Academic journal article The International Journal of Behavioral Consultation and Therapy

Current Behavioral Models of Client and Consultee Resistance: A Critical Review

Academic journal article The International Journal of Behavioral Consultation and Therapy

Current Behavioral Models of Client and Consultee Resistance: A Critical Review

Article excerpt

Abstract

Resistance is the phenomena that occurs in the therapeutic relationship when the patient refuses to complete tasks assigned by the therapist which would benefit the patient in improving their psychological situation. Resistance is also used to describe situations in the consulting relationship where the consultee does not do what the consultant suggests. Often resistance leads to poor treatment integrity and/or staff burn out. As a result, this resistance is a factor that warrants a behavioral interpretation and investigation. Currently several behavioral models of resistance exist. In this paper, we explore each of these models and critique the logical and empirical support. Future research directions will be discussed.

Keywords: Resistance, Behavioral Models, Functional Assessment, Consultation

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Introduction

The functional analysis of verbal behavior began in 1945, with the publication of the Harvard Symposium on Operationalism in Psychological Review. In paper by B.F. Skinner entitled "The Operational Analysis of Psychological Terms" it was argued that by observing the contingencies and setting conditions under which a verbal community typically used the ordinary language terms, the interpreter could interpret the terms in a descriptive functional assessment. This approach is critical to the scientific investigation of events that on the surface may not appear to be readily available to a behavioral interpretation or behavioral research (Leigland, 1996). Leigland lamented that behaviorally oriented clinicians have done little research on terms that have been important to non-behavioral clinicians.

One term, which appears to have importance to traditional clinicians and consultants, is "resistance". Resistance can be defined as anything that a client or consultee does that impedes progress (Wickstrom & Witt, 1983). What is termed resistance in consultation can have serious implications for treatment integrity (Wickstrom, Jones, LaFleur & Witt, 1998). Resistance to change in verbal therapies and consultation is a phenomenon that has substantial representation (Cautilli & SantilliConnor, 2000; Patterson & Chamberlain, 1994) with some early discussion within the behavioral literature (e.g., DeVoge & Beck, 1978; Skinner, 1957). Resistance appears to interest a broad spectrum of clinicians both behavioral (e.g., DeVoge & Beck, 1978; Lazurus & Fay, 1982) and non-behavioral (e.g., Mandanes, 1981) in orientation. However, supporting data are lacking to most of the theoretical conceptualizations including behavioral interpretations (Patterson & Chamberlain, 1994).

In deconstructing resistance or conducting an analysis of its use, behavioral psychologists find therapists and consultants use the word in the context of therapeutic failure. For example, Dougherty (2000) refers to resistance as a consultee's failure to participate constructively in the process of consultation. Resistance can occur in the treatment relationship, where the client does not improve or, in the consulting relationship, where the consultee fails to implement the treatment. The clinical literature is replete with examples from different traditions of techniques to manage this problem if it arises in the therapeutic context (e.g., Spinks & Birchler, 1982). In one study using regression analysis, Patterson and Chamberlain (1994) showed that parental resistance to parent training reduced therapist effectiveness and these parents showed fewer improvements in discipline.

As pointed out by Cautilli and Santilli-Connor (2000), the term resistance is often used to describe a relationship in which the client, or in the case of consultation, the consultee, does not comply with the tasks that the therapist or consultant suggests. A review of the literature shows that many factors increase the probability that a consultee will be "resistant. …

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