Rethinking Resistance: A Compassionate Approach to Eating Disorder Treatment

As clinicians working in eating disorder treatment, we often encounter clients who appear unmotivated, resistant, or ambivalent about recovery. The traditional view might label these presentations as "difficult" or "non-compliant," but what if we shifted our perspective?

The Myth of Motivation

Research challenges our common assumptions about motivation in eating disorder treatment. Surprisingly, verbal expressions of motivation – those statements we often prize during assessment and treatment – aren't reliable indicators of actual readiness or capacity for change. This insight invites us to reconsider how we approach treatment with clients who seem reluctant to engage.

When a client presents as resistant or ambivalent, they're often protecting themselves in the only way they know how.

Every behaviour, even those we might find challenging, serves a function.

That client who answers everything with "I don't know"? They might be wrestling with profound uncertainty or fear. The one who discloses crucial information only at session's end? They're likely testing the waters of vulnerability in a way that feels safe to them.

The Power of Non-Attachment

One of the most powerful shifts clinicians can make comes from embracing "caring non-attachment." This is a delicate balance captured in the phrase -

"I desperately want you to recover, but I don't need you to."

This stance simultaneously communicates genuine care while removing the pressure that often drives clients away from treatment. It gives them space to own their recovery journey while knowing they have steady support, regardless of their choices.

Instead of pushing for change or becoming frustrated with perceived resistance, consider this approach:

1. Respond neutrally to bids for connection, even when they come through challenging behaviours
2. Maintain warmth and support in the face of therapy-interfering behaviours
3. Validate distress consistently and specifically
4. Recognise that what might look like resistance could be self-regulation

We must also consider that what we perceive as resistance might be related to trauma responses or neurodivergent presentations. Those "resistant" behaviours might actually be crucial self-regulating strategies. Before labelling a behaviour as therapy-interfering, ask yourself: Is this actually causing harm, or am I just finding it uncomfortable?

Hope in the Process

What is useful about this approach is how often those "resistant" behaviours naturally decrease over time when met with consistent validation and support. When clients feel truly seen and understood – not just in their struggles but in the wisdom of their protective strategies – they often become more open to exploring change on their own terms.

This way of working requires us to:

• Release our attachment to specific outcomes
• Trust in the process of therapy
• Maintain empathy without enabling
• Stay curious about the function of behaviours
• Hold hope while respecting client autonomy

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Moving Forward

The field of eating disorder treatment continues to evolve, and our understanding of resistance and motivation must evolve with it. By adopting a more nuanced and compassionate approach to ambivalence, we can create therapeutic spaces where clients feel safe enough to explore change at their own pace.

Remember: Every client deserves quality treatment, not just the ones who present as motivated or "ready" for change. Sometimes, the clients who challenge us most are the ones who teach us the most about what true healing looks like.

To learn more, check out our free resource Working with Unmotivated or Ambivalent Clients
Or for training around working with high risk and ambivalent clients, see our on demand online course Working With Highly Complex Eating Disorders

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