From the Guidelines
When working with a dismissive client in behavioral therapy, the most effective approach is to use motivational interviewing techniques, as recommended by the most recent and highest quality study 1, to explore ambivalence about therapy and collaborate on setting specific, measurable objectives. This approach is crucial in establishing rapport and validating the client's concerns while maintaining therapeutic boundaries. The key principles of motivational interviewing include expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy 1. By using these techniques, therapists can help clients articulate their own reasons for potential change and involve them in determining specific, measurable objectives that address their priorities. Throughout treatment, consistently demonstrating the value of therapy through small, achievable wins can build credibility and reduce resistance. Consider using cognitive restructuring to address underlying beliefs about help-seeking or vulnerability that may fuel dismissive attitudes. Transparency about the therapeutic process can also reduce resistance, as dismissive clients often respond better when they understand the rationale behind interventions. If resistance persists, directly discussing the therapeutic relationship and barriers to engagement can sometimes break through dismissiveness by bringing the dynamic into conscious awareness for collaborative problem-solving. Some of the key strategies for behavioral change include self-monitoring, scheduled follow-up, regular feedback, and multi-component approaches 1. Additionally, electronically delivered behavioral interventions may provide additional support beyond what the primary care clinician can offer, especially for those who are comfortable with technology 1. Overall, the goal of behavioral therapy is to support healthier habits and improve adherence to dietary change and physical exercise, which can lead to improvements in health, physical stamina, and quality of life 1.
From the Research
Approaches for Dismissive Clients in Behavioral Therapy
- A dismissive client in behavioral therapy can be challenging to work with, and research suggests that addressing client ambivalence and motivation is crucial for a successful therapeutic relationship 2.
- The therapeutic alliance is a critical component of effective therapy, and alliance ruptures can have a detrimental effect on therapy if left unrepaired 3, 4.
- To address a dismissive client, therapists can use techniques such as:
- Motivational Interviewing (MI) as an adjunct to Cognitive Behavior Therapy (CBT) to increase motivation for and commitment to the intervention 5.
- Carefully addressing client ambivalence and counter-change talk (CCT) to prevent alliance rupture and preserve client engagement in therapy 2.
- Using the core processes of Acceptance and Commitment Therapy (ACT), such as defusion, perspective-taking, choice, and values, to restore a cooperative and engaged alliance repair 3.
- A strong therapeutic alliance is essential for the adherent and competent implementation of therapeutic techniques, and therapists should monitor the alliance during psychotherapeutic treatment 6.