Resistance/reactance level
Beutler, Harwood, Michelson, Song & Holman (2011)
Journal of clinical psychology: in session

Abstract

Patients exhibiting low levels of trait-like resistance respond better to directive types of treatment. Patients with high levels of resistance respond best to nondirective treatments.  

Introduction

Reactance is a patient’s failure to respond favourably with therapy procedures. This implies that the psychotherapy environment, including the psychotherapist, plays a role in including noncompliance. A therapist has some control over the failure of therapy resulting from a patient’s poor motivation or failure to change. It also reflects a failure of the therapist to fit treatment to the receptivity of the patient.

Definitions

Resistance and reactance

Psychoanalytic theory characterized resistance as the patient’s unconscious avoidance of unconscious threatening material that might be disclosed and threatened in analytic work. Resistance was an inherent striving to avoid, repress, or control conflicted thoughts and feelings. This implies both a state-like and trait-like quality associated with psychopathology. Once activated, this can escalate to become reactant-oppositional, noncompliant and rigid. This can include a failure to act.

Reactance is a state of mind aroused by a threat to one’s perceived legitimate freedom, motivated the individual to restore the thwarted freedom. This is more often confined to state-like behaviour that occurs in normal personality expression. This is expressed as directly oppositional behaviour.

Therapist directiveness

Therapist directiveness refers to the extent to which a therapist dictates the pace and direction of therapy and communicates as a direction of needed change, as well as the overall predominance of control established by the therapist to elicit change. It is the degree to which the therapist is the primary agent of therapeutic process or change through the selection of specific techniques and/or the adaption of a specific interpersonal demeanor.

Effective therapeutic change is greatest when the level of therapist directiveness corresponds inversely to patient level of resistance.

Summary of therapeutic practices

Low levels of trait-like resistance serve as indicators for patients who respond to directive interventions.

The following therapeutic practices are recommended: 1) psychotherapist can recognize the manifestations of resistance as both a state and trait. Cues for state-like manifestations of resistance include expressed anger at the treatment or therapist. 2) Therapeutic responses to expressions of resistant entail: acknowledgement and reflection of the patient’s concerns and anger, discussion of the therapeutic relationship and renegotiation of the therapeutic contact regarding goals and therapeutic roles. These responses are designed to defuse the immediate consequences of resistance and to infuse the patient with some sense of control. 3) Anticipate these reactions by initially assessing the level of patient reactance. 4) Match therapist directiveness to patient reactance. High reactance indicates a treatment that will de-emphasize therapist authority and guidance, employ task that are designed to bolster patient control and self-direction, and de-emphasize the use of rigid homework assignments. Homework assignments may be presented as experiments that require minimal over action on the part of the patient. The amount of listening versus talking should shift toward the patient. 5) Beware matching the level of therapist directiveness to the therapist’s reactance level. It is the patient’s level of reactance that provides the optimal fit. 6) Avoid stimulating the patient’s level of resistance 7) View some manifestations of client resistance as a signal that ineffective methods are being used.