Resistance

By: Dr. Suzanne LaCombe, draft version.

"It is a truism that no one comes into therapy to change. This is the reality of resistance."

(Author Unknown)

The above quote raises a few reservations for me on the concept of resistance.

The idea of "resistance" historically came from psychoanalysis. The analsyst's job was to provide insightful interpretations that explained the patient's actions or feelings as a way of increasing his or her awareness.

This insight was supposed to automatically change the client's problem behaviours and feelings. Today, we know that true insight works much differently and it's not enough to merely understand how you behaviour evolved.

Where it gets tricky is when a client objected to the analyst's interpretation, it might be dismissed and labelled by the psychoanalyst as a form of "resistance".

Within the context of the therapeutic relationship, the power was heavily weighted on the analyst. You can imagine then, how uncomfortable it might be for patients, especially if they weren't ready to hear it or the analyst got it completely wrong, which of course, is entirely possible.

The power differential between client and therapist also lends itself to potential misattunements if the countertransference is not well handled by the therapist.

Today, as I understand it, the focus in psychoanalytic circles is on helping the patient attain a state whereby the interpretation is timed for an optimal experience. In this way, the interpretation fits better with the patient's current view up to that point.¹ (Not all psychoanalytic therapists use this new approach however, so it's always best to be cautious--as it is for any therapist--when choosing a psychoanalyst.)

The use of "resistance" has gained widespread usage in many different psychotherapies. The concept is reflected in the difficulties in "breaking down" barriers with clients  (a poor choice of phrasing in my opinion). A therapist might express a frustration with how resistive a client can be in holding onto a pattern that they interpret as dysfunctional.

The inherent problem with this kind of thinking is that it implies the client is resistant for reasons that are not logical and/or that the client is engaging in irrational thinking. It is similarly believed that the client's unconscious is willingly engaging in these resistive patterns--for no good reason--and indeed, it forms a part of their "dysfunction".

A neurobiological perspective--in my opinion--offers a much more humane explanation for the resistance we all feel when we embark on change.

Briefly stated here are the important points to consider when you look at "resistance" in therapy from a neurobiological perspective:

• Early (i.e. developmentally) patterns of response that were adaptive, or in reaction to an overwhelming event (e.g. a traumatic experience), are imprinted in the nervous system.

• These automatic responses resist attempts at conscious or intentional modification. In other words, we can't change them just by wishing them away or by thinking differently (i.e. by left brain activity).

What's important to understand is that these patterned responses were adaptive when they were first laid down and they served as important strategies for survival.

From the point of view of the nervous system, this "resistance" to modification is a desirable feature, as it is energy efficient. That is, we won't waste energy relearning what we already know.

The downside is that, once imprinted in the brain systems, what were once perfectly good, adaptable survival strategies lose their effectiveness when the environment changes (i.e. when we grow up to be adults).

What was once "normal" (ie. adaptational) in the past becomes the root of what appears to be "abnormal" behavior in the present.

"An abnormal reaction to an abnormal situation is normal behaviour.".

Victor Frankl, Concentration-Camp Survivor

These procedural patterns are right-brain-based and are best approached from this perspective. That is, if we appreciate that the roots of our resistance are fear-based, then, given enough safety in the environment (which often means in the relationship), the individual is better able to move past what's holding them back.

This safety is achieved in moments of attunement, repairs of attunement and re-attunement in a therapeutic relationship or otherwise, a deep relationship with a trusting significant other.

...which is why choosing the right therapist, one you feel is attuned to you, is all the more important. An attuned therapist makes you feel emotionally safe.

Obviously, I there's much more to say on the subject...until then. Dr. Suzanne LaCombe.

Note

1I am not an expert in psychoanalysis. I am drawing on the few experiences I have had with the treatment model and my limited reading on the subject. Please do no hesitate to post comments if you feel I have not adequately captured it.

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