Dealing with Resistance in Psychotherapy

217 Pages·2005·1.147 MB·English

by  Althea J. Horner

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Dealing with Resistance
in Psychotherapy
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Dealing with Resistance
in Psychotherapy
Althea J. Horner
JASONARONSON
Lanham • Boulder • New York • Toronto • Oxford
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Published in the United States of America
by Jason Aronson
An imprint of Rowman & Littlefield Publishers, Inc.
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Copyright © 2005 by Althea J. Horner
All rights reserved. No part of this publication may be reproduced, stored in a re-
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Contents
Introduction vii
1 The Core Relationship Problem as Resistance 1
2 Constructing the Developmental Hypothesis 15
3 Countertransference Resistance and Therapeutic Impasse 27
4 Transference Resistances of the “Good Boy”
and the “Good Girl” 35
5 The Sexualization of the Core Relationship Problem
as Resistance 45
6 The Wish for Power as Resistance 53
7 Envy as Resistance 73
8 The “Constructed Self” as Resistance 81
9 The Need to Understand as Resistance 87
10 Common Attitudes as Sources of Resistance 93
11 Motives as Resistance 103
12 Symptoms as Resistance 115
13 Interpretation of Transference Resistance in
Brief Psychotherapy 127
v
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vi Contents
Epilogue 171
References 173
Index 179
About the Author 189
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Introduction
AWAY OF THINKING
What I hope to communicate in this book is away of thinkingand not
a directory of what to do and when to do it. Ultimately, how one
applies what is learned here or elsewhere depends on one’s own ability to
relate, as well as one’s level of interpersonal skills and theoretical knowl-
edge. This is a way of thinking that can accommodate more than one the-
ory. There is, nonetheless, a basic assumption of how we become who we are,
which emphasizes the developmental perspective and the relational, interpersonal
matrix within which that development takes place—an assumption rooted in
object relations theory. All theories start with the same observations of
human behavior, although in each of them the data are organized accord-
ing to different principles. We may think in terms of psychosexual stages,
in terms of Bowlby and a failure or pathology of attachment, in terms of
Mahlerian stages of separation and individuation, or in terms of Erikson-
ian stages of the individual in relation to society. We may think in terms
of a Freudian Oedipal conflict, a Kohutian reaction to failure of empathy,
a Winnicottian false-self adaptation to impingement, or even in terms of
Skinnerian shaping.
There is also the recent work of Allan Schore (1996) and the psy-
choneurology of development in infancy, the neurological underpinnings
of interpersonal attachment, and the capacity to regulate affect and self-
soothe. There is the older work of Piaget (1952) as it relates to cognitive
functioning in healthy and pathological states and the studies of Chess
and Thomas (1971) of constitutionally based differences in the infant.
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viii Introduction
There is also family systems theory; the philosophy of Buber and the im-
portance of the I–thou encounter with existential questions concerning
being itself; language and thought and the search for the individual’s
meanings embedded in ordinary words, the emphasis on linguistics—all
of these are concepts that will enhance our psychoanalytic theory if we al-
low them into our creative synthesis.
Winnicott (1965) points out that the mother serves as a bridge between
the child’s experiences of self that originate within him and those that are
responses to the external world of reality. If we view the self as developing
within the context of the mother–child matrix—and this includes all facets of
that self, including the way it controls its impulses, uses its potential in-
tellect, or structures reality—then we can expect to find a correspondence be-
tween disturbances of that psychological self and the nature of the relationship
with the primary mothering object. This will be manifest in the develop-
mental history of the individual, in the nature of the individual’s inner
psychological world, in the quality of present-day relationships and
functioning, and, in particular, in the quality of the individual’s relation-
ship with the therapist.
Using the concepts of object relations theory, consideration of the basic
processes of organization will clarify how the inner mental configurations
of the self, the object, and their interrelationships come into being. What
is the nature of the process? What is to be organized? What facilitates it?
What interferes with it? What is the outcome of its failure? We have to
look closely at the baby’s own contribution to the process with respect
to the kind of brain he or she is born with and how it does its work, what
is referred to by ego psychologists as the synthetic function of the ego
(Horner [1979] 1984).
There are some cases in which the dominance of the right brain that is
manifest in mathematical or musical genius may very well interfere with
the child’s negotiation of his or her interpersonal milieu and the linguistic
frame that dominates it. Many such individuals were notably late talkers
(Sowell 1998). It was found that 90 percent of these children are males, that
they come from families with a particular cognitive style, and that a ma-
jority of the parents are engineers, accountants, computer specialists, and
scientists. Many of the children are precocious in music, math, and mem-
ory. Some such children have been erroneously diagnosed and treated as
retarded or autistic with destructive outcomes for the child and the family.
Atypical development will be the result, leading to problems that cannot
be laid at the doorstep of an unempathic mother. Obviously such children
can be negatively impacted by parents who have their own need to have
the child perform well in school from the start or to have the child fit into
some desired norm. These parents may also become overly invested in the
child’s precociousness and neglect the emotional side of the child’s devel-
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Introduction ix
opment. If in therapy later in life, this individual’s very brilliance may
come to stand as a resistance. If the therapist, like the parents, is so taken
by the patient’s intelligence, the therapist will neglect the emotional–
relational issues that are buried or repressed—that is, the core relationship
problem and the defenses against its exploration.
A pathological grandiose self (Kohut 1971) may become consolidated
around the extraordinary talents or intelligence of the individual. It will
then stand as the major defense against the terrors of loss of self-cohesion,
a persecutory object, or an underlying anaclitic depression. Any attempt
to make such an interpretation is most likely to be experienced as an at-
tack on the self, evoking a paranoid reaction. Kohut’s approach is most
useful with such a patient.
One individual with this character structure reported a dream in which
pus was coming out of his mother’s breast. He abruptly ended his treat-
ment when the therapist attempted such an interpretation. We can specu-
late that, had he continued his therapy, this dream would eventually come
to be understood as a metaphor for his core relationship problem and
would emerge as a resistance to a dependent transference (which is a form
of transference resistance) as a defense against the toxicity he would at-
tribute to the therapist.
THE CORE RELATIONSHIP PROBLEM
REENACTED WITH THE THERAPIST
Of the dynamics of transference, Freud (1912) says that, in analysis, there
is a tendency toward the activation of unconscious fantasy, and that this
process is a regressive one that revives the subject’s infantile imagoes (102).
He adds that when a person’s need for love is not entirely satisfied by re-
ality, that person tends to approach every new person he meets with an-
ticipatory ideas, and that these are directed toward the analyst. He com-
ments that “this cathexis will have recourse to prototypes, will attach itself
to one of the stereotype plates which are present in the subject” (100).
The analogy of stereotype plates lends itself well to the concept of self-
and object representations as structure, and the manner in which these
representations are played out analogously to Freud’s stereotype plates in
the treatment situation. To the extent that the patient, for one reason or an-
other, must cling to this stereotypical manner of relating, the transference
will be a powerful source of resistance.
In their research of treatment outcomes, Luborsky (1988) and his col-
leagues found that patients benefit most when the therapist correctly iden-
tifies their core relationship problem regardless of the presenting problem.
This means that we also cannot be boxed within the medical frame of