You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
The negatve therapeutic reaction (N.T.R. is a challenge to to psychoanalytic theory and technique. Because it addresses the issue of treatment failure and offers a rich ground for understanding those cases that seem intractable, the concept continues to be the focus of articles and conferences. At the 1979 London conference on the topic (Limentani, 1981), it was clear that, although controversy still exists, the study of this difficult problem continues to intrigue analysts from all over the world.
The N.T.R. is defined in two ways. In its more restricted definition it is linked to paradoxical worsening following correct analytic work or improvement, while in the broader sense it is linked to resistance to recovery, interminable analysis, and iatrogenically produced treatment impasses. This challenging clinical phenomenon has been alternately described as a special type of resistance, as a character defense rooted in negativism, and chronic and deeply embedded negative transference. The use of projection contributes to the countertransference difficulties and tests the understanding, skill, and boundaries of the analyst.
In this article, I will offer a comprehensive review and synthesis of the vast but fragmented published literrature on the N.T.R. Two levels of conceptualization exist. One explanation of the N.T.R. involves patient pathology and intrapsychic factors, especially narcissistic issues and envy. On another level, the N.T.R. is seen as the