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A twenty-four-year-old single woman with a history of multiple hospitalizations for borderline personality disorder characterized by hyperactivity, low frustration tolerance, quasi-delusional thinking, and impulsivity, which had proved refractory to treatment, related to her new psychiatrist with an attitude of hostile derision of all his psychotherapeutic and pharmacotherapeutic interventions. The psychiatrist, along with other members of the hospital staff, found himself responding to the patient with hate which interfered with the treatment program. Consultation revealed the role of the patient's deep envy in perpetuating this anti-therapeutic attitude in both staff and patient. This was mediated through projective identification, by which the patient projected on to the psychiatrist and others the split-off, depreciated parts of her own self. The patient then attacked these projected elements, which were now experienced in the guise of the therapist's empathy, objectivity, and therapeutic skills. The origins of this defensive pattern in the patient's early yearning for and envy of a distant and unsatisfying mother could then be explicated. When the patient's contemporary disavowal of her oral dependency was understood in this light and worked through by the staff, interventions could be made to avert yet another negative therapeutic reaction. The authors include a detailed theoretical discussion of the psychodynamics of envy in the negative therapeutic reaction.