Resistance to Change in Psychotherapy

Fear of regret can be a major source of resistance.

Posted Jan 07, 2019

Over the years, I've noticed that a major source of resistance to change in psychotherapy is the fear of regret. In other words, if you've been doing something for years and it has not been working, changing means you have to deal with the regret of not having done it a long time ago. For example, my patient Carl knows that not billing his clients for all of the time he spends working for them costs him a great deal of money. He loses money for the time he worked, and the clients have gotten used to underpaying him. We have discussed his reluctance to charge for time worked, and at first he said it was because he feared his clients would object to the larger bills. But he tried it once or twice and there was no negative reaction from his clients. I asked what else might explain his reluctance to change. He said, "If I start charging properly and my clients do not object, I will feel like an idiot for all those years—all the money I have lost for years by under-charging."

Roberto Delgado Webb/unsplash
Source: Roberto Delgado Webb/unsplash

Although I have understood this intellectually and made that interpretation to many patients, it is only recently that I've come to understand it emotionally. When I was in graduate school many years ago, I went to Florida on semester break with some friends. The weather was miserable for the first several days, and when the sun finally came out, I sunbathed too long without enough sunscreen. I got sun poisoning and have had many brown spots on my face as a result. They are not the result of aging, but of that mistake I made. Over the years I have tried many creams and potions to remove the dark spots, but none worked. Recently, I read that the best thing for brown spots is lemon juice. Simple. Cheap. Just put lemon juice on the spots and they gradually disappear. Well, guess what? It's working and the brown spots are gradually disappearing. I expected to feel jubilant. But instead, I feel like a jerk for living with the brown spots for so many years and never using this simple remedy!

Of course, it is important to know why Carl started undercharging in the first place. And why I didn't deal with my brown spots years ago. As for Carl, his resistance to being financially successful is related to his relationship with his father. His father has always been critical of him and Carl is sure that he cannot be as financially successful as his father. And as long as he is not financially successful, his father gives him money. But Carl also pays the price; he feels like a "boy" instead of a "man."

For me, I think I have delayed treatment of the brown spots because I blamed myself. Every day I looked in the mirror and chided myself for staying out in the sun so long. My mother would have said, "How can you be so stupid?" I've been saying it to myself for years.

In conclusion, whatever the unconscious reasons for self-destructive behavior might be, insight is not necessarily the only antidote. In order to change, we also have to tolerate regret and forgive ourselves for having behaved in a self-destructive way for so long. There's a price for change and we have to be willing to pay it.

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