How to Get to the Heart of Resistance

The moment a client begins to resist, progress often comes to a crashing halt.

But with the right strategies and a little creativity, we can usually get people back on course.

For instance, when Marsha Linehan, PhD encounters resistance, she often starts to chip away at it by asking one key question.

In the video below, Marsha will share a few simple strategies that can keep clients moving forward. She’ll also share one key question that gets at the heart of resistance.

Take a look – it’s just about 4 minutes.

This video was taken from the Next Level Practitioner training program where members receive a daily video like this from one of the top 25 experts in our field. That program is not open for new members right now, but if you want to be on a waiting list in case it opens up, please click here.

How do you work to break through resistance? Please leave a comment below.

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118 Comments

  1. Michael Kirkton says:

    Thank u Diane, for posting … and yur perspective on getting well and happy… its the desired outcome …the hopeful hug part about it.

  2. Diane Randall says:

    Why is the ladder hot? Better yet, actual fact: The ladder is NOT HOT, nor should it be presented that way.
    (Full disclosure: I am a client/patient, having recently ended “in-person” therapy with an incredible, mindfulness-based teacher/guide (LMSW Counselor.)

    I did not watch this video but read all the comments (which is why I chose to not watch). I am visiting today to continue my emotional/spiritual path of freedom.

    Yes, climbing out takes much courage. But again I say, the ladder is NOT HOT! Actually, that’s something the patient would imagine due to their (do not correct) fear and resistance. We often imagine and/or create pain very well all by ourselves, thank you very much. The idea that it is “too painful” to climb out of our personal hell is an illusion that hopefully, the therapist can help remove. Yes, the ladder may be very, very high some days… or sometimes rickety – etc., etc. But, I am surrounded by helpful, loving guides (not therapists looking down at me, making me climb that hot ladder!).

    Yes, I may cry – a lot. I may become tired and need rest and water. At that point, my therapist would advise me to “feel my heels,” which I have shared with my adult daughter, who loves that even though, yes: She is resistant to real therapy. I’m now able to respect and support all of her choices; of course, we have so much in common. By the way, I experienced resistance with my counselor. She is, after all, a woman older and smarter than me, with boundaries! She taught me that “assertiveness is not aggression.” We got to the point where I could recognize when I was resisting… ah.

    It must be difficult for therapists when patients are too blocked by fear to grow, but we all have to learn acceptance and wish each other well.

    Thank you so very much for these posts and for all the therapists’ thoughtful feedback.

    • Joan says:

      Good morning. Thank you for your response that reflects so much sensitivity, And thank you for coming out to speak freely your thoughts and feelings. I must agree I usually have preference for one practioner to another one. But for the most your note is telling me that “we are our best therapist if not friend”. Because as someone said it, heee, not all anger are”bad”, and to quote “healthy”. Although I wonder how long does it takes to find the way to our own “acceptance”. I am not a therapist , but a reader of your comment, and find a strong and growing “individual” woman who is also a good example of a loving parent. Keep the good work, and thinking well “being assertive is showing caring.” My best to you on your journey.

  3. Rose Merke says:

    I think it is always imperative to let the client know that this is not easy. It is hard and take courage and practice.

  4. Marcia says:

    In my role of being a therapist, I am the first to reach out to the client in a reassured way to create a sense of safety and trust and to invite my client to share, and usually he shows the willingness and the openness to coming out of his shell. It is in the initialrapport building that I can see how well we can do in the session. Once the client agrees to show that she needs and wants the help, this is telling me that I earned his trust. And then we can start to really do some deep “diving” from there. Acknowledging and validating are part of the listening we do to encourage and suggest to the client that we are present. But it does seldom help with the resistance totally.

  5. Irene Feigin says:

    I focus on establishing trust and safety, introduce “safe place” in hypnotherapy, relaxation, or visualization.
    I also think that sensorimotor therapy and work with body through various approaches is a good way to bypass resistance.

  6. Marcia says:

    In this video, Marsha and her client show some indecision about what to do , especially due to her client fear and reticence to let herself being pushed into a different place. I think having a role play and reverse the role to give the client an opportunity to say what she thinks or believes as her preferred choice to act upon “plans” – if there is any. “Climbing the heated ladder” can seem a greater threat – depending on whether her client has ptsd or not. Thank you for the great video.

  7. Nancy says:

    To add some flavor to the therapy, I would use MI to get to the root of the problem. Since the pts often aren’t clear about what troubles them and why they act the way they do, they rely on us to “talk through” the subject in questions. I received a training on how to use motivation interviews and I’ve found this to be extremely helpful to the pts.

  8. Kip Leitner says:

    I think it’s worth saying that in the example here Lineham is practicing a component of Dialectical Behavior Therapy (DBT), a model she created. That model imports from Cognitive Behavior Therapy (CBT) the “action-benefit” cognitive aspect, so that’s what she is explaining in the video. Carl Jung, the mage himself, spoke of how the psyche “makes deals,” and in this case the deal being offered is “endure known, limited pain on the hot ladder in order to escape the known unending pain of the pit.” The way in which the psyche of a person may (or may not) accept this deal depends on a lot of different conditions and variables, including the inter-subjective field between client and therapist, feelings of safety, point in their long term process and a whole host of other criteria. Some clients will certainly be attracted to this “deal-making” aspect in the psyche while others may not. There is a difference we all know between a “hard sell” and a “soft sell,” so I thinking taking that into account matters. And, presumably the person is paying for treatment, so they’d probably like to see *something* that might be for sale. In the best of narrative therapy, the therapist, if she has made good contact with the client and has discerned things deeply, can certainly do no harm by creating a window shopping experience to see if the client is interested. If the client walks on by, then you have to try something else.

  9. Acknowledging their resistance, validating their brain trying to keep them safe, and then doing what has been called “Fear-Setting” has worked very well. Also, encouraging them to build resilience to pain by practicing just being mindful of the feeling – letting it be there for a while and notice that it is just painful and doesn’t injure themselves in any way.

  10. Jane Gilbert says:

    By encouraging the client to invite the pain and distress and, ultimately shame, in for a cup of tea, I am hopeful that it’s power over the client will be defused

  11. prakash mackay says:

    Honor your resistance , let them have it fully and be curious about how it is serving them and has served them in the past

  12. Amy Yellow says:

    All the comments make so much sense. Each touches on an important piece of this picture.

    Thank you. Amy Yellow

  13. Using Motivational Interviewing Strategies, which is very congruent with what Marsha is saying. I never argue with the patient, I validate where they are, and I don’t judge them for wanting to avoid. Life is hard, treatment can be exhausting, and pts sometimes get discouraged. It all makes sense. I also encourage change, because while feeling those things is very real, making a decision to stay in it doesn’t make sense either. I like Marsha’s metaphor. Pts also sometimes express discouragement with how long “getting better” will take. I also talk about how time will pass regardless and so, it isn’t about 6 months or 5 years, it’s about where do you want to be in 6 months or 5 years. Growing, evolving, and changing is the only way to be in a better place when time passes.

    I tell patients this got me through graduate school. I use an analogy of 10 years of school seemed soooo long. I thought, “It’s seems like forever; I’ll be 30 years olds before I finish.” Then, I thought, “I’ll be 30 regardless. The question is, where do I want to be when I am.” This thinking got me through the long road of grad school—and 30’is long passed.

  14. Sam says:

    Thanks so much. Very effective. I see lot of comments from therapists that hate this idea. I am curious if the reason is they prefer to sit with a client and do talk therapy for many years or rather do efecthve proven work that Marsha has once again proven with many study’s that they actually work.

  15. Malka h susswein says:

    That was a great clip!
    Learnt a new technique

  16. J. Dragon says:

    In hearing how Marsha used a metaphor to help her client out of trauma (or feelings), and the client being frozen (or burning) in it from the example given, Marsha was positioned ‘above’ the client, waiting for the client to reach her and her resources. This feels hierarchal.

    In working with those who have severe trauma, and being one who’s experienced this as well, shame or terror would have needed to be addressed first before the grief would probably be expressed. Marsha said ‘shame’ first and perhaps that ‘Freudian slip’ needed to be addressed more.

    What Marsha didn’t mention is the Inner child work. Instead of the therapist being ‘above’ the client who has to climb out without the resources next to her, the child is the one who is really ‘frozen/burning’ and needs the rescue. The resource is the Adult part who can help the child out of the past and into the safety of the present moment. I feel that having the therapist being in any position that could be seen as an ‘authority figure’ and the IC not present, makes for more dependency on the therapist rather than building the inner resources through the development of the ‘love’ bonding/connection within.

    I also work with belief work through ThetaHealing Technique to assist the very hurt part/s to release the resistance, finding out how it serves them, what would be the worst thing if the resistance was no longer there, if the tears showed, and then let them hear themselves as we go down deeper into those neuro-connections (feelings). There is always a reason the resistance is held in place, and clearing that rather than positioning in an unequal way, seems more connecting and empathetic to the experience. I then witness special teachings (Creator’s downloads) to help change the neurological, emotional, spiritual, and somatic programming. I bring the IC to the present with the client so there is safety to have whatever feelings are ready for release.

    And just to say that her example of climbing out of hell for someone who survived extreme abuse is a poor one.

  17. Mike says:

    Interesting. Thank you.

  18. Also – change the metaphor. I as a therapist can “be there” for the client to get out of hell by throwing water on that hot ladder. (Tools, new ways of thinking, emotional support, belief in the client’s ability, etc.) They still have to climb the ladder, but not alone. Dr. Linehan’s metaphor implies bootstrapping.

  19. I believe that clients have to experience the support and develop the belief that they can be valuable enough, strong enough and courageous enough to not be crushed and obliterated by the feelings of sadness, grief and especially despair. The early messages of “don’t exist” and/or “I won’t exist,” if I experience these feelings are very powerful inhibitors. Clients also need to believe that they can “get through” the quicksand of feelings to the other side. Circumstances of abuse (or insecure attachment) often never ended from the child’s perspective, so it felt like the feelings would last forever. Survival dictated that the child could only cope with all of that through denial and avoidance.
    I sell hope that there is healing in loving choices.

  20. dennis duPont says:

    Long ago, I learned from the ego psychologists (I am a chaplain who works with alot of grief on different levels), that resistance is a two edge sword, it is both ego protecting (particularly from shame) and yet it is the edge of growth…I often ask, as a chaplain, not a therapist, what tools are available in this process…

  21. Shannon Lightfoot says:

    In my opinion, Marsha got it right first time when she referred to the emotion ‘shame’; Marsha did not need to correct herself. It is my experience that the shame that underlies other emotions leads or gives cause to resistance.

  22. CJ says:

    How can you do this with little children (5yr old)? My son lashes out physically when he doesn’t want to deal with feelings that he’s uncomfortable with (such as fear, hurt, and loss of control).

    • Sandra Cohen says:

      Try to help your son by giving his emotions a name and validating them. He may be confused and overwhelmed by feelings that he doesn’t fully understand.Spell out his feelings in detail and show that you understand what he is feeling and the reason for his feeling.Help him to own the feeling and then help him to express it in a more appropriate safe way.

  23. Vasilica Vasilescu, PhD says:

    Great example. It is so true. It is no way out. Climb that ladder.
    Many thanks

  24. pia says:

    Great analogy. Climb that ladder. A really good one analogy break on through to the other side . .
    on a different note
    a person i know when i commented on how i am impressed at how they get so much done . . . after a while said . . it’s a blessing and a curse . . “i have a hard time being able to to “just be”. .

  25. Ms. Louise Forde says:

    I am always amused by stories that say this is going to hurt like hell but you must hurt like hell before you get well. Fear is a big issue and honesty is great but I find it a great challenge to accept help when what you tell me is also very scary. I see the theoretical value in explaining the process of pain but I ultimately need to ask myself what I would be willing to accept from a counselor. First I must have trust and respect. Then I need to have confidence in my own ability to withstand pain and not die. The process of pain acceptance is to believe you are in control of the degree of pain you experience and how you can halt the process if it becomes too painful or if you need a break. Becoming more self-aware and more confident can often be the first stage of recovery from painful experience. Fear tells the body it is in danger so the person experiencing the pain needs to have the knowledge and skill to self-monitor. Teaching the brain and body new ways to understand pain often comes first. Thanks once again for the opportunity to share information.

  26. Cheryl Holub says:

    ( A calm soothing voice is essential as is the established rapport
    trust and the knowledge they are safe.)!

    When they are scared, worried or exhausted or all combined
    the client needs to trust you as a healer to often go on.
    So I tell a story about watching raindrops on the outside
    of a window pane…

    I have often ask if they have ever noticed the way the raindrops roll down
    on a window pane? As the drops roll down the window they join other drops
    and become larger and heavier, til they reach the bottom of the pane.

    I share that I believe grieving or releasing their pain is like that.
    That they know have already gone through the worst and survived.
    They are already survivors!

    Though remembering is painful, releasing that pain
    is like the rain drops that cluster on the windows and fall as one.
    We are often releasing clusters of painful events that are similar
    at the same time. Which makes healing faster than the time it took
    for them to experience each separate painful event. And much better than
    staying stuck in that painful place.

    • Mike says:

      Great tips. Thanks!

  27. Annie Hughes says:

    I was a mental health nurse and now I’ve recently completed counselling study so I’m very new but what I found in some others’ stories and indeed my own, it was necessary to go back to how difficult painful emotions were dealt with in the family unit. For me, sadness, pain, grief had to be shut down or there were extremely bad traumatic results. That set me up to not feel (as well as trauma stuff). Going back to how that little girl felt was paramount and I truly needed the therapist to help me get back into that little girls head. When I didn’t want to go back there, it was a matter of can we just see what that little part of you wants to do. Obviously trauma therapy was more needed for myself, but I also found with many people if I just touched on that story, not in much detail ie leaving out the trauma bit, they responded to the little wounded part of themselves. So newbie counsellor I don’t know what that process is called but it worked.

  28. Barbara Caspy says:

    Thank you Ruth and Marsha! I like Marsha’s idea of telling a story to a client who is resistant. I agree that a client needs to know that as a therapist I understand that they’re experiencing excruciating pain, before they’re willing to work with me on difficult emotions. I assure my clients that we’ll go slowly. I also explain to them that if they hold back experiencing sadness, grief, and sometimes anger, that then they can’t be free to feel joy and happiness.

  29. Josette says:

    Thank you for selling strategy
    In my practice I ask client to imagine what it would feel like without the resistance.
    Then ask them to describe the feeling from their heart space.
    This practice allows clients to shift slowly from being uncomfortable to allowing
    the feeling of uncomfortable to become comfortable.

  30. Jasmine says:

    Loved the selling and story.

  31. Susan says:

    I think some of the commenters don’t understand the value of the “cognitive road map”! For me , working with my own issues around recovery from addiction and facing the long decline of my disabled spouse, (I’m a retired therapist), my thoughts are a tight metallic shield that keep landing me in despair. Sometimes a new way of thinking does release the stranglehold. Especially for people who have explored their story a million times and it still doesn’t help.

    • Lee says:

      What is the cognitive road map you are talking about ?
      I have been to so many counsellors and therapists over the years. I’m sick of the sound of my own voice and repeating old painful trauma. Nothing ive done ever has really helped me. I hate life, i hate having to exist in this miserable state im in. I keep trying, i go on each day for one reson only, my beautiful 18 year old daughter. But i have no fight left and im struggling and so unhappy all the time.
      I have learnt very well how to pretend that im ok because no one understands or can do anything to help, or for that matter, reallt cares. I completely understand why people commit suicide and everyone says ” I had no idea ” or ” didn’t know it was that bad”
      I don’t want to go through hours of tears and bringing everything up again, only to feel worse or just the same as before.
      It takes all my energy just to focus on each day and get through to the next. I’m so tired. My head, heart and spirit are done in.
      I exists in limbo and pretence. This isn’t living and I’ve forgotten what it was like to be any other way. I walk around in a fog and cant remember what i did yesterday. I hate living like this. I dispair !!!!
      How i long for some peace in my head and happiness in my heart.

      • Fran says:

        hello Lee
        Your pain seems to have touched some of us in this community. Reaching out for friendship wherever I can has helped me feel less isolated and more motivated to search for resources both internal and external. Medication was only one resource. I found the pain to be a signal that I had to change my life to be more meaningful,more satisfying,more pleasurable. This has been an ongoing journey. Connecting to sources of spiritual wisdom has been an important resource. I knew I needed more power than I had available in my mind and personality. Finding this in community that values spiritual connection was particularly helpful to enable me to bear the pain of loss.

      • Will says:

        Hi Lee. I’ve had times like you describe, living more to not hurt others than to thrive or explore a possibility of a satisfying future. A couple years ago, I had a change with some meds that brought relief, and the work is continuous but structures help. Chronic stress and grief do not help. I think an inner turmoil can be traumatizing, changing our self and world view, and it feels like a life-sentence. Early pain can lead to a fore-shortened life expectancy. Chronic depression keeps a person stuck. I realized at 50 I had adhd. That was a new frame for me. Ive been learning about letting go, self forgiveness, and self-compassion. I hope you find help that fits your needs.

      • nm says:

        I hear you. I understand as though I wrote this. The only thing that keeps me going is my daughter also.
        Hope you find your peace.

  32. Vivian says:

    I use Motivational interviewing with highly resistant clients. It works. But at the same time I let them know that in this process they are not alone. The client for first time feels the support.

  33. Joseph says:

    I understand that for some people it is a matter of not wanting to loose control. They are afraid and feel deeply alone. Depending upon the person, I draw the analogy of child birth. Through the pain something tender and marvelous will emerge. Something that is waiting for you to care for it, guide it and marvel at its genius.

  34. Esther says:

    Timing. It ‘s all about timing matching emotional tolerance. Pushing beyond that is futile. Building personal resources to increase tolerance is vital. It’s my job to keep my finger on the pulse of that with my client as my best resource.

  35. Kim says:

    To work through resistance I explore/validate the “good reasons” that resistance part came on line in the first place. We would not develop resistance unless there had been pain that was too difficult to feel when the even occurred. I’ve seen this acknowledgement soften the resistance. The resistance is about protecting us from pain. Then I might talk about the new skills required to be with the pain that arises.

  36. Jo Dee Davis says:

    I have read most of the interesting and helpful comments. I think a lot about the story that involves going down into hell with them instead of being up there supporting, coaching and waiting, and I believe we should not and cannot go down there. First, we cannot, because, although we can “get it” quite deeply, we should never believe we know what their personal hell is. Second, we are more dependable and trustworthy if we stay safe. A person in hell almost always believes that if you are in hell also, you can’t be much help.

  37. Binta says:

    How do you do it! You are definitely one of my wizards who leads me back to Kansas. Just when I’m stuck with a client (especially) a BPD you air the very notion that opens up a way to engage a reaistant client. I think it was Yalom who said resistance is not a client issue, it’s a therapist issue. Learning how to skillfully guide a client through their personal hell is a challenging and exhilarating experience. Thank you once again for sharing the exact key to open the door and restore my faith in my self. With this information I am empowered and no longer afraid to attend the next session.

  38. Marcia says:

    What I have found helpful is using Motivational Interviewing with young people and also a variety of CBT tools to help them start to looke forward. Their was a webinar where they discussed how to handle anxiety which I found very helpful with older teens and adults. Just this week I did a timeline with a resistant male who was able to decrease his anger and focus on getting a pet when he remembered how that helped in his early years of life and grieved the loss of that pet when surrounded around violent parents. By the end of the session, he was making his plan to adopt a new critter and his whole rageful demeaner reversed. Also like doing a geneagram with clients to show them the supportive people they had in life and can draw from those situations today to move forward.

  39. Susie says:

    would be nice if there were actually a question in her rambling!

  40. Mike Thomas says:

    Great tips! I appreciate the use of metaphor with clients to help them see possibility in a difficult approach by using the power of aligning with their unconscious mind in an emotionally powerful story. I am reminded of the approach in IFS of practicing asking the client about the parts that either distract or criticize with acceptance; to allow them a voice and seek to help the client to discover the higher intention of those parts of some form of protection. I have found that resistance is only an illusion that parts display from deep in the unconscious, child-self, and they simply need to be acknowledged for their intention in order to rally a “team effort” to collectively support the “exile,” the part that is in pain. Once the parts realize there is no need need for resistance to protect the core-self, they integrate into collaboration in healing. This has been my personal experience, and as I engage in dialogue (and sometimes a story as a metaphor) with clients about the higher intention of ALL parts, they usually step toward the necessary challenging emotions with renewed energy and intrinsic motivation. Essentially, they just need to be reminded how perfect EVERY PART of themselves is perfect exactly as it is. Then they usually think moving forward is their idea.

    Thanks for this great video reminder of the power of metaphor!

  41. ml farell says:

    well, at least this explains what the therapist I hired was trying (and failing) to do. I am surprised this works. To me it felt like she was treating me like an idiot.

    • Philip says:

      Totally. Far too many so-called therapists position themselves above the client in a God-like/saviour way. Totally ineffective.

  42. Carrol laneulie says:

    Hi ,Carroll again….this is exactly how I tried to help my husband advance from his obvious hell from child abuse, to no avail.
    He just was not able to come out from behind his self inflicted mask of fear.

  43. Paula says:

    I use a similar analogy-You have to go through the fire to get to the other side.

  44. Alexandra Winterburn says:

    Thank you for that. Great advice.

    This matches my way of working where I often help client reflect on the bigger picture and through it explore all their existing options. Helping them acknowledge their stuckness sometimes by simply pointing out ‘you’ve tried that way time and time again and know it leads to the same outcome- what do you have to lose by attempting a different tactic?’ This often helps the client gain a moment of clearer perspective where even if they don’t seize the moment they would at least experience a taste of the freedom and maybe power which could come with the realisation that they do indeed have other options.

    In most cases I have found that the clients return with reports of a positive shift in their process or situation.

  45. Janet says:

    There are quite a few therapists resisting the ideas of Marsha’s metaphor of the ladder out of Hell.
    I was able to get something done that I hadn’t been able to do in months. For myself, this was the most effective thing to overcome resistance that I’ve heard.
    I suggest you please just try it, they might like it, even though you might not at first, and most importantly…it could actually help you both.

  46. MAUREEN ANDERSON says:

    By persevering and showing them that l will not give up on them.

  47. When strong resistance arises in a client, I let them know that their subconscious mind is doing its best to protect them from deep emotional pain, but that the only way to do that is to keep the symptoms they really want to be free of. Then I tell them that the fear of the pain, as well as knowing how powerful it is, keeps it buried like infected tissue, festering and creating problems for them. Then I tell them that the subconscious mind doesn’t really understand time like the conscious mind does. It doesn’t realize that, while uncovering that deep pain will feel worse than the symptoms the client is struggling with, the pain will come and go: it will pass. The subconscious mind believes it will be there forever, but by ventilating it and giving it some room instead of keeping it buried, It will be really intense at first, but then it will pass.

    I use a very powerful and elegant technique to resolve the subconscious source of emotional pain and dysfunction, so the passage of that deeper pain almost often takes place in seconds. I never tell them that it will be that fast, but it usually is and we both wonder at that fact afterwards.

    • Jane Vance says:

      What is it that you do to help your clients. Will you share your technique please.

  48. Resistance is just a word that can have different meaning for each and everyone. So I would ask:” How do you know that you have resistance? Where do you feel it in your body?”
    Coming away from labelling is key in my work with clients, connecting them to their bodily sensations. I find this kind of approach very successful. After all emotions are ALWAYS linked to bodily sensations!
    The same goes for the fear of facing their scariest Trauma. It’s always getting them out of their head and into the body. Sometimes first I’ll suggest doing some TRE in order to build more resilience before addressing those painful memories and often the problem resolves even without addressing them!

  49. Ruth says:

    Marsha’s ideas and stories are very useful. I usually use paradoxical interventions with high resistant clients

    • Sandra Cohen says:

      Can you give an example of paradoxical interventions?

      • Lolita says:

        A wanting for more corrections and repair ?

  50. Conrad says:

    In ”Death of resistance’ Steve De Shazer one of the pioneers of Solution Focussed Brief Therapy said there is no such thing as resistance, only the wrong question. SFBT is like a dance with the client leading the worker, if the worker looses step with the client it is the workers responsibility to find it again not the clients.

  51. Thank you/ Some excellent points here. Telling the right story at the right time can be very effective. And I really like the thought that the patient needs to understand, and believe, that you can understand their pain. For many patients I see, I’m reminded of the old spiritual, “Nobody Knows the Trouble I’ve Seen”. It’s hard for them to believe that anyone has ever experienced pain at the level they are feeling. And so frequently, as Marsha Linehan points out, their answer is to avoid the pain–to shut down and do their best to feel nothing. But that doesn’t work either. I like the story of the hot ladder out of Hell. I’m going to remember that one! Thanks again.

  52. Susan Ainsworth says:

    I find these podcasts very short but some useful tips to work with clients.

  53. I am an EFT coach-not a therapist. EFT makes resistance easy to break down because you can take down each snippet causing blocks. Eg. I start by tapping Even though I don’t want to think or feel about it, you can’t make me, I am convinced it will be too painful…(and the rest of the EFT tapping process) Then I break down an even that seems to be a big one with the same feelings and first to come to mind in EARLY years for them. I ask them to describe the story and as soon as they show any signs of discomfort, we stop right there with that feeling. Eg. A client had a horrible event at a family friend’s summer camp where her father beat her. She started telling me the story….I was getting into the car (and how do you feel right there–trapped) so we started tapping on Even though I feel trapped because we can’t talk or laugh in the car with dad… When you use tapping to break down a single BIG episode into freeze frames and take it down in stages, it’s amazing how an event clears out of both the mind and body! In one of two hours or tapping, you can clean up a major event that might’ve started the entire pattern that keeps the client stuck. I’ts like pulling out the bottom of the house or cards. Then the rest of the “pattern” falls apart. It’s amazing!

  54. Dee says:

    Another thing-I loved this approach. Especially the part when you tell them you are going to help them through the pain and up the ladder. That’s what I needed in my own personal therapy and when I finally trusted someone enough to help me I was able to climb it. Thank you for sharing such a valuable and insightful video.

  55. Dee says:

    Excellent video. I’m always hesitant to share my own story of going through my own emotional pain. How do I know when it is appropriate and when it isn’t?

  56. Susan says:

    In a group setting we encourage the client to make friends with the sad or hurt little child or young person inside and show compassion to them through writing drawing and / or verbally exploring the feelings. I find this helps them to be more compassionate to themselves as adults, and therefore more able to push through the resistance talked about above. Interesting to read of so many different approaches, really depends of who you are supporting and their level of fragility, I guess.

  57. Jack says:

    An interesting take on how to get a client to move out of their resistance. My understanding of working with resistance comes from the Motivational Interviewing perspective. Within this approach, the client’s “resistance” is seen more as an ambivalence, being stuck or lack of motivation towards change. If the client is at the contemplative stage or higher in their relationship to the “problem”, then the salesperson approach could be beneficial in giving them a map of what to do or where to go regarding their interior and therefore potentially help them find their own motivation for change. I like the “ladder out of hell” image which for some clients, once they resolve their ambivalence towards change with our help, can then feel validated in their experience and then use this image to help them gain some traction in the necessary work of facing certain emotions. I’m not sure however the salesperson approach will work with every client who’s displaying resistance. In my experience, it really depends on where the client is in relation to the perceived problem. If there is an expressed readiness for the benefits of getting beyond painful emotions, then the salesperson approach can be useful. If there is lingering resistance, if the client is not ready to move out of where we think they should be, then I think we need to proceed carefully/slowly and not so much emphasize the value of facing certain emotions but taking the necessary time in helping them resolve their fears towards change in general. Questions like: “What would it mean for you to face your sadness at this time”? “What resources would you have to draw upon if you were going to face these emotions”? And of course, getting them to consider: “What can you imagine will happen if you don’t face these emotions”? Sure, we as therapists can lay it out of them and sell the new behavior as Dr. Linehan suggests, as a way of persuading them towards change however, if it comes from us, if we are the ones providing the motivation/reasons for change, (as the experts/salespeople) then I think the possibility for their reactance/relapse is much more likely. In my experience, when encountering any resistance, it is often more useful to spend the time getting the client to explore their own relationship to one of life’s certitudes, and that is that everything changes; whether we are ready for it or not. What Dr. Linehan says is true, there is only one way to stop pain from running one’s life, and that is to go through it! For the clients who are ready/motivated for this work, part of the job is giving them the map. For those who are not, we mustn’t put them in the same treatment category as those who are clearly ready, willing and able to go down that road.

    • Gail says:

      I go back to the client’s WANT – what they ultimately want. Once their will is engaged they are more likely to get themselves on the path and through the resistance. This can be tricky because sometimes the client has given up on their own Want in life. For me the client is the expert in their own life. I am the facilitator and support person.

      Sadness – I talk about sadness being an authentic part of themselves. It validates them – it validates their experience. Yes they did suffer and they were important and their feelings do matter. They did want something different and it didn’t happen and of course they are going to feel the way they do as uncomfortable as it is. To stymy the feeling is to put value on all the other variables and not on their own experience. This helped me to deal with my own grief – I let myself go back to the little girl who suffered and validate her feelings.

    • Jay says:

      I really like this approach Jack as it is more about collaborating with the client and using some thoughtful open-ended questions to get at their own reasons for changing or not changing however the case may be at the time and then helping them move forward when they are ready.

  58. When Marsha suggested we explain to the client the value of their engaging with the issue –
    I must admit to feeling some resistance !

    Because, in my experience, rational arguments satisfy the speaker much more than the listener.
    Depending on rational argument was arguably a big factor in Hillary Clinton losing.

    I was much more comfortable with Marsha’s suggestion that we try to inhabit the client’s world, willing to people alongside them in the ‘hell’.
    And, I suggest, alongside, as they climb up the ladder.
    ( after all, professional sales people utter more questions than statements. They realise that they have two ears and one mouth!

    I really liked Marsha’s belief in telling the client, this is going to be difficult, not easy. A beautiful truth.

    Thank You.

  59. Patricia Kapphahn says:

    Thank you. I like the hell analogy and have a client who could benefit from this approach.

  60. A helpful and very clear and brief input. Thank you.

    I used to practice as a probation office in the UK many moons ago and ‘clients’ did not attend voluntarily. There was a lot of resistance as you might imagine. My task was made easier if I was able to ‘sell’, as you put it, the value of becoming a client instead of an offender.

    Bill O’Hanlon’s and the TA question – what stops you [doing x] – proved very helpful as it enhanced the choice of – as you say – staying in hell or moving out, even though it is a hard journey.

  61. Patricia Austin says:

    That was great – thank you! I would be happy to use the hot ladder method having first gained my client’s trust that I would be with her on the ladder all the way. I have also been able to unstick clients by asking if they think they’d be able to look at their avoidance as a type of experiment – then we gradually get around to their pain as the cause. Have found it helps if they speak about the trauma in the third person, then graduating to being able to tell their own story, the first person, when they feel safer showing emotion.
    Thank you again for these great ‘insights’ – love ’em!

  62. I find a mindfulness approach, asking about their experience as they are resisting, can help move past it. Part of what is calling for recognition is the need to resist. Cognitively combatting that need doesn’t feel right to me, particularly since it won’t reach the preverbal aspects of the client needing to be met and held.

    • Bernie Liebl says:

      Ah, good. Kind of exploring the resistance. Maybe also using meta-cognition. Just let the resistance be, not attack it. I like the expression “the need to resist” because this is how I experience it. Can you suggest some further reading on that?

  63. Terry says:

    I like the hell analogy.
    Sometimes highlighting the pain of staying as you are contrasted with the alternative of a better future provides some compelling momentum.
    Recently I worked with a family where they had held on to shame and grief and anger for 20 years. This was now impacting 3 generations, from the grandmother to the children, some of whom were now grownups. I decorated a box with black paper and put all the feelings I had heard and observed in the family related to this old pain on the box. Then I took another bright box with butterflies and put all the hopeful, positive characteristics I had heard and seen on that box. I then put the two boxes on the table and asked the family what legacy they wanted to give to the children in the family.
    The black box over-shadowing the butterfly one, or did they want to let the black one go and move forward with the butterfly one? A number of family members found this very helpful in deciding how they wanted to relate to each other and plan to move into the future.

    • Tracey Martin-Cole says:

      fabulous! Thank you, that will work with a family I am working with where grandparent incest has become the ‘new normal’ and the children have been in therapy and are ready to move but the parents are not – and their focusing on the hurt/pain/fear is holding the children back. So that will be a wonderful way to highlight the future focus – and hopefully won’t affect another generation.

  64. Elaine Dolan says:

    In doing bodywork, denial and not being able to face things often percolate on their own if the client feels the safety of the container. I agree, they need to know that you get exactly HOW painful this issue is for them, because if it’s glossed-over or worse, trivialized, you have lost their trust. Curiosity about the *shape and size* of the pain, and asking *What would it take to make it dissolve or fall open, or crack open or blow up or whither of it’s own accord* can help image the change and inch the process along.

  65. I disagree with everything about this approach for every client with the exception of the most destructive acting out client.

    The moment I feel myself trying to “sell” my client this is my internal signal that I have lost the empathic thread of connection. If I find myself feeling like a “car salesman” I have most certainly entered into a dark place of manipulation. In my mind a “car salesman” is in the business of convincing someone to buy something they don’t need but the seller needs to sell. This is a manipulation- the antithesis of authenticity. Without authenticity I have no real connection- much less a connection that heals.

    Isn’t maintaining an empathetic connection (without necessarily buying into your clients experience of their reality) the whole point of therapy? I would argue that in order to understand my clients emotional hell I need to understand that hell. My job is to climb down there with them and maintain my sanity ( emotional boundaries) while working to understand my clients emotional reality. Then and only then have I earned the right to suggest a way out, a hand up.

    The ladder itself is one made out of compassion, empathy and kindness. This ladder involves opening to a deeper understanding and acceptance with of why they have been in emotional hell.

    In my experience most of the pain that keeps my clients stuck is underground or unconscious and difficult to face. Strong arming my client will most certainly backfire in this case.

    Contrary to what this trainer says, most clients I have encountered don’t refuse to experience negative emotions. Rather they are unaware of the emotions that are driving the behavior that is causing the current pain of their lives. Therefore they aren’t willfully refusing to do the work of therapy and are in need of being “sold” on the idea of experiencing more pain. It follows that consciously arguing with them to experience more pain is counterproductive.

    While I may confront my client with some variation of the Dr. Phill line ” how’s that working for you?” my job is to extend compassion, not selling them on more pain.

    I train therapists who treat Adult Daughters of Narcissistic Mothers who are trapped in the role of the “good daughter”.

    In my practice and in the training I provide -my ladder is always a suggestion, an offering from one human being to another. It is ALWAYS my clients decision to accept the hand up, therapeutic suggestion or interpretation.

    In my opinion, without this approach I am one more in a long line of attachment figures who used manipulation for my own gain under the guise of ” For Your Own Good”.

    It is an easy trap to fall into- particularly when we feel internal or external pressure to ” DO SOMETHING” . In my view it is almost always a mistake. There is another way.

    • Tracey Martin-Cole says:

      I didn’t see Marsha’s explanation as forcing the client or being inauthentic – rather, the acknoweldgment that we cannot know their pain, but we can find an analogy to the pain and the dynamic or the pattern that we have learned belongs to them through our attuned engagment.

      Once we understand that pattern, we are letting them know it “looks like we are at the top looking down” but really we are “here to help you climb the ladder” and “we know it is painful” but it is the only way out.

      The ladder is always an option – we can’t make them climb it – Marsha is explaining how we can lead (sell it) to them as a way out of their pain = how to understand the dynamic, and giving them hope that there IS a way out, they don’t want to know we are “in it with them” how can we help them if we are?

      I have had clients that have been to therapists that are so ’empathetic’ that they are in effect colluding with the client as victim, and even ones that get upset when they know the facts, and say unhelpful things like “oh you poor thing, I understand” when the clients soon tunes out and leaves therapy to look for someone ‘strong’ enough to ‘contain’ them in their pain, accept them there, but then can offer them hope.

      • Gail says:

        I like your distinctions – I felt a similar response
        to the metaphor of hell.

    • Lloyd says:

      Although I liked the concept of a ladder and at first this appealed to me I can see that it much better to join them in the hell and climb the ladder together with compassion, empathy and kindness.

      • Philip says:

        Absolutely. Leave all notions of hierarchy behind ! That in itself can generate so-called “resistance”. This term in itself is labelling, a type of unhelpful cognitive distortions.

  66. Ada Grasselli says:

    Thank you for the metaphor. I also think the key is that the person feels you deeply understand his/her pain.

  67. Bea Schild says:

    I like the metaphor. It makes sense. I think it works best, when people already know, that the have a choice.

  68. i’m having a difficult time trying to find the effectiveness in taking an intellectual approach to why a client should have a feeling….in my time

    feelings come when folks feel safe enuf to allow, them…resistance will melt when the time is right. . respectively, this sounds like trying to push somebody into expressing a painful feeling that they aren’t ready to express. it wouldn’t work for me, i know that. i’d lock up even tighter if i was being preached to about why i need to come out from my hiding place with stories about how i’ll suffer in hell untill…what??? in my belief, resistance serves a purpose…when it isn’t needed any more, it dissolves

    maybe i’m missing something here….somehow the image comes to mind of ripping open a rose bud, rather than watering it and fertilizing it until it opens on its own.

    • Philip says:

      Fully agree

    • I agree Mikki- So very well put. Resistance serves a purpose, yes. And when no longer needed dissolves ! Thank you. We don’t need to lose sight of that. To do so is harmful and arrogant and misses the point of respecting all of a clients experience. Do so and we generate more resistance.

  69. Anna Rickell says:

    I found that it is useful to get the patient to begin to speculate what is their. Feeling about their feelings. That can foster curiosity about less sensitive issues and over time they develop increasing ability to explore within themselves…. and begin to share and grow.

  70. I use story-telling too, and surprise. I know that we can be masters of our selves and that confidence radiates I expect. I took a lady who’d had hip surgery aged 88 out of the hospital yesterday and surprised her first of all by saying “we’re getting out of here today, I going to take you to see a tree.” She is a very intelligent woman and she just thought that statement was hilarious, and ended up walking a mile to sit under a spreading chestnut tree and back. She thanked me over and over for such an interesting day. I will follow up with the poem Under a Spreading Chestnut Tree tomorrow. (She had threatened to kill herself on Monday – so in 5 days I turned it around)

  71. Pamela Blunt says:

    I also like the Hell and hot ladder analogy and will definitely use it in my work. I very much agree that people need to know that we really hear the level of suffering that they are living.

    Sometimes my clients have a strong, lifelong programming about not letting anyone see them cry. This is fairly common in the U.S., isn’t it? As they gradually feel safer letting themselves express sadness in varying degrees and as it naturally arises, I think they learn that it is not so scary to be vulnerable. It is something we seem to learn and re-learn to trust in industrialized cultures.

    How I co-create that safety varies from person to person based on their comfort levels. Paradoxically, often just giving someone clear permission NOT to express their sadness (or any emotion, memory, etc.) until they are ready relieves a big tension and fear for them, and more openness follows.

    I used to work in a hospice program. Some people grieved openly and easily and others were afraid that once they started crying they wouldn’t be able to stop. I did share my own experiences and those I had observed. Usually, there is significant change in breathing and tension in the throat and other areas when one is resisting grief. It sometimes helps to just work with it somatically: first noticing how breathing IS happening, how grief lives in them and then allowing oneself to open into breathing more fully in a natural way—an exploration, not an exercise, often with that breath comes the tears. To resist arises again, one can become curious about how that happens with guidance.

    I sometimes call my clients on the day after sessions where the floodgates have opened because I have found that they always feel so much better the next day, often motivated to go out and connect with people or just feel more alive than they have in months. I call because I want to highlight the connection between their experiencing of grief and the true relief that offers to them versus what they thought would happen.

    And sometimes, people just aren’t ready and I have to respect that and continue to find ways for them them to share at the level they are currently capable of sharing.

  72. Pam Paulson says:

    As a drama therapist I may begin to use externalizing langauage regarding resistance to put the client in relation to resistance. If they are open I would refer to resistance as a character and interview them as resistance. I would ask how you help this client. What strengthens you, how long have you been with this client. What weakens you. What are your hopes and dreams for this client. Then something in the conversation may allow for the opposite of resistance which could be openness, bravery…and then interview this character. Then maybe create a scene that puts them in conversation together. Not an actual scene from the persons life but begin dymbolucally so it’s less threatening. I could also ask them to do a sculpture of when resistance is strongest and what their preferred relatationship to resistance would be. Bringing the client into their body and imagination takes it out of the resistance to therapy and brings a more playful engagement. Just some ideas. Thanks, Psm

  73. Trish Walsh says:

    oh gosh – no the burning ladder in hell (with therapist above/on the outside) approach doesnt resonnate with me for a couple different reasons. I think its critical that the client feels you are WITH them – every step of the way. The ladder creates a visual image of they, alone, in hell, the therapist way up high, away from them. And on top of that what lies between is a very painful (just the image of grasping a burning hot ladder thats going to burn your hands can be so anxiety producing – the pain of that!). Creating a very safe space and gently guiding in to the unfelt feelings, being with them in this place (being with them is the key key part!) as they were very alone/or felt alone when the trauma first occurred) – being with them step by step to feel the blocked feelings, process the suspicious that they hold of themselves/other or the world. (as another person above mentioned with exposure therapy) building the resilience/tolerance to feeling those feelings – being WITH the client, creating an extremely safe and compassionate space for the healing and processing to take place – is SO key. When resistance appears – keeping the goal front and centre (there should be a goal of how they want to feel – clearly articulated at the beginning. Trust in the therapist will help them move towards this goal – yes have to move through painful feelings but they have company there. just my thoughts

    • Pamela Blunt says:

      Good points. To me the bottom line is that I am always sitting with an individual. Whatever happens must be responsive to that. There is no ‘they’ but just a ‘we’ which is also changing in every moment. Compassion, responsiveness and presence for what is arising/emerging ir primary. And that ladder might be a worthy offering to someone, if tailored to what is happening in that moment.

    • Yes, being with the client is everything.

    • i soooo agree!

    • Trish Walsh says:

      PS – the resistance of course is fear (often terror) – so the question is how can we help move them through the fear? (by adding an image of more fear? and alone-ness? just a thought as a consideration)

      • Pamela Blunt says:

        Yes. I remember my own terror and times of “resistance” through my own healing process. With some kinds of trauma the option to say ‘no’ was taken away. In respecting ‘no’, I am respecting someone’s need to set a boundary, which is very therapeutic. That place inside of us that knows when we are ready, when there is a ‘yes’ for something gets repressed and disconnected when boundaries are totally disrespected through acts of sexual, physical abuse, torture and many other forms of trauma. I often see ‘resistance’ more as a person learning to trust that inner voice and reconnect with that internal compass. I don’t really know what anyone needs more than they do.

  74. JoAnn Baird says:

    This can be tricky territory because resistance, as we know, is a defense. The defense is the way the person survived, sometimes horrendous and abject early childhood trauma. I had a client who told me up front in her therapy process that she could not and would not go beyond the barrier of nine years of age. I worked with this client weekly, gradually building trust and providing a safe place and a safe parental-type friendship. After about a year, the client journaled, writing most days, shared her survival strategies (she continued to live in an environment that was not nurturing). When we re-assessed progress after one year, the client reported having 2-3 nightmares per month, rather than the beginning 4-5 per week, more confidence, less free-floating anxiety, and more sense of joy in her life (ie: appreciation of nature, her writing, coloring mandalas, knitting). I may never have broken down that line in the sand she specified, but we got to talk about the barrier and why she didn’t want to go there, but in talking about the barrier she developed a coherent narrative. She just couldn’t or wouldn’t go back there and try to desensitize or reprocess the dark emotions. Maybe some day she will, but in the meantime, for once in her life, she had someone who respected her pain and her boundary around that pain.
    My point is, that breaking through resistance can be about trust, timing, severity, and duration. This client was 60 years old and was surviving with equally severe, chronic physical problems. I think she is a living miracle…just that she’s alive and functioning and not in a mental ward or drugged out.
    We may never get through that wall and may never want to. Breaking down resistance has to be a collaborative process. There is no one size, fits all. I think that sometimes living in hell is the devil the client knows and only the client ultimately knows whether it is better to live with him or leap into the unknown, in Marsha’s metaphor “climb” into the unknown.
    I love the metaphor.

    • Pamela Blunt says:

      This is true. I think of clients who had major, chronic medical issues and just didn’t have the energy it takes to face some of those terrifying demons. I also don’t beleive that the ONLY way out is through. Again, we are sitting with individuals. I have seen people make tremendous changes without processing traumatic memories in direct way. I also have the deepest respect and admiration for each and every one of them.

  75. Loved your “climbing out of hell” story! I will use that!

  76. Kathy Precht says:

    There is a lot of focus lately on trauma informed care and understanding resistance through a trauma informed lens. Through this lens, the client’s behavior can be understood as the way they have been able to survive traumatic life experiences. However, their behavior is not working for them anymore (and perhaps it never has but they have reached a point where it really doesn’t work for them) because it is simply keeping them in what Dr. Linehan referred to as “hell”.

  77. Debbie Davis says:

    This is brilliant. I have often focussed on the positives…of what lies ahead for the client if they face their sadness, grief, anger or feelings of shame. Providing a story of getting out of “hell” is useful for the client who cannot visualize themselves being in a better place. Thank you Marsha!

  78. Ute says:

    I find it really helpful at first valuate the resistance and be with it. So the client feel that is nothing wrong to be resistant. And than I explore with the client why this resistance make sense and have meaning in there life. So they can really feel and understand that resistance is something very functional for them. Than I try to find out with the client at what age this resistance served them to ” survive”. To valuate the resistance in my experience leads to a relaxation in the emotional system and to a reduction of tension in the nervoussystemfrommthat point clients feel more secure to contact their pain and suffering.

    • Tom Dickinson says:

      In my own work, at the point I was able to see how the resistance, which I experienced on this occasion as black hatred around my heart served me at a very young age with my father, I was asked to consider whether I still needed it. That eventually led to a deep healing catharsis.

  79. Esther Brandon says:

    So well said, the person needs to get out of hell but the ladder is hot. From my experience, it is so important to let the person know they are not alone (the need to know you are not alone may connect to the importance of healthy early childhood attachment versus unhealthy attachment, many people who have suffered trauma as a child also experienced unhealthy attachment with their primary caregivers.

  80. Rebekah says:

    I like the pro and con approach but that’s sometimes a too rational approach for someone who is resistant. I Like the hell analogy simply because it creates a picture. If they can retell it, they can do it.
    Thank you.

  81. Shae Hepburn says:

    I wish it were that simple. There has to be a willingness and a readiness to FEEL the pain fully. I don’t think “selling” new behaviour works, because if it did, then it wouldn’t be difficult for people to do it themselves automatically.Nobody wants to numb out difficult feelings and emotions, we do it because strong emotions are hard to take, and the more we do it the more we find it easier NOT to connect to difficult emotions.

    I would say that this is a process and it’s about programming the brain to exposure. I say this because resistance can be a habit a person gets into in order to avoid an unpleasant reality and priming the brain to exposure in this case works beautifully. It’s about getting the person purposefully to bring up and sit with a painful emotion every day for a few minutes.Whatever the emotion is is not important, but best to start with an emotion that comes with less load or is easier to handle.It’s important that it is timed for a short period of time because the part of us that feels resistant needs to know that the process will end within a specific burst of time (I don’t know why this works but it does) And see what comes up. I then use the dial up method when nothing comes up. I personally did it successfully to get un-numb from emotions and to start feeling again. And it ABSOLUTELY works. The dial method is about imagining a dial with 0 for no feelings to 100 for the most intense feeling and it’s about starting from 0 and cramming up tp 100. The exercise can only be considered complete when it is possible to feel the feeling at 100 feeling the feeling intensely:almost over the top. Even if this happens for less than a second, one has the choice to go back to say 5 for example and regulate it. I find that the best thing is not to necessarily bring up a memory connected to the emotion but simply concentrate on feeling the emotion, without content first. I have found that once the resistance is comfortable with this, memories connected to the emotions (and so the resistance)will come up to be integrated. This is not something that always works super fast, but it works.With some people it takes longer wth others not so much. It depends on how much resistance the person is holding on to, or how long the habit has been going on.

    • Jo Dee Davis says:

      EMDR and counting both allow this to happen in a regulated way.

  82. thank you

  83. Eleanore Carson says:

    Develop A VERY strong awareness of the present moment and all the potential that is a part of that moment,,,which is the only way one can move with energy and inner guidance. Eleanore

  84. Charles Herr says:

    I way something similar: What isn’t felt, doesn’t change. It stays the same. Pushing it away doesn’t make it go away. It is there anyway and comes back. Turning toward the sad part of yourself (something in you) that is sad with compassion, that part of you won’t feel alone, because it has you to listen to it and why it is so sad. Once you have heard it, it can shift, change. It isn’t your enemy. You can’t speed grieving up, but you can slow it down–by refusing to be with it, without falling into it.
    And yes, a little at a time. If it is too much, we can come up for air, take a break, before going back, gently.

    • Charles Herr says:

      I SAY something similar (not “way”)

  85. Ulrike Senicourt, therapist in privat practice , Paris says:

    This was soooooo good. Thanks for the Laddermetaphor !!!
    I mainly work with the “resistant part” as i am an Ego- state -fan ;-) Once the resistant part has been honored and understaood in his protective function (which doesnt really function ;-) ) it lets the patient work up the hot ladder .

    Merci encore !

  86. Shirleen Roach says:

    I almost always ask them, “how would your life be different if you did not have these problems?” Once they describe their ideal life, I start to work providing encouragement and support for them to redesign their life. Having hope that change is possible is extremely important to “climbing the ladder that is described by Marsha in the video.

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