Academic journal article International Journal of Psychoanalysis

No, Twice No: An Attempt to Define and Dismantle the 'Negative Therapeutic Reaction'

Academic journal article International Journal of Psychoanalysis

No, Twice No: An Attempt to Define and Dismantle the 'Negative Therapeutic Reaction'

Article excerpt

A1 recent Congress announced on its programme: 'New perspectives on the negative therapeutic reaction'.2 It is an interesting sign of the times, for psy- choanalysts scarcely ever speak about the N.T.R and the literature on the question, in comparison with the mass of publications, is quite scarce. But analysts are increasingly concerned with the limits and effectiveness of the treatment, with the value and stability of its results. Judging by what they say, one would imagine that they are no longer confronted with anything but 'impossible cases'. What's more, they question whether their models are really pertinent to the treatment. It is as if experience did not so much 'con- tradict'3 the theory - a contradiction in which one can find the promise of a reshaping or refinement of the initial conception - as 'negate' it; as if it were an internal necessity of our science, which is becoming ever more 'civi- lized' or sophisticated, to be indefinitely contested, or even held in check - albeit quietly, without fuss - by our experience, which is ever more discon- certing and, in its own way, often discrete, 'wilder' than before. So much so that one could just as well argue that the N.T.R. has become, as I once heard it said, an anachronistic concept - insofar as it is deemed to be too attached to the manifest, taking what is simply a moment in the process as an absolute rejection - as the contrary, namely, that it is spreading through- out the whole body of psychoanalysis in crisis.

It will be noticed at once that it is precisely in those circles where thera- peutic concerns have been most prominent - in the United States, where the title of 'Dr' is required by psychoanalysts for those wishing to practise analysis - that this crisis, which, as we know, follows a period of success, is the most visible: there is a preference for shorter and more efficient thera- pies and, above all, therapies which promise positive results (adaptation, feelings of well-being, fulfilment, creativity). So we are going through a time of disaffection, of a negative reaction to psychoanalysis, and there is no guarantee that in France, in spite of the apparent excitement, we shall be preserved from it.

I said that it was rare to hear psychoanalysts speaking about the negative therapeutic reaction today. When they do, it is generally: (1) to note the state of impasse, and to give a wholly verbal explanation for the failure of a treatment; (2) and particularly when this failure occurs or, in the end, becomes more pronounced; (3) to impute it to the patient: "If it went wrong, it was because he did an N.T.R. on me"4 (just as a mother might say of her child, who, in order to hold her back, obtain her love, arouse her concern, or, why not, out of ill will, chooses to harm himself first).

While the analyst was justified in expecting the analysis, in view of the work of elucidation accomplished, to result in a liberating change, in fact it is the opposite that occurs: there is a return if not an aggravation of the old symptoms, or even the development of new ones, a new upsurge of conflicts, the proclamation of a permanent state of suffering: the worst is always certain...The patient, it is said, 'prefers' to suffer than to be cured. It might be better to consider that he does not want to exchange the total- ity of his suffering, as if this ill were a personal asset, for even a partial improvement which would represent for him, first and foremost, a response to his analyst's expectations, the satisfaction of his all too evident wish, submission to his demand: "You must change". Better to remain ill than tomber gue^ri (lit. 'fall cured'). The fall, or relapse, protects one from loss.

We know that it is in a text that many regard as a 'testament' and as continuing to define the framework of our current difficulties, that Freud comes up against, and seems thoroughly discouraged by, "this force which is defending itself by every possible means against recovery and which is absolutely resolved to hold on to illness and suffering" (Freud, 1937, p. …

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