The problem of the negative therapeutic reaction

After an Introduction by Giorgio Meneguz, Karen Horney examines the phenomenon that Freud termed “negative therapeutic reaction”, namely the paradoxical worsening of a pa-tient’s condition following accurate interpretations or therapeutic progress. While acknowledg-ing Freud’s description of the phenomenon, Horney proposes a different psychodynamic expla-nation. In certain patients with a character structure marked by intense competitiveness, hostility, and grandiose ambitions, a correct interpretation may be experienced as a narcissistic injury or as evidence of the analyst’s superiority. The patient may therefore respond with resentment, de-valuation of the analyst, and a retreat from improvement. Progress in treatment may also evoke a fear of success, since achievement is unconsciously associated with rivalry, retaliation from others, or loss of affection. The negative reaction thus emerges from the interplay of hostility, excessive need for affection, and defensive inhibition of success. Five typical responses to a good interpretation are described, and hostility toward the analyst is seen not merely a superficial re-action but a central element of the patient’s character structure. Technically, it is recommended to focus on the patient’s immediate emotional reactions toward the analyst and to interpret these dynamics before turning to reconstructions of early childhood experience.

Keywords: Negative therapeutic reaction; Psychoanalysis; Hostility; Competitiveness; Character analysis

Karen Horney, Il problema della reazione terapeutica negativa (1931) in "PSICOTERAPIA E SCIENZE UMANE" 2/2026, pp 219-238, DOI: 10.3280/PU2026-002002