The author traces the gradual development of Freud's thinking on the negative therapeutic reaction and its relationship to the development of his theory of the deathinstinct. The analysis of the negative therapeutic reaction leads to a series of reflections on both technical (on the problem of construction) and theoretical issues of the topographic distribution of ego and non-ego, trauma and seduction, original repression, etc. He disagrees with authors who would limit Freud's thought on this issue to the series: unconscious guilt, need for punishment, and the deathinstinct. Currently, the concept of the negative therapeutic reaction has been extended to
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encompass every impediment in an analysis, including some aspects of the negative transference. But this was certainly not what Freud meant. Freud described a process that occurred in two phases. In the first, the analysis progresses well and there is an amelioration in the state of the patient. When the analyst communicates his or her satisfaction with the work accomplished, a second phase of aggravation of symptoms results. This biphasic process was, according to Freud, a typical succession of events characteristic of the process; it evokes human diphasic sexuality and the structure of the after-repression. Freud used the biological metaphor of the unicellular organism, the protist, that gradually becomes poisoned by its own excretions. The organism could survive by changing its environment, or by developing into a more complex system with specialization of functions. The first mode he equated with splitting inside/outside, the second with growing psychic complexity. The ego that does not safeguard itself by purifying itself, either by splitting or by symbolization, can be destroyed. This protist model of the biphasic structure of the negative therapeutic reaction suggests that it is a very primitive, archaic, original process of mentalization, conserved in the depths of the superego. The problem of the constitution of the ego and its limits, the problem of the relation of the ego and non-ego, of the relation of the ego to its own proper origins through the primary identifications by which it was constituted and separated, are all involved. The problem is not so much unconscious guilt that the cruelty of the superego introduces, but rather the limits of the ego and its relationship to its own origins, origins which it shares with the superego. The expression of the analyst's approval, experienced as the equivalent of the accomplishment of an incestuous desire, reveals to the patient his or her oedipal culpability. The negative therapeutic response as a confirmatory response to constructions was noted by Freud. Roussillon speculates on the phases of the negative therapeutic reaction as a possible mode of reminiscence of ahistorical experiences, unknown to the self or split-off, hence an indefinite repetition that can only be recovered by and through a precise reconstruction, and activated in the process of a construction. Thus conceptualized, the negative therapeutic reaction appears as the way to approach an elaborate ego functioning that cannot be actualized in the analysis in any other fashion.
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Wilson, E., Jr. (1992). Revue Française De Psychanalyse. XLIX, 1985. Psychoanal. Q., 61:151-152