Carsky M
Int J Psychoanal Psychother. 1985;11:435-58.
Selected literature is reviewed, and clinical material is presented to discuss the phenomena of negative therapeutic reaction, interaction, and impasses in psychotherapy. It is suggested that certain seriously ill patients, in whose therapy an impasse develops, suffer from both the primitive superego pathology or other intrapsychic conflicts that have been described in the literature on negative therapeutic reaction and from a tendency to act so as to recreate these struggles in the external field, often in the form of negative therapeutic interactions. In some such cases, outside assistance for the therapist is necessary in order for the treatment to move beyond a stalemate. In seriously disturbed, hospitalized patients, interventions by the entire treatment team, not simply the therapist alone or the therapist and supervisor, are sometimes required to enable the treatment to proceed. This may be due to the primitive and extremely violent nature of such patients' conflicts, which may strain the limits of a dyadic relationship.
回顾了相关文献，并展示了临床资料，以讨论心理治疗中的消极治疗反应、互动和僵局现象。研究表明，某些病情严重的患者在治疗中陷入僵局，他们既患有原始超我病理学或其他在消极治疗反应文献中所描述的心理内部冲突，又有一种倾向，即通过在外部领域重现这些冲突来行事，通常表现为消极治疗互动的形式。在一些此类案例中，为了使治疗突破僵局，治疗师需要外部协助。对于病情严重且情绪紊乱的住院患者，有时需要整个治疗团队进行干预，而不仅仅是治疗师本人或治疗师与督导，才能使治疗继续进行。这可能是由于此类患者冲突的原始性和极端暴力性，这可能会使二元关系的界限变得紧张。
