Transformations in Negative Therapeutic Reaction | April 24

Negative therapeutic reaction, a term coined by Freud (1923) to describe the patient’s abrupt and reflexive turning away from the analytic relationship immediately following recognition of the analyst’s understanding and interpretive helpfulness, has evolved in how it is understood theoretically and applied clinically over the past century. Notably, identifying the determinative role of envy and destructive narcissism has obviated pessimism about the analyzability of individuals demonstrating these reactions. I suggest that further gains may accrue if this phenomenon is viewed as a shared unconscious phantasy of failure to survive the turbulence associated with catastrophic change in the analytic group-of-two. From this vertex, negative therapeutic reactions do not originate in individual subjectivity tethered to the death instinct. Rather, they express as Bergstein (2015) has shown with Bion’s concept of ‘attacks on linking’, a powerful drive to communicate a disturbed primitive relationship between mother and infant relived, or lived for the first time, within the healthy domain of the analytic field inhabited by the analytic group-of-two.

Clinical vignettes illustrate how subtle and more overt negative therapeutic reactions previously understood as reflecting the patient’s individual subjectivity communicated to the analyst via projective identification may be reinterpreted as intersubjectively engendered events. I conclude that such an orientation contributes to a more accurate understanding of the pre-reflexive unity of subjective experience and shared unconscious phantasies that give rise to negative therapeutic reactions, allowing the analyst to feel more optimistic and surer footed when encountering these inevitable responses to unanticipated emotional openings in the analytic field.

Caron Harrang, LICSW, FIPA is a board-certified psychoanalyst in private practice in Seattle, Washington (USA). She is an IPA training and supervising psychoanalyst on faculty at Northwestern Psychoanalytic Society and Institute. Caron is a co-editor and chapter author of Body as Psychoanalytic Object: Clinical applications from Winnicott to Bion and Beyond (Routledge, forthcoming).

Learning Objectives:
At the end of this program/session/event participants will be able to:

1. Define the Freudian concept of ‘negative therapeutic reaction’ and its evolution as a psychoanalytic concept over the past century.
2. Discuss a field theory model of negative therapeutic reaction and how it can be understood as a shared unconscious phantasy of failure to survive the turbulence associated with catastrophic change in the analytic group-of-two.
3. Identify how negative therapeutic reactions, previously understood as reflecting the patient’s individual subjectivity, may be experienced and interpreted as intersubjectively engendered events in the analytic field.