If you were to hear the word resistance in terms of therapy, you may think it means a person who is reluctant to go to their sessions or engage with the treatment plan. In certain cases, this may be what is happening, but in many others, it might not be that clear-cut.
Sometimes treatment resistance can happen even when the person is already in treatment and genuinely wants to get better. This makes it harder to spot, partly because the person themselves may not realize it is happening. Understanding why people resist mental health treatment, even when they want help, is essential for finding effective solutions.
To help with this understanding, this page will cover:
Research on the psychotherapy process describes resistance in treatment as something that happens in virtually every therapeutic relationship.[1] It can happen regardless of the type of therapy being used and is considered a normal part of the process that nearly everyone encounters at some point. Therapy avoidance behaviors in adults may include:
Whichever way resistance presents itself, it’s important to understand that subconscious resistance in therapy is common. You’re not consciously deciding to self-sabotage your own treatment, but it can explain why therapy feels stuck when you think you’re doing everything you’re supposed to be doing.
Resistance to therapy causes confusion for a lot of people, especially when you genuinely want to get better but find yourself consistently pulling away from the work. But patient resistance in mental health settings is well documented, and understanding its origins can help you work through it.
Research on ambivalence in therapy tested what happens when clients express both the desire to change and the desire to stay the same in the same session.[2] The study found that improvements in motivational language predicted later behavior change most strongly in clients who were ambivalent at the start.
This suggests that wanting to change and resisting change at the same time is a difficult, but normal, starting position for people in therapy. It’s also the state where therapeutic work often has the most traction.
The different patterns of behavior you’ve built over the years, even the ones that are causing you harm, exist for a reason. It may have been a coping mechanism formed during a traumatic period of your life, or turning to a substance to deal with the stress of a demanding job.
Either way, your mind doesn’t give those up without a fight, because from its perspective, they kept you safe during a time when you needed it. This emotional resistance to change feels protective to the mind, even when it works against your conscious goals.
Asking to let go of something familiar in exchange for something unknown might register in your mind as a risk, even when you know the change would be good for you.
Defense mechanisms in mental health, like denial, intellectualization, projection, and minimization, are all examples of automatic psychological responses that may have been developed to protect you from emotional pain.
When you’re in therapy, these mechanisms can be the thing standing between you and the work that needs to happen.
One study found that people who relied more heavily on established defense mechanisms at the start of their treatment had worse outcomes.[3] Promisingly, though, those whose defenses matured over the course of therapy showed large improvements in depression.
Another study found something similar, in that those with deeply ingrained defenses predicted persistent depression symptoms at a six-month follow-up.[4]
If you notice yourself analyzing your feelings rather than actually feeling them, that could be a defense doing exactly what it’s designed to do.
Opening up in the past may have led to you being dismissed or hurt, and your nervous system learned that vulnerability equals danger. When you’re in treatment, therapy then asks you to open up, and do the exact thing your history has taught you to avoid.
Research on attachment in clinical populations found that only 33% of participants had secure attachment styles.[5] This is important because insecure attachment was linked with higher anxiety and more cognitive avoidance to manage those feelings.
A review found that avoidant clients can sometimes minimize and intellectualize, while less avoidant clients were shown to seek assurance.[6] Both of those patterns are relational styles you learned growing up, and they follow you into the therapy room because that’s what relational patterns do.
Therapy avoidance behaviors in adults often have their roots in these early attachment experiences.
You may recognize some of the signs of resistance below in yourself, but don’t be too hard on yourself if you do. They can help you understand what’s happening so you can bring it into the conversation with your treatment team.
These psychological barriers to therapy are documented in the psychotherapy literature and show up across every type of therapy.[1] Recognizing them in yourself is the first step toward working with them rather than being run by them.
AMFM is here to help you or your loved one take the next steps towards an improved mental well-being.
Sometimes what looks like resistance in therapy may actually be other conditions that have gone undiagnosed. Understanding the difference here matters because each one calls for a different therapeutic response.
If you’ve dealt with trauma in the past, the therapeutic process could be the very thing that’s causing the resistance.
Research on post-traumatic stress disorder (PTSD) clients found that avoidance is a self-reinforcing protective response. This is because avoidance works in the short term, and so it persists as a way of avoiding pain.[7]
The “window of tolerance” model can help explain how this works. The model describes the Goldilocks zone where you can both think and feel at the same time.[8] Inside that zone, the discomfort is workable, but outside it, your nervous system may move into panic, known as hyperarousal, or shutdown, known as hypoarousal.
When this is the case, wanting to quit therapy after a difficult session might be your nervous system telling you it was pushed past what it could handle.
Therapy resistance in depression and anxiety can show up differently. However, hopelessness is a hallmark symptom of depression, and when it’s at its most intense, it can look very similar to resistance.
Fear of recovery in therapy can also emerge here, as the prospect of change feels impossible when hopelessness is overwhelming.
Research on hopelessness in therapy found that treatment that couldn’t improve hopelessness predicted poor outcomes in cognitive therapy, which then led to higher dropout rates.[9]
The important distinction to make is that this kind of disengagement requires a different clinical response. Raising this with your therapist can help them adjust to the situation.
When you’ve lived with a condition for a long time, your identity can start to form around it. If you’ve never received effective help for the condition, you may have adapted to accommodate it. Psychologists call this identity engulfment, and it can affect the way you see yourself and the world around you.[10]
Recovery asks you to let go of that version of yourself and step into someone you don’t fully know yet. That prospect can feel genuinely unsettling, even though you know you want to let go of the version causing the most problems.
This is where resistance can start, and you might find yourself showing the signs of treatment resistance we covered earlier.
If you feel like your identity has been formed by a mental health condition, it’s something you should discuss with your therapist.
While resistance is something your therapist can help you with, it should be addressed together. This means that there are things that both you and your therapist can do to ensure the best possible outcome.
The most powerful thing you can do with resistance is acknowledge it and talk it through. Research on alliance rupture found that when breakdowns in the client-therapist relationship were addressed directly, it produced better treatment outcomes than if no rupture had occurred at all.[11]
What this tells us is that engagement challenges in therapy can be a positive, as they’re a chance to resolve what is holding you back and move forward stronger. It can be nerve-wracking to bring this up, but therapists are professionals who have likely experienced the same situation many times before.
Try telling your therapist, “I think I’ve been avoiding something,” or “I wanted to cancel our session this week, and I’m not sure why.”
This can change the dynamic entirely, and it only takes one honest conversation.
A good therapist expects resistance at some point, but not because it’s anything you’ve done wrong. It happens so often that it’s treated as clinical material.
A meta-analysis found that clients with high levels of resistance did better when their therapist took a nondirective approach rather than a directive one.[1]
A therapist who pushes harder when you push back can, according to the research, make things worse. A good therapist will meet your resistance with curiosity rather than pressure.
Addressing mental health treatment barriers like pacing can make the difference between progress and prolonged stagnation. If the work is moving faster than you feel comfortable with, it is important to say so.
The window of tolerance research we presented earlier supports this directly. Processing works best inside a zone where you can both think and feel at the same time.[8] Telling your therapist your concerns about the pace can give them the information they need to adjust how quickly things are moving.
If anything you’ve read on this page today has struck a chord with you, it is crucial that you get the right support. Resistance in therapy can feel isolating, especially when you’re doing everything that you’re supposed to be doing.
While it can be daunting, recognizing that something is getting in the way of recovery is already a big step toward overcoming the obstacles.
AMFM (A Mission For Michael) Mental Health Treatment provides mental health care for adults experiencing a variety of conditions. Our clinical team is experienced in working with the kinds of barriers covered here and is able to adapt the treatment you receive to where you are now.
For those who need the structure of a full-time therapeutic environment, we offer residential programs at our locations across the U.S. We also offer flexible outpatient treatment options for those who need support around daily life.
AMFM Mental Health Treatment accepts insurance and is in-network with most major providers. To check your insurance coverage for mental health care, simply complete our confidential online verification form or call us at 866-478-4383.
If you’re feeling stuck in treatment in ways that are hard to explain, we can help you work out what the right next step looks like. Contact us today, and a member of our team will be more than happy to guide you through your options.
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