February 2022
Sometimes, not often, a person comes for therapy who is uninterested in allowing me to do my job. They have a fixed idea about what I should be doing. They tell me they don’t want to share their history; they just want me to “fix” what’s troubling them. I tell them that I can’t possibly know what to do from a description of their symptoms and nothing else; I need to have a fuller sense of where they’ve come from and something of their current life, ideas, things that make them happy, as well as points of distress. Psychotherapy isn’t like prescribing a pill for a condition. Taking a careful and thorough history really matters.
Psychotherapy is a collaborative enterprise. It isn’t me doing stuff to you; it is me listening and guiding you to another way of looking at the issues that are causing difficulties, and working with you so that life is easier for you.
As I’ve said, sometimes, very rarely, a person comes for therapy but from the outset doesn’t want to tell me anything about themselves. I remember when I was learning my art, I had a client that when I said I’m interested in understanding her, she said, “I don’t want you to know anything about me.” What was I supposed to do with her, and why was she there?
Another person reported irritation with me when asked about her past. She couldn’t see a purpose in my questions. For her, my investigation didn’t fulfill her objectives. I replied, they fulfilled mine. I was the one trying to understand her. She may well have felt that her resistance to my inquiries was realistic, but really it wasn’t. There was more: she missed sessions and she was late paying my fee. I realized there was a mismatch at work and we needed to drop the whole thing. Not everyone can work together. It’s also probable that she wasn’t ready to actually do psychotherapy at all. Everything has a season, as they say.
It is important for therapy that a strong working alliance is developed and if the client resents the therapeutic strategy taken by the therapist, then no alliance can actually develop.
Note here, that I prefer not to use the word ‘resistance’. The reason for this is that that term developed out of Freudian psychoanalysis where power relations between therapist and client are intrinsic to that purpose of therapy. Psychological resistance is seen by psychoanalysts as a case of clients clinging to their disease at an unconscious level in defence against the parent-therapist (using the concept of transference as what is seen to go on between therapist and client). That idea, I think, is flawed and suggests the therapist always knows what is going on, and the client is always just oblivious. Therapy, as far as I and many others see it, is much more horizontal than that hierarchical model. We are two people working together, both relatively capable of choice making.
Opposition in therapy may not be aimed at a disagreement concerning the therapeutic strategy adopted by the psychotherapist. Sometimes it arises from an opposition to specific techniques used in session, or non-compliance with agreed exercises (for instance, collecting dreams, keeping a journal, or some other homework) or a dislike of words or phrases used by the therapist, or resistant body language, or repeated non-attendance at planned sessions. Sometimes it manifests in other ways. A client might not want to talk about certain things and will change the subject repeatedly when those subjects come up. Sometimes their objections manifest in not paying the session fee, or delaying it for longer than is polite. All these need to be properly addressed by the therapist and client, and not left to insidiously rupture the therapeutic alliance. When they are effectively addressed by both psychotherapist and client, then two things can happen: a strengthening of the therapeutic relationship resulting in an intrinsic healing, or total rupture. Sometimes total rupture is the only way, but that depends on the choices we make. It’s ideal that both parties agree to what happens next, as good communication is essential in an effective therapeutic transaction.
