PubMed · 9395997
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V Bloom. 1997. Interminable analysis?. https://doi.org/10.1521/jaap.1.1997.25.2.313
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Part II of this paper presents an outline for the assessment of suitability for psychotherapy based on the patient's ability to participate in the basic tasks of the therapeutic process and provides a coherent approach to this complex and difficult task. Several factors, such as therapeutic interaction and relational history, influencing the patient's ability to form a productive working relationship can be assessed clinically and are well supported by research. Others, such as motivation and supportive life circumstances, although less supported by research, still appear to be clinically important. Influences on the ability to create a model of the patient's psychopathology, such as introspection, circumscribed focus, and some aspects of the model itself, are supported by limited research but important for some therapies. There is little research on trial interventions, though these remain a crucial assessment dimension for short-term therapies, particularly. Countertransference, although traditionally not viewed as part of assessment, is actually an important tool that has been validated by research.
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Destructive narcissism, characterized by a perverse alliance between the self and an omnipotent bad internal object, constitutes a serious obstacle to psychoanalytic psychotherapy. This paper draws together various object relations theories of destructive narcissism, and presents a case study of a failed psychotherapy to illustrate the transference--counter-transference constellations and their associated enactments in treatment of this disturbance.