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So let’s pick up where we left off last time. We were talking about the different kinds of defenses. Basically, when facing feelings in therapy we can resist them in two ways, by using a defense or enacting a past relationship, the transference. That’s why writers refer to defense resistance or transference resistance.
What do we mean by a transference resistance. A patient enacts a past relationship with you to avoid the rise of feelings. Let’s compare two ways of avoiding feelings. A patient is exploring anger toward her verbally abusive husband. You ask, “What is the feeling toward him when he verbally abuses you?” She may resist the feeling by using the defense of rationalization: “I think the reason he does that is because he had a hard day at work.” Or she may resist the feeling by enacting a relationship from her past. After you ask your question, she looks away, crosses her arms, distances from you, and says, “I’m not sure that’s a question I can answer. Can you give me a list of feelings? Maybe then I can figure out what you are asking.” Instead of using a verbal defense, she uses many non-verbal defenses. She distances from you. She pulls away. She acts helpless and passive, expecting you to become more helpful and active. Instead of using one defense, her defenses operate together to create a pathological relationship: the transference. Instead of just pushing away a feeling, she pushes you away. Now her problem is not just a defense, but an entire way of relating to you and other people.
Now your work must shift from defense identification to transference resistance identification. Instead of pointing out single defenses, point out how she is relating to herself and to you. If you point out a single defense, it will have as little effect as if you took one brick out of a wall. Let’s look at this difference in intervention. I
Defense identification: “Well that may be the reason he verbally attacked you, but if we don’t cover your feeling with reasons, what is the feeling toward him for calling you a fat cow?”
Resistance identification: “Do you notice how you look away and avoid my eyes? And do you notice how you are pulling away from me and crossing your arms? Do you notice how you start to distance with me? Do you notice how you are sitting here expectantly?”
Through this series of questions you help her see a pattern of behavior, a pathological mode of relating that would prevent any relationship for change from forming. When you sense your therapy is stuck, check to see if you have established a consensus on the problem and the therapeutic task. If so, then check to see if the patient is collaborating with you. If not, you may need to shift your attention away from the defenses to the way the patient is relating to you and herself (the transference resistance).
Whereas most approaches interpret this relationship (the transference), in ISTDP we don’t. Interpretations enact the transference resistance. For instance, if you interpret to a passive patient, he may listen wide-eyed, expecting to be magically cured in any moment by your interpretation. Instead, address the transference resistance non-interpretively to block and deactivate the projections upon which it is based. That’s what we are going to learn to do in our webinar on this topic in the Spring.
In the meantime, don’t forget to purchase our dvds on working with the fragile patient. The set includes a cd with the entire transcript and an in-depth analysis so you can follow the video with the transcript. Meanwhile, we have some new teaching videos coming out in the New Year. And don’t miss our webinar on psychodiagnosis in January.
Thanks so much for all your support and have a Happy Holiday,
P.S. If you have questions you want us to address send them to firstname.lastname@example.org and we’ll answer them in future blogs.