Clients with internalizing disorders, such as depression or anxiety, may be especially prone to resistance that goes unnoticed by their therapists. These clients may be inhibited in their interpersonal style and reluctant to overtly challenge or confront their treaters (Hill, Thompson, Cogar, & Denman, 1993; Lynch, Seretis, & Hempel, 2016). Rather than make it an “elephant in the room”, internalizing clients often hide their disagreement or even claim to be on board with a therapist’s recommendations (Muran, Eubanks-Carter, & Safran, 2010). However, resistance in this population may still be apparent through covert acts such as statements that distance the therapist, avoidance of certain topics, or physical withdrawal (Ackerman & Hilsenroth, 2001; Hill et al., 1993). Therapists must be highly attuned to even subtle signs of such resistance in order to effectively address it and enhance collaboration.
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