Finell J S
Psychoanal Rev. 1987 Winter;74(4):487-515.
In this paper, I have summarized the large body of literature on the N.T.R. and noted that the term has been broadened from Freud's original definition of deterioration following improvement or correct analytic work to include a negativistic, ongoing narcissistic reaction with failure to recover. Like Freud, Klein became very pessimistic about reversing this phenomenon. The N.T.R. is a multidetermined but not unitary clinical phenomenon that has generated much controversy. Its dynamics involve interpersonal and intrapsychic elements. Aggression, revenge, and oppositional reactions interfere with analytic progress and may range from temporary to a characteristic way of responding in the analysis. Aggression, the reaction to early frustration and deprivation, plays a large part in the narcissistic organization. Patients who experience N.T.Rs. are shown to have strong narcissistic features. Interpersonally, conflict between longings for fusion and the wish for separateness is central. The transference-countertransference is made difficult by projective identification. Envy and narcissism are critical in the N.T.R. patient's intrapsychic dynamics. Clinical material illustrated the difficult interpersonal and intrapsychic factors that prevailed in a severe N.T.R. patient. The N.T.R. is an insidious obstacle to analytic success and one that requires mastery of the interpersonal and intrapsychic dynamics of the patient and the treatment situation.
在本文中，我总结了关于负性治疗反应（N.T.R.）的大量文献，并指出该术语已从弗洛伊德最初对改善或正确分析工作后病情恶化的定义扩展到包括一种消极的、持续的自恋反应且无法康复的情况。与弗洛伊德一样，克莱因对扭转这一现象变得非常悲观。负性治疗反应是一种由多种因素决定但并非单一的临床现象，引发了诸多争议。其动力学涉及人际和内心因素。攻击、报复和对立反应会干扰分析进程，其范围可能从暂时的到分析中一种典型的反应方式。攻击作为对早期挫折和剥夺的反应，在自恋组织中起很大作用。出现负性治疗反应的患者表现出强烈的自恋特征。在人际关系方面，渴望融合与渴望分离之间的冲突是核心。投射性认同使移情 - 反移情变得困难。嫉妒和自恋在负性治疗反应患者的内心动力学中至关重要。临床资料说明了在一位严重的负性治疗反应患者中普遍存在的困难人际和内心因素。负性治疗反应是分析成功的一个潜在障碍，是一个需要掌握患者的人际和内心动力学以及治疗情境的障碍。
