A Primer Of Handling The Negative Therapeutic Reaction

In a negative therapeutic reaction the progress of treatment triggers a particular destructive dynamic in the patient. Initially, therapists considered it to be a result of the patient's pathology, but contemporary clinicians recognize that the therapist may significantly contribute to this process. Object relations clinicians see the individual as a social being that develops in relation to others whom the individual internalizes as good and bad objects. Jeffrey Seinfeld explores how an internal sabotaging self is identified with a rejecting object. This self is a reservoir of memories of how original caregivers rejected the child's needs, and the patient now expects the world to reject and disappoint her. If patients experience the therapist as a kind or caring person, they may feel that they are being lured into dependency and subsequent disappointment. Paradoxically, if patients feel attached to the therapist, this same attachment is experienced as a threatening dependency that must be destroyed. A relationship that could eventually strengthen the personality is rejected, and instead a negative reaction to the therapist and the therapeutic process is established. Jeffrey Seinfeld shows that in order for patients to heal, they must separate from the internal bad objects.This is often done with aggression against the therapist, who must be able to withstand the intense hostility, rage, and abuse of the patient. Only by surviving this aggression in the negative therapeutic reaction can the therapist allow the patient to integrate good and bad part objects in the transference. The therapist can eventually serve as a bridge in the integration of the divided good and bad selves and objects. Through case histories Seinfeld illustrates his way of entering into the patient's internal world. By helping patients understand the transference of their internal objects, they begin to understand their own experience of self and others, which leads to character change.

This is a fully-updated, comprehensive guide for trainees preparing for the MRCPsych CASC exam (Clinical Assessment of Skills and Competencies). Success in the CASC is the final step in being awarded the MRCPsych qualification, which signifies the physician has fulfilled the necessary training requirements and has passed the membership exams conducted by the Royal College of Psychiatrists. The book is presented in a clear layout and covers the full range of psychiatry subspecialties likely to be encountered on exam day.

Traditionally, trauma has been defined as negatively impacting external events, with resulting damage. This book puts forth an entirely different thesis: trauma is universal, occurring under even the best of circumstances and unavoidably sculpting the very building blocks of character structure. In Traumatic Experiences of Normal Development, Dr. Carl Shubs depathologizes the experience of trauma by presenting a listening perspective which helps recognize the presence and effects of traumatic experiences of normal development (TEND) by using a reconstruction of object relations theory. This outlook redefines trauma as the breach in intrapsychic organization of Self, Affect, and Other (SAO), the three components of object relations units, which combine to form intricate and changeable constellations that are no less than the total experience of living in any given moment. Bridging the gap between the trauma and analytic communities, as well as integrating intrapsychic and relational frameworks, the SAO/ TEND perspective provides a trauma-based band of attunement for attending to all relational encounters including those occurring in therapy. Though targeted to mental health professionals, this book will help enable therapists and sophisticated lay readers alike to recognize the impact of relational encounters, providing new tools to understand the traumas we have experienced and to minimize the hold they have on us.

Winner of the International Society for the Study of Trauma and Dissociation's (ISSTD) Pierre Janet Writing Award, 2015. What really happens in dissociation. Dissociative processes have long burdened trauma survivors with the dilemma of longing to feel “real” at the same time as they desperately want to avoid the pain that comes with that healing—a dilemma that often presents particularly acute difficulties for healing professionals. Recent clinical and neurobiological research sheds some light into the dark corners of a mind undergoing persistent dissociation, but its integration into the practice of talking therapy has never, until now, been fully realized. Intensive Psychotherapy for Persistent Dissociative Processes brings readers into the consultation room, and into the minds of both patient and therapist, like no other work on the treatment of trauma and dissociation. Richard A. Chefetz marries neuroscientific sophistication with a wealth of extended case histories, following patients over several years and offering several verbatim session transcripts. His unpacking of the emotionally impactful experience of psychodynamic talking therapy is masterfully written, clearly accessible, and singularly thorough. From neurobiological foundations he builds a working understanding of dissociation and its clinical manifestations. Drawing on theories of self-states and their involvement in dissociative experiences, he demonstrates how to identify persistent dissociation and its related psychodynamic processes, including repetition compulsion and enactment. He then guides readers through the beginning stages of a treatment, with particular attention to the psychodynamics of emotion in both patient and therapist. The second half of the book immerses readers in emotionally challenging clinical processes, offering insight into the neurobiology of fear and depersonalization, as well as case examples detailing struggles with histories of incest, sexual addiction, severe negativity, negative therapeutic reactions, enactment, and object-coercive doubting. The narrative style of Chefetz’s casework is nearly novelistic, bringing to life the clinical setting and the struggles in both patient and therapist. The only mystery in this clinical exposition, as it explores several cases over a number of years, is what will happen next. In the depth of his examples and in continual, self-reflexive analysis of flaws in past treatments, Chefetz is both a generous guide and an expert storyteller. Intensive Psychotherapy for Persistent Dissociative Processes is unique in its ability to place readers in the consultation room of psychodynamic therapy. With an evidence-focused approach based in neurobiology and a bold clinical scope, it will be indispensible to new and experienced therapists alike as they grapple with the most intractable clinical obstacles.

Q & A format/discusses the 'as-if' personality/malignant narcissism/projective identification/cumulative trauma/etc.

Treating borderline patients is one of the most challenging areas in psychotherapy because of the patient's extreme emotional expressions, the strain it places on the therapist, and the danger of the patient acting out and harming himself or the therapeutic relationship. Many clinicians consider this patient population difficult, if not impossible, to treat. However, in recent years dedicated experts have focused their clinical and research efforts on the borderline patient and have produced treatments that increase our success in working with borderline patients. Transference-Focused Therapy (TFP) is psychodynamic treatment designed especially for borderline patients. This book provides a concise and comprehensive introduction to TFP that will be useful both to experienced clinicians and also to students of psychotherapy. TFP has its roots in object relations and it emphasizes that the transference is the key to understanding and producing change. The patient's internal world of object representations unfolds and is lived in the transference with the therapist. The therapist listens for and makes use of the relationship that is revealed through words, silence, or, as often occurs in the case of individuals with some borderline personality disorder, acting out in subtle or not-so-subtle ways. This primer offers clinicians a way to understand and then use the transference and countertransference for change in the patient.