THE MANAGEMENT OF
AND OTHER DIFFICULT CLIENTS
Resistant cases or difficult clients are issues that were rarely discussed amongst traditional behavioural therapists until interest grew in complex psychiatric cases, often involving both Axis I and II according to DSM classification (APA, 1994). The concept of ‘resistance’ was traditionally used in psychoanalytic circles to describe personality characteristics and attitudes of a client, rather than aspects of the therapeutic process. Behavioural and cognitive therapists, on the other hand, were more concerned to identify and define problem behaviours that may arise within the therapeutic context. Obviously, this could also involve therapist behaviour.
Turkat & Meyer (1982) have suggested that ‘resistance is client behaviour that the therapist labels antitherapeutic’ (p. 158) in any given context performed by individuals and evaluated by the therapist subsequently. Clearly, sources of resistant behaviours may be varied, depending on individual circumstances in the therapeutic process, and it is probably futile to attempt a comprehensive list. Turkat & Meyer (1982) have illustrated this with nine specific examples, referring to reinforcement and punishment conditions, avoidance situations, modification methodology, skill deficit, therapeu tic relationship, goal discrepancy, client misconceptions, client manipulation and so on.
When discussing ‘difficult’ and ‘resistant’ patients it may also be useful to distinguish between cases which are not understood fully, and individuals who do not adhere to therapeutic recommendations. Accordingly, different strategies may apply to rectify each distinct problem. These issues are
Obsessive-Compulsive Disorder: Theory, Research and Treatment.
Edited by Ross G. Menzies and Padmal de Silva. © 2003 John Wiley & Sons, Ltd.