Theoretical literature is contradictory in most areas, but virtually all theories agree on the existence of patient resistance and propose similar implications, meanings, and effects of its manifestation. However, theories differ widely in both the assumed causes of resistance and the methods of dealing with resistant patients. Common to various theoretical definitions is an assumption that resistance is both a dispositional trait and an in‐therapy state of oppositional, angry, irritable, and suspicious behaviors. Reactance is a special class of resistance that is manifest in oppositional and uncooperative behavior. Resistance bodes poorly for treatment effectiveness. Nondirective and paradoxical strategies have been found to be quite successful in overcoming resistant and reactant states, while matching low‐directive and self‐directed treatments with resistant patients circumvents the effects of resistance traits. © 2002 John Wiley & Sons, Inc. J Clin Psychol/In Session 58: 207–217, 2002.