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October 22, 1957. RISISTANCE. Sandor Lorand, M.D.
The distinction in the literature between resistance and defense mechanisms is not clear. Some authors use the terms synonymously, others clearly differentiate the two. Dr. Lorand disagrees with Ella Freeman Sharpe and others who use the terms synonymously. He defines resistance as the type of behavior in analysis by means of which a patient tries to thwart the analyst's attempts to analyze his defenses in the service of altering his habitual patterns of thinking, feeling, and acting. Resistance can be said to be a defense in the sense that it is part of the patient's protection of a vested interest in his neurosis with which the analyst interferes. This definition makes resistance a part of the psychoanalytic therapeutic process which aims to resolve the individual defense mechanisms. This definition and differentiation are not novel. In The Problem of Anxiety, Freud described five resistances deriving from the ego, the superego, and the id. The ego gives rise to three resistances, repression, transference, and the secondary gain from illness. The id gives rise to the repetition compulsion. The superego gives rise to the sense of guilt or need for punishment.
Relevant clinical instances are discussed. Problems attendant on starting analysis are handled without rigid insistence upon the application of rules. A particular patient who had great anxiety about lying on the couch was during fifteen sessions interviewed face to face and sufficiently reassured to then be analyzed on the couch. A patient's silence can occur at any stage of the analysis and at times attempts at interpretation, reassurance, or suggestion can be tried. When a patient is initially silent, the analyst should help him to communicate. A patient