HISTORY OF CONFRONTATION IN PSYCHOTHERAPY

The psychoanalytic use of confrontation was, of course, originated by Sigmund Freud. Freud believed that the pathological factor in neurosis was not the patient’s ignorance of his mental mechanisms but his “inner resistance,” which brought the ignorance into being in the first place. Therefore, Freud generally remained passive and limited confrontation to interpretation of transference and resistance, and to occasional reality testing.Freudian psychoanalysts have in general continued to follow this practice.

Many analysts who followed Freud used confrontation in a less limited way. Karen Horney, who broke with Freud over the importance of the influence of cultural factors, rejected the role of the analyst as merely an “interpreting voice” rather than a reactive human being. If she believed the patient was “running into a blind alley” she would not hesitate to actively intervene and suggest alternatives.

Alfred Adler was the first of these analysts who actively confronted his patients with their self-deception. He encouraged them to relinquish negative “life-styles” and to adopt “positive roles.” Sandor Rado, who also began as a classical analyst, originated the “adaptational” school of analysis. He confronted patients with the need for change and emphasized that insight occurs only through practice in daily living as the patient “automatizes” new, more healthy behavior.Bernard Robbins was originally identified with Horney, but late went on to develop confrontation to its ultimate therapeutic advantage. He believed that it is necessary for therapists to actively intervene in getting patients to change their actual practice: “Inner growth does not come from within, but through man’s practice on the outside world (Robbins, 1952).

Many family therapists use even more active confrontation techniques. For example, Salvator Minuchin uses confrontation in a process he calls “restructuring operations” which are “the therapeutic interventions that confront and challenge a family in the attempt to force a therapeutic change.”