Psychodynamic Psychotherapy Video #4: Resistance

So my book will finally be available on Monday, I’m caught up on all the work I’ve been neglecting and now have some free time to focus on other things, such as continuing my video series on psychodynamic psychotherapy. This is the fourth installment and it deals with resistance in the early phases of treatment.

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

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32 Responses to Psychodynamic Psychotherapy Video #4: Resistance

  1. Gordon says:

    Very good video about a subject that I think is very important to success in therapy. Personally I find it hard to differentiate between the skepticism defense mechanism and true skepticism. For example, if my therapist starts treating my best friend I would probably not mind at first, but I could use it to rationalize my resistance through skepticism later on. However, it’s also valid skepticism as these kind of relationships can get messy and many therapists would not agree with it.

    Ps: I did notice a bit of camera shyness.

    • Joseph Burgo, Ph.D. says:

      Thanks, Gordon. Yeah, I’m still working on my video presence. I’ve come to the conclusion that what I really need is an actual audience. I’m much more “myself” when I’m talking to a real person than a camera. I think most people are this way.

  2. RC says:

    You describe our defense mechanisms as lies we tell ourselves to avoid unbearable pain. Do you mean the pain of psychological symtoms like anxiety, panic and depression that we are trying to avoid? Or more emotional pain like sadness or anger or self-hatred? Maybe both?

    This is where I often get confused in therapy. I would much rather feel the pain of an emotion than the pain of chronic anxiety and panic attacks, but it seems that I have little conscious control over that decision. In your book, do you touch upon psychological “symptoms” as defenses as well as behavioral defenses, like lying, using drugs or alcohol?

    Congratulations on the book. I look forward to the Kindle version for download.

  3. Gary Bebout says:

    I’ve come to know you in a way through your videos and emails. I can see that you would be a competent therapist. I like your style, and would anticipate your training and methodology in cutting through the superficial, and coming to realizations and real help.

  4. Warren says:

    I often think that the pain of resistance and defenses needs to be greater than the existential problem for therapy to be of a certain efficacy worthy of the activities engagement. You mention that resistance is a defense, and people need their defenses. Defenses work, but of course at a price. What I find interesting is that, the defense; either a thinking patten, emotion or behaviour, eventually becomes more painful, than the pain it is supposed to assuage. A trip to the dentist causes me sheer animal terror. But eventually, when my toothache intensifies and has troubled me for long enough, the pain of confrontation becomes less than the pain of avoidance.

    • Joseph Burgo, Ph.D. says:

      Yes, but don’t you know people whose defenses work well enough that they NEVER get to that point? On occasion, I feel envious of those people who just get by, whose life works in some minimal way and they don’t have to confront the deeper pain. I do know that it doesn’t really work and that true intimacy is impossible, but there’s a kind of superficial appeal to their lives.

      • Natalie says:

        Had to comment on this Joe. Its so easy to envy people who seem to have it together on the surface especially when your own personal experience is different. Its also hard when you’re surrounded by family who have this personality structure because there is a lost opportunity for a relationship of deep significance. I’m sure they are still walking around with their pain and traumas locked away inside stopping them from knowing themselves and others in a real way. While battling our inner demons can be unbearably painful the outcome is worth it. Your writing experiences show when there’s a will there’s a way.

      • Warren says:

        Very true. As a writer, and indeed the human being I am, I often envy those who pass through a nine-five week, weekends drinking beer and watching shit t.v, never a thought of introspection or indeed what else there may be out there in the world, or what indeed once was historically, or could be in the future. To be otherwise is both a blessing and a curse. The very fact we call a problem, a problem, is because it evokes in us unwanted intense negative feelings. But only in solving these problems do we grow in consciousness, and the lamp we shine on our next, perhaps bigger problem, grows in luminosity. As a therapist, you are also something of a teacher, and the only way to teach with integrity, is to lead the way where you expect others to follow. I was once bemoaning a similar complaint to a retried miner with no education beyond High School. He said to me, ‘if you know better, then you should do better, it’s not a choice, it’s your duty’. He was right.

  5. maureen says:

    This is an off-topic question but I’m hoping you can answer it (anyone can feel free to chime in if they like). Would you recommend CBT or DBT for someone who has symptoms of depression, anxiety, and self-harming behavior but not BPD? I know DBT was creating for BPD but how much can it benefit people who don’t have that?

    • Joseph Burgo, Ph.D. says:

      I’m not a big fan of CBT techniques, period. They just seem like bandaids and I’m interested in the deeper meaning. I know there will be other visitors to the site who will feel differently.

      • Maureen says:

        I’m interested in CBT/DBT because it seems to be focused on problem-solving and helping the person function, rather than paying someone to listen to you whine about your mother or just taking pills. I tried a CBT group last year which helped me fix my sleep issues, but I don’t know if it’s helpful with other depression symptoms. In the past I have seen psychoanalysts which I thought was quite useless; basically 45 mins of “how do you feel about that?”. I think psychoanalysis is more beneficial for therapists because it gives them long-term clients to profit off of. That said, I know seeing a psychoanalyst has helped a lot of people, but maybe it’s not for me (I certainly can’t afford long-term therapy right now).

    • annonymous says:

      Maureen from what I know of DBT it can be very helpful in helping to cope with the issues you are struggling with so that (if you choose) you’re then in a better position to benefit from in depth psychotherapy to bring about a more comprehensive understanding of yourself and your struggles. Good luck!

  6. adrian.d says:

    Interesting, I’m waiting for the speech about dependency.
    It’s a great idea to publish these videos, they make it pretty clear what to expect when starting that kind of therapy, and could help the skeptical ones to give it a chance beyond the first 3-4 sessions.
    Just a technical note: the audio could only be heard on the left channel (a bit annoying for those who have to use headphones).

    • Joseph Burgo, Ph.D. says:

      Thanks for the technical comment. I have a new wireless mike and I’ll try to figure out what I’m doing wrong.

  7. Barb says:

    I watched the video. I think I can understand the perspective of those who are showing resistance. I can really relate to not wanting to feel the emotional pain again. I do respect the brave clients who keep doing the work.

  8. maureen says:

    Hmm I did not really understand “resistance” until you explained it. I have been accused of being resistant by several therapists; typically by the 3rd session I’m tired of the therapy, feel it’s not worth my time/money, and quit. Then months later I pick up with a new therapist. In the future, maybe you could discuss how you overcome resistance in therapy with your clients?

    • Joseph Burgo, Ph.D. says:

      First of all, I rarely use the word “resistance” with my clients. In order to deal with it, I usually bring up (gently) the possible reasons behind the resistance. Based on what you say, I would think that a fear of coming to need and depend upon your therapist might be the issue.

  9. annonymous says:

    Joe I’d be interested in your thoughts in the next video about dependency on what to do with hard to hold clients such as those with borderline and/or self-harm/suicidal tendencies or overwhelming abandonment fears (if this fits in with the rest of the content).

    • Joseph Burgo, Ph.D. says:

      I will try. A primary consideration is frequency of sessions. I’ve never successfully worked with a client suffering from borderline issues once a week. They can’t bear the length of time between sessions.

  10. KT says:

    When I was in therapy (I am in an unfortunate break secondary to finances and stuckness, one of which is real and the other is probably a defense), I got into the habit of writing something after every session. The discussion above reminded me of something I had written about this idea of ” is it crazier and more painful to keep your unhealthy defenses and have a kind of superficial happiness or go to therapy and start to try to break these down which is very painful”. Is it good? Bad? right? wrong? Anyway this is something I wrote about it. Dr. Burgo please let me know if posting these things is appropriate, I worry a bit about the language and also “triggering” other people. Feel free to not post for any reason.

    It is Thursday evening
    I feel fine, no “appointment” today
    The trip went well
    It was great to be in Seattle
    So much Oxygen, seafood, trees, rain
    And up and coming bands
    I remember last Thursday evening
    After the usual appointment
    The usual suspects showed up
    I didn’t feel so well
    Anxious, afraid, uneasy
    Full of shame
    No compartment to hide it in
    And so one must ask why?
    Why will I go back to the room next Thursday?
    And pay this person
    This stubborn, intense seemingly sometimes crazy
    Human being
    To look at me squirm around for an hour?
    I invite and pay for this pain and fear and shame
    And stomachaches
    I mostly dread it now
    At the very moment I look forward to it
    But everywhere else seems so fused
    To the surface of things
    The world seems intent
    On fucking around
    No one wants to look at the mystery anymore
    Of us
    Well I’m not interested in fucking around anymore!
    Most of the time anyway
    And this room, and this person
    Seem to want to know about the mystery and the truth
    And I don’t know why
    And I know it seems insane
    But I would rather have sorrow and honesty
    If that is what is true
    Than superficial happiness
    The lie is more painful
    For me

  11. rory says:

    Dr. Burgo,
    I have finally bit the bullet and made an appt with a psychotherapist near me. I have been struggling for 5 yrs to pull myself out of whatever I am in, to no avail.
    I saw 2 therapist, both so incompetent they were actually funny, (not really). Just this spring I met with one who was very kind, professional and empathetic. I was able to open up to her like no other person. Just as your video on resistance says as soon as I felt the relief of some anxiety and panic attacks I felt stronger and began to feel that everything was ok, like all the pain had magically disappeared. I finished seeing her after 8 sessions.
    A little while later when a crisis came up I found myself wishing I could talk to her. It was not until then that I began to experience sexual feelings for her whenever I found my inner chatter talking things over to “her”. I am married with two children and had no idea what was happening until I found your blog. I guess that was transference.
    Anyhow, so now that I have this appt I am very nervous that what I have to talk about will be too trivial and I will be embarrassed and I would like to ask you, if I had a transference with one therapist will it happen again? Yikes!!

    • Joseph Burgo, Ph.D. says:

      It could easily happen again. But I’m curious about why you didn’t go back to your prior therapist, especially since you felt able to open up to her so completely. Those sexual feelings aren’t necessarily something to be avoided but a reaction to be understood.

      • rory says:

        Well, I did not go back to her for a few reasons and they may not be the right ones. Her approach is CBT and EFT. From your posts, I can recognize that I am a client heavily guarded with my defence mechanisms; saying things like, “oh, I know , I am very self aware.” In reality, I am not very self aware and she was able to tell me things about myself and why I did things that were new and insightful. However, books like, Hold Me Tight, and other self help books just are not what I am after at this stage of my life. I need to know the why’s. I have always had a much deeper interest in my own psych, and others, but the last 5 yrs I have been rendered stupid, unable to get out of myself and this funk of worthlessness.
        I don’t know why but I felt that she felt we were finished. Kind of like, ” If you ever need to talk feel free to come back” and I left thinking, need to talk- I am not even started!
        After those sessions I have remebered some things she pointed out, which at the time I dismissed, and now I know she was bang on! Actually it was her website, which had flagged “shame” that led me to you and your blog.
        For those reasons, and many months of reflection here on your site, I searched for a pychotherapist. I am hoping she will be able to delve deeper into the reasons for my deep pain. Books like the best seller you recently reviewed just make everything pretty and sugary and as soon as I get down to the activities of daily living that approach gets dirty and messy and all the sugar falls off.
        I am nervous to start and I was hoping I could bring in some shield so there will be no transference. There may not be—- right? tks RM

        • Joseph Burgo, Ph.D. says:

          I see. Yes, that sounds like a better choice. Think of the transference as a tool, a way to gain insight into yourself, rather than an obstruction or something to be avoided. In my experience, you can’t avoid it anyway.

          • rory says:

            just one more question that I meant to ask in my first post. When I carefully read and chose the pychotherapist that I ended up emailing, it stated on her website that her practice was full and she was not taking new clients at this time.
            I sent a message stating that I did realize she was not seeing anyone but when a spot became available would she please consider seeing me. The next day I recieved an email from her stating that my timing was good and she could see me. When I called she was able to see me exactly when I was able to go.
            As is a typical reaction from me when I feel someone is trying to pull the wool over me I instantly felt distrust towards her. I felt anger and then doubted how busy she really is. I felt .that it was said to bring in clients to a popular therapist. I know that is not a good way to go into a relationship.Those kind of things bug me – big time. I even went back on line to search for another but her philosophy appeals to me.
            Now I am trying to relax, thinking that maybe she didn’t update her website or whatever. I will give it a chance.
            Maybe I just want to quit before I start. Do you think it is silly for me to be doubting that?
            Thank you so very much. RM

            • Joseph Burgo, Ph.D. says:

              I don’t think it’s silly. Under the circumstances you describe, the same thoughts would’ve crossed my mind. But I don’t think that’s a reason to disqualify her before you even get started. At some point, you’ll need to discuss this with her. It’s bound to be revealing no matter what comes out.

  12. Catherine says:

    Very interesting! Thanks. Looking forward to #5

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