Resistance

In 1912 Freud(12) wrote, 'The resistance accompanies the treatment step by step. Every single association, every act of the person under treatment must reckon with the resistance and represents a compromise between the forces that are striving towards recovery and the opposing ones'. The patient's resistance defends the patient's illness from the clinician's attempt to treat it and change it. Resistance may be conscious, preconscious, or unconscious. It may take many forms, including not taking medication as prescribed, forgetting appointments with the psychiatrist, changing the subject in the middle of an appointment to something trivial, and discounting every insight the psychiatrist offers. The patient's characteristic defence mechanisms are often transformed into resistances in the treatment situation. If a patient sexualizes relationships as a way of avoiding abandonment, that same patient may sexualize the treatment relationship to assure the therapist's continued interest and allay the fear that the therapist may stop the treatment. The dynamic psychiatrist knows that all progress will be accompanied by some degree of resistance, and the exploration of resistance is a major part of therapeutic work. Resistance is intimately related to transference because the patient often rebels against the doctor resulting from unconscious transference configurations that lead the patient to oppose the doctor's help.

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