want, is to get to the root, the engine, driving your difficulties. So, can we look at a specific time when you experienced anxiety? This will give us a clear picture of the problem which we can use to get to the engine." In its essence, pressure is encouragement from the therapist to the patient. It is encouragement to renounce defences, tolerate anxiety, and walk, with the therapist, into those places which have previously been off-limits. It is a way of saying, "There's nothing in there we cannot face together, and we do so in your service, to relieve you of painful difficulties." Patients with low resistance are often quite responsive to pressure alone. However, as explained above, those are the patients who are healthiest to begin with. For patients with higher levels of resistance, usually the product of a more traumatised early phase of life, pressure quickly leads to the patient erecting barriers with the therapist. Those barriers are the patient's habitual defences against avoided feelings. The combination of intentional (conscious) and unintentional (unconscious) defences is called the resistance. The therapist is constantly monitoring for both the rise in anxiety and the appearance of resistance. When resistance does make its appearance, new interventions, in addition to pressure, are called for. II. Challenge: Pointing out and interrupting defenses in concert with the patient Challenge is a two-stage process. The first stage is clarification, which is the therapist's effort to confirm that resistance is operating, and also to acquaint the patient with the specific defense being deployed. Patients are often quite unaware of their own defenses. Clarification takes the form of a question, meant to clarify the defense to both patient and therapist: "Do you notice that when you speak of being angry with your boss that you smile and giggle? Is a smile something you sometimes do to cover up a deeper feeling?" When a defense is properly clarified, both patient and therapist can work together against it, because it represents an obstacle to the therapeutic task of getting to the patient's true feelings. A defense which has not been clarified is still invisible to the patient. It is also important to note that in childhood, defenses can be a useful tool in emotionally overwhelming or traumatic situations. According to Los Angeles-based psychiatrist Katherine Watkins, M.D. "defenses such as dissociation and repression can shield us from intense feelings that we