Ego Boundary Deficits and the Negative Therapeutic Inter-Action: A Tale of a Whale, a Whale of a Tale

Defined variously and unsatisfactorily as a worsening of the patient's condition following a correct interpretation, the negative therapeutic reaction is typically blamed on the patient: "the operation was a success but the patient died." For most neurotic patients unconscious guilt objects to progress and activates the need to suffer. For most character-disturbed patients envy cannot bear the analyst's cleverness. However, patients with ego boundary problems-even sectors of psychosis-may require a different explanatory mechanism, where a correct interpretation may be experienced as a penetration and an engulfment, threatening the intactness of the self. A short-term, time-limited, psychoanalytic psychotherapy that went off the rails following a correct but ill-timed interpretation is presented as an opportunity to amend analytic theory, here favoring the interactional over the intrapsychic. Herman Melville helps tell the tale.