Patients' theories of pathogenesis

Certain patients embark upon analytic treatment with well thought out theories regarding the origins of their difficulties. Although there is always some validity to such theories, they turn out to be incomplete and serve to screen painful recollections and pathogenic unconscious wishes and the defenses against them. Two cases are presented to illustrate how analysands use these theories in the service of resistance. Painstaking analytic work is required to elucidate their defensive nature. The narcissistic importance of such theories in maintaining a coherent narrative about one's life in the face of uncertainty is discussed, and technical and countertransference considerations are explored.