Are You Suffering in Therapy

Are you suffering while working with a resistant patient these days?

Perfect. This patient is just trying to help you grow. Yeah. You. (Me too.) No patient can cause us to suffer in therapy unless we resist the way he is with us right now. We don’t have to like what we feel when we are with that patient. It’s just if we refuse to experience what we feel with him, we will suffer. Suffering as a therapist almost always originates from saying NO to the patient you have. It’s how we divorce ourselves from the way life is presenting itself to us in this moment.

I’m not saying you have to give up on the patient changing. But for a start we may need to accept our rejection of the patient, and then accept the feeling in ourselves we are rejecting. Accepting him and ourselves is how we align ourselves with reality, no matter how bad it seems with that patient.

How often we comment on the patient’s resistance, reciting the collaborative things he doesn’t do, that we want him to do, because our fantasy patient would do those things. That’s our resistance. It’s not his job to be the way we want him to be. He should be the way he is with us: that’s how he collaborates. An oncologist doesn’t get upset that a cancer patient has cancer. Why get upset when the patient demonstrates all of his relational cancer in therapy? We need to know what to treat. He’s just showing us what we need to know. But rather than explore what his behavior is hiding, we try to change his behavior. We become control freaks, but rationalize it as therapy.

Patients are not fooled. They see we have an agenda to get them to “shape up”. They see we want control over their behavior. They see our resistance. As long as we resist being with them as they are, they will resist us. Once we stop resisting the patient we have, encounter begins.

How to facilitate that? First, remember that resistance is just the impersonal defenses the patient uses to deal with his feelings in relationships. If you don’t take them as personal, you can “decenter” from your feelings, desires, and reactions, and focus instead on his feelings and desires which are hidden underneath his relational behavior.

When your patient’s resistance continues, you are probably resisting him. So ask yourself: how I am I resisting this patient? What feelings are coming up in me? How am I trying to control him so I don’t have to feel my feelings? When I stop trying to control him, what do feel within myself? What do my feelings tell me about myself and my history? Can I let myself have these feelings, so I can get some new information about myself?

In fact, we are not resisting the patient. We resist the feelings rising within us when we are with that patient. If we cannot tolerate that rise of feelings within us, acting out begins, although we call it “intervening.” The most common form of acting out is challenging the patient to change his behavior.

Instead, we need to tolerate the feelings that rise within us while the patient avoids contact with us, then do the work:

1) point out his relational behavior and then ask for feelings toward you;

2) point out the price and function of his behaviors and ask for feelings toward you;

3) differentiate him from his behavior; and

4) challenge the resistance: ask what he would like to do about his self-defeating behavior.

If the patient can see his resistance, its price and function, and the fact that his behavior is not him, then he will realize you are challenging his behavior, not him. And you won’t get a misalliance. If you can see your resistance behavior in session, its price and function, and the fact that this resistance is not you, then you will be able to relate to him instead of your resistance.

There are two people in the room, both with feelings. If the patient resists a close relationship with the therapist, we call it resistance. If the therapist resists a close relationship with the patient, we call it counter-resistance. Hmm. Another thing we share in common with our patients.








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