Psychological resistance can manifest in various ways, such as denying the existence or severity of a problem, rationalizing or minimizing one's responsibility for it, rejecting or distrusting the therapist's or consultant's suggestions, withholding or distorting information, or sabotaging the treatment process.
[3] This and similar negative attitudes may be the result of social stigmatization of a particular condition, such as psychological resistance towards insulin treatment of diabetes.
The discovery of resistance (German: Widerstand) was central to Sigmund Freud's theory of psychoanalysis: for Freud, the theory of repression is the cornerstone on which the whole structure of psychoanalysis rests, and all his accounts of its discovery "are alike in emphasizing the fact that the concept of repression was inevitably suggested by the clinical phenomenon of resistance".
[6] There are several things an individual may disagree with in the therapy setting that can lead to realistic psychological resistance, such as general therapeutic technique or words and phrases utilized by a physician or therapist.
Some examples include avoidance of certain lines of questioning, outright refusal to cooperate, and sudden loss of effort and interest during sessions.
[6] Realistic resistance can have negative consequences for the therapeutic process and outcome, such as reducing client engagement, motivation, and adherence to treatment[7] because of avoidance of certain lines of questioning, outright refusal to cooperate, and sudden loss of effort and interest during sessions.
Therefore, it is important for therapists to identify the above mentioned behavioral markers to address realistic resistance in a collaborative and empathic manner.
[7] To manage realistic resistance, it is important to ensure that the client is kept in the loop which can be done by explaining the rationale and evidence for the therapeutic approach and techniques.
[7] Additionally, therapists often use motivational interviewing techniques to elicit the client's reasons for change, explore ambivalence, and enhance self-efficacy.
[7] Resistance is based on instinctively autonomous ways of reacting in which clients both reveal and keep hidden aspects of themselves from the therapist or another person.
[8] Examples of the expression of resistance are canceling or rescheduling appointments, avoiding consideration of identified themes, forgetting to complete homework assignments, and the like.
[9] By using these strategies, therapists can reduce interpersonal resistance and enhance the therapeutic relationship with their clients, which can facilitate change and improve outcomes.
When the therapist pays attention to their passive feelings, it can make him/her understand this behavior of the client as resistance coming from fear of losing control.
Relevant to the question of treatment planning are research studies that have looked at resistance traits as indicators and contra-indicators for different types of interventions.