Symptom Resistance

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

“It was an important discovery for me,

when I discovered in my patients

unconscious need

preserve their diseases."

Joyce McDougall "Body Theaters"

The article is not about acute, but about chronic symptoms. The text of the article is the result of a reflexive therapeutic experience of working with clients with a symptomatic request.

When dealing with a chronic symptom, you inevitably encounter strong client resistance. This resistance is usually unconscious and is aimed at keeping the symptom. Even Z. Freud wrote about this at one time, calling such a phenomenon - secondary benefit of a symptom.

Let's try to understand the essence of this phenomenon. What caused the resistance? What is the client resisting? How to overcome it? In what cases is it not necessary to do this?

I will list the main reasons for the resistance of the symptom:

- habit;

- loss of the established identity;

- loss of the usual ways of satisfying the need;

- loss of a manipulative way of solving the problem;

- the need to revise the value system;

- loss of familiar meanings;

- loss of existing meanings for loved ones;

- fear of change.

I will dwell in more detail on the reasons highlighted above.

Habit

The initially arisen symptom interferes with the person, does not fit into his established ways of life, makes him change patterns of behavior, form new habits. However, over time, the "symptomatic way of life" becomes automatic. The severity and intensity of unpleasant sensations decrease and become chronic. The symptom, initially being an element of the clinical picture of the disease, eventually grows into the structure of the personality and can even become one of its features.

The symptom shifts the focus of the client's attention from his psychological problem (problems of relations with oneself, the Other, the World) to himself. Emotional I-experiences are shifted into the realm of sensations and experiences about the symptom. As a result, a person receives a temporary weakening of anxiety - it goes from acute to chronic and ceases to be realized and experienced as a problem. On the periphery of consciousness, only undifferentiated anxiety remains.

As a result, the person becomes fixated on the symptom - falls into the trap of the symptom - and stops growing personally. Much of the energy of personal growth turns out to be directed towards living with the symptom and trying to overcome it.

Over time, he learns to live with the symptom, gets used to it. And habits are not easy to change.

Loss of established identity

A symptom that has grown into the image of the I becomes a part of it, a component of a person's identity. The symptom actually arises at the place of the “hole in the identity” with the aim of plugging it (G. Ammon). In this case, getting rid of the symptom would inevitably lead to a change in identity.

But the person does not yet have another - "asymptomatic identity". Changing your identity is not easy. For this, there must be some serious reasons, such as a personal crisis or some kind of "stunning" personality event. And the person stubbornly maintains an already established identity based on the symptom and supporting it.

Loss of habitual ways of satisfying a need

With the help of a symptom, as you know, a person gets the opportunity to satisfy a number of his needs. The symptom provides him with the opportunity to receive, the attention of others, care, love, rest, the opportunity not to do something that you do not want, etc. The symptomatic way of contact opens up the opportunity for a person to get away from an unpleasant situation or from solving a difficult problem.

In the case of resorting to a symptom to satisfy a social need, a person has the opportunity not to directly ask others about it. It is a crooked, often manipulative way of contact that allows you to ask for something without asking.

Consequently, refusing a symptom, a person will have to abandon his usual ways of satisfying needs, to look for other, asymptomatic ways - more direct ones, which, for a number of reasons, are not yet available to him. See my article "Psychosomatic Games" about this.

The need to revise the value system

A chronic symptom (especially a severe one associated with disability) inevitably changes the value system of the individual. For such a person, the value of health is at the top of the pyramid of his values. And values, as you know, determine the goals and objectives of the individual, form his trajectory of development. The prospect of getting rid of the symptom will inevitably lead to a revision of human values. And this will require additional efforts and awareness from him.

Loss of established meanings for loved ones

The symptom over time becomes overgrown with different meanings. This applies not only to the bearer of the symptom himself, but also to those people who surround the person. Close people living with a carrier of a chronic symptom are inevitably forced to be included in the current “symptomatic situation”. They have new functions and responsibilities. Some do it out of compassion, some out of guilt, some out of duty. In some cases, the symptom can even become the meaning of life for the person living with the bearer of the symptom. In this case, the prospect of getting rid of the symptom in their loved one may cause resistance from the family system, or from its individual interested members. See my article "Symptom as a Systemic Phenomenon"

The above reasons for the resistance of a symptom, as a rule, are not recognized by a person. Not being aware does not mean that they are not available to him. For the person himself, they most often manifest themselves in the form of fears. The main fear here is the fear of change. This common fear includes a number of specific fears:

• fear of changes in the usual ways of life
• fear of identity changes
• fear of losing familiar life meanings and values.

In symptom therapy, it is necessary to meet the client's highlighted fears, work through them and overcome them.

The mere awareness of the causes and mechanisms of a symptom is often not enough for its disappearance. This is just the beginning of working with him. The most difficult thing for the client here, no matter how strange it may seem, is to abandon the symptom, replacing it with another - asymptomatic way of life. It is important, before giving up a symptom, to find and master another, more effective way of life, more productive forms of contact with the world, others and with oneself.

The main questions to work with at this stage will be the following:

• How to learn to live without a symptom?
• How to fill the void formed at the site of the symptom?
• How to replace it?
• How to build an asymptomatic identity?

At this stage, therapeutic experimentation becomes appropriate, allowing the client to meet and experience new experiences and assimilate them into their new identity.

Otherwise, the client, deprived of the usual, symptomatic forms of life, turns out to be disintegrated and confused. And he has no choice but to either return to the usual symptom, or replace it with another.