Recognizing resistance in the working phase
In the second week, whenever the nurse asks about her marriage, the client changes the subject to the hospital food, and she has arrived 15 minutes late to the last two sessions. These behaviors appear when painful material comes close, which is the classic picture of resistance. Resistance is an expected event in the working phase, when the client begins to face difficult issues. The nurse gently notes the pattern and explores what makes the topic hard, without forcing it or ignoring it.
Why gentle exploration works
Resistance protects the client from anxiety that feels overwhelming. Pointing out the pattern in a calm, nonjudgmental way, for example, "I notice that when we talk about your marriage, we move to another topic. What is it like to talk about it?", helps her become aware of the avoidance and invites her to examine it. This allows her to approach the painful topic at a pace she can tolerate. The relationship stays consistent, and trust built in the orientation phase is used to support the work.
| Option | Effect |
|---|
| Shorten the sessions until she is ready | Rewards avoidance and makes the relationship less consistent |
| Tell her the marriage must be discussed | Raises anxiety and increases resistance |
| Gently note the pattern and explore it | Builds insight at a tolerable pace |
| Go back to orientation and rewrite the contract | Misreads a normal working-phase event as failure |
Why the other responses are wrong
Shortening the sessions reduces contact precisely when support is needed and teaches her that avoidance works. Insisting that the marriage must be discussed to meet contract goals turns the session into a power struggle and usually increases resistance. Returning to the orientation phase and rewriting the contract treats a normal part of the working phase as a sign that the relationship has failed; the contract remains valid, and the nurse may simply remind her of its terms, such as the session time.
Watch out! Lateness, missed sessions, changing the subject, and superficial talk are all forms of resistance. Also consider transference, in which the client reacts to the nurse as she would to someone from her past.
Exam takeaway
Key point! Resistance is expected in the working phase; the nurse explores it gently, neither forcing the topic nor ignoring the pattern. Consistency in session time and length supports the work.