Resistance (psychotherapy)

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In psychotherapy, resistance refers to the negative experience and / or behavior of a patient towards the treatment, a certain aspect of the treatment or the person of the therapist. The term was introduced by Sigmund Freud into the psychotherapy debate that began in 1895 between Freud and Josef Breuer . In the various schools of psychotherapy, the patient's rejection of the treatment is sometimes differently designated, interpreted and explained.

Resistance in Psychoanalysis

In psychoanalysis resistance is considered a key concept, its processing and resolution is regarded as one of the important impact factors of the psychoanalytic treatment. Freud first used the term in the Studies on Hysteria (1895d). He initially conceptualized the observation that the desired emergence of memory in the then still hypnotic therapy unconsciously opposes a force that corresponds to that of the original repression at the origin of the symptom. The resistance is closely related to the defense processes through which the neurotic symptoms arose, but is not to be equated with them. Rather, it is a treatment-technical term that describes a multitude of phenomena of behavior and experience that hinder access to the patient's unconscious during treatment : "Whatever disturbs the continuation of the work is resistance." Over time, Freud conceptualized the understanding and gradual interpretation of the resistances as a specific feature of psychoanalytic treatment. The resistance is then just as part of the treatment as the transmission . In the various forms, resistances can arise in all phases of treatment and make it possible to understand the individual development of the symptoms in the current treatment situation. Freud already distinguished different forms of resistance, which can be fed from different sources, the ego , the id , the super-ego and the therapeutic work itself. An initial systematic description of the forms of resistance and defense was drawn up in 1936 by Anna Freud . A comprehensive differentiation of the various forms in which resistance can manifest itself, such as B. Missing therapy sessions, arriving late, missing dreams, acting out or being bored, was first described in 1967 by Ralph R. Greenson . Depending on which signs indicate resistance, one speaks of association resistance, intellectual resistance, interpretation resistance, transference resistance, superego resistance or character resistance. The strength of the ego shows in the type of resistance, i.e. how mature the defense mechanisms that the ego has at their disposal. For example, acting is interpreted as a sign of ego weakness.

Forms of resistance, further developments

In a modification of earlier statements, Freud distinguished five forms of resistance in inhibition, symptom and fear (1926d). He assumed that more forms would become writable over time. They were modified and expanded several times by later authors.

  • The displacement resistance : To be referred to the forms in which the ego against the emergence of memory and the verbalization of material intended.
  • The resistance that can arise in connection with secondary gain from illness : by this Freud and a. the 'advantage' a patient seeks to obtain by seeking to modify the psychoanalytic treatment - and with it the analyst - for the purpose of his desire for infantile satisfaction or relief on the part of the lovingly caring people.
  • The transference resistance : The treatment process is hindered by the transference of the attachment figures, who were impressed in early childhood, to the person of the analyst. The recovery on the basis of diagnosis and therapy is achieved through an overly positive (eroticized) transference as well as an overly negative one, e.g. B. transference accompanied by fear or antipathy made more difficult - also known as transference hate love.

Freud describes these first three resistances as ego resistances.

The term transference resistance combines three aspects: 1. the resistance against becoming aware of the transference as such, 2. the resistance in the form of positive or negative transference (love-hate) and 3. the resistance against the final dissolution of the transference.

Resistance to the dissolution of the transference arises from the fact that the patient, as soon as he begins to sense the therapist's personality, which has hitherto remained hidden behind the transference, is confronted with the prospect of saying goodbye to the object internalized in the superego that soon after its birth became the object of strong and strongest affects, be it the desire associated with them, positive or negative. According to Freud, narcissistic love-hate relationships with those who are emotionally failing, although necessary for the child's survival, and who are also hostile to instinctual upbringing and internalized into the superego, bind considerable amounts of libido, which the ego of the person concerned has to release if it really wants to contribute to recovery, or consciously use for the various, instinctual needs of the id in the context of catching up on mental and emotional maturity.

If this succeeds, it not only becomes apparent what the id actually wants from its ego-consciousness, but also leads to the liberation of the libido quantities, previously sadomasochistically fixed in the narcissistic-infantile ambitions of the ego, to more realistic ideas about the true nature of the people around them in terms of their merits no less than their weaknesses and problems. These insights are also gradually internalized into the super-ego, because that is the function of this instance or organ of the soul according to Freud. The super-ego can and should absorb experiences (phenomenon of “imprinting”; neurosynaptic storage) in order to advise the ego in the future in the sense of satisfying id needs. The transmission is thus considered in the context of the resistance analysis. The transference resistance forms a common strand with the transference neurosis , or the two poles of the same problem.

  • Super-ego resistance : These are inhibitions that result from feelings of shame and guilt, which are suggested to the ego of the super-ego, which has been brought up to be hostile to moral instincts, and therefore hinder the progress of treatment towards the liberation of the id from its repressed state into the unconscious . Attempts to interpret dreams or other behavior are at least partially rejected by the ego as soon as they arouse feelings of shame or guilt - supplemented by rationalizations that promote the advantages of moral education in the context of the more secular social systems. Freud explains more about the general character of such rationalizations in The Future of an Illusion (1927).
  • Es-resistance: Resistance to habits, rationalizations and modes of functioning, the illusory content of which is diagnosed in the treatment sessions and which should therefore be therapeutically changed or completely abandoned.

In 1945 Fenichel distinguished two types of ego resistance:

  • The acute resistance : the patient is directed against the statements or interpretations of the analyst through concrete behavior such as silence. Because this type of resistance is concrete (in the sense of an emergency measure), it can be addressed and made more easily aware of the patient than the character resistance mentioned below.
  • Character resistance : Independent of immediate situations, character resistance is expressed in the transference.

Glover (1995) differentiates between overt and inconspicuous resistance:

  • Obvious resistance can be seen in the following behaviors that cannot be explained as coincidence: "Lateness, missing hours, silence, proliferation, automatic rejection or misunderstanding of all the analyst's utterances, mock stupidity, constant absent-mindedness, falling asleep and finally breaking off treatment".
  • Inconspicuous resistance can manifest itself, for example, in the apparent consent to everything or the offer of interesting material without emotional involvement.

Erik H. Erikson coined the term identity resistance, which addresses the patient's fear that the analyst towards him could destroy the pathogenic, albeit valued "core" of his identity by subverting, infiltrating or destroying it through his own values ​​and ideas of happiness Brings collapse.

The expansion of the treatment spectrum of psychoanalysis changed the view of the phenomena of resistance. Many recent authors conclude that in patients with early disorders such as resistance-acting forms may be based on developmental deficits and have a different function. They can be seen as a reparative attempt to maintain the object relationship . Accordingly, they should not be interpreted, but rather overcome through empathic support.

Since the 1950s there have been representations that resistance can arise not only in the patient but also in the analyst, which must be revealed as a phenomenon of countertransference in order not to hinder the therapeutic process. In addition, in the course of the interpersonal approaches in psychoanalysis, the focus was increasingly on how the analyst's attitudes and attitudes also contribute to the emergence of resistance.

Dealing with the resistance

In psychoanalysis, the resistances are gradually traced back to their unconscious roots and explained to the patient. Since a common source of resistance is the transfer relationship, analysis of transfer resistances plays an important role. This brings the unconscious mechanisms from the there and then into the here and now and can be worked through in the therapeutic relationship. If the resistance analysis succeeds, the repressed motives can be gradually integrated, which at the same time progresses the treatment itself. Different analysts react differently to resistance, which is related to their character, previous and past relationships, and the form of the day.

In 1967, Zachatias proposed to abandon the interpretation of the resistance and to limit oneself to the pure description of the resistance behavior, which could be described as "descriptive processing of resistance". In doing so, he follows Freud's instruction not to give any substantive interpretation.

Karl König used the term “optimal level of resistance” to make it clear that psychoanalysis is not about keeping the resistance of its patients as low as possible, but about enabling them to undergo increasing restructuring, which ultimately becomes available among all Use forces for each of the various id concerns instead of neurotically ignorant keeping this instinctual desire away from the realm of conscious perception of reality.

There is disagreement within psychoanalysis over the question of when resistance should be interpreted. The orientation, which goes back to Melanie Klein , takes the view that resistance must be interpreted very early, especially if it is accompanied by a negative transference and is therefore fearful. According to this view, this fear diminishes through interpretation.

There is agreement that the relationship-regulating function of resistance should be the focus, as well as that the appropriate handling of resistance always depends on the patient's structural level or the current level of regression. This view goes back to Michael Balint , among others , who described that in certain phases of the regression linguistic messages cannot be understood as such by the patient.

Resistance in Gestalt Therapy

In Gestalt therapy , the aspect of the patient's creative performance is perceived, which is expressed in resistance. The behavior that becomes visible in it was and is the best solution in the present moment or in a past situation for the patient. From the point of view of Gestalt therapy, it initially proves to be useful for the patient. In this respect, Gestalt therapy does not assume that the resistance runs counter to the patient's actual interest and that its dissolution or elimination must be the immediate or only goal.

Alternatively, the terms contact disorder and contact interruption are used in Gestalt therapy . This is not about resistance to contact at all, but to certain contact offers that the client perceives as harmful. Resistance is a healthy, growth-promoting attitude that can be directed against too much or too little contact.

Resistance can u. a. represent a protective measure that is important.

An internal conflict is often expressed in resistance. This conflict can consist in the fact that what was once a solution may be resolved at a later point in time. It may no longer be sufficient to cope with current situations, and that new steps must now be dared to which the patient may choose. U, unable to see (yet). In gestalt therapy work, the focus is then on bringing this behavior more (or for the first time, if it happens unconsciously) into consciousness and researching it. It is about increasing and deepening the patient's awareness of their behavior and experiences, including their ability not to want something and to say no. In any case, this is a starting point for new learning steps, if the patient can and wants to walk them.

Gestalt therapy emphasizes that the designation of behavior as “resistance” is an ascription by the therapist, an attempt on his part to explain why the patient does not accept certain offers from the therapist and does not take certain steps. From the perspective of Gestalt therapy, this view, which was founded by classical psychoanalysis, now contains the risk that the therapist will orientate himself towards his own norms and concepts and make ascriptions of guilt that put him in a kind of opposition to the patient. From the point of view of Gestalt therapy, however, this hinders the relationship between the therapist and the patient. It is one of the basic positions of Gestalt therapy that the therapist does not see himself as a "superior knower".

Resistance in behavior therapy

In behavior therapy , resistance is viewed as a result of the patient's learning experience or a lack of competence on the part of the therapist. In early behavior therapy, the use of the term resistance was seen primarily as an attempt on the part of psychoanalysis to exercise self-control over highly structured patients. It was suggested to give the patient the opportunity to address all of his fears in the sense of a "resistance-reducing sequence" for the purpose of correcting misinterpretations, if necessary.

Resistance in Health Oriented Cognitive Therapy

In health-oriented cognitive therapy , some basic assumptions are made about resistance that can make it easier to deal with resistance in treatment by changing perspective. So it is formulated that the resistance is mainly generated by the therapist, has a function in the therapeutic relationship, is a helpful indication that something is going too fast or in the wrong direction. Also the aspect that the client shows his own will with the resistance and shows his cooperation, only by other means.

Resistance in Hypnotherapy and NLP

Against the background of the specific treatment technique of hypnotherapy , Milton H. Erickson emphasizes the interpersonal importance of resistance to the intrapsychic. He describes communicative and suggestive techniques to avoid resistance in hypnosis treatment, for example through the use of indirect and alternative language patterns instead of direct suggestions. Furthermore, the possibilities lead to utilization and the conscious provocation of resistance. Building on the view of resistance as an interpersonal phenomenon, neurolinguistic programming assumes that by establishing a lockstep, the patient can be led into almost any changed experience and behavior without creating resistance.

See also

Individual evidence

  1. ↑ a b Christian Müller: Lexikon der Psychiatrie: Collected treatises of the most common psychopathological terms . Springer-Verlag, 2013, ISBN 978-3-642-96154-0 , p. 584 ( limited preview in Google Book search).
  2. ↑ Michael Ermann : Resistance. In: Wolfgang Mertens , Bruno Waldvogel (Ed.): Handbook of basic psychoanalytical concepts. 3rd, revised. u. exp. Edition. Kohlhammer, Stuttgart 2008, ISBN 978-3-17-017244-9 , pp. 838, 239, 240.
  3. ↑ Michael Ermann: Resistance. In: Wolfgang Mertens , Bruno Waldvogel (Ed.): Handbook of basic psychoanalytical concepts. 3rd, revised. u. exp. Edition. Kohlhammer, Stuttgart 2008, ISBN 978-3-17-017244-9 , pp. 838, 239.
  4. ↑ Sigmund Freud: On the psychology of dream processes. GW II / III, p. 521.
  5. ↑ Jean Laplanche ; J. B, Pontalis: The vocabulary of psychoanalysis . Suhrkamp, ​​Frankfurt am Main 1992, pp. 622-626.
  6. ^ Jean Laplanche, JB Pontalis: The vocabulary of psychoanalysis . Suhrkamp, ​​1973, ISBN 3-518-27607-7 , p. 612 (title of the original edition: Vocabulaire de la Psychanalyse . 1967).
  7. ↑ Michael Ermann: Resistance. In: Wolfgang Mertens , Bruno Waldvogel (Ed.): Handbook of basic psychoanalytical concepts. 3rd, revised. u. exp. Edition. Kohlhammer, Stuttgart 2008, ISBN 978-3-17-017244-9 , pp. 838f, 240.
  8. ↑ Anna Freud: The I and the defense mechanisms. 19th edition. Fischer Taschenbuchverlag, Frankfurt am Main 2006, ISBN 3-596-42001-6 .
  9. ↑ Ralph R. Greenson: Technique and Practice of Psychoanalysis . 9th edition. Klett-Cotta, Stuttgart 2007, ISBN 978-3-608-94283-5 ( limited preview in the Google book search).
  10. ↑ a b Michael Ermann: Psychosomatic medicine and psychotherapy: a textbook on a psychoanalytic basis . W. Kohlhammer Verlag, 2007, ISBN 978-3-17-019664-3 , pp. 423 ( limited preview in Google Book search).
  11. ↑ Sigmund Freud: Inhibition, Symptom and Anxiety . International Psychoanalytischer Verlag, 1926, p. 117 ( online at archive.org ).
  12. ↑ Sigmund Freud: Inhibition, Symptom and Anxiety. GW XIV, pp. 189-193.
  13. ↑ a b c d e f g h i H. Kibel: Resistance in group psychotherapy . In: Volker Tschuschke (Ed.): Practice of group psychotherapy . Georg Thieme, Stuttgart 2001, ISBN 3-13-127971-0 , p. 154–155 ( limited preview in Google Book search).
  14. ↑ a b Helmut Thomä & Horst Kächele : Textbook of psychoanalytic therapy. Basics . 2nd Edition. tape  1 . Sptringer, Berlin 1989, ISBN 3-662-08325-6 , pp. 103-104 , doi : 10.1007 / 978-3-662-08324-6 ( limited preview in Google book search).
  15. ↑ Maja Müller-Spahn: Symbolism - Dream - Creativity in dealing with psychological problems . Vandenhoeck & Ruprecht, Göttingen 2005, ISBN 3-525-46236-0 , pp. 151 ( limited preview in Google Book search).
  16. ↑ a b c d e Helmut Thomä, Horst Kächele, A. Bilger, B. Thomä: Psychoanalytical Therapy: Basics . Springer Science & Business Media, 2006, ISBN 3-540-29750-2 , pp. 122 ( limited preview in Google Book search).
  17. ↑ Sigmund Freud: Inhibition, Symptom and Anxiety. GW XIV, p. 193.
  18. ↑ Sigmund Freud: Inhibition, Symptom and Anxiety. GW XIV, p. 192.
  19. ↑ a b Wolfgang Senf, Michael Broda: Practice of Psychotherapy: An integrative textbook . Georg Thieme Verlag, 2011, ISBN 978-3-13-158545-5 , p. 166 ( limited preview in Google Book search).
  20. ↑ Karl König: Countertransference Analysis . Vandenhoeck & Ruprecht, 1993, ISBN 3-525-45755-3 , pp. 80 ( limited preview in Google Book search).
  21. ↑ Joseph Sandler , Christopher Dare, Alex Holder: The basic concepts of psychoanalytic therapy . Klett-Cotta, 2001, ISBN 3-608-94357-9 , p. 121 ( limited preview in Google Book search).
  22. ↑ a b c Inge Seiffge-Krenke: Psychoanalytic and depth psychologically based psychotherapy with young people . Klett-Cotta, 2007, ISBN 978-3-608-94440-2 , p. 191 ( limited preview in Google Book search).
  23. ↑ Helmut Thomä, Horst Kächele, A. Bilger, B. Thomä: Psychoanalytic Therapy: Basics . Springer Science & Business Media, 2006, ISBN 3-540-29750-2 , pp. 153 ( limited preview in Google Book search).
  24. ↑ a b Michael Ermann: Resistance. In: Wolfgang Mertens , Bruno Waldvogel (Ed.): Handbook of basic psychoanalytical concepts. 3rd, revised. u. exp. Edition. Kohlhammer, Stuttgart 2008, p. 841.
  25. ↑ a b Michael Ermann: Resistance. In: Wolfgang Mertens , Bruno Waldvogel (Ed.): Handbook of basic psychoanalytical concepts. 3rd, revised. u. exp. Edition. Kohlhammer, Stuttgart 2008, p. 842.
  26. ↑ Michael Ermann: Resistance. In: Wolfgang Mertens , Bruno Waldvogel (Ed.): Handbook of basic psychoanalytical concepts. 3rd, revised. u. exp. Edition. Kohlhammer, Stuttgart 2008, pp. 838f.
  27. ↑ Karl König: Countertransference Analysis . Vandenhoeck & Ruprecht, 1993, ISBN 978-3-525-45755-9 , pp. 78 ( limited preview in Google Book search).
  28. ↑ Volker Tschuschke, Dietmar Czogalik (ed.): Psychotherapy - Which effects change? On the question of the mechanisms of action of therapeutic processes . Springer, 2013, p. 293 ( limited preview in Google Book search).
  29. ↑ E. and M. Polster: Gestalt therapy - therapy without resistance. In: Gestalt criticism. 1/2002.
  30. ↑ Keyword: Resistance in the Lexicon of Gestalt Therapy .
  31. ↑ K. Schneider: Welcome resistance. A concept and its understanding in Gestalt therapy. In: Gestalt criticism. 2/2002.
  32. ↑ J. Latner: The Gestalt Therapy Book. New York 1986, p. 125 f.
  33. ↑ M. Mehrgardt: Epistemological foundation of gestalt therapy. In: R. Fuhr u. a. (Ed.): Handbuch der Gestalttherapie . Hogrefe, Göttingen 1999, p. 500 ff.
  34. ↑ Jürgen Margraf : Textbook of behavior therapy . tape 1 : Basics ( limited preview in Google Book Search).
  35. ↑ Jürgen Margraf: Textbook of behavior therapy . 2nd Edition. tape 2 : Disorders of Adulthood , p. 634 ( limited preview in Google Book search).
  36. ↑ Jürgen Margraf, Silvia Schneider: Textbook of behavior therapy . tape 1 : Basics, diagnostics, procedures, framework conditions . Springer Science & Business Media, 2008, ISBN 978-3-540-79540-7 , pp. 494 ( limited preview in Google Book search).
  37. ↑ Luc Isebaert: Kurzzeittherapie - a practical manual. The health-oriented cognitive therapy . 2nd Edition. Thieme, 2009, ISBN 978-3-13-139622-8 , pp. 38 f . ( limited preview in Google Book search).
  38. ↑ Thies Stahl : The concept of "resistance" in Milton Erickson's psychotherapy, in communication therapy and in neurolinguistic programming. In: Hilarion Petzold (Ed.), Resistance - A controversial concept in psychotherapy , Junfermann Verlag, Paderborn, 1981. S. 15 online
  39. ↑ Thies Stahl: The concept of "resistance" in Milton Erickson's psychotherapy, in communication therapy and in neurolinguistic programming. In: Hilarion Petzold (Ed.), Resistance - A controversial concept in psychotherapy , Junfermann Verlag, Paderborn, 1981. S. 17ff online
  40. ↑ Thies Stahl: The concept of "resistance" in Milton Erickson's psychotherapy, in communication therapy and in neurolinguistic programming. In: Hilarion Petzold (Ed.), Resistance - A controversial concept in psychotherapy , Junfermann Verlag, Paderborn, 1981. P. 25 online