Blockages in Therapy

Compiled and edited from lectures on psychoanalytic technique given by the late Karen Horney at the American Institute for Psychoanalysis during the years 1946, 1950, 1951 and 1952. Further lectures in this series will appear in subsequent issues of the Journal.

When a patient comes into analysis he wants to change but doesn't know exactly what. He is unaware of the multiple factors that are hindering him from changing. Some of these factors we call “blockages.” The concept and the use of the term “resistance” puts too much onus on the part of the patient. It is too generalized an idea. On the other hand, the term “blockages” includes those forces which retard the analysis, e.g., all the patient's neurotic difficulties. The patient's defenses are considered identical with his obstructive forces (“retarding forces”).

What do these “blockages” stem from? They stem from his obstructive forces. However, they are not altogether obstructive to his growth. For example, the compulsively helpful patient may be useful in his relationship with other people. A patient whose major defense is mastery may have a good impetus really to tackle his difficulties. In therapy, the forces a patient uses toward neurotic goals may be of use in initiating the analytical process.

How do these obstructive forces show in the analytic process? The patient in treatment soon reveals his “blockages” in many areas of his waking life—in school, job, marital, and other interpersonal relationships. When we speak of “blockages” in treatment, we are pointing to some of the difficulties known and unknown to the patient when he comes in for treatment. For example, a patient who comes to a physician to obtain treatment for a fractured leg, not only comes in with a fracture but also with his attitude toward it.

In analytical therapy we see something similar. We attempt to make the distinction between what the patient comes in with and his attitude toward it. More important, we also distinguish what he withholds