Working with Resistance

Resistant patients are patients who have not been able to confront the reality of past and present losses, disappointments, and frustrations, who instead protect themselves from the pain of their grief by clinging to their defenses. The resistant patient is a defended patient within whom there is conflict between those healthy forces that press "yes" and those unhealthy counterforces that insist "no." Such patients resist feeling what they know they should feel and doing what they know they should do. Working with Resistance integrates concepts drawn from classical psychoanalysis, self psychology, and object relations theory and presents a contemporary theory of therapeutic action that takes into consideration structural conflict, structural deficit, and relational conflict - all of which ultimately both fuel the patient's progress in the treatment and oppose the patient's movement toward health and the realization of his potential. As part of the work to be done, patient and therapist must be able to understand and name, in a profoundly respectful fashion, both sets of forces - those healthy ones that impel the patient in the direction of progress and those unhealthy resistive ones that impede such progress. Before the defenses can be relinquished and the resistances overcome, the patient must come to appreciate his investment in the defenses, how they serve him, and the price he pays for holding on to them. Martha Stark has always been interested in exploring the relationship between theory and practice - the ways in which theoretical constructs can be translated into the clinical situation. To that end, she proposes specific interventions for each step of the process by which the defenses are worked through and the resistances are rendered less necessary. Conflict statements, for example, are empathic interventions that highlight the conflict within the patient between his knowledge of reality, informed by the present, and his experience of reality, informed

Booknews

In order to explore a patient's resistance and refusal to grieve, Stark (psychoanalysis, Harvard Medical School) draws on concepts from classical psychoanalysis, object relations theory, and self- psychology. She presents a model of the mind that takes into consideration the relationship between unmourned loses and how such losses are internally recorded as both absence of good, and presence of bad. The CiP data refers to the 1994 hard cover edition. Annotation c. Book News, Inc., Portland, OR

Martha Stark, M.D., is on the faculty of both the Boston Psychoanalytic Institute and the Massachusetts Institute for Psychoanalysis. She is also a clinical instructor in psychiatry at the Harvard Medical School, has a teaching appointment at the Massachusetts Mental Health Center, and is on the faculty of the Center for Psychoanalytic Studies at the Massachusetts General Hospital.