Negative Therapeutic Motivation and Negative Therapeutic Alliance

Freud described the negative therapeutic reaction as one of many factors leading to failure or protracted treatment. In this paper another factor contributing to failure in treatment is identified as the negative therapeutic motivation, which exists long before the patient sees the analyst or has any idea what analysis is about. The negative therapeutic motivation is an unconscious wish to go into analysis or therapy in order to make the analyst fail. This motivation is part of every treatment, regardless of degree or type of pathology. The phenomenon is, however, more visible in certain types of patients, such as those with severe masochistic disturbances, and at certain ages, such as adolescence. Material from several cases, especially suicidal adolescent cases, is used to illustrate the patient's need to make the analyst fail in order to maintain an idealized image of a loving, loved, and omnipotent mother. This is maintained by the externalization and displacement of negatively cathected parts of self and object onto the analyst. The negative therapeutic motivation is shared by mother and patient. Both seek help in order to make others fail. The negative therapeutic motivation is a repetition of an established pattern where mother and child obliterate the significance of any object other than mother. In most of the cases presented the negative therapeutic motivation relates to the

phenomenon of the "bypassed father." The defensive need to maintain the illusion of a purified pleasure dyad and the inability of both patient and mother to move beyond the stage of dyadic omnipotence underlie the negative therapeutic motivation.