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Section 4
Therapist Emotional Reactions and Client Resistance

Question 4 | Test | Table of Contents

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In the last section, we discussed the three shields of saying no, having passion, and believing to avoid burn-out.

In this section, we will be discussing the role of client denial and resistance to the basic protocol for educating a battered woman and how this can affect a therapist.

As you know, when a woman makes the decision to return to her battering partner, it may be one of the last decisions she ever makes. By this I mean, of course as you know, all too many women are killed by their battering partner. The Bureau of Justice Statistics indicates that the percent of female murder victims killed by their intimate partners is as high as 30 percent.

In my first session with Josie, a 21-year-old pregnant woman, I felt it was particularly important to discuss the basics regarding her safety. You will see how this discussion of safety can lead to therapist burn-out. Josie was in the hospital two times within the same month after being severely beaten by her husband Paul. The first visit was for minor bruises and sprains, but this time she had two swollen eyes and a broken wrist. She stated in our first session, "When I was at the hospital, I still feared for my life. I was afraid Paul had followed me there and would come crashing into the room. When the nurse notified Security, he followed her to the hospital and was found outside the emergency room door smoking a cigarette with two ambulance attendants."

5 Areas of Client Resistance

As I go through the five basics I used to educate Josie regarding her safety, note the role that Josie's denial and resistance plays in this first session. The section that follows this will provide you with a technique not to deal with your client's resistance, but to provide three steps that you may use when dealing with your own arrogance. The five areas of client resistance are:

♦ 1. Resistance to Information Regarding Dangers of the Cycle of Abuse
As you know, what was a punch in the side today may quickly become a push down the stairs tomorrow. I stated to Josie, "It sounds like the injuries for your second visit to the emergency room were much worse than your first. Do you think Paul's violence is becoming more intense and cumulative as time goes on?" Josie's reaction to this first protocol of providing information about the cycle of abuse, indicated her denial of the escalating danger she and her unborn child were in. Josie's stated, "No, I think he just had a really bad day the last time he beat me. It's not usually that bad. I could never leave him, though. I just can't imagine trying to raise my baby without him around. I would do just about anything to keep this relationship from ending."

♦ 2. Resistance to Information Regarding Housing Options
When housing options were presented Josie was resistant to leave her home and Paul, and denied her situation. She stated, "I just can't bring myself to tell my sisters or parents about what's been happening. I really don't think they'd understand, and it isn't really all that bad. And I'd be too embarrassed to go to a shelter. Those women have it so much worse than me; they'd just think I was weak for going there. I mean, I really have no choice but to stay at home with Paul." As mentioned, the next section will relate client resistance to therapist arrogance.

♦ 3. Resistance to Information Regarding Child Implications
Josie denied the dangers and lethality of her situation to both her and her unborn child and resisted the information I was providing. Josie stated, "Paul hadn't ever hit me in the stomach before, but I'm sure he didn't mean to hurt the baby. I'm only four months pregnant. He probably just forgot because he was so angry with me."

♦ 4. Resistance to Information Regarding Feelings of Guilt and Blame
I asked Josie if she felt that she was to blame for the abuse and Paul's anger. Have you found, like I have with Josie, that a battered woman often denies her problem and danger by blaming herself? Josie stated, "It's all so silly really, that this whole thing ever happened. I fell asleep on the couch while I was folding laundry, and when Paul got home he exploded with anger that he had to dig through the pile of laundry to find his sweatpants. If I had just stayed awake long enough to fold everything and put it all away it wouldn't have happened at all."

♦ 5. Resistance to Information Regarding the Legal Process
As I explained to Josie her options about filing charges, advocacy, Child Protective Services, community agencies, and Law Enforcement, she seemed resistant to charge the man she loved with assault. Josie stated to me, "At first I was certain that I would press charges against Paul. I gave consent for photography when I was at the hospital. The fact that he was now attacking my unborn child made things seem really bad, worse than ever. But, once I got home he was so sweet and apologetic, I just knew that the legal stuff would only make him mad again, so I dropped it."

Think of a battered client you are currently treating... Have you found that your attempts to educate him or her of their dangers are met with resistance and denial, as with Josie? As with many battered clients, this denial can allow the battered client to become so disillusioned that she will die for love rather than leave her battering partner. Think of the last Josie you treated. Did you, or do you, experience feelings of frustration or perhaps anguish following the session that might be a precursor to burn-out for you?

In this section, I have explained the five areas of education regarding: the Dangers of the Cycle of Abuse, Housing Options, Child Implications, Feelings of Guilt or Blame, the Legal Process, and Evaluating Relationships. I have also given examples of the resistance and denial that takes place with many battered clients as they hear this information. Is it beneficial for you to turn the CD off and think of a battered woman you are currently treating? Is there one of these basics that you may have forgotten? Or, do you need to do some emotional releasing regarding their denial, which may be striking a personal cord for you?

As mentioned earlier, the next section will discuss a technique I use concerning a client's resistance and denial. However, this technique may surprise you, because it is not a technique for the client, but rather a technique for the therapist. I use the technique to avoid the Trap of Arrogance.

Peer-Reviewed Journal Article References:
Aviram, A., Westra, H. A., Constantino, M. J., & Antony, M. M. (2016). Responsive management of early resistance in cognitive–behavioral therapy for generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 84(9), 783–794. 

Ayanian, A. H., Tausch, N., Acar, Y. G., Chayinska, M., Cheung, W.-Y., & Lukyanova, Y. (2021). Resistance in repressiveontexts: A comprehensive test of psychological predictors. Journal of Personality and Social Psychology, 120(4), 912–939.

DelTosta, J. E., Ellis, M. V., & McNamara, M. L. (2019). Trainee vicarious traumatization: Examining supervisory working alliance and trainee empathy. Training and Education in Professional Psychology, 13(4), 300–306.

Urmanche, A. A., Oliveira, J. T., Gonçalves, M. M., Eubanks, C. F., & Muran, J. C. (2019). Ambivalence, resistance, and alliance ruptures in psychotherapy: It’s complicated. Psychoanalytic Psychology, 36(2), 139–147.

Westra, H. A., Aviram, A., Connors, L., Kertes, A., & Ahmed, M. (2012). Therapist emotional reactions and client resistance in cognitive behavioral therapy. Psychotherapy, 49(2), 163–172.

QUESTION 4
What are the six areas of domestic violence education, when met with client resistance, which may be fostering burn-out for you? To select and enter your answer go to Test.

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