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The analyst in his clinical practice often encounters uncertainties that challenge his capacity to conceptualize the nature of his patient's pathology under the theoretical schemata of psychoanalysis. These uncertainties are particularly strong in situations in which the clinical experience seems to contradict the expectations created by his science. In such cases, the search for answers and explanations becomes compelling.
The negative therapeutic reaction is such an experience. It has been described in the psychoanalytic literature as a paradoxical clinical phenomenon, and a systematic effort has been made to provide a sharper picture of its occurrence in order to integrate it into the main body of psychoanalytic knowledge.
Freud, in his paper “The Ego and the Id” (1923), first described the phenomenon as referring to “certain people who behave in 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 discomfort and their condition becomes worse…. there is something in these people that sets itself against their recovery and its approach is dreaded as though it were danger” (p. 49). Freud provided no clinical vignettes to identify these patients, but several other authors after him have done so. It is evident that the psychoanalytic clinican still encounters considerable difficulty in defining,