The article begins with a definition of the negative therapeutic reaction as "paradoxical worsening following correct analytic work or improvement, while in the broader sense it is limited to resistance to recovery, interminable analysis, and iatrogenically produced treatment impasses." Beginning with a review of Freud's work on the negative therapeutic reaction, Finell considers other literature which contributes to the understanding of it from both interpersonal and intrapsychic approaches. Her case report vividly elaborates the difficulties in analyzing a patient who exhibits a negative therapeutic reaction. Finell's openness in discussing failure in therapy and her extensive bibliography can be helpful to the clinician dealing with problem cases.