The decision to pursue mental health treatment is a significant one, often filled with mixed feelings like anxiety, anticipation and hope. Following the many hours of tours, paperwork, assessments, and intake discussions, family members may expect to see their young adult quickly engage, integrate into their treatment community, and begin to improve right away. However, progress is rarely this linear. As our Partner & Chief Clinical Officer, Dr. Amanda Fialk, LCSW, LICSW emphasizes, resistance during treatment is not only common but can also be a very natural part of the clinical process, especially for young adults. With the right treatment team in place, families can find the support they need to navigate through these challenges if and when they arise.
In this article, Dr. Fialk offers valuable insights on how resistance may manifest, what it can signify, and how parents can shift their perspective to best support the treatment journey.
Signs of ‘resistance’ during mental health treatment and why it occurs
Since treatment requires a willingness to embrace change and transition, it’s common for an individual’s journey to include periods of resistance, often at the start, middle or even end of treatment.
“This is something we expect and prepare for,” explains Dr. Fialk. “It’s a natural, human protective mechanism. We work to reassure parents and family members that resistance doesn’t mean progress isn’t happening. In fact, young people sometimes learn more by working through periods of resistance than those who don’t experience it at all. There are valuable lessons in perseverance during these moments, and it’s not an indication that treatment is failing—quite the opposite in some cases.”
She adds, “It’s also important to remember that a young person’s behavior and acts of resistance are not personal slights. Rather, they provide valuable insight into what the individual is feeling, which can then be addressed and worked through with the guidance of their clinical treatment team.”
| Common Resistance Behavior/s in Treatment | Potential Underlying Message |
| Not responding to communications | I don’t believe in myself/ It’s painful to go there |
| Combative language/aggression | It is easier for me to be angry than to address pain or fear |
| Constantly negotiating boundaries | I’m sick of being controlled |
| Silence/not sharing | I’m anxious/depressed/feeling hopeless |
The importance of family members’ responses to a young adult’s acts of resistance
For families supporting a young adult who is resistant during treatment, it’s important to first reflect on their own reactions to the behavior. Common responses we see from families include:
- Wanting to punish, discipline, or lash out in frustration
- Feeling emotionally drained and helpless, and wanting to give up
- Expressing anger and frustration over wasted time and money
- Feeling personally attacked, slighted, or manipulated
“All of these reactions, though very human and understandable, can significantly impact a young person during a vulnerable time,” shares Dr. Fialk. “Our goal is to help parents recognize and validate these feelings, while also guiding them to reframe, understand, and respond to them in more constructive ways. In these moments, showing up for your young person—without reacting, judging, or instructing—can be all they need to feel supported and to engage more fully in their treatment. They are doing the best they can, and it’s vital to remind them of their resilience and encourage them to keep moving forward.“
Ways to support a young adult who is resistant to treatment (in a constructive way)
Because we offer so much in the way of family and parent therapy, one-on-one coaching, psychoeducation and skill-building services at The Dorm, there are many opportunities for our clinicians to provide parents/guardians or primary family members with the tools they need to engage with their young adult loved one productively. These approaches include:
Paradoxical intervention and positive reinforcement
“A lot of emphasis is placed on building and sustaining positive rapport within family relationships, and focusing on what’s working rather than what’s not,” Dr. Fialk explains. “Young adult clients are often already acutely aware, and sometimes painfully self-conscious, about what isn’t working. With highly-resistant clients, we find that they respond more effectively to support than to confrontation. Rather than meeting resistance with resistance, it’s helpful for loved ones to acknowledge and appreciate their efforts, no matter how small. Sometimes, simply showing up to a session or group—even in silence—is progress worth celebrating.”
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Curiosity, empathy and mindfulness
In all aspects of care, a helpful approach is to look at a young person’s journey and actions through the lens of generous and kind curiosity, positive regard and empathy. “All of us are doing the best we can with what we have”, reminds Dr. Fialk. “Keeping this mindset can be helpful when weathering some difficult days, weeks or even months.”
Finally, it can be helpful to model mindfulness practices with a young adult loved one, even if they don’t engage with those same practices right away (at The Dorm they are learning them in treatment!). It can go a long way to simply be present with them in the moment: to be the calm eye of the storm, which we know, eventually, will pass.
Thank you, Dr Fialk, for your expert input. To learn more about our family therapy and coaching services and approach, please speak to our team and visit us here.
