{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T01:46:19Z","timestamp":1778636779980,"version":"3.51.4"},"reference-count":25,"publisher":"Guilford Publications","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychodynamic Psychiatry"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p> The impact of intense countertransference affects in working with patients experiencing complex trauma can have a critical effect on decisions about euthanasia, especially when such decisions are made solely on the grounds of a psychiatric condition. These countertransference dynamics become particularly significant in the context of the rising number of euthanasia requests by psychiatric patients in the Netherlands. We contend that for a subgroup of patients with complex trauma, attachment trauma, and personality disorders, the label \u201ctreatment-resistant\u201d may be applied prematurely and incorrectly. This may occur when highly complex transference-countertransference dynamics are not properly assessed, and tertiary treatment options like intensive short-term dynamic psychotherapy (ISTDP) are not considered, particularly in cases of chronic and severe childhood trauma leading to an unconscious reservoir of murderous rage that is directed at the self. A long-term therapeutic relationship can activate unconscious transferences, leading to the reenactment of previous attachment trauma. We propose that assessments for euthanasia must include a psychological analysis of the unconscious transference, enactment, and countertransference involved. This article presents a hypothetical case example to illustrate how a patient labeled as \u201ctreatment-resistant\u201d can be supported through a psychodynamic formulation and proposes further pathways for clinical decision-making. <\/jats:p>","DOI":"10.1521\/pdps.2025.53.1.002","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T17:07:32Z","timestamp":1737565652000},"page":"45-60","source":"Crossref","is-referenced-by-count":4,"title":["Who's Afraid of Murderous Rage? When Euthanasia Colludes with Self-Destructiveness"],"prefix":"10.1521","volume":"53","author":[{"given":"Ardalan","family":"Najjarkakhaki","sequence":"first","affiliation":[{"name":"Psychotherapist, Parnassia Psychiatric Institute, Department of 1nP, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Frederickson","sequence":"additional","affiliation":[{"name":"Psychotherapist, New Washington School of Psychiatry, Washington, D.C."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerrie","family":"Bloothoofd","sequence":"additional","affiliation":[{"name":"Psychologist, Transparant Centrum GGZ, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"377","reference":[{"key":"ref1","volume-title":"Reaching through resistance: Advanced psychotherapy techniques.","author":"Abbass A.","year":"2015"},{"key":"ref2","doi-asserted-by":"crossref","DOI":"10.7208\/chicago\/9780226924601.001.0001","volume-title":"Steps to an ecology of mind: Collected essays in anthropology, psychiatry, evolution, and epistemology.","author":"Bateson G.","year":"2000"},{"issue":"1","key":"ref3","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1080\/02668734.2011.652657","volume":"26","author":"Briggs S.","year":"2012","journal-title":"Psychoanalytic Psychotherapy"},{"issue":"2","key":"ref4","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1207\/s15327809jls1402_1","volume":"14","author":"Chi M. 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