Roll with the resistance

How to Work with the Help-Rejecting Client

Written by Emma Nagle, LCSW | May 5, 2025

Some clients come to therapy asking for help, then resist every suggestion you offer. It’s not defiance. It’s a defense.

As a therapist, understanding the help-rejecting client means moving beyond frustration and into deeper empathy. This means acknowledgment of resistance as a form of protection, not opposition.

This article will offer a framework for understanding what the help-rejecting clients is, and a breakdown of how to best approach this dynamic in the therapeutic relationship.

Help-rejecting clients are often described in clinical terms as having "help-rejecting complaining" traits. These clients frequently present with complaints and suffering, yet subtly (or overtly) resist any suggestions, reframing, or offers of help. From a psychodynamic perspective, this is seen not as defiance, but as an expression of deeper psychological pain and wounding.

Understand the Defense, Not Just the Behavior

Therapists should view help-rejecting behavior as a defense mechanism, meaning it is a tactic for avoiding uncomfortable thoughts or feelings. Rejecting help is often rooted in early experiences of:

• Neglect or inconsistent care

• Shaming or punishing responses to vulnerability

• A history of help being unreliable, controlling, or humiliating

These clients may have internalized the belief that accepting help is unsafe or that they are unworthy of genuine care.

So how do we meet these clients with compassion instead of conflict?

Drawing from Nancy McWilliams' psychodynamic lens, here are some thoughtful therapeutic approaches to improve engagement with help-rejecting clients without reinforcing the very patterns they fear most.

1...Stay Empathic and Non-Intrusive

Avoid pushing solutions.

Stay present and curious rather than corrective.

Validate their distress without rushing to fix it.

For example:

“It really sounds like you’ve been carrying this a long time. That sounds exhausting.”

2. Name the Pattern—Gently, Over Time

Only once trust is established, reflect the relational pattern with compassion:

“I notice that when we explore ideas for support, something in you seems to pull away. I wonder what that feels like for you.”

3. Don’t Get Pulled into Power Struggles

Therapists may feel frustrated, helpless, or even rejected themselves. Avoid trying to “win” cooperation, which often recreates the dynamic of control the client is defending against.

Instead, model emotional neutrality and hold space without agenda.

4. Honor Their Need for Autonomy

Help-rejecting clients often have a deep fear of dependency. In Psychoanalytic Diagnosis (2011), McWilliams advises therapists to frame any exploration as collaborative, not directive.

You might say:
“You know yourself best—would it feel okay to sit with a few options, without needing to choose any right now?”

5. Use the Therapeutic Relationship as a Healing Model

The goal is not to get the client to “accept help,” but to slowly build a relationship where help doesn’t feel threatening.

You’ll know there is progress when you see your client is able to tolerate feeling cared for without shame or suspicion.

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Learning to roll with resistance doesn’t just apply to the client—it applies to us, too.

Supporting help-rejecting clients isn’t only about clinical interventions; it also requires noticing what gets activated in us. For any therapist, tending to those internal responses, better known as our countertransference, is just as essential as any technique we use in the room.

Working with this help-rejecting dynamic can stir up frustration, helplessness, or self-doubt. It can often lead to feelings of inadequacy or irritation or a strong urge to prove your value or “be helpful.”

Examining your own experience in the therapeutic relationship and utilizing supervision when necessary can help you avoid acting on those impulses. This reflection work on the part of the therapist and the feelings that arise can provide valuable pieces of information about the client's early relational dynamics and their inner world.

In summary, don’t try to out-help the help-rejecting client. Instead, roll with the resistance. Build a space where being helped feels safe, empowering, and shame-free—even if that process is slow and nonlinear.

“If we can share our story with someone who responds with empathy and understanding, shame can't survive.”

—Brené Brown

References:

Brown, B. (2012). Daring greatly: How the courage to be vulnerable transforms the way we live, love, parent, and lead. Gotham Books.

McWilliams, N. (2011). Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process (2nd ed.). The Guilford Press.