A Discussion of the Paper by Helena Besserman Vianna on 'A Peculiar Form of Resistance to Psycho-Analytical Treatment'

It is well known that Freud's references to the negative therapeutic reaction are not very frequent and that this phenomenon has very seldom been treated in works published after Freud. However, it is worth consideration, for it represents a common cause of failure—or a menace to success—of the analytical process. It is therefore to the credit of Dr Vianna (this issue) to have taken it up, the more so since it gives us an opportunity to relate her observations to our own experience and understanding of the problem.

This confrontation is likely to elicit some surprise among us. The negative therapeutic reaction is a phenomenon we all talk about but which we are in fact far from understanding. In our opinion, the problem should be approached from two different points of view which, while closely related, should be clearly distinguished: first, the delimitation of the phenomenon itself, and second, the processes that underlie or produce the phenomenon. The first process appears to us through our difficulty in clearly determining, at the level of clinical description, those elements that should be ranged under the label of negative therapeutic reaction and those that should be seen as other forms of resistance or other causes for the failure of a psychoanalytical treatment.

We have at our disposal a clear and concrete point of departure: Freud's description of the negative therapeutic reaction as a paradoxical response on the part of the analysand to an interpretation, which constitutes in itself a step forward towards analytic understanding. Instead of improving, as one expects, the state of the patient becomes worse.

However, as far as the concept of negative therapeutic reaction is concerned, there seems to be an evolution parallel to the one we can observe in connexion with other analytical concepts: the phenomenon, clearly defined at the beginning, becomes diluted, gradually losing its specificity and encompassing phenomena that seem to have nothing to do wit