There are of course many therapists who would question the basic assumption of resistance and reframe it as therapist incompetence. But if you must, you might think along the lines of measures of noncompliance, or failure to complete assignments. Seef for example Assessment of homework completion. By Kazantzis, Nikolaos; Deane, Frank P.; Ronan, Kevin R.

Kazantzis, Nikolaos (Ed); Deane, Frank P. (Ed); Ronan, Kevin R. (Ed); L'Abate, Luciano (Ed). (2005). Using homework assignments in cognitive behavior therapy (pp. 61-72). New York, NY, US: Routledge/Taylor & Francis Group, xiv, 436 pp.

The process of learning through completion of homework assignments can serve several functions. Homework enables the collection of data to evaluate thoughts and beliefs, provides an opportunity for the learning and maintenance of adaptive skills, and shifts the focus of therapy to the more objective and concrete. In many ways then, a client's completion of homework assignments is important in ensuring the short- and long-term benefits of therapy. In addition, it is usually of clinical and conceptual interest when clients do not undertake homework activities, are able to undertake only part of the homework activity, or decide to engage in activities different from those discussed in their therapy sessions. However, homework noncompliance also has a role to play in therapy. At the very least, noncompliance provides the opportunity to obtain further information for the cognitive conceptualization and to review treatment goals--both of which are likely to improve treatment outcome. Since homework assignments were originally conceived as an opportunity for gathering information and learning, we propose that "compliance" is an imprecise construct for measuring a client's engagement with homework activities. The aim of this chapter is to discuss the issues in assessing homework completion in cognitive behavioral therapy. We begin by discussing the definition of homework completion, review existing measures available in the literature, and propose a new measure of homework completion drawing on the theoretical basis for homework outlined in Chapter 2. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

I 100% agree and feel like that is how "resistance" in conceptualized  these days (I hope). Thanks for being a client advocate! My whole paper is about how resistance is indicative of a poor therapeutic alliance on the therapist side.... but I need a standard set of criteria to 1. show the IRB that I am being ethical in recruiting client participants and 2. to define "resistance" for clinicians in a way that is standard and more valid. I'd prefer something that looks at the therapist's behavior and attitude as a way to measure the level of discord in the relationship, but alas.... 

If you're really focusing on therapist error as a course of treatment failure, then you probably ought to be up-front about this - I can't imagine your IRB objecting to that.

Your best bet, in this case, might be to use assessment procedures developed in the Motivational Interviewing tradition. The link below will get you into a NIDA system meant to facilitate training and evaluation of MI therapists. The Word file is a training manual used in New Jersey's corrections department.

What you may not like here is that the scales generally require someone to observe the session. Which makes sense when you think about it, but means a lot more work for the researcher.

If you decide to go with resistance as such (and it isn't always therapist error! Most of us are ambivalent about change), then you might check out Hazari et al. (2013), "The clinical utility of different quantitative methods for measuring treatment resistance in major depression," from the Journal of Affective Disorders. (No, I do not have a PDF copy.) Or any of a number of articles about measuring treatment resistance in other conditions.

Another option would be to assess denial of illness. I'm attaching one sample of a scale used for this purpose.

The options, by the way, are not mutually exclusive.

https://www.drugabuse.gov/sites/default/files/files/MIA-STEP_Factsheet.pdf

The point of the study is not to place blame on party or the other (because it's not that simple nor it that helpful), but to examine the interactions and relationship dynamics that create friction in the relationship. I was asking about ways to determine if discord (resistance) exists in specific therapeutic relationships to standardize how clinicians are determining which relationships are challenging. I want to demonstrate that client selection is not being influenced by harmful biases. Idealy, I'd be able to test for both therapist and client factors (without attributing blame) that might indicate a potentially poor alliance across different presenting problems/ diagnoses. I am not seeing tools that don't place blame on one party or the other that are appropriate. Thanks anyways! These articles are fascinating.

If you are interested in the patient-therapist relationship, that should be the focus. It places or emphasises the dynamic relationship between "the two frightened people in the room" (Wilfred Bion.) I am from a psychoanalytic background and thus will perceive this question in a very different way. Since the relationship is the single most important factor in psychotherapy, regardless of whether it is CBT, psychoanalytic, etc we look at the moment-by-moment happenings in a session.

We would begin with a single case study which would be repeated again and again in order to build up clinical knowledge of what takes place between the patient and therapist and only after multiple studies can we begin to generalise. The work of RD Hinshelwood would be very important here. Hinshelwood is a British Kleinian whose work has included single case studies as a viable format.

You might also enquire into the work of Lester Lubosky and Paul Crits-Christoph who deveoped a "manualised" system which might be helpful to you. I know the Menniger Clinic has done a great deal of work through Lubosky's ideas - although there are those who are critical because of the assumptions he makes - we all make assumptions!

I am somewhat puzzled by your reference to "resistance" and "challenging". All patients are challenging in one way or another. Similarly, therapists are also challenging to the patient! We (I) do not necessarily respond in the same way to all patients; it is dependent on my understanding of the patient.

It is also the question of how you understand "resistance." There are many reasons for "resistance" in a patient, including defence mechanisms which require the therapist to understand. This is especially important because in some patients, breaking down a resistance too soon could lead to a "break-down." That is, either the patient's vulnerability is too overwhelming; or the break-down in the relationship itself.  Understanding the meaning of "resistance"or how you define resistance is therefore important. I am uncertain as to what you mean; and it can also seem to be something that is objectively problematic, rather than a normal part the therapeutic relationship. Can "resistance" be objectively described? Can the therapist aslo be "resistant"? I think that is also possible.

I am concerned about how human relationships can be "generalised" in such a way that we forget that the therapist is not objective in a way that scientific methodology is objective. To give an example, in the UK, which is where I was trained, psychoanalytic or psychodynamic models have to be "manualised" else there is no NHS (National Health Service) funding. Some very accomplished psychoanalysts like Prof. Peter Fonagy and Prof. Alessandra Lemma etc have developed "manualised" versions of "mentalisation" and also developed "Dynamic Internpersonal Psychotherapy (DIT) which means than non-psychoanalytic clinicians or even non-therapists eg nurses can follow a manualised format. It was done on the basis that preserving psychodynamic therapy in the NHS is better than nothing.

Nevertheless, the idea we can or should manualise or generalise involves philosophical questions as well. There will always be natural incompatibilities between patient and therapist, but the question is whether both parties are sufficiently committed to work at the relationship. It has been my experience that working through these "break-downs" are far more important and can lead to the patient (and therapist) really gaining insight into their relationships outside the consulting room. Since the concept of transference is crucial, these working-throughs in therapy are taken "outside" by the patient.

For me, understanding why is there an impasse is vitally important. The patient could be "diagnosed" as being "resistant" but I believe it is far more complex. Another question that comes to mind is how do you recognise and isolate "resistance"?

Sorry if this is unhelpful to you, but I am fascinated by your study.

Kind regards,

Ros

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The mechanisms of resistance may be evaluated case by case, but, not measured, because there will not be a patient which reacts the same way as each other. We are in the relative subjectivity universe, and not in the field of objectivity. The resistant to the imputes or therapeutic inductions should be treated with sharped empathy and high understanding, as their fears, panic and frustration, complexes and low self-esteem block his person and unleash their enormous suffering.