RESISTANCE REVISITED S t e v e de S h a z e r

ABSTRACT: It was a coincidence t h a t I was asked to talk about "resistance" at Ground Rounds at the U n i v e r s i t y of Texas, Departm e n t of P s y c h i a t r y , on the t e n t h a n n i v e r s a r y of mailing the first version of " D e a t h of Resistance" to a j o u r n a l in 1979. Although the paper was s u b s e q u e n t l y rejected 17 times and revised six times, it was e v e n t u a l l y published in Family Process (de Shazer, 1984). I still insist t h a t the concept of resistance was a bad idea for therapists to have in their heads.

In 1978, after sitting behind the mirror and seeing our t e a m (at the B r i e f F a m i l y T h e r a p y Center) 1 work with clients advertised as "highly resistant" by the referring therapists and seeing these clients cooperate readily with us, we decided t h a t a little conceptual violence was called for and t h u s we m u r d e r e d resistance. Subsequently, in 1979, I wrote a paper entitled "The D e a t h of Resistance" and I naively t h o u g h t I was t h r o u g h with the whole concept when I mailed the paper in 1979. Of course I was not: I have been h a u n t e d by the ghost of resistance ever since. That paper went through 6 major revisions (without changing the basic idea or the title) and was firmly rejected by every j o u r n a l in the field at least once before 1 What else could a group of therapists, half "brief" therapists and half "family" therapists call their institute?

Steve de Shazer, is director of the Brief Family Therapy Center, Milwaukee, Wisconsin. This paper was presented April 14, 1989, at Ground Rounds, University of Texas, Southwest Medical Center, Department of Psychiatry, Dallas, Texas. Reprint requests should be sent to Steve de Shazer, Brief Family Therapy Center, 6815 West Capitol Drive, Milwaukee, WI 54316. Contemporary Family Therapy 11(4), Winter 1989 9 1989 H uman Sciences Press

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it was finally published by F a m i l y Process in 1984. Of course, in order to get it published, I put m y thesis in r a t h e r theoretical terms: I could not say "I confess: I m u r d e r e d it because it had outlived its usefulness."

F R O M M E T A P H O R TO F A C T A funny thing happens to concepts over time. No m a t t e r how useful any concept might be at the start, e v e n t u a l l y t h e y all seem to become reified. Instead of r e m a i n i n g e x p l a n a t o r y metaphors, t h e y become facts. That is, r a t h e r t h a n saying "it is as if the client is resisting change," once reified, people begin to say things like "the client is resisting" and e v e n t u a l l y t h e y begin to say t h a t "resistance exists and m u s t be sought out." At this point, the concept has outlived its usefulness and needs to be gotten rid of because, once reified, it can never again be a metaphor. Thus, our metaphorical m u r d e r of resistance. It is clear, of course, t h a t the concept or m e t a p h o r of resistance was part of a conceptual map, not part of some reality t h a t is "out there." Resistance was a very peculiar concept. In essence, it m e a n t t h a t the t h e r a p i s t and client/patient had a fight and then, when the t h e r a p i s t won and resistance was overcome, the loser of the fight got to go home c h a n g e d - - w h i c h is really w h a t the client came to t h e r a p y for in the first place. So losing was winning. The concept of resistance was a bad idea: In fact, it is one of those ideas t h a t actually handicap therapists. As therapists, we do not need an e x p l a n a t o r y m e t a p h o r dealing with non-change or resistance to change. After all, according to clients and various theories, things seem to not change with little or no help from anyone. Clinically speaking, non-change does not need to be explained or even described but, since we are in the business of change, the processes of change need to be described as clearly and simply as possible. Indeed, w h a t we need is s o m e - - h o p e f u l l y f e w - - c l e a r and simple ideas about how to help our patients or clients m a k e changes they will find satisfactory. W h a t we need is a theory of how change develops within the t h e r a p e u t i c context. Change needs to be described in such a w a y t h a t therapists u n d e r s t a n d w h a t to do and how to do it. Obviously, such a theory of change-in-the-therapycontext needs to be built up out of a series of u t t e r l y simple and clear principles.

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In theory construction "it's always a matter of the application of a series of utterly simple basic principles and t h e - - e n o r m o u s - difficulty is only one of applying these in the confusion our language c r e a t e s . . . [Interestingly,] the difficulty in applying the simple basic principles shakes our confidence in the principles themselves" (Wittgenstein, 1975, p. 133). Having murdered "resistance," we needed to get rid of the corpse, 2 which meant that we have to develop a new first principle, and in 1978 my colleagues and I developed a concept we called "cooperating" (de Shazer, 1980): Each family, individual, or couple shows a unique way of attempting to cooperate, and the therapist's job becomes, first, to describe that particular manner to himself that the family shows and, then, to cooperate with the client's way and, thus to promote change (de Shazer, 1982, pp. 9-10). Subsequently, my colleagues and I have developed a full-fledged theory of how change develops within the therapeutic context (de Shazer, 1985, 1988b). We have worked hard at sticking to applying simple clear descriptions built on this simple basic principle. We have no remorse and have never given resistance another thought.

T H E C O N C E P T OF R E S I S T A N C E About the same time that Family Process (finally) agreed to publish "The Death of Resistance," Anderson and Stewart published a book called Mastering Resistance (1983). Their point of view could not be more different from mine. For them, almost anything that does not go exactly the way the therapist thinks it should go is a form of resistance. From their point of view, "throughout the course of treatment, therapists must deal with each member's multiple expressions of resistance to change while simultaneously being alert to the function of resistances for the family as a whole" (p. 2). Here I would like to point to Einstein's idea that your theory determines what you see. As I see it, there is lot to be said for the idea that reality is the invention of beliefs. For instance, if, as An2 The corpse included a related concept, Power, which died at the same time (de Shazer, 1986, 1988).

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derson and S t e w a r t say, "there appears to be almost universal recognition t h a t resistance exists" (p. 120) then, when a t h e r a p i s t looks for resistance in every knook and cranny he or she is sure to find it2 This is known as a self-fulfi!ling prophecy which m e a n s t h a t even a "false" definition of the situation can lead to behaviors t h a t change the false definition into a true one. A reign of error deve]ops as the prophet points to the facts as proving t h a t he was right from the start. Clearly, predictions help to d e t e r m i n e s u b s e q u e n t behavior. It is as if a prediction about one's behavior (and the behavior of others) in a specific situation leads to a script or a plan or a map or a vision of the behavioral sequences in t h a t situation. Subsequently, when the imagined situation is at hand, the same vision will be used to guide one's behavior (Erickson, 1954; de Shazer, 1978; Sherman, Skov, Hervitz, & Stock, 1981). It is i m p o r t a n t to r e m e m b e r t h a t resistance did not exist like a refrigerator exists and, therefore, there is no "truth" or "falsity" to our definitions and descriptions of reality. There was no such thing as resistance, it was only a concept, and thus a figment of imagination.

Resistance comes from the therapist's head. In family t h e r a p y it is a common idea t h a t the family who comes in saying t h e y w a n t to change, paradoxically, also does not w a n t to change. The evidence for this so-called paradox is t h a t w h e n the t h e r a p i s t tells t h e m to do something t h e y will frequently not do it (this is known as "resistance-to-change"). However, the family m e m b e r s do not say t h e y did not t a k e the suggestion because t h e y really do not w a n t to change. They might give other reasons: The t h e r a p i s t is reading b e t w e e n the lines, which is always a dangerous hobby because there m a y be nothing there. From one perspective, the family m e m b e r s - - w h o do not do the t a s k - - c a n be seen as expressing resistance, plain and simple. But, this phenomenon can be seen differently. Simply, they did not do the t a s k the t h e r a p i s t gave t h e m to do; and they did not do it in response to something the t h e r a p i s t did. Perhaps, the intervention simply ran counter to the client's desires because it was too foreign

3 After all, t h e r e m i g h t be an e n t r y in the Guinness Book of Records for "the most resistance ever discovered by a t h e r a p i s t without a t e a m in a single hour."

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to them. In some w a y or another, the suggestion simply did not fit for this family. This leads to the idea t h a t "resistance" was actually the result of t h e r a p e u t i c error. Well, that's certainly b e t t e r t h a n a view t h a t b l a m e s the p a t i e n t or client and/or the family as a whole. The therapist can use the clients' response to help her modify her own behavior. It is, after all, not their fault t h a t the t h e r a p i s t did the wrong t h i n g in a t t e m p t i n g to help t h e m change. However, attributing b l a m e to either p a r t y of an interaction is theoretically unsound. Such a split b e t w e e n m e m b e r s of a s y s t e m inevitably creates imaginary oppositions. B u t clinically, both t h e r a p i s t s and clients are in it t o g e t h e r and cooperation is w h a t we want. R e m e m b e r , "resistance" was j u s t a label used to describe some interactive events. B u t is this a theoretically necessary or even p r a g m a t i c a l l y useful concept? Can t h e r a p i s t s (and their clients) get along w i t h o u t it? Suppose that, instead, we t a k e clients' w a n t i n g to change "at face value."

CHANGE For m a n y y e a r s now, m y colleagues and I have read a lot of philosophy, both E a s t e r n and Western. In both traditions there has long been a minority view t h a t change is a continuous p r o c e s s - not an event. In fact, the Buddhists will say t h a t stability is an illusion, a simple m e m o r y of the w a y things were at a specific mom e n t in the past. In contrast, the most common view in the t h e r a p y world is t h a t the problems and complaints b r o u g h t to therapists are "always happening." The p a r e n t s will say t h a t J a k e always wets the bed or an individual might complain about "the voices in m y head" or "I've been depressed for so long I cannot r e m e m b e r when it started." E v e n in theoretical terms, the problem is described as being embedded in a r e d u n d a n t pattern: it is the same damn thing over and over, or it is more of the same of something t h a t is not working. Then t h e r a p i s t s used the concept of resistance to "explain" how come problems continued in spite of the best interventions. After the funeral for resistance 4, we needed to find new ways to 4 We buried it in my back yard u n d e r the tulip patch in keeping with traditions developed in m u r d e r mysteries. If one looks hard, one can see a w e a t h e r e d tomb-

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do therapy. We soon discovered t h a t - - w h e n asked in the right w a y or at the right time or s o m e t h i n g - - 6 7 % of our clients are able to describe times when the complaint is not happening b u t should be. We also discovered t h a t - - i f asked in the right w a y - - 6 7 % of our clients tell us t h a t things have changed for the b e t t e r in the interval b e t w e e n their initial telephone call to us and the first session. Sometimes these differences will be exactly of the type they were seeking from t h e r a p y (Weiner-Davis, de Shazer, & Gingerich, 1987). So, we received some e n c o u r a g e m e n t for the idea t h a t change is constant and some contradiction for the idea t h a t problems or complaints "always" happen. Thus our new w a y to do t h e r a p y is based on t a l k i n g about e x c e p t i o n s - - t i m e s when the complaint is unexpectedly absent and/or times in the future when the solution has developed. We have found t h a t the easiest w a y for therapists to cooperate with their clients is to find out w h a t the clients are a l r e a d y doing w h e n the complaint is absent (i.e., labeled "exceptions") and help t h e m to do more of the same of something t h a t works. Of course we are not always successful in helping our clients invent exceptions to their complaint. In those cases we have found it useful to have the clients imagine w h a t things will be like in the morning after the problem miraculously disappears. When they are able to describe the day after the miracle in detail, then we have found t h a t asking t h e m to "pretend there was a miracle" can be enough to prompt the development of a solution (de Shazer, 1988b).

RESEARCH Since the d e a t h of resistance, our average n u m b e r of sessions per case has declined from seven in 1979 to 4.5 in 19885 (Kiser, 1988). Our success rate has increased from 72.1% in 1979 (clients met their goal or made significant progress) to 80.37% in 1988. 6

stone s a y i n g "Here lies R e s i s t a n c e / H e w a s a good a n d u s e f u l fellow in h i s youth/ R.I.P./1978." 5 T h i s a v e r a g e holds for t h e 1000 cases m o s t r e c e n t l y completed. N = 163 r a n d o m l y selected cases in w h i c h t h e t h e r a p i s t w a s e i t h e r a m e m b e r of t h e BFTC s t a f f or a p a r t i c i p a n t in t h e BFTC t r a i n i n g p r o g r a m . T h e y were contacted by n e u t r a l r e s e a r c h a s s i s t a n t s .

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With four sessions or more, 61.29% say they also met a secondary goal; while with three sessions or less only 44.26% report achieving a secondary goal. Seventy-six percent reported "no new problems needing therapy" had developed and 67% reported improvement in other areas that they attributed to the therapy (Kiser, 1988).

CONCLUSION It seems that therapists and clients alike can go on quite well without the concept of resistance. Theoretically it has proved to be unnecessary and, in fact, pragmatically its absence, or rather the presence of the concept of cooperating, has proved useful. Therapy is much more fun for everyone when the topic of conversation is centered around the times when the complaint is unexpectedly absent, focusing on what it is that the clients are doing that is useful, effective, good for them, and fun.

REFERENCES Anderson, C., & Stewart, S. (1983). Mastering resistance. New York: Guilford. de Shazer, S. (1978). Brief hypnotherapy of two sexual dysfunctions: The crystal ball technique. American Journal of Clinical Hypnosis, 20(3), 203-208. de Shazer, S. (1980). Brief family therapy: A metaphorical task. Journal of Marital and Family Therapy, 6, 471-476. de Shazer, S. (1982) Pattern of brief family therapy. New York: Guilford. de Shazer, S. (1984). The death of resistance. Family Process, 23, 11-21. de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton. de Shazer, S. (1986). Ein requiem der macht. Zeitslchrift fur systemische Therapie, 4, 208-212. English translation (1988a). A requiem for power. Contemporary Family Therapy, 10, 69-72. Erickson, M. H. (1954). Pseudo-orientation in time as a hypnotic procedure. Journal of Clinical and Experimental Hypnosis, 2, 261-283. Kiser, D. (1988). A follow-up study conducted at the Brief Family Therapy Center. Unpublished manuscript. Sherman, S., Skov, R., Hervitz, E., & Stock, C. (1981). The effects of explaining hypethetical future events: From possibility to probability to ~ctuality and beyond. Journal of Experimental Social Psychology, 17, 142-158. Weiner-Davis, M., de Shazer, S., & Gingerich, W. (1987). Using pretreatment change to construct a therapeutic solution: An exploratory study. Journal of Marital and Family Therapy, 13, 359-363. Wittgenstein, L. (1975). Philosophical remarks. Chicago: University of Chicago Press. Trans. Hargreaves & White.