chapter  2
On Negative Th erapeutic Reaction
BySHELLEY ORGEL
Pages 10

We see, Freud wrote, “that an unconscious sense of guilt fi nds satisfaction in the illness and refuses to give up the punishment of suff ering” (p. 49). In Freud’s view, the locus of the battle is between the patient’s sadistic superego and his masochistic ego. Th e relatively neutral analyst is a weak outside bystander to this energy-absorbing intrapsychic struggle. Th e patient’s unavailability, Freud (1924) wrote, “thwarts our educative aims … our attempts to exert an infl uence” (p. 166). I think he meant here that the analyst is unable to use the suggestive power of the physician’s authority to mobilize a wish in the suff ering patient to get better as a way of attaining the analyst’s love. One weapon was available to those inclined to use it, Freud thought. Such an analyst, enacting the part of the patient’s primitive ego ideal, assumes the omnipotence attributed to the original parent. What is sacrifi ced is the psychoanalytic principle that mandates giving “the patient’s ego freedom to decide.” Th is analyst famously plays “the part of prophet, savior, and redeemer to the patient.”