less in need of empathy, even though you should use it here, also.

The general rule should be, the more resistant the client, the more empathy is needed in the process; the more motivated the client, the less empathy is needed. For compelling research that substantiates the powerful and pervasive influence that empathy has on therapeutic outcomes, see Burns and Nolen-Hoeksema (1992) and Hubble, Duncan, and Miller (2006).

Timing is Everything and "Baby Steps" are Not a Joke

A significant amount of resistance comes from poor timing. The most common timing mistakes center on introducing new ideas prior to your client being ready to accept those ideas. Anytime you are experiencing resistance, ask yourself, "Am I getting ahead of my client?" If you find that you are ahead of your client, slow your pace, back up, and take smaller steps. Explaining before the client is ready to accept, confronting too soon, and moving too quickly to an action phase are all common forms of bad timing.

In the movie What About Bob, Richard Dreyfuss plays a psychiatrist who suggests to his client, Bob, played by Bill Murray, that he read his book entitled Baby Steps. He further instructs Bob to take only baby steps toward solving his host of neuroses. As the movie progresses, Bob develops a highly dependent relationship with his psychiatrist as he begins to take baby steps and solve his problems. Although this movie was a hilarious spoof on therapy, the concept is not to be taken lightly. In many areas of life, you must slow down to go faster. Therapy is clearly one of these areas. Teaching and allowing clients to take smaller steps are vital components of effective therapy. Getting ahead of your clients in the change process is a sure way to experience the frustrations of what appears to be resistance.

In order to not rush your client, I suggest that you constantly ask yourself, "What could I say that might move my client the smallest step possible toward where he needs to be to resolve his problem?" In other words, although your client may have an ultimate goal, your immediate task is to simply move your client closer to that goal using the smallest step possible. Rarely should your immediate task be to reach the ultimate goal.

This approach solves two problems. First, it does not push the client excessively and thereby create resistance. In fact, if you can stay "behind" your client in the process, then you can actually have the client pulling you along toward his solution. Second, this approach takes an enormous amount of pressure off of you. The task at hand becomes manageable, and you are more able to remain balanced in sessions. Therapists also need to learn to take baby steps. This skill is an enormous stress reducer.

Therapeutic Tip: Many therapists use scaling techniques to get a feel for the client's position relative to psychological concepts such as the level of emotion, commitment, tolerance, etcetera. Most therapists use a 1 to 10 scale for such assessments. However, in order to allow movement in even smaller steps, I suggest using a 1 to 100 scale. Moving from a six to a seven may be difficult for your client. However, moving from a 63 to a 65 will likely be perceived as achievable.

Accepting the Invitation to Take the Pain

People come to counseling because they feel bad. They are worried, stressed, lonely, in conflict, or unresolved, and are bewildered as to the direction to go in order to relieve themselves of their pain. To some extent, all clients want to be relieved of their pain without suffering. They do not want to move through their pain, they want to avoid it altogether. Clients would love for you to just take their pain away without any additional distress. As a result, all clients will—to varying degrees—"invite" you to take their pain. Even though the ultimate objective is for clients to feel better, relieving their pain, in and of itself, should not be the primary objective.

This is not to say that we should not provide an environment where clients can fully experience and ventilate their pain. Indeed, the provision of such an environment is one of the greatest gifts we give clients. However, once the anger and the tears are "dumped," we do not pick them up and take them with us. We do not try to directly repair the wound. Instead, we structure our dialogue to honor clients' pain while recognizing that it is theirs and not ours.

As most have been taught in their training programs, this is the difference between sympathy and empathy. Sympathy tends to drain motivation and can reinforce stuckness and suffering. Empathy recognizes and respects clients' suffering. It may actually increase it. Yet, when expressed appropriately, empathy also increases the motivation to change.

Clients extend the invitation to take their pain in a host of ways. It is often difficult to discern how much of what is being communicated is an invitation to embrace their pain as opposed to a genuine expression of frustration. Undeniably, the message is often mixed. Common ways the invitation is extended include histrionic expressions of problems; asking for advice (that is "yes, but-ted" and rarely accepted); expressing problems while avoiding any serious discussion of alternative actions; failing to do what they have expressed is clearly needed; wanting the therapist to change the behavior of another person not present; and framing problems in a clearly unsolvable manner.

We send the message that we have accepted the pain through our actions, the words we use, and the tone in which they are stated. This is often quite subtle. For example, as will be discussed later, the use of the word "we" in reference to problem ownership conveys that the therapist has taken the task of solving the problem as his own. "We need to see what we can do the resolve this," is an example of such a statement. The fine points of such communications should not be underestimated in the quest to avoid cultivating resistance.

Another common way to communicate that the invitation is accepted is by allowing the therapeutic tension to move to a position between the client and the therapist, and not be kept within the client. As previously discussed, moving too quickly puts pressure on the client and, thus, creates tension between the client and the therapist. At another level, it communicates that the therapist wants a quick resolve because she has taken on the problem as hers. Similarly, it is a mistake to excessively pursue clients and keep them in therapy when they appear unmotivated. If the therapist is working harder than the client to get the client to therapy, the responsibility for wellness is clearly misplaced, and resistance is certain.

Felder and Weiss (1991) argue that the therapist taking excessive responsibility for the client is the most common reason for resistance. They point out that excessive concern by the therapist tends to neutralize client motivation. This is because the more responsibility therapists take for clients, the less responsibility is given to clients for helping themselves. Thus, the level of concern displayed is always a delicate balance between the amount needed to maintain client motivation and being so excessive that the client hands the psychological work to the therapist. Therapists who fall into this trap often complain that they are working hard for their clients and getting nowhere. Yet, they are blind to the resistance they are creating through their excessive hard work. Perhaps the secondary gain of knowing we are "working hard" for our clients is just too significant of a feeling for mental health professionals. As a result, we are extremely reluctant to relinquish it to only the mere chance that clients may work through their problems by themselves.

Felder and Weiss (1991) provide an interesting example of accepting the invitation to take the pain. A colleague, John Warkentin, advised that if a client becomes suicidal, that the therapist should make certain that his fee does not go unpaid. To allow the fee to go unpaid would send a signal to the client that she is defective and cannot be held responsible for her debt. To allow the fee to go unpaid sends the message to the client that she is not responsible for herself by reason of some flaw. It would also be a sure indication that the therapist is attempting to take the pain. To the contrary, the client should remain invested in her own well-being, and the therapist should promote such an investment. One must not forget that the client is likely suicidal because she sees herself as flawed already. To relinquish the fee would only reinforce the self-perception.

One of the reasons therapists tend to accept the invitation to take the client's pain is that many therapists feel unproductive unless they perceive that they are making the client feel better. Such therapists have never learned how to be comfortable in the presence of the client's suffering. Such therapists usually have a high need to nurture. Unfortunately, this need to nurture overrides effective technique and they unconsciously send a message that they accept the invitation to take the client's pain.

It is a mistake to put too much of the immediate focus on techniques and responses that result in clients feeling better temporarily. Therapists who do this in excess run the risk of creating a therapeutic relationship that repeatedly band-aids the client's problems with no long-term resolution. You will know if you have done this because you will recognize the patterns that emerge. Clients will come in with their current catastrophes, you will talk with them and get them momentarily relieved of their agony, and they go their way only to return and repeat the pattern. Or, perhaps clients will make statements like, "I just love talking with you. I feel so good for the few days that follow. Then I get down on myself and have to come back to get another boost from our talks. You are a wonderful person. I am so glad you are in my life." Although such comments may be immediately gratifying for counselors, they can be an indication of a classic therapeutic error.

The error is that you have not designed a dialogue that keeps the therapeutic tension with clients. This therapeutic error fosters resistance in a covert manner. The mistake is often unseen because your repeated band-aiding appears to be effective initially; however, the effect is short-lived. Problems arise because the motivation for genuine, lasting change is diminished as a result of clients being able to get quick, temporary relief. You have used your understanding and skills to take away too much of your clients' pain. Subsequently, the motivation for long-term change is reduced as well.

Often, such clients are often the ones that you carry in your mind as you go through your weekend. You hurt while your clients go nowhere. As the pattern repeats, such clients become quite exhausting. After awhile, you wonder if you should stay in this business when you feel so bad and your clients make so little progress. You experience your clients as resistant when, through your style of dialogue, you have removed their motivation to change through an over emphasis on feeling better. You have forgotten the wisdom of Albert Ellis who is fond of pointing out that feeling better does not equal getting better.

It is important to remember that you should not appear to place blame on clients in the slightest way when constructing a dialogue that maintains the therapeutic tension. With highly resistant clients, recognition of the clients' part in creating their pain should emerge from within as a result of their constantly explaining the dynamics of their situation to you. The dialogue styles taught in this course always have this underlying goal.

Failure to Recognize and Respond to the Client's Stage of Change

Although we commonly view change as a momentary or short-term event, it is not. In most instances, change takes place gradually, over time. To help understand the process of change, Prochaska has developed a transtheoretical model of change that conceptualizes change as occurring over time in relative stages (Prochaska, DiClemente, & Norcross, 1992). However, this perspective has appeared to be ignored by many counseling theories. Most counseling theories approach clients as if they were all at the same general point in their struggles. Yet experience teaches us otherwise. The Transtheoretical Model construes change as a process involving progression through a series of five stages. A brief explanation of the five stages follows.

1. Precontemplation is the stage in which people are not intending to take action in the foreseeable future, usually measured as the next six months at least. However, people can spend years in this stage. Although family, friends, or employers may be acutely aware of the problem, people in this stage are typically unaware or under-aware of their problem. Alternatively, they may have tried to change a number of times and may have become demoralized by their inability to do so. Such people tend to avoid reading, talking, or thinking about the negative consequences of not changing. When they show up for therapy, it is often because of pressure or coercion from others.

People who attend therapy because of threats of losing their job, threats of divorce, or threats from parents or principals are often in this stage. People who are court ordered, or people who must attend in order to receive medications often fall into this category also. Those in denial typically fall into this stage. Many times, once pressure to attend is removed, they drop out. They may make statements like, "I guess I have faults, but there's nothing I really need to change," or they may only "wish" to change. Such clients are often characterized in most theories as resistant or unmotivated or as not ready for change. The fact is traditional counseling theories are often not designed for such clients and do not present approaches that are effective in helping and managing them.

Unfortunately, a substantial portion of clients seen at community mental health centers fall into the precontemplation category and are immediately pigeonholed as resistant.For such clients, it is imperative to spend much time building rapport and discussing their situations in a non-threatening manner. Your (covert) goal should be to engage them in a discussion of how the situation is a problem. The least threatening way to do this is to inquire as to how it is a problem for them. Remember, these clients usually do not recognize that a problem exits. Any session in which there is some recognition of a problem should be considered a success. To expect more is unrealistic and a cognitive distortion of the therapist.

Remain puzzled and naïve in the midst of overwhelming evidence of issues. Do the unexpected by not pointing out the obvious and not criticizing them for their lack of movement. Seeking immediate action is most often futile and a therapeutic mistake. They are masters of avoidance and you cannot create movement if they do not allow it. You will likely be defeated in your efforts if you appear coercive. Remember, if you push these clients, all they have to do to sabotage and thwart your efforts is nothing.

2. Contemplation is the stage in which people are aware that a problem exists and are intending to change in the next six months. However, just as in the precontemplation stage, people can spend years in this stage. It is in the contemplation stage that people are deeply struggling with the pros and cons of change. The internal conflict between the sacrifices and benefits of change produces profound ambivalence that keeps people stuck in this stage. Thus, there is awareness that a problem exists, but no commitment to action. They make statements such as, "I have a problem that I think I should work on," with the operative word being "think" and not "work." We often characterize this phenomenon as chronic contemplation or procrastination. Examples of people in this stage may include those considering divorce, changing jobs, losing weight, or starting an exercise program.

These people are not suited for approaches that assume immediate action is forthcoming. The therapeutic focus should be on examining the internal struggles. Any conversation that engages the client in a discussion of the pros and cons of change should be considered a success. Gestalt techniques such as the empty chair may be appropriate but may be experienced as quite threatening. The main point here is that therapists should keep in mind that it is a mistake to measure success in terms of immediate action. With contemplators, if you seek immediate action, you will likely increase resistance.

3. Preparation is the stage in which people are intending to take action in the immediate future, usually measured as the next month. They have typically taken some significant action in the past year. For example, if they are planning to divorce, they may have seen an attorney. If they are beginning their diet, they may have consulted a physician or joined a health club. They may have read a self-help book and scheduled an appointment with you. The preparation stage is a planning phase in which clients are beginning to actively carry out their plans—small behavioral changes have occurred and additional action is planned for the very near future. Thus, the primary focus should be on whatever is needed to sustain a continued commitment toward further action. These are the people best suited for most commonly taught counseling theories.

4. Action is the stage in which people have made specific overt modifications in their lifestyles within the past six months. The major changes for which they have been preparing are occurring. Because they are in the midst of change, they may be encountering unexpected consequences about their choices and motivations. The counselor's job is to provide an environment where all of the issues present can be analyzed. An emphasis on long-term consequences may be important, as doubts are likely to emerge. Or, perhaps there is little doubt about the current course of action, and the client is seeking validation of the decisions that he has made. Regardless, counselors should give emphasis to continued support and encouragement. This is also the point where issues of relapse begin to emerge because of the consequences of change becoming more real. Thus, along with promoting continued movement, the focus should begin including vigilance against relapse.

5. Maintenance is the stage in which major changes have occurred and people are working to prevent relapse. Because the major changes are already in place, people do not apply change processes as frequently as do people in the action stage. Here, clients are less tempted to relapse and increasingly more confident that they can continue their change. However, maintenance should not be viewed as a static stage. Maintenance does not mean completion. It is critical that clients continue to work to nourish implemented changes. The therapist should focus on gathering an understanding of what the client is doing that is working and reinforcing a continuation of such behaviors. Alcohol and drug clients who have been clean for a reasonable period fall into this category. Failure to properly understand and attend to the maintenance stage could result in backsliding into old familiar patterns.

The relationship between Prochaska's model and resistance is self-evident. Too frequently, therapists approach clients as if they were in a later stage of change when they are not. Most commonly, we assume clients come to therapy ready to change (preparation stage) when they are actually in a precontemplative or contemplative stage. Highly resistant clients are almost always in the precontemplation or contemplation stage.

Furthermore, the therapeutic approaches used for each stage vary considerably. What works for a preparation or action stage will likely be ineffective for the precontemplation or contemplation stage. What is effective for someone in the preparation stage will indeed create much resistance for the precontemplator or contemplator.

To effectively manage precontemplators and contemplators, you might suggest that they, "…move cautiously and slowly as they consider alternatives to their problems and move forward with change." Note that this statement continues to suggest that they "consider alternatives" and "move forward with change." It just presents these ideas with the admonition to "move cautiously and slowly." Why do we present it this way for these stages? Because that's what they are going to do anyway! Why fight it? Join with them at their stage of change, and then proceed from there. Give them the freedom to act independently; this is what they want. If you have an extremely oppositional precontemplator, you might go so far as to paradox him by suggesting that he is not ready to change and you are not sure how to proceed. (You could not be more honest and accurate in your assessment.)

Adjusting approaches and goals relative to the client's stage of change results in a much more cooperative relationship. Although what is presented in this course will work to some degree in all stages, most of what is presented is focused on dealing with those in the precontemplative and contemplative stages.

It is also important to be aware that people do not progress through these stages only once. The more common pattern is to cycle through the stages several times. Many times, clients progress nicely, only to reach a point of stagnation where they move back to a former stage. This is not unusual. Be prepared for such recycling and adjust accordingly. Clients may also be at different stages of change relative to different problems and components of problems. Recognizing this, therapists may have to constantly adjust approaches as different problems are addressed. To enhance movement, therapists should learn of past progress and struggles, building a knowledge base of client strengths and resources from which to draw as new issues arise.

After a stage of change is determined, therapists should be careful to set goals appropriate for the current stage or one stage beyond the client's present stage (Littrell, 1998). This approach results in more manageable goals and more motivated clients. Goals that are only appropriate for later stages will appear unfathomable and impossible to those in the beginning stages of change. Such goals are a nice way to create resistance, though.

The following brief assessment questionnaire comes from Littrell (1998) who adapted it from the work of Prochaska, Norcross, and DiClemente. This brief assessment is useful in determining general stages of change.

YES NO 1. I solved my problems more than six months ago.

YES NO 2. I have taken action on my problem within the past six months.

YES NO 3. I am intending to take action in the next month.

YES NO 4. I am intending to take action in the next six months.

Assess the stage of change using the following criteria:

Precontemplation: no to all

Contemplation: yes to #4 and no to all others

Preparation: yes to #3 and #4, but no to the others

Action: yes to #2 and no to #1

Maintenance: yes to #1

It should be noted that Prochaska, DiClemente, and Norcross (1992) argue that the stage of change is the second best predictor of client progress. The most influential factors are centered on therapeutic components such as helping relationships, consciousness raising, and self-liberation (i.e., self-commitment). It follows that correctly identifying a client's stage of change and aiming toward taking small steps that consistently prepare the client for the next stage of change are strategic for utilizing these findings.

Therapeutic Tip: If you have not currently conceptualized your clients by their stages of change, I suggest you do so. Then, before each session, review the stage of change in which you suspect your client to be and acquire a mindset going into each session to respond accordingly. This is yet another technique that will not only reduce resistance and help your clients, but will also greatly reduce your personal stress. As you learn to approach clients with not expecting more than is reasonable relative to their stages of change, you take pressure off yourself to perform therapeutic miracles. Your assessment of what can realistically be expected becomes more grounded in reality. In turn, you will feel better about your work.

Cognitive Distortions of Therapists That Foster Resistance

Cognitive distortions are most commonly associated with client problems. Yet, some therapists hold internal beliefs that lead to unproductive therapeutic approaches that invite resistance. Many times, we may not be consciously aware of our beliefs and how they lead to the resistance we wish to avoid. Sometimes, one needs to look inward and ask what fundamental beliefs are held about one's self and therapy, and how these beliefs may be encouraging resistant behavior from clients.

There are numerous cognitive distortions that promote what feels like resistant behaviors. Some of these distortions are listed below, along with a brief discussion of the pitfalls inherent in them. I am certain that there are many other cognitive distortions with similar themes; however, a study of these should suffice to exemplify how our own attitudes, no matter how good the intentions, may work against us. Some of the distortions discussed are my own and some are adapted from the writings of Aldo Pucci (2001) and Corey, Corey, & Callanan (2003).

As you read, ask yourself how many of these might apply to you. It is very difficult to be a therapist and not at some time or another have embraced some of these thoughts. Beginning therapists are especially likely to fall victim to these notions. If, as you read, you realize that you are hearing echoes of your own thoughts, consider how you might adjust your thinking in order to reduce resistance.

"My clients want to change."

"My clients do not want to change."

"My clients should not be ambivalent toward changing."

"My clients should be easy to work with."

These statements cloud an accurate perception of the truth—clients are ambivalent about change. That's why they are talking to a counselor. To hope for or assume anything other than ambivalence with regard to change is unrealistic and unproductive. Erroneous beliefs about motivations and conflicts associated with change often lead the dialogue in unrealistic directions. Learn to accept and be at peace with your clients' ambivalence toward change.

"My job is to make my clients feel better."

"It is beneficial to try to remove my clients' distress and discomfort."

As noted previously, the notion that clients come to counseling to feel better does not necessarily mean that we should attempt to alleviate all of their distress. Too much sympathy and distress abatement may lead to a lack of motivation to change on the part of clients. In such instances, you are only "band-aiding" the problem. With resistant clients, counselors should strive to keep prominent the emotional distress that results from repeating unproductive behaviors. This provides an emotional reason to act. Hence, the therapeutic tension should stay with the client, not with the therapist.

"My clients should and will change when they understand the logical flaws of their current behavior and the logical benefits of alternative approaches."

"If I could only present stronger arguments for change, my clients would 'see the light' and begin doing things differently."

These two statements stem from the assumption that change occurs because of logic. Oh, if it were only so easy! As noted elsewhere in this course, people do not change because of logic; they change when they have an emotionally compelling reason. The problem with the cognitive distortions above is that they lead to a dialogue that presents what appear to be logical arguments for change. Rarely will logical arguments, in and of themselves, produce change. More importantly, arguing for change through logic often creates resistance. Change is a much more complex process than mere logic. The fact is that logic plays only a small part in the overall dynamics that foster change. Therapy is the art of getting clients in touch with all of the underlying factors that support the logic.

"The more I put pressure on my clients to change, the faster they will change."

"I go into every session with an agenda to get the client to do something different."

With resistant clients, such cognitions are likely to hinder the therapeutic process. Increased pressure often slows change and promotes resistance. Agendas aimed at getting clients to act immediately are very likely to fail. Approaches that are more paradoxical in nature have a greater chance for success. Therefore, to promote change with resistant clients, remove the pressure to change. For example, you might suggest that your client move slowly at implementing new behaviors.

"My clients should work as hard as I am."

"I have to be successful with all of my clients."

"My job is my life." (Thus, failure at work = failure in life.)

"I am responsible for my clients' behavior."

Such statements will likely put undue pressure on you to promote change in your clients. When this pressure is transferred to clients, resistance may result. The fact is that your work and your client's work are different. You should be working hard to create a dialogue that maximizes the potential for change and avoids the pitfalls of the nonprofessional whose understanding of the change process is limited. Clients should be working hard at facing their inner struggles and at adjusting to the realities of their lives. If you feel you are working harder than your clients toward a resolution of their problems, something is amiss. You are likely working at the wrong thing.

Further, I know of no therapist who has been successful with all of her clients. The truth is that sometimes the therapeutic process just does not work, no matter how hard you try. If you are unrealistically burdening yourself with your clients' lack of progress, then get real and cut yourself some slack.

Chapter 4: General Principles for Dealing with Resistance

This chapter addresses overarching ideas for handling resistance. Some of what is presented here is based on correcting therapist errors presented in the last chapter. This creates some redundancy in the presentation of some of the material. However, from my experiences in teaching these concepts, I have concluded that it is more practical and effective to divide the "what not to do" and "what to do" components into two separate sections. Besides, redundancy is not necessarily a bad thing. Most learning is a result of spaced repetition—in other words, redundancy.

Please bear in mind that the ideas and techniques presented in this course are intended for use with clients who display considerable resistance in therapy. In general, the more resistant the client, the more you will be required to adjust your approach. Although you could use these techniques with all clients, if clients are highly cooperative, some of these techniques may be unnecessary or even excessively time consuming.

Furthermore, if I am confident of my rapport and of the motivation of the client to implement change, I may respond in a manner quite opposite of what I am suggesting. The bottom line is, do not assume that you must employ certain approaches in all situations. One of the things that make therapy so interesting is that each situation is unique, and there are no set rules on how to approach every situation. What may increase resistance in one situation may be extremely therapeutic in another. Research has repeatedly indicated that the client-therapist relationship is a critical or primary factor that contributes to change. Therapeutic relationships are often quite unique from one client to another.

That being said, some fundamental guidelines to consider are provided below. Bear in mind that resistance is a complex matter. You cannot effectively resolve your resistance problems with just one or two maxims. Yet, you can have great impact through the application of these principles, as these points are pertinent for the majority of situations.

Averting Resistance By Honoring It

Before addressing some specific principles, I would like to point out that we frequently can prevent resistance by foreseeing it and circumventing it before it arises. Many times, we can almost predict that certain procedures, questions, and approaches common to mental health practice are likely to arouse resistance. This being the case, it is amazing how often we continue on without making any attempt to thwart the relatively certain resistance we are kindling.

When you know that there is potential resistance on the horizon, it is best to make attempts to avert it before you get there. This is typically done with some dialogue that attempts to lessen the probability that the client will respond in a resistant manner. What follows are two excellent examples of how taking time to address issues in advance can be very effective at circumventing future resistance.

In one of my seminars, a woman who was quite frustrated with the excessive intake interviews she is required to complete in her work with adolescents, told me how she has learned to avoid shutdown to interview questions. Before the intake begins, she says something to the effect:

I am going to ask you a series of questions. To some of these questions you are going to answer, "I don't know." Sometimes you will answer, "I don't know," because you don't know. Sometimes you will say, "I don't know," because you are really saying, "I don't know you well enough to tell you the answer to such a personal question." If this is the case, I want you to know that I understand, and that you do not have to answer such questions. Perhaps some time in the future when you feel more comfortable, you can reveal more about yourself.

Prior to making this introductory statement, "I don't know" responses were common. She recognized that such responses resulted from the intake interview process itself, which is prone to arouse resistance. After implementing her own policy of addressing client feelings with the above statement prior to encountering such feelings, she stated that she has not had any problems with gathering information from adolescents. This is an excellent example of how taking a few moments to recognize the client's position and to address potential resistance areas can go a long way in reducing resistance. Such approaches should be standard practice with the unrealistic, burdensome interviews that mental health professionals must conduct.

A colleague of mine, Dr. Graham Disque, uses a similar approach to everything he says and does in the counseling session. Prior to beginning sessions, he tells clients that if they do not understand why he is asking or doing something, or if they are uncomfortable with anything he asks them to do, they are to stop and ask why he is doing what he is doing and express their discomfort. In other words, he sets a tone where the entire counseling process is wide open to explanation. Nothing is a secret. Nothing is covert. Nothing is done without the client understanding what the counselor is trying to accomplish. The client is not pushed to discuss any topic he does not want to discuss. All discomfort is addressed first, if the client so desires. Dr. Disque refers to this approach as honoring the resistance.

By taking the time to allow the client to understand the process, and by respecting and addressing the client's discomfort with certain topics, resistance is dissolved. This is a beautiful example of creating an atmosphere that continuously allows the client the freedom to address his concerns. The client is given complete control. When this is done, there is nothing to resist! There are only topics to discuss. Every session is designed to deal with each moment of resistance as it arises, and prior to it becoming a major barrier to therapeutic progress.

Approaches similar to these should be implemented whenever experience dictates that resistance is looming on the horizon. By recognizing and honoring the resistance, many problems can be averted.

Basic Principle #1: Do the Unexpected

Clients vary considerably in their degree of embarrassment and willingness to discuss problems. Some clients are fearful of discussing their problems. Such clients may feel inadequate or shameful for having problems. Clients reluctant to talk often anticipate responses that include criticism. Other clients, however, talk openly about their diagnoses and problems as if they are proud of them and are challenging the counselor to do something about them. Open clients, who are also resistant, are often prepared for confrontation, and have a packaged set of responses regarding their situations. Regardless of the degree of openness, resistant clients tend to anticipate certain common responses and have well prepared answers that are intended to defend the status quo. These responses usually present arguments for the futility of their situation or contend that the problem lies with someone else.

Clients who have talked to non-mental health professionals (and some professionals) have likely heard the standard "how-to-fix-your-situation" advice commonly dispensed. Most frequently, this advice does not mesh with the client's view of the world. Years of research and experience have taught us that such socially typical responses are of little benefit. If socially typical responses were effective, we would not need trained counselors—clients could talk to anyone and get better!

As therapists, we know that socially typical responses are, by and large, ineffective in creating therapeutic movement. Typical responses beget typical reactions, and typical reactions keep clients stuck in their situations. In such scenarios, what appears to be resistance is fueled by the commonplace. This is one reason why the brief therapists argue that problems are maintained by attempted solutions that are ineffective (Walter & Peller, 1992). Our typical responses and reactions are likely to be incorporated into established, ineffective, attempted solutions. The more we respond in a typical manner, the more likely we are to become part of the system that maintains problems.

In order to avoid the pitfalls of typical responses and the resistance that follows, you must consistently strive to avoid the commonplace. You must avoid typical verbal and non-verbal responses. In doing this, you surprise clients, you confound their anticipation of your response, and you begin disrupting the patterns that are inherent to their problems.

The unexpected does not have to be complex or foreign to counselors. The better techniques taught in training programs are unexpected by most clients. The empathic statement, the avoidance of questions with preordained answers, the lack of criticism, the nonjudgmental posture, or the statement that has the appearance of puzzlement or agreement with the client are all unexpected. Most of what is recommended in this course is unexpected by clients, but known in some manner by counselors.

Basic Principle #2: Slow the Pace, Focus on Details, Process Feelings Relative to Meaning

When resistance is encountered, the prevailing urge is to speed up the session and break through the resistance. Instead, slow the pace. Increase your use of silence. Make sure that each statement by the client is fully addressed and processed in detail. "The devil is in the details," is more than a bit of folk wisdom. By addressing the details, you show genuine concern and respect for the client's issues, and you are more likely to get to the crux of the issue.

Take a moment and review a few of your most successful cases and breakthroughs. You will find that your success was because you took the time to discover and discuss a detail in the client's world that had never been addressed previously. It is my experience that these elements are always present when significant therapeutic impact has occurred. I challenge you to review your own experiences and disprove this idea. Resistance dissipates when details are processed. "First seek details" should be your established rule of thumb. The devil is in the details and so is the solution!

Ferreting out details is also essential to the basic counseling skill of funneling problems into manageable segments. As noted in the last chapter, manageable segments always include a person, place, and time. The process moves from deciding which problem to address to finding a particular person, place, and time element of the problem to gathering specific details about the observable and psychological dynamics of the person, place, and time elements. When you recognize that details are essential for solutions, you will naturally move through these steps. Thus, recognition of the critical importance of gathering details puts you on the right track.

As you gather details, process the client's feelings relative to meaning. You should constantly seek to determine the specific feelings present as the client discusses situations. Effort should be made to determine the most precise feeling word that accurately fits what the client is experiencing. Once this is established, you should seek to answer the question: What does this situation mean relative to the client and her world? Feelings and meaning should be brought to the forefront and allowed to be present in the room. This is where clients find emotionally compelling reasons to change.

These steps are foundational to the therapeutic process. Most people have never openly explored these dynamics in detail. Lay conversations rarely tolerate this level of emotion and depth. This will have a very different feel for clients and perhaps for some therapists. Through this process, ineffective client logic will begin to slowly dissolve, and genuine reasons for change emerge. That which is processed, changes. A pace that is too quick does not allow time for thorough processing.

One way to slow the pace is to increase your use of silence and the time between speaking your words. Increasing your use of silence does two things—it creates pressure to fill the space and it provides time to think and feel (Gerber, 1986). Most resistant clients avoid both of these tasks. Yet, it is the pressure to fill the space as well as the time to think and feel that leads to clients doing the work. The real therapeutic work is done in the time between the words, during the quiet moments when new perspectives are embraced. If this is the case, then increase your use of silence and increase this therapeutic work time.

Taking this a step further, many therapists often feel as if they are trying to pull or push their clients through the change process. This is not only hard work; it is very stress-producing. To make matters worse, it fuels resistance. The key is to slow your pace to the point that you appear to be "behind" clients in your understanding and awareness. Thus, you keep clients explaining to you in order to pull you along. You create an environment where it appears that you are trying to catch up with them. When this state is achieved, resistance dissolves.

Please note, however, that slowing the pace does not mean to become passive and slow the therapeutic work. To the contrary, you slow the pace to intensify the therapeutic work. You slow the pace in order to focus on and magnify clients' internal struggles, and to search for answers. As noted, the therapeutic tension should not be between therapists and