How Can We Help Masochistic Inpatients Not to Sabotage Psychiatric Treatment Before It Even Starts?Ness, David E. MD; Groat, Michael PhDJournal of Psychiatric Practice®: March 2011 - Volume 17 - Issue 2 - p 124–128 doi: 10.1097/01.pra.0000396064.97645.b8 Columns Abstract Author Information Upon admission for psychiatric hospitalization, some patients present the treating staff with alienating or antagonistic behaviors that threaten to sabotage the treatment before it even begins. These may include passive-aggressive behavior, withdrawal and isolation, contention against unit rules, protestations about the futility of treatment efforts, or oppositional behavior. Diagnostically, many such patients fall into the category of narcissistic-masochistic personality disorder, and their alienating behavior contrasts with their underlying sense of neediness. An important element in treating these patients, in addition to processing countertransferences, is to reframe the behaviors early on as being a self-defeating defense. Reframing in this way can help to defuse the emotional intensity around alienating or antagonistic behavior, and to focus the treatment upon the issue that is most damaging to the patient, namely the tendency toward self-defeat. (Journal of Psychiatric Practice. 2011;17:124–128). The Menninger Clinic and Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX © 2011 Lippincott Williams & Wilkins, Inc.