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.)
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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 Short-Term, Anxiety-Provoking Psychotherapy
In short-term, anxiety-provoking psychotherapy, confrontation has both a therapeutic and an educational role. In this latter sense, it may have a great deal to do with learning, which plays a crucial role in making psychotherapy therapeutic.
Confrontation as a Mode of Teaching
Whatever else it may be, confrontation is predominantly a device for teaching. Explanation and gentle, caring concern as a method of confrontation, in good times and in bad, will lead to identification with a model that will allow the patient freedom of choice. This result is the proper goal of confrontation.
The Meanings of Confrontation
It is more difficult to account for the success of a confronting approach than to understand why it fails. The therapist’s best instrument is his awareness of the nature of his countertransference when he is faced with a resistant patient and chooses a confronting or noncontronting approach.
