Clients’ resistance to therapists’ proposals: Managing epistemic and deontic status

• We examine client resistance to therapists’ proposals for behavioural change.
• Clients’ resistance was formulated with an ‘inability to comply’ account.
• Clients indexed their epistemic stance in the domain of their own experience.
• Clients asserted their deontic right to reject a proposed course of future action.

This paper uses conversation analysis (CA) to examine client resistance in Cognitive Behavioural Therapy (CBT) sessions for clients with depression. Analysis focuses on clients’ responses to therapists’ proposals for behavioural change. Typically, clients displayed active resistance to such proposals by drawing on one of three types of ‘inability to comply’ account: (1) appeals to restrictive situational factors; (2) appeals to fixed physical states; (3) assertions of previous effort to do what the therapist was proposing. Each type of account involved clients utilising knowledge from personal experience as their reason for resisting the proposal. In formulating their accounts, clients’ turns were designed in ways that displayed their epistemic stance in relation to the situation under discussion. By indexing their superior epistemic authority in the domain of their experience, clients were able to invoke their ultimate right to reject the therapist's proposed course of action. The implications for CBT practice are discussed.