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Recognizing Resistance in the Therapeutic Environment

Recognizing Resistance in the Therapeutic Environment

Despite the proliferation of competing psychoanalytic theories in the past three decades, for most analysts the recognition and interpretation of resistance (as well as transference) remains at the core of psychoanalytic technique. While resistance has been defined as encompassing all of a patient's defensive efforts to avoid self-knowledge (Moore and Fine), operationally it means those behaviors that help the patient ward off disturbing feelings such as anxiety, anger, disgust, depression, envy, jealousy, guilt and shame.

Even though any and all behavior can be used defensively, i.e., in the service of resistance, there are certain kinds of behavior whose configuration make them naturally fit to ward off a specific unpleasant affect. A common example is portraying oneself as a victim to defend against recognizing one's own sadistic impulses. The defense mechanism used, of course, is projection, but the simple equation: I am not the sadist; you are the sadist, is often obscured by the patients emphasizing the role of victim while leaving the malign enemy unidentified.

In like manner there are behaviors whose configurations are so specific to warding off the experience of guilt on the one hand or shame on the other that they can reasonably be termed superego and narcissistic resistances. In his classification of resistances at the end of Inhibitions, Symptoms and Anxiety (1926), Freud directly mentions the superego resistance, but the analogous term narcissistic resistance is not to be found. Instead he uses the term gain from illness and refers to examples that illustrate the pride gained by neurotics from their symptoms. Freud says an obsessive-compulsive person believes that he is better than anyone else because he is especially clean and conscientious, as well as the pride of the paranoiac in the intellectual brilliance of his imagination (Calef, personnel communication 1979).

Superego Resistance

Guilt is the affect experienced when one has transgressed an ethical or moral code, whether in fact or in fantasy. It is experienced in the active mode, i.e., "I have done something bad," but it is not only the specific action condemned but the entire self. While many patients directly state that they feel guilty, closer examination often reveals that they are experiencing another emotion. True guilt is most often expressed verbally as: I feel terrible or I feel awful. In structural terms guilt represents tension between the ego and the superego and the weapon by which the ego is punished for a transgression.

There are four specific responses to guilt: the wishes to confess, to seek punishment, to seek absolution, and to make restitution. The first three responses are the motives for the superego resistance. Though absolution and punishment may seem antithetical, both can reduce an unconscious sense of guilt without its ever becoming conscious.

Once the therapist is alerted to the possibility that a patient's behavior may be motivated by the need for punishment or the desire for absolution, recognizing the motivation behind such common behavior as confessing to trivial misdeeds or being accident-prone is simple. Even coming late to the treatment session can be used as a source of absolution, if the therapist ignores the behavior, or of punishment if the therapist comments, no matter how neutrally. The patient will abstract what he needs to believe from the therapist's behavior. However, at other times the behavior that expresses some form of the superego resistance may be so well-disguised that it is not even suspected.

Mrs. H., a married mother of four children, came to analysis in her mid-30s because she was frightened by involuntary orgasms. Long after she had understood the unconscious significance of this symptom and had resolved many other conflicts, she showed no desire to terminate the analysis. In order to justify the prolongation of her treatment she produced much rich data and "analyzed it" in considerable detail, yet this "analysis" seemed to have little effect on her life.

At one point she calmly related going to the blood bank to make her quarterly donation. Even though she told the nurse that her veins were small and only those in the left arm could be used, the nurse insisted on using the right arm. Only after the right arm had been unsuccessfully punctured a half-dozen times did the nurse turn to the left arm. The patient left with a badly aching, black and blue right arm. After finishing her story she went on to other events.

As I could find no unconscious theme in the material, I asked how she felt when I had not commented on her story of the blood bank. She replied that it was perfectly all right. As I had not criticized her, she felt she had my permission to refuse suffering the pain again. This incident led to the realization that she needed to continue in treatment because I was a relatively benign superego whose silence absolved her of the guilt she rarely experienced and never expressed. Mrs. H. had used my listening quietly to gain absolution without either of us being consciously aware of the process.

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