Change is seldom an easy or simple process. It helps to have an understanding of the reasons for resistance to change, and respect for the difficulties involved.
A mother and father bring their 14-year-old daughter to therapy because she is not completing her school work, and they are especially distressed that her bedroom is a “disaster.” This problem was recently brought to a crisis when an argument between mother and daughter led to the daughter throwing things, then threatening suicide. The father was called at work and quickly came home to rush the daughter to the emergency room. After being seen by a psychiatrist, she was diagnosed with possible bipolar disorder type 2, plus possible ADHD (although she could spend hours reading fiction), and she was prescribed two medications. She was already taking medications for her serious asthma, and the parents requested a referral for therapy because they wanted to avoid more medication.
The typical sequence of events surrounding her not completing tasks at home and school is that mother would attempt to enlighten her daughter on the benefits of completing tasks. The daughter’s response would be that she was incapable of staying focused enough to finish her work, and that her parents did not understand her. On occasions similar to the one that led to the trip to the emergency room, this interaction would escalate to the point where the father would be called to intervene and to calm things down. This was the first time that the interaction had escalated to the point where the daughter expressed suicidal intent.
The therapist proposed evidence-based parent effectiveness training. He defined the problem as a result of the daughter seeing herself as incapable and therefore not responsible. Parents agreed this was not a helpful self-view. The therapist asked the mother if she had ever won an argument with her 14-year-old daughter. Mother admitted that she could not remember ever convincing her daughter to change. It was recommended that the parents set a deadline for school work or room-straightening. If the deadline was not met, she would need to be in her room without her beloved electronic devices until the work was done. The therapist explained this would communicate to the daughter that she was capable of completing the task. Mother agreed to give this approach a try. Father, who was tired of having to intervene, agreed to this but feared his daughter’s escalation would require his intervention.
At the next appointment, Mother said she had tried to hold her daughter accountable by sending her to her room. The daughter screamed and cried for over an hour, yelling she would rather be dead, and was not capable of completing the work. Finally, the mother let her out of the room with the promise they would work on homework together when she was calmer. This occurred three days prior to the appointment and the homework had not yet been done.
Some therapists might have responded by telling the parents that they were enabling their daughter by not holding her responsible, or providing some other criticism of their behavior for resisting the recommended plan. This therapist, however, was not surprised by their lack of follow through. He understood that when people hold steadfastly to their behavioral patterns, they usually do so because important needs are getting met. In this situation, it came out that the mother had noticed that her daughter would have more frequent and more serious asthma attacks when stressed. The byproduct of this underlying fear was that appropriate parental authority was inhibited. If the therapist was to be helpful to the parents and teenager, he had to find a way to motivate change while taking their fears into consideration.
More often than not, we are all genuinely surprised when people make a major change in their lifestyle, whether it is losing weight, altering workaholic ways to spend more time with family, or discontinuing jealous rages. We all have areas where we know we should make a change, perhaps feel foolish that we do not change, but nevertheless remain the same. Change is difficult for everyone. In fact, if change were easy, there would be little need for therapists. What makes change so difficult is that, like the above family, we all have gotten needs met by our patterns of behavior, and we fear (often on an unconscious level) that things will be worse, or at least less satisfying, if we do things differently.
Good therapists are not surprised by resistance to change, because they respect and understand that the people they are seeing have reasons for their present behavior. In my book, Thinking Like a Therapist: A Novel Overview of Psychotherapy , I discuss a number of ways therapists effectively approach people’s resistance to change. Further, I discuss how people outside of therapy sometimes overcome their proclivity for the status quo. (For more information, see www.thinkinglikeatherapist.com.)
In the second session, the therapist firstly apologized for not fully appreciating the difficult task the parents had in helping their child. He suggested that they take their child to the physician treating the asthma and discuss the risks of added stress as a result of therapy. They then could make an informed choice about continuing therapy.
At the third session, the parents stated that the physician had educated them on handling an exacerbation of the asthma symptoms by use of a peak flow monitor and rescue inhaler. The physician told them that the asthma should not be used as an excuse to avoid responsibility. They stated that they had made the choice to move forward with therapy despite the burden. The therapist warned them that the teen would initially test limits, and only change when she realized that the parents were resolved in their expectation of adherence. However, he stated that his initial suggestions had been to move much too fast, and that moving slower toward change would be more tolerable for everyone, even if it took longer. He then suggested that the parents use the room timeouts with loss of electronic devices for only one half-hour initially, with gradual incremental increases in the timeout time for infractions.
The family returned in two weeks saying that there had been a significant improvement. After two days of half-hour timeouts, they decided on their own that they wanted things to improve more quickly, and kept her in her room the entire evening because she would not complete her homework. She ranted for two hours and they did not relent. They were a little concerned when she got quiet, so they checked on her and found she was sleeping, and that her breathing was not labored. The next night they threatened to similarly discipline her, and her homework was done adequately in an hour.
Some readers might wonder why the therapist initially talked very little to the teenager. This was by design. The therapist viewed the teenager as having too much power, and therefore did not want to include her in the decisions until the parents had established authority. With some progress being made, the therapist focused much of his attention on her. He had her describe what new freedom she might like, since she was showing greater responsibility.
In summary, resistance is a normal and expected reaction to change. Overcoming resistance to change entails finding new ways to get important needs met, while avoiding problems. A therapist’s respect for the difficulties of this process is an essential ingredient.
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