Client Resistance in Therapy

Client resistance means unwillingness or opposition to change and growth in therapy sessions. This could be conscious or unconscious. Resistance can cause ruptures in the therapeutic alliance and hence it is important to be aware of the kinds of resistance that there are and how a therapist can work with a resistant client.

This article will explore the different forms of client resistance, how to manage it, and how to work with resistant clients, including children.

Signs of a Resistant Client

It is helpful if a therapist recognises a client’s resistance early on so that they can adjust their approach and address underlying issues more effectively. Common signs include:

• Clients give vague, short or evasive answers to questions.
• Conversations revolve around surface-level topics rather than deeper emotional or psychological concerns. The client might always want to focus on their day to day happenings.
• Clients consistently forget to complete homework given in therapy or implement interventions suggested by the therapists.
• A pattern of missing or postponing sessions might signal avoidance. Another way could be that the client always arrives 10-15 minutes late to the sessions.
• Some clients challenge the therapist’s insights or resist therapeutic suggestions.
• Sessions feel repetitive, with little progress in the client’s concerns.

Types of Resistance in Therapy

1. Reluctant Clients

These clients are mandated or pressured to attend therapy by others (court, family, employer) and may feel they don’t need help. They often show minimal engagement and may passively comply while avoiding real change. I had a teenager client who was coerced by her parents to seek therapy, her responses were usually “I don’t know”. She showed significant reluctance towards therapy. As a client who is a teenager and has experienced trauma in her life, I wanted to make sure she had the autonomy to choose for herself.

The primary aim was that the client felt safe. Together, me and the client decided to give therapy a try for 3 to 4 sessions, after which we decided to review where the client is at before moving forward. This helped her feel at ease and she had the freedom to make a choice. It has been over a year now that she is seeking therapy from me.

How to Approach:

• Normalize their feelings of reluctance.
• Offer them choices to give them a sense of control.
• Focus on building rapport before diving into deeper work.

2. Reactive Clients

These individuals strongly defend against change and may argue with or challenge the therapist. They often dispute interpretations, rationalize behaviors, and resist exploring deeper issues due to fear or distrust. It might be useful to check where the client stands in terms of the stages of the change model (transtheoretical model) by Prochaska and DiClemente. It can act as a guiding light for the therapists in the session.

How to Approach:

• Validate their perspective instead of confronting them head-on.
• Use Motivational Interviewing to explore ambivalence.
• Assess their readiness for change using the Stages of Change Model.

3. Silent/Withdrawn Clients

These clients maintain emotional distance by only sharing minimal details, curt answers, and long silences. While physically present, they create barriers to meaningful therapeutic work through their withdrawal. It might be helpful to understand where the silence is coming from – is the client anxious, confused about what to talk, does not have the bandwidth to engage emotionally or something else.

Example: A young adult client hardly spoke in sessions. Instead of coercing him to talk, I introduced other techniques like using metaphors to help express emotions. Over time, he became more comfortable with verbal communication and later on the emotional wheel was introduced to him to help him with emotional vocabulary.

How to Approach:

• Understand the root of the silence (anxiety, uncertainty, emotional overwhelm, etc.).
• Use alternative forms of expression (writing, art, movement-based therapy).
• Offer reassurance that silence is okay while gently encouraging participation.

4. Premature Termination Clients

They may seem engaged initially but tend to leave therapy when approaching difficult material or when beginning to experience change. This can stem from fear of vulnerability or anxiety about change.

Example: A client who was initially enthusiastic about therapy but suddenly started coming late to sessions when we started exploring past trauma. When the client was invited to discuss this, we acknowledged that discomfort was a natural part of growth and developed strategies to manage distress.

How to Approach:

• Identify underlying fears about therapy and change.
• Emphasize that therapy is a gradual process, not a forced transformation.
• Set small, manageable goals to prevent overwhelm.

5. Intellectualizing Clients

This type of client would use excessive rationalization and abstract discussions to avoid connecting with emotions and getting to in-depth work. They may be highly articulate about their issues but resist processing feelings directly.

Example: A client could describe her childhood trauma in a very fact based manner but she struggled to acknowledge the emotional impact it had had on her. By using somatic, mindfulness techniques, therapy helped her connect with emotions in a safe, gradual way.

How to Approach:

• Gently redirect from abstract discussions to emotional exploration.
• Use grounding techniques to help clients connect with bodily sensations and emotions.
• Encourage reflective exercises such as journaling about feelings rather than thoughts.

6. Crisis-Only Clients

They seek therapy only during acute difficulties but disengage once the immediate crisis passes. This pattern prevents deeper work on underlying issues that lead to recurring crises.

Example: A client returned to therapy each time she had a relationship breakup but left once she felt stable. I helped her see the pattern and encouraged deeper work on attachment styles and self-worth.

How to Approach:

• Validate the immediate distress but highlight recurring patterns.
• Shift the focus from crisis management to long-term growth.
• Create a treatment plan that extends beyond the crisis.

7. People-Pleasing Clients

These clients focus on being “good patients” by saying what they think the therapist wants to hear. They may struggle to express disagreement or negative feelings about therapy.

Example: A client always agreed with my interpretations but later revealed he was afraid of disappointing me. We worked on assertiveness and the ability to express genuine feelings.

How to Approach:

• Reinforce that honesty is more important than saying the “right” thing.
• Create a safe space for disagreement and differing opinions.

8. The Therapy-Hopping Client

These are the clients who have a pattern of changing therapists frequently, they do not stick to a therapist for a long period of time to form a deep therapeutic alliance or make substantial progress. They often reason this by citing dissatisfaction with previous therapists but may actually be avoiding deeper work by constantly starting over.

Example: A client had seen six different therapists in two years. When we explored her therapy history, she realized that she often left as soon as therapy became emotionally challenging. She had a fear of being truly seen and vulnerable, so starting over with new therapists felt safer. By identifying this pattern, we worked on gradually increasing her comfort with emotional depth and commitment to longer-term work.

How to Approach:

• Explore the client’s history with therapy.
• Helping the client understand therapy is not about immediate relief but it also involves talking through some uncomfortable and unpleasant parts of our lives.
• Set realistic expectations about the therapeutic process.

Working with Resistant Clients

I think a crucial take away from this article can be the mindset of the therapist – the way therapists look at resistance. Instead of viewing resistance as a barrier, it helps to see it as a form of self-protection. Building a strong therapeutic alliance should always come before challenging a client’s defenses. If a client feels safe, they are more likely to open up and engage in meaningful work.

1. Motivational Interviewing (MI)

It is one of the best techniques for working with resistance in therapy. It emphasizes “rolling with resistance” rather than confronting it directly. Instead of pushing a client to change, Motivational Interviewing helps explore ambivalence and support autonomy, making clients feel understood and in control of their decisions. Since resistant clients often feel like change is being imposed on them, MI helps by guiding rather than directing.

Key MI strategies that align with handling resistance include:

• Reflective Listening: Acknowledging the client’s feelings without judgment.
• Affirmations: Reinforcing strengths and efforts.
• Evoking Change Talk: Encouraging clients to articulate their own reasons for change.
• OARS Technique (Open-ended questions, Affirmations, Reflective listening, Summarizing): Keeps the conversation client-centered and non-confrontational.

2. Roll With the Resistance – Paradoxical Interventions

Instead of fighting against resistance, paradoxical interventions accept it. For example, if a client refuses to change their sleeping habit even though they complain about inability to sleep, a therapist can suggest that they continue with their current practice. This can make clients think about their actions and take responsibility to change.

3. Confront the Resistance Without Fighting It

Noticing resistance without pressuring clients is an effective approach. Observations that are non-judgemental, compassionate and bring in curiosity, such as saying, “I noticed you didn’t complete the thing we discussed last week. What was that experience like for you?” , invite thoughts rather than defensiveness.

4. Establish Clear Goals

Resistance often diminishes when therapy has structured, client focused goals. Early discussions should focus on identifying what the client hopes to achieve, and setting some goals. These goals should be revisited periodically to understand progress and to invite client’s thoughts. Written treatment plans serve as tangible reminders of their progress and motivation.

5. Reframing Resistance

Fred J. Hanna, PhD, emphasizes that resistance should not be met with resistance.

“When the client is resisting the therapist and the therapist starts getting irritated, then you have two people resisting each other. That’s not therapy; that’s war.”

Rather, therapists can interpret resistance in a positive light for the client. For instance, if a client continues resisting, a therapist could say,

“If you directed the same amount of energy into working on the goals you have set for therapy, you would be extremely successful.”

6. Teachable Moments

Resistance reveals information about the client, it is a window into a client’s fears, values, and the strategies they use to guard themselves. If a client avoids difficult conversations, therapists can ask gently, “I am wondering what makes this concern so difficult to discuss?” By making resistance an opportunity to reflect on oneself, therapists encourage clients to engage more.

7. Strengthen the Therapeutic Alliance

The most effective means of reducing resistance is through a strong therapeutic alliance. Establishing rapport and trust makes clients feel at ease about sharing their worries, doubts or concerns regarding the therapy process. At times, placing greater emphasis on the therapeutic relationship than interventions creates more openness in the long run.

Engaging a Resistant Child in Therapy

The way resistance shows up and is dealt with changes when we talk about children in therapy. Parents and therapists might find themselves in a position when the child feels uncomfortable about the idea of opening up to someone they don’t know. This reluctance can often reflect a child’s uncertainty, fear, or simply a lack of understanding about what therapy entails. Some strategies for overcoming resistance with children could be –

• Describe therapy as a safe environment for sharing feelings, emphasizing that the therapist is there to help, not to judge.
• Involve the child in the therapeutic process, allowing them to have a say in their sessions and fostering a sense of control and autonomy.
• Start with less formal activities to ease children into the process. Play- way activities could be used to make the sessions fun.
• Connect therapy to the child’s personal goals or interests to boost motivation. Come to the level of the child to explain this, jargon might end up making them feel disconnected and/or intimidated.
• Validate their feelings and discuss any fears they have about therapy.

To engage a child who is resistant towards therapy, a therapist needs to take a personalized approach that makes the session fun, rewarding and makes it meaningful for the child. One way to do this is to use the child’s interests to plan the activities. This could be done by incorporating themes or characters into the tasks. Including sensory activities like slime or sensory bins can act as big motivators for children who crave tactile input and turn what might seem like boring tasks into a fun sensory experience that enhances child’s engagement.

Another powerful tool is to offer choices to the children. A simple choice board gives children a sense of control and makes them feel they have some say in the therapy. This sense of autonomy can increase their willingness to participate. Building a therapeutic relationship through consistent and meaningful interactions also reduces resistance. The stronger the rapport between therapist and child the more the child will trust the process and be open to participating. Using these strategies creates a dynamic and fun environment that achieves therapeutic goals and reduces frustration for the child and therapist.

Movement-based activities like obstacle courses, dance or yoga can also reduce resistance by helping children to use their energy and focus. Some children struggle to transition from one activity to the next. Using songs with movement or a timer-based game like “how quickly can we clean up?” can make these transitions feel less like a chore and more like a game.

How Therapists Handle Insecurities Caused by Client Resistance

I know, resistance feels personal and can end up creating self doubt in therapists. Anderson & Therapists must engage themselves in practice self-reflection, supervision and seek support to recognize that resistance is not a reflection of their competence but rather an opportunity to enquire or modify their approach. Some strategies for therapists to handle resistance could be –

1. Engaging in professional development and education
2. Practicing self – reflection and seeking supervision
3. Reframing resistance as information rather than interpreting it as a personal attack
4. Setting realistic expectations from self and from the client
5. Engaging in self- care practices

Mentalyc: Freeing Therapists to Focus on Clients

Resistance is challenging enough without the added burden of documentation. Mentalyc automates therapy notes, allowing MHPs to dedicate their entire attention to the client. With AI-based note-taking, therapists can connect more authentically, monitor client progress effectively, and at the same time get rid of the administrative burden that often comes with therapy work. By using Mentalyc, therapists can build stronger therapeutic relationships and tackle resistance more efficiently without the distraction of documentation.

Conclusion

Resistance is a normal aspect of therapy and it doesn’t have to hinder progress. By recognizing resistance and its multiple forms, by using effective strategies to deal with it and nurturing a solid therapeutic alliance, mental health professionals can help the clients in navigating their defenses and achieving significant progress. With tools like Mentalyc managing the therapist’s paperwork, therapists can remain fully engaged, ensuring clients get the support they need to break through the resistance in order to change.