Basic psychoanalytic concepts. VII. The negative therapeutic reaction

Paradox as symptom in the borderline patient's struggle for self-differentiation

TOPIC

Paradox as symptom in patients diagnosed with borderline personality disorder (BPD).

PURPOSE

To conceptualize the nature of difficulties arising in psychotherapy with patients diagnosed with BPD.

SOURCES

Review of the literature and clinical data from the author's work.

CONCLUSIONS

The borderline dilemma is inherently paradoxical and, in some ways, reflects the human condition. Psychoanalytic concepts can further our understanding of the therapeutic difficulties encountered in the struggle to make sense of life's inherent dualities. The borderline patient is acutely sensitive to these dualities, which the therapist must tolerate and understand. Often, a negative therapeutic reaction may impede progress.

Unresolved grief presenting with features of a negative therapeutic reaction

A 44-year-old depressed widow in psychodynamic psychotherapy suffered repeated relapses of symptoms following improvement. This was seen as a negative therapeutic reaction.

The negative therapeutic reaction: the uses of negation

The negative therapeutic reaction can be used as a lens illuminating issues of psychoanalytic technique and therapeutic change. Its paradoxical development is examined within the context of current controversies involving the concepts of borderline personality organization and empathy. Negative therapeutic reactions are seen to reflect, among other failings, the failure of theory to "contain" dialectical tensions between self and other, subject and object, health and illness. Greater theoretical sophistication can point the way toward vigorous and more hopeful therapeutic engagement of these challenging reactions.

Can the primary care physician be better trained in the psychosocial dimensions of patient care?

Our modern health care system has tended to emphasize technological competence and subspecialization. The primary care internist/family physician has recieved limited training in the behavioral aspects of medicine and, resultingly, is less able to obtain and apply the knowledge and skills necessary to effectively help the patient handle those mutually interacting somatic, phychological and sociological dimensions of his illness. Through the use of selected case histories the author has attempted to illustrate how utilization of these skills, obtained during a supervised fellowship program, leads to psychological growth and better understanding of his role as physician. Ultimately this effects clinical improvement in his medical patients with longstanding difficulties.

Masochism: a clinical and theoretical overview

This paper will review some of the theoretical and clinical features of masochism from an eclectic point of view. The topic of masochism has been taken up by authors of many perspectives because it addresses one of the anomalous, absurd, difficult-to-explain aspects of behavior for which no psychological system has an easy answer. Therefore, a wide-ranging literature on the topic of masochism is available. However, few previous reviewers have attempted to draw from a variety of disciplines and theoretical frameworks. In this review the historical development of the term and some of the psychoanalytic conceptualizations will be presented first. Since previous reviews of masochism from a strictly psychoanalytic perspective are adequate (Brenner, 1959; Eisenbud, 1967; Fenichel, 1945; Loewenstein, 1957; Panken, 1967), our discussions of masochism will be developed employing more extensively the interpersonal, social, learning theory, and biological perspectives.