Often, although they know it would be important, patients do not perform therapeutic tasks, these resistances are attitudes, behaviors or cognitions that can delay or prevent therapeutic change.
Some of these resistances are presented in the first evaluation phase, the client may question the proposed treatment by refusing to speak honestly, answering the therapist’s questions succinctly and with little information, constantly hitting the professional or not performing the tasks.
- Although these resistances are often caused by inappropriate interventions at the motivational stage.
- Many therapists choose to assign full responsibility to clients.
- Alluding to passivity.
- Stubbornness.
- Or interest in boycotting therapy.
Without a doubt, the therapist can discontinue therapy if he finds that it is no longer useful to the client, however, assuming that he does not want or cannot be treated by the resistance he presents is not the most practical way to act.
The motivational approach of therapy – which can be observed, for example, in the motivational interview, based on adapting the therapy style to the different phases of client change – ensures that patient resistance is a problem for the therapist.
Therefore, without convincing you that the client does not want to be treated and will not improve, it would be advisable to collect these resistances and think about what may have led the client to put obstacles to change.
When there are patients who do not perform therapeutic tasks, the “guilty” may be the type of therapy or the fact that the work performed does not adapt to the characteristics of the person.
To do this, it is good to expose the problem in session, because sincerity and authenticity are particularly relevant to establish a good therapeutic relationship and find solutions to the resistances that arise.
One situation that may worry us is that the client is questioning the professionalism of the therapist because he does not have gray hair, a lush moustache or does not wear a jacket.
What begins as a simple comment at the start of treatment can then become a resistance, according to which the client questions the psychologist.
The patient doubts that what happens during the session is useful, or feels that the age of the therapist is insufficient to work on certain issues, from childhood problems to sexual or relationship problems.
Addressing failures and using certain strategies, such as those described above, can transform expectations of seemingly complicated treatments into an opportunity to strengthen the therapeutic alliance.
Some of the strategies proposed by Labrador (2011) in his manual “Difficult Situations in Therapy” are designed to explain the problem and ask the client about their reservations and the skills that he believes the therapist does not possess.
In addition, it is also necessary to expose the strengths of the therapist’s youth, such as motivation or contact with the latest psychological advances, to leave an academic environment.
During the evaluation and intervention itself, it is very possible that the client does not fulfill his duties, even the most basic ones, such as keeping a simple diary, are very important because they are necessary for the functional analysis and development of a treatment plan.
For this reason, it is extremely important that the client brings their notes every week, here are some strategies to achieve it:
There are people who by their profession cannot take a role wherever they go, others are not masters in the art of writing and homework can be something that generates anxiety, others can be so forgetful that they do not. I don’t even remember writing anything during the day, and when they start writing at night, they forget everything.
For this reason, offering other options, such as taking notes on your phone, saving them or using apps like Mentalcheck or Self-Monitoring can be helpful, these approaches help us overcome the barrier of incomplete files and perform a deeper assessment. .
What if, despite all these adjustments, we still have patients who do not perform therapeutic tasks?
If there doesn’t seem to be a major problem that prevents it from ending, as a last resort, the therapist may say that therapy can only continue if tasks are performed.
The idea of conditioning therapy is to call the client the day before the appointment and ask if the task is over, if the answer is negative, the next day’s session will be canceled, and so on.
Of course, this should be seen as a last resort. After all, although tasks are essential for clinical practice, many patients cannot postpone treatment due to the nature of their difficulties.
The ultimate goal of the interventions described above is to provide the client with the most appropriate, effective and useful therapy for the problem it presents, and should be implemented if the task in question is deemed necessary. If you can change the task type or delete it and look for other ways to achieve the goal, this will be the most recommended alternative.