Psychological resistance

Psychological resistance is the phenomenon often encountered in clinical practice in which patients either directly or indirectly exhibit paradoxical opposing behaviors in presumably a clinically initiated push and pull of a change process. It impedes the development of authentic, reciprocally nurturing experiences in a clinical setting. It is established that the common source of resistances and defenses is shame, further its pervasive nature in trans diagnostic roles are identified. Psychological resistance is the phenomenon often encountered in clinical practice in which patients either directly or indirectly exhibit paradoxical opposing behaviors in presumably a clinically initiated push and pull of a change process. It impedes the development of authentic, reciprocally nurturing experiences in a clinical setting. It is established that the common source of resistances and defenses is shame, further its pervasive nature in trans diagnostic roles are identified. Examples of psychological resistance are perfectionism, criticizing, contemptuous attitude, being self-critical, preoccupation with appearance, social withdrawal, need to be seen as independent and invulnerable, or an inability to accept compliments or constructive criticism. The discovery of resistance (German: Widerstand) was central to Sigmund Freud's theory of psychoanalysis: for Freud, the theory of repression is the corner-stone on which the whole structure of psychoanalysis rests, and all his accounts of its discovery 'are alike in emphasizing the fact that the concept of repression was inevitably suggested by the clinical phenomenon of resistance'. In an early exposition of his new technique, Freud wrote that 'There is, however, another point of view which you may take up in order to understand the psychoanalytic method. The discovery of the unconscious and the introduction of it into consciousness is performed in the face of a continuous resistance on the part of the patient. The process of bringing this unconscious material to light is associated with pain, and because of this pain the patient again and again rejects it'. He went on to add that 'It is for you then to interpose in this conflict in the patient's mental life. If you succeed in persuading him to accept, by virtue of a better understanding, something that up to now, in consequence of this automatic regulation by pain, he has rejected (repressed), you will then have accomplished something towards his education...Psychoanalytic treatment may in general be conceived of as such a re-education in overcoming internal resistances'. Although the term resistance as it is known today in psychotherapy is largely associated with Sigmund Freud, the idea that some patients 'cling to their disease' was a popular one in medicine in the nineteenth century, and referred to patients whose maladies were presumed to persist due to the secondary gains of social, physical, and financial benefits associated with illness. While Freud was trained in what is known as the (secondary) gain from illness that follows a neurosis, he was more interested in the unconscious processes through which he could explain the primary gains that patients derive from their psychiatric symptoms. The model he devised to do so suggests that the symptoms represent an unconscious tradeoff in exchange for the sufferer being spared other, experientially worse, psychological displeasures, by way of what Freud labeled a compromise formation; 'settling the conflict by constructing a symptom is the most convenient way out and the one most agreeable to the pleasure principle'. Thus, contrasting the primary gain (internal benefits) and secondary gain (external benefits) from illness, Freud wrote: 'In civil life illness can be used as a screen to gloss over incompetence in one's profession or in competition with other people; while in the family it can serve as a means for the other members and extorting proofs of their love or for imposing one's will upon them… we sum it up in the term 'gain from illness'… But there are other motives, that lie still deeper, for holding on to being ill… ut these cannot be understood without a fresh journey into psychological theory'. To Freud, the primary gains that stood behind the patient's resistance were the result of an intrapsychic compromise, reached between two or more conflicting agencies: 'psychoanalysis...maintains that the isolation and unconsciousness of this group of ideas have been caused by an active opposition on the part of other groups'. Freud called the one psychic agency the 'repressing' consciousness, and the other agency, the unconscious, he eventually referred to as the 'id'. The compromise the two competing parties strive for is to achieve maximum drive satisfaction with minimum resultant pain (negative reactions from within and without). Freud theorized that psychopathology was due to unsuccessful compromises – 'We have long observed that every neurosis has the result, and therefore probably the purpose, of forcing the patient out of real life, of alienating him from actuality' – as opposed to 'successful defense' which resulted in 'apparent health'.