Academic journal article Journal of Cognitive Psychotherapy

Resistance, Reactance, and Reluctance to Change: A Cognitive Attributional Approach to Strategic Interventions

Academic journal article Journal of Cognitive Psychotherapy

Resistance, Reactance, and Reluctance to Change: A Cognitive Attributional Approach to Strategic Interventions

Article excerpt

The metaphor of resistance supports a view of psychotherapy as a struggle against patients' willful opposition. Strategic psychotherapy claims a special efficacy in working with resistant interactions through a shift in metaphor from resistance to the notion of joining. This paper provides a rationale for the application of joining interventions in terms of cognitive attribution theory. The same conservative cognitive processes that give rise to symptoms also result in many of the interactional phenomena of resistance. Attributions of causality and control to self or other lead to cognitive processes of dissonance reduction, reactance, emotional exacerbation, and withdrawal. The broad concept of resistance can then be replaced by a more detailed description of cognitive modes allowing psychotherapists to tailor interventions to the specific cognitive mechanisms that maintain symptoms. The cognitive attributional approach to resistance makes it apparent that there is no need for subterfuge or misdirection in strategic psychotherapy.

Strategic psychotherapy has claimed a special efficacy in working with resistant clients (Dowd & Milne, 1986; Fisch, Weakland & Segal, 1978; Rabkin, 1977; Shoham-Salomon & Rosenthal, 1987). However, the theory of strategic therapy has been couched in logical abstractions distant from psychological reality (Watzlawick, Weakland, & Fisch, 1974) making it difficult to integrate with other modes of psychotherapy. This article is an attempt to ground the techniques of strategic psychotherapy in the theoretical framework of cognitive social psychology. The emerging metapsychology of cognitive psychotherapy can provide a coherent rationale for the effectiveness of strategic interventions (Liotti, 1987). Such a cognitive theory can guide the utilization of paradoxical injunctions and other strategic techniques, provide a framework for empirical studies of treatment efficacy, and address the ethical problems of strategic therapy by demonstrating why there is no need for deception.

In this article I will suggest that there is a class of problems commonly presented to psychotherapists in which the mechanisms of symptom persistence and psychotherapeutic resistance involve the same conservative cognitive processes that act to maintain an adaptive level of coherence and consistency in the person's selfrepresentation. These conservative cognitive processes are selected by attributions of cause and control to self or other and are amplified by self-awareness. The paradoxical interventions of strategic psychotherapy work by first joining and then changing clients' attributions of the cause and control of their behavior. A shift in attributions modifies the underlying conservative cognitive process to promote behavioral and attitudinal change.

SYMPTOM PERSISTENCE AND RESISTANCE

The Metaphor of Resistance

Psychodynamic theory tends to situate resistance entirely within the patient (Lewis & Evans, 1986). But the metaphor of resistance hides a conflict between clients' experience that they cannot change and therapists' presumption that they simply will not. The therapist who labels a client's behavior "resistance," attributes willfulness to the client where the client may have experienced only powerlessness and loss of control. Occasionally, this attribution may help clients to view themselves as more powerful. However, the contrast between the client's "can't change" and the therapist's "won't change" is problematic because it also conveys a moral distinction between actions that people are held responsible for and those actions or events that just happen to them as accidents. As such, the metaphor of resistance carries a weight of moral pejoration in which clients are held responsible for their own misery. While this may absolve therapists of responsibility for failure with highly resistant clients, this stance can also lead to a counter-therapeutic nihilism. …

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