How Persuasion Works in Psychotherapy: Unlocking Therapeutic Success

The Art and Science of Persuasion in Therapy

I’ve been watching a tape of a popular Intensive Short-Term Dynamic Psychotherapy (ISTDP) trainer. It’s been fascinating. The trainer is confrontational yet remarkably effective.

Two men in a tense meeting. One, in a blue shirt, is angrily pointing and yelling at the other, who is seated with papers on a desk.

This confrontational approach contrasts with research by Dr. Henny A. Westra and Alyssa Di Bartolomeo, my former coach. Their findings suggest that confrontation often worsens resistance, leading to poor therapy outcomes.

How can this be explained?

The answer may lie in persuasiveness. Strong persuasive skills can counteract the issues that often arise from confrontation.

The Underrated Power of Persuasion

"Persuasion" in therapy isn’t about trickery; it's about helping clients believe in the process and facilitating change. Researchers Alexandre Vaz and Daniel Sousa define persuasiveness as communication that builds hope and trust. This dynamic is crucial to the influence of therapy.

Clients often feel hopeless, entangled in unhelpful self-narratives. These stories can keep them stuck. For instance, a depressed person may feel convinced that nothing can improve, while an angry person might blame others. Their narratives are part of the problem. Therapy must provide a hopeful new explanation—or "rationale"—for their pain, along with a clear path forward.

Providing this rationale is essential for achieving agreement on the goals of therapy and the steps necessary to attain these goals. Without this alignment, progress can stall. Both clients and therapists need to be working toward the same goal in a cohesive manner. Here’s where persuasion steps in, aligning therapist and client, fostering hope and engagement.

ISTDP's Persuasive Engine: Present Responses and Emotional Heat

How do ISTDP therapists gain client buy-in, even when resistance arises? Throughout the session I’m observing, the therapist often directs focus towards the client's immediate, in-the-moment experience.

For example:

Therapist: "So what's going on?"
Client: (Takes a deep breath) "Oh, I don't know. Everything should be fine." (Minimizing)
Therapist: "You just took a breath and sort of held it. It seems like you're holding things in. Could this holding back be what's keeping you stuck? Can we discuss what you’re holding inside?"

In this exchange, the therapist uses the client’s immediate action—holding their breath—as evidence for an interpretation (the act of holding things in) and a therapeutic task (opening up about it). It’s convincing because it ties directly to the client’s own experience.

Critical turning points often occur when the client’s emotions run high. In the tape, the ISTDP therapist persistently confronts the client, who grows increasingly frustrated and angry. At these emotional peaks, the therapist delivers calm, clarifying explanations.

This approach is aligned with Vaz and Sousa’s research, which indicates that people are more receptive to new ideas during emotional experiences. Their mental flexibility increases, making it an opportune moment for persuasion. The ISTDP therapist appears to leverage this timing effectively, allowing emotions to build before offering persuasive reframing.

The Cost: Fighting With One Hand Tied?

Returning to Westra’s research, it appears that when a client pushes back—arguing or ignoring the therapist—attempting to confront them often escalates resistance. A more effective approach typically involves understanding their viewpoint, acknowledging their feelings, supporting their independence, and steering clear of arguments. This seems to contradict the confrontational style embraced by the ISTDP therapist.

Let’s entertain the possibility that both perspectives hold validity. Resistance should not prompt confrontation. Meanwhile, persuasive techniques can guide the client towards therapy goals and the necessary actions to achieve them.

If this holds true, therapists employing confrontational ISTDP techniques may be operating with limitations. As I observe the tape, I’m intrigued by whether the therapist must continually mobilize their persuasion skills to manage the resistance produced by their confrontational approach. Without the confrontational elements, could their persuasive abilities become even more potent?

Timing, Timing, Timing

A pivotal element we cannot overlook is timing. Westra’s findings suggest that confrontation isn’t inherently negative; rather, the effectiveness of confrontation hinges on its timing. Confronting clients during moments of resistance is generally counterproductive.

Two people sit across from each other in a room, engaged in a discussion. One writes on a pad. Two abstract paintings hang on the wall.

Therefore, timing becomes crucial in navigating both resistance and persuasion in therapy.

Westra underscores the significance of timing when responding to resistance. We must know when to step back and validate the client versus when to propel the conversation forward. Conversely, Vaz’s research highlights the importance of recognizing when clients may be most receptive to new ideas—often induced by strong emotional experiences.

Perhaps the solution doesn’t lie in choosing between persuasion and managing resistance. Instead, the real power may come from effectively combining these skills. Picture a therapist who can craft convincing explanations grounded in the client’s immediate experience (as seen in ISTDP) while also adeptly identifying signs of resistance. This therapist could respond appropriately—validating or reflecting on feelings—before resistance intensifies.

Beyond the Paradox: Towards Skillful Integration

From my observations, I've gathered three vital insights:

Explanations of therapeutic actions should be closely connected to the client's real-time experiences, making them challenging to refute.
The ideal moment for confrontation is not when clients display pushback.
The best time to extend explanations is when clients experience heightened emotions.

A therapist masterfully integrating these skills could leverage persuasion when clients are receptive while simultaneously mitigating the friction associated with resistance. Such an approach would harness the strengths of the ISTDP method while addressing its limitations, as evidenced by research on managing resistance effectively.

While this level of attunement may be challenging—requiring both strong persuasion skills and profound sensitivity to the client—the rewards could lead to more effective therapeutic outcomes.

I aspire to reach such a level of mastery in my practice one day.

Best,

Jordan (the counselor)