ABSTRACT
We now examine three specific issues that regularly arise, each of which interferes with progress. The use of the term resistance is purposeful, since we want to emphasize that many apparently self-defeating behaviors are more accurately conceptualized and treated as anxiety avoidances. They stem from fear, not from oppositionalism or an attempt to sabotage treatment. In these cases, it is the role of therapist to make that explicit to the patient, and to work out manageable steps towards the goal. The assumption is that resistance is never the patient’s fault, any more than having an anxiety disorder is the patient’s fault. And it is our responsibility to observe it, point it out to the patient, conceptualize it as a meta-problem, and suggest concrete steps to overcome it. Resistance as a response to unmanageable anxiety will typically emerge repeatedly during the course of treatment. The sources of anxiety can be varied, from exposure assignments that are too difficult, to more subtle triggers such as the patient’s difficulty coping with skepticism or uncertainty, alternate belief systems, or the anticipation that changes will bring a clash in lifestyles. Family issues may well emerge as forces afraid of change. And a patient’s demoralization (and its partner depression) may sap him of the energy, enthusiasm, and hope required for this kind of active approach.
Many self-defeating behaviors are more accurately conceptualized and treated as anxiety avoidance.
Resistance is never the patient’s fault.
