Symptom Intensification Following Memory Recovery: A Clinical Discussion

The failure of a patient to react favorably with clinical improvement following a recovered memory of incidents upon which symptoms have been founded is one of the really important problems still remaining to be clearly understood in analysis. Our usual conception of the significance of a memory returned from amnesia is that the analytic work has modified anxiety reactions and defenses, and strengthened the ego to the point where the conscious ego can allow the memory to come through. This event ordinarily has cathartic value, and indicates a healthier relationship of the patient with the previously repressed unconscious conflicts centered around the memory in question. At times, this ideal situation does not follow and the memory recovery is not followed by clinical improvement. Some of the dynamics underlying this failure in therapeutic response is the subject considered in this paper.

Freud deals with this question somewhat in his remarks on “negative therapeutic reaction” where he lays stress on the factor of unconscious guilt and its masochistic expression. He makes reference to this important problem in his paper on The Economic Problem in Masochism:1 “I have described elsewhere how in analytic treatment we come across patients whose behavior in regard to the effects of the analysis compels us to ascribe to them an ‘unconscious’ feeling of guilt. I there mentioned the trait by which these people are recognized (the ‘negative therapeutic reaction’), and I did not conceal the fact that a strong feeling of this kind amounts to one of the most difficult resistances and the greatest menace to the success of our medical or educative aims. The gratification of this unconscious sense of guilt is perhaps the strongest item in the whole ‘advantage through illness’ (which is as a rule composed of many different gains), i.e., in the sum-total of the forces which oppose the cure and struggle against relinquishing the neurosis; the suffering