Stage 5: Therapist Generates Empathic Confrontation

Once the patient identifies and verbalizes the maladaptive relational pattern, the therapist generates a confrontation by empathically refusing to participate in the manipulation. The therapist does this to prevent the patient from controlling the therapist through primitive manipulations, which are not conducive to healthy relationships based on mutual respect, honesty, and autonomy. The patient wants to manipulate the therapist into being a character in his or her internal drama of object relations that were distorted and split in early childhood because they were experienced as "bad" or unacceptable. All of these dysfunctional object relations of the patient's internal world are the product of disappointing relationships in early childhood. The unacceptable parts of the self gain expression through the maladaptive relational pattern the patient uses to form and maintain relationships.

During therapy, the patient projects these unacceptable parts of the self onto the therapist and then tries to control them by manipulating the therapist into experiencing the corresponding affective states. This manipulation is the patient's maladaptive relational pattern and the emotional reaction in the therapist is the positive countertransference. Giving in to the patient's manipulations on this level would result in the therapist becoming part of the problem. So, the therapist needs to empathically confront the manipulations that comprise the maladaptive relational pattern of the patient. Although the term "manipulation" might not be used in the confrontation, the therapist must make it clear that he or she is not willing to participate in the patient's dysfunctional method of relating.

Generating the confrontation is a climactic process in therapy because the patient is being confronted to acknowledge a style of manipulation that has required great effort to camouflage. Because it is a sensitive and potentially volatile issue for the patient, the confrontation must be done with great awareness and care. Again, training and supervision are necessary.



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