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Michigan Psychoanalytic Institute & Society

Understanding the Negative Therapeutic Reaction in the Contemporary Analytic Treatment of Severe Depression (Seminar for Advanced Clinicians)

Patricia L. Gibbs, Ph.D.
Lecturer, Michigan Psychoanalytic Institute

Five Mondays / September 12, 19, 26, October 3, 10, 2011
7:00-8:30 p.m. Fee: $175 7.5 CE Credit Hours
Michigan Psychoanalytic Institute, 32841 Middlebelt Road, Farmington Hills

This seminar is designed for psychotherapists who are experienced clinicians in their fields, and who, preferably, have some personal analysis or intensive psychotherapy. It is hoped that class discussions will be enriched by the intellectually stimulating combination of the experienced instructor along with an experienced group of class participants.


Why do some patients cling to stagnation and self-destruction just as analytic treatment begins to yield signs of progress and health?

Joan Riviere's classic paper: "A Contribution to the Analysis of the Negative Therapeutic Reaction" will provide the starting point for this seminar. Riviere reveals why some patients unconsciously equate the development of a genuine transference with death and madness. Melanie Klein's earlier work on manic-depression and the depressive position will be also be read to review the patient's use of manic defenses in the negative therapeutic reaction. Riviere states that the negative therapeutic reaction involves patients unconsciously feeling that they must heal and "save" all their broken objects before they can be helped by the transference necessitated in analytic treatment. Riviere's view of the negative therapeutic reaction will be illustrated by contemporary published articles focused on treating such patients successfully.

Seminar participants will be able to:
• Identify the central features of Rivere's conceptualization of the negative therapeutic reaction.
• After understanding Riviere's conclusion that the negative therapeutic reaction prevents the establishment of a genuinely mutative transference, evaluate her conclusion based on clinical readings in class and one's own clinical work.
• Identify the unconscious object relations and defensive challenges associated with Klein's depressive position, and apply these Kleinian concepts to Riviere's hypothesis that the negative therapeutic reaction involves patients unconsciously feeling they must heal and "save" all their broken objects.
• Read and evaluate contemporary clinical papers illustrating analytic work with patients involved in a negative therapeutic reaction.