Dr Leonie White
Clinical Family Therapist, Psychologist & Co-Director Queensland Institute of Family Therapy
Would you like to build cooperative, collaborative relationships as a vehicle
for change, growth, and healing?
Would you like a new way to think about 'resistance'?
“There is no such thing as resistance: This assumption is intended to guide the SF [Solution Focused] therapists away from power struggles with clients. We have always been guided by Erickson’s concept of utilizing what clients bring to therapy (Erickson and Rossi, 1976; Erickson, 1977), an idea that was translated into the solution-focused concept of “cooperating with how clients cooperate” (deShazer, 1982: 9 – 10). This helps SF therapists to focus more on the clients’ point of view than on their own, and to avoid arguments about change. The most helpful question SF therapists can ask themselves is
“What is motivating this person?” not “Why is this person resistant?”
Lipchik, Becker, Brasher, Derks and Volkman, 2005: 57
Customers or Window Shoppers?
One of the most common challenges that supervisees and trainees come to me with is when clients don’t seem to be ‘buying what’s on offer’ in counselling and therapy.
This can happen when clients have different ideas to professionals about what the problem is, who has the problem, and what would be helpful in relation to the problem. Even when people desire change, we know that change can be scarey and difficult. Remember the saying "better the devil you know"? Motivation and readiness for change can be impacted by a whole host of factors.
It's also important to acknowledge the "elephant in the room" that sometimes clients aren't in our room by choice, they might be there at the behest of a parent, partner or other family member. Sometimes clients are referred by other services such as their school, a justice service, or child safety, and sometimes this means that our clients have different ideas as to whether there even is a problem, who it's a problem for and who should be involved in any changes. And of course, sometimes our clients have had past experiences with services that they didn't experience as helpful or even at times respectful.
These situations can lead to clients often being viewed as ‘resistant’, and sometimes the therapist can end up feeling like they are working harder for change than their client.
What’s been your experience?
Is everyone you work with a ‘customer’?
Or would some of them rather you could ‘sell’ a family member something helpful?
Or do you meet with people who might not actually be keen to ‘buy’ anything at all?
Do you have great relationships with your clients, and have lots of talk about … but sometimes it seems nothing ever really changes?
Do you have mandated clients?
Do you have clients who have had negative past experiences of services?
Do you feel like you are wanting change more that your client? Or wanting a differnt type of change than what they are after?
Do you view clients as resistant at times?
It can be so confusing and frustrating when clinicians care about their clients, want the absolute best for them and have great client relationships but "change" just doesn’t seem to be happening, or isn't happening as a quickly as a clinician would like.
Declaring the Death of Resistance.
In 1984 Steve de Shazer, Solution Focused Therapist, offered a solution for this – a way forward towards change that would ‘declare the death of resistance’. This was in fact the title of an article he wrote that challenged the dominant discourse of the time which was 'resistance'. Interested? Read on for find out a range of ideas to move away from the idea of resistance and move towards building cooperative, collaborative relationships for change growth and healing.
Language Matters
“… ‘resistance’ is seen as located in the family
and is described as something the family is doing.
… behaviour that is commonly labelled as ‘resistance’ can be usefully re-described.
One way of doing so is to conceptualise or think in terms of ‘cooperating’.
… ‘ing’ helps to keep the therapist thinking in terms of processes or continuing interactions between the subsystems, rather than the condition that might be implied by the use of ‘cooperation’”.
DeShazer, 1984: 13
Language Matters because our brains construct our reality, and they do this in a context, in relationships, and using language. I’m big on language – really big! Language plays a huge part in how we construct our reality which then influences how we think, feel, and act. And this then significantly impacts our relationships, including our therapeutic relationships.
Let’s take a minute to think about your language and the reality it’s creating. What language do you use to describe clients when they don’t seem to be "buying what you are offering"? For example, let’s think of a client who has experienced trauma and as a result of this takes a longer time to build trust and can become distressed easily. Now let's weave in a little neuroscience, drawing on understandings from polyvagal theory: Do you use the words “disruptive” or “difficult” with clients or “dysregulated” and “distressed”?
When we view clients as disruptive or difficult it implies that the person has a stable, negative trait unlikely to change, and maybe even that we think something not so great about their character. This doesn’t produce any insight into what might be helpful and limits options, creating a negative feedback loop i.e., we get stuck in unhelpful patterns with our clients.
When we view clients as distressed or dysregulated this implies behaviour and emotions are a temporary state that can and will change. It also implies that the person was once regulated and something happened to cause dysregulation. This perspective is more likely to elicit in the therapist a sense of curiosity about what happened and opens discussion and options
Language, Perspective and Polyvagal Theory
When we consider language, perspective, and polyvagal theory we make a shift from disruptive to dysregulated and this “assists healthcare providers to send more signals of safety and stokes a virtuous cycle, creating a positive feedback loop” (Sanders & Thompson, 2022: 157). When we use compassion, this leads to neuroception of compassion as a signal for safety, supporting regulation and helping to move up the autonomic ladder together.
Now let’s apply this idea to our language around clients and "resistance". Do you use the language of resistance, e.g., "This client is being resistant?" or do you use language in your thinking like "Have I found the right way to connect with this client? Am I understanding what is motivating this client?"
Helpful and Unhelpful Patterns.
“The distinction between (a) the family-as-a-system, and (b) family-therapy-as-a-system leads to a clinical perspective, or stance, that includes a focus on changing. Once this focus is clear, the therapist can help create the expectation of changing and consequently promoting changing. That is, techniques can be developed using positive feedback loops. Moreover, this distinction leads to a therapeutic stance in which not changing is a surprise”.
DeShazer, 1984: 11
“Once the distinction is drawn between the family-as-a-system and family-therapy-as-a-system, the therapeutic focus becomes more clear. That is, changing is a process or processes that involve co-operating between two subsystems of the therapeutic suprasystem. Therefore the therapist’s stance is not if change will occur, but rather when, or where, or what type of changing will occur.”
DeShazer, 1984: 16.
The way we think about and approach our relationships with our clients can lead us to get stuck in either helpful or unhelpful patterns. Or if you like, either vicious or virtuous cycles.
For example, if we view clients as "resistant" or "difficult" this locates the problem within the client – a type of pathologizing. It also reduces manoeuvrability because the focus is on them" (family-as-a-system) reducing our options (because we cannot control others) when in fact as Systemic Family Therapists we want to take the helicopter view for maximum manoeuvrability with multiple options. And Family Therapists are conscious to work in non-pathologizing, non-blaming ways, instead understanding people in their context, in the bigger picture of family life, culture and society rather than "being a problem".
Have you ever fallen into the trap of trying to "convince" a client or their parent/carer of something?
Are there times when the more you try to convince them, the more they get stuck in and attached to their stance?
When a clinician is feeling stuck or at an impasse it is helpful to step back and notice any patterns that are happening and any unhelpful cycles they might have unintentionally entered into. A conscious move at this time from a family-as-a-system perspective to a family-therapy-as-a-system perspective, gives the option for the clinician to do something different within the "system" and create a new pattern - a difference that just might make a difference.
A Window Shopper Metaphor.
I really, really love a good metaphor and here’s one I use frequently in supervision and teaching: Window Shopping. Chances are, if you’ve had a supervision with me you’ve heard me talk about window shopping or even "window shopping for coats" or "buying coats" 😉
Let’s play with the window shopping metaphor. Imagine that you are walking along the footpath of a road lined with all different types of shops. As you are walking along a thunderstorm blows in and there’s a sudden down pour of rain. You don’t have an umbrella with you, so you quickly duck into the closest shop. A coat shop.
Maybe this is great fortune because you need a new coat, and so you are actually a customer for a coat. If you are, then you’ll probably be really open to meeting with the shop assistant, talking with them and maybe even taking their advice on coats.
Alternatively, you might decide you don’t need a new coat but someone else in your family (or life) does. If this is the case, you might also welcome a conversation with the shop assistant, but it will be a different conversation because you’ll be talking about the other person you want to buy the coat for (not yourself because you don’t need a coat). Or you might decide that person should come into the coat shop themselves.
Or maybe you’re not interested in coats at all – you’re literally only in the shop because the rain forced you in. Your conversation with the shop assistant is going to be very different. You might not even want to talk to them, despite them trying their hardest to show you different coats and find the right coat for you… even going out the back to search for more options and ask their colleague for advice on how to sell you a coat.
In playing with this metaphor let’s think of these three scenarios as three different types of relationships as understood within a Solution Focused Therapy approach:
The customer relationship: A person who would like to buy themselves a coat
The complainant relationship: A person who would like someone else to have a coat
The visitor relationship: A person who doesn’t think they need or want a coat
This metaphor is a great way to help us understand the different types of relationships we can have with our clients as therapists. Not everyone we see has come to us to buy a coat, some have but others think someone else in their life needs a coat and some think there is no need for a coat. And remember that's because people have different ideas about whether or not there is a problem, what the problem is, whose job it is to be involved and how the problem is best solved. And they've had a variety of past experiences with different services. In order to be effective in building relationships and supporting change we have to keep this in mind and we have to meet our clients where they are at before we can start to walk with them down the road of engagement and towards healing and change.
Putting the window shopping metaphor to use – practical tips for different types of relationships.
Take a moment to consider the question:
What type of therapeutic relationship do you have with your client?
With each family member?
Would you say it’s a customer relationship? Or not?
The first and most important tip is … let’s remember that it’s important to think of the "relationships" we have because within the relationship there is the manoeuvrability that comes from the shift from family-as-a-system to family-therapist-as-a-system. If we go along with De Shazer’s idea of "declaring the death of resistance" and moving away from what has been a dominant discourse of resistance we can think and act in different ways as the therapist, and create possibilities.
Another way to think about it is that “resistance” is the client’s way of letting the professional know that they are not working with them in the ways they find most useful and helpful, and we need to do something different. Or adding in some ideas from neuroscience, perhaps this client or family is experiencing an emotional fear reaction that they may not even have conscious awareness of – remember that neuroception works a "light speed" and that "faulty neuroception" happens particularly if people have past difficult or traumatic experiences or relationships.
Considering the type of relationship we have with our clients provide guideposts for our approach to our work, and we must always work in ways that create conditions of safety within the therapeutic relationship.
How do you know what type of relationship you have and what it means in terms of guideposts for your work? While there will always be unique individual differences, here are some general guidelines to get you thinking.
Customer Relationship
In a customer relationship the client will find the conversation useful and see their part in things. They will be motivated and willing to do things like take onboard your ideas, take actions, and even do homework tasks.
Complainant Relationship
In a complainant relationship, the client may aknowledge that there is a problem, but they won’t see themselves as playing a part in the difficulties (perhaps instead that they are a recipient of difficulties from others), and may talk a lot about how someone else or something else needs to change.
Visitor Relationship
In a visitor relationship the client isn’t really in the market for support or change. They may not know what they want, or have any expectation or desire for change. They may not even recognise there’s a problem because a family member has 'dragged them in' or they may be a mandated client.
Practical Tips and Ideas
Some ideas to invite a complainant relationship or a visitor relationship to work towards becoming a customer relationship include:
Invite clients and families to talk about skills and successes. These can be unrelated to the problem e.g., anything that is going well in life of that they enjoy like friends, baking, skateboarding or fishing.
Look for exceptions to the problem, e.g., a time when they kept their cool with their children or when the anxiety did not get the best of them.
Use competence questions to promote talk about successes and self-compliments, e.g., “How did you manage to do that?”
Acknowledge the client’s pain/distress/difficulties e.g., “How have you managed to keep going?”.
Carefully tailor questions during the session and homework tasks to the client’s motivation for behaviour change - consider a "noticing" task instead of an active doing task and encourage reflection e.g., a time when the problem was less present or that they caught a "glimpse" of their preferred future.
Be careful about wanting change - it is not helpful to want change more than your client and you’ll likely get a response like “Yes, but…” Always start with where the client is at and go at the client‘s pace.
For visitor relationships and mandated clients acknowledge they would rather not be there and be curious about how they ended up meeting with you, and listen for who and what is important to them.
Empathise with the clients’ position and adopt a non-judgmental stance. It’s not your job to determine the "truth" but rather to work towards understanding.
Find out what they want to achieve (because they are there) e.g., “what do we need to do to get Mum/Child Safety/Teacher off your back?”, “If you have to be here what can we do to make this useful for you?”
Do not give active homework tasks – instead remember to 'Hasten Slowly'.
Don’t take comments or standoff attitudes personally – there is a story behind every person.
But most importantly, be human:
Focus on getting to know and appreciating your client.
See your client as human - Objectify the problem, not the person.
Mentalise your client's situation and past experiences.
Consider your "way of being" in the relationship.
And don’t rush. Nothing happens without a strong relational foundation.
“It is important to be aware that building rapport takes times, and to be mindful that imposing techniques too soon may activate the client’s stress response,
inhibiting the therapeutic process”
Rothschild (2000)
“Neuroscience clearly indicates that who we are as therapists is far more significant
than our body of knowledge”
Kandel (2006)
Thanks for reading - I hope you found this helpful and useful.
Leonie
References
Kandel, E. R. (2006). In search of memory: The emergence of a new science of mind. New York: Norton.
De Shazer, S. (1984). The death of resistance. Family Process, 23, 11 – 17.
Sanders, M. R. & Thompson, G.S. (2022). Polyvagal Theory and the Developing Child: Systems of Care for Strengthening Kids, Families, and Commuities.
Rothschild, B. (2000). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. W.W.Norton & Company: New York.
Lipchick, E., Becker, M., Brasher, B., Derks, J. & Volkman, J. (2005). Neuroscience: A new direction for solution-focused thinkers? Journal of Systemic Therapies, 24(3), 49 – 69.
Please note that this article is educational in nature and does not constitute professional advice.
Photo Attributions:
Window Shopping Photo by Harold Wijnholds on Unsplash
Elephant Photo by Photo by Susan Wilkinson on Unsplash
Other Photos via Canva