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IN A PREVIOUS PAPER (Springmann, 1971) I suggested a rational approach to the classification of noninterpretative psychotherapeutic interventions. I based this on Ezriel's concept of object relations. Since then, I have gradually become aware that Ezriel's contribution (1956), (1959), (1967) to the theory and practice of psychotherapeutic interventions in general has not really been granted the attention it deserves. It is therefore my purpose in this paper to try to give these theories some of their due, to sketch their development, starting with a brief reference to the problem of negative therapeutic reaction, illustrating, as I go along, with clinical material from the literature and of my own.
The problem of negative therapeutic reactions, namely the aggravation of symptoms and/or appearance of overt anxiety following essentially correct interpretations, was called attention to by Freud himself early in his work, and later repeatedly referred to by him. At first, Freud (1918) attributed the phenomenon to a childish form of rebellion on the part of the patient; later (1937a), partly to guilt feelings and the need for self-punishment, and partly to the operation of the destructiveness of the death instinct.
Other authors have taken up the problem and dealt with it—each according to his conception of psychoanalytic theory. Thus Fairbairn (1943) attributed negative therapeutic reactions to the extreme anxiety aroused by psychoanalytic efforts to release internalized bad objects from repression. Strachey (1934) had tackled the problem from a different angle. He argued that material was never repressed without good reason; that by its very nature it must have aroused anxiety and that repression occurred mainly for this anxiety to be allayed. Consequently, any attempt to