There are patients who no matter how much the therapist asks and invites: “Do you notice, do you notice… would it not be nice…. would you like to….” etc., etc. it will not gain traction. No amount of inviting or trying to press through will pierce the resistance.
Though the aforementioned type of interventions can of course work wonders with patients who are less resistant and with less superego pathology, attempting them with a highly resistant patient in the clutches of superego resistance is akin to “bargaining with the superego,” according to Marvin Skorman, who said he was citing Davanloo (Personal communications, 2012-2021).
Davanloo proposed the need for total respect for the patient, but also disrespect for the resistance. In Intensive Short-Term Dynamic Psychotherapy: Selected papers of Habib Davanloo (2000), Davanloo wrote:
“One of the essential ingredients of the therapist’s attitude in this technique is
that while maintaining the greatest sympathy and respect for the patient, he has neither sympathy nor respect for the patient’s resistance and conveys an atmosphere of considerable disrespect for it. As a large part of the patient is identified with his defenses, this part of him becomes angry at having them treated with such disrespect. But underneath there is another part of him that begins to turn against them, to appreciate profoundly the therapist’s relentless determination to free him from his burden and to sense dimly the relief he would feel if this could be accomplished” (p. 210).
This was an important component in my training with Marvin Skorman over the decade I was with him. It’s a risky approach because if not carried out well the results can be disastrous. It’s not meant for all patients or at all junctures of treatment. But is is also an essential approach with highly resistant patients who are in the grip of a vicious superego function.
With patients with heavy superego pathology, trying to approach them without the “talking down to the superego” is like bringing a cup of water to put out a forest fire.
I am reminded how Marvin often cited Davanloo describing this intervention. “Davanloo would say that if you’re not talking down to the superego, he said it’s like someone falling out of a ten story building, and as they go by the ninth floor, you put your head out the window and say, ‘don’t worry, everything’s okay so far.’ Davanloo said that you’re doing the patient a disservice by not speaking up to to the defenses. Many therapists don’t do that, instead many are just supportive or understanding, even though they’re supporting a maladaptive lifestyle which is not helping the patient” (Personal Communication, March 4th, 2023).
On this day in March, Marvin reiterated what I heard him say many times before, which was this: “The other analogy that Davanloo used to give was Churchill talking down to Hitler during World War Two. Even though England was hanging on by a thread, Churchill would talk down to Hitler. With a stern voice, Churchill would say…” and then Marvin would use words from the following section of Churchill’s “We shall Fight on the Beaches” speech:
“Even though large tracts of Europe and many old and famous States have fallen or may fall into the grip of the Gestapo and all the odious apparatus of Nazi rule, we shall not flag or fail. We shall go on to the end, we shall fight in France, we shall fight on the seas and oceans, we shall fight with growing confidence and growing strength in the air, we shall defend our Island, whatever the cost may be, we shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender…”
(Winston Churchill’s speech: We Shall Fight on the Beaches June 4, 1940,
House of Commons).
It’s the voice of Churchill talking down to the Nazis that is the voice we use when we “talk down to the superego.”
A link to Churchill’s full speech: