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The psychotherapeutic process depends on the existence of a personalised relation developing within the reality of the analytic interchange of free association and interpretation. A major technical problem is the analysand who is in a state of unrelatedness, or in a false or conventional relation. The analytic task is then to analyse this state so as to enable the patient to move to a state of authentic relation. The analyst's sense of pleasure and success when this occurs leads me to call this move a positive therapeutic reaction.
Freud's negative therapeutic reaction (Freud, 1923) had a paradoxical quality in that the analyst expected improvement but found deterioration. The positive therapeutic reaction is similarly paradoxical in that what is actually an improvement can seem like a deterioration in the working alliance. This is because the overt patient response, the development of a negative transference, occurs with such an immediacy and intensity of conviction. The reaction is “positive” because an impasse resolves, therapeutic work occurs and the negative transference responds to interpretation.
The positive therapeutic reaction may be described and understood in a theoretical framework developed elsewhere (Kinston, 1980, 1982, 1983). This framework can only be briefly reviewed here.
Early psychoanalytic writers, including Freud, imagined narcissism as inherently dual. It embraced on the one hand the person's sense of him-self