The Process of Confrontation

Abstract

Confrontations direct attention to important but overlooked, denied, or incongruous patient communications. These interventions are used to (a) encourage the patient to resolve inconsistencies, (b) note denial or acting out behaviors, (c) help the patient face an uncomfortable reality, or (d) indicate that clinical material has psychodynamic importance. This chapter outlines three specific forms of confrontation (i.e., spotlight, connective, and prohibitive), provides suggestions for when to confront patients, and includes detailed clinical examples. Although they are potentially powerful interventions, confrontations are not without clinical risk. Improperly worded or poorly timed confrontations can lead to alliance ruptures or unnecessary patient distress. They can also be overused or underused by psychodynamic therapists. Suggestions for wording and the appropriate using confrontations are provided.