NEGATIVE THERAPEUTIC REACTION

ABSTRACT For the last 80 years the term 'negative therapeutic reaction' has been used by psychoanalysts and psychotherapists to define the phenomenon of improvement followed by deterioration of a client's psychological or symptomatic condition, apparently in response to their therapist's interventions. Negative therapeutic reaction has been the subject of many papers written by these practitioners, who in various ways have attempted to clarify and understand what goes wrong in such therapeutic encounters.
This paper summarises the ideas of many psychoanalytic writers and practitioners who have worked throughout the span of the twentieth century, and up to the present day. Various aspects of negative therapeutic reaction are explored, such as alternative definitions of the concept, possible origins of NTR, the impact of the therapeutic relationship, and treatment implications. These ideas are compared and discussed, drawing mainly on the object relations theories of Fairbairn (1943), and illustrated through examples from myth, literature, research and clinical vignettes.     

A LIGHT- AND ELECTRON-MICROSCOPIC STUDY OF THE SO-CALLED UNI-VISCERAL SHWARTZMAN REACTION

A morphological study was made on a particular model of Shwartzman reaction which was so designed as to occur mainly in the liver with minimal influence to the other parts of the body. The study was mainly focused on its mechanism; the role of the granulocytes, Kupffer cells, platelets and precipitated fibrin. It was revealed that Kupffer cells were severely damaged by the first, preparative injection and the most conspicuous finding after the second, provocative injection was marked granulocytic infiltration followed by massive hepatic cell necrosis. The infiltrating granulocytes sticked to the endothelium, degenerated Kupffer cells, or other granulocytes and, often aggregated around precipitated fibrin. The erythrocytes in the sinusoid also showed aggregation after the provocative injection of the endotoxin, which was, however, rather loose and easily washed out from the sinusoid by perfusion. It is suggested from the above observations that aggregation of granulocytes as well as precipitated fibrin plays an important role to disturb blood stream mechanically and leads to massive necrosis in the liver.     

ANALYSIS OF AUTONOMIC REACTION PATTERNS

Analysis-of-variance models are presented for use with autonomic data. Applications are illustrated for experiments where either single variable or multiple variable autonomic recordings are obtained. The analysis provides a test of significance for both transient responses to a stimulus and the more sustained effects that persist for some time. Consistency and stability of idiosyncratic reaction patterns are expressed by intraclass correlation coefficients. Multiple group comparisons are suggested as a method of evaluating differential reaction patterns induced by separate stressors. Three independent dimensions of autonomic activity are isolated by analysis of variance: sustained activity, reactivity, and nonspecific variability. Individual Ss can be assigned scores on each dimension, and these scores can be processed by multiple regression procedures to predict Ss’ performance on other behavioral tasks or personality scales.