How to Deal With Resistance in CBT

Cognitive Behavioral Therapy (CBT) is an active and structured form of therapy that helps clients learn alternate ways of thinking about their issues as a means of overcoming them. During this process, clients will frequently become resistant to treatment. In large part, this resistance occurs because clients fear change, even positive change, in their lives.

Instructions

Ensure that the Client is being Resistant

• 1

  Determine if the client is fearful or resistant. The client is expected to trust the therapist implicitly with a great many intimate details. The client must feel that you are engaged in the therapeutic process and that you are ethical in your dealings before any trust can be established.

• 2

  Examine your own actions for potential errors. Ask yourself if the client is actually resisting the homework assigned each week or if your expectations might be set a bit high at this time in the therapy.

• 3

  Analyze the client’s history to determine if there is any comorbidity or prescribed drugs that may interfere with the client’s participation. A client that is unable to participate in her therapy is not resistant. Rather, the therapist must engage with the client’s primary care physician to determine if another approach is needed.

Dealing with Resistance

• 4

  Improve the client’s understanding of the therapeutic process. According to Dr. Robert Leahy, director of the American Institute for Cognitive Therapy, some clients have a misconception that therapy requires attention to past events, while CBT requires that the client remain in the present. Educating the client about the CBT process helps them focus on the here-and-now and decreases their resistance.

• 5

  Use the Socratic method of questioning to engage the client, not only when you are gathering information but also when you are imparting it. The Socratic method allows the client to draw her own conclusions about information in either direction of flow. CBT is a fact-based method and this method reduces the client’s capability to resist by asking her to confront actions, behaviors and consequences in the world as it is now.

• 6

  Help the client decatastrophize consequences. A client may resist a portion of treatment, such as homework, due to fear of the consequences of failure. That is, a client may be fearful of speaking to a store clerk because she may stutter and the clerk may laugh at her. Help the client assess the impact of the clerk’s laughter and help her reduce the anxiety she may feel over the possibility it may occur.

• 7

  Help the client increase the skills she needs for correctly interpreting her issues and acting collaboratively in her therapy. Doing so will increase her ability to direct her own therapy and will reduce her resistance to therapy.