Re:Resistance and Motivating for change

Your main problem, if I understand it correctly, is that your client isn't "bringing anything to the table" in session. There are a number of possible explanations of course, many of which I'm sure you've already considered: insufficient socialization to the process; a lack of understanding, or belief in, the cognitive model, etc.

Based on what you've written, however, my gut is telling me there's a problem with the therapeutic alliance. Developing and maintaining true collaborative empiricism seems to be one of the toughest aspects of cognitive therapy, and it sounds like you're dragging the client along instead of making progress together.

You say, for example that the client "does not report emotion, cognitions or even dreams that can be used to engage with," but you also say that you find it promising that the client is bringing up session content with her PDN. If you're not working with the client's material, then what exactly is the content of the sessions?

I'm also curious about the other members of the client's therapeutic team. What, for instance, was their reaction to the client's criticism of your competence? Also, what are their theoretical backgrounds? Is it possible they're unwittingly unravelling your progress between sessions?

Your insight about the client's anxiety as you approach sensitive material may very well be correct, but if the two of you aren't yet able to deal with elementary tasks like identifying automatic thoughts, developing adaptive responses, etc., it seems like it might be a bad idea to try and tackle more central issues at this point.

I've tried a real "scattershot" approach with my response here, so I'm certain that much (if not all) of this is missing the mark. Take it for what it is: a bunch of wild guesses based on imcomplete evidence :) I know you're ready to move on past the "developing a good therapuetic relationship" phase of treatment, but based on what you've written, I think it might be worthwhile to spend a little more time on the issue.

Replies:

Re:Resistance and Motivating for change, by Laurette, 10/20/03 Re:Resistance and Motivating for change, by Jim Pretzer, 10/20/03

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