Adapting psychotherapy to patient reactance level: A meta‐analytic review

Abstract

Resistance and its extreme variation, reactance, are uniformly observed across varieties of psychotherapy.Social psychologists note that reactant individuals prove to be less so when offered a receptive and nondirective environment. We provide definitions of reactance, review its frequent measures, and offer a clinical example. A meta-analysis of 13 controlled studies (1,208 patients) examined the degree to which treatment outcomes are enhanced when therapists offer less directive treatments to high-reactance patients. The results revealed a large effect size (d = .79), confirming that highly reactant individuals did better in psychotherapy when the therapist assumed a reflective and nondirective stance than a directive and authoritative one. To a lesser degree, the opposite was also true. Limitations of the research and diversity considerations are noted. Practice recommendations are provided to minimize a patient's reactant behavior. K E Y W O R D S meta-analysis, psychotherapy outcome, reactance, resistance, systematic treatment selection, treatment adaptations 1 | INTRODUCTION Patients who willingly enter psychotherapy typically do so because of a desire to change. At the same time, that desired change can prove a difficult and frightening process and is often met with what clinicians refer to asresistance. The clinician is then confronted with the thorny question, "Why is it that one who wants to change then resists doing so when offered the opportunity?" The role of the clinician is to serve as a facilitator for reconciling these contradictory inclinations of the patient and to produce change and growth in the process. Psychological

Tratamientos Psicológicos Personalizados: Orientaciones Clínicas

“…La resistencia del paciente con respecto al cambio es uno de los principales desafíos a los que se tiene que enfrentar todo terapeuta. Se trata de una tendencia a evitar realizar los cambios recomendados por el terapeuta, debido a una aprehensión o aversión al cambio (Beutler, Edwards y Someah, 2018).…”

Military Culture and Post-Military Transitioning Among Veterans: A Qualitative Analysis

“…Indeed, the American Psychological Association Task Force on Evidence-Based Relationships and Responsiveness highlights the considerable empirical support for attending to the psychotherapy relationship and matching appropriate interpersonal approaches in conjunction with evidence-based treatments (see Norcross & Lambert, 2018;Norcross & Wompold, 2011). Relatedly, a recent metaanalysis on patients' reactance level (low versus high avoidance/resistance) suggests therapy effectiveness is associated with clinicians' corresponding level of directiveness (Beutler, Edwards, & Someah, 2018). When considering the findings of the present study concerning possible situational and/or dispositional resistance towards treatment among some veterans, maintaining an open, reflective, collaborative, and transparent therapeutic posture (as opposed to more directive and/or structured approaches) may increase engagement and/or improve therapy-related outcomes.…”

An Integrative Approach to Clinical Decision-Making for Treating Patients With Binge-Eating Disorder

“…In general, people who are less open to change tend to be less compliant in treatment (Morey, 1991). A recent meta-analysis found that patients higher in resistance received less benefit from psychotherapy, and were more prone to dropping out of treatment (Beutler et al, 2018a). The same review found that patients high in resistance responded better to less directive interventions by psychotherapists, and that patients low in resistance did better in more directive therapies (Beutler et al, 2018a).…”

“…A recent meta-analysis found that patients higher in resistance received less benefit from psychotherapy, and were more prone to dropping out of treatment (Beutler et al, 2018a). The same review found that patients high in resistance responded better to less directive interventions by psychotherapists, and that patients low in resistance did better in more directive therapies (Beutler et al, 2018a). There is no research that we are aware of that assesses those with BED on their level of resistance or interpersonal compliance.…”

“…We do so to characterize those with BED on the six patient domains that are related to treatment processes and outcomes. These domains were identified by Harwood et al (2011) and have received empirical support as predictors of patient outcomes (Beutler et al, 2002, 2011, 2018a,b; Beutler and Castonguay, 2006). We hypothesize that: (1) patients with BED will demonstrate higher functional impairment compared national and local normative samples; (2) the BED sample will have lower levels of social support and interpersonal functioning compared to non-clinical groups, but higher levels compared ED clinical samples; (3) those with BED will have greater comorbidities and complexity of concurrent disorders and higher self-reported problems with substance-use compared to the general population, but lower levels compared to ED comparison groups; (4) patients with BED will have higher indices of internalizing coping style relative to a normative non-clinical sample (we do not make specific hypotheses about externalizing coping style); (5) the BED sample will score significantly lower than non-clinical populations and other ED groups on measures of resistance ; and (6) those with BED will score higher on measures of subjective distress compared to normative samples, but will score lower than other ED groups.…”