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Once again, Althea Horner has brought forth a valuable book that clarifies one of the central, brain-hammering difficulties we face in our clinical work—how to identify and manage resistance in psychotherapy. Not content to deal with the patient's resistance, she takes up the therapist's resistance as well, which, as a supervisor of psychotherapists, she is eminently qualified to take on.
For Horner, in this and in her several previous works, each of the developmental stages is associated with its own vulnerabilities and possible derailments. In the current volume, as in her 1998 volume Working with the Core Relationship Problem in Psychotherapy, she sustains a shift in emphasis from the simply structural to the dynamically relational. Nevertheless, her work continues to be firmly founded on an object relations model, on the dynamic interplay of self and object-representations and their associated affects, wishes, values, and fears. Her approach to resistance in clinical treatment proceeds from this theoretical orientation, one which this reader finds altogether congenial.
Although this is a book on resistance, Horner uses the term grudgingly and prefers instead to think in terms of how individuals manifest character defenses and adaptive strategies in treatment. Her chief concern, but not her only concern, is transference resistance and its corollary, countertransference resistance. Impasses in treatment, in her experience, can often be traced to transference resistance and collusion or a failure to recognize or adequately engage it on the part of the therapist. In turn, the genesis of these resistances can be traced to a core relationship conflict, the same term but differently intended from Luborsky's concept. Transference resistance, then, becomes understood as an expression of the core relationship conflict, itself an outcome of derailment during the stages of pre-attachment, attachment, symbiosis, separation-individuation, rapprochement, identity achievement and