In Session: Psychotherapy in Practice最新文献

The phenomena that comprise “resistance” in therapy are described and discussed from a cognitive viewpoint. The cases of Brian, Julie, and Victoria are reviewed to illustrate similar and contrasting manifestations of resistance, and suggestions for further individualized conceptualization and intervention are presented. Emphasis is placed on gaining an accurate, empathic understanding of the client's difficulties in changing. This is coupled with methods that allow the client some autonomy in charting the course of therapy, while reinforcing the importance of the therapist's active involvement in educating and stimulating the client toward greater awareness and adaptability. In order to be maximally effective in encouraging such changes, therapists must be aware of their own tendencies to react adversely to client resistance. It is vital that therapists maintain their professionalism and confidence in persevering toward a better understanding of what will be helpful to their clients. © 1996 John Wiley & Sons, Inc.

In this article, resistance is looked at in an integrative way that attempts to abstract and synthesize the main assumptions made by the different therapy approaches. The phenomena of resistance can be seen at the behavioral, interpersonal, cognitive, and affective levels. A set of integrative working assumptions are proposed in which resistance reflects meaningful information about clients' conflicts among various aspects of themselves relating to change. In addition to this intrapersonal perspective, resistance is also seen as determined by interpersonal factors, and can occur with or without conscious awareness. Integrative approaches to working with these conflicts are described. © 1996 John Wiley & Sons, Inc.

Theoretical literature is contradictory in most areas, but virtually all theories agree on the existence of patient resistance. Furthermore, these theories propose similar views regarding the implications, and effects of resistance. 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. While the focus of this article is on resistance as a general phenomenon, the vast majority of research has given particular attention to a special class of resistance that is the reaction against the sense of being controlled by others. This “reactance” is manifested in oppositional, angry, and uncooperative behavior. In both its general and more specific forms, resistance bodes poorly for treatment effectiveness. However, nondirective and paradoxical strategies have been found to be quite successful in overcoming resistant and reactant states. In addition, matching low-directive and self-directed treatments with potentially resistant patients tends to attenuate the negative effects of resistance traits. © 1996 John Wiley & Sons, Inc.

The concept of resistance, having been used over the years with differing meanings in a variety of theoretical perspectives, no longer has any real clarity of meaning. Since it has the inherent danger of being demeaning to the client and of diminishing the possibility of the achievement of a mutually collaborative dialogue between therapist and client, I believe that its use within psychotherapeutic discourse should be discontinued. © 1996 John Wiley & Sons, Inc.

The case of Victoria illustrates psychotherapy with a woman faced with a difficult and unexpected divorce. The authors present a summary of typical struggles faced by Victoria through three phases of therapy. The therapy focused initially on coping with the divorce, then moved to work on her career dissatisfaction and, finally, to her efforts to develop a new relationship. The case presentation illustrates resistance as it manifested itself in both a behavioral manner and as in-session resistance to awareness of internal states. The behavioral mode of resistance is manifested by her inability to follow through on decisions made in therapy sessions and by her interruptions of ongoing therapy. The resistance to awareness is illustrated by a transcript of a typical in-session exchange. The authors also describe interventions intended to work with the resistance. © 1996 John Wiley & Sons, Inc.

Brian, a 36-year-old, single, white male, entered cognitive therapy in response to a depressive episode, precipitated by the loss of a job. In addition to his Major Depression, the client met diagnostic criteria for Dysthymia and Personality Disorder Not Otherwise Specified. The first three sessions focused on Brian's unemployment crisis and related dysphoria, as well as his passive-avoidant approach to life. Brian collaborated with the therapist in formulating a treatment plan and quickly found a new job, whereupon he abruptly withdrew from therapy. Shortly thereafter, Brian contacted the therapist in a renewed state of “crisis,” and returned for a fourth session. The therapist attempted to draw a link between Brian's passive-avoidant style and his vulnerability to problems such as those he was currently experiencing. The client had difficulty understanding the therapist's thread of logic, became somewhat defensive and combative, and did not return for further sessions. © 1996 John Wiley & Sons, Inc.

This article discusses resistance in psychotherapy using the contemporary interpersonal communication model of psychotherapy. This perspective defines resistance as moments during sessions when the patient and therapist are interacting with one another in such a way that the patient is kept from becoming aware of any covert experiences or transactional patterns that are conflictual and anxiety provoking. The ways in which resistance may be conceptualized and worked with are discussed and applied to three patient vignettes, with an emphasis on working with resistances as they are manifested in the patient-therapist relationship. Some of the potential reactions of the terapist to resistance are discussed, including some relatively beneficial and some problematic instances. © 1996 John Wiley & Sons, Inc.