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Resistance and Change in CBT
Jim Pretzer · 11/29/96 at 6:50 PM ET
In discussing Metacognitive Processes, Brad Alford emphasized the Neurotic Paradox that, since immediate consequences have a stronger impact on behavior than delayed consequences, behaviors which have immediate positive consequences and delayed negative consequences tend to be maintained. When the timing is right, small immediate payoffs can maintain behaviors which are dysfunctional in terms of long-term consequences. This produces behavior which may sometimes get labled as resistance, however, this isn1t true resistance. It is the effects of consequences on behavior and an operant approach would be to deal with it through modifying environmental contingencies. A cognitive-behavioral perspective adds the possibility of dealing with this situation through increasing the focus on long-term consequences, choosing to ignore the immediate payoffs of dysfunctional behavior, or using rational responses to change the individual1s perception of the immediate and delayed consequences of behavior.
Bob Leahy presented an Investment Model of Depressive Decision-Making. He argued that motivation to change or resist change results from the organism1s expectation regarding the consequences of behavior. He argued that depressed individuals differ from non-depressed individuals in that they pursue a minimization strategy. In other words, they focus on avoiding losses rather than pursuing gain. This strategy seems reasonable but results in decreased motivation, reduced effort, fewer successes, and tends to perpetuate and intensify depression. In fact, most of the features of depression can be seen as effects of the individual focusing on avoiding loss rather than pursuing gain. Pessimism, avoidance of hope, lack of persistence, and other aspects of depression are ways of avoiding or minimizing the risk of loss.
Tom Dowd discussed his research looking at resistance in terms of psychological reactance, the individual1s efforts to restore lost or threatened control or autonomy. He argued reactance is a stable trait on which individuals differ and presented Ross Perot as a prototypical individual likely to be high in reactance. Individuals with certain personality disorders tend to be low in reactance (Dependent for example) while others tend to be high in reactance (borderline and obsessive compulsive). Tom suggests that individuals who are high in reactance will resist therapeutic interventions in order to maintain autonomy and suggests that this is likely to be more of an issue with some diagnostic groups than others. While Tom didn1t emphasize it, this implies that therapist behaviors which appear controlling will increase resistance in individuals who are high in reactance. Therapist behaviors which maximize client autonomy should decrease resistance with clients who are high in reactance. At this point it is not clear if we can modify an individual1s level of reactance or not.
John Riskin discussed a Theory-Based Eclectic Approach in Cognitive Therapy. He argued that Cognitive Therapy provide a conceptual framework which can incorporate perspectives and techniques derived from other approaches and that Cognitive Therapy can be advanced by doing so. His view is that incorporating perspectives and techniques from other approaches may help us deal more effectively with impasses in therapy. However, the details of how he was suggesting that we do this were not clear to me.
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