where such promptings originated and how they are now operating will have to be

given the patient.

This explanation may at first fall on deaf ears, but as the therapist consistently
demonstrates their existence
from the patient’s reactions and patterns, the patient may eventually grasp their
significance. The impulse
to make oneself dependent and the destructiveness of this impulse, the connection
of suffering and
symptoms with a pervasive need for punishment, the masochistic desire to appease a
sadistic conscience
that derives from a bad parental introject, the operation of a devalued self-image,
with the subversive gains
that accrue from victimizing oneself, must be repeated at every opportunity,
confronting the patient with
questions as to why he or she continues to sponsor such activities. When we
consider the many patient,
therapist, environmental, transferential and resistance variables that have been
described above, and that
are parcels of all therapies, irrespective of type, it becomes apparent that
empirical research into their