Psychotherapy, Do We Really Want to Change?
"I am finally at the point where I can think about him without falling to pieces. This is what I think a psychologist would say. But I can't be sure, because I won't see one. ...Both Mutti and Dan have suggested it...my reaction was a combination of sputtering indignation and hurt tinged with anger." Flying Changes, A novel by Sara Gruen, Harper, 2005.
Logic says that people enter psychotherapy because they want help. They feel depressed, anxious, angry, obsessed or in some other type of life crisis. Perhaps a parent, close friend, spouse or someone very close has died. What ever the particular set of circumstances, the person is in great emotional pain. When we have physical pain, most of us will see the doctor. We worry that the source of the pain could be cancer, appendicitis, angina, heart attack, or some disease that frightens us. We want help. But, when it comes to emotional crises, do we really want help? Does the fact that we start treatment with a psychologist, social worker or psychiatrist, mean we really want to change?
To the extent that we do not want help, even when we go to psychotherapy, is the extent to which we are experiencing what is called "resistance."
Resistance is a defense mechanism that is used to fend off something that is threatening.
Some of the factors behind resistance are:
1. Not wanting to recognize feelings, fantasies, and motives that, even though we have them, are too unpleasant and unacceptable to admit to.
2. One of those feelings that we find unacceptable is that we have angry or romantic thoughts and feelings about the therapist.
3. Hiding our disappointment with the therapist because he seems un-empathic and we do want to reveal how we feel about it.
4. We want to demonstrate to the therapist that we are self-sufficient.
However, one of the strongest sources of resistance to the therapist and to therapy has to do with feeling of humiliation. There are those people who feel threatened by putting themselves into the hands of the therapist. To them, therapy feels like submitting to this other person who is viewed as more powerful and, therefore, the patient fears that they will become "nothing." Under these circumstances, the patient believes that its better to hold onto the suffering than to be what he thinks of as submission. Put simply, ego or pride or narcissism gets in the way.
In this type of person, suffering and feeling wronged by others becomes a self defining way of being. If the suffering were to end, they would not know what to do with themselves. As a matter of fact, continuing to feel wronged, hurt and angry becomes a way for the individual to convince himself and others that he is right. Proving he is right becomes a way of demonstrating his superior intelligence over others, including the therapist. "See, I am right. See how I continue to suffer? See how the world mistreats me? No, you do not see it because you are a terrible therapist who does not know what he is talking about."
To this kind of troubled person, there is victory in their own defeat. This patient would rather be right in their reasons for suffering than change their way of living. This type of patient falls under Personality Disorder. There is no conscious of the behavioral patterns and there is a long history of this pattern of behavior.
Much is made about the differences between the "psychodynamic talking therapies" and the cognitive behavioral therapies. In terms of the person who needs to prove how defeated the type of psychotherapy and type of psychotherapist makes no difference.
So, what is the purpose of writing this essay if this type of person does not want to change and what can be done about it? Good questions. Here is my answer:
Resistance of all types are often outside of the individual's conscience awareness. Becoming aware can change a lot. It is hoped that this type of article will raise awareness. In these circumstances it is the role of the therapist to help the patient understand their resistance.
It is important to state that resistance is not a bad thing. It becomes part of the therapy between patient and therapist. When this type of resistance occurs in a patient, raising awareness becomes the central theme of therapy. Remember, not all people feels this way. Everyone does not have the same resistance. This type is one of the toughest to deal with because the patient is so invested in holding on to their pain.
It is also important to emphasize that the intent here is not to blame the patient. Quite to the contrary, the doctor does not blame the patient for having the flu. Same here.
Your comments and questions are encouraged.
what if the "inner deep" rejects any changes? - Stephan - Jan 8th 2012
I have liked the article. There is, however, one thing not claer to me: what (as in my case) the "inner deep" - in general - rejects any changes (-> awareness is there!). Can psychotherapy still be "sucessful"?
PS: Any feedback (via e-mail) is highly appreciated.