Roger P. says, ” My interest in these techniques grew out of a number of encounters with resistant patients who stated that they were seeking change while at the same time they clung tenaciously to the symptoms and discomforts that brought them in. Such patients tended to externalize problems and emphasize that the world was beyond their control while demonstrating the ability to control the therapy situation by fending off therapist attempts at exploration, interpretation, or direction. These patients often took the role of the help rejecting complainer, first identified by Jerome Frank and later described by other clinicians. Thus,they continually attempted to pull advice from the therapist only to reject any suggestions that might be offered. They made their problems seem insoluble and appeared to take a special delight and pride in the insurmountability of their difficulties.
Perhaps the key to this type of patient’s control of the therapy situation is his expectation that no matter what he does, the therapist will try to be therapeutic.The patient remains relatively confident that his negative view of himself will be matched by therapeutic interventions aimed at getting him to see the “causes” of his views, the alternatives he is overlooking, the positive assets he has, or the resistive nature of his communications. Typically, a static balance soon evolves in which the patient’s negative statements are repeatedly counterbalanced by therapist intervention.While this kind of patient behavior may get attention and possibly preserve some inappropriate truths for the patient — such as,even the therapist can’t help me solve my problems — it can prove extremely frustrating to therapists and potentially destructive of the therapeutic relationship.It eventually becomes imperative that the therapist somehow disturb the nonproductive stability of the resistant behavior. The use of Anti-Expectation Techniques allows the therapist to regain control over this impasse to therapeutic progress.”
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