BALANCED ON THE HORNS OF A DILEMMA: OBSERVATIONS ON WORK WITH CHRONIC DEPRESSION

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Abstract

ABSTRACT

There are patients who present in treatment with depression that is chronic and unmoving over many years. This article proposes that this type of patient is attached to and defensively uses the symptom in a way that may be described as narcissistic. The amelioration of the symptom is experienced as a threatened loss that must be defended against, despite the patient's unbearable suffering. This dynamic is illustrated as it appeared in three cases treated at a community-based mental health clinic. In each, modification of the symptom was aggressively resisted, creating an insurmountable impasse in the guise of seeking treatment.

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