[The treatment barrier as a severity factor in depression]

The term treatment barrier describes obstacles to the treatment process. These obstacles affect the patient: there may be melancholic crypts in encysted trauma ; there may be a link rooted to a dead person in the form of attachment to the internal object: there are different forms of moral masochism. Barriers relating to the therapist may be seen in therapists who take a dogmatic position: the therapist must realise these counter-attitudes and their impatience or irritation movements. In the patient doctor-interaction, understanding previous treatment failures and the relationship style developed with other therapists plays an important role. The concept of the negative therapeutic reaction in which any clinical progress returns to aggravation must also be investigated.