A test of psychotherapists' and nontherapists' recognition of correct and incorrect process in managing client resistance

Abstract

ObjectivePsychotherapist management of client resistance (i.e., opposition to change or the therapy process) has a significant impact on therapy outcomes. This study aimed at assessing psychotherapists' and nontherapists' abilities to recognise empirically supported correct and erroneous therapist responses to client resistance.MethodSeventy‐eight therapists and 111 nontherapists completed a rapidly administered novel skills test, Therapist Errors in Resistance Management (TERM), assessing recognition of correct and erroneous resistance management.ResultsParticipants were, on average, less than half as accurate at recognising therapist errors (recognised below chance levels) compared with correct therapist responses to resistance (recognised above chance levels). Therapists outperformed nontherapists in accurate recognition of therapist responding. However, among the therapist group, greater clinical experience did not predict superior recognition of therapist errors.ConclusionThese results indicate that therapists and nontherapists alike may have difficulty detecting erroneous therapist responses to resistance, tending to mistake empirically contraindicated directive responses for correct responding. This may reflect the difficult and unintuitive nature of correct resistance responding and may suggest a need for increased training in process acuity and resistance management in therapist education.

Developing expertise in psychotherapy: The case for process coding as clinical training.

“…Similarly, identifying specific moments of error in therapist moment-to-moment responsivity to negative process markers within a disagreement episode (i.e., using demand instead of support in responding to instances of client counterchange talk) significantly predicted client outcomes up to 1 year posttreatment in a clinical trial of cognitive behavioral therapy for generalized anxiety disorder (Olson et al, 2021). Furthermore, Cooper et al (2022) asked a group of randomly sampled undergraduate and graduate students to state what they would say next following video vignettes of a priori-defined “therapist errors” in managing ambivalence compared to correct therapist management. The probability of resistance following errors was 70% compared to only 6% for correct management.…”

“…Consistent with these findings of negative process detection failure, Hara et al (2015) found that therapist ratings of resistance during a course of cognitive behavioral therapy for severe generalized anxiety were unrelated to outcome, but trained observer ratings were highly predictive of outcome, even up to 1-year posttreatment (and again supporting that such abilities can be acquired through training and practice). Further, Cooper et al (2022) used a rapid test of process recognition with brief video vignettes that reflected good and poor therapist management of resistance. The test was validated through expert consensus and the impact of the depicted therapist responses on increasing (poor management) or decreasing (good management) subsequent resistance.…”