Reaching through Resistance

by Allan Abbass, MD

A New Metapsychology of the Unconscious
Helps Patients Succeed in Psychotherapy

About half of all psychotherapy clients have little to no response—or can even worsen—in treatment. Why? They unknowingly use treatment-defeating behaviors, or resistances, placing all manner of obstacles to prevent emotional closeness and a successful collaboration with the therapist. It is as if they cannot allow treatment to succeed. This can be frustrating and demoralizing for both the therapist and the client.

How can you and your client detect and handle treatment resistance? How can you reach through to the person beneath this resistance—the person your client was meant to be?

For treatment to succeed, you need to recognize and challenge treatment resistance from the first session. Reaching through Resistance will help you

  • detect treatment resistance from the first client contact
  • understand the emotional factors that drive treatment resistance
  • discern different degrees and forms of resistance
  • recognize signs of unconscious anxiety in the body
  • activate and monitor unprocessed, unconscious impulses and feelings
  • turn a client against his or her own long-held defeating behaviors
  • regulate intense anxiety when emotions are activated
  • mobilize the client’s unconscious wish to become well
  • recognize signs of a powerful healing force: the unconscious therapeutic alliance

By rapid detection of avoidance patterns and use of specific interventions developed to handle them, you can empower a collaborative, vigorous treatment alliance and begin to mobilize the healing forces within your client.


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About the Author

Allan Abbass, MD—psychiatrist, teacher, and researcher—is the author of Reaching through Resistance: Advanced Psychotherapy Techniques. He is a professor of psychiatry and psychology and the founding director of the Centre for Emotions and Health at Dalhousie University in Halifax, Canada.
In 2013 he was awarded the Douglas Utting Prize for his contributions in the area of major depression. His innovative program to diagnose and treat emotional contributors to medically unexplained symptoms in the emergency department won a quality award and a national designation as a “Canadian Leading Practice.”
Since 2000 he has been consulted widely by governments, universities, and health agencies on the cost-effectiveness and applicability of short-term psychotherapy. He provides invited presentations around the world as well as ongoing video-recording-based training to professionals in several countries.
He has been a consultant to the American Psychological Association on the Unified Psychotherapy Project and to the American Psychoanalytic Association, where he serves on the Scientific Committee. He was a board member for the International Experiential Dynamic Therapy Association and an editorial board member for the American Psychological Association journal Psychotherapy. He is a visiting faculty member at institutions in the United States, England, and Italy.

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