It has been observed in exploratory psychoanalysis that some patients have an initial period of effective work and then have a deterioration in their condition. This has been called a negative therapeutic reaction. Sometimes character traits of self-punitiveness have been noted in such instances. It is important in such instances for the therapist to be self-observant for feelings of helplessness, guilt, and anger, and to aim instead for understanding with the patient why the condition has gotten worse.


Not to be confused with negative therapeutic reactions are negative transference phenomena. These are a common aspect of treatment. In developmentally immature patients, ones who have unintegrated self-schemas and who are vulnerable to feeling fragmented, empty, worthless, or bad, negative transference reactions can occur and seem to the patient "the whole picture.'' That is, they are not mitigated by simultaneous schemas of a therapeutic alliance. Early interpretation of the negative transferences and/or very early emphasis on signs of the therapist being helpful in a therapeutic alliance may be needed to prevent the patient from dropping out prematurely in the midst of a negative transference reaction.

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