The   psychoanalytic use of  confrontation was,  of  course, originated     by Sigmund  Freud. Freud believed that the pathological factor in   neurosis was not the patient’s ignorance of his mental mechanisms but his “inner resistance,”  which brought the ignorance into being  in  the first place. Therefore, Freud generally remained passive and  limited  confrontation to interpretation of  transference and resistance, and to occasional reality testing.Freudian psychoanalysts  have in general  continued to follow this practice.

Many analysts who followed Freud used confrontation in a less     limited way. Karen Horney, who broke with Freud over the importance  of the influence of cultural factors, rejected the role of  the analyst as merely an “interpreting voice” rather than a reactive human being. If  she believed the patient was “running into a blind alley” she would not hesitate to actively intervene and suggest alternatives.

Alfred Adler  was the first of  these analysts who actively confronted   his patients with their self-deception. He encouraged them to  relinquish negative “life-styles” and to adopt “positive roles.” Sandor Rado, who also began as a classical analyst,  originated the “adaptational” school of analysis. He confronted patients with the need for change and emphasized that insight occurs only through practice in daily living  as the patient “automatizes”  new, more healthy behavior.Bernard Robbins was originally identified with Horney, but late went on to develop confrontation to its ultimate  therapeutic advantage. He believed that it is necessary for therapists to actively  intervene in getting patients to change their actual practice: “Inner growth does not come from within, but through man’s practice on  the outside  world (Robbins, 1952).

Many family therapists use even  more  active confrontation      techniques. For example,  Salvator Minuchin uses confrontation in a   process he calls “restructuring operations”  which are  “the  therapeutic interventions that confront and challenge a family in the attempt to force a therapeutic change.”

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