Addressing Resistance in Therapy: A Literature Review

Identifying the Practice Problem

Task:

This assignment is about clients who are resistant to treatment where I do my internship. I will attach a paper I have written so that the writer uses that as a resource to understand what I need. I wrote it but had a high percentage on the plagiarism score. I need the writer to focus on a plagiarism-free work. Thanks. Evidence based practice is essential to effective social work practice.

For this assignment, you are required to (a) identify a current practice problem relevant in your current agency (i.e., working with resistant clients, engaging clients when they don’t talk much, having negative perceptions about your client, countertransference, etc.), (b) after identifying your practice problem, conduct an extensive literature search as it relates to your practice problem that provides you with a complete understanding of the practice problem. Based on your findings in the literature, what did you discover that will help you address your practice problem? How might your research guide your work in your field agency?

How literature helps to address this practice problem

Existing research offers evidence-based skills, knowledge, and tools that guide one in addressing situations with clients. The traditional model (medical) has been employed by several clinicians to address resistant clients as it conceptualizes alcoholism as a progressive disease first advocated by Jellinek (1952, 1960). The client is often regarded as an individual that will not accept the reality of addiction, which warrants confrontation and education to reawaken this person to become more aware of the nature and gravity of his/her alcohol dependence. For successful therapy, respect is required even when treating the most challenging client with alcohol addiction. As per Nicholas (2006) of the Annals of American Psychotherapy Association, the client’s readiness towards treatment is a myth which requires the therapist’s readiness for the most challenging client to educate, instruct, advise, confront, guide, reassure and direct them on how to approach and resolve adverse/challenging situations. Hester and Miller (1989) mentioned Behavioral Self-Control Training (BSCT) as a treatment approach that can be used to pursue a goal of moderate and non-problematic drinking or "controlled drinking (p. 141)."

Bischoff and Tracey (1996) posit that clients were more likely to be resistant when therapists are directive than nondirective. It is healthy when resistance is moderate during therapy but prolong or intense resistance can lead to early or premature termination. Bischoff and Tracey (1996) suggested non-directive behaviors like listening, encouraging, and offering support, which may specifically be helpful when the resistance from a client(s) is acting as a roadblock to the therapeutic process.

The most common interventions for such clients are individual counseling and psychoeducational group therapy. Individual counseling goals determine what behaviors to change and what attitudes to promote (rating on a scale of 1-10) and could be used in several sessions and data collected over time to provide accountability and evidence for the effectiveness of practice (Baker, 2012) then encourage self-monitoring for clients. As for psychoeducation group therapy, the writer recommends the usage of a pre-experimental pretest and posttest as well as the designation of instruments to test, assess knowledge and attitudes. This writer went further to state that pretest data can be collected before the intervention begins, and posttest data can be collected at the end of the intervention program then a correlated test used to compare the scores to determine if desired changes occurred.