The Problem of the Negative Therapeutic Reaction

There are many reasons for an impairment of a patient's condition during analysis; their common denominator is the arousal of anxiety, with which either the patient or the analyst is unable to deal adequately.

What Freud1 has called the “negative therapeutic reaction” is not, indiscriminately, every deterioration of the patient's condition; but the fact that the patient may show an increase in symptoms, become discouraged, or wish to break off treatment immediately following an encouragement or a real elucidation of some problem, at a time, that is to say, when one might reasonably expect him to feel relief. In fact, the patient very often actually feels this relief distinctly, and then after a short while reacts as described. Freud considers this reaction indicative of a bad prognosis in the particular case, and, as it is a frequent occurrence, a serious barrier to therapeutic endeavors in general.

When Freud first published these observations many questions arose concerning the specific nature of such an impairment, among them, Are we so sure in our expectation of what should bring relief to the patient? I remember my own scepticism on the