Stuck! Resolving Resistance in Psychotherapy by Addressing Ambivalence
Friday, May 10, 2024
*** This event has been postponed; please watch for a fall date to be announced soon. ***
9:00 a.m. – 4:30 p.m.
Richmont’s Atlanta Campus
OR Live Webinar
Presentation Description
Resistant. Oppositional. Borderline. Mental health professionals commonly use such terms to describe patients who, despite expressing a strong desire to reduce their emotional distress, repeatedly reject or ignore their therapist’s interpretations and advice. Conversely, therapists may label themselves as inadequate when dealing with these patients. When this continues session after session, both the client and therapist end up feeling stuck and frustrated. This presentation, based on Dr. Buchanan’s Book A Clinician’s Guide to Pathological Ambivalence: How to Be on Your Client’s Side Without Taking a Side, suggests interpreting a client’s apparent resistance, as severe ambivalence, which is rooted in early experience, biological functioning, and psychological narrative. The narratives which these clients have formed result in the development of strong but conflicting needs (such as wanting connection but fearing rejection) that can slow down, confuse or even halt the therapeutic process. The natural tendencies of therapists to take the side for growth can lead to many kinds of therapeutic obstacles. The therapist will be most effective when utilizing skills that promote a sense of being on the client’s side without taking any side. These skills empower the change to occur from within the client and minimize the likelihood that the therapist will become the target of the ambivalence, engage in power struggles, prematurely discount the client’s beliefs, unknowingly participate in the client’s previously formed scripts or, potentially the most damaging, perceive the client as resistant. The concept of pathological ambivalence draws from several established theoretical perspectives in explaining why some people seem to sabotage their progress in psychotherapy and how some therapists become unintentional enablers. Specific strategies and case examples will be shared that enable the therapist to avoid these common pitfalls focusing instead on facilitating a resolution of pathological ambivalence and helping the client re-evaluate and change their narratives.
Presenter: Linda Paulk Buchanan ’83, Ph.D.
Dr. Linda Buchanan founded Atlanta Center for Eating Disorders in 1993 which was acquired by Walden Behavioral Care in 2017. In 1983, Dr. Buchanan received her master’s degree from Georgia State University and a Diploma from the Psychological Studies Institute (now known as Richmont Graduate University) in Christian Counseling. Dr. Buchanan then went on to receive her Ph.D. in 1993. In 2019, she published A Clinician’s Guide to Pathological Ambivalence, the content of which she has presented at local, national and international conferences. She has also self-published three workbooks (one serves as a client companion to the Clinician’s Guide). Additionally, she has published two research articles on the treatment of eating disorders, two outcome studies of the treatment provided at Atlanta Center for Eating Disorders and two book chapters. Dr. Buchanan has served as a peer reviewer of American Psychological Association (APA) Journals and writes a blog called From One Therapist to Another, writing about her experience gained in over 35 years of clinical practice. She serves as president of the board of EDIN; an Atlanta based non-profit dedicated to raising awareness of eating disorders and received the 2023 Georgia Psychological Association Service award in part for this work. She has been married for over 35 years and is the mother of two adopted sons.
Learning Objectives: As a result of attending, participants will be able to:
1) Conceptualize resistance as Pathological Ambivalence
2) List factors that explain why some individuals are more prone to developing PA than others.
3) Quickly identify common expressions of PA.
4) Utilize strategies for sidestepping power struggles to empower clients to resolve ambivalence from within
5) Help their clients understand and identify narratives and their projections while avoiding participating in the schemas or being the object of the projections.
6) Utilize and practice evidence based strategies from a wide range of perspectives such as DBT, ACT, MI for dealing with Ambivalence.
7) If desired, explore their own narratives and how they impact their own ambivalence
Continuing Education: 6 CE Hours Available
Target Audience: Psychotherapists from all disciplines: Psychologists, Counselors, Marriage and Family Therapists, Social Workers, graduate students
Instruction Level: Appropriate for all levels
Schedule of the Day
9:00-10:30 a.m. CONTENT BLOCK:
I. Understanding Resistance as Ambivalence
A. Relabel resistance as ambivalence
B. Ambivalence is normal
C. Common therapist reactions to client resistance
II. Theoretical Perspectives On Resistance
A. We all have parts (Theoretical Orientations)
B. We all create narratives (Theoretical Orientations)
III. Etiology of Pathological Ambivalence
IV. Common Forms of Ambivalence
Experiential Exercise
10:30 -10:45 a.m. BREAK
10:45 a.m. -12:15 p.m. CONTENT BLOCK:
V. Therapeutic Stance
A. Stay out of split
B. Implications for Individual Therapy
C. Responsibility for Change
D. Dialectical Framework
12:15-1:15 p.m. LUNCH
1:15-2:45 p.m. CONTENT BLOCK:
VI. Treatment Strategies
A. Education
B. Assessment of Scripts
C. Working With Parts
D. Integrating parts or splits
2:45-3:00 p.m. BREAK
3:00-4:10 p.m. CONTENT BLOCK:
E. Rewriting the script
F. Rewiring the Brain
VII. Experiential Training
4:10-4:30 p.m. Questions
Refund policy: In order to receive a refund, requests must be submitted prior to May 3, 2024.
For questions, please contact Amy Estes at ContinuingEd@Richmont.edu.
There is no known commercial support for this program.
Richmont Graduate University has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 4534. Programs that do not qualify for NBCC credit are clearly identified. Richmont Graduate University is solely responsible for all aspects of the programs.
Richmont Graduate University is approved by the American Psychological Association to sponsor continuing education for psychologists. Richmont Graduate University maintains responsibility for this program and its content.
Presentation References:
Acevedo, B.P., Aron, E.N., Aron, A., Snagster, M.D., Collins, N., & Brown, L.L. (2014). The highly sensitive brain: an fMRI study of sensory processing sensitivity and response to others emotions. Brain and Behavior, 4(4), 580-594.
Ribeiro, A., Stiles, I.M., Angus, W.B., Angus, L., Sousa, I. & Gonçalves, M.M. (2014). Ambivalence in emotion-focused therapy for depression: The maintenance of problematically dominant self-narratives, Psychotherapy Research, 24:6, 702-710, DOI: 10.1080/10503307.2013.879620
Braga C, Ribeiro A.P., Sousa, I, & Gonçalves, M.M. (2019). Ambivalence predicts symptomatology in cognitive-behavioral and narrative therapies: An exploratory study. Frontier Psychology. 10:1244. doi: 10.3389/fpsyg.2019.01244
Hunter, J.A., Button M.L., & Westra, H.A. (2014). Ambivalence and alliance ruptures in cognitive behavioral therapy for generalized anxiety. Cognitive Behavior Therapy. 43(3):201-8. doi: 10.1080/16506073.2014.899617.
Ribeiro, A.P., Goncalves, M.M., Silva, J.R., Bras, A. & Sousa, I. (2015) Ambivalence in narrative therapy: A comparison between recovered and unchanged cases. Clinical Psychology and Psychotherapy. 23(2), 166-174. https://core.ac.uk/download/pdf/55642786.pdf
Ritschel, L. A., Lim, N. E., & Stewart, L. M. (2015). Transdiagnostic applications of DBT for adolescents and adults. American Journal of Psychotherapy, 69(2), 111–128. https://doi.org/10.1176/appi.psychotherapy.2015.69.2.111
Ryland, S., Johnson, L.N. & Bernards, J.C. (2022). Honoring protective responses: Reframing resistance in therapy using polyvagal theory. Contemporary Family Therapy. 44, 267–275. https://doi.org/10.1007/s10591-021-09584-8
Urmanche, A. A., Oliveira, J. T., Gonçalves, M. M., Eubanks, C. F., & Muran, J. C. (2019). Ambivalence, resistance, and alliance ruptures in psychotherapy: It’s complicated. Psychoanalytic Psychology, 36(2), 139–147. https://doi.org/10.1037/pap0000237
Vasiliki, Y., Stalikus A., Pezirkianidis, C. & Pouludi.M. (2018). The relationships between client resistance and attachment to therapist in psychotherapy. Journal of Contemporary Psychotherapy, 13. https://doi.org/10.1007/s10879-018-9406-y