TECHNIQUE OF ANTI-EXPECTATION PSYCHOTHERAPY

In dealing with resistance, the major aspect of the technique involves the therapist trying to break into the patient’s closed system. This is done by aligning oneself with the patient’s negative comments while echoing and greatly amplifying the views that the patient probably expects the therapist to oppose.

For example,this might mean initially agreeing with the resistant neurotic housewife’s complaint that she doesn’t keep her house clean enough, and possibly even suggesting that she spend more than her usual ten hours a day cleaning.Or it might mean aligning oneself, at least temporarily, with a patient’s statement that he must be defective since he is not perfect at everything he does.

When such techniques are employed, patients usually begin to find it extremely difficult to be resistive since there is no one to resist. From this position the therapist can begin to have the patient confront behavior and gain control over it.These techniques may be seen as “anti-expectation” — in that the therapist consistently goes against what the patient expects. It is done, however, within a framework that strongly implies that the therapist will be therapeutic.The results are: patients find themselves unable to use comfortable old defenses, since they no longer produce the expected feedback; interactions are marked by the humor of the unexpected; and patients are forced to look at their problems from a different perspective.

It should be emphasized that Anti-Expectation Techniques usually represent only one segment of the therapy. Further, they do not substitute for a theoretical understanding of case material. Thus, such techniques are probably most effectively put into play after a strong therapeutic relationship has been established, the case has been conceptualized theoretically, and there are indications that the techniques are unlikely to precipitate harmful activities — such as self-destructive behavior.

Employing such techniques is difficult and requires considerable therapist sensitivity and skill.The therapist must develop the ability to resist the pull of the patient’s message and continually anticipate where an anti-expectation communication will lead.The therapist must be able to put the intervention across without sarcasm and refrain from responding,at least initially,to the humorous or almost absurd aspects of the interactions.

Finally, and perhaps most important, care must be taken to insure that the techniques are being employed to further the patient’s progress and not to just fulfill the therapist’s needs to exert power or express hostile feelings.