A new book by York University psychology Professor Robert Muller offers help for therapists dealing with patients who resist treatment.
Trauma and the Avoidant Client, to be officially released this week by W.W. Norton & Company, offers practical guidance for treating clients who withdraw into themselves or avoid disclosing 
painful past experiences.
Right: Robert Muller
“Trauma therapy is difficult to begin with, but when patients reject help it becomes that much more challenging,” says Muller, a professor of clinical psychology in York’s Faculty of Health. “Unfortunately, a large segment of people needing therapy fall into this category. Rather than simply labelling them as resistant to treatment, it’s important to try and devise alternative means of offering them help,” he says.
In his book, Muller, who specializes in treating trauma within families, explains the defensive and interpersonal patterns seen among avoidant individuals and lays out a game plan for effective treatment. Through detailed case examples and practical clinical instruction, readers will learn how to build trust with clients, help them connect with and commit to the treatment process, and facilitate mourning to face the loss associated with trauma.
The theoretical framework driving Muller’s approach is that of attachment theory, pioneered in the 1970s by psychiatrist John Bowlby. He posited that humans form attachments as a survival mechanism to seek protection from real or perceived threats. Even when a protector’s caregiving skills are lacking, the developing child does what’s necessary to maintain the relationship; this 
shapes negative patterns of defence and affect, carrying over into adulthood.
Muller offers practical advice on how to address the “I’m-no-victim” identity often adopted by such clients, who tend to see people as either strong or weak and have difficulty understanding that there are shades of grey.
“These types of clients split their life stories in two in order to keep the two worlds of strength and vulnerability compartmentalized,” Muller says. “Despite their personal histories of trauma, they will maintain a defensive veneer so that they’re viewed as and feel strong, independent, self-reliant and normal.”
This can be resolved, he writes, by gently and tactfully pointing out narrative discrepancies, bringing the focus back to the original attachment and using the client’s symptoms as motivators.
Muller also offers candid advice based on his personal experience dealing with counter-transference – a phenomenon in which the therapist’s personal issues can sometimes get in the way of therapy.
In addition to his role at York, Muller is a supervising psychologist at the Hincks-Dellcrest Centre, specializing in the areas of trauma, attachment and psychotherapy. He is lead investigator in a multi-site program to treat intra-familial trauma and has over 20 years of clinical experience in the field.
Muller’s lab is funded by the Provincial Centre of Excellence for Child & Youth Mental Health at the Children’s Hospital of Eastern Ontario.
For more information about the book, click here.