(Final version accepted 17 May 2012)

The author discusses the clinical consequences of the failure to structure ambivalence in terms of a conflict, and explains the paradoxical patterns that are then set up, particularly in the various kinds of negative therapeutic reaction. He then explores four instances of primary traumatism that contribute to the failure of the initial binding of the drives and to the individual's subsequent inability to set up a conflict of ambivalence that could curb the clinical manifestations of destructiveness.