Reaching through Resistance

Overview

Written for therapists of all experience levels, Reaching through Resistance will help therapists rapidly assess resistance and provide emotionally engaged psychotherapy to treatment-resistant and complex patients.
Using numerous and extensive vignettes, Reaching through Resistance teaches therapists how to reach through to the person beneath long-held treatment-defeating behaviors to help the client become the person he or she was meant to be. The book outlines clear, systematic steps for assessing a patient’s needs and intervening to mobilize and process intense underlying, anxiety-provoking impulses and feelings.

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Key skills taught in the book

Assess and manage barriers to initial engagement
Assess unconscious anxiety pathways
Assess the nature and degree of resistance
Assess thresholds of emotion intolerance
Turn patients against their own long-held resistances
Identify the somatic experiences of feelings and impulses
Build patients’ psychic capacity to overcome emotional intolerance
Understand and assist patients mired in self-destructive cycles and fearfulness
Recognize signs of an emerging unconscious therapeutic alliance
Help patients with chronic depression, psychosomatic disorders, anxiety disorders, dissociative disorders, and personality disorders

Parts

Part 1: An overview of the metapsychology of unconscious operations, including categories of anxiety, patterns of resistance, levels of emotional mobilization, and core therapy techniques with numerous illustrative case vignettes.

Part 2: Details of how to diagnose and work with the spectra of resistant patients, including those with high resistance, depression, and fragile character structure. Each chapter outlines the metapsychology, assessment findings, key clinical processes, challenges, and typical outcomes with different patient categories.

Appendix: Outline of the existing evidence base for short-term psychodynamic psychotherapy and intensive short-term dynamic psychotherapy, including new cost-effectiveness studies.

Who should read the book

Therapists at all levels of experience who want to improve their understanding of and technical approaches to complex and treatment-resistant patients.

Reviews for Reaching through Resistance

“The reader will find numerous clinical vignettes showing how to put theory
into practice that leads to enduring change. This model of work is showing
some of the most impressive outcomes in psychotherapy research today. If you
want to know how to do clinical work that leads to change, this book is essential reading.”
Dr. David Malan, DM, FRCPsych, author of Individual Psychotherapy and the Science of Psychodynamics

“This masterpiece of clinical acumen and sophisticated technique comes from the researcher-clinician who has done the most to establish empirical backing for short-term dynamic psychotherapy. Allan Abbass has spelled out, with the skillful use of fascinating case material, the principles underlying the practice of Davanloo’s intensive short-term dynamic psychotherapy. In exceptionally clear prose, he demonstrates how one can reach behind the resistances of even the most repressed and fragile character types and offer them genuine, lasting change. This book is a gold mine of clinical insight.”
Stanley B. Messer, PhD, Dean and Distinguished Professor, Graduate School of Applied and Professional Psychology, Rutgers University

“Allan Abbass has masterfully integrated the work of his mentors with his own research, theory, and clinical learning into an organized and graceful approach to short-term psychotherapy. The book is practical and clear in its recommended psychotherapeutic approach that is supported by both theory and empirical research. It is also rich in clinical examples. Dr. Abbass’s ideas are very helpful to practitioners of all levels.”
Raymond A. Levy, PsyD, Clinical Director, Massachusetts General Hospital Psychotherapy Research Program, Harvard University

“The internationally recognized master clinician and researcher Dr. Allan Abbass offers readers one of the most clearly articulated descriptions of how to conduct intensive psychotherapy. Using extensive case material and clear descriptions of the technique and process, Abbass demonstrates how to expertly transform the lives of those suffering with crippling psychological disturbances. A must-read for psychotherapists who want to improve their effectiveness and reach the most treatment refractory patients.”
Jeffrey J. Magnavita, PhD, ABPP, Past President, Society for the Advancement of Psychotherapy, and coeditor of the Journal of Unified Psychotherapy and Clinical Science

“Dr. Abbass’s work springs from a profound and nuanced psychoanalytic understanding of his patients, combined with a highly innovative approach to engaging the patient in corrective emotional experiences. He offers wonderful examples of how to engage patients to lead them to the point where they have transformative experiences. This revolutionary book will richly repay those who devote their time to really study it.”
Sherwood Waldron, MD, Chair, Psychoanalytic Research Consortium

“One of the perennial problems for psychotherapists is the paradoxical situation in which the patient often resists the help offered by the therapist. In this superb new volume, Allan Abbass provides a systematic approach to dealing with that inevitable resistance. Both beginning and advanced therapists will benefit from the clinical wisdom in these pages.”
Glen O. Gabbard, MD, author of Long-Term Psychodynamic Psychotherapy: A Basic Text

“This is a wonderful book on how to work to reach toward people beneath their blocks and encourage maximal treatment engagement. Filled with both theoretical innovations and a myriad of interventions you can use to help patients build psychological strength, become more relationally competent, and process difficult feelings, this book will help you be a more effective therapist.”“This is a wonderful book on how to work to reach toward people beneath their blocks and encourage maximal treatment engagement. Filled with both theoretical innovations and a myriad of interventions you can use to help patients build psychological strength, become more relationally competent, and process difficult feelings, this book will help you be a more effective therapist.”
Leslie S. Greenberg, Distinguished Research Professor Emeritus, Department of Psychology, York University

“Using compelling clinical illustrations, Dr. Abbass has crafted a conceptually rich, empirically robust, and technically clear guide to the practice of intensive short-term psychotherapy.”
Molyn Leszcz, MD, FRCPC, Professor and Interim Chair, Department of Psychiatry, University of Toronto

“This book is desperately needed in our field. Written in clear language, this volume is packed with research data, as well as detailed illustrations and case vignettes that bring the concepts to life. This is a sophisticated text for therapists who, like Abbass himself, are dedicated to going all out to help even the most troubled and treatment-resistant patients. It is ultimately a book of hope.”
Patricia Coughlin, PhD, Clinical Professor, UNM School of Medicine, and author of Intensive Short-Term Dynamic Psychotherapy and coauthor of Lives Transformed

“Abbass presents in clear and jargon-free prose an approach to therapy that some may find congenial, some may find challenging, and many will experience as a highly stimulating blend of both. Richly illustrated with clinical detail, the book presents an active version of psychodynamic therapy that has been tested in the crucible of systematic research.”
Paul L. Wachtel, PhD, Distinguished Professor, Doctoral Program in Clinical Psychology, City University of New York

“Allan Abbass unveils his process of conducting ISTDP by providing clear and concise guidelines that are useful to the beginner, intermediate, and master clinician. He presents vignettes from psychotherapy sessions for almost any scenario a therapist and patient might face together when working deeply with emotions. This book is a must-read for learning the art and science of ISTDP!”
Kristin A. R. Osborn, MA, LMHC, Harvard Medical School, and President, International Experiential Dynamic Therapy Association

“Reaching through Resistance provides an excellent update on intensive short-term dynamic therapy . . . The book builds on the rich clinical experience of the author and is full of very helpful examples for psychotherapeutic interventions using ISTDP. A must for therapists treating patients with various levels and forms of resistance.”
Falk Leichsenring, University of Giessen, Germany

“Many patients do not respond to an appropriate course of therapy. In this book, Dr. Allan Abbass describes a systematic way to address such cases of ‘treatment resistance.’ I particularly liked the detailed case vignettes, which illustrate how to connect to the person who is suffering beneath the symptoms.”
Michael Thase, MD, Professor of Psychiatry, University of Pennsylvania

“Abbass has presented an approach to short-term psychodynamic psychotherapy that is both sophisticated and readable. The copious use of case material adds to the interest and accessibility of the book.”
George Stricker, PhD, Professor, American School of Professional Psychology, Argosy University, Washington DC

“Dr. Abbass offers a model of understanding early attachment patterns, trauma, emotions, anxiety, and bodily reactions in psychotherapy. In addition, he rovides some of the most extensive clinical vignettes used to illustrate the many varied technical interventions presented that I have ever seen. This provides readers with a very clear understanding of how they might intervene in relation to the model of therapy being presented, which makes the book a useful resource for clinicians at any level of experience.”
Mark Hilsenroth, Professor, Adelphi University

“Dr. Allan Abbass is a giant in the field of short-term dynamic therapy, and this book is a tour de force. The combination of detailed cases and comprehensive explanatory material from a preeminent researcher and teacher makes Reaching through Resistance a must-read.”
Howard Schubiner, MD, author of Unlearn Your Pain; Director, Mind-Body Program, Providence Hospital, Southfield, Michigan; and Clinical Professor, Wayne State University

“In the tradition of Davanloo and Malan, Abbass is exploring methods to rapidly get beyond resistance to modify central conflicts. The intense focus on the current relationship between therapist and patient provides an avenue for both assessment of levels of pathology and change.”
John F. Clarkin, Clinical Professor of Psychology in Psychiatry, Weill Cornell Medical College

Reaching through Resistance belongs in every psychotherapist’s library. In a tone notable for its respect for the struggles of patients and those who try to help them, Allan Abbass systematically explores the theoretical foundations of intensive short-term dynamic psychotherapy, illustrates its implementation with verbatim clinical material, and reviews the extensive empirical support for this approach. Unlike therapists who are good at what they do but not so good at communicating it, Abbass is an outstanding teacher. Readers will emerge from their engagement with this masterwork not only with a greater understanding of the phenomenon of resistance but also with much more skill in addressing it.”
Nancy McWilliams PhD, ABPP, Rutgers Graduate School of Applied and Professional Psychology

“In Reaching through Resistance, Allan Abbass, MD, a master clinician, provides the reader with a crisp rendition of the setting of intensive short-term dynamic psychotherapy and then gently rains a lovely series of illustrative examples of how an astute clinician can accurately pace the patient and use the scaffolding erected by what feels like resistance as a guide to relieving the double-binds and internal admonitions of troubled people who have been hobbled by unconscious self-protective strategies gone awry. Both newly minted and experienced ISTDP psychotherapists will find Reaching a satisfying thesaurus of what could be said in the thick of intense engagements that both respect the patient’s adaptive defenses and helps the patient join the clinician in putting them aside and growing. I highly recommend Reaching through Resistance.”
Richard A. Chefetz, MD, private practice, Washington, DC, author of Intensive Psychotherapy for Persistent Dissociative Processes

About the Author

Allan Abbass, MD—psychiatrist, teacher, and researcher—is the author of Reaching through Resistance: Advanced Psychotherapy Techniques. He is a professor of psychiatry and psychology and the founding director of the Centre for Emotions and Health at Dalhousie University in Halifax, Canada.
In 2013 he was awarded the Douglas Utting Prize for his contributions in the area of major depression. His innovative program to diagnose and treat emotional contributors to medically unexplained symptoms in the emergency department won a quality award and a national designation as a “Canadian Leading Practice.”
Since 2000 he has been consulted widely by governments, universities, and health agencies on the cost-effectiveness and applicability of short-term psychotherapy. He provides invited presentations around the world as well as ongoing video-recording-based training to professionals in several countries.
He has been a consultant to the American Psychological Association on the Unified Psychotherapy Project and to the American Psychoanalytic Association, where he serves on the Scientific Committee. He was a board member for the International Experiential Dynamic Therapy Association and an editorial board member for the American Psychological Association journal Psychotherapy. He is a visiting faculty member at institutions in the United States, England, and Italy.

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