부적치료반응: 오래된 역설, 새로운 희망
Negative Therapeutic Reaction: The Old Paradox, New Hope
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Why do some clients react adversely to the progress of therapy and get 'worse' instead of 'better'? This puzzling paradox is called‘negative therapeutic reaction', the phenomenon of improvement followed by deterioration of a client's psychological or symptomatic condition, apparently in response to the therapist's interventions. This paper explores the possible unconscious origins of negative therapeutic reaction. Unconscious guilt, envy, pathological narcissism, painful attachment to the bad object, craving for or fear of fusion, masochism, inability to communicate and psychotic retreat are the major origins. Clinical vignettes illustrate the underlying complexities of the possible origins. Since negative therapeutic reaction is as much challenging as perplexing to therapists, therapy oftentimes drops or becomes unterminable. Treatment suggestions from the perspective of classical psychoanalytic approach are focused mainly on the interpretation of the client's unconscious destructive fantasies. Neutrality and patience of the therapist is key to help client reach deeper insight. On the other hand, psychoanalytic approaches that emphasize the inter-subjectivity between the client and therapist focus on the therapeutic relationship. Considering that every failure in the treatment is interactive and can be a reenactment of the unconsciously internalized relationship, therapist should keep on watching his/her counter-transference. Also negative therapeutic reaction can be perceived not as a failure but as a process of the treatment. Furthermore, the recent development in modern psychoanalysis allows us to see negative therapeutic reaction as another chance. The perspective is changing from client's intra-psychological response to inter-subjective one, from the one that destroys therapy to the one that is constructive and needs to be communicated, from the one that can be explained and interpreted by language to the 'unspeakable' one that the therapist should contact and experience in him/her. This new perspective enables the therapist to continue to be in contact with client even in the middle of therapeutic impasse. It also helps the therapist to use negative therapeutic reaction creatively so that it could be a way to communicate and understand client's entangled inner world rather than a therapeutic crisis. Some more ideas on therapeutic implications and faith are discussed drawing mainly on Wilfred Bion's work to deepen the thoughts on this issue.
Abstract
Why do some clients react adversely to the progress of therapy and get 'worse' instead of 'better'? This puzzling paradox is called‘negative therapeutic reaction', the phenomenon of improvement followed by deterioration of a client's psychological or symptomatic condition, apparently in response to the therapist's interventions. This paper explores the possible unconscious origins of negative therapeutic reaction. Unconscious guilt, envy, pathological narcissism, painful attachment to the bad object, craving for or fear of fusion, masochism, inability to communicate and psychotic retreat are the major origins. Clinical vignettes illustrate the underlying complexities of the possible origins. Since negative therapeutic reaction is as much challenging as perplexing to therapists, therapy oftentimes drops or becomes unterminable. Treatment suggestions from the perspective of classical psychoanalytic approach are focused mainly on the interpretation of the client's unconscious destructive fantasies. Neutrality and patience of the therapist is key to help client reach deeper insight. On the other hand, psychoanalytic approaches that emphasize the inter-subjectivity between the client and therapist focus on the therapeutic relationship. Considering that every failure in the treatment is interactive and can be a reenactment of the unconsciously internalized relationship, therapist should keep on watching his/her counter-transference. Also negative therapeutic reaction can be perceived not as a failure but as a process of the treatment. Furthermore, the recent development in modern psychoanalysis allows us to see negative therapeutic reaction as another chance. The perspective is changing from client's intra-psychological response to inter-subjective one, from the one that destroys therapy to the one that is constructive and needs to be communicated, from the one that can be explained and interpreted by language to the 'unspeakable' one that the therapist should contact and experience in him/her. This new perspective enables the therapist to continue to be in contact with client even in the middle of therapeutic impasse. It also helps the therapist to use negative therapeutic reaction creatively so that it could be a way to communicate and understand client's entangled inner world rather than a therapeutic crisis. Some more ideas on therapeutic implications and faith are discussed drawing mainly on Wilfred Bion's work to deepen the thoughts on this issue.
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