5 Tips for Working with Resistance in Therapy

Resistance. It is one of those words that can send a ripple of self-doubt through even the most seasoned clinician. A patient skips sessions, dodges questions, or shifts topics every time you get close to something meaningful. It is tempting to push through, problem solve, or reframe. But what if resistance is not the enemy of therapy, but a doorway into something deeper?

Here are five ways to approach resistance in therapy with curiosity and clinical wisdom.

1. Assume resistance makes sense

Start with the belief that resistance is protective, not pathological. It is a signal that something feels too vulnerable, too fast, or too unknown. Instead of trying to get rid of it, try to understand what it is trying to protect. Ask yourself, "What would it mean if this patient let down this defense right now?"

2. Slow down the pace

When resistance shows up, it often means the pace of therapy is mismatched with the patient's capacity. This is an invitation to slow down. Reflect on the process itself. Wonder with your patient, “What feels hard to talk about right now?” This opens space for a meta-conversation about the therapy relationship without demanding change.

3. Track your own responses

Resistance does not just show up in the patient. It stirs something in us, too. Do you feel annoyed, confused, bored, defeated? Your countertransference can be a clue. Instead of reacting, reflect. These feelings may mirror how others have responded to the patient before. Staying curious about your own reactions can help you stay present rather than pushy.

4. Frame resistance as part of the work

Normalize it. Let your patient know resistance is expected and often a sign that therapy is getting closer to something important. You might say, “Sometimes when we’re near something meaningful, part of us wants to shut it down. That makes sense. We can take our time here.”

5. Remember the relationship is the intervention

When resistance surfaces, the way you respond becomes the therapy. Will you retreat, interpret, confront, or connect? When you can hold steady with empathy and respect, you offer a new relational experience. One that does not demand change but invites safety.

Final thought: Working with resistance can feel uncertain, even uncomfortable. But it is also where therapy begins to deepen.

From Diagnosis to Depth: Learning Case Formulation as a PMHNP

I was recently reading The Personality Syndromes by Jonathan Shedler, and one line stopped me in my tracks:

“Without a coherent case formulation, treatment can devolve into a haphazard ‘spaghetti-on-the-wall’ process, with the clinician trying one intervention after another, hoping something will ‘stick’. It can also devolve into aimless, directionless ‘supportive therapy’ in which the therapist has essentially given up on meaningful change.”

THIS! This right here is exactly how I felt when I first began offering psychotherapy as a PMHNP.

In school, we were taught how to diagnose. We might’ve been introduced to various therapy theories, watched tapes, and observed some sessions. But what I never truly learned, and what I now realize is a cornerstone of meaningful psychotherapy, was how to develop a case formulation.

Sure, we wrote up plenty of case studies using a biopsychosocial or medical model. We practiced writing SMART goals. But the deeper process of crafting a therapy case formulation? The kind that links symptoms to inner conflicts, defenses, attachment patterns, and early relational templates? I’ve either fully dissociated that from my program… or it just wasn’t there.

So now, this is the work I’m actively doing, learning how to conceptualize cases not just through a diagnostic lens, but through a psychotherapy lens.

What about you?
How were you taught case formulation (if at all)?
And how has your understanding of it evolved in your therapy work?

Let’s talk about it, because if you’ve ever felt like you were just tossing interventions at the wall, you’re not alone.

Stop Collecting Tools—Start Building Roots

In the early days of adding psychotherapy to my PMHNP practice, I felt like I was in a constant sprint—chasing certifications, flipping through workbooks, listening to podcasts at 1.5x speed. I thought if I just consumed enough knowledge, I’d suddenly feel like I belonged in the therapy room.

But the truth is, no course could teach me what it feels like to sit in a session when a patient goes silent… or angry… or weepy… or disconnected. No worksheet told me what to do when transference showed up, or when my own countertransference surprised me.

I didn’t need more checklists. I needed more roots.

The Temptation of Tools

We’re trained to act. To treat. To fix. So it makes sense that when we step into the therapy space, we reach for tools—we want a clear modality, a workbook, a map. Something known.

But therapy isn’t only a set of steps. It’s a relationship. A process. An unfolding.

That’s why learning the framework of therapy—not just the interventions—is the real game-changer.

What It Means to Be Rooted

Being rooted doesn’t mean having all the answers. It means having a strong enough foundation that you’re not swayed by every wave of doubt. You can sit with the unknown. You can pause instead of rush. You can notice what's happening—in the room, in the relationship, in yourself.

And you can begin to trust that you are part of the work—not separate from it.

Growth Doesn’t Happen in Isolation

I’ve seen how powerful it is to grow with others. Not in a massive forum where you’re lost in the scroll or one of 30 thumbnails in a zoom. But in small, honest spaces—where people know your name, your style, your stuck spots.

That’s where confidence grows. Not from having the “right” intervention, but from knowing how to hold a moment in therapy—and yourself in it.

If You’re Craving That Groundedness

If you’ve been running on therapy fumes—piecing together skills from courses but still feeling shaky in sessions—you’re not alone.

Join us in The Consultation Room. Let’s dig in together. Build those roots.
Because the deeper they go, the more we can hold.

The Consultation Room is a mentorship and consultation space for PMHNPs ready to grow their therapy voice and deepen their clinical work. Doors to our small peer group open soon.

Rooted in the Work: A Note from the Founder

When I first decided to offer therapy as part of my PMHNP practice, one of the biggest questions I had—and one I hear often from other nurse practitioners—was:

“What trainings should I do?”

CBT? DBT? EMDR? ACT?

These are amazing modalities, no doubt. But what they all have in common—and what I’ve found to be the most transformative in my own work—hasn’t been just collecting more tools. It’s been deeply understanding the framework of therapy itself.

Think of it like this: the therapeutic alliance is the trunk of the tree. Every training, technique, and modality? They’re the branches. Without a strong trunk, it doesn’t matter how many branches you add—they won’t hold.

Through formal classes, peer consultation, and way too many books to count, I’ve come to believe that learning how therapy works—how to build trust, work with transference, attune to the process—is what truly helps us grow as psychotherapists.