One kind of negative therapeutic reaction

A case is reported in which a young man for several years experienced his analysis primarily as a source of pain. Each new insight he achieved was an occasion for increased distress rather than liberation. Considerable analytic work elucidating motives for this negative therapeutic reaction produced no change in it. Eventually, it could be determined that the patient's need to suffer within the treatment relationship served a specific form of denial in fantasy that has not, to the author's knowledge, been described elsewhere. The importance of covert libidinal, object-preservative aims in such frustrating and destructive impasses is discussed, as well as the role of countertransference enactment.