Death anxiety: A hidden factor in countertransference hate

We suggest that when diffucult patients attack our grandiosity and sense of self, we are vulnerable to countertransference anxieties similar, if not identical, to the kind existentialists refer to as "ontological". The latter refers specifically to a threat to our psychological equilibrium and is meant to describe the utter ambivalence we associate with death anxiety. In this paper, we are proposing the presence, in certain therapeutic situations, of just such counter-transference reactions to so-called "aversive" patients. We believe that terms like "aversive", "obnoxious", or "impossible" are professional euphemisms used to mask the degree of anxiety we often feel, and that there is a collusion present both within and without our profession, especially in psychotherapeutic and psychoanalytic centers, which keeps us from exploring death-related issues within ourselves as well as in our patients.