Processes of clinical change and resistance - A theoretical synthesis

Evidence from both experimental laboratory studies and clinical observation supports the behavioral principle that immediate (compared with delayed) c onsequences are most influential in shaping future actions. This presents t he theoretical possibility of conflicts of consequences (e.g., short-term p ositive vs. long-term negative). As one example, resistance to completing t herapeutic homework assignments that instruct clients to approach feared si tuations may result in short-term positive outcomes, such as freedom from n egative emotional experience (emotional avoidance), but is dysfunctional ov ertime. Thus, temporal conflicts of consequences is one theoretic source of resistance in clinical treatment. In this article, the authors articulate how the activation of the metacognitive level theoretically mediates confli cts between short-term (immediate) and long-term (delayed) consequences, th ereby facilitating therapeutic change and reducing resistance. This synthes is unifies principles of behaviorism and contemporary clinical cognitive th eory.