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When Freud first discussed the negative therapeutic reaction in The Ego and the Id in 1923 he gave both a clinical description of it and a psychological explanation. In this chapter I want to suggest that the clinical description and the psychological explanation may not be as intrinsically connected as Freud thought.
Freud does not give actual case material, but his clinical description is as follows:
There are certain people who behave in a quite peculiar fashion during the work of analysis. When one speaks hopefully to them or expresses satisfaction with the progress of the treatment, they show signs of discontent and their condition invariably becomes worse. One begins by regarding this as defiance and as an attempt to prove their superiority to the physician, but later one comes to take a deeper and juster view. One becomes convinced, not only that such people cannot endure any praise or appreciation, but that they react inversely to the progress of the treatment. Every partial solution that ought to result, and in other people does result, in an improvement or a temporary suspension of symptoms produces in them for the time being an exacerbation of their illness; they get worse during the treatment instead of getting better. They exhibit what is known as a ‘negative therapeutic reaction’.
Thus the clinical phenomenon, according to Freud, is that when the analyst thinks and says that progress has occurred, the patient gets
worse; he ‘backtracks’ on his earlier progress. Freud had already touched on a similar phenomenon in one of his papers on character, ‘Those wrecked by success’ (1916).
Freud's explanation of the negative therapeutic reaction is that it occurs because of an unconscious sense of guilt, or need for punishment. Indeed, he drew attention to the clinical phenomenon mainly because he thought it provided evidence for the usefulness of the concept of the superego. This is how he puts it:
In the end we come to see that we are dealing with what