Discussion

I WOULD LIKE TO REVIEW first some of Dr. Grotstein's basic formulations and definitions and then relate them to several implications of the negative therapeutic reaction from the perspective of interpersonal and developmental theory.

The model of the mind is intrapsychic and endopsychic, and it is pre-interpersonal, although implicit is a receptiveness to human relatedness in an external reality which is interpersonal. Early infantile fantasies, the prototypes of yet undeveloped organizing principles, are introjected and become internal objects. Some of these fantasies, particularly those attached to experiences of greed, envy, and the belief that undifferentiated objects upon which the infant is quite dependent can be destroyed and recreated, are not relinquished. These fantasies constitute the principle ingredients of a bad-self conception. For reasons that are intrapsychic, and not interpersonal, the infant does not emerge from a paranoid-schizoid position onto the threshold of the depressive position, and subsequently experiences an almost chronic paranoid anxiety with beliefs of being possessed, controlled, and in a pact with the Devil. Most threatening to these people is the emergence of consciousness insofar as it brings about the possibility of acknowledging dependency and the relinquishing of omnipotent fantasies about creation and destruction. One can speculate that idealizations are tenaciously retained because they cannot contain the pain of disillusionment while separating and individuating from the object upon whom they depend. The internal objects, the unconscious fantasies, seemingly made a pact in order to obtain a moment of nonexistence, of obliviousness to dependency and the pain of human relatedness, and the person continues to live in a morbidly psychotic fantasy world in which he continues to 'create' gods and devils of his underworld to explain his bitter existence.

What emerges from this mental process is a person who spends much time li