Resistance – Psychodynamic Psychiatry Fifth Edition – Glen O. Gabbard



sisyphus (Photo credit: AK Rockefeller)

p. 22      RESISTANCE

“… the patient’s wish to preserve the status quo, to oppose the treater’s efforts to produce insight and change.  In his early papers on technique, Freud (1912/1958) had already noted these powerful oppositional forces:  ‘The resistance accompanies the treatment step by step. Every single association, every act of the person under treatment must reckon with the resistance and represents a compromise between the forces that are striving towards recovery and the opposing ones.’

Resistances to treatment are as ubiquitous as transference phenomena and may take many forms, including being late for appointments, refusing to take medications, forgetting the psychiatrist’s advice or interpretations, being silent in therapy sessions, focusing on unimportant material during sessions, forgetting to pay the therapy bill, to name only a few.

Resistance may be conscious, preconscious or unconscious.  All resistance has in common an attempt to avoid unpleasant feelings, whether anger, guilt, hate, love (if directed towards a forbidden object such as the therapist), envy, shame, grief, anxiety, or some combination of these.

The dynamic psychiatrist expects to encounter resistance to treatment and is prepared to address the phenomenon as part and parcel of the treatment process. Whereas other treaters might get angry when their patients do not comply with prescribed treatments, dynamic psychiatrists are curious to know what this resistance is protecting and what past situation is being reenacted.”

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