Academic journal article American Journal of Psychotherapy

Resistance: Friend or Foe?

Academic journal article American Journal of Psychotherapy

Resistance: Friend or Foe?

Article excerpt

This paper shows resistances in a benign light. The view is presented that psychoanalysts able to view resistances in a friendly light as challenges and guides, rather than as onerous roadblocks, experience maximum success for the patient and maximum satisfaction for themselves. The use of psychoanalytic technique to this end is demonstrated.


When patients enter my consulting room to begin analysis, they are in pain but they don't understand why. They are not aware that the pain is the result of unconscious conflicts and compromise formations that can cause disabling symptoms: anxiety reactions, depressive affect, phobias, and compulsive acts. We all have wishes, fantasies, and desires based on libidinal (sexual and aggressive) drive derivatives. These are constantly pressing for discharge and are cathected with a great amount of psychic energy. At the same time, a counter-cathexis of energy blocks off the ego's capacity to master the excitation and stimulation of these derivatives. "The neurotic conflict, by definition, is one between a tendency striving for discharge and another tendency that tries to prevent this discharge"(1) (p. 129). This conflict takes place between the id and the ego. The psychoanalytic theory of conflict has been expanded by Brenner(2) who states, "It is unpleasure that is responsible for defense and conflict, in connection with infantile instinctual wishes and, further, that this unpleasure is of two kinds, anxiety and what I call depressive affect" (p. 7).

It is the analyst who must understand patients in ways they cannot understand themselves by exploring with them a world new to them, the world of the unconscious. In order to unlock, enter, and journey through the unconscious, the analyst must be an authority of unconscious processes with an in-depth knowledge of psychoanalytic theory and technique. This knowledge when coupled with empathy enables the analyst to learn how patients relate (transference) who, then, can bring into consciousness the unconscious world of the patient. For patients to change and grow, their egosyntonic behaviors and character traits must become ego-dystonic so they may experience them consciously and thereby expand the ego. When the unconscious becomes conscious, the ego expands and can tolerate the stimulation, excitation, frustration, and anxiety produced. At that point, patients use this conscious information to help change their lives. Psychoanalysis is an emotional experience, not an intellectual process.

By making the unconscious conscious, patients can and do develop insights leading to change, growth and the attainment of love but the route is seldom direct since patients are not aware of resistances. Resistance is a defense against insight. There is always a reason, often multiple reasons, why patients use a specific resistance. Both the analyst and patients must be comfortable with the search for them. Patients can never be comfortable with the search if the analyst is not. The more pejorative the analyst is toward resistances, the more resistant patients will become.

The analyst must help patients become friendly with the resistances thereby turning the work into an exploration rather than a battle. Even the word "resistance" can be anxiety producing. In the beginning of an analysis, it is useful to help patients become aware that they are not aware. To work with the anxiety produced by not knowing at the beginning of treatment launches the patients' role of exploration into the unknown. Careful attention must be paid by the analyst to any anxiety produced in patients at the point they begin to become aware that they are not aware of unconscious motivations. By sensitively, consistently and empathetically, exploring with patients the discomfort about not knowing, the course of analysis becomes an exploration. I tell patients, "The answers are inside of you. I will explore with you what they are." To speak of "exploring the unknown" with patients is, then, less likely to create fear in both patient and analyst than to use the word "resistance. …

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