The negative therapeutic reaction in psychoanalysis is the paradoxical phenomenon whereby a plausible interpretation produces, rather than improvement, a worsening of the analysand's condition.

Freud's formulations Freud first named the negative therapeutic reaction in The Ego and the Id of 1923, seeing its cause, not merely in the analysand's desire to be superior to their analyst, but (more deeply) in an underlying sense of guilt: "the obstacle of an unconscious sense of guilt....they get worse during the treatment instead of getting better".S. Freud, On Metapsychology (PFL 11) p. 390-1 The following year he offered the alternative formulation of a need for punishment instead;S. Freud, On Metapsychology (PFL 11) p. 421 but in his thirties summation it was again unconscious guilt to which he attributed "the negative therapeutic reaction which is so disagreeable from the prognostic point of view".S. Freud, New Introductory Lectures on Psychoanalysis (PFL 2) p. 143

Precursors to the idea can be found in his own article Criminals from a sense of guilt, as well as in Karl Abraham's 1919 article on envy and narcissism as enemies of the analytic work.H. Etchigoyen, The Fundamentals of Psychoanalytic Technique (2005) p. 739

Later developments The negative therapeutic reaction is unusual in psychoanalytic history in never being the subject of major controversy, while still be steadily worked on and reformulated in later analytic phases. These have added additional motivations behind the reaction to that singled out by Freud.H. Etchigoyen, The Fundamentals of Psychoanalytic Technique (2005) p. 738=9 Joan Riviere pointed to the neurotic's fear of any change in condition, even from worse to better, while the desire to spite the analyst may also be a motive.O. Fenichel, The Psychoanalytic Theory of Neurosis (1946) p. 298 and p. 559 Lacan highlighted the role of amour propre in the hatred of being helped by any outside force.J. Lacan, Écrits (1997) p. 13 Object relations theory has also pointed to the way that underdoing defences means the patient experiencing their underlying conflicts more fully, and reacting negatively to that.D. Bell, Reason and Passion (1997) p. 107-8

See also

References

Further reading Karen Horney, The Problem of the Negative Therapeutic Reaction' (1936) J. Seinfeld, A Primer of Handling the Negative Therapeutic Reaction (2002)

External links Negative Therapeutic Reaction