Geral Blanchard, LPC, is a psychotherapist who is university trained in psychology and anthropology. Formerly of Wyoming and currently residing in Iowa, Geral travels the world in search of ancient secrets that can augment the art and science of healing. From Western neuroscience to Amazonian shamanism, he has developed an understanding of how to combine old and new healing strategies to optimize recovery, whether from psychological or physical maladies.
Getting to know resistance, getting to know your patient
Geral T. Blanchard • Sep 03, 2022
There's no such thing as a resistant patient
This article has two intentions:
- to define the clinical term resistance and
- to determine when it is healthy and when it is unhealthy.
Resistance:
A subtle, overt, or even aggressive display of opposition to how they are being treated. It must be understood that resistance can be a normal and often protective human behavior that occurs with almost every person who desires, or is pushed into making, changes in their behavior or lifestyle.
For control driven therapists – prison workers, parole officers, child protection workers, assistant principals, and overscheduled therapists, as a few examples – any noncompliance to institutionalized rules may be classified as defiance. Professionals who may not be very self-aware often, and sometimes out of their own needs to be efficient and in the driver’s seat, hastily personalize the patient’s response and see it in simple terms, as little more than defiance. This can bring on punitive consequences and encourage still further resistance on both sides.
It is too simple to categorize resistance as a pathological feature or even as inherently problematic. It can be a very helpful window to understanding people, a way to find out what threatens a seemingly threatening patient. It is an opening to human understanding if first approached with curiosity and respect rather than harsh judgments or a desire to shut it down.
Often this assertion of honor over one’s life is born of a sense of powerlessness, which is compensated for with displays of power, control, or resistance. Looking in on the “fish bowl” of therapy, both parties can be equally afflicted and oblivious to the unfolding process. They can get swept up in an emotional battle.
Shaming and blaming are common precipitating factors. Being insensitively or judgmentally exposed for their mistakes, a patient will naturally resist anyone – often someone that is reminiscent of an emotionally abusive parent or partner – who rubs their nose in their missteps, particularly when it is done in a public setting.
Resistance shows up when there is a control imbalance. If a domestic abuser constantly attempts to control his wife, expect her to resist a police officer who tells her to just “leave the bum,” as if it is that simple.
Jeffrey Kottler, a brilliant and self-aware psychotherapist wrote in Compassionate Therapy, “…when clients are difficult it is because they are trying desperately to maintain homeostasis in their lives.” So, talk about it.
From my experience, minorities -- especially Native Americans and African Americans -- particularly after intergenerational and institutionalized discrimination and persecution, could easily be diagnosed as pathological if they did not resist authority figures who refuse to get to know them and the full context of their life experiences. When we see signs of learned helplessness and masochism, people are often branded as being submissive, overly compliant, or servile.
The dominant majority society often places resistant persons in a “drama of evil,” a simplistic world of good guys and bad guys that demonizes them. This alienating form of moralization is a lazy person’s way of avoiding the responsibility of getting to know their client.
In the book Engaging Resistance, Flinton and Scholz said of their work with sexual abusers, “Our contention is that many obstacles that impeded successful treatment, which were once seen as the ‘offender’s problem,’ can be overcome by changing the change agents.” It starts with the helpers truly being helpers. They went on: “Redefining resistance begins with redefining our goals as change agents. If our daily interactions with clients pathologize them, find shortcomings, and create ostracism, we’ll probably achieve these results and end up with individuals who may be worse off than when we met them.” At that point, helpers tend to rebrand the client as "resistant" and that simply deepens client resolve not to cooperate with persons they believe don’t have their best interests at heart.
If we explore the passionate reasons that can fuel noncompliance or even obstructionism, not take client reactions so personally, and if we spend less time feeding the resistance by our reactionary (vs. responsive) demeanor, we can team up and move people along the path of change.
In The Difficult Connection, Geral Blanchard provocatively contends: “There is no such thing as a resistant patient, only therapists who don’t know how to connect.” He suggests resistance can be an aid to understanding; the therapist’s job is to translate the unwanted behavior into words that can be expressed in a safe environment. He recommends exploring resistance for the following factors:
- As a response arising from fear, feeling unsafe around the helping professional. Can they even safely acknowledge feeling unsafe, given the community or family they came from? Must they appear tough?
- It may be a signal that the change agent is moving way too fast. Ask.
- It shows up when the helper has failed to acknowledge the patient’s positive attributes, like assertiveness, self-care, or self-compassion. Administer an online positive psychology assessment such as “VIA Character Strengths Inventory." Then discuss it, and draw upon those strengths.
- It often arises from being misunderstood, so take time for radical listening and clarification.
- It may be a natural reaction to being labeled as mentally ill, as an unfit parent, or as a criminal.
- It can spring from distrust of the helper’s poorly communicated motives or goals. Build trust. Find common ground. Then solve problems.
- It can arise when there are financial consequences like lost wages for attending meetings or hearings, or in response to high counseling fees.
- Resistance can arise from being defined by the client’s last, or worst behavior, as if that is all they are about.
- The client may not feel accepted as an equal in the change process, in therapy, or in the legal system. Collaboration can be invited again and again to overcome resistance.
- It can arise in response to the helper’s inflexibility or judgmentalness.
- Resistance is a common reaction to helpers who use coercion, bullying, or threats that are intended to elicit change. Lay down the sword.
- Resisting may be the only way the client can nonverbally say “Go to hell” to someone they believe is dissing them or taking control over their life. Share this handout with them and be open to discussing it.
- Sometimes cooperation is diminished when the helper is boring, cold, demanding, impersonal, or approaches the client in a mechanical one-size-fits-all way.
Reuben Fine, a psychoanalyst, once offered this insight, “Just as the rigid authoritarian parent virtually creates a rebellious attitude in the child, the technique-dominated analyst creates a great deal of resentment in the patient.”
Jeffrey Kottler again: “Every client has a unique way of communicating and cooperating in therapy; it is our job to discover what that way is and make the best use of it.”
Finally, if helpers are afraid of anger and conflict, they may be unable to connect with their clients. Angry people are secretly fearful people – fearful of being embarrassed, put-down, criticized, or losing control. Their rage can be seen as a maladaptive effort to return a semblance of control or homeostasis to a life that has been spinning out of control. A client’s angry resistance and a helper’s countertransference can best be understood as the desperate attempt of cornered individuals to assuage feelings of fearfulness and powerlessness. Healthy empowerment is the answer.
Other Topics
Basics of MDMA
Rituals and Ceremony
Brain and MDMA
Trauma
Heart
Energy Movement
Quantum Physics
Native Cosmologies
Nature
Spirituality/Enlightenment
Kogi Tribe
Books written by Geral T. Blanchard
More Articles
In recent years psychotherapists have become increasingly aware of the risk of transmitting trauma intergenerationally. By examining the impact of the Holocaust, or the experiences of Native Americans who were systematically abused by colonizers including the Catholic Church, it becomes obvious that indirect passage of depression, despair, anxiety, and damaged self-regard are but a few of the ancestral legacies of uninterrupted abuse. If, however, trauma can be passed from generation to generation without direct experience, could it also be possible for the reverse to happen?
Just as we have started to witness the reality of individual post-traumatic growth (PTG) – not just bouncing back after trauma but bouncing forward – could we entertain the concept of intergenerational growth (IG) – in other words, thriving from generation to generation?
There can be two levels at which trauma is processed. The first tier may be a time of quiet denial or the dissociation of nearly all thoughts of how painful the past was. The body feels it, but the mind does not speak it. On the second level a person awakens to the entirety of it, often an unpredicted and sudden onslaught of previously suppressed details with extensive associated pain. When trauma is reconstituted at the second level it often happens unwillingly. A person may be swept away by an awakening that seems very ugly. It feels like too much to absorb in its entirety. The result is often to feel afraid, even shattered – at first. Now with everything out in the open, what must be done with it?
At the second level of awareness, it is almost impossible to go on pretending that everything is fine. No longer can the visuals and emotions be kept submerged. One wonders, “Damn it, will I ever get better?”
Traumatized persons, with their pervasive pain, typically seek mood altering experiences. This can include ascetic restrictions, hedonistic over-eating, chemical dependency, sexual dependency, sexual anorexia or celibacy, romance addiction, relationship dependency, compulsive gambling, TV or movie binging, rock climbing, auto racing, reliance on antidepressants and/or antianxiety medications, religious addiction, and so much more that can serve to pacify, distract, and avoid unpleasant thoughts and feelings. By thrill-seeking, the higher the risks being engaged, the greater mood alteration one can experience. It’s a big dopamine splash and more.
These are the adult versions of childhood thumb sucking, according to Dr. Harvey Milkman, the author of Craving for Ecstasy (the feeling of ecstasy, not the drug). Harvey pointedly said, “Growing up consists of finding the right substitute for your thumb.”
There are many emotional reactions to a drug-free spiritual awakening experience and a ceremonial MDMA journey. While this article focuses on empathy – both the feeling and the cognitive component – it is obvious to those who have awakened from a spiritual emergency that a variety of related emotions arise.
It is one thing to imagine how another person feels. Psychopaths, despite what the general public believes, are very good at empathy on an intellectual level. Even criminal psychopaths can put themselves in another person’s position and understand their perspective. It is bigger, better, and far healthier when empathy, in its deepest sense, allows us to “feel with” other people by recognizing a sense of oneness with them, what’s called unity consciousness. To hurt others would be to hurt ourselves.
It’s impossible to talk about projection without incorporating a discussion about Sigmund Freud and Donald Trump. In this article I will skip Donald but throw in a little Carl Jung. Freud, of course, named several distinctive defense measures – reality distorting strategies to keep us safe. Two of the big ones are displacement and projection.
First, a definition of projection: This is evident when an individual attributes their own unacceptable impulses onto others. For example, a person might accuse others of engaging in thievery when, in fact, they are swindling money from their employer. Some of the behaviors and thoughts we are most ashamed of could be called shadows. We can see them first in other people before we can “call them out” in ourselves. We are defending against humiliation and mortification lest we be exposed.
Does this empathogen work in a similar manner as psychedelics, blasting us off to a sudden and dramatic awakening of the mind and soul? Not necessarily. Much like massive stress, psychedelics and MDMA can knock people off an unhealthy path and offer them an entirely different trajectory, but there is a lot of arduous individual work that must follow the use of these propellants.
So, could it be concluded that MDMA is a transcendent spiritual event -- a chemical event, or perhaps a neurological experience? By themselves, both seem unlikely. They can change activity in the brain, but enlightenment comes from hard work before and after their use. Entheogens and empathogens likely have a catalytic but not a primary casual effect in awakening.
Many events in life can change us, some in profound ways, others somewhat superficially. Some positively, some negatively. Some temporarily, some permanently. Let’s break it down.
With the “help” of psychology and the diagnoses of PTSD and C-PTSD, an entire trauma industry has developed. Much help has been delivered and, unfortunately, in many instances the assigned labels stick like glue and there can be difficulty relinquishing the newly imposed identity of “breakage.”
Many life events are transformative:
Many great minds have come out of India. Like countless spelling bee champions, Mahatma Gandhi, and Aurobindo Ghose who later took on the name of Sri Aurobindo. Sri Aurobindo became a highly regarded spiritual teacher and author in the twentieth century. His main insight was that what many humans experience during altered or higher states of consciousness are glimpses of the future of evolution. And, he contended, one day these states of expansion will be normal for the whole human race.
Countless numbers of people are seeking the unity consciousness that MDMA can offer. It can make them feel bigger. And more deeply connected and powerful. Like many billions of tiny ants inching a fourteen-wheeler up a hill, every tiny bit of effort pulls the big rig along. Similarly, each one of the eight billion or so people residing on our planet today may, via a combined assemblage of singular efforts, raise their individual consciousness, while tugging the entire race forward.
“Where did all the time go?” That is the ubiquitous question every patient asks after a treatment. They ingest the medicine at 9 a.m. and, after what seems like perhaps an hour or so but was actually five or six, and once the eye mask comes off there is bewilderment as to just how much time has passed. Of course, this is all built on the bedrock notion in Western culture that time is a straight line and linear manifestation. And that there is such a thing as time! Stepping out of existing paradigms, even if for a brief “time” can be eye opening while your eyes are closed.
Traditional Native American cultures have long believed that time is a circular phenomenon. Remotely like the movie Groundhog Day suggests, every day is very similar and reoccurring like the last. In indigenous worldviews, the sun rises and the sun sets, routinely; we always have a predictable reset of sorts, the start of what we call a “new day,” or what Arapahos called “sleeps,” both reflecting measurements of time.
Dark nights of the soul as Saint John of the Cross called those long, despairing periods of our life, are never easy, in fact they are usually dreadful. They are so necessarily awful and so damn long because some of us don’t do subtlety very well. If we are open to these moments, even a tiny bit, they can serve as an internally calculated and blaring wakeup call that will guide us to solace.
John Nelson, in Healing the Split, refers to a fleeting or ephemeral sense of a higher purpose, not fully conceptualized, but compellingly near the heart. It holds answers to life’s pain but isn’t quite within our grasp…at least until the dark clouds engulf us. Then, with great staying power and inexperience matched with trust, a spiritual emergence nears surface awareness. And it always happens, as psychiatrist Stan Groff defined it, around the time of a blurry spiritual emergency.