Comprehensive Skill Building for Working with Highly Resistant Patients

Includes 56 skills for working with highly resistant patients

Audio course: $197, includes a pdf file of the manuscript so you can read it, study it, and practice it with colleagues.

Please note: These products have many hours of audio content. You will be sent several files to download – we appreciate your patience with the downloading.


Do you have patients where you get stuck? Maybe they become passive and helpless. Or they become oppositional. Or you find yourself trying to explore feelings and the patient says, “I don’t have feelings.” Or, “I don’t know how to feel.” In response, you find yourself overworking and the patient is underworking. These skill-building exercises are for you.
We are often taught to see the ways patients avoid feelings, but we aren’t usually taught to recognize how patients avoid emotional closeness in therapy. We aren’t taught how to recognize old attachment patterns that prevent us from forming a therapeutic alliance. That’s what these studies will do.
We’ve developed these studies over the past ten years with hundreds of therapists. And we’ve refined them in response to their feedback. As a result, our students keep telling us that they are able to help patients they weren’t able to help before. You can imagine their excitement when practicing skills leads to increased effectiveness.
For the first time, we’re making these skill-building audio studies public. Previously, only some of these studies were available through multi-year training programs. Now, this audio course will teach you how to quickly identify and address subtle defenses used by highly resistant patients. You will learn how to help resistant patients see their relational defenses, the behaviors they use that defeat their relationships. If you have tried to explore feelings with resistant patients and got nowhere, these studies will show you how to recognize patients’ relational behaviors with you in the here and now. And you will learn how to intervene systematically in a stepwise fashion that builds the patient’s capacity for emotional closeness.

How It Works

In this practice-oriented course, you are the therapist asking me scripted questions. And I am your “patient”, responding with excessive defenses. You will intervene. Then I will give you a recommended answer and teach and supervise you along the way, showing you how to assess the patient’s strengths and weaknesses, so you can help the patient. Through the alternation of teaching and skill building, I’ll show you how to put your knowledge into effective practice. This is like an audio language course, except you’re learning a new language of therapy.
As we explore numerous examples of each defense, you’ll have ample practice time to learn how to recognize defenses immediately and intervene effectively. You’ll rapidly improve your skills and learn to handle problems easily that would have stumped you in the past.

Skills You’ll Acquire

Audio Lecture: Theory and technique of working with highly resistant patients

Step one: draw the patient’s attention to the way he is relating to you

  • Making links to the task—pivots to the problem
  • Using the unconscious therapeutic alliance for defense work
  • Deactivating projection of will in the first session
  • Making links from current relationships to the therapy relationship
  • Using the current relationship to ask about the therapy relationship

Step Two: Identification—help the patient see his relational defenses

  • Addressing signs of emerging resistance
  • When the patient objects to resistance Identification
  • Identifying the resistance to the patient
  • Endurance in identifying the patient’s relational behaviors and inviting feelings

Step Three: Clarification—help the patient see the price and function of his relational defenses

  • Identifying the relational behaviors, and clarifying the price and function of the resistance
  • Identifying and clarifying the price of the patient’s relational behaviors—Detachment
  • Identifying and clarifying the price of the patient’s relational behaviors: helplessness
  • Identifying and clarifying the passive transference resistance

Step Four: Challenging the Resistance—asking the patient what he wants to do

  • The Phase of challenge with a helpless transference resistance
  • Challenging the resistance
  • Identifying relational behaviors moving to challenge
  • Resistance identification, clarification, and challenge in the phase of asking for a problem

Step Five: Heightening conflict between the patient’s Resistance and his wish to become well

  • From challenge to heightening the conflict between the patient’s resistance and his wish to become well
  • From identification to challenge to head-on collision
  • Resistance identification, clarification, and challenge
  • Resistance identification, clarification, challenge, and head on collision
  • Deactivating the omnipotent transference: when the patient expects you to do all the work
  • Deactivating the patient’s identification with the resistance
  • The helpless transference resistance, from resistance identification to head-on collision
  • Identification, clarification, challenge, and head-on collision: endurance process exercise
  • Resistance Process Study: deactivating the passive/omnipotent transference: when the patient waits for you to change him
  • Projection of the unconscious therapeutic alliance: when the patient invites you to be the spokesperson for his healthy longings, while he argues with them
  • Identify and deactivate defiance
  • Passive transference resistance process exercise
  • Short range head-on collision
  • Character resistance: the patient who resists from the initial moments of therapy
  • Mirroring the resistance
  • Identification with the resistance—mirroring the crystallized passive resistance
  • Identification with the resistance: Mirroring the detached transference resistance
  • Mirroring the resistance to develop conflict within the patient
  • Mirroring the superego in the superego resistance
  • Mirroring the superego resistance: when the patient idealizes suffering
  • Projection of will
  • Blocking projection and mirroring denial in the highly resistant helpless patient
  • Deactivating a defiant transference resistance
  • Head on collisions to a character resistance
  • Deactivating projection of will in high resistance
  • Defenses with highly resistant criminals: when criminals invite you to collude with their defenses