This article reports the case of a young man who experienced suicidal impulses in competitive situations involving both relationship and career issues. The clinical data illustrate the concept of "identification with the aggressor" in relation to a father's angry, rivalrous feelings toward his son. The author discusses dynamics operating in families where immature or insecure parents compete with and show resentment toward the child of the same sex and direct overt or covert aggression toward him/her. Later, the internalized aggression emerges as a negative thought process when the individual strives to achieve personal or vocational goals. An exploration of the theoretical implications of the case contributes to an understanding of unresolved Oedipal issues that can affect young people at risk for suicide, particularly high-achieving adolescents who seemingly have everything to live for.

Firestone, R.W. (1990). Prescription for psychotherapy.
Psychotherapy, 27(4), 627-635.

A systematic approach to therapy based on a comprehensive theory of psychopathology and a comparative model of mental health is set forth. Humans are conceptualized as in conflict between the active pursuit of goals in the real world, and an inward, self-protective defense system. The resolution of this conflict has a profound effect on an individual's overall functioning. A case study illustrates a therapeutic process utilizing methods based on this theory.

Regression may be precipitated by significant changes, both positive and negative, in an individual's life. The author conceptualizes regression as the defense mechanism that is used to heal the fracture in the original bond with the mother caused by events, symbolic or real, that remind one of being separate and vulnerable to death. Guilt reactions, separation anxiety, and fear of death are increased by negative events such as illness, financial loss, failure, rejection, or death of a loved one. Regression may be activated as well by any significant positive experience or unusual achievement indicative of strength, independence, or personal power, that challenges an individual's image of him/herself in the family. The paper delineates five stages of progressive retreat that characterize regressive episodes catalyzed by an atypical success or accomplishment.

Negative cognitions are capable of interfering with the natural flow of excitement and sexual desire at any point prior to, during, or following a sexual encounter. The source of these inimical thought patterns can be found in internalized parental attitudes that are transmitted intergenerationally and that also form the basis of sexual stereotyping. This paper describes the application of Voice Therapy methods to the resulting sexual problems manifested in many couple relationships. Clinical material excerpted from group sessions illustrate the content of the "voice" process -- the negative cognitions -- and demonstrate the angry affect that accompanies the verbalization of such thoughts and attitudes. Exposing self-attacks and critical thoughts about one's partner has been shown to have positive results in terms of improved sexual relationships. Also discussed are those prevailing cultural views that function to reinforce each individual's "critical inner voice," thereby contributing to much of the sexual distress experienced in personal relationships.

Human beings spend their lives in a restricted range of personal relationships and experiences. Their freedom and initiative are constricted by a self-destructive process. Furthermore, their internal conflict is primarily unconscious, and they are generally unaware of the circle of guilt that limits them. Guilt reactions are mediated by an internal thought process or dialogue referred to here as the "critical inner voice." The voice is a system of negative thoughts, antithetical to the self, that plays a major part in human suffering and significantly limits an individual's goal-directed behavior. The voice represents the introjected negative thoughts and hostile attitudes of one's parents, and it ranges from unconscious or subliminal to fully conscious. The form and the substance of experience that people permit themselves is regulated by this system of self-accusatory thoughts and injunctions. To whatever degree these self-critical thoughts remain unconscious, they cause considerable damage, and the individual is unable to break the cycle. The "voice" of the so-called normal or neurotic individual is directly analogous to the hallucinated voices of the schizophrenic person. The content of these voices, when analyzed, reveals the same regulatory process and is characterized by the same hostility and vindictiveness toward the self.  The author's concept of guilt refers to an insidious process of self-limitation and self-hatred that seriously restricts people's lives. Out of a sense of guilt, people become self-denying, self-defeating, self-destructive, and even suicidal. The "voice" represents the thought process underlying the behavior noted above.