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Asch, S.S. (1976). Varieties of Negative Therapeutic Reaction and Problems of Technique. J. Amer. Psychoanal. Assn., 24:383-407.

(1976). Journal of the American Psychoanalytic Association, 24:383-407

Varieties of Negative Therapeutic Reaction and Problems of Technique

Stuart S. Asch, M.D.

SUMMARY

1. Freud's concept of the negative therapeutic reaction limited its etiology to a sense of guilt, or a need for punishment. I have found it clinically useful to add the following etiologies: (a) a masochistic ego responding to a special psychopathology

of the ego ideal; (b) a defense against the regressive pull back to symbiosis with a depressed preoedipal object, and (c) an extension of Freud's original category of "unconscious guilt," to include preoedipal "crimes," such as responsibility for birth trauma to mother, mother's castration, etc.

2. These three roots of the N.T.R. are elucidated in terms of structural deformities of both the ego and superego due to pathological introjections related to early experiences with the mothering object.

3. The decisive role of defective separation and individuation is emphasized.

4. The common association of N.T.R. with depression and the connection of these to Freud's concept of "borrowed guilt" is related to the ambivalent identifications.

5. Discussion of the technical management includes: the characteristically difficult transference and countertransference problems with such patients, the unique problems they present in the terminal phase, and the special situations in which it may be essential to break off treatment in order to avoid catastrophic acting out.

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