Children with severe trauma and attachment wounds are often angry, oppositional and defiant, mistrustful, contemptuous of authority, and lack genuine and caring relationships. It is not surprising, therefore, that they can be extremely resistant to therapy and therapeutic relationships. Many families that enter our treatment program have experienced a number of prior treatment failures.
Strategies for reducing resistance
There are a variety of therapeutic responses and strategies that we have found to be effective in managing and reducing resistance:
- Remain proactive: As the therapist, we set the tone for the relationship and the treatment process throughout.
- Neutral emotional response: It is important that the therapist avoids negative emotional responses (e.g., anger, shock, rejection). They should not get “triggered” by the child’s attitudes and behaviors.
- Avoid control battles: Resistance has no power or influence when it “falls on deaf ears.” The therapist does not engage in most control battles and power struggles.
- Take the wind out of the child’s sails by turning the negative into a positive: For example, a therapist may encourage an oppositional child to look into their eyes and say, “I don’t want to do it your way.” The child is now complying with the therapist’s request, and the therapist can praise the child’s honesty and be empathic.
- Acknowledge choices and consequences: Introduce the child to the concept that resistance is a choice and has consequences. For example, the therapist informs the child that they are free to choose to be noncompliant in therapy, and follows that up with a dialogue regarding all the possible consequences of that choice.
- Convey commitment and perseverance: Children have often learned to “wait the other person out,” having realized that they can succeed in getting their way because others become frustrated, confused, or hopeless in dealing with them. Instead, the therapist sends a clear 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). For example, the therapist may dialogue with a co-therapist (third-party conversation) about the child’s resistant behaviors in a nonchalant way, which eliminates the power of resistance.
- Identify underlying emotions: Resistance is generally fueled by fear and anxiety. Acknowledging and displaying genuine concern and compassion for the child’s underlying fears of vulnerability, abandonment, abuse, and loss, switches the focus from superficial manipulation to meaningful emotions.
- Offer empathy: The therapist communicates the message, “I understand why you do not want to participate in therapy; if I had a background like yours, I would not trust anyone either; how sad that you were taught to be afraid and mistrustful.” This will result in the child feeling understood and validated and often reduces their defensiveness and resistance.
- Positive frame: The therapist encourages, validates, empowers, and guides the child to success and hope. The message conveyed is, “I know you can do this; you can be a winner; I have faith in you.”
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