The Resistant Client In Forensic Therapy: Therapeutic Approaches To Enhance Participation And Recovery

Ideally, all clients would be open to medically necessary psychological treatment to improve their mental health. Yet, in the forensic world, is not uncommon to come across “resistant” clients—clients who are unwilling to fully participate in therapy and heal their mental condition.  Although initially resistant to therapy, once they undergo the process, many forensic clients find it helpful and end up benefitting from therapy.  The key is to understand why clients who need therapy may be resistant to obtain it, and how to help the client overcome their resistance so they can improve their mental health.  

There are a number of different causes of client resistance to therapy. Cultural or societal stigma may make a client feel as if they are  “crazy” or “weak” for seeking therapeutic help. They may feel fearful or awkward having to be in the vulnerable position of relying on stranger for help with deeply personal issues. Other clients may have authority issues stemming from childhood (abusive, authoritarian parents) and may resist another authority figure (therapist) “telling them what to do.” Also, when referred to therapy in a forensic case, the client may be unsure of what to expect, and may not understand why they may need therapeutic help. While some clients may simply refuse to participate in therapy from the beginning, others may passively resist—making appointments and then cancelling—because they don’t want to seem like the “bad guy.”  This, however, impedes their progress and hinders their chance at recovering their mental health.

Fortunately, there are various ways for a therapist to help a client overcome their resistance to therapy.  First, the therapist can use psychoeducation to teach the clients about the benefits of therapy:  improved motivation and self-esteem, ability to get back to their ordinary routine, reduced symptoms of anxiety, depression, and PTSD, and improved interpersonal relationships and work performance. Once the client begins therapy, but is still resistant (missing appointments, not doing their homework), the therapist needs to determine if they are building a strong enough rapport with the client. To improve rapport, the therapist can use techniques such as reflection (repeating back the client’s statements), empathy (putting themselves in client’s shoes), and unconditional positive regard (nonjudgmental communication).  In addition, the therapist can use the technique known as “Matching and mirroring” to match the client’s verbal and nonverbal style to enhance communication and understanding. Finally, the therapist needs to determine if they are meeting the client’s therapeutic objectives, or whether they are dealing with tangential issues that don’t correspond with the client’s therapeutic needs. If the latter is the case, then the therapy needs to be redirected to meet the client’s goals.

Although not all clients need or want therapy, there are many who would benefit from it, especially in the forensic context. It is true that therapy in a forensic case may be the first, and only, opportunity for the client to be exposed to mental health therapeutic treatment. Moreover, many clients would do well in therapy if they can overcome their initial resistance to participate fully.  By being empathetic and sensitive to the client’s needs, the competent forensic therapist can help the client overcome their fears and doubts about therapy—opening the door for the client to make significant progress in recovering their mental health.

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