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Matching Clients to Therapists
Based on Client Resistance

Short Restatement of Matching Recommendations

Therapy directiveness should be inversely related to client resistance. The more resistant the client, the less therapist control, structure and directiveness there should be. Paradoxical interventions are recommended for clients with high resistance.

Client Assessments

For assessing client resistance, Beutler and Harwood (2000, p. 43) recommended several instruments, the shortest of which is the Therapeutic Reactance Scale (TRS) (Dowd, Milne, & Wise, 1991). This 28 question instrument was reduced to 10 questions for TMatch, based on factor analysis. See the link below for details.

Therapist Assessments

Therapist control, structure, and directiveness was assessed with ten questions, which were given different weights and then combined to give an overall rating. Use of paradoxical interventions was assessed with one question:

  1. How much do you try to direct or guide what clients discuss during therapy?
  2. To what degree is what happens during your therapy planned?
  3. How often do you give specific advice to clients?
  4. To what degree is your usual method of therapy structured?
  5. To what extent is your therapy under your control, vs. collaborative with your clients?
  6. In general, how confrontational is your therapy?
  7. In general, how directive are you with clients during therapy?
  8. To how many of your clients do you assign homework?
  9. When you assign homework to a client, how often do you do this?
  10. When you assign homework, to what degree is this homework self-directed by your clients?
  11. How comfortable are you using the technique of Paradoxical Interventions?

Future Use of Resistance for Client-Therapist Matching

Results of Study: Client Assessment

The Beutler et. al recommendations are for clients high in resistance. However, it is not clear what the score cutoff level is for high resistance. At the level I selected, only one client was high enough to trigger matching recommendations, and no client was very high. For future use of this criterion, client assessment needs to be improved. It would be worthwhile to try using the entire 28 questions in the Therapeutic Reactance Scale, rather than just the 10 questions selected for this study. If that doesn't work well, perhaps a more subtle assessment instrument can be located.

Results of Study: Therapist Assessment

Statistical analsysis of the answers indicated that it may be more productive to make the dimensions of control, structure, and directiveness into separate scales. Questions 1 and 2, which were very explicit, had very small variations in answers among therapists. These questions should be expanded and possibly made more subtle. The qualitative part of the study indicated that the questions about homework need to be rewritten, as therapists had different opinions as to exactly what type of assignment counted as homework. Statistical analysis of the question on paradoxical interventions indicated that this question seemed to have effectively differentiated among therapists.

Results of Study: Matching Success

The results for this matching criterion were encouraging. With the improvements in client and therapist assessment discussed above, client resistance should be a useful aspect of client-therapist matching.

The next step for client-therapist matching based on the principles of Prescriptive Psychotherapy would be to integrate the assessment instruments (and quantitative information) developed by Larry Beutler and his associates into a matching system, or to develop a matching system from scratch using these instruments and information. Click the link above for a more complete discussion of this subject, or click here.


For more information, or to give feedback, email Kenneth Frankel, Ph.D.

References

Beutler, L. E., & Consoli, A. J. (1992). Systematic eclectic psychotherapy. In J. C. Norcross & M. R. Goldfried, (Eds.), Handbook of psychotherapy integration (pp. 264- 299). New York: Basic Books.

Beutler, L. E., & Harwood, T. M. (2000). Prescriptive psychotherapy: A practical guide to systematic treatment selection. New York: Oxford University Press.

Beutler, L. E., Rocco, F., Moleiro, C. M., & Talebi, H. (2001). Resistance. Psychotherapy, 38 (4), 431-436.

Dowd, E. T., Milne, C. R., & Wise, S. L. (1991). The Therapeutic Reactance Scale: A measure of psychological reactance. Journal of Counseling and Development, 69, 541-545.