Resistance

Resistance and Therapeutic Practice

Taking a new step, uttering a new word, is what people fear the most. [i](Dostoevsky) 

Resistance & Cessation 

The task of the skilled practitioner is to exercise command over their themselves & their interactions with clients & others – to manage themselves & their own responses – ensure they maintain maximum flexibility & dexterity in the therapeutic process –therapeutic relationship is collective cognition – inflexibility is cognitive death in any therapeutic process – the core skill in any therapeutic process is interactional flexibility – symmetrical and complementary interaction – organized living systems are predictable 

The concept of resistance has long standing currency in therapeutic practice through its origins in Psychoanalysis. Each new modality has either embraced the concept of resistance as originally defined[ii], or made some attempt to redefine resistance, usually with some difficulty. Resistance as an idea is certainly resilient and has defied attempts to rework it[iii] or get rid of it[iv]. 

This essay is about the application of the concept of resistance in the contextual approaches to therapeutic practice and service delivery, including family therapy and systemic practice, with particular reference to bower(method)and bower(note). 

Resistance is analogy[v]. Not everyone sees it this way. Other modalities in the domain of helping and social assistance[vi] see the concept of resistance as being literally true. This is a critical distinction. We as humans are uniquely designed for this distinction. Our extraordinarily elaborate and preposterous cognition relies on this distinction. We apprehend and process the literal through our reflexive command of analogy. Analogy is not amorphous or free floating, it ordinarily derives from our human experience of the literal. Simply, this is like that, and that is how we think, from the literal into the analogy and back again, each defining and describing the other, each an explanation and refinement of the other. The human brain is designed for this. It is unlikely that the idea of resistance is not both, analogy and literally so. 

Every practitioner, and every service delivery agency, in the domain of helping and social assistance must make up their own mind about this, about the relationship between resistance as analogy and resistance as having some literal existence. The practitioner certainly feels it, experiences resistance somewhere inside their own body. Transference maybe. That experience is both, it is literal, it is analogy, in one breath, in one moment. No, this is not transference. This is constraint. The distinctions matter. We need to explore this experience. How resistance is understood and conceptualized will shape the practice of that practitioner and agency, and it will shape the relationship with clients and patients. In this essay I will be recommending that practitioners and agencies embrace resistance as both, literally true and as analogy, as the most dexterous and flexible way to manage this most common and pervasive of experiences in therapeutic practice and service delivery. 

Psychotherapy, and its variant forms of personal and contextual service delivery, is a body centered, physical, visceral activity, notwithstanding its preoccupation with words and language in the exchange. It is not ethereal. These words are not disembodied. There are two or more real, physical, bodies in the exchange, in the room, in the space, online, or in some form. The voices, the language, the emotions, the movement, are all located, in, between, and connected to these bodies. The skilled therapeutic practitioner must have full command over themselves, over the body that is the vehicle for this exchange in language, over the presentation and movement of that body, over the voice, the sound of that voice, their use of that language, the specific words they use and don’t use, how well they articulate words, how those words are presented, and what those words represent and represented, how and where they position themselves, how close, how distant, face to face, alongside, eye to eye, the practical power differentials, and the specifics of the specific interactions that practitioner has with the client and everyone else.  

Psychotherapy is a hybrid exchange with a point and purpose, ordinarily about functional matters of relationship and morality, fractures in relationship, breaches of morality, now and in the past. Whilst the specific subject matter of each different modality may well vary, the exchange itself is most definitely carried by reciprocity and compassion[vii] moderated by ideas about inclusion and exclusion. Each modality has its own idea and theory about who is to be included in this therapeutic dialogue and who is excluded. Reciprocity is the ordinary give and take between the people engaged in a significant exchange with each other, in this therapeutic dialogue. This reciprocal exchange, this give and take, includes some people, and excludes most. It is circular and recursive, each side of the dialogue informing the other and acting as a catalyst for the other’s response. It is ordinarily about functional matters of importance in the life of one side of this dialogue (e.g., parenting, intimacy, love, relationships, trauma, etc.). This therapeutic dialogue peddles compassion, empathy, as a primary virtue of the dialogue itself, the absence of which contradicts the point and purpose of the therapeutic dialogue. The therapeutic relationship is intended to be a deeply compassionate and empathic exchange between the practitioner and the client or clients, carrying significant reciprocal characteristics to enable the functional matters of significance in that dialogue to be practically transacted. In other words, the therapeutic process peddles compassion, and a limited form of reciprocity, as its stock in trade. Every modality peddles compassion as its central virtue. Each modality has a different take on reciprocity premised upon its own definition of its point and purpose. It may be fair to suggest that each modality exploits compassion and empathy in a substantially similar way, to achieve each modality’s idiosyncratic definition of what reciprocal ends look like. That may well be where the different modalities part company with each other. Some modalities certainly privilege compassion and empathy as the pathway to change, often linking that to other virtues such as hope.  

The task of the practitioner is to exercise significant command over themselves and their interactions with the client(s) and others. Why? Because they are peddling private compassion and empathy for public purpose.  This means that the practitioner must manage their use of compassion and empathy in the exchange with the client(s) and others, and moderate this to achieve defined and reciprocal ends. Compassion and empathy are a given in this therapeutic process. Reciprocity is a negotiated part of that process. Different modalities negotiate reciprocity differently. Some modalities assume that therapeutic reciprocity is implicit in the problem. Others, such bower(method), locate the definition of therapeutic reciprocity in the contract for therapy itself.     

The peddling of private compassion and empathy, for broader public purpose, carries with it an inherent risk, and that risk has been well articulated by every modality from psychoanalysis to the present day. That is in the various definitions of resistance, transference and countertransference, which are deeply interlinked concepts. The truth is that, if compassion and empathy are to be exploited in this way by the practitioner, then that practitioner is going to feel and think things with, for and about the client(s) and others, that inform the reciprocal point and purpose of the therapeutic dialogue itself. These feelings and thoughts are not disembodied, they are not located somewhere else, they are located inside the body and specifically in the neurobiology of the practitioner. 

The therapeutic relationship is collective, and it is cognitive. The therapeutic process is a process of embodied cognition; a big, collective, physical, visceral, and continuous think. To this end, the practitioner must manage themselves and their own emotional, physical, and cognitive responses to the client(s) to ensure they maintain maximum flexibility and dexterity in the therapeutic process. Inflexibility is cognitive death to any therapeutic process. A core skill in any therapeutic process is interactional flexibility. Any interaction in any moment is either symmetrical or complementary. Any process of interaction is ordinarily both symmetrical and complementary. This is in the nature of living systems. They are inclusive and exclusive; they are organized, constrained, patterned, and deeply predictable. Resistance is the emotional, physical, and cognitive experience of the practitioner about the client(s) in relationship to the contract for therapy, the specific, reciprocal, basis of the therapeutic relationship and exchange itself. 

Therapists expect gratitude or at least respect. When efforts are met with indifference, skepticism and hostility the therapist response is not rational. 

Resistance is Personal Overt and Covert 

Feels personal – become frustrated, insecure, & rejecting of client – unwittingly communicate anger and frustration, furthering the resistance – sending the whole process into a negative spiral leading to failure of the therapeutic process – impacts on therapist fatigue 

It is personal to the practitioner. Because the professional therapeutic relationship peddles compassion as one of its most central propositions, the practitioner ‘feels’. If the practitioner does not feel, then there is no therapeutic relationship. For there to be a therapeutic relationship the practitioner must feel. We cannot have it both ways. The therapeutic relationship is contractual and reciprocal and complementary. The reciprocity is necessarily unequal. The client makes a request of the practitioner about a problem or symptom. The practitioner does not make a similar request of the client about a problem or symptom. In return, the practitioner asks the client to be straight forward and honest with them about everything pertaining to this problem or symptom. That ‘everything’ is defined by the practitioner, and not by the client. It is not an equal sharing of innermost thoughts and feelings and outermost relational privacy and issues. To this extent the therapeutic relationship is unequal, and such inequality needs to be managed extremely carefully. Unchecked poorly managed inequality can undermine the contractual relationship between the practitioner and client and as such undermine the very particular form of complementarity entered in this therapeutic process. To manage this very fragile form of contractual complementarity in relationship to a symptom or problem, a symmetrical form of compassion (as empathy) is created and exploited to engage the client in the most appropriate therapeutic relationship. A deeply sympathetic and compassionate relationship is generated with the client(s) intended to carry forward common virtues (e.g., gentleness, justice, wisdom, sincerity, righteous indignation, endurance, friendliness, et al[viii]) that enable a full dialogue about the matters the practitioner has been asked to address. This is a relationship of symmetrical compassion design to deliver on a reciprocal complementarity. This is echoes in other attachment relationships, such as that between a parent and a child. We must be cautious with this similarity as this is an echo only, and it is not literally true.  The therapeutic relationship is unique and must be conceptualized as such, and it must be reconceptualized in these terms with every new therapeutic relationship. Symmetrical compassion and complementary reciprocity.  It is personal and the practitioner feels it, often quite intensely, when the therapeutic process runs into heavy emotional or cognitive weather. That is how resistance is experienced, and it is real, and it is literally true, and it is an analogy but not only an analogy. Resistance is in fact, or at least in these terms, spatial and temporal, literal and analogic, located on the inside and on the outside, in fact neurobiological and socio-relational in one single moment and move. 

[i] Dostoevsky, Crime and Punishment 

[ii] Sigmund Freud: An Outline of Psychoanalysis, 1940 

[iii] White, M and Epston, D.   Narrative Means to Therapeutic Ends Norton Books 1990  

[iv] De Shazer The Death of Resistance Fam Proc 23:11-17, 1984  

[v] Sapolsky,R This is Your Brain on Metaphors  Opinionator, New York Times, Nov 14th 2010 

[vi] Donzelot, J 1979 The Policing of Families Pantheon Books 

 [vii] Robinson, M (2020) The  Twin pillars of Morality 

[viii] Robinson, M (2020) Virtues