On refusal

Traditionally, all efforts to counter psychotherapeutic work have been captured under the umbrella term, "resistance." However, it is useful to distinguish a concept of refusal. Resistance entails therapeutically a gradual elaboration of unconscious, preconscious, and partially conscious experience. Refusal manifests as a willful nonparticipation in offering or responding to material that can be symbolized. All communication has an element of refusal, which occurs at various levels of persistence, intensity, and legitimacy. Clinical examples are provided to discriminate refusal from resistance proper, and to describe three categories of mental and group experience, (a) refusal to perceive external experience; (b) refusal to think about what one knows, and (c) refusal to think about what one does not know. Therapeutic impasses may relate to limitations of the therapist's creativity and flexibility in thinking about and dealing with refusals, including one's own.