In the course of psychotherapy there are often moments when the therapist encounters not only overt manifestations of resistance but also more subtle forms of avoidance.

One such form is trivialization—a situation in which the patient appears to follow the rule of free association, yet in reality avoids the most significant and conflict-laden aspects of their inner world.

How can we determine when the material the patient is presenting amounts to trivialization and avoidance of important material ?

The emergence of this challenge generally takes place during the transition from the early phase to the midphase of therapy. As the patient’s level of acting out diminishes and the patient’s dynamics become concentrated in the frame of the treatment, he or she may begin to avoid the most affectively charged and conflictual areas of his or her pathology by falling into a general state of trivialization in the therapy.

It may take a while for the therapist to become aware of this issue because the patient may at first seem to be adhering to the basic rule of free association. However, there are certain behavioral correlates to trivialization. One possibility is that the patient may appear to be working adequately in sessions (with the therapist often in a corresponding “lulled” state) but may report intense, unexplained moments of severe anxiety or dysphoria between sessions that communicate a distress not seen in the sessions. 

Trivialization may also be present if a sense develops that the patient is settling into a relationship with the therapist that becomes so gratifying in itself that it begins to replace outside reality in the patient’s life—a so-called “transference cure.” This can appear as a flight into health where the patient seems better but, aside from a decrease in the level of acting out, there is no change in his or her life outside the sessions—no resolution of problems in interpersonal relations, level of functioning, or identity diffusion. In this state, the therapy may be principally a source of gratification, and the therapist may be experienced as an interested companion. The content of the sessions might consist of reports on the patient’s daily life at the surface level, with no evidence of self-reflectiveness or ongoing consciousness of the severity of the problems that brought the patient into treatment. The therapist can be lulled into a state of forgetting the severity of the patient’s problems, and effort might be necessary for the therapist to remind himself or herself of the unsatisfactory state of the patient’s work, social, and love life. Therapy can become a refuge from challenges to self-esteem experienced in the outside world. 

The therapist’s task of deciding when material represents trivialization does not counter the principle of free association but rather complements it with adequate appreciation of the power of resistance. In other words, the relevance of the patient’s associations may be in demonstrating resistance to deep exploration. 

In this case the therapist should point out the retreat into relatively inessential material— especially because patient histories reveal cases in which years were lost attending to trivial material in therapy while the patient’s life continued to deteriorate.

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(c) Yuliia Holopiorova,

Ukrainian Association of Transference-Focused Psychotherapy

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