Regardless of the patient’s earliest protestations that he wants to change, what he really hopes to find is some ease from the suffering of his symptoms. He also wants some affirmation of his view of himself and the world. Castelnuovo-Tedesco believes that the problem for the therapist throughout the work is the complexity and ambiguity of desire. We might begin with the statement made at assessment about what the patient wants, but we know that only the transference will reveal more than the conscious desires accepted by the ego and permitted by the superego.

The patient, for his part, responds to the therapist with a range of behaviors traditionally described as resistance, i.e., by balancing “change” with efforts to maintain the status quo. Resistance typically manifests itself as soon as it becomes apparent to the patient that treatment (and, certainly, cure) will involve both more and less than he had anticipated. The “less” part refers to his discovery that he will receive less direct gratification than unconsciously he has sought and expected; the “more” part refers to the realization that 106inevitably some modification of his personal attitudes is called for. (Castelnuovo-Tedesco, 1986, p. 272)