The Relationships Between Client Resistance and Attachment to Therapist in Psychotherapy

Abstract

Through the lens of contemporary views on client resistance and attachment theory, which underpins the role of security in psychotherapy, the present study examines the relation between client resistance and client attachment to therapist. Forty-six clients and 19 therapists in long-term psychotherapy completed the Client Attachment to Therapist Scale and a therapist-reported questionnaire for client resistance, respectively, in three different times including the therapist’s summer holidays, so as to take into consideration the role of the therapist’s temporary absence as a real relationship component. Results indicate that resistance is negatively associated with clients’ secure attachment to their therapists, while it is positively associated with insecure attachment patterns. Also, holidays in psychotherapy were found to intervene in the interrelation between client’s resistive behaviors and attachment security. These preliminary findings indicate the interpersonal and statelike character of client resistance, a conceptual shift that augments clinical work as clients and their resistances are seen in more benevolent terms.

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Journal of Contemporary Psychotherapy (2019) 49:99–109
https://doi.org/10.1007/s10879-018-9406-y
ORIGINAL PAPER
The Relationships Between Client Resistance andAttachment
toTherapist inPsychotherapy
VasilikiYotsidi1,2· AnastassiosStalikas1· ChristosPezirkianidis1· MariaPouloudi1
Published online: 21 September 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract
Through the lens of contemporary views on client resistance and attachment theory, which underpins the role of security in
psychotherapy, the present study examines the relation between client resistance and client attachment to therapist. Forty-six
clients and 19 therapists in long-term psychotherapy completed the Client Attachment to Therapist Scale and a therapist-
reported questionnaire for client resistance, respectively, in three different times including the therapist’s summer holidays, so
as to take into consideration the role of the therapist’s temporary absence as a real relationship component. Results indicate
that resistance is negatively associated with clients’ secure attachment to their therapists, while it is positively associated with
insecure attachment patterns. Also, holidays in psychotherapy were found to intervene in the interrelation between client’s
resistive behaviors and attachment security. These preliminary findings indicate the interpersonal and statelike character of
client resistance, a conceptual shift that augments clinical work as clients and their resistances are seen in more benevolent
terms.
Keywords Client resistance· Client attachment to therapist· Therapeutic relationship· Vacations· Security
It is well-established that client resistance is an integral part
of therapeutic work, a clinically important variable that
accompanies treatment step-by-step (Beutler etal. 2011).
Yet, resistance was also discussed as if it was some disrup-
tive, negative, anti-therapy behavior or attitude that relates
negatively with several treatment process- and outcome-
related variables. In particular, resistance has been asso-
ciated with low working alliance levels (Callahan 2000;
Watson and McMullen 2005), therapeutic setting viola-
tions (Choi-Kain and Gunderson 2009), low client percep-
tions of therapist’s empathy (Hara etal. 2016), low early
engagement (Yasky etal. 2016), homework noncompliance,
in-session avoidance and debating with the therapist (Avi-
ram and Westra 2011; Newman 2002), as well as an overall
reduced engagement with the treatment process (Beutler
etal. 2011). Furthermore, lack of improvement, drop-outs
and premature termination of therapy have been consistently
associated with client resistance (Beutler etal. 2002; Button
etal. 2015). While the unfavorable role of client resistance
on treatment is clear, little is known about how resistance
unfolds in the here-and-now of the therapeutic relationship,
and especially in relation to the client attachment to the
therapist.
Contemporary views of client resistance focus on its co-
construction in the therapeutic interplay (e.g., Tuckett 2003;
Van Denburg and Kiesler 2002) as well as on its protective
and affirmative role, as a safeguard of psychological security
(e.g., Frankel and Levitt 2006; Miller 2003; Mouque 2005).
Respectively, rather than being a necessary evil or even an
anathema for the clinicians, resistance can also be framed
in terms of the ways the client protects himself against a
perceived threat that sometimes can even be, at least in part,
real. Along these lines, when dealing with resistance clini-
cians may also take into account its latent “threatening affir-
mation”, as Schafer (1973) called it. That is, either resting
on client’s attempt to avoid painful affects, such as sadness,
guilt, anger and shame (Greenson 1967), or driven by the
so-called “safety principle” (Sandler etal. 1970), resist-
ance may also defend client’s psychological security and
* Vasiliki Yotsidi
vickyyotsidi@netscape.net
1 Department ofPsychology, Panteion University ofSocial
andPolitical Sciences, Athens, Greece
2 2nd Psychiatric Clinic oftheMedical School, National
andKapodistrian University ofAthens, University General
Hospital “Attikon”, 1 Rimini str., Chaidari, 12462Athens,
Greece
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