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.

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