Negative Therapeutic Reaction Research Articles

Abrupt Terminations In The Treatment of Suicidal and Self‐Harming Young People: The Negativel in the Therapeutic Relationship

Psychotherapy with suicidal and self‐harming young people is complex, as this population group is difficult to engage in treatment and their internal reactions may remain concealed, leading to impulsive suicide attempts or abandonment of treatment. The resulting countertransference reactions of confusion, guilt and shame are most distressing and often cause psychotherapists to avoid treating this population group. Safety concerns increase when self‐destructive patients abandon therapy, or their condition worsens despite the therapist's best efforts. The vicissitudes of the adolescent developmental process suggest that, in some cases, withholding information, rejection of the therapist's caring interventions, and abrupt termination of treatment arise from the need for separation and independence and are ego syntonic and therefore suicide protecting. In other cases, the risk for suicide may be increased because of the transference experience of hostile abandonment. A negative therapeutic reaction (NTR) is a disturbing development in the course of psychotherapy that has not been adequately explained in the treatment of suicidal young people. This article is a consideration of whether these negative reactions associated with abrupt, unplanned terminations, in the treatment of self‐destructive young people, should appropriately be thought of as an NTR or as a developmental stage in separation.

On looking into The Ego and the Id 100 years after its publication

ABSTRACT Freud's publication of The Ego and the Id sparked a diverging set of psychoanalytic models - ego psychology, structural conflict theory, Kleinianism, object relations theories, Lacanianism, etc. - each of which attempted to deal with the clinical limitations of his first topography in regard to unconscious guilt, negative therapeutic reactions and primitive character organizations. This paper attempts to look back on these developments from the perspective of contemporary, post-Freudian psychoanalytic theories.

Interpersonal Trust and Borderline Personality Disorder: Insights From Clinical Practice and Research: Introduction.

Individuals suffering from borderline personality disorder (BPD) show a pervasive sense that others cannot be trusted, are vulnerable to negative therapeutic reactions, and can oscillate between idealized and persecutory interactions with others. These trust processing impairments impact both the immediate and wider social milieu of individuals with BPD, including therapist-patient interactions. Recently, research started unraveling the social-cognitive mechanisms of these impairments in BPD. In this Special Issue, we attempt to close the gap between research findings and clinical theories on trust processing impairment in BPD. The first section includes five original studies on trust processing in BPD. The second section includes five articulations of trust processing impairment as a treatment target in evidence-based treatments for BPD and as an indispensable "common factor" in the treatment of BPD. These cutting-edge research and clinical contributions advance a potential integrative, clinical science framework for conceptualizing and intervening effectively with those who struggle with BPD.

Hate in the service of love: the negative therapeutic reaction revisited in couple therapy

For many years, the negative therapeutic reaction (NTR) was regarded as a form of resistance arising solely in individual psychoanalytic treatment. The possibility, however, that the NTR may also appear in couples has recently emerged as worthy of exploration. After presenting a case in which NTR dynamics predominate, and reviewing analytic literature about the NTR, the authors propose a conceptualisation of a couple-based form of the NTR that relies upon both paradoxical motivations and paradoxical uses of projective and introjective identification. The countertransference reactions these couples tend to induce in therapists will also be explored, and methods for their management will be suggested.

The binds that bond: disavowed vulnerability in couples with early relational trauma

It is suggested that for some couples with early relational trauma, disavowal of vulnerability is paramount to psychic survival. However, rigidly projecting vulnerability into the other leaves these couples in a bind that bonds them to one another unconsciously. If they disavow their vulnerability, they will feel chronically disconnected from the other. If they reclaim it, they have to face the profound grief and loss of a childhood that never was. As both members of the couple are in this unconscious bind, it is suggested that they form a shared defence; an internalised destructive couple, akin to Rosenfeld’s mafia/gang in the individual. In doing so, they unconsciously cling to a protective, defensive position in relation to one another and, sometimes, to the treatment. An elaborated case example illustrates how such a powerful shared defence can lead to a negative therapeutic reaction halting the progress of the treatment.

The murder of the dead father: The Shoah and contemporary antisemitism

ABSTRACT It is suggested in this paper that in the Shoah one is confronted with the abolition of the Law of the Dead Father and the re-establishing of the tyranny of the narcissistic father. In the extermination of the Jews of Europe in the Shoah, the aim was the destruction of the rules of genealogy and filiation to both mother and father that establish the social and give rise to personhood and are at the core of the oedipal structure. The rule of absolute power – the destruction of any sense of maternal care and paternal rules – leads ultimately to the creation of the abject. Freud distinguished between two different types of obstacles to psychoanalytic treatment that are expressions of the death drive. The first is bound and is related to the superego; it is connected to the negative therapeutic reaction, masochism, and the unconscious sense of guilt. The other manifestation of the death drive is unbound and diffuse. If the first is understandable, the second, he suggests, escapes any understanding. The paper makes use of this distinction to examine Hannah Arendt’s notion of the banality of evil.

LO NEGATIVO EN TRANSFERENCIA. DESAFÍOS A LA CONSECUCIÓN DEL TRATAMIENTO

Starting from a clinical material where there is an attempt to interrupt treatment, this paper proposes to visualize the transference vicissitudes and the difficulties that arise when giving continuity to a psychoanalytic process. In order to contribute to the training of the psychotherapist, a historical account is carried out, enabling a theoretical-clinical interweaving. Concepts such as negative transference and negative therapeutic reaction are presented, from Freud to other historically significant authors who have contributed to this conceptualization.Changing techniques is considered key for the psychotherapist in training, especially with patients who hover on the margins of neurosis.

Annotation to Internalized Homophobia and the Negative Therapeutic Reaction (Friedman and Downey, 1995).

Free AccessAnnotation to Internalized Homophobia and the Negative Therapeutic Reaction (Friedman and Downey, 1995)Jennifer I. DowneyJennifer I. DowneyEditor of Psychodynamic Psychiatry and Clinical Professor of Psychiatry at Columbia University. She is a Past President of the AAPDPP.Jennifer I. Downey, M.D. [email protected]Search for more papers by this authorPublished Online:March 2022https://doi.org/10.1521/pdps.2022.50.1.86PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About"Annotation to Internalized Homophobia and the Negative Therapeutic Reaction (Friedman and Downey, 1995)." , 50(1), pp. 86–87 Previous article Next article FiguresReferencesRelatedDetails Volume 50Issue 1Mar 2022 Information© 2022 The American Academy of Psychoanalysis and Dynamic PsychiatryPDF download

Internalized Homophobia and the Negative Therapeutic Reaction.

Internalized Homophobia and the Negative Therapeutic Reaction.

Two models of masochism

ABSTRACT In this paper, the author discusses two models of masochism. The starting point is a two-perspective theory on therapeutic action, put forward at the Anna Freud Centre. In one model, focus is on processes reflecting functions the patient has acquired (or not). In the other model, focus is on available representations. In the latter theory, one goes into the psychic material (the representations), in process or function theory, again, one concentrates on the use of the material. From these two perspectives, the author looks into masochism and the negative therapeutic reaction. In both models masochism seems to reflect a felt impossibility to accept vulnerability. The vulnerability, however, relates (in respective theory) to different realities. Three cases are used as illustrations.

The limits of interpretation. A reading of Bion’s “On Arrogance”

ABSTRACT When re-read today, “On arrogance”, a very brief paper Bion wrote in 1958, reveals its extraordinary topicality. We can think of it both as a commentary on Sophocles’ Oedipus Rex and as an essay on the “disease” of psychoanalysis. In both cases, lying at its centre is the triad of curiosity–stupidity–arrogance that drives us to know the truth “at any cost”. In this paper Bion redefines the crime of Oedipus (and therefore of psychoanalysis) around epistemic instinct and no longer around sexuality; he unveils the objectifying attitude of the analyst he revolutionizes the understanding of negative therapeutic reactions. The analyst’s “psychosis” (or that of psychoanalysis) finds expression in the phenomena of wanting to become a psychoanalyst, of aspiring to be “scientific” (as opposed to gaining a hermeneutical understanding), of wanting to tell the patient what he believes to be the truth, and finally of looking “down upon” his patients and colleagues. Anticipating the themes of Transformations and A Memory of the Future, “On arrogance” lays the groundwork for a cogent criticism of the ideology of psychoanalysis and an effective ethical re-foundation of the discipline.

Inconsolable Infantile States and the Challenges of Meeting Them

Occasionally a patient comes along who is so frozen in an infantile state of disorganized attachment that the patient cannot take what the therapist is offering yet cannot leave the therapist either. Instead the two remain stuck in an unholy scenario of protracted destructive enactments, chronic mis-attunement, and rigid indigestible projective identifications. These seemingly impossible therapeutic encounters can include psychotic transferences, negative therapeutic reactions, or impasses. This article examines two such cases in detail and explores possible ways of understanding what failed in each of them and the impact of this on the therapist.

Love Pathology in Narcissistic Patients Can Be Treated Effectively

Love Pathology in Narcissistic Patients Can Be Treated Effectively

‘Am I a Ceadas child?’: exploring the nature and experience of shame in the psychotherapy of an adolescent boy

ABSTRACTAlthough shame is a central affect running through all phases of psychosexual and social development, it is usually masked by guilt and therefore it is not readily recognised, explored, and understood within the therapeutic situation. Moreover, there is a tendency to treat all shame manifestations as if they operate at the same level. The author proposes the need to distinguish between two qualitatively discrete manifestations of shame states which, albeit intertwined, operate at different levels and require different understanding and technique: a primary, unconscious kind based on psychobiological survival and triggered by a condition of psychic and physical danger, and a secondary, social shame, mainly conscious, based heavily on vision and evoked in social situations. The natural, primary form of shame becomes pathological after catastrophic chronic exposure of the primitive ego to unthinkable anxieties. Such premature rupture of primary skin containment may result in omnipotence-based pathological organisations impeding or precluding acceptance of guilt and need for reparation. Pathological primary shame predisposes the individual to states of pathological secondary shame. When initial traumatic conditions are re-activated and re-experienced in therapy, they may trigger re-enactments and, possibly, a negative therapeutic reaction. Recognising variations and mixed states of primary and secondary shame states, especially when shame is compounded with guilt, can provide guidance in the assessment of the fragility of the ego, and therefore inform our technique and the therapeutic process. This theoretical position is discussed with the help of clinical material from a twice-weekly psychotherapy of a 16-year-old boy imbued with shame compounded with guilt, related to transgenerational objectification and dehumanising experiences.

Early therapeutic process related to dropout in mentalization-based treatment with dual diagnosis patients.

Negative therapeutic reaction was first described by Freud, and theories about this phenomenon have focused on various patient factors, for example, unconscious guilt, narcissistic pride, and overw ...

Issues in consultation for treatments with distressed activated abuser/protector self-states in dissociative identity disorder

ABSTRACTThe identified “problem self-state” in a dissociative disorder consultation is like the identified patient in a family therapy; the one who is identified may have an assigned role to be blamed which serves the function of deflecting the activities of painful self-states in other family members. In consultation, the “family” includes the therapist in addition to the patient. When the state identified as a problem self-state is an abuser/protector self-state, complications often involve the profound nature of transference–countertransference enactments between patient and therapist, the delusion of separateness, chronic and acute threats of suicide, negative therapeutic reactions, and the evocation of intense negativity. They also involve affect phobia in both patient and therapist, and the emergence of intense shame in the clinical dyad amongst additional potential burdens in these complicated treatments. The task of the consultant is to protect both patient and therapist from an untoward outcome while relieving the painful burdens entailed by the treatment. The typical core dynamic of the abuser/protector state is as a repository for shame/humiliation welded to anger/rage. This dynamic, and others, must be understood in order to resolve these impasses and create useful movement toward growth in both patient and therapist.

Sur le chemin du maléfique... Le moi inconscient

Le maléfique est pluriel et le moi inconscient polysémique. La figure du double de Dostoïevski, une réaction thérapeutique négative, une réflexion sur le négatif et l’inhumain font apparaître diverses facettes du moi inconscient mises au service du maléfique : surmoi, cli-vage, résistance, élaboration négative. Par ailleurs, certains artistes contribuent au travail de culture et à l’élargissement de la conscience de soi publique.

Clinical applications of Matte Blanco's thinking

Translations of summaryIgnacio Matte Blanco (1908–1995) left very few specific indications about the applications of his theoretical notions to his interpretative style. The author shows how he uses Matte Blanco to formulate some of his own interpretations. The first part of the paper uses clinical vignettes to illustrate some of Matte‐Blanco's concepts. Their theoretical vocabulary is thus made explicit. Then two psychoanalytic sessions are discussed at greater length, together with one from a therapy, so that the use of Matte‐Blanco's notions can be seen clearly, allowing for a fresh perspective on areas of psychoanalytic theory, particularly dreams, psychopathology viewed according to the proportions of asymmetrical and symmetrical functioning in the patient's bi‐logical mental system, the multidimensionality of the unconscious, the structural unconscious, the emotion‐thought relationship, projective identification, resistance, and negative therapeutic reaction. The practical consequences of all this are elaborated, particularly the ensuing possibility of ‘thinking with the patient' in the session. This enables the patient to introject a form of mental functioning in which the asymmetrical mode is not invaded by the symmetric mode (a parallel can be seen here with the Bionian concept of dialogue between the psychotic and non‐psychotic parts of the mind).

The Ontogeny, Cultural Context, and Treatment of Disgust

This article links Lawrence Josephs’ valuable thoughts on The Treatment of Oedipal Disgust: When one Person’s Sexual Delight is Another’s Disgust to Freud’s ideas concerning negation and the origins of judgment. In keeping with a comparative-integrative spirit, the author references relevant concepts from diverse contributors, from classical to contemporary. Jacobson and Christensen’s acceptance approach that Josephs found useful in a couple’s treatment where disgust was a major issue is discussed in terms of how it might be seen from a variety of psychoanalytic perspectives, with particular reference to the founder of our discipline. The fundamental importance of boundaries is emphasized throughout, with disgust providing an excellent illustration of their significance to the establishment and protection of the self. The evolution of revulsion in individual and cultural development is described. Case material is introduced to illustrate potent links between oral disgust stimulated by relational stress and trauma in the first year of life and subsequent disgust (e.g., oedipal). Revulsion’s role in negative therapeutic reactions is examined.

Ces malades qui ne veulent pas guérir. À propos de la réaction thérapeutique négative en psychanalyse

In an article of 1923, Freud emphasizes the strange behaviour of some patients, who refuse to be healed seeming to prefer keeping their sickness than recover their former health. Freud called that bizarre occurrence, “the negative therapeutic reaction”. He radically differentiates it from the various forms of “resistance”, which, after being analysed, leads to a curative process. Freud finds three main reasons to “that negative therapeutic reaction”: “Moral masochism”, which is a mixture of sexuality and suffering, “compulsive repetition”, which is the tendency for neurotic patients to repeat their symptoms indefinitely, “death compulsion”, which is the wrong side of eroticism. Besides that, such patients may be found in other fields than psychoanalysis: In the medical field, for example, where some patients prefer remaining sick, because their disease gives a meaning to their lives, in psychiatry, where certain persons avoid being confronted to the reality and even in literature, where some characters prefer being jailed rather to escape to the punishment. In Dostoïevski's novel, Crime and punishment, Raskolnikov gives oneself up, because he no longer supports not being punished for his crime, even though the police had not caught him.