Resistance (psychoanalysis)

Resistance, in psychoanalysis, refers to the client's defence mechanisms that emerge from unconscious content coming to fruition through process.[1] Resistance is the repression of unconscious drives from integration into conscious awareness.[2]

Sigmund Freud, the founder of psychoanalytic theory, developed his concept of resistance as he worked with patients who suddenly developed uncooperative behaviors during sessions of talk therapy. He reasoned that an individual that is suffering from a psychological affliction, which Freud believed to be derived from the presence of suppressed illicit or unwanted thoughts, may inadvertently attempt to impede any attempt to confront a subconsciously perceived threat. This would be for the purpose of inhibiting the revelation of any repressed information from within the unconscious mind.[3]

History

Having developed the theory of resistance through his direct experiences with patients undergoing therapy, Sigmund Freud noticed that patients would avoid subjects and topics that struck too closely to uncomfortable memories or unacceptable emotions and desires. Freud then integrated these findings with his previous theories concerning the functions of the id, ego and super-ego. As a result, he eventually advanced his concept of resistance by developing it into a multitude of individual forms that included repression, transference, ego-resistance, "working-through", and self-sabotage.[4]

The common theory behind many of Sigmund Freud's psychoanalytic techniques, alluding to the fundamentals of psychoanalysis as a science, was that it is possible that memories that have been lost from consciousness provide hints of their existence by the means of prompting certain thoughts and behaviors.[5] Accordingly, the aim of psychoanalysis is to bring what is unconscious or preconscious into consciousness through verbalization. Afterwards, the act of bringing such thoughts into consciousness prevents them from motivating behavior and thus allowing the individual to exert more personal control.[6]

In an early exposition of his new technique, Freud wrote that "There is, however, another point of view which you may take up in order to understand the psychoanalytic method. The discovery of the unconscious and the introduction of it into consciousness is performed in the face of a continuous resistance on the part of the patient. The process of bringing this unconscious material to light is associated with pain, and because of this pain the patient again and again rejects it".[7] He went on to add that "It is for you then to interpose in this conflict in the patient's mental life. If you succeed in persuading him to accept, by virtue of a better understanding, something that up to now, in consequence of this automatic regulation by pain, he has rejected (repressed), you will then have accomplished something towards his education ... Psychoanalytic treatment may in general be conceived of as such a re-education in overcoming internal resistances".[7]

Primary/secondary gains from illness in resistance

Although the term resistance as it is known today in psychotherapy is largely associated with Sigmund Freud, the idea that some patients "cling to their disease"[7] was a popular one in medicine in the nineteenth century, and referred to patients whose maladies were presumed to persist due to the secondary gains of social, physical, and financial benefits associated with illness.[8] While Freud was trained in what is known as the (secondary) gain from illness that follows a neurosis,[9] he was more interested in the unconscious processes through which he could explain the primary gains that patients derive from their psychiatric symptoms.[10][11]

The model he devised to do so suggests that the symptoms represent an unconscious tradeoff in exchange for the sufferer being spared other, experientially worse, psychological displeasures, by way of what Freud labeled a compromise formation; "settling the conflict by constructing a symptom is the most convenient way out and the one most agreeable to the pleasure principle".[12]

Thus, contrasting the primary gain (internal benefits) and secondary gain (external benefits) from illness, Freud wrote: "In civil life illness can be used as a screen to gloss over incompetence in one's profession or in competition with other people; while in the family it can serve as a means for the other members and extorting proofs of their love or for imposing one's will upon them ... we sum it up in the term 'gain from illness' ... But there are other motives, that lie still deeper, for holding on to being ill ... [b]ut these cannot be understood without a fresh journey into psychological theory".[13]

Resistance as the product of conflicting agencies

To Freud, the primary gains that stood behind the patient's resistance were the result of an intrapsychic compromise, reached between two or more conflicting agencies: "psychoanalysis ... maintains that the isolation and unconsciousness of this [one] group of ideas have been caused by an active opposition on the part of other groups".[14] Freud called the one psychic agency the "repressing" consciousness,[15] and the other agency, the unconscious, he eventually referred to as the "id".[16][17]

The compromise the two competing parties strive for is to achieve maximum drive satisfaction with minimum resultant pain (negative reactions from within and without). Freud theorized that psychopathology was due to unsuccessful compromises – "We have long observed that every neurosis has the result, and therefore probably the purpose, of forcing the patient out of real life, of alienating him from actuality"[18] – as opposed to "successful defense" which resulted in "apparent health".[15]

Key players in the Kompromisslösung theory of symptom production, at the core of Freud's theory of resistance, were: repression (often used interchangeably with the term anticathexis), defense, displeasure, anxiety, danger, compromise, and symptom. As Freud wrote, "The action undertaken to protect repression is observable in analytic treatment as resistance. Resistance presupposes the existence of what I have called anticathexis."[19]

Forms of resistance

In 1926, Freud was to alter his view of anxiety, with implications for his view of resistance. "Whereas the old view made it natural to suppose that anxiety arose from the libido belonging to the repressed instinctual impulses, the new one, on the contrary, made the ego the source of anxiety".[20]

Freud still understood resistance to be intimately bound up with the fact of transference: "It may thus be said that the theory of psycho-analysis is an attempt to account for two observed facts that strike one conspicuously and unexpectedly whenever an attempt is made to trace the symptoms of a neurotic back to their source in his past life: the facts of transference and resistance. Any line of investigation, no matter what its direction, which recognizes these two facts and takes them as the starting-point of its work may call itself psychoanalysis, though it arrives at results other than my own".[21] Indeed, to this day most major schools of psychotherapeutic thought continue to at least recognize, if not "take as the starting-point", the two phenomena of transference and resistance.[8][22][23][24]

Nevertheless his new conceptualisation of the role of anxiety caused him to reframe the phenomena of resistance, to embrace how "The analyst has to combat no less than five kinds of resistance, emanating from three directions – the ego, the id and the superego".[25] He considered the ego to be the source of three types of resistance: repression, transference and gain from illness, i.e., secondary gain.[25] Freud defined a fourth variety, Id resistance, arising from the id, as resistance that requires "working-through"[20] the product of the repetition compulsion. A fifth, coming from the superego and the last to be discovered, "... seems to originate from the sense of guilt or the need for punishment"[20] – i.e., self-sabotage.

All these serve the explicit purpose of defending the ego against feelings of discomfort, for, as Freud wrote: "It is hard for the ego to direct its attention to perceptions and ideas which it has up till now made a rule of avoiding, or to acknowledge as belonging to itself impulses that are the complete opposite of those which it knows as its own."[19]

Repression

Repression is the form of resistance where the ego pushes offensive memories, ideas, and impulses down into the unconscious. Essentially, the patient is unconsciously hiding memories from the conscious mind.[26]

Transference

Typically unconscious, transference is when the patient allows past experiences to affect present relationships. In therapy, this may come about if the therapist reminds the patient, either consciously or unconsciously, of someone in their past who may have had an early impact on their life. Subsequently, the patient may suddenly tend to regard the therapist in either a positive or negative manner, depending upon the nature of the past influence.[27]

Ego-resistance

This form of resistance is a neurotic regression to a proposed state of childlike safety. Usually, it involves the patient's attempts to gain attention and sympathy by emphasizing minor medical symptoms (i.e. headaches, nausea, and depression).[26][28]

Id resistance

Id resistance is the opposition put up by the unconscious id against any change in its accustomed patterns of gratification.[28] Id resistance reflects the unconscious desire for consistency in a manner that is based upon the pleasure principle. Since the id is an innate portion of human instinct, interpretation of the conscious is an insufficient method, thus the psychoanalyst must first be able to surmount resistances by the means of deduction of patients' unconscious defenses that are presented through exploitation of the mechanism of transference.[26]

Freud's analysis

As Freud's clinical practice progressed, he noticed how, even when his patients' conscious minds had accepted the existence of, and begun working through their neurotic patterns, they still had to deal with what he called Id resistance: "the resistance of the unconscious...the power of the compulsion to repeat – the attraction exerted by the unconscious prototypes upon the repressed instinctual process".[29]

Later developments

W. R. D. Fairbairn saw id resistance in terms of early attachment to an internalised bad object, so that the individual remained bound by ties of yearning towards, and anger at rejection by, the repudiating parent of childhood.[30]

Id resistance manifests itself in group therapy in three main psychosexual forms: oral-level id resistance might take the form of an obsequious dependence on the therapist's words, or alternatively express hostility in cutting, biting remarks;[31] anal hostility can be displayed in dumping material indiscriminately on the therapist; and phallic-level id resistance appears in the form of competition with, and/or seductive ploys towards, therapist and other group members.[32] Acting out and acting in of id resistances in group therapy need to be contained by an emphasis on words as the central means of therapeutic interaction.[33]

Eric Berne saw personality in terms of a life-script laid down in early childhood, and considered that the main obstacle to recovery in therapy "is the pull of the script, something like the Id resistance of Freud".[34]

Superego resistance

Superego resistance is the opposition put up in therapy against recovery by the patient's conscience, their sense of underlying guilt.[28] It prompts personal punishment by the means of self-sabotage or self-imposed impediment. It has been considered by some (though not by Freud)[35] the weakest form of resistance, reflecting the moralistic sentiments of the superego.[26]

Freud's late formulation

Freud in the twenties came belatedly to the realisation of the importance of an 'unconscious morality' in opposing his therapeutic aims.[36] Thereupon he divided the sources of resistance into five, pointing out that "The fifth, coming from the super-ego and the last to be discovered…seems to originate from the sense of guilt or need for punishment".[37] However he also pointed out how often the patient does not feel guilty so much as unwell, when their superego resistance is in operation.[38]

Subsequent developments

Object relations theory tended to see superego resistance in terms of a patient's relationship with an internalised critical/persecutory parent figure.[39] Reluctance to end the 'security' of the bond to the internalised parent strengthens the superego resistance.[40] Where the ego ideal is harshly perfectionist, or represents an internalised mother who idealised suffering over enjoyment,[41] superego resistance takes the form of a refusal to be 'corrupted' by the progress of the therapy.[42]

In group therapy, superego resistance may be externalised or internalised. In the first case, a moralistic sub-group may form, which is hypercritical of other, less conformist members; while in the second case (of internalisation), the severity of the inward conscience, and the need for punishment, may lead to action destructive to the self and to the progress of the treatment.[43]

Freud's treatment of resistance

Freud viewed all five categories of resistance as requiring more than just intellectual insight or understanding to overcome. Instead he favored a slow process of working through.

Working through allows patients "... to get to know this resistance" and "... discover the repressed instinctual trends which are feeding the resistance" and it is this experientially convincing process that "distinguishes analytic treatment from every kind of suggestive treatment".[44] For this reason Freud insisted that therapists remain neutral, saying only as much as "is absolutely necessary to keep him [the patient] talking", so that resistance could be seen as clearly as possible in patients' transference, and become obvious to the patients themselves.[45] The inextricable link suggested by Freud between transference and resistance[10][46] perhaps encapsulates his legacy to psychotherapy.

Applications

Psychoanalysis is, altogether, considered to be a type of insight-oriented therapeutic program. Despite general initial reservations, these types of programs have since transitioned from being quite marginal to becoming more well-known and mainstream.[47] In consideration to the theory of resistance itself, within a clinical setting, the expression of resistance is considered to be a significant stage to recovery because it reveals the presence of repression. Additionally, it is indicative of progress in the effort of resolving any underlying issues that may be the cause of personal dysfunction. As resistance is theorized to be a manifestation of the unconscious mind's attempts to protect the ego, it is the task of the psychoanalyst to combat this opposition by directing the patient to confront the unacceptable desires or uncomfortable memories. By this course of action, the patient may reach a cathartic conclusion.[48]

Criticisms

Steve de Shazer, using a solution-focused therapy model, declared in the mid-1980s that resistance was dead, and that clients who do not follow therapists' directions should be seen as "cooperating" by showing therapists how best to help them.[49]

Psychoanalysts and their critics remain divided with regard to the concept of resistance. Since Freud first developed his theory of resistance, he has been significantly criticized for using personally favorable and unfalsifiable theory, among other problems.[50][51][52][53][54][55] For example, if a patient were to agree with a psychoanalyst's inference about themselves, it is a confirmation that there is something they are repressing; however, if the patient disagrees, it is also a sign they are engaged in repression, which means the psychoanalyst is correct in either scenario (see also: Gaslighting, Kafkatrap).[55][56][57] Additionally, some relational psychoanalysts believe that the success of psychoanalysis is not due its various explanatory systems or its reasoning about repression, but rather simply due to the process of interpersonal communication.[57][58][59]

References

Karen, Horney (1939). New Ways in Psychoanalysis. W. W. Norton & Company. p. 21. ISBN 978-0-393-31230-0. [U]nconscious motivations remain unconscious because we are interested in not becoming aware of them. [...] It implies that if an attempt is made to unearth unconscious motivations we will have to put up a struggle because some interest of ours is at stake. This, in succinct terms, is the concept of 'resistance', which is of paramount value to therapy.
Karen, Horney (1939). New Ways in Psychoanalysis. W. W. Norton & Company. p. 34. ISBN 978-0-393-31230-0. By resistance is meant the energy with which an individual protects repressed feelings or thoughts against their integration into conscious awareness. [... in order] not to become aware of certain drives.
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Harrington, Anne; Dunne, John (2015). "When mindfulness is therapy: ethical qualms, historical perspectives" (PDF). American Psychologist. 70 (7): 621–631. doi:10.1037/a0039460. PMID 26436312. S2CID 43129186.
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Gladding, Samuel (1998). "Premises of solution-focused family therapy". Family Therapy: History, Theory, and Practice (2nd ed.). Upper Saddle River, NJ: Merrill. p. 259. ISBN 013836396X. OCLC 35910308. Another premise of solution-focused family therapy is that families really want to change. As a way of underscoring this idea, deShazer (1984) declared the death of 'resistance' as a concept. Thus, when families do not follow therapists' directions, they are 'cooperating' by teaching therapists the best way to help them.
As early as 1932, psychoanalyst Sándor Ferenczi wrote: "The possibility should not be rejected out of hand that the analyst's habit of identifying any obstacle encountered as resistance on the part of the patient can be misused in an equally paranoid, that is, delusional, way for the projection or disavowal of his own complexes." Dupont, Judith, ed. (1988) [1932]. The clinical diary of Sándor Ferenczi. Cambridge, MA: Harvard University Press. p. 26. ISBN 0674135261. OCLC 17952532.
Rieff, Philip (1979) [1959]. Freud, the mind of the moralist (3rd ed.). Chicago: University of Chicago Press. p. 98. ISBN 0226716406. OCLC 5103089. Built into the therapy, through the notion of resistance, is disavowal of the patient's critical judgment. Indeed, the concept of resistance is a mode of attack for the therapist. [...] Whatever was important, the patient 'resisted'. Whatever the patient 'resisted' was important. Freud applied his theory of resistance not only to the strategies and compliances of patients, but to the general public's reception of his science. Time has weakened the invincible explanation Freud gave of why his ideas met objection.
Holt, Robert R. (October 1985). "The current status of psychoanalytic theory". Psychoanalytic Psychology. 2 (4): 289–315 [307]. doi:10.1037/0736-9735.2.4.289. American psychoanalysis has lived for so long within a snug cocoon of myth that it seems unable to go through the predictable pains of metamorphosis into a viably progressive discipline. The protective threads it has wound around itself include warding off all criticism as resistance, idolatry of Freud, and faithful internalization of all his faults as a scientist and writer.
Mathers, Carola B. B. (May 1986). "Psychoanalysis: science or nonscience?". Bulletin of the Royal College of Psychiatrists. 10 (5): 103–104. doi:10.1192/S0140078900027267. In the framework of psychoanalysis the problem of describing real phenomena is evident: one cannot 'see' transference or resistance, and a sceptic (in the lay sense) might argue that he could not perceive these phenomena through their effects either.
Cioffi, Frank (1998). Freud and the question of pseudoscience. Chicago: Open Court Publishing Company. p. 155. ISBN 081269385X. OCLC 39281914. Wolheim continues: 'The original wishes might remain unconscious; if, that is, repression persisted, now manifesting itself in the form of resistance.' One suspects a certain disingenuousness in retaining the word 'resistance' to designate the non-occurrence of the 'inner change in the patient' [...] when it has hitherto been used to refer to the reluctance of the patient to accept interpretations or his failure to produce material confirmatory of them. The effect of its retention is to blind us to the fact that no criterion but therapeutic inefficacy is provided for determining when this kind of resistance has been encountered.
Boudry, Maarten; Buekens, Filip (May 2011). "The epistemic predicament of a pseudoscience: social constructivism confronts Freudian psychoanalysis" (PDF). Theoria. 77 (2): 159–179. doi:10.1111/j.1755-2567.2011.01098.x. hdl:1854/LU-1108932. when Freud was unable to find traces of a pathological complex or unconscious desire to account for a patient's behaviour, he was undeterred and treated this as a token of unconscious resistance. The more the material offered by a patient resisted interpretation, the more it counted in favour of the theory. This characteristic pattern of reasoning in psychoanalysis bears a striking resemblance to conspiracy theorizing (Farrell 1996). [...] The way in which the concept of resistance has been put to use by Freud and his acolytes, for example, has been rightly dismissed by critics as a specimen of heads-I-win-tails-you-lose reasoning. Nevertheless, it proves difficult to disentangle such fallacious reasoning from psychoanalytic theory itself, because it is effectively supported by the way the unconscious is conceptualized in Freudian theory. If Freud's model of the human mind is correct, and if the unconscious really is some sort of trickster in disguise, then indeed it becomes natural to label counter-arguments and criticisms as manifestations of unconscious resistance to psychoanalytic 'truths' and 'interpretations'.
Holowchak, Andrew (2012). "The problem of unassailability: analogy and adequacy of constructions in Freudian psychoanalysis". Psychoanalytic Psychology. 29 (2): 255–266 [257]. doi:10.1037/a0020863. Freud also maintains that a properly trained analyst does not take 'yes' and 'no' answers literally, but only within the context of all that has transpired thus far between therapist and patient. Both replies are ambiguous and either reply can be a sign of a patient's resistance. 'Yes' can be a symptom of resistance, as when a patient agrees with a construction to avoid or delay disclosure of some unconscious truth. Yet it can also indicate honest agreement. 'No' is most often also a symptom of resistance, as when a patient disagrees with a construction to block further penetration by an analysis. Yet it too can also indicate honest disagreement.
Dorpat, Theodore L. (1996). Gaslighting, the double whammy, interrogation, and other methods of covert control in psychotherapy and psychoanalysis. Northvale, NJ: Jason Aronson. pp. 241, 245. ISBN 978-1568218281. OCLC 34548677. I do not mean to imply that a patient who disagrees or opposes something the analyst says or does may not also be manifesting resistance. What I do assert is that the criteria for determining the presence of resistance should not include merely the fact of the patient's disagreement or nonacceptance. Though some clinicians would not define resistance as the patient's disagreement with the analyst, they do in practice deal with their patients' disagreement or opposition to interpretations as if they were 'resistances' and something to overcome. [...] Freud's militaristic view of resistance was, I suspect, inextricably linked with, and probably an integral aspect of, the unanalyzed authoritarian tendencies in his personality. [...] Psychoanalysis urgently needs a modified, nonadversarial concept of resistance, a view that does not blame the patient or rationalize the use of charisma or coercive methods for overcoming resistance. In the past decade, an interactional and nonadversarial concept of resistance is evolving in which resistance is conceptualized as the product of both parties of the analytic dialogue.
Gill, Merton (January 1995). "Classical and relational psychoanalysis". Psychoanalytic Psychology. 12 (1): 89–107 [101]. doi:10.1037/h0079600. Busch (this issue) also draws attention to the paucity of explicit discussion of resistance in relational (and object relations?) writing. The observation is an interesting one. [...] Furthermore, a number of recent authors, including Schafer and Spezzano (1993), describe what is called resistance as an interpersonal communication. It may be, therefore, that the absence of explicit reference to resistance in relational writing results from dealing in interpersonal terms with what is called resistance in classical analysis, but without the explicit understanding and revision of what in classical analysis is called resistance, as suggested by Schafer.
Ringstrom, Philip A. (January 2007). "Scenes that write themselves: improvisational moments in relational psychoanaysis". Psychoanalytic Dialogues. 17 (1): 69–99. doi:10.1080/10481880701301303. S2CID 144179634. As a consequence, in contrast to the traditional therapist's role, the relational approach makes it makes it 'open game' for the patient to question the thoughts, intentions, and perspective of the therapist without this being seen a priori as resistance.