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The central issue raised in this paper concerns how the therapeutic action of a treatment dominated by negative transference can be understood. As a preamble
to this question, Epstein first compares the contributions of Fromm and Sullivan in their approaches to working with patients. He notes that Fromm did not pay much attention to the tact and timing of his interpretations, while Sullivan "was keenly aware that the analyst, in order to be therapeutic, would have to enable the patient at all times to preserve his nucleus of self in the therapeutic situation." Participant observation is then employed and helps the therapist to "meet our patient's therapeutic needs." Winnicott's ideas about primary and secondary environmental (parental) failure are briefly cited, eventuating in the statement that the main task of therapy is to learn how to function with the patient to correct secondary environmental failure or to prevent it from recurring. Extensive clinical material is presented from the case of a perfectionistic, pseudomasochistic patient seen twice weekly in psychotherapy. This patient wished the treatment situation to become a place in which to incapacitate the therapist and to attempt to cure himself while complaining that he could get no help. Under this onslaught the therapist chose not to "defend" himself by explanation, apology, or retaliatory "therapeutic measures." While claiming that emotional neutrality is not possible in treating patients with primitive mental states (which is how he viewed this patient), Epstein does establish three major tenets for the handling of the therapist's own feelings: (1) he should be aware of all his feelings; (2) he should try to determine to what extent they are appropriate; and (3) he should reduce the intensity of these feeling tones to the extent that appears to be therapeutically warranted. By maintaining a quiet, relaxed, and accepting attitude, the therapist enables the patient to increase his tolerance o