[Working with Resistance in Analytic and Psychodynamic Psychotherapy: A Qualitative Expert Interview Study]

In psychoanalytic theory, resistance is considered - alongside transference and countertransference - a central element of the treatment process. Managing resistance is therefore regarded as a therapeutic core competence. The aim of this study was to explore how psychoanalytic and psychodynamic psychotherapists address resistance in clinical practice.

A qualitative expert survey was conducted. Six psychoanalytic and six psychodynamic psychotherapists were interviewed using semi-structured formats. Transcripts were analyzed through qualitative content analysis employing a combined deductive-inductive approach.

Findings were organized according to Kaslow's competence framework into knowledge (about resistance), attitude (in contact with resistance), and skills (in the handling of resistance). Within knowledge, therapists emphasized personal conceptualizations of resistance (characteristics, functions, sources) and its distinction from defense. Opinions diverged regarding the applicability of the concept to structural disorders. Attitude referred to therapists' inner resonance with manifestations of resistance and their active engagement with it in the therapeutic relationship. Empathy and a willingness to understand resistance were highlighted as essential. Skills encompassed general principles (working from surface to depth), specific interventions (clarification, confrontation, interpretation), timing of interventions (at first occurrence vs. after repeated manifestations), and approaches with structurally impaired patients. Experts stressed that resistance work must be tailored to patient parameters such as conflict, level of personality functioning, or attachment style.

Consensus was reached on the importance of an appropriate therapeutic attitude, while issues such as timing of interventions and applicability to structural disorders remained contested. No standard intervention could be identified; rather, effective resistance work was seen as needing to "fit" the individual patient.

Experts regard resistance work as a clinical core competence comprising knowledge, attitude, and specific skills. Consequently, competence development in this domain should be addressed through practice-based, competence-oriented training formats in psychotherapy training.