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A sense of loss and transient depression is often seen in that phase of psychotherapy when the patient has relinquished a neurotic yet still gratifying activity. Despite the patient's realization that the specific neurotic behavior was ultimately self-defeating or counterproductive, he misses the immediate pleasure or momentary relief from discomfort that the activity had allowed him. Fortunately, in time, healthier substitutes are usually found in the curative process. Nevertheless, neurotic activity is not easily relinquished, and entrenched modes of behavior constitute formidable resistances since these older patterns often involve a needed self-concept as well as a guide to dealing with others in a manner which, if not completely satisfying, is at least secure.
Such resistances to change are grossly magnified in the psychotherapy of the depressed individual since, in these cases, the giving up of neurotic maneuvers threatens the very source of the patient's sense of self-worth and possibility of gratification. More than in any other neurotic individual, the self-esteem of the depressive is intimately interwoven with specific distortions regarding his own conduct and in specific types of interrelations with others. Therefore, the depressive will cling tenaciously to reliable, proven modes of being despite conscious knowledge of the ultimate disappointment inherent in pursuing his pathological life style.
In addition to the increased force of resistance, the depressive presents specific mechanisms to avoid therapeutic change. It is with these particular resistances, found most prominently in depression, as well as with the therapeutic resolution of these obstacles that this paper is mainly concerned. Depression is to be considered as more than simply a symptom manifestation, but as representing specific intrapsychic organization and characteristic interpersonal relationships that may cut across diagnostic entities. This type of personality disturbance has been descr