Processes of clinical change and resistance. A theoretical synthesis

Evidence from both experimental laboratory studies and clinical observation supports the behavioral principle that immediate (compared with delayed) consequences are most influential in shaping future actions. This presents the theoretical possibility of conflicts of consequences (e.g., short-term positive vs. long-term negative). As one example, resistance to completing therapeutic homework assignments that instruct clients to approach feared situations may result in short-term positive outcomes, such as freedom from negative emotional experience (emotional avoidance), but is dysfunctional over time. Thus, temporal conflicts of consequences is one theoretic source of resistance in clinical treatment. In this article, the authors articulate how the activation of the metacognitive level theoretically mediates conflicts between short-term (immediate) and long-term (delayed) consequences, thereby facilitating therapeutic change and reducing resistance. This synthesis unifies principles of behaviorism and contemporary clinical cognitive theory.