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Valenstein, A.F. (1973). On Attachment to Painful Feelings and the Negative Therapeutic Reaction. Psychoanal. St. Child, 28:365-392.
(1973). Psychoanalytic Study of the Child, 28:365-392
On Attachment to Painful Feelings and the Negative Therapeutic Reaction
Arthur F. Valenstein, M.D.
This patient, as well as others of a similar type whom I have treated, is illustrative of those individuals whose attachment to pain signifies an original attachment to painfully perceived objects and inconstant objects at that. It appears that in the development of such individuals, instead of the early pleasurable object experiences being consolidated into love and a sense of trust, the opposite occurs. Early affects are predominantly painful and as such recur consistently, crystallizing in the direction of attachment to pain and distrust of objects. The painful affects are then held to, both as a defense and as an instinctually charged concomitant of object experience.
On this fundamentally pregenital base may be grafted more sophisticated object-oriented experience deriving from beyond the oral level; that is to say, from the anal and phallic levels. Thus, object experience moves progressively not only from "who eats whom," but also to "who controls whom," "who shreds whom," "who dumps on whom," "who pierces whom," "who shafts whom," and "who screws whom," whether heterosexually or homosexually. The amalgam of all three levels condensed as they are into specific current experience adds up to the pain and degradation of the transference neurosis or transferencepsychosis.
In this context then, the obsessive isolation and mental discord and conflictual turbulence serve to set the self off from the anaclitically needed object and represent integrity and strength, especially in the light of the essential passivity which so often coexists. Within it all a paranoid outlook declares the persecutory nature of the object tie, while it also establishes the defense. Altogether this constitutes a formidable and miserable situation for such neurotic patients, who, as I have pointed out, are also more than neurotic.
Furthermore, as I see it, the nuclear determinant of the "negative therapeutic reaction" is located developmentally much earlier than definitive superego formation. It originates in the very young child's failure to establish constancy in relation to a positively valued object, without which increments of pleasurable affect are neither consolidated out of object experience, nor reliably anticipated thereafter. In fact, the opposite prevails, namely, the development of an affinity for painful affect, the painful affect states connoting the inconsistently pleasure-unpleasure-yielding object.
The case report also exemplifies the technical difficulties encountered in the treatment of such conditions, and the limitations of psychoanalysis as such. Since the major disturbance in self and object relations constitutes an early developmental defect in ego structure, psychoanalytic interpretations, which after all cannot really reach the preverbal-earliest verbal level of development, are nonmutative and relatively ineffective. Such disturbances are even strongly resistant to interpersonal, experiential, nonverbal therapeutic measures. However, if the therapist persists in working toward the possibility that the patient can and will progressively and adaptively use both what is recapitulated and articulately remembered, and what is behaviorally recapitulated and reconstructed from the time when it cannot be literally remembered, then the outcome might be the achievement of a significant measure of corrective experiential reeducation supplemented by cognitive understanding. And through it the patient may gain increasing leverage on the way in which he has habitually abused relationships to realize an Erlebnis (i.e., an inner emotional experience) which was paradoxically fulfilling even though not pleasurably or harmoniously satisfying.
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