The requirement of confrontation is absolute in therapy when a change in behavior is crucial to avert a crisis. This confrontation must take place in a friendly and supportive manner, and in the spirit of collaboration, so that the patient understands that it is the therapist’s wish to help him or her live in a new way that is more effective, productive, and gratifying. This is the type of confrontation that has made short-term therapy possible and can increase the efficiency of other therapies.
How can the therapist, through such confrontation, help the patient to overcome resistance to change, which in routine psychoanalysis takes years to “work through”? It is the acute suffering of most of the patients who seek our help that is the main source of motivation to change. Resistance to change is often overcome by suffering. Moreover, once relief from immediate pressure occurs, the patient is willing to examine other areas of disturbed functioning with diminished resistance.In assessing sources of difficulty, it is essential to confront the patient not only with the effects of his own behavior and thinking but also with the effects of confusing, limiting, and exploiting behavior of others. This includes the basic limitations embedded in the patient’s specific social and economic reality. In this way we can help patients deal with destructive life situations that are not exclusively of their own making. When we help patients to realize what they are not responsible for, they are more able and willing to accept their actual contributions to existing problems.
Since all dysfunction takes place within a disturbed system of human interaction, it is additionally essential that wherever possible we bring family, peers, and even appropriate community members into the therapeutic situation. In this way, not only can confrontation be appropriately directed, but needed change in whole social units can be effected.Individuals in these units can learn to be therapeutically confronting with one another.
Pointing out sources of the patient’s difficulty should be only a prelude for the confrontation of needed change. When the therapist sees that change is required to avoid a crisis he, using appropriate timing and supportive manner, will confront the patient with the needed changed activity. Changed activity will produce a new, healthier consciousness and existence. This is the only source of inner growth and useful insight.We know a person’s consciousness only by its practice. Confrontation leading to changed human practice will produce the therapeutic “cure” — a changed person with a changed consciousness.
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