Such tactics that indicate a response style resistance can include: “discounting, limit setting, thought censoring/editing, externalization, counselor stroking, seductiveness, forgetting, last minute disclosure, and false promising.”
Full Answer
Why does my client resist therapy?
If a client has issues from childhood resulting from a controlling parent or has problems with authority figures, then they may unconsciously resist what is being perceived as external control from the therapist. 4) Failing to realize that noncompliance is part of the “pathology” that needs to be treated.
Why is it important to recognize and understand client resistance?
Recognizing and accurately understanding client resistance are important factors in creating an environment conducive to client change. Often the processing of a client’s resistant behavior becomes a major breakthrough in the counseling process.
How do you identify resistant behavior in clients?
Otani (1989) identified such behaviors as frequent pauses, taciturnity, silence, and minimal talk as signs that the client may be engaging in this type of resistant behavior.
How do counselors deal with highly resistant clients?
When encountering resistance, counselors could benefit by taking some of their own advice, said Clifton Mitchell, a professor and author of “Effective Techniques for Dealing with Highly Resistant Clients.” “We tell our clients things like, ‘You can’t change other people; you can only change yourself.’
What are the symptoms of treatment-resistant depression?
What Are The Signs And Symptoms Of Treatment-Resistant Depression?A lack of response to antidepressants and psychotherapy treatments.Increasingly severe and longer episodes of depression.Brief improvements followed by a return of depression symptoms.High anxiety or anxiety disorder.
What is a treatment-resistant patient?
“Although there is some disagreement as to how to define treatment-resistant depression, a patient is generally considered to have it if the individual hasn't responded to adequate doses of two different antidepressants taken for a sufficient duration of time, which is usually six weeks,” explains Jaskaran Singh, M.D.
What is a resistant patient?
Resistance is the means through which patients manipulate the sequential structure of the visit to postpone acceptance until their treatment preferences and concerns are satisfied.
What factors contribute to patient noncompliance?
Factors found to be significantly associated with non-compliance on bi-variate analysis were: female gender (OR = 1.90, CI =1.32-4.57),level of education (Illiteracy) (OR = 5.27, CI = 4.63 - 7.19), urban population (OR =5.22, CI= 3.65 - 8.22), irregularity of the follow-up (OR = 8.41, CI = 4.90 - 11.92), non-adherence ...
Why do people resist mental health treatment?
People resist accepting that they are mentally ill because: They are experiencing denial - a common first reaction to shocking or bad news such as a death or the diagnosis of a seriously disabling illness. They are in pain due to the social stigma associated with mental illness.
What defines treatment-resistant depression?
Abstract. Treatment-resistant depression (TRD) typically refers to inadequate response to at least one antidepressant trial of adequate doses and duration. TRD is a relatively common occurrence in clinical practice, with up to 50% to 60% of the patients not achieving adequate response following antidepressant treatment ...
What is treatment noncompliance?
Non-compliance with treatment refers to the non-use or discontinuity of the treatment process and inattention or failure to follow the prescribed treatment by the patient.
What are the five factors that contribute to adherence?
Adherence is a multifactorial problem that can be influenced by various factors. The factors can be roughly divided in the following five dimensions: Social and economic, health care system, health condition, therapy and patient [3].
What is the most important factor in patient compliance?
The most important factors related to the medications affecting patient compliance are efficacy, dosage schedule, and the delivery mechanism. Patients are more likely to avoid taking drugs they believe to be non-effective, as well as those with complex dosage requirements and delivery mechanisms.
When faced with a resistant client, should counselors practice mindfulness toward this balance of change?
When faced with a resistant client, counselors should practice mindfulness toward this balance of change. Delineating between what is within a counselor’s control and what isn’t can help professionals retool approaches or recognize when a certain path of interaction isn’t worth pushing.
When encountering resistance, counselors could benefit by taking some of their own advice?
When encountering resistance, counselors could benefit by taking some of their own advice, said Clifton Mitchell, a professor and author of “Effective Techniques for Dealing with Highly Resistant Clients.”
Why is response quality resistance important?
This is done because a client wants to withhold or restrict information given to the counselor as a means of taking control of the session. Response quality resistance is most commonly seen in clients who are mandated to attend counseling (for court or disciplinary reasons).
What is the resistance to counseling?
Logistic management resistance refers to a technical form of the behavior in which clients disrupt counseling by forgetting or ditching appointments , refusing to pay and asking personal favors of the counselor. Clients who want out of counseling try to create openings for themselves by “ignoring, and in some cases outright defying, established counseling guidelines.”
Why do counselors resist?
In some cases, such reluctance may be due to the level of trauma or physical and mental harm a client has sustained (as in cases of child or spousal abuse) increasing the difficulty for them to open up to a counselor. In other cases, what may look like resistance is actually a product of culture. Such behavior needs to be recognized by counselors as separate from resistance.
What is response content resistance?
Response content resistance: When a client does engage, but seemingly deflects direct questions or certain topics, they may be demonstrating response content resistance. For instance, small talk (about trivial topics like entertainment, rumors or the weather) may not be viewed as harmless in a counseling context, but rather a deliberate manipulation of the relationship. By diverting attention or overreacting, clients block the two-way street a session is intended to create, becoming more difficult for counselors to reach the underlying issues.
How does race affect counseling?
Authors of “Broaching the subjects of race, ethnicity, and culture during the counseling process” explained that race, for example, can affect how clients interpret and ascribe cultural meaning to different phenomena; which can be difficult for counselors to understand without first recognizing the role of race.
What does a therapist assume about client resistance?
Oftentimes a therapist will assume that client resistance is 100% based on something within the client. In reality, the therapist’s inability to build a strong therapeutic relationship with the client may be a contributing factor.
How to deal with client resistance?
The best approach to coping with client resistance or noncompliance is for the therapist to look in the mirror. If all efforts at treatment have apparently failed, then the therapist can step back, regroup, and assess the problem (s) in the treatment protocol. In fact, if the therapist finds themself frustrated with the client’s effort, they may be best-served to “let go” of expectations, as this is a sign that the therapist’s personal agenda is not being met.
How to deal with anxiety in a therapist?
To address therapist anxieties, a therapist needs a good support system, including people with whom they can discuss their fears. It is also good for a therapist to reframe their fears with anxiety-reducing strategies, such as: 1 Challenging unrealistic performance expectations placed on the self 2 Reminding oneself that it’s okay to make mistakes 3 Focusing on the client rather than on the self 4 Realizing that no mistake is fatal and that part of good therapy involves the concept of “rupture and repair.” When ruptures in the therapeutic relationship occur, repairing of the relationship can be healing in and of itself.
Why do therapists need to be willing to engage with their clients?
When a therapist tries to keep the relationship with their clients at a distance because of fears, such as fear of countertransference issues, the clients may sense this distancing. The effectiveness of therapy might then be diminished. A therapist can benefit from taking emotional risks with their clients. Client relationships aren’t so fragile that mistakes can’t be dealt with and overcome.
What happens if a therapist is not client centered?
If a therapist lacks a client-centered approach, then the client will notice (if not consciously, then unconsciously) that their therapist is inflexible or rigid. If a client has issues from childhood resulting from a controlling parent or has problems with authority figures, then they may unconsciously resist what is being perceived as external control from the therapist.
What are the issues that contribute to client resistance?
Issues contributing to client resistance may include fears of failure or the fear of terminating therapy. One question a therapist can use to address these types of fears is, “What would happen if you were successful?” or something else along those lines. Always explore topics of resistance with curiosity and encouragement.
Why is it important for therapists to understand when they are placing unrealistic expectations on clients based on the therapist?
Remember, clients have their own personal experiences that may or may not be conducive to certain treatment outcomes.
How long does it take for a patient to go into remission after taking antidepressants?
Several large-scale clinical trials have examined response rates to traditional therapeutic approaches for depression. In the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, the cumulative remission rate after 4 trials of antidepressant treatment (within 14 months) was 67%.125Even after sequential treatments, 10% to 20% of the MDD patients remained significantly symptomatic for 2 years or longer.69,70In general, it is accepted that although antidepressant medications can be effective in treating MDD, they fail to achieve remission in approximately 1 out of 3 patients.73
What are the perils of diagnosing TRD?
One of the perils of diagnosing TRD is that of “pseudo-resistance”.107Pseudo-re sistance may encompass the profile of patients who unfortunately were prescribed suboptimal doses of AD or had early discontinuation of a medication for any number of reasons, including intolerable side effects, patient non-adherence or under-dosing. Further, comorbidities such as anxiety disorders, personality disorders or substance-use disorders may complicate the clinical picture and can have deleterious effects on treatment response.114,127When interviewing patients in assessment of TRD, the potential for recall bias when reporting pharmacological trials and response adds a significant layer of difficulty in diagnosing TRD. Prospectively using objective clinical scales such as the Hamilton Depression Rating Scale48and the Inventory of Depressive Symptomatology124and retrospectively using treatment history forms such as the Antidepressant Treatment History Form (ATHF)127can be very helpful in delineating the nature and course of the treatment resistance. Since the ATHF was initially developed, there have been several developments in the treatment of MDD and specifically TRD, some of which will be elaborated upon in the ensuing sections of this paper. As such, the authors of the original ATHF127developed an updated and revised version, the short form ATHF (ATHF-SF), as well as an instruction manual and scoring checklist, among other documents.128Importantly, the ATHF-SF focuses on the current episode of depression, as opposed to life-time trials of pharmacological treatments, a more streamlined approach to assessing the level of resistance of the current illness episode. Utilizing a standardized approach to understand the level of treatment resistance in the current episode of depression may provide a useful measure of consistency in assessment of TRD.
What is TRD treatment?
Treatment-resistant depression (TRD) is a subset of Major Depressive Disorder which does not respond to traditional and first-line therapeutic options. There are several definitions and staging models of TRD and a consensus for each has not yet been established. However, in common for each model is the inadequate response to at least 2 trials of antidepressant pharmacotherapy. In this review, a comprehensive analysis of existing literature regarding the challenges and management of TRD has been compiled. A PubMed search was performed to assemble meta-analyses, trials and reviews on the topic of TRD. First, we address the confounds in the definitions and staging models of TRD, and subsequently the difficulties inherent in assessing the illness. Pharmacological augmentation strategies including lithium, triiodothyronine and second-generation antipsychotics are reviewed, as is switching of antidepressant class. Somatic therapies, including several modalities of brain stimulation (electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy and deep brain stimulation) are detailed, psychotherapeutic strategies and subsequently novel therapeutics including ketamine, psilocybin, anti-inflammatories and new directions are reviewed in this manuscript. Our review of the evidence suggests that further large-scale work is necessary to understand the appropriate treatment pathways for TRD and to prescribe effective therapeutic options for patients suffering from TRD.
How many trials of antidepressants are there for TRD?
Although many definitions for TRD have been proposed, the general consensus appears to be 2 unsuccessful trials of antidepressant pharmacotherapy (AD). Several “staging” models to classify levels of treatment resistance have been proposed. The initial model proposed by Thase and Rush138included treatment resistance levels ranging from one failed AD trial to a lack of response to electroconvulsive therapy (ECT). Further staging models have included the Massachusetts General Hospital Staging method117which carefully documents the optimization of medication doses and number of failed medications. The Souery Operational Criteria for TRD provide a slightly different approach to staging TRD as an illness, by defining TRD as any single failure of an adequate (6–8 week) trial of an AD.133The Maudsley Staging Method (MSM) assesses treatment resistance in depression in a “multi-dimensional” manner.34The majority of investigations into TRD utilize the definition of at least 2 suitable trials of AD without adequate response, although even the term “adequate response” may be fraught with contention, as there is not consensus on what constitutes “adequate.” In fact, even the term TRD may not be the ideal term to define a depressive illness that is not responding to therapeutic interventions. The term “difficult-to-treat depression” has been suggested, with the benefit of not introducing any “therapeutic nihilism” to the psychiatrist–patient relationship.103For consistency in this manuscript, we will use the term TRD. There has been considerable debate regarding what constitutes TRD, and whether medications from more than one class must be trialed prior to meeting criteria for this classification, or that the focus should be regarding homogeneous biological subtypes or endophenotypes.23However, the argument may be made that lack of achieving remission may be classified as an inadequate response as residual depressive symptoms can significantly contribute to difficulty functioning. Chronically depressed patients have a lower chance of recovery,98and often suffer from TRD.25,87
How often is ECT used for TRD?
In the treatment of TRD, ECT is applied 2–3 times per week and acute courses can range between 6–18 total sessions. A report from the Consortium for Research in ECT (CORE)57revealed that over half of the subjects showed an improvement within the first week. Other studies have reported that over 50% of patients who have failed to respond to one or more adequate antidepressant medication trials respond to ECT.120Meta-analyses have shown that ECT is superior to sham ECT, placebo or antidepressant medications.45,111
Why is ECT so stigmatized?
Unfortunately, ECT has suffered from extensive stigma in the public eye, likely due to the invasive nature of the treatment and largely due to subsequent negative and abusive portrayals in the media91including in One flew over the Cuckoo’s Nest, where ECT was portrayed as a punishment, delivered to an individual who did not have a psychotic or affective illness as a form of behavioural control. Along with restriction to access due to availability and risk of memory side effects, this stigma has resulted in ECT being administered to an exceptionally small proportion of individuals with MDD. In fact, a recent investigation of American health insurance databases identified that only 0.25% of almost 1 million patients with a mood disorder received ECT.142This gross underutilization of ECT persists, despite significant progress in reducing the cognitive side effect profile and alterations in the method of ECT, including seizure threshold titration, inclusion of highly tolerable anaesthetic agents and improvements in peri-procedural care. In 2001, however, the American Psychiatric Association published guidelines4advising that ECT should be used more frequently than just in “last resort” scenarios in severe medication-resistant patients or where the psychiatric condition is “life-threatening.”
What is the response rate of ECT?
Bitemporal Standard pulse ECT is the most commonly used form,76with a response rate of up to 75%. While the response rate for Right Unilateral Ultrabrief ECT is slightly lower, it remains highly effective. A report by the CORE Group57found that 65% of patients who underwent bilateral ECT 3 times per week achieved remission by the tenth treatment. In the entire sample, 75% of patients achieved remission by the end of the course, reinforcing the impressive efficacy rate of ECT.
What are the challenges of being an alcohol and drug counselor?
Alcohol and drug counselors, along with other mental health professionals, face a number of challenges and special issues when working with people who have suffered abuse or neglect as children. Like most people, counselors become upset or angry when they hear about children getting hurt or being abused. Some counselors are recovering from substance abuse disorders and were themselves abused or neglected as children, and they may find themselves in a professional situation where they have to confront their own abuse experience and its impact on their lives. As a consequence, counselors who were abused or who had substance-abusing parents may experience feelings that interfere with their efforts to work effectively with adult survivors. For example, counselors may find it difficult to relate to clients effectively and to reach a balance of providing enough--but not too much--support and distance.
What is NCBI bookshelf?
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
When family therapy is agreed on as a useful component of substance abuse treatment, it should only be conducted by a?
When family therapy is agreed on as a useful component of substance abuse treatment, it should only be conducted by a licensed mental health professional with specific training in the area of child abuse and neglect.
How long does it take to recover from substance abuse?
In-depth attention to issues of childhood abuse and neglect is generally not appropriate during this stage. The second stage of recovery may last anywhere from 30 days to 2 years, during which clients are establishing new and "sober" relationships, securing employment, participating in support groups such as 12-Step programs, and possibly reconnecting with family. During this second stage, clients may feel a need to address childhood abuse and neglect issues but should not be expected to do so. The third stage is, in many ways, the rest of the clients' lives, during which they are recovering from their substance abuse disorders. In this stage, clients generally can better deal with a broader range of issues.
What is the goal of a substance abuse counselor?
The treatment provider's first goal for clients is generally to help them stop using substances and maintain abstinence. Clients may wonder or inquire why they are being asked about their childhood in a program for substance abuse and dependence. For the therapeutic process to be effective, both counselors and clients may need to reach a deeper understanding of how the past contributes to present problems. Although the counselor is primarily concerned with substance abuse, she is often in the crucial position to identify clients' other needs, which if not addressed might lead to relapse or escalation of substance use.
How to handle abuse history?
Once abuse history has been disclosed, it is important that it be acknowledged and not dismissed by the counselor. Counselors should be aware that clients may be hypervigilant regarding counselors' reactions to their experiences. Clients may interpret seemingly insignificant behaviors as signs of blame or rejection and may need considerable reassurance from the counselor that she does not hold them responsible for the abuse or view them differently because she knows about it. Sometimes, clients will project personal discomfort about discussing the abuse onto the counselor and may need to hear that the counselor is willing and able to discuss abuse issues without becoming overwhelmed or rejecting the client.
What is sequential model of treatment?
Many programs use a sequential model of treatment, in which a period of abstinence is required before a client can move on to psychotherapeutic treatment of issues related to childhood abuse or neglect. Many treatment providers associated with programs of this sort believe that psychotherapeutic intervention for issues surrounding clients' abuse history cannot be effective until the client has maintained abstinence for some period. During the time that the client is achieving abstinence, the counselor can gather information about relevant psychological issues, including those related to a history of abuse and neglect, which can then be passed on to a mental health practitioner when formal psychotherapy is undertaken. An important exception, however, is in cases of ongoing violence either directed toward or perpetrated by the client. In recent years, as alcohol and drug counselors have recognized the significant overlap between the addiction and abuse populations and their treatment issues, many have come to believe that people who have suffered severe abuse and neglect as children may not be able to stop abusing substances until they deal with abuse issues early in the treatment process. Two treatment models of this sort are available--the integrated model and the concurrent model.
What is concurrent treatment model?
In a concurrent treatment model, referrals are made as appropriate for needed mental health services while the substance abuse treatment continues. In this model, staff members who are not substance abuse treatment professionals may deliver mental health treatment. In any situation where clients are receiving services from different providers, all parties involved should work together to act in the best interests of the clients.
Why is acknowledging past abuse important?
Acknowledging past abuse can be an important step for clients in treatment because it breaks the secrecy and shame that are so often part of the abuse legacy. Many clients may find it easier to "confide" their history to a computer screen or a piece of paper than to another person. For some clients, the act of acknowledging is so relieving that it is healing in and of itself. However, for most, acknowledgement alone is not enough and requires additional therapeutic work for full resolution of abuse-related issues.
Why are clients resistant to change?
Counselors try to move their clients towards an acceptance of responsibility while clients may be more inclined to strive for evasion of responsibility (King, 1992). Clients simply may not be ready to move where their counselor is taking them. Some clients may be resistant because there is a purpose for their symptoms. The benefits of maintaining their dysfunctional beliefs or behaviors far outweigh the benefits of overcoming them. These clients may enjoy the support and attention they receive by having a mental health condition and may be hesitant to lose the associated benefits. In some cases clients may be resistant to change because change in and of itself is a frightening prospect. As human beings we are creatures of habit, and asking someone to change may lead to the development of resistant behaviors as a productive measure.
What role does a counselor play in a client's resistance?
roles. The counselor may expect the client to respond in a particular way, and when they do not respond accordingly they assume the client is being resistant. The interventions and techniques used by counselors also may contribute to in-session resistance. Counselors need to be cognizant of the interventions they use, ensuring that they are appropriate for their client in the given moment. Similarly, counselors should only assign homework assignments that are relevant to the issue at hand and that are not too time consuming for the client.
How do counselors contribute to client resistance?
Counselors, both consciously and unconsciously, contribute to client resistance. Counselors may have failed to establish rapport with their client. They may have misguided expectations of client behavior and client roles. The counselor may expect the client to respond in a particular way, and when they do not respond accordingly they assume the client is being resistant. The interventions and techniques used by counselors also may contribute to in-session resistance. Counselors need to be cognizant of the interventions they use, ensuring that they are appropriate for their client in the given moment. Similarly, counselors should only assign homework assignments that are relevant to the issue at hand and that are not too time consuming for the client.
What are the causes of client resistance?
Counselors, both consciously and unconsciously, contribute to client resistance. Counselors may have failed to establish rapport with their client. They may have misguided expectations of client behavior and client
What are the resistances in counseling?
This category of resistance consists of behavior patterns clients engage in that violate the basics rules underlying the practice of counseling. The most common forms include poor appointment keeping, payment delay/refusal, and personal favor asking. The object is to avoid engaging the counselor in the counseling process by creating a distraction. These forms of resistance signify that the client may have a negative attitude towards the counselor or towards the counseling process. By ignoring, and in some cases outright defying, established counseling guidelines clients are creating a way for themselves to not participate in the therapeutic relationship.
How does resistance affect the family system?
The family systems theorists view resistance as an unconscious attempt to protect other family members by avoiding any disturbance to the delicate homeostatic balance of the system in which change and growth have unconsciously become associated with disloyalty, betrayal, and loss. Clients become reluctant to change their beliefs or behaviors for fear that doing so will negatively impact other family members. While these changes might be in their best interests, clients place the family’s welfare ahead of their own.
What is response quantity resistance?
Response quantity resistance is viewed as the client’s noncompliance with the change process. This category consists of a class of behaviors whereby the client limits the amount of information communicated to the counselor. Silence and minimal talk are typical forms of resistance in this category. Otani (1989) identified such behaviors as frequent pauses, taciturnity, silence, and minimal talk as signs that the client may be engaging in this type of resistant behavior. By limiting the amount of information they give to the counselor, clients are able to control the counseling session and prevent the discussion of difficult or emotionally painful topics. This behavior is observed most frequently among involuntary clients, such as court-referred clients (Dyer & Vriend, 1988).
What to do if counseling doesn't work?
If counseling doesn't seem helpful, talk to your psychotherapist about trying a different approach. Or consider seeing someone else. As with medications, it may take several tries to find a treatment that works. Psychotherapy for depression may include:
What to ask a psychiatrist about depression?
Consider your response to treatment, including medications, psychotherapy or other treatments you've tried.
What to do if your doctor prescribed antidepressants?
If your primary care doctor prescribed antidepressants and your depression symptoms continue despite treatment, ask your doctor if he or she can recommend a health care provider who specializes in diagnosing and treating mental health conditions.