Defences in therapy

KATHY STEELE / DOLORES MOSQUERA

• WHY ARE DEFENSES RELEVANT IN THERAPY?
•
Defenses serve as protection for clients who may need further skills or
support to move forward.

•
Identifying defenses can help us understand complex cases better and
handle countertransference better.

•
Once defenses are identified, we can explore conflicts, identify relevant
difficulties for clients and adapt the work.

•
If defenses are not identified therapy often gets stuck.

•
All defenses are about avoidance
• HOW DO WE FEEL IN THERAPY WHEN
CLIENTS PRESENT WITH DEFENSES?

• Confused Lost Ambivalent Irritated

Frustrated Hopeless At fault Angry
Intimidated Disgusted Ashamed Helpless
• Resistance is perhaps best conceptualized as phobic
avoidance of what the client believes is too overwhelming
to realize or is too activated to realize. (Steele et al.,
2017)

• Phobic avoidance can develop for certain attachment and

trauma-related inner experiences (Steele et al., 2005; Van
der Hart et al., 2006)
• “Resistance” implies there is an obstruction interjected by the client
that disrupts an otherwise natural trajectory of treatment.

•
Resistance is not an obstruction but is the major and essential work
of psychotherapy (e.g.,Messer, 2002).

•
In fact, our clients come to treatment because they are blocked in
ways they cannot overcome themselves, and which involve their
natural coping strategies.
• A CO-CREATED PROBLEM

• “When therapy does not progress it is usually a function of

both the client’s resistance and the therapist’s counter-
resistance.
• Therapeutic stalemates are, in effect, a mutual creation of
client and therapist.” - H. S. Strean (1993,p. 2)
• “Resistance” may not lie with the client, but with the therapist,
who may:
•

• Fail to attend to the therapeutic relationship

• Not formulate a coherent treatment plan
• Not keep adequate boundaries or a clear treatment frame
• Be overly rigid and unavailable / or too lax and available (caretaking)
• Focus too much on content instead of process
• Not adequately paced treatment
• Engage in chronic defense or rescue
 By accepting resistance as an
• “

inevitable, even desirable, feature of

our work, we are equipped better to
be truly accepting of our clients and
therapeutic in interacting with them. ”
- S. B. Messer, 2002, p. 163
•
• IT’S NOT JUST ABOUT WHAT HAPPENED…BUT ALSO ABOUT:
• Degree of trauma-related phobias
Difficulties tolerating positive emotion
Chronic defenses
Severity of personality disorder
Degree of attachment disturbance
Degree of regulatory difficulties
Overall integrative deficits / capacities
Degree of non-realization
Degree of inner cooperation
• Resistance is often due to trauma related defences:
• Phobia of inner experience (including thoughts, fantasies, wishes,
needs, emotions, predictions, perceptions, sensations, and
movement)

• ¡ Phobia of dissociative parts of self

¡ Phobia of traumatic memories
¡ Phobia of attachment and of attachment loss
¡ The phobia of change
(Steele et al., 2005;Van der Hart et al., 2006; Steele et al., 2017)
• The fear of getting better:

• Although clients want to feel better, they are often afraid of feeling
“good”
¡ Pleasure or excitement involve hyperarousal, which may be
associated with traumatizing events, fear, etc.
¡ They may have negative predictions or beliefs:
¡ “If I feel good, then something bad will happen.”
¡ “Better not to feel good; I will just feel worse afterwards.”
¡ Clients must first learn to associate pleasurable sensations/affects
with safety
• TYPICAL INNER CONFLICTS THAT CONTRIBUTE TO
RESISTANCE

• ¡ I want to know / I don’t want to know

¡ It’s true / I made it up; it’s not real
¡ Avoidance of parts
¡ Loyalty to the perpetrator: I love him / I hate him
¡ Avoidance of closeness / Fear of abandonment
¡ I want to get better / Getting better means things will be worse
•
TYPICAL INNER CONFLICTS THAT CONTRIBUTE TO
RESISTANCE
• What are the client’s core conflicts (may be held in various
dissociative parts? (e.g.,“I want to be close: Being close is
dangerous;” “I want to feel better: I don’t deserve to feel
better.”)
¡ Do not take one side or the other, but hold both for and
with the client
¡ What affects, cognitions, predictions, etc. are at the heart of
the conflict?
¡ What strategies does the client use to avoid inner conflicts?
¡ How do these conflicts manifest in the experience of the
moment?
RELUCTANCE VS. CHARACTEROLOGICAL RESISTANCE
(as in personality disorders)

• Reluctance
¡ Ego-dystonic
¡ Insight
¡ Change is relatively straightforward
¡ Intense transference is not part of resistance
¡ Typically able to acknowledge and discuss resistance
RELUCTANCE VS. CHARACTEROLOGICAL RESISTANCE

• Characterological Resistance
¡ Ego syntonic
¡ Lack of insight
¡ Change is complex and slow
¡ Intense transference is a major component of resistance
¡ Typically unable to acknowledge or discuss resistance
• RESISTANCE IN THE DISSOCIATIVE PATIENT

•
Resistance can appear to be present in one dissociative part of
the client but not in another.
This is just another manifestation of non-realization:“That is
not mine; that is not me.”
It is important to realize that a “resistant” dissociative part has
an essential function of expressing something the client as a
whole cannot yet own, but which nonetheless comes from the
client.