Possible Reason for Resistance in Therapy: The Therapist’s Age Resistance in therapy is more common than you think. One very common resistance-filled occurrence is that the patient questions the therapist’s professionalism for not having gray hair, a lush mustache, a face full of wrinkles, or not wearing a suit.
What happens when a client is resistant to therapy?
Anyone who has ever performed therapy such as psychotherapy has run into resistance. When you have a resistant client, you often leave the session feeling like you just spent the therapeutic hour banging your head into a wall. Put simply, it can be highly stressful and frustrating.
How do you deal with resistance to therapy?
If goals for therapy have been arrived at collaboratively between therapist and client and there is still noncompliance, then resistance can be addressed as part of what needs to be focused on in treatment. The resistance should be actively discussed with the client, without judgment or surprise.
Why is my child so resistant to therapy?
Sometimes resistance is about fear of dealing with scary situations. A good therapist is sensitive to the child’s needs, feelings, and readiness to deal with scary things. Anyway, glad your child is better, and that you advocate for your child. I’m new to private practice.
Can therapists put a stop to the therapeutic process?
Undoubtedly, therapists can put a stop to the therapeutic process if they don’t think it’s profitable for the client anymore. However, considering the client’s resistance the reason why they can’t be treated or assuming they don’t want to get better because of it is completely wrong. We can see this issue from the approach of motivational therapy.
What does treatment-resistant mean?
“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 are some reasons that a person may be resistant to treatment?
Treatment resistance is seen in people with many mental health disorders, including the following:ADD/ADHD.Depression.Anxiety.Bipolar disorder.Addictions.Schizophrenia.
What is the definition of 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 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.
How common is treatment resistant mental illness?
Treatment resistance affects 20–60% of patients with psychiatric disorders; and is associated with increased healthcare burden and costs up to ten-fold higher relative to patients in general.
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.
Is there hope for treatment-resistant depression?
Taking an antidepressant or going to psychological counseling (psychotherapy) eases depression symptoms for most people. But with treatment-resistant depression, standard treatments aren't enough. They may not help much at all, or your symptoms may improve, only to keep coming back.
What is treatment-resistant anxiety?
Treatment-resistant (or refractory) GAD is defined as failure to respond to at least 1 trial of antidepressant therapy at adequate dose and duration.
Is treatment-resistant depression a disability?
Treatment-resistant depression can be a disability that interferes with your ability to maintain a job. The ADA outlines mental health disorders like depression as potential disabilities that may qualify you for financial assistance, including supplemental income and health insurance.
How many cases of depression are treatment-resistant?
Basically, 30% of people with depression are diagnosed with treatment-resistant depression. Of those, a further 37% resist TRD strategies.
Can you become resistant to antidepressants?
However, in some people, a particular antidepressant may simply stop working over time. Doctors don't fully understand what causes the so-called "poop-out" effect or antidepressant tolerance — known as tachyphylaxis — or why it occurs in some people and not in others.
What is the strongest antidepressant?
The most effective antidepressant compared to placebo was the tricyclic antidepressant amitriptyline, which increased the chances of treatment response more than two-fold (odds ratio [OR] 2.13, 95% credible interval [CrI] 1.89 to 2.41).
What is treatment resistant depression?
Although definitions may vary, when two or more treatment attempts of adequate dose and duration fail to provide expected relief, the disorder may be considered “treatment-resistant depression.”
What is the lack of any response to medication or psychotherapy treatment?
A lack of any response to medication or psychotherapy treatment. Not enough of a response to standard depression treatments. Brief improvements followed by a return of depressive symptoms. Because standard treatments do not work well or at all, people may begin to experience profound hopelessness.
How to treat depression resistant to anesthesia?
Electroconvulsive therapy (ECT): Perhaps the most effective treatment for resistant depression is ECT. ECT is a procedure that is administered under general anesthesia. Electric currents are passed through the brain triggering a brief seizure. It seems to cause changes in brain chemistry that can reduce depression (and reverse symptoms of other mental illnesses). Although it is generally considered safe, it can have side effects such as some short-term memory loss as well as some physical side effects. ECT is often initially administered two to three times per week. The duration of the treatment can vary but a total of six to 12 sessions is common.
What is the best treatment for depression?
Electroconvulsive therapy (ECT): Perhaps the most effective treatment for resistant depression is ECT. ECT is a procedure that is administered under general anesthesia. Electric currents are passed through the brain triggering a brief seizure.
How many people are in remission after taking antidepressants?
Studies have found that 30% to 40% of people only experience a partial remission of depressive symptoms after taking antidepressants. 1 Approximately 10% to 15% of people don't respond to antidepressant treatments at all. Consequences for people with treatment-resistant depression can be significant.
What to do if you have been treated for depression but your symptoms have not improved?
If you have been treated for depression but your symptoms have not improved, you should talk to your doctor. Treatment-resistant depression is not an official diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), nor is it consistently defined.
Can depression be treated?
It's important to remember that even if depression does not respond to the first couple of treatments, that doesn't mean it cannot be treated. But it may require a different approach to treatment. You should work with your doctor to monitor your symptoms and response to treatment so that you can find an option that works for you.
Why do people resist therapy?
Many times, resistance in therapy stems from inadequate interventions in the motivational stage, which is a crucial part of the therapeutic process.
What is resistance in therapy?
Resistance in therapy refers to patient attitudes, behaviors, or cognitions that may delay or avoid therapeutic change. Usually, it’s present during the first stages of evaluation because that’s where the client may begin to question the treatment. In addition to this, they may refuse to speak sincerely or answer the therapist’s questions politely.
What is the ultimate goal of therapy?
The ultimate goal will always be to offer the client the most appropriate, effective, and useful therapy according to their issue. If there’s the possibility of changing the type of task or eliminating it and finding other means to reach the goal, don’t hesitate to look for them.
What to do if a patient doesn't do self-records?
When this happens, as a last resort, you can confront the patient. Tell them that if they don’t do their self-records, there won’t be a therapy session the following week. To condition the therapy, call the patient the day before the appointment and ask if they completed their self-records.
How to help a patient who forgot to fill in self records?
Allow external aid. For example, if the patient forgets to fill in their self-records, send them a text reminding them. There are also things they can do during the therapy session. Help them establish a series of alarms or make reminders they can place in easily-seen spots so they never forget.
Why are there age gaps between therapists?
The reason for this is that older patients are most likely going to believe a young therapist won’t be able to relate to their issues.
What can be a simple comment at the beginning of a treatment?
What may start as a simple comment at the beginning of the treatment can become a resistance later on. That’s when the patient will begin to doubt their psychologist in every way. Perhaps they think their therapist doesn’t have the right tools or information in order to help them.
What does Treatment-Resistant Mean?
Treatment-resistant is a clinical term used to describe the situation when your condition doesn’t respond to a prescription medication as expected – it may work partially, or not at all. Unfortunately, this is an all too common experience for patients diagnosed with major depressive disorder. [ i] Treatment-resistance occurs in a variety of mood disorders including depression, bi-polar disorder and even schizophrenia; as well as many anxiety syndromes, such as obsessive compulsive disorder (OCD). In fact, any medical condition may present with treatment-resistance, such as a pneumonia that fails to respond to first-line antibiotics.
What happens when a medication fails to alleviate your suffering?
When a medication fails to alleviate your suffering, there is always the possibility that you were misdiagnosed or that one or more additional undiagnosed medical conditions (called comorbidities) may be present.
How long does it take for a psychiatrist to prescribe a medication?
The psychiatrist diagnoses you with major depression, prescribes an antidepressant, and cautions that it will take two to three weeks for the drug to begin take effect. You remain despondent but faithfully take the medication as prescribed, and hope for a full recovery from the pain that feels unbearable at times.
How to get out of bed and loathe the work you once enjoyed?
Finally, you get up enough courage to seek professional help. Pushing aside your fears and misgivings you select a doctor, pull together the necessary financial support, and find someone to care for the kids while you attend the treatment sessions.
Do psychiatrists treat patients the same way?
Not all psychiatrists treat patients in the same way even when they agree upon the diagnosis. Some have preferences for particular medications and type of psychotherapy (talk-therapy) they prefer to administer. If you have given your current treatment plan a few months and there is no improvement in how you are feeling or functioning, it may be time to seek out another psychiatrist with a different approach, that would include a thoughtful, stepwise set of interventions until you find a therapeutic regimen that’s most effective. It is imperative that you trust, connect with, and respect your doctor. Feeling that the two of you are a good fit, and that you observe a gradual improvement in your condition over time, are the “must haves” when it comes to mental health treatment. Accept nothing less!
Does antidepressant work with augmentation?
The first antidepressant may not work, even with augmentation. There are many types of antidepressants that work in different ways and on different circuits in the brain and, of course, each person may respond to them a little differently. It is important to understand that it may take a couple of attempts to find the right medication.
How To Address Resistance in Therapy?
When you use a paradoxical approach, you don’t try to fight the resistance, you actually support it. For example, say a client is having trouble sleeping and you have recommended some changes in their sleep hygiene. You find out they have not changed any of their behavior and are still complaining of sleep. Instead of chastising them for their non-compliance, you tell your client that they should not change any behavior and just keep on taking the same approach to bedtime. Because certain clients are oppositional in nature, it is hoped they will defy your recommendations and actually do the opposite behavior (which is what you wanted them to do in the first place). Numerous research studies have supported the use of paradoxical interventions for those with highly resistant behavior. (Beutler, Moleiro & Talebi, 2002).
What is the job of a therapist when a client is exhibiting resistance?
If the client is exhibiting resistance, it is the job of the therapist to assist in reducing it as much as it is the client’s responsibility to change their behavior. Whatever your definition, one thing is sure, resistance is negatively related to treatment success (Beutler, Moleiro & Talebi, 2002).
What does it mean when a client doesn't do homework?
In many forms of psychotherapy it is popular to give homework. A telltale sign of resistance is a client who does not complete their homework or follow up on your suggestions. In order for therapy to be successful, a client needs to at least think about what was discussed in session in their daily life. Not doing homework is a sign they are forgetting about the session as soon as it is over.
What does it mean when you feel like a client is not making progress?
When you feel like a client is not much making much progress it is natural to feel frustrated and a bit guilty. You want to make sure you are providing them with the best therapy possible so you spend extra time on their case, planning new strategies and interventions.
How to build a therapeutic relationship with a client?
A strong therapeutic relationship also allows clients to be honest with the therapist in case they do not agree or believe in a suggested intervention. Your relationship with a client should be a focus of the first session and be a part of every session after. It is important to prioritize your relationship, even if it means putting a planned intervention on the back-burner.
When to revisit goals?
When you have established goals, you can easily revisit them, especially when you feel therapy may have veered off course due to resistance. This will remind the client what they are working towards and spur internal motivation, helping break through the blockades of change.
Do clients cancel sessions?
Almost all clients cancel a session from time to time, but when a pattern develops it is a worrisome sign. Someone who is motivated to change will make attending sessions a priority.
What does the therapist say to a child?
The therapist gives the message, “I will persevere with you no matter how long it takes.”. • Do not resist the resistance: The therapist allows the child to express resistance while remaining calm and projecting an air of indifference regarding behavior (not the child).
Does a therapist engage in power struggles?
The therapist does not engage in most control battles and power struggles. • Doing more of the same: Prescribing the symptom or current behavior “takes the wind out of the sails.”. For example, a therapist may encourage an oppositional child to look into his or her eyes and say, “I don’t want to do it your way.”.
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 to avoid resistance in counseling?
Instead, he advises counselors to simply listen to the client and focus on not creating resistance and not fostering defensiveness. Then, step back and let change happen, he says. “If you go in there and make not creating resistance your first priority and let the change come as a second priority, with highly resistant clients, you’re more likely to get change.”
How does reality therapy help with resistance?
“As a teacher and practitioner of reality therapy, I suggest that the counselor begin by asking clients what other people in their environment are doing to them, how they oppress them, reject them, make unreasonable demands on them and control them. It is important for counselors to connect with clients on the basis of the client’s reality rather than putting emphasis on the counselor’s agenda. In other words, the counselor may want the client to make better choices, but without connecting with the client’s perceptions in the beginning of the counseling process, the counselor might facilitate more resistance rather than less.”
What does it mean when a counselor says "I don't know"?
If a counselor empathizes with the client and agrees that the problem is difficult to figure out, the counselor is indicating that he or she is joining the client in the attempt to find a solution, Mitchell says. Too often, he adds, counselors make the mistake of treating an “I don’t know” answer as a barrier rather than an opportunity to work with the client. “Use it as a doorway into the struggle,” he says. “Most people don’t realize it’s a great place to get to.” Assuming the role of “expert” can also get counselors into trouble with resistant clients, Mitchell says. When a counselor gives ideas or suggestions related to a client’s problems and starts hearing “Yes, but …” answers, it’s time for the counselor to vacate the expert seat, he says. “You need to stay in a naïve, puzzled, unknowing, curious position. You need to not have knowledge; you need the client explaining to you. We want them talking, not us talking. If you’re not buying what I’m selling, I need to quit selling.” Encouraging clients to analyze their situation and explain it to the counselor is important, Mitchell says, because in the process, they might discover insight for improving the situation.
How does a counselor help a client move forward?
The counselor-client relationship is key to helping the client move forward, Wubbolding says. “Clients are less resistant if they feel connected with the counselor. If counseling is to be successful, the client must be willing to discuss the issue, examine it and make plans. If clients will not disclose their inner wants, actions, feelings and thinking, change is very difficult. But in the context of a safe, trusting relationship, they are more likely to disclose such information. After clients lower their defenses, they can then more freely discuss their inner thoughts and feelings. After this occurs, the counselor can help them conduct a more fearless self-evaluation.”
What is the key to resistance management?
The concept of counselors focusing exclusively on their interactions with clients and letting change happen on its own is key to the successful management of resistance and the pivotal point of effective therapy, says Mitchell. For 10 years, the American Counseling Association member has studied and presented seminars on dealing with resistance in therapy. “Although most therapists have been trained extensively in theoretical approaches, few have had extensive training in dealing with resistance,” he says.
Why do counselors label clients as resistant?
So, we label them as resistant as a result of our inability and lack of therapeutic skills. There is always a reason the client is responding the way they are. Our job is to understand the client’s world to the degree that we see their behavior for what it is and not as resistance.”
What does Mitchell say about "I don't know"?
Mitchell admits that receiving “I don’t know” answers from clients can be frustrating and make counselors feel as though they aren’t getting anywhere in session. But he advises counselors not to grow discouraged or to waste time fighting the client’s response.
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 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.
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
What is an augmentation therapy?
Augmentation or adjunctive therapy includes the addition of a second medication, not usually considered an antidepressant on its own, to a first-line pharmacotherapeutic option. Below, we have focused on the three main augmentation strategies with strong evidence vs placebo augmentation in detail: lithium, T3 and second-generation antipsychotics.148
Is TRD a first line treatment?
There are multiple modalities of somatic or brain stimulation therapies which have been investigated and applied in the treatment of TRD and are not first line but are turned to once several trials of pharmacotherapy and/or psychosocial therapies have been ineffective.