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(1972). Journal of the American Psychoanalytic Association, 20:235-245

Freud's Conception of the Negative Therapeutic Reaction, with Comments on Instinct Theory

Hans W. Loewald, M.D.

IT IS HARD TO GAIN an unambiguous view or a consensus regarding the concept of the negative therapeutic reaction. The theoretical issues involved are as complex and difficult as is its clinical management. If one adheres more or less to what Freud appears to have meant by the term, the Pandora's box of the unconscious sense of guilt, masochism, and the death instinct soon opens. I say Pandora's box, because I believe it is not as easy as many psychoanalysts seem to think, nowadays, to dispose of Freud's ideas on the relations between the problems of guilt and masochism and the death and life instincts. Analysts by and large are comfortable with the dual instinct theory formulated in terms of sexual and aggressive drives, but most of them, including theoreticians, shy away from life and death instincts, Eros and Thanatos, and especially from the notion of inner and silent workings of the death instinct.

On the other hand, if one refuses to allow oneself to be confined by Freud's u

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