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Freud's conception of the negative therapeutic reaction, as outlined and elaborated in some of his later writings, is re-examined, especially in terms of some of its theoretical implications regarding instinct theory. A reformulation of the concept of instinctual drives is proposed. The negative therapeutic reaction is conceived by Freud as the manifestation of self-destructive tendencies which are not primarily a by-product of reactions against the therapist and his efforts but stem from a deeply rooted intrapsychic imbalance between libidinal and aggressive drives (or of the life and death instincts). This imbalance in favor of the destructive drives may appear in the form of unconscious guilt feelings (superego versus ego) and pervasive masochistic tendencies, or in the more primitive and intractable form of unstructured ("unbound") destructive forces which have not attained sufficient psychic representation to be assignable to the superego as a mental province. In this insidious form the negative therapeutic reaction must be attributed to distorted organization of the instinctual drives themselves, prior to their structuralization in psychic subsystems. It is in this sense that Freud ultimately traces the negative therapeutic reaction back to a prevalence of the destructive drive or death instinct in the economy of mental life. The presence of an unconscious sense of guilt already presupposes the binding of such destructive forces in the subsystem superego.
In its more intractable forms the negative therapeutic reaction is rooted in preoedipal, primitive distortions of instinctual and ego development and is thus hardly amenable to interpretations in terms of guilt, conscience, and need for punishment.