Confrontation in Psychotherapy

The Oxford English Dictionary defines the verb “confront” as “to bring a person face to face with.” Exactly how psychotherapists bring their patients “face to face with” their problems in a way that will lead to change is what differentiates the various psychotherapies that have developed since the classical psychoanalytic approach of Freud. The dictionary’s alternative definition of “confront,” “to face in hostility or defiance … to oppose,” has lead many people to view “confront” as an aggressive means to express opposition. This is not the sense in which the term is used in psychotherapy. (10 pp.)

Confrontation with the “Real” Analyst

The issue of the real person of the therapist is a critical variable in treatment outcome. For neurotic patients with a solid reality sense it does not appear to be of central importance to treatment outcome. For patients with a less firm hold on reality the real characteristics of the analyst may be a major aspect of the treatment process.

The Place of Confrontation in Modern Psychotherapy

The secret of taking care of the patient is caring for him. This is a reconciliation of those polar positions of psychotherapy, objectivity and intimacy, reason and feeling, each so vital, each so helpless without the other. Intimacy makes objectivity usable, while objectivity justifies and spends the gained intimacy.

Confrontation in the Therapeutic Process

We should distinguish two different kinds of confrontation: the angry confrontation and the empathic confrontation. An angry confrontation is one in which the therapist is annoyed, angered, or even enraged at something he does not like that the patient is doing. The empathic confrontation is no less forceful but comes from a different psychology on the part of the therapist. The change he is working toward is to help his patient accept himself for what he is.

The Technique of Confrontation and Social Class Differences

Confrontation techniques become one means for a therapist to indicate that he is not a representative of a system. He confronts and so becomes a vulnerable practitioner. Social class differences have been long neglected producing an image of rigidity and middle-class specificity for the whole art. Therapists must take social distance and system representation into account.

Confrontation as a Demand for Change

It is essentially through the acquisition of insight that the patient eventually moves ahead to higher levels of maturity. And it is essentially with these goals in mind that the therapist introduces his confrontations as major steps in the therapeutic process.

Confrontation in the Psychotherapy of Adolescent Patients

There are many adolescent patients who are not able to navigate between the Scylla of excessive rigidity and the Charybdis of passive gratification. For them effective psychotherapy requires a therapist who is willing to help them develop skills in navigation by recognizing the dangers from both sides. When parents are unable or unwilling to challenge extreme irrational values, it it becomes essential that the psychiatrist be willing to step in and fill the gap.

Confrontation in the Analysis of the Transference Resistance

Unlike interpretation, social confrontation is designed to induce internal conflict. It is the difference between saying “This is the third session you have wasted this week,” and “You are once more reacting as if only bad can come from our work together.” Tis analysis of transference anxieties has proved to open the way to reaching and engaging with the very hardest of the so-called hard to reach.

Confrontation, Countertransference, and Context

Confrontation draws upon empathy. Countertransference distortions are likely when we find ourselves angry, disappointed, exasperated, especially frustrated, or jealous. Confrontations can also be contaminated by fantasies of being the magic healer, rescuer, shaman, sage, or parent.