A practically written guide that presents tangible, stress-reducing techniques for dealing with your most difficult clients. Theories of resistance are examined and a model presented that empowers mental health professionals to resolve roadblocks in therapy. For the first time, hundreds of ideas from a broad array of theories are presented together in one complete package. When consistently used together, these ideas and techniques allow the therapist to create a therapeutic environment where resistance is successfully managed. A valuable resource that both the working professional and student will turn to when seeking realistic, pragmatic ideas and strategies for overcoming stagnation and creating therapeutic movement. The book is indexed and designed for quick access to ideas and approaches.
Effective Techniques for Dealing with Highly Resistant Clients, 2nd Edition
Innovative Approaches to Prevent, Avoid, and Resolve Resistance
Table of Contents
1 Developing a Personal Philosophy for Handling Resistance
Resistance Control = Stress Control
2 Understanding Resistance
Conventional Definitions
Alternative Perspectives: The Social Interaction Theorists
Resistance and Influence: Breaking the Negative Cycle
Client Dynamics Often Mislabeled as Resistance
The Positive Side of Resistance
3 Common Errors Therapists Make That Create and Foster Resistance
Your Client is Not Making Progress Toward What?
Why Most People Come to Therapy?
The Essential Ingredient Necessary Before We Help Anyone
The Perils of Assuming a Knowing Attitude
Rogers is Still Right and Why People Change
Timing is Everything and "Baby Steps" are Not a Joke
Accepting the Invitation to Take the Pain
Failure to Recognize and Respond to the Client's Stage of Change
Cognitive Distortions of Therapists That Foster Resistance
4 General Principles for Dealing with Resistance
Averting Resistance By Honoring It
Basic Principle #1: Do the Unexpected
Basic Principle #2: Slow the Pace, Focus on Details, Process Feelings Relative to Meaning
Basic Principle #3: Treat Clients' Resistance with Respect
Basic Principle #4: Maintain an Attitude of Naïve Puzzlement
Basic Principle #5: Never Label Clients with Terms That Imply Resistance
Basic Principle #6: Focus Where Clients are Stuck
Basic Principle #7: Frame All Desires in the Positive
Basic Principle #8: If They Are Not Confused, Confuse Them
Basic Principle #9: Resist the Urge to Confront Initially
5 Words: The Fundamental Tool of Therapists
Two Fundamental Rules of Language Every Therapist Should Know
Lessons from Aikido
Why it is Crucial to Develop the "Desire Side" of the Motivation to Change
The Influence of Words on Mental Processing: Why the Words You Choose are so Important
The Compelling Power of Priming
Summary Points Regarding Language and Therapy
6 Goal Creating Language and Techniques
Always Take Time to Establish an Answer to This Inquiry
Enhancing the "Desire Side" of Change
Goal Creating Dialogue for Resistant Clients
Goal Creation Through Enhanced Empathic Responses
Ask the Miracle Question
A Few Points on Creating Viable Goals
Critical Points for Viable Goals/Problem-Solutions
7 To Ask or Not to Ask, That is the Question
The Problems with Questions Lie Just Beneath the Surface
Generally, Do Not Ask Questions Under the Following Circumstances
What to do if You Have the Urge to Ask a Question
How to Convert Questions Into Curious Commands
Voice Tone
Generally, Use Questions for These Purposes
Do Not Assume Clients Are Not Asking Themselves Questions in Their Own Mind
Advantages of Avoiding Questions
8 Managing "I Don’t Know" Responses
What Does "I Don’t Know" Mean?
Responding to "I Don’t Know"
How to Avoid "I Don’t Know" Responses
Inquire of a Wise Friend
The Classic Pretend Technique
Using "I Don't Know" to Open Therapeutic Doors
9 Dealing with Silence
The Meaning Behind the Silence
General Points to Keep in Mind When Encountering Silence
Specific Techniques for Dealing with Silence
10 Responding to Challenges Regarding Therapist Competence
11 Other Linguistic Techniques for Dealing with Resistance
Embedded Suggestions: The Frazzled Therapist's Friend
Tip for Increasing the Impact of Embedded Suggestions
How to Talk Positive to Negative People Without Them Knowing It
Divide and Conquer: Separating Thoughts, Feelings, and Actions
Continually Suggest That the Resistance is Temporary
Build from What Currently Exists
The Disempowering Power of "We"
The Power of Using "If" Wisely
Increasing Impact Through Deliberate Use of the Client's Name
Pacing and Leading
Putting it All Together: How to Create Highly Therapeutic, Fully Influential Responses
12 Other Approaches for Dealing with Resistance
Reframing
Paradox
Case Examples and Discussion
Dangling the Carrot
Expanding the Context
Encouragement Does Not Always Encourage
Change Your Theoretical Approach
Change Your Communication Mode
Immediacy: Discussing What’s Occurring Right Now, Right Now
Go with the Energy
Directly Hand the "Ball" to Them
Explain the Limits of Therapy
Acknowledge Your Contributions to the Lack of Progress
After Much Time and Consideration, Confront
Therapeutically Surrender to the Client
If You Have Done Everything in This Manual That is Fitting with No Progress, Fire the Client
13 Other Issues, Thoughts, and Suggestions
Dealing with Resistance in a Managed Care Environment: Arguments for Thorough, Effective Approaches
Clarifying Our Role to the World
Common Characteristics of Clients
When You Know You are Not Their First
Concluding Thoughts
Appendix
My Client Has Me So Frustrated That I Am Willing to Answer Each of These Questions and Make Needed Adjustments
"This book should have been entitled, ‘Everything you didn’t learn about doing therapy in graduate school and wished you had.’It is filled with stress reducing, cutting-edge ideas for managing resistance. A highly practical, must-readfor all therapists.”
Bill O'Hanlon, author ofChange 101
"...tremendously useful to me in my work...by far, the best presentation of the therapeutic relationship I've yet run across. It makes me feel excited again about being a counselor and instills hope in me that I can actually help my clients change." Tal Parsons, Los Angeles
"The next evolution in counseling...The methods I've used from this book have greatly improved my success in gaining cooperation and participation during counseling sessions. It's also relieved a lot of stress." D. Kirkham, "Mind Explorer"
"...courageously presents practical ideas and methods for helping counselors get beyond reasons for clients' resistance and avoidance. The book matches his training sessions: unambiguously presented, eminently practical, and highly engaging.”
Robert E. Wubbolding, Ed.D., Director, Center for Reality Therapy
"Stop resisting and buy this book! Simply put, it is the most practical book ever written on managing resistance. Your clients will be glad you read it!"
Scott Miller, Ph.D., Co-director, Institute for the Study of Therapeutic Change
“Simply the best book ever written on managing resistance. You will keep this book on your desk and reference it often. Mitchell's emphasis on how choice of words affects mental processing is invaluable. Plus, he provides a host of practical techniques that will teach you how to use therapeutic time wisely.” Meg Selig,author of, Changepower! 37 Secrets to Habit Change Success
"Words cannot express how grateful I am for this helpful tool! One subject not covered very much in graduate school is dealing with "resistant" clients. I purchased the book because I have a difficult time responding to silence, "I don't know," etc. This book is honestly more helpful than any other book I read in graduate school. Thank you so much!" Sincerely, Amber Blackmon, LAC
"I've been in the counseling field since 1992 and this isthe most insightful clinical book I've ever found...I often dip into Mitchell's book when I'm having trouble. It always helps me solve my problem and usually leaves me feeling more inspired as well." Claire Hatch, author ofSave Your Marriage: Get Rid of Your Resentment
"Dr. Mitchell presents a treasure trove of practical skills that are immediately useful for counselors at all levels...by far the best one I have ever come across!...this book has been my "secret weapon" throughout my counseling training." Steven Starks, Phoenix
"Just wanted to send you an email to write how much I appreciate your book about resistance. It lies on my bedside table. When I feel tired and the need of consolation and encouragement, I read it. My mind turns and fills me with new force. Recommend the book very much. A robust and practically useful book in my everyday work. It should definitely be translated into Swedish." Janne Larson, Social Worker, Gothenberg, Sweden
Dear Dr. Mitchell,
I bought your book in 2013, but only now I got around to reading it - due, or better say, thanks to the fact that I have now a very "difficult" case. I had to find answers quickly to the resistant strategies that my client had been using on me for about 6 sessions in a row. I had read only about the first 40 pages or so of the book and I already found enough resources and insights to turn the therapeutic relationship around. I mean TOTALLY. Whereas just two sessions ago I was doing almost all the work to little or no effect, at the end of the last session (yesterday) my client said "I feel like I need to do something." This is thanks to the wonderful tips, insights, and strategies in your book.Warm regards from Romania, Anton Suluman
