I Hear you Knocking, but you can't come in: Two Reasons to Refuse the Good Object

There are patients I have treated with the analytic method who, at some point in the process, refuse to explore, reflect, change, or even consider new ways of relating to themselves or others. Sooner or later, change becomes the enemy. Taking in a new, more successful or hopeful object is avoided and the view of the self as bad is clung to. Change, growth, and the creation of a more friendly or enjoyable internal world is fought off. Of course, this manifests in external difficulties and dysfunctional relationships. In the transference, the analytic relationship begins to feel like a debate, a duel, or a dead end. At first, this antigrowth attitude may look like the patient is simply feeling unable or too frightened to change. However, this attitude in fact involves a more active refusal against life and progress. Indeed, the successful analysis of these difficult patients seems to lie in the ongoing interpretation of their active participation in this psychic standoff.

In the psychoanalytic literature, these types of patients have been studied from several vantage points. Freud (1918) felt their refusal was related to rebellion, and later on he conceptualized it as part of the death instinct (1923). Karen Horney (1936) emphasized issues of competition, fear of success, and progress leading to abandonment. Melanie Klein (1957) thought envy was involved. Others, such as Olinick (1964), Valenstein (1973), Asch (1976), and Loewald (1972) have attributed an important role to masochism. Rosenfeld (1971, 1975) wrote about narcissism playing an important role, along with envy. Kernberg (1984) investigated the destructive feelings that were directed at the analyst.

Many of these authors have noted how their patients tended