The Negative Therapeutic Reaction in Severe Characterological Depression

Despite the efficacy of pharmacological agents in treating successfully a variety of depressive conditions, there remain a number of individuals who require, in addition, intensive psychotherapy to function adequately and to become free of troublesome symptoms or self-defeating behaviors. Such individuals present with chronic, often life-long dysphoria, which, on occasion, escalates into a severe depressive episode. These individuals do not exhibit a complete recovery between episodes, but constantly have to fend off feelings of futility and hopelessness. The onset of the illness is usually insidious and in early adult life or even adolescence. There is also the creation of patterns of relationships characterized by the over valuation of a significant other and the masochistic need for affirmation of worth from that other. Such individuals also present with a pervasive anhedonia and guilt over possible pleasurable activities. Some may be lacking in social skills, whereas others may go through the motions of requisite social behavior without deriving much meaning or gratification from these actions. Not infrequently, such individuals lack spontaneity and dread the opportunity to “let loose” or just have fun. Most personal gratifications, such as stylish clothes, or material possessions, must be justified to serve some utilitarian purpose. Finally, there is a continual sense of personal unworthiness, or at times, inherent evil and selfishness despite higher moral or, at least, conventional patterns of existence. They also reveal marked distortions as to their own worth, the judgment of others, and the consequences of fulfilling desires or intentions. Such individuals may be categorized as suffering from characterological depressions because their very