Responding to Resistance in Therapy

Despite the increased awareness of mental health care, and the often media-hyped status of therapy and having a therapist, it can still be a challenge to engage a child or young person in therapeutic services and activities. The reasons for this are varied but understanding them can help to determine the best course of action for a clinician to take when trying to engage a hard-to-reach client.

At Chaddock, we utilize our Developmental Trauma and Attachment Program treatment model to help us understand a child’s resistance to therapy. Our model, designed as a pyramid, allows us to consider child and adolescent behavior based on the part of the brain they are working from (back, mid or front (also known as the cortex)).

As a clinician, I know that when a child or young person enters my therapy space, particularly at the beginning or early in the therapy process, they are more than likely to be in back brain (or survival mode). This is because we have asked them to meet with someone they do not know, in a space that isn’t familiar, to talk about things that are often painful, potentially embarrassing and almost always, hard. I’m not going to lie, I think I’d feel pretty uncomfortable about that too, and I’m an adult!

Because I know this, I will tailor my approach to meet the child where they are at. We must remember that it is hard to think clearly when we are in back brain (we all know what happens when we go to the grocery store on a empty stomach) and children cannot regulate independently. I will focus on staying attuned, providing opportunities for coregulation and developing felt safety (an environment where individuals feel emotionally secure enough within their relationships with others to explore their thoughts, feelings, and experiences without fear of judgment or harm).

When we encounter resistance further into therapy, after emotional, relational and physical safety have been established, the likelihood is that something has caused the young person to revert to back brain responses and behavior. Often, we see this when our client has entered into the therapy session in their front brain, or cortex, and is ready to engage in an approach such as trauma-focused cognitive behavior therapy, however during the interaction the client becomes withdrawn and refuses to speak or look at the therapist. Whatever we have asked of them is challenging that emotional, relational or physical safety we have worked to build and they have jumped back to the safety of fight, flight or freeze. The luxury of our treatment model allows us to put cortex-focused modalities on the shelf and re-visit our back brain supports, attuning and co-regulating until safety is once again established.

So, the next time you encounter resistance in a therapy session ask yourself, “What part of the brain is my client in and am I speaking to that part?” I guarantee, resistance will diminish once you’re speaking the same language.