TABLE 1 - uploaded by Ze’ev Frankel
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Theoretical conceptualizations of resistance to change and working strategies to address resistance are reviewed within six contemporary postmodern psy-chotherapies: relational psychoanalytic therapy, personal construct psychother-apy, process-experiential psychotherapy, depth-oriented brief therapy, narrative therapy, and motivational interviewing...
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... Trying to understand the roots of client resistance, Prochaska and Prochaska (1999) proposed that people don't change for two main reasons: (a) some clients don't have the necessary information or resources to carry out the change, which is resolved through psychoeducation and developing coping skills; (b) others show ambivalence toward changing (Arkowitz, 2002;Beutler et al., 2011;Frankel & Levitt, 2006;Moyers & Rollnick, 2002;Prochaska & Prochaska, 1999). Engle and Arkowitz define ambivalence as "a subset of resistance in which there are movements toward change as well as movements away from change" (2006, p. 3), due to fears or apprehensions (conscious or unconscious) regarding the desired change, and/or the methods required to make the change happen. ...
... However, there are very few studies that allow us to understand how clients' ambivalence is managed and resolved (Braga et al., 2017). Thus, this type of resistance remains one of the most important and least studied phenomena in clinical practice (Beutler et al., 2002;Cowan & Presbury, 2000;Engle & Arkowitz, 2006;Frankel & Levitt, 2006;Moyers & Rollnick, 2002;Wachtel, 1999). The following section will present the main empirical and theoretical contributions about understanding and helping resolve clients' ambivalence toward change. ...
... Despite the increasing number of authors that support the negotiation paradigm of resistance (Ecker & Hulley, 1996;Engle & Arkowitz, 2006;Frankel & Levitt, 2006;Greenberg et al., 1996;Herrera, 2013;Honos-Webb & Stiles, 1998;Johnson, 1992;Ribeiro, et al., 2014b;Winter, 1992), there is surprisingly little empirical research exploring these ideas. When health psychology researchers try to understand "why" patients do not adhere, they use quantitative self-report methods (Hornsey et al., 2018;Letelier et al., 2011) or qualitative interviews/focus groups (Bommel e et al., 2014;Pound et al., 2005). ...
A patient's ambivalence toward medical and psychotherapeutic treatment is a strong predictor of its outcome. This is especially relevant in the treatment of common chronic conditions such as hypertension (HT), in which most patients do not maintain the lifestyle changes that lie at the heart of the medical treatment. Despite the growing theoretical interest, there is little empirical research on how patients deal with and resolve their ambivalence, and almost all of the studies focus on psychotherapy clients, not on chronic illness patients. This study aims to understand how patients with AHT deal with their ambivalence toward their medical treatment, using dialogical self-theory and qualitative research methods. We interviewed 51 hypertensive patients to identify their anti and pro adherence “voices” and the different strategies patients use for dealing with their ambivalence. Results describe integration strategies, which allow both opposing voices to express themselves and be heard, and domination strategies which reject or dismiss one of the voices. The temporal dynamics between PRO and ANTI adherence voices during the interviews are also explored. These results are discussed to contribute to the research on ambivalence and support concrete guidelines for dealing with patient nonadherence.
... Contemporary views of client resistance focus on its coconstruction in the therapeutic interplay (e.g., Tuckett 2003;Van Denburg and Kiesler 2002) as well as on its protective and affirmative role, as a safeguard of psychological security (e.g., Frankel and Levitt 2006;Miller 2003;Mouque 2005). Respectively, rather than being a necessary evil or even an anathema for the clinicians, resistance can also be framed in terms of the ways the client protects himself against a perceived threat that sometimes can even be, at least in part, real. ...
Through the lens of contemporary views on client resistance and attachment theory, which underpins the role of security in psychotherapy, the present study examines the relation between client resistance and client attachment to therapist. Forty-six clients and 19 therapists in long-term psychotherapy completed the Client Attachment to Therapist Scale and a therapist-reported questionnaire for client resistance, respectively, in three different times including the therapist’s summer holidays, so as to take into consideration the role of the therapist’s temporary absence as a real relationship component. Results indicate that resistance is negatively associated with clients’ secure attachment to their therapists, while it is positively associated with insecure attachment patterns. Also, holidays in psychotherapy were found to intervene in the interrelation between client’s resistive behaviors and attachment security. These preliminary findings indicate the interpersonal and statelike character of client resistance, a conceptual shift that augments clinical work as clients and their resistances are seen in more benevolent terms.
... If the therapist takes too active of a role in the development of a narrative, it will lose salience to the client. Thus, the newly constructed narrative will be lacking in the client's knowledge, strengths, and abilities (Frankel & Levitt, 2006). To further this exploration, narrative therapists assume a curious and inquiring stance, which facilitates a "richer account of clients' resources via increased sensitivity and creativity in identifying strengths related to clients' problems" (Frankel & Levitt, 2006, p. 229). ...
The concept of identity is one aspect that can be explored to deepen a wide range of treatment approaches. This article seeks to outline a group approach based on narrative theory, which addresses identity issues in an innovative way to positively affect the creation of a more positive identity and positively impact long term recovery.
Research problem. Patients’ low adherence to medical treatment in chronic illnesses is one of the biggest public health concerns. Hypertension in particular has a prevalence of over 20% in Chile and other western countries, with 30-60% adherence rates for medication intake, and lower for lifestyle changes. Numerous studies have helped understand different patient, treatment, illness and patient-caregiver communication factors associated with patients’ adherence. However, these studies have not been able to fully explain the ambivalence of those patients who ask for medical assistance, but nevertheless fail to follow the treatment as agreed. For this reason, these models fail to suitably predict patients’ future behaviour, only predicting their conscious intention to adhere. Also, they regard adherence as an individual phenomenon, disregarding possible interaction effects between patient and treatment/caregiver characteristics.
Methods and theoretical background. This dissertation explores patient non adherence as a manifestation of resistance, using theoretical models based on constructivism and dialogical self theories. It aims to explore, describe and relate patients’ adherence to their interactional patterns with caregivers, their personality traits, their experience with the illness and their implicit constructs and schemas about adhering or not adhering to the medical treatment. In order to do this, qualitative methods were used to analyse 51 in depth patient interviews.
Results and Discussion. Two different prototypes of patients emerged: those who keep control and those who give up control of the treatment. Each prototype of patient engages the caregiver in different interactional patterns, some associated with high and some with low adherence. Regarding patients’ constructs and schemas, the main implicit values associated with non-adherence were: self-esteem, autonomy, affiliation, wellbeing, or feeling that the extra effort is not worth it. Finally, almost all patients had both pro and anti adherence “voices”, and they used different implicit strategies to resolve their ambivalence: integration strategies allowed both voices to express themselves and be heard, and was associated with higher and more stable adherence. On the contrary, domination strategies aimed to reject or dismiss one of the voices, and were associated to poorer or less stable adherence. These results are discussed in relation to adherence research and intervention.
A tradition stretching back to early Greek philosophy has described the mind as a field of struggle or even battle. This comparison has been termed the agonistic metaphor, based on the Hellenistic notion of athletic contests. Today, it is not uncommon for psychotherapists and the general public to seek solutions to mental health problems agonistically. Examples of this are cited from major psychodynamic, cognitive, behavioral, family, and humanistic theorists, and advantages and disadvantages of the metaphor are explored. Although agonistic thinking can energize clients and ennoble the therapeutic journey, it runs the risk of ignoring educative aspects of problematic situations and ironically perpetuating the resistance it predicts. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
