Resistance in Therapy

A cornerstone in Freud’s theory of psychotherapy is the theory of resistance.

The idea is that the patient will resist change is his/her life and in psychotherapy to a certain extent. This is due to painful feelings that have been previously repressed coming to the surface during therapy. The patient wants to get better, but will resist feeling the pain. This is a natural human impulse: the resist and avoid pain. The therapist must help the patient deal with and accept that pain is a part of the process of getting better in psychotherapy.

Another related theory is that some patients feel they stand to gain something from suffering and feeling bad. They may find it  difficult to get better unless this is dealt with. One common gain is that the pain associated with the symptoms will feel safer and better for the patient than feeling some deeper (and unconscious) pain. Its a trade off.

For some people feeling good and happy is associated with pain and danger, so in therapy they might resist getting better. Being unwell is safer even if it does not feel good.

Being unwell or suffering can in some cases be experienced as being in control. You might feel powerful as someone who is suffering and it can be a way to get attention and love from people around you. Maybe as a child you only got attention when you were sick or unwell.

Resistance in therapy can also be associated with what Freud described as repetition compulsion. It is the need to repeat old patterns in order to solve them. Giving up the pattern or the problem can feel like losing something important or losing connection to a person or a feeling. When we identify with our problems and suffering that we have known since childhood we might resist letting go of it completely. We hold on to what we know and identify with.

Resisting change is a common phenomenon in many of us. As human beings we survive by being in control and knowing what is going on. Any change can feel threatening to the status quo even if it’s a change for the better. Even if it means holding on to a problem.

Resistance may show in following ways during psychotherapy:

canceling or rescheduling appointments

avoiding important issues in therapy

being angry with the therapist

forgetting to complete homework assignments

downplaying the importance of an issue

getting better suddenly

For some clients resistance is more prevalent and more difficult to deal with. For others resistance can more easily be dealt with and worked through. If resistance is more prevalent it may interfere with the therapeutic process, yet trying to push through it will make it worse. So in my work as a therapist I will attempt to work with resistance rather than against it. This way the patient can feel a sense of control during the process and slowly learn to trust that underlying feelings can be dealt with safely in time.