Some Types Of Resistance And Their Meaning

Video: Some Types Of Resistance And Their Meaning

Video: Some Types Of Resistance And Their Meaning
Video: What is Resistor? Different Types of Resistors and Different Characteristics of Resistors 2024, March
Some Types Of Resistance And Their Meaning
Some Types Of Resistance And Their Meaning
Anonim

The psychotherapist's attitude towards a difficult client depends not only on his general theoretical orientation, but on the importance attached to the behavior of a particular client at a given moment in time. Resistance can be a perfectly normal and healthy attempt by the client to pause the process until a detailed analysis of the consequences of the coming changes can be made. The cause of resistance can also be expressed disorders of character. Resistance is used to avoid discomfort and may also be due to fear of success. Resistance may be motivated by self-punishment, or it may reflect rebellious sentiments. It can be caused by neurological disease or even annoying family members. In the context of sexual dysfunctions, resistance is classified according to the cause (Munjack & Oziel, 1978). Expanding the approach proposed by the authors to a broader population of clients, five types of resistance can be distinguished, due to different reasons and, accordingly, requiring different approaches.

Type I resistance - the client simply does not understand what the therapist expects from him. Clients who are prone to this kind of resistance often have a poor understanding of the mechanisms of action of psychotherapy or have an overly concrete mindset. One client said, when asked how he ended up with a therapist, that he took the bus. In this case, we are not talking about an attempt to joke or evade a direct answer: the person simply did not understand for what purpose the question was asked. Problematic behavior of a client with type I resistance is associated with the client's naivety or ambiguous questions from the therapist, sometimes with both. Having discovered the cause of misunderstandings, the psychotherapist can adjust his expectations, the distribution of roles and goals of psychotherapy, and in the future, when communicating with this client, will be expressed more accurately.

With type II resistance, the client does not cope with the prescribed tasks, because he does not have the necessary knowledge or skills. This does not mean that the client is deliberately opposing the therapist, he is simply not able to do what is asked of him. "How do you feel now?" - several times the psychotherapist asks a young woman who is clearly upset about something. The client replies “I don’t know” with increasing irritation, because she really doesn’t know, at the moment she cannot accurately describe her feelings. The way out of the predicament is quite obvious: ask clients to do only what they are currently capable of, at least until they have acquired new skills.

Type III resistance is due to insufficient motivation, clients are apathetic and indifferent to all actions of the psychotherapist. This behavior may be the result of previous failures in psychotherapy or a lack of faith in oneself. According to Ellis, clients' resistance is most often based on their unrealistic demands on the surrounding reality ("People are not fair to me") and defeatist attitudes ("My situation is hopeless and will never improve") (Ellis, 1985). Some clients are especially difficult to communicate not only because of their irrational beliefs, but also because they meet with hostility any attempt to challenge these beliefs. Type III resistance manifests itself when the client rejects any attempts to establish cooperation with him: “Why waste time talking with you? Nothing will change at all. My wife will leave me all the same. At least my depression allows me to postpone this moment."

The intervention strategy for this type of resistance also logically follows from its premises. The task of the therapist is to instill hope in the client, as well as to find possible sources of reinforcement for him. In the case described above, the client was made clear that if his own mood worries him a little and is unlikely to be able to save the marriage, he should consider the impact of his behavior on the children. This served as an excuse for the client to improve his life for the sake of children who suffered from a lack of parental care.

Type IV resistance is a "traditional" variation on the theme of guilt and anxiety and is recognized primarily by psychoanalysts. In the process of therapy, the effectiveness of defense mechanisms decreases, previously suppressed feelings come to the surface, which, in fact, forces the client to resist. The work can proceed smoothly enough, as long as the pain points are not affected, then the client, willingly or unwillingly, begins to sabotage further progress. Most often, the leading force here is the fear of sharing personal experiences with a stranger, fear of the unknown, fear due to the experience of past attempts to get help, fear of feeling judged, fear of pain that inevitably accompanies the study of personal problems (Kushner & Sher, 1991). Dealing with such resistance is the main strong point of insight-oriented psychodynamic therapy: providing support, building trust, facilitating the client's self-acceptance process and, when the opportunity arises, interpreting the situation.

Type V resistance is due to the secondary benefits the client receives from their symptoms. In general, most examples of self-harm that we see in clients (or ourselves) revolve around a few core themes (Dyer, 1976; Ford, 1981). Take, for example, a client with a chronic somatisation (psychosomatic) disorder who is absolutely not amenable to therapy. Regardless of whether his condition is a manifestation of Munchausen's syndrome, that is, a complex artificially cultivated disease, or more common hypochondria, the client receives a number of benefits from this, which makes change unlikely.

Whatever symptoms we are talking about: feelings of guilt, obsessive reflections, outbursts of irritation, secondary benefits create a kind of buffer between the client and the outside world.

1. Secondary benefits allow the client to postpone decision-making, do nothing. As long as the client is able to distract us (and himself) from his favorite method of acting out, he does not need to take risks, embarking on the path of personal growth and change.

2. They help the client to avoid responsibility. “It’s not my fault / I couldn’t do anything” are the most frequent statements of difficult clients who tend to shift the responsibility for their problems onto others. Blaming others for their suffering, wanting to punish imaginary enemies, such clients are oblivious to their own role in creating problems.

3. They help the client maintain the status quo. As long as the focus is on the past, there is no way to deal with the present and the future. The client is in a safe, familiar environment (no matter how terrible it may be), he does not have to do hard work to change the established lifestyle.

One client, who vehemently resisted any attempt to force him to admit his need to end all intimate relationships, ended up listing all the secondary benefits he received:

• Left alone, I begin to feel sorry for myself. The fault of others is that they do not understand me.

• Many sympathize with me, feel sorry for me.

• I prefer to call myself “difficult” rather than “difficult”. I like to be different from your other clients. In this case, you really have to pay extra attention to me.

• As long as I break off relations with a person, before he has time to get to know me intimately, I will not have to change and learn to build a mature, adult relationship. I can remain selfish and condescending to myself.

• The existence of this problem allows me to justify myself - because of it I have not achieved great success in life. I am afraid that, having resolved this problem, I will be forced to admit that I am unable to achieve my goals. For now, at least I can pretend that if I wanted to, I could achieve whatever I want.

• I like to think about the fact that I will end a relationship of my own free will before anyone else thinks of leaving me. As long as I control the outcome of the situation, it is not so painful for me.

By challenging these strategies and forcing the client to accept that the goal of the games they are playing is to avoid change, we take an important step and help the client accept responsibility for their lives. Secondary benefits are valuable only as long as the clients do not realize the meaning of their actions, as soon as the background of their behavior comes to the detriment of themselves, clients are more inclined to laugh at themselves than to take up the old. By combining a confrontational strategy with a systems approach to eliminate reinforcing secondary benefits external factors, it is often possible to significantly reduce client resistance.

Jeffrey A. Kottler. The compleat therapist. Compassionate therapy: Working with difficult clients. San Francisco: Jossey-Bass. 1991

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