On resistance

One of the most cherished explanations for psychotherapy gone wrong is that the patient is ”treatment-resistant” i e opposes the therapeutic process. Originally Sigmund Freud was the one who first put forward this theory, which in fact frees the therapist from all responsibility. I have as yet not found one single therapist who has thought of how this feels for the patient or what consequenses it has for the patient.
I can tell you: The patient can never utter one single word of critiscism regarding the ”help” he has gotten – anybody smiles benevolently and understands that all is his own fault, he has been reluctant and resistent towards any ”help”. The man in the street knows that the fault is the patient´s there cannot be anything amiss in the therapist´s work.
I found an interesting man on the Internet the other day, a man who seemed to understand this dilemma. His name was Allan Abbass. One of the leading names in the ISTDP-movement (Intensive Short-Term Dynamic Therapy).
He spoke so adamantly about the therapist´s shortcomings, that I immediately decided to make a closer acquaintace.
I was immediately sorely disappointed.
I quote:
”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.”

The same old song. All is the patient´s fault. The terapist is the helpless victim of the vicious treatment-defeating patient. This is the eternal sacred explanation for all the therapist´s shortcomings. It is never the therapist´s fault.
But no, that is not what Abbass means. He has discovered how the therapist may defend himself.
I remember vividly how my short term terapists pointed their fingers at me and chanted: ”Don´t you see what YOU are doing?” No, I said perplexed. ”You WANT to exclude US!” No, I don´t. ”SIGH! She doesn´t understand what she is doing.”

But Abbass has an understanding word for me. He says:

After these patients had experienced years of childhood deprivation and abuse, the system often re-creates thwarted attachment efforts and adds to their burdens.

Note: The System. Not the patient this time. But this is the only time he says anything in the patient´s defence. After this brief moment of understanding he goes on to explain how the patient must be confronted with his ”treatment resistance”. Helping the patient with the original trauma seems never to be an option.

In my case – after 30 years of hard work to save my sanity, working like a maniac against several therapists in a row – I know that what happened was exactly that: my therapists repeated the reactions of a poisonous and thwarting system once more, adding to my burdens abundantly. And then they explained that I was treatment resistant.

At the time I used to say that their system was just as brutal and ignorant as if they had asked me to put my finger in a candle flame and keep it there. And then when I withdrew they would explain that I was treatment resistant.

I got no help, needless to say. Finally my situation was really dangerous, I wanted to go under the train every day for a very long period of time.
At this time of dire need I found Stettbacher/Jenson about whom I have been writing abundantly. Without their wonderful and precise self help method I would not be here.

It is true, Stettbacher/Jenson work the way Abbass describes: once you have seen and felt the emotions involved in your very real original problems you take a big stride forwards. You understand in depth the dilemma you were in when the original trauma happened. You are back in the reality of the child and you are convinced that you will die.

So to me there is really no reason to ”provoke” anything or question anything. In front of death anybody will flee for their lives.

So I wish you would stop talking about the patient resisting treatment and instead focus on advising the therapists to give the right sort of help. And the right sort of help is not confronting the patient with his resistance. Because the patient must resist as long as his situation is not understood. A therapist who lacks the knowledge required is in fact abusive.
Abuse must be resisted.


To my great delight I see that my blog has readers as far away as the United States. Not many, of course, since I have been writing in Swedish. So now let´s try English and a bilingual blog. Because today I have something very important to say, something that is new even to myself, at least partly.

My first bilingual blog will dwell on the wellknown concept of resistance.

As long as I can remember all therapists of all times have excused their own failures by telling the world that the patient resists treatment.

Why on earth would the patient do that?

Sigmund Freud knew why. Because the patient doesn´t actually want to be cured. To be cured entails too much pain, too much effort, too much humiliation, to much adult responsibility. The patient CHOOSES not to grow up, the patient chooses to thwart the therapist´s ambitions, because the patient is jealous and envious and full of unconscious hatred. Modern ISTDP-therapists confirm this notion and talk extensively of ”treatment-resistant” patients.


Who am I to dispute that?

Freud built a bulletproof system to protect his methods and explain his failures. If the patient didn´t improve – and most of his patients did not – it was because the patient resisted treatment, was scared to death of the truth about his shortcomings, felt guilt because of his oedipal hatred, and his oedipal defeat, did not want to confess to his murderous rage etc etc.

So when I a good hundred years later said that I got no help from psychiatry, anybody in the street could diagnose me with treatment resistance. With a sad, condescending, patronizing smile. If I showed how hurt I was by this it was further proof of my incompetence and unfitness for therapy of any higher order. ”Therapy is hard work,” one of my oldest friends sadly instructed me, which to me meant that she had swallowed the therapist saving ideology line, hook and sinker.

I read nine of the twelwe volumes of the complete works of Sigmund Freud when they came in Swedish in the 90´ in a new modern edition. To me it was blatantly clear that Freud never bothered to ask his patients, he just decided that they were afraid of getting well and that explained everything. The very thought that there could be something wrong with the treatment obviously never even occurred to him. He certainly strove to refine his methods, but that the core of the method could be wrong – of course not. The patients were scared of the truth, period.

And so it goes on and on until the modern day. Almost all schools of treatment repeat treatment resistance. Without asking the patients.

And I say: as long as they go on harping on the treatment resistance they will go nowhere. It is a dead end.

Treatment resistance exists. Of course. If the therapist asks you to put you finger in the candle flame and keep it there you will resist. He may tell you a hundred times that you´ll be fine. You won´t believe him. And you are right. And he is wrong.

When you leg is broken and he comes right up to you and gives you a sturdy kick on that leg you will scream with pain. He may smile and point his finger at you oversensitivity, it won´t help one bit.

And the more he tries to attack your ”treatment resistance” the more you will withdraw, much to his annoyance.

This is what treatment resistance is about. Brutal AND harmful AND ignorant treatment will produce an enormous and presistent resistance. At the patient`s expense, of course. In addition to his original trauma he will now have a second trauma – the treatment trauma.

And some people will find his sad appearance somewhat comical. And tell him all about how much better off he would be if he understood the therapist instead of putting up a fuss.

In the above linked excerpt the patients are subjected to interrogation of the third degree without any chance of giving the right answer. All is wrong with the patient, nothing is wrong with the heartless treatment.


Till min stora förtjusning ser jag att min blogg har läsare långt borta i USA. Inte många, förstås, eftersom jag har skrivit på svenska. Så låt oss pröva på engelska och en tvåspråkig blogg. För idag har jag nånting mycket viktigt att säga, någonting som är nytt till och med för mig själv, i alla fall delvis. Min första tvåspråkiga blogg kommer att dröja vid det välkända begreppet motstånd.

Så långt tillbaka jag kan minnas har alla terapeuter i alla tider ursäktat sina misslyckanden genom att berätta för världen att patienten gör motstånd mot behandlingen.

Varför i hela friden skulle en patient göra det?

Sigmund Freud visste varför. För att patienten egentligen inte vill bli botad. Att bli botad innefattar alldeles för mycket smärta, för mycket ansträngning, för mycket förödmjukelse, för mycket vuxenansvar. Patienten VÄLJER att inte växa upp, patienten väljer att motarbeta terapeutens ambitioner, för patienten är svartsjuk och avundsjuk och full av omedvetet hat. Moderna ISTDP-terapeuter bekräftar denna tanke och talar omständligt om ”behandlingsresistenta” patienter.


Vem är jag att ifrågasätta det?

Freud byggde upp ett skottsäkert system för att skydda sina metoder och förklara sina misslyckanden. Om patienten inte blev bättre – och de flesta av hans patienter blev inte det – berodde det på att patienten gjorde motstånd mot behandlingen, var dödsrädd för sanningen om sina tillkortakommanden, kände skuld på grund av sitt oidipala hat, och sitt oidipala nederlag, vägrade att erkänna sitt mordiska hat, etc, etc.

Så när jag drygt hundra år senare sa att jag inte hade fått någon hjälp från psykiatrin så kunde vem som helst på gatan diagnosticera mig med motstånd mot behandlingen. Med ett sorgset, förklenande och nedlåtande leende. Om jag visade hur sårad jag blev så var det ytterligare ett bevis på min inkompetens och min olämplighet för någon kvalificerad terapi. ”Det är hårt jobb att gå i terapi,” tillrättavisade mig en av mina äldsta vänner med ett ledset leende, vilket för mig betydde att hon hade svalt hela den terapeutskyddande ideologin.

Jag läste nio av de tolv volymerna av Sigmund Freuds samlade verk när de kom på svenska på 90-talet i en ny modern upplaga. För mig var det helt uppenbart att Freud aldrig besvärade sig med att fråga sina patienter. Han bara beslöt att de var rädda för att bli friska och det förklarade allt. Själva tanken att det kunde vara något fel på behandlingen föll honom tydligen aldrig in. Visst, han strävade efter att förfina sina metoder, men att grunden för metoden kunde vara fel – naturligtvis inte. Patienterna var rädda för sanningen, punkt, slut. Och så fortsätter det än idag. Nästan alla terapeutiska skolor upprepar motståndet mot behandlingen.

Och jag säger: Så länge som dom fortsätter att tjata om motståndet mot behandlingen kommer de inte att komma någon vart. Det är en återvändsgränd.

Motstånd mot behandlingen finns. Naturligtvis. Om terapeuten ber dig att sätta fingret i en ljuslåga och hålla det där kommer du att göra motstånd. Han kan säga hundra gånger att det inte skadar dig. Du tror honom inte. Och du har rätt. Och han har fel.

När du har brutit benet och han kommer rakt fram till dig och ger dig en redig spark på detta ben då skriker du av smärta. Han kan le och peka finger åt din överkänslighet, det hjälper inte ett skvatt.

Och ju mera han försöker angripa ditt ”motstånd” desto mera kommer du att dra dig tillbaka, till hans förtret.

Det här är vad motstånd mot behandlingen handlar om. Brutal OCH skadlig OCH okunnig behandling åstadkommer ett enormt och ihållande motstånd. På patientens bekostnad, givetvis. I tillägg till hans ursprungliga trauma kommer han nu att ha ett andra trauma – behandlingstraumat.

En del människor kommer att tycka att hans trista uppenbarelse är något komisk. Och tala om för honom hur mycket bättre han skulle klara sig om han började samarbeta i stället.

I utdraget som jag länkade till här ovan utsätts patienterna för tredje gradens förhör utan en chans att komma med det rätta svaret. Allt är fel på patienten, ingenting på den hjärtlösa behandlingen.