A Contribution to the Analysis of the Negative Therapeutic Reaction

Joan Riviere, author; LONDON
In this contribution my aim is to draw attention to the important bearing recent theoretical conclusions have on the practical side of the problem of the negative therapeutic reaction. I mean the latest work of Melanie Klein and in particular her Lucerne Congress paper on the depressive position.2
To start with, it is necessary to define what is meant by the negative therapeutic reaction. Freud gave this title to something that he regarded as a specific manifestation among the variety of our case-material, though he says that in a lesser measure this factor has to be reckoned with in very many cases. When I referred to Freud’s remarks on this point, I was interested to find that actually they are not exactly what they are generally remembered and represented as being. The negative therapeutic reaction, I should say, is generally understood as a condition which ultimately precludes analysis and makes it impossible; the phrase is constantly used as meaning unanalysable. Freud’s remarks on the point are almost all in The Ego and the Id, the last eighteen pages of which deal with the problem of the unconscious sense of guilt. He says, ‘Certain people cannot endure any praise or appreciation of progress in the treatment. Every partial solution that ought to result, and with others does result, in an improvement or temporary suspension of symptoms produces in them for the time being an exacerbation; they get worse instead of better’. This last sentence might imply that they are unanalysable; but he does not actually say so, and has just said the exacerbation is for the time being. He says the obstacle is ‘extremely difficult to overcome’; ‘often there is no counteracting force of similar intensity’; and that ‘it must be honestly confessed that here is another limitation to the efficacy of analysis’—but he does not say a preventive. Clearly the point is merely one of degree, and he might concur in the general attitude taken up. He is not, however, actually as pessimistic about it as people incline to suppose; and this interested me, because it is not intelligible why one reaction should be thought more unanalysable than another. The eighteen pages in The Ego and the Id are in fact part of his contribution towards analysing it; and our understanding of it has now been very greatly advanced by Melanie Klein.