| Abstract: | A significant proportion of the cases that come for therapy, perhaps as high as 25 percent, do so at the initiative of some outside person or agency. A brief literature survey describing the particular motivational set established by such extrinsic motivation is examined, and its potential as the  gathering point -the summation of the internal along with the external resistance-is discussed. Clinical vignettes are presented to illustrate how important it is for the therapist to step away from the patient's designation (of him or her) as the enemy and available scapegoat in the saga of the unacceptable mandate. Only by the therapist's acknowledging the legitimacy of the patient's negativism towards the mandate, and dissociating both therapist and therapy from this external resistance can the internal resistance to change be successfully addressed. To not make this distinction is to risk the patient's characteristic rebelliousness and authority conflicts, perseverating on the mandate and subverting the quiet cry for help that is audible in every troubled individual, if we allow ourselves to hear it. |
