The document discusses a case vignette where a therapist unintentionally reveals his "real self" to his patient, disrupting their established relationship. This is conceptualized as a moment where the therapist's subjectivity emerges, allowing for a deeper level of intersubjective relating between patient and therapist. The emergence of the therapist's subjectivity can advance the patient's subjectivity as well, as she introduces denied aspects of herself. This phenomenon of the patient resisting the former relationship is termed "positive resistance", which becomes the focus of dialogue and helps the patient access multiple self-states.

1. Toward a View of “Positive Resistance”:
One Perspective on Change in Psychoanalytic
Psychotherapy
James Tobin, Ph.D.
Licensed Psychologist PSY 22074
220 Newport Center Drive, Suite 1
Newport Beach, CA 92660
949-338-4388
Assistant Professor of Clinical Psychology
601 South Lewis Street
Argosy University
Orange, CA 92868
714-620-3804
1

2. Case Vignette
Case Vignette
2

3. Section A.
Case Vignette
When the Therapist
Becomes “Real”
3

4. Section A.
When the Therapist Becomes “Real”
•
•
•
My goal in this presentation is to describe an
approach toward understanding and working with one
form of an unexpected “surprise” experience in
clinical practice I am sure we all face.
The case vignette features an interaction in which the
therapist reveals himself to the patient in an
unintended, spontaneous way.
Ghent (1990) describes this type of interaction as a
moment of the therapist’s “surrender” to the patient
and the clinical process. These moments are
contrasted with voluntary self-disclosures of the
therapist’s countertransference reactions.
4

5. Section A.
When the Therapist Becomes “Real”
•
The moment of surrender in the case vignette represents
(1) a breaching of a patterned form of relatedness
established between patient and therapist and (2) a
deviation from the therapist’s “relational” persona
(how the therapist modifies or adapts oneself to work with
a given patient).
•
Moments of surrender arise from “being in the
moment” (Ghent, 1990) in which the therapist
foregoes a persona anchored in technique
(Hoffman, 1983).
5

6. Section A.
When the Therapist Becomes “Real”
•
What occurs is the sudden emergence of what may
be characterized as the therapist’s “real” self -which I am distinguishing from the therapist’s
“relational” self.
6

7. Section A.
When the Therapist Becomes “Real”
•
These moments have the effect of imploding an
established (status-quo) relational mode of
being between patient and therapist, injecting a
shared moment neither can deny and that
permanently alters how each sees and relates to
the other.
7

8. Section A.
When the Therapist Becomes “Real”
•
•
Moments of regression and integration experienced by
patients throughout treatment and even in one particular
session have been described (Gilhooley, 2005); the case
suggests a moment of surrender that can be viewed as
the therapist’s necessary regression.
These moments are necessary because, as
intersubjective theory suggests (Stolorow, Brandchaft, &
Atwood, 1987), patient and therapist at some point in
treatment arrive at a mode of relatedness that becomes
“calcified” – there is an inevitable press to move toward
a deeper level of relating (moving from self-object to
self-self relatedness); I see the therapist as the agent
of this transition.
8

9. Section B.
Case Vignette
The Therapist’s Use of
Self
9

10. Section B.
The Therapist’s Use of Self
•
Traditional psychoanalytic theory characterizes the
therapist as a “blank screen” who allows the
patient’s transference to emerge in pure form in the
context of a neutral and non-gratifying position.
10

11. Section B.
The Therapist’s Use of Self
•
In the traditional model, the therapist is an “object” of
the patient’s drives and drive derivatives; the
therapist as object is a subjectivity not relevant.
•
Only the patient possesses a “psychic reality” and
the analyst is oriented solely toward representing that
reality (McLaughlin, 1981).
11

12. Section B.
The Therapist’s Use of Self
•
Contemporary psychoanalytic theory views patient
and therapist as influencing, and being influenced by,
each other (2-person psychology).
•
No longer a “blank screen,” the therapist is an object
(of the patient’s self) but also a separate subject
with a separate subjectivity (Chodorow, 1989) who
co-participates in influencing the relational field along
with the patient (Stern, 2010).
12

13. Section B.
The Therapist’s Use of Self
•
The 2-person psychology model holds several
important implications for contemporary therapists:
a) The patient can no longer be viewed as accepting at
face value the therapist’s words or behaviors (“the
naïve patient fallacy”) (Hoffman, 1983);
b) Patients are accurately and intuitively reading the
therapist’s hidden communications and identity (Aron,
1991; Singer, 1977);
13

14. Section B.
The Therapist’s Use of Self
c) A new mode of psychoanalytic listening is suggested:
“A consequence of the analyst’s perspective on
himself as a participant in a relationship is that he will
devote attention not only to the patient’s attitude
toward the analyst but also to the patient’s view of
the analyst’s attitude toward the patient” (Gill,
1982, p. 112);
14

15. Section B.
The Therapist’s Use of Self
d) The therapist uses his or her subjective experience to
attempt to understand the patient better (Aron, 1991;
Frankel, 2006).
e) Those drawn to the psychotherapy professions likely
have strong conflicts regarding voyeuristic and
exhibitionistic wishes: there are longings to be
known by patients as well as hidden from them
(Aron, 1991).
15

16. Section C.
Case Vignette
How the Therapist Selects
a “Way of Being”
16

17. Section C.
How the Therapist Selects a “Way of Being”
•
Presumably all therapists accommodate to their
patients and at some level select a relational mode of
being in which the therapist’s true character is
altered or suppressed, to a greater or lesser
degree.
•
My gazing away from Jessica is one example of this.
17

18. Section C.
How the Therapist Selects a “Way of Being”
•
This choice or “way of being” with the patient is
usually conceptualized as an issue of technique,
i.e., it is based on the therapist’s assessment of the
patient’s level of ego functioning, identity
development, and capacity to take in and use
alternative views and challenges.
18

19. Section C.
How the Therapist Selects a “Way of Being”
•
This assessment yields a stylistic way of being that
resides at some point along a continuum from
empathy (therapist as self-object) to
interpretation/confrontation/use of self/ transparency
(therapist as a separate subject).
•
In my work I seem to drift toward a point on this
continuum and linger there, despite modest attempts
to move in one direction or another that gradually
become more infrequent.
19

20. Section D.
The Patient’s Accommodation
Case Vignette
to the Therapist
20

21. Section D.
The Patient’s Accommodation to the Therapist
•
The case vignette, however, suggests that the
therapist’s subjectivity is revealed or suppressed not
only for conscious technical reasons oriented toward
the patient, but for reasons related to the
therapist’s own psychology and unconscious
conflicts around being revealed in the clinical
situation.
21

22. Section D.
The Patient’s Accommodation to the Therapist
•
What I realized in working with Jessica is that the
differences in our innate tendencies and
predispositions were unconsciously utilized by me: I
had not wanted to acknowledge Jessica’s
familiarity to me as my own transference object
AND ALSO as a person whose core emotional
experience was quite similar to my own (I had not
wanted to see myself in her).
22

23. Section D.
The Patient’s Accommodation to the Therapist
•
Consequently, I had established an interpersonal
decorum or relational culture with Jessica in which my
apparent ease and spontaneity was set against her
stiffness and hesitancy (a form of polarized role
induction).
•
Jessica’s stiffness and lack of spontaneity positioned
me in relation to her singularly (and rigidly) as the
agent of loosening her up, which had the paradoxical
effect of rigidifying how I saw and interacted with her
(who I was in relation to her).
23

24. Section D.
The Patient’s Accommodation to the Therapist
•
Wolstein (1983) observed that the patient’s
resistances often are interpersonal efforts to cope
with the analyst’s personality, character, and
metapsychology.
24

25. Section D.
The Patient’s Accommodation to the Therapist
•
In his seminal paper “The Patient as Interpreter of the
Analyst’s Experience,” Hoffman (1983) describes the
patient’s capacity to apprehend the therapist’s
character and unresolved conflicts; in this paper,
Hoffman argues that successful treatment involves
the therapist recognizing how the patient has
chosen to adapt to the therapist.
25

26. Section D.
The Patient’s Accommodation to the Therapist
•
Similarly, Aron (1991) and Wolstein (1983, 1988,
1994) argue that it is helpful to approach the
patient’s resistances as possible reflections of
the therapist’s. Aron (1991), in summarizing
Wolstein’s work, states that “ … the ultimate outcome
of successfully analyzing resistances is that the
patients would learn more not only about their own
psychologies but also about the psychology of others
in their lives, particularly about the psychology of their
own analysts” (p. 35).
26

27. Section D.
The Patient’s Accommodation to the Therapist
•
In response to therapists’ (counter-)resistances, what
many patients do is communicate observations about
the therapist’s character/relational mode of being
through displaced material or descriptions of
these characteristics as aspects of themselves in
the form of “identifications” (Aron, 1991).
•
This became apparent in my work with Jessica as her
“stiffness” became and was my own
(metaphorically/physically), was in each of us, and
was by “osmosis” moving back and forth between us.
27

28. Section E.
Caseof Intersubjectivity
Vignette
Application
to the Case
28

29. Section E.
Application of Intersubjectivity to the Case
•
Intersubjectivity (Stolorow, Brandchaft, & Atwood,
1987) is a theory of relatedness in which self and
other are independent beings who engage with each
other in a way that promotes “subjective expression”
as well as “shared experience.”
29

30. Section E.
Application of Intersubjectivity to the Case
•
The other is an object of the self’s subjectivity (“selfobject” relatedness) but is also a separate subjectivity
(“self-self” relatedness).
•
Advanced intersubjectivity represent a developmental
progression in which both domains of relatedness can be
simultaneously engaged and amplified.
•
When the intersubjective model is applied to the
therapeutic situation, there exists a paradox: the clinical
process between patient and therapist is simultaneously
an experience of separateness and relatedness,
subjectivity and objectivity (Pizer, 1992, 2003).
30

31. Section E.
Application of Intersubjectivity to the Case
•
Therapist and patient are simultaneously a subject
and an object to each other (Wolstein, 1983).
•
How each character’s subjectivity is concealed
and revealed in the course of treatment, what
these patterns may mean, and how they are
analyzed, is a central feature of treatment.
•
Using the intersubjective model, my crying can be
seen as a release from self-object relatedness and
entry into self-self relatedness (in many ways, each of
us had served as a self-object for the other).
31

32. Section E.
Application of Intersubjectivity to the Case
•
I believe that moments of countertransference
surrender emanate from the mutual need for
advanced intersubjective relating – unlocking
both patient and therapist from a more primitive
(status-quo) form of relatedness revolving around
distortion, concealment, and accommodation.
•
The therapist “reads” the signal for this advancement
in the clinical process and responds to it, often
unwittingly.
32

33. Section F.
Case Vignette
“Positive Resistance”
33

34. Section F.
“Positive Resistance”
•
The emergence of the therapist’s subjectivity often
has the effect of advancing the patient’s subjectivity
(each character is pulled toward an advanced form of
self-self intersubjective relatedness).
•
In this phase of treatment, Jessica introduced aspects
of her self that had been denied, censored or
defended against (due in part to my own resistances).
•
She became more visible, both to me and to herself,
and no longer abided by intervention strategies I
had previously relied on.
34

35. Section F.
“Positive Resistance”
•
The patient began to act in a way that resisted what
my persona had been before I cried – that is, she
jettisoned a former way of being with me that had
been devised to conform to how I had
accommodated to her (which had a lot to do with
what I could/could not tolerate in relating to her).
•
There is not really a term for this phenomenon in the
psychoanalytic literature – I am calling it “positive
resistance.”
35

36. Section F.
“Positive Resistance”
•
The patient was freed to unveil a new persona in
relation to the therapist (and to herself) who was more
“real” or subjective because the therapist had become
more real.
•
Ghent (1990), in discussing Winnicott’s theorizing about the
impact of impingement on identity formation, describes “the
individual then (who) exists by not being found” (p. 120). For
me, treatment can be seen as a process of finding the
patient in the context of the therapist’s impingements.
36

37. Section F.
“Positive Resistance”
•
If the patient’s positive resistance can be effectively
analyzed, her ability to access denied internal selfstates and multiple conceptions of self can be
advanced (she becomes more visible to her own
self – which is important to this case given
Jessica’s fear and suspicion that she inevitably
became invisible to her partners).
37

38. Section F.
“Positive Resistance”
•
It is interesting to note that a patient’s positive
resistance often leads to her becoming increasingly
less known and understood by the therapist; new
clinical data is generated that cannot be successfully
assimilated by the therapist’s previous construction of
the patient.
•
Frosh (2009) characterizes this phenomenon as the
“incorrigibility of otherness” (p. 187).
38

39. Section F.
“Positive Resistance”
•
As positive resistance unfolds, the patient’s
coalescing self-experience becomes the focal topic
of dialogue.
•
Over time, the patient’s self-experience may still
overlap the therapist’s metapsychology but no longer
does entirely (the patient begins to exist outside of
the therapist’s construction/comprehension).
39

40. Section F.
“Positive Resistance”
•
With this perspective, treatment may be viewed as
the launching of the patient toward the inception
of her own metapsychology – which has a lot to
do with the therapist’s capacity to tolerate not
knowing/not understanding (humility). This is
another important component of the “impossible
profession.”
40

41. Section F.
“Positive Resistance”
•
Wolstein (1994) describes this well: “The mutative
center of therapy moves away from the therapist's
constructive narration about the patient as such,
over to both their experiential psychologies of the
self. Breaking through the set parameters of
interpretive schematics to the live experience of
interpersonal exploration, as it happens,
indefinitely enlarges the range of therapeutic action: it
opens out to the unique selfic sources of both their
individual psychologies. The growing awareness of
two uniquely individual selves in interpersonal
relationship, with two uniquely individual
philosophies of life, signifies a sea change of
psychoanalytic approach” (p. 488).
41

42. Section G.
Case Vignette for
Summary and Implications
Technique
42

43. Section G.
Summary and Implications for Technique
•
•
•
Both patient and therapist create a relational mode of
being that restricts the emergence of unconscious, denied
or unformulated observations of the identity of each other
and of oneself (Hoffman, 1983; Levenson, 1972; Racker,
1968).
In the course of psychoanalytic psychotherapy, there is an
ongoing stream of interpersonal sequences in which each
character’s subjectivity is alternatively concealed and
revealed.
Intersubjective theory provides a framework for
understanding the mutually-determined and reciprocal
processes of relatedness in the therapeutic situation.
43

44. Section G.
Summary and Implications for Technique
•
Moments occur in treatment when the therapist’s “real”
self is revealed as co-existing with a “relational” self: how
each is seen or exists by not being seen (is found or
“exists by not being found”) is the central clinical
phenomenon I hope the presentation has illustrated.
•
I conceive of a successful therapy as the meaningful
amplification of each character’s unique subjectivity in the
context of the therapeutic relationship.
44

45. Section G.
Summary and Implications for Technique
•
The case suggests that moments of the therapist’s
surrendering of his relational persona are inevitable
and implode a collusive status-quo relational culture
established by patient and therapist.
•
The emerging subjectivity of the therapist alters how
he is seen by the patient and renders his prior
relational persona as distinct from his real self.
45

46. Section G.
Summary and Implications for Technique
•
If the therapist is able to organize the patient around a
careful non-defensive inquiry about aspects of the
therapist’s subjectivity newly recognized, an
advanced state of intersubjectivity in the relational
field will be promoted.
•
This fosters the patient’s capacity to find herself (or
more of herself), and to be found by the therapist,
through a phase of treatment I call “positive
resistance.”
46

47. Section G.
Summary and Implications for Technique
•
The therapist is always finding a way to be with the
patient (sometimes defensively, sometimes not), but
perhaps even more importantly the patient is finding
a way to be with the therapist.
•
What can be very alarming for any therapist is the
moment when he discovers, with the help of the
patient, that despite his intentions he brings
something to the table the patient needs to
accommodate to and perhaps has been stifled by.
47

48. Section G.
Summary and Implications for Technique
•
Implications for technique include the therapist’s need
to expand his mode of listening to achieve a
greater sensitivity to the patient’s displaced
commentary about her adaptation to the therapist’s
character, resistances, and intersubjective limitations.
48

49. Section G.
Summary and Implications for Technique
•
The therapist must be mindful of ways to intuitively
and/or systematically gain insight into the relational
culture he has engendered in the clinical situation
–and aspects of that culture that deter from the
patient’s expression of her own subjectivity and
progression toward advanced levels of
intersubjectivity.
49

50. Section G.
Summary and Implications for Technique
•
The patient’s observations of the therapist must be
actively explored by the therapist “with the genuine
belief that I (the therapist) may find out something
about myself (himself) that I (he) did not previously
recognize” (Aron, 1991, p. 37).
50

51. Section G.
Summary and Implications for Technique
•
Aron (1991) suggests that the patient can be asked to
speculate about what she thinks is going on for the
therapist around a particular issue but also warns
that exploring the patient’s perceptions of the
therapist may be used defensively, by the patient
and/or therapist.
51

52. Section G.
Summary and Implications for Technique
•
Several writers (Bollas, 1989; Renik, 1996, 1999)
have argued for the importance of the therapist to
establish himself as a separate subjectivity actively,
and make available to the patient aspects of the
therapist’s inner life for the patient to use.
•
Yet transparency must be used cautiously and
supported with a rationale such as the one presented
today.
52

53. Section G.
Summary and Implications for Technique
•
The therapist must always strive to achieve a
dynamic balance between technical decision-making
and spontaneity in the clinical situation, and must
remain mindful of how and when his own
defenses/resistances exist embedded within and
condoned by technique.
53

54. Section G.
Summary and Implications for Technique
•
Training typically does not focus on moments of the
therapists’ unconscious self-disclosures and
corresponding states of regression in which the
therapist no longer knows who he is in relation to his
own self and to his patient.
•
Though the patient is typically viewed as being
vulnerable to the therapist, my view is that the
therapist is just as or even more vulnerable to the
patient – especially in light of my argument that it
is the therapist (not the patient) who is the agent
of intersubjective progression.
54

55. Section G.
Summary and Implications for Technique
•
Many therapists struggle with this reality and tend to
rely on defensive maneuverings.
•
The therapist must be prepared for the emergence of
his own vulnerability in the clinical situation, and
eager to learn something new about himself (Gill,
1983) even if it is disheartening or painful.
55

56. References
• Aron, L. (1991). The patient’s experience of the
analyst’s subjectivity. Psychoanalytic Dialogues, 1, 2951.
• Bollas, C. (1989). Forces of Destiny: Psychoanalysis
and human idiom. London: Free Association Books.
• Chodorow, N. (1989). Feminism and psychoanalytic
theory. New Haven, CT: Yale University Press.
• Frankel, S. A. (2006). The clinical use of therapeutic
disjunctions. Psychoanalytic Psychology, 23, 56-71..
• Frosh, S. (2009). What does the other want? In C.
Flaskas & D. Pococh (Eds.), Systems and
psychoanalysis: Contemporary integrations in family
therapy (pp. 185-202). London: Karnac Books.
56

57. References
• Ghent, E. (1990). Masochism, submission, surrender.
Contemporary Psychoanalysis, 26, 108-136
• Gilhooley, D. (2005). Aspects of disintegration and
integration in patient speech. Modern Psychoanalysis,
30, 20-42.
• Gill, M.M. (1982). Analysis of transference I: Theory
and technique. New York: International Universities
Press.
• Hoffman, I. Z. (1983). The patient as interpreter of the
analyst’s experience. Contemporary Psychoanalysis,
19, 389-422.
• Levenson, E. (1972). The fallacy of understanding.
New York: Basic Books.
57

58. References
• McLaughlin, J.T. (1981). Transference, psychic reality,
and countertransference.
• Pizer, S. (1992). The negotiation of paradox in the
analytic process. Psychoanalytic Dialogues, 2, 215240.
• Pizer, S. (2003). When the crunch is a (k)not: A crimp
in relational dialogue. Psychoanalytic Dialogues, 13,
171-192.
• Renik, O. (1996). The perils of neutrality.
Psychoanalytic Quarterly, 65, 495-517.
• Renik, O. (1999). Getting real in analysis. Journal of
Analytical Psychology, 44, 167-187.
58

59. References
• Stern, D. B. (2010). Partners in thought. Working with
unformulated experience, dissociation, and enactment.
New York: Routledge.
• Stolorow, R.D., Brandchaft, B., & Atwood, G.E. (1987).
Psychoanalytic treatment: An intersubjective approach.
Hillsdale, NJ: The Analytic Press.
• Wolstein, B. (1983). The pluralism of perspectives on
countertransference. Contemporary Psychoanalysis, 19,
506-521.
• Wolstein, B. (1988). Introduction. In B. Wolstein (Ed.),
Essential papers on countertransference (pp. 1-15). New
York: New York University Press.
• Wolstein, B. (1994). The evolving newness of
interpersonal psychoanalysis: From the vantage point of
immediate experience. Contemporary Psychoanalysis,
30, 473-499.
59

60. Abstract
A case vignette will be presented that features a
unique moment in a psychoanalytic treatment when I
unexpectedly revealed to my patient an aspect of my
personhood. This moment will be considered from the
perspective of intersubjective theory which focuses on
the dynamic tension between forms of relatedness
centering on the other as object for the self vs. a
separate subjectivity. The interaction in the vignette
will be conceptualized as a countertransferential
“surrendering” in which my emerging subjectivity
breached a relational mode of being co-created by the
patient and myself and resulted in an alteration of my
persona vis-à-vis the patient.
60

61. Abstract
The patient’s response to this moment is characterized
as “positive resistance” in that it stimulated a new
phase of treatment in which formerly dissociated
elements of the patient’s identity – once subverted by
the patient’s accommodation to my persona – entered
the interpersonal field. Issues of technique including
the therapist’s capacity to tolerate personal revelation,
self-observe, and recognize how his own character
may inhibit the patient’s potential for intersubjective
relatedness will be considered.
61

62. Toward a View of “Positive Resistance”:
One Perspective on Change in Psychoanalytic
Psychotherapy
James Tobin, Ph.D.
Licensed Psychologist PSY 22074
220 Newport Center Drive, Suite 1
Newport Beach, CA 92660
949-338-4388
Assistant Professor of Clinical Psychology
601 South Lewis Street
Argosy University
Orange, CA 92868
714-620-3804
62