Recognizing Resistance in the Therapeutic Environment

Despite the proliferation of competing psychoanalytic theories in the past three decades, for most analysts the recognition and interpretation of resistance (as well as transference) remains at the core of psychoanalytic technique. While resistance has been defined as encompassing all of a patient's defensive efforts to avoid self-knowledge (Moore and Fine), operationally it means those behaviors that help the patient ward off disturbing feelings such as anxiety, anger, disgust, depression, envy, jealousy, guilt and shame.

Even though any and all behavior can be used defensively, i.e., in the service of resistance, there are certain kinds of behavior whose configuration make them naturally fit to ward off a specific unpleasant affect. A common example is portraying oneself as a victim to defend against recognizing one's own sadistic impulses. The defense mechanism used, of course, is projection, but the simple equation: I am not the sadist; you are the sadist, is often obscured by the patients emphasizing the role of victim while leaving the malign enemy unidentified.

In like manner there are behaviors whose configurations are so specific to warding off the experience of guilt on the one hand or shame on the other that they can reasonably be termed superego and narcissistic resistances. In his classification of resistances at the end of Inhibitions, Symptoms and Anxiety (1926), Freud directly mentions the superego resistance, but the analogous term narcissistic resistance is not to be found. Instead he uses the term gain from illness and refers to examples that illustrate the pride gained by neurotics from their symptoms. Freud says an obsessive-compulsive person believes that he is better than anyone else because he is especially clean and conscientious, as well as the pride of the paranoiac in the intellectual brilliance of his imagination (Calef, personnel communication 1979).

Superego Resistance

Guilt is the affect experienced when one has transgressed an ethical or moral code, whether in fact or in fantasy. It is experienced in the active mode, i.e., "I have done something bad," but it is not only the specific action condemned but the entire self. While many patients directly state that they feel guilty, closer examination often reveals that they are experiencing another emotion. True guilt is most often expressed verbally as: I feel terrible or I feel awful. In structural terms guilt represents tension between the ego and the superego and the weapon by which the ego is punished for a transgression.

There are four specific responses to guilt: the wishes to confess, to seek punishment, to seek absolution, and to make restitution. The first three responses are the motives for the superego resistance. Though absolution and punishment may seem antithetical, both can reduce an unconscious sense of guilt without its ever becoming conscious.

Once the therapist is alerted to the possibility that a patient's behavior may be motivated by the need for punishment or the desire for absolution, recognizing the motivation behind such common behavior as confessing to trivial misdeeds or being accident-prone is simple. Even coming late to the treatment session can be used as a source of absolution, if the therapist ignores the behavior, or of punishment if the therapist comments, no matter how neutrally. The patient will abstract what he needs to believe from the therapist's behavior. However, at other times the behavior that expresses some form of the superego resistance may be so well-disguised that it is not even suspected.

Mrs. H., a married mother of four children, came to analysis in her mid-30s because she was frightened by involuntary orgasms. Long after she had understood the unconscious significance of this symptom and had resolved many other conflicts, she showed no desire to terminate the analysis. In order to justify the prolongation of her treatment she produced much rich data and "analyzed it" in considerable detail, yet this "analysis" seemed to have little effect on her life.

At one point she calmly related going to the blood bank to make her quarterly donation. Even though she told the nurse that her veins were small and only those in the left arm could be used, the nurse insisted on using the right arm. Only after the right arm had been unsuccessfully punctured a half-dozen times did the nurse turn to the left arm. The patient left with a badly aching, black and blue right arm. After finishing her story she went on to other events.

As I could find no unconscious theme in the material, I asked how she felt when I had not commented on her story of the blood bank. She replied that it was perfectly all right. As I had not criticized her, she felt she had my permission to refuse suffering the pain again. This incident led to the realization that she needed to continue in treatment because I was a relatively benign superego whose silence absolved her of the guilt she rarely experienced and never expressed. Mrs. H. had used my listening quietly to gain absolution without either of us being consciously aware of the process.

Narcissistic Resistance

Shame, like guilt, is a very painful affect but unlike guilt, which can be experienced alone, shame requires an observer, whether in fact or fantasy. It occurs when a perceived defect in oneself is exposed to others and is thus experienced in the passive mode. Again, like guilt, it involves the entire person and not only the specific defect. While most often connected with the sense of sight, it may also be connected to other physical senses such as touch, taste and smell.

The generic term shame covers a large continuum from embarrassment to humiliation and as such is the opposite of a feeling of pride. The initial response to feeling ashamed is the desire to hide one's face, genitals or thoughts. It is often expressed verbally as feeling foolish or stupid. The commonly expressed responses to shame "I could have died!" or "I could have gone through the floor!" illustrate the desire to have the defect hidden from view. The specific responses to feeling humiliated-the wish to hide, the need to be special and the need to devalue the observer-constitute the motivations of the narcissistic resistance. Hiding the defect removes the cause of the shame, while being special undoes the shame. Devaluing the observer is again based on the mechanism of the projection: It is you, not I, who is defective.

The behavior that best expresses these needs is relatively common but not often understood. On being told that the analyst would be on vacation for two weeks in August, one patient responded by announcing that he would be away for three weeks in June. Years later he revealed that he had momentarily felt humiliated when he recognized that he was upset at anticipating the analyst's absence so he suppressed the feeling, and proved that it didn't matter by setting his own vacation earlier and for an even longer time.

Another patient often "impulsively" bought very expensive gifts for himself or his family with no more explanation than "I just wanted it." It never occurred to him that he had been unable to make love to his wife the night before he had purchased a $25,000 watch.

Mr. L., a divorced 40-year-old, used narcissistic resistance almost exclusively during the first few years of his analysis. At the end of his first week on the couch he asked if he had convinced me that there was absolutely nothing wrong with him. He continued the analysis only because he "modestly" conceded that he might have overlooked something.

He was short and slight but his aquiline face and dark tapered beard, erect bearing and haughty expression made him very attractive to women. In fact, his numerous conquests provided the content of most of his sessions. Other subjects were the special cars that only he could find and buy and the business deals that only he could make. Finally a slip of the tongue at the end of the first year hinted that there were, indeed, women who did not respond to his approaches, women he had never mentioned.

Following this lead I discovered that he never mentioned any cause for humiliation but instead talked about a conquest, a car or a business deal that restored his pride. In fact, his sensitivity to humiliation was so great that he was constantly faced with the need to suppress humiliating thoughts. Instead of recalling such thoughts he talked incessantly about events that made him feel special. By inference, he was also devaluing me because he was quite certain that I could never conquer the beauties who threw themselves at him, nor could I make the fortune he had made so effortlessly. The loss of that fortune, largely because he could never acknowledge the realistic financial dangers he faced, ultimately made some analytic work possible. In the sixth year of analysis he proudly told me that he had been able to ask the floor maid at a hotel to open his door because he had left his key in the room. In the past he would have been so humiliated that he could never have exposed the defect to anyone. He explained that forgetting meant that his brain was not working perfectly.

Conclusion

In my experience, superego and narcissistic resistances are used by all character types, but they seem to be used more frequently by borderline, narcissistic and paranoid characters than by obsessional or hysterical characters. When enacted, as they usually are, they can be easily missed unless the therapist is fully aware that he may be dealing with unconscious guilt or shame. As always, the more accurate the recognition of the form and meaning of a resistance, the more precise the interpretation based on that recognition will be and the greater effect it will have on the therapy.

References:

References1. Freud S. Inhibitions, Symptoms and Anxiety. In: Standard Edition Vol. XX. London: The Hogarth Press; 1926.
2. Moore BE, Fine BD. Psychoanalytic Terms and Concepts. New Haven, Conn.: Yale University Press; 1990.