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Ivimey, M. (1948). Negative Therapeutic Reaction. Am. J. Psychoanal., 8(1):24-33.

(1948). American Journal of Psychoanalysis, 8(1):24-33

Negative Therapeutic Reaction

Muriel Ivimey, M.D.

The reaction in analytic therapy to be discussed here is one that was observed by Freud and called by him “negative therapeutic reaction.” In 1927, in the volume The Ego and the Id, chapter V, Freud wrote: “There are certain people who behave in a quite peculiar fashion during the work of analysis. When one speaks hopefully to them or expresses satisfaction with the progress of the treatment, they show signs of discontent and their condition invariably becomes worse. One begins by regarding this as defiance and as an attempt to prove their superiority to the physician, but later one comes to take a deeper and truer view. One becomes convinced, not only that such people cannot endure praise or appreciation, but that they react inversely to the progress of the treatment. Every partial solution that ought to result, and in other people does result, in an improvement or a temporary suspension of symptoms produces in them for the time being an exacerbation of their illness; they get worse during the treatment instead of getting better. They exhibit the so-called negative therapeutic reaction.

“There is no doubt that there is something in these people that sets itself against their recovery and dreads its approach as though it were a danger. We are accustomed to say that the need for illness has got the upper hand in them over the desire for health. … This reveals itself as the most powerful of all obstacles to recovery. … In the end we come to see that we are dealing with what may be called a ‘moral’ factor, a sense of guilt, which is finding atonement in the illness and is refusing to give up the penalty of suffering.

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