Shirah Vollmer MD

The Musings of Dr. Vollmer


Posted by Dr. Vollmer on January 29, 2013

Martha Stark MD says “the pioneers of psychotherapy quickly learned that an unconscious psychological force worked against a patient’s conscious desire for cure. This impediment to change was captured in the term resistance. Each new understanding of resistance opened a door to fresh clinical challenges.” Sheldon Roth MD wrote in his Foreword to Dr. Stark’s book, “success in working through resistance reawakens the dormant possibility of that frail, but intensely human quality-choice.” Dr. Stark continues, “my contention is that the resistant patient is, ultimately, someone who has not yet grieved, has not yet confronted certain intolerably painful realities about his past and present objects.”

A fictional patient comes to mind. Becky, fifty-one, went to visit her father, eighty-five, in his assisted living facility. “My dad told me that my mom would not let him hold me on his lap when I was little because my mom was afraid he would sexually abuse me, but then again, he changed all of my diapers. I just got sick listening to this.” Becky says, with the disbelief that new family dysfunction can be uncovered all these years into her adulthood. “It is hard for you to fathom how your mom prevented your dad from showing love to you,” I say, to which Becky quickly changes the subject. Becky’s resistance in that moment was a clear indication that at that moment, she could not emotionally process the fact that her mom consciously made her life more difficult by telling her father not to be loving towards her. She also could not begin to process that her dad accepted her mom’s distorted reality. He could have insisted on having his children on his lap. Becky moved on to talking about her problems at work. This was not the time to unpack her experience visiting her dad that day. Her resistance was too great. It seemed that she was not ready to grieve the absence of a loving father figure from a very early age. She also was not ready to grieve the loss of a mother who wanted her child to grow up with two loving and caring parents. We will come back to these issues, but now she wants to focus on the lighter issues of work stress. Dr. Stark notes that anxiety must be “titrated”. Becky did this for herself by changing the subject. She wanted to preserve her status quo with her dad. Later on, I suspect, she wil be at a point where she wants to understand her family history, so she can stop being disappointed with what she did not get. As Jon pointed out, time is necessary for this resistance to fade. Patience, as he also says, is key.




4 Responses to “Resistance”

  1. Jon said

    Yes, time is necessary for the resistance to fade, but this brings up a parallelism between psychotherapy (where a team is trying to mend a broken psyche) and engineering (where a team is trying to create something new). While time is of fundamental importance, it is but a third of The Triple Constraint – cost, schedule, and performance. How much resources will be expended, when will milestones be achieved, and how well and which milestones are achieved – these must all be taken into account and traded, one for another. This is an important part of the art, both in mending and creating.

  2. Shelly said

    One has to wonder if Becky’s mother’s fears were real fears or if she wanted all of Becky’s love and attention for herself? One also has to wonder if Becky’s father is also telling the truth or is making up stories as an excuse for being a cold parent all those years. Did Becky have siblings and did Becky’s father treat all of them similarly, or was she an only child?

    • Shirah said

      Yes, Shelly, I think you nailed it. I do think that Becky’s mother was threatened if love was shared between both parents. I also think that you are right that Becky’s father did not give pushback and hence his “cold” parenting is also an issue. Yes, Becky has many siblings and yes, they were all treated in the same “cold” fashion. Thanks.

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