Resistance: Psychodynamic and Behavioral Approaches

RESISTANCE AND THE PROCESS OF THERAPEUTIC CHANGE Paul L. Wachtel Psychotherapy, whether practiced from a psychodynamic or a behavioral point of view,! is rarely as straightforward as textbooks and case reports usually seem to imply. More often the work proceeds in fits and starts (and often does not seem to be proceeding at all, but rather unraveling or moving backward). The "typical" case is in fact quite atypical. Almost all cases present substantial difficulties for which the therapist feels, at least some of the time, quite unprepared. Practicing psychotherapy is a difficult-if also rewarding-way to earn a living. It is no profession for the individual who likes certainty, predictability, or a fairly constant sense that one knows what one is doing. There are few professions in which feeling stupid or stymied is as likely to be a part of one's ordinary professional day, even for those at the pinnacle of the field. Indeed, I would be loath to refer a patient to any therapist who declared that he almost always felt effective and clear about what was going on. Such a feeling can be maintained, I believe, only by an inordinate amount of bravado and lack of critical self-reflection. But the therapist trying to get some ideas about how to work with 1 These are, of course, not the only two points of view in psychotherapy; nor do I believe they are the only two of value.