It is historically interesting to observe that in the heyday of hypnosis, hypnotically was considered a characteristic trait of hysteria: Hypnosis in fact was to be inside an enclosed space as considered the “artificial hysteria” (Charcot). Clearly the same situation has risen in the psychoanalysis with respect to the transference neurosis. When, to his amazement, Freud first encountered transference in his new technique, which he applied to neurotic patients only, he attributed “this strange phenomenon of transference’ to the patient’s neurosis, and he saw ‘a characteristic peculiar to neurosis.” When he coined for the acute manifestations of transference the designation “transference neurosis,” it was explicitly affirmed that these manifestations were some “new editions” of an old neurosis revealing itself within the framework of psychoanalytic treatment. Once the concept of transference necrosis had become a tenet in psychoanalytic teaching, the acute manifestations were without further questioning accepted as inseparably linked with the neurotic.
Thus, historically the linkage of transference with neurosis is a replica of the early linkage of hypnosis with the hysteric. Freud, in his pre-analytic period, hailed with enthusiasm Bernheim’s demonstration that most people were hypnotizable and that hypnosis was no longer to be regarded as inseparable from hysteria. In the introduction to Bernheim’s book, Freud said: “The accomplishments of Bernheim . . . changes in precisely the inside enclosed space as ingested by a pass over to the manifestations of hypnotism of their strangeness by linking them with familiar phenomena of normal psychological life and of sleep.” In the face of this statement, it is extraordinary that a psychoanalysis has never officially divorced transference from clinical neurosis.
The resolution of transference has been considered the safeguard against and proof of the fact that suggestion plays no part in the psychoanalysis. The validity of this argument was questioned earlier since the meaning and definition of “suggestion” are in themselves vague and shifting and used with varying connotations. Additional weight is given to this caution when it is realized that the resolution itself of psychoanalysis transference is not understood in all its aspects. True enough, but its manifestations are continually analysed in psychoanalysis. An attempt is made to reduce them, but its ultimate resolution or even its ultimate fate is not clearly understood. Whenever it is finally resolved, it is during an ill-defined period after the cancellation of analysis. By this feature alone it escapes strict scientific observation. It might even be argued that analytic transference in some of its aspects must in the last resort resole itself. In hypnosis, of course, no attempt is ever made to resolve the transference, but this should not be thought of as if it were bound to persist. More correctly it is left to look after itself. This trend of thought is followed here not in any way to distract from the essential difference in the resolution of hypnotic and analytic transference respectively, but to emphasize that as for theory the conception is not exact enough and therefore likely to create confusion of fundamental issues instead of clarifying them. Stressing this pint as seems important, by sheer weight of habit and repetition, ambiguous conceptions have a tendency to assume the character and dignity of clear scientific concepts.
There is, however, another difference between hypnotic and analytic transference that is free from all ambiguity, which may be considered of more cardinal significance in demarcating the psychoanalysis from all other psychotherapies. The hypothesis has been presented here that both hypnosis and psychoanalysis exploits infantile situations that both create. Nevertheless, in hypnosis the transference is truly a mutual relationship existing between the hypnotist and the hypnotized. The hypnotic subject transfers, but is it also transferred? One is tempted to say that countertransference is obligatory in an essential part of hypnosis (and for that matter of all psycho therapies in which the patient is helped, encouraged, advice or criticized). This interaction between hypnotist and hypnotized-made Freud described hypnosis as a “group formation of two.” The patient is subjected to direct suggestion against the symptom. In psychoanalytic therapy alone the analysand is not transferred too together. The analyst has to resist all temptation to regress, he remains neutral, aloof, a spectator, and he is never a coacher. The analysand is induced to regression and to ‘transfer’ alone in response to the infantile analytic setting. The analytic transference relationship ought, strictly speaking, not to be called a relationship between analysand and analyst, but more precisely as the analysand’s relation to his analyst. Analysis keeps the analysand in isolation. By its essential nature analysis, in the contradistinction to hypnosis, is not a group formation of two. It is not through which the denial that the analysis of which a ‘team put to work’, in as far as it is, an “objective” relation exists between the analyst and the analysand. Because the analyst remains outside the regressive movement, because it is his duty to prove resistant to countertransference by virtue of his own analysis, suggestion can inherently play no part in the classical procedure of psychoanalytic technique.
It is of historical interest to look back upon the development of psychoanalysis and find that, although the theoretical basis as shown in the essay has never been advanced, the subject of countertransference was unconsciously felt to be the most vulnerable point and the most significant issue in the psychoanalysis. The literature regarding the ‘handling of transference’ easily verifies this statement. Though this postulated immunity to arrested developments in the concept of the analyst’s passivity rightly arose, but was wrongly allowed to be extended to an idea of passivity governing the whole of psychoanalytic technique.
To make transference and its developments the essential difference between a psychoanalysis and all other psycho therapies, making differences as it may define psychoanalytic technique as the only psychotherapeutic method in which compound-to-one-sided, infantile regression - analytic transference - is induced in a patient (analysand), analysed, worked through, and finally solved.
It is the analysis of the transference that is generally acknowledged to be the central feature of analytic technique. Freud regarded transference and resistance as facts of observations, not as conceptual representations. He wrote “ . . . the theory of the psychoanalysis is an attempt to account for two striking and unexcepted facts of observation that emerge whenever we have made an attempt to trace the symptoms of a neurotic back to their sources in his past life: The facts of transference and of resistance . . . anyone who takes up other sides of the problem while avoiding these two hypotheses will hardly escape a charge of misappropriations of property by attempted impersonation, if he persists in calling himself a psychoanalyst.” Rapaport (1967) argued, in his posthumously published paper on the methodology of psychoanalyses, that transference and resistance inevitably follow from the fact that the analyst situation is interpersonal.
Despite this general agreement on the centrality of transference and resistance in techniques, it is that we have not pursued the analyst of the transference as systematically and comprehensively as it could be and should be, in that the relative privacy in which psychoanalysis work makes it impossible to state this view anything more than one or one’s impression. On the assumption that evens if wrong, reviewing issues in the analysis of the transference will be useful and to state several reasons that an important aspect of the transference, namely, resistance to the awareness of the transference, is especially often slighted in analytic practice.
Distinguishing it clearly between two types of interpretation of the transference is first. The one is an interpretation of resistance to the awareness of transference. The other is an interpretation of resistance to the resolution of transference. Greenson had shown the distinction in outline literature (1967) and Stone (1967). We may call the first kind of resistance defence transference. Although that subjectively we have mainly employed a term to refer to a phase of analysis characterized by a general resistance to the transference of wishes, it can also be ill-used for more isolated instances of transference of defence. For its imbounding place of value the containing quality of some construing measures under which has usually been called the second kind of resistance transference resistance. With some oversimplification, one might say that in resistance to the awareness of transference, the transference is what is resisted, whereas in resistance to the resolution of transference, the transference is what does the resisting.
Another descriptive way of stating this distinction between resistance and the awareness of transference and resistance ti the resolution of transference is between implicit and indirect references to the transference and explicit or direct references to the transference. They have intended the interpretation of resistance to awareness of the transference to make the implicit transference explicit, while we have intended the interpretation of resistance to the resolution of transference to make the patient realize that the already explicit transference does include a determinant from the past.
It is also important to distinguish between the general concept of an interpretation of resistance to the resolution of transference and a particular variety of such an interpretation, namely, a genetic transference interpretation - that is, an interpretation of how an attitude in the present is an inappropriate carry-over from the past. While there is a tendency among analysts to deal with explicit references to the transference primarily by a genetic transference interpretation, and there are other ways of working toward a resolution of transference? However, it can be to argue that not only is not enough emphasis being given to interpretation of the transference in the here-and-now, that is, to the interpretation of implicit manifestations of the transference, but also that interpretations intended to resolve the transference as manifested in explicit references to the transference should be primarily in the here-and-now, than genetic transference interpretations.
A patient’s statement that he feels the analyst is harsh, for example, is, at least to begin with, likely best dealt with not by interpreting that this is a displacement from the patient’s feeling that his father was harsh but by an elucidation of another aspect of this here-and-now attitude, such as what has gone on in the analytic situation that seems to the patient to justify his feeling or what was the anxiety that made it so difficult for him to express his feelings. How the patient experiences the actual situation is an example of the role of the actual situation in a manifestation of transference, which will be one of the implicitly major points.
Transference interpretations are here-and-now a genetic transference interpretation, in which is of course exemplified in Freud’s writings and are in the repertoire of every analyst. Nevertheless, they have not distinguished them sharply enough.
Because Freud’s case histories focus much more on the yield of analysis than on the details of the process, they are readily but perhaps incorrectly construed as emphasizing work outside the transference much more than work with the transference, and, even within the transference, emphasizing genetic transference interpretations much more than work with the transference in the here-and-now. The example of Freud’s case reports may have played a role in what is readily considered as a common maldistribution of emphasis in these two respects - not enough on the transference and, within the transference, not enough on the here-and-now.
Before turning within the issues in the analysis of the transference, least of mention, what is a primary reason for a failure to deal adequately with the transference, it is that work with the transference is that aspect of analysis that involves both analyst and patient in the most affect-laden and potentially disturbing interactions. Both participants in the analytic situation are motivated to avoid these interactions. Flight away from the transference and to the past can be a relief to both patient and analyst.
A divisional split in which a discussion will draw into five parts, as: (1) The principle that the transference should be encouraged to expand as much as possible within the analytic situation because the analytic work is best done within the transference: (2) The interpretation of disguised allusions to the transference as a main technique for encouraging the expansion of the transference within the analytic situation: (3) The principle that all transference has a connection with something in the present actual analytic situation: (4) How the connection between transference and the analytic situation is used in interpreting resistance to the awareness of transference, and (5) the resolution of transference within a here-and-now as, the role of genetic transference interpretation.
The importance of transference interpretation will surely be agreeing to by all analysts, the greater effectiveness of transference interpretations than interpretations outside the transference will be agreeing to by many, but what of the relative roles of interpretation of the transference and interpretation outside the transference?
Freud can be read either as saying that the analysis of the transference is auxiliary to the analysis of the neurosis or that the analysis of the transference is equivalent ti the analysis of the neurosis. The first position is stated in his saying that the disturbance of the transference has to be overcome by the analysis of transference resistance to get on with the work of analysing the neurosis. It is also implied in his restatement that the ultimate task of analysis is to remember the past, to fill the gaps in memory. The second position is stated in his saying that the victory must be won on the field of the transference and that the mastery of the transference neurosis “coincides with getting rid of the illness that was originally brought to the treatment.” In this second view, he says that after the resistance is overcome, memories appear without difficulty.
These two different positions also find expression in the two very different ways in which Freud speaks of the transference. In Dynamics of Transference, he refers to the transference, on the one hand, as “the most powerful resistance to the treatment,” but, as doing us, the inestimable service of making the patient’s, . . . immediate impulses and manifest. For when all is said and done, destroying anyone in an absentia is impossible or in effigies. Freud wrote once, in summary: “This is the possible work of the therapeutic process that falls into two phases. In the first, all in the libido is forced from the symptoms into the transference and concentrated there: In the second, the struggle is waged around this new object and the libido is liberated from it.”
The detailed demonstration that he advocated that the transference should be encouraged to expand as much as possible within the analytic situation lies in clarifying that resistance is primarily expressed by repetition, which repetition takes place both within and outside the analytic situation, but that the analyst seeks to deal with it primarily within the analytic situation, that repetition can be not only in the motor sphere (acting) but also in the physical sphere, and that the physical sphere is not confined to remembering but includes the present, too.
Freud’s emphasis that the purpose of resistance is to prevent remembering can obscure his point that resistance shows itself primarily by repetition, whether inside or outside the analytic situation: “The greater the resistance the more extensively willing acting out ( repetition ) replaces remembering.” Similarly in The Dynamics of Transference Freud said, that the main reason that the transference is so well suited to serve the resistance is that the unconscious impulses “do not want to be remembered . . . but endeavour to reproduce themselves . . .” The transference is a resistance primarily as far as it is a repetition.
The point can be restated as for the relation between transference and resistance. The resistance empresses itself in repetition, that is, in transference both inside and outside the analytic situation. To deal with the transference, therefore, is equivalent to dealing with the resistance. Freud emphasized transference within the analytic situation so strongly that it has come to mean only repetition with the analytic situation. Even though, conceptually speaking, repetition outside the analytic situation is transference too, and Freud once used the term that way: “We soon perceive that the transference is itself only a piece of repetition, and that the repetition is a transference of the forgotten past not only onto the doctor but also onto all the other aspects of the current situation. We . . . find . . . the compulsion to repeat, which now replaces the impulsion to remember, not only in his personal attitude to his doctor but also in every other activity and relationship that may occupy his life at the time. . . .”
Realizing that the expansion of the repetition inside the analytic satiation is important, whether or not in a reciprocal relationship to repetition outside the analytic situation, is the avenue to control the repetition: “The main instrument . . . for curbing the patient’s compulsion to repeat and for turning it into a motive for remembering lies in the handling of the transference. We render the compulsion harmless, and indeed useful, by giving it the right to assert itself in a definite field.”
Kanzer has discussed this issue well in his paper on The Motor Sphere of the Transference (1966). He writes of a “double-pronged stick-and-carrot” technique by which the transference is fostered within the analytic situation and discouraged outside the analytic situation. The “stick,” is the principle of abstinence as exemplified in the admonition against making important decisions during treatment, and the ‘carrot’ is the opportunity afforded the transference to expand within the treatment ‘in almost complete freedom” as in a playground?” Every bit as Freud put it: “Provided only that the patient shows compliance enough to respect the necessary conditions of the analysis, we regularly succeed in giving all the symptoms of the illness a new transference meaning and in replacing his ordinary neurosis by a “transference psychoneuroses” of which he can be cured by the therapeutic work.”
The reason that being expressed within the treatment is desirable for the transference is that there, it “is at every point accessible to our intervention.” In a later statement he made the same point this way: We have followed this new edition [the transference-neurosis] of the old disorder from its start, we have observed its origin and growth, and we are especially well able to find our way about in it since, as its object, we are situated at it's very centre’. It is not that the transference is forced into the treatment, but that it is spontaneously but implicitly present and is encouraged to expand there and become explicit.
Freud emphasized acting in the transference so strongly that one can look out over that which repetition in the transference, which of those, is that does not necessarily mean it an id enacted. Repetition need not go as far as motor behaviour. It can also be expressed in attitudes, feedings, and intentions, and, indeed, the repetition often does take such form than motor action. Such repetition is in the psychical rather than the motor sphere. The importance of masking this clear is that Freud can be mistakenly read to mean that repetition in the psychical sphere can only mean remembering the past, as when he writes that the analyst “is prepared for a perpetual struggle with his patient to keep in the psychical sphere all the impulses that the patient would like to direct inti the motor sphere, and he celebrates it as a triumph for the treatment if he can bring it about that something the patient wishes to discharge in action are disposed of through the work of remembering.”
It is true that the analyst’s efforts are to convert acting in the motor sphere into awareness in the psychical sphere, but transference may be in the psychical sphere to begin with, although disguised. The psychical sphere includes awareness in the transference plus remembering.
An objection one hears, from both analyst and patient, to a heavy emphasis on interpretation of associations about the patient’s real life primarily about the transference is that it means the analyst is disregarding the importance of what goes on in the patient’s real life. The criticism is not justified. To emphasize the transference meaning is not to deny or belittle other meanings, but to focus on the one of several meanings of the content that is the most important for the analytic process, for the reasons that were earliest of commenting.
Another way in which interpretations of resistance to the transference can be, or at least appear to the patient to find faults with so important of the patient’s outside life is to make the interpretation as though the outside behaviour is primarily “an-acting out” of the transference. The patient may undertake some actions in the outside world as an expression of and resistance to the transference, that is, acting out. Still the interpretation of associations about actions in the outside world as having implications for the transference embraces to an awakening spark of meaning that can only be that the choice of an outside action figure in associations with the co-determined need to express the transference indirectly. It is because of the resistance to awareness of the transference that the transference has to be disguised. When the disguise is unmasked by interpretation, despite the inevitable differences between the outside situations and the transference situation, the content is clearly the same for the analytic work. Therefore, the analysis of the transference and the analysis of the neurosis coincide. In particular, the advocacy of its analysis is that of the transference for its own sake rather than to overcome the neurosis, Freud wrote that the mastering of the transference neurosis ‘coincides with getting rid of the illness that was originally brought to the treatment’.
The analytic situation itself fosters the development of attitudes with primary determinants in the past, i.e., transferences. The analyst’s keep backs in providence of whose patients are with few and equivocal cues. The purpose of the analytic situation fosters the development of strong emotional responses, and the very fact that the patient has a neurosis means, as Freud said, that“ . . . it is a perfectly normal and intelligible thing that the libidinal cathexis [we would now add negative feelings] of someone who is partly unsatisfied, a cathexis held readies in anticipation, should be directed as well to the figure of the doctor."
While the analytic setup itself fosters the expansion of the transference within the analytic situation, the interpretation of resistance to the awareness of transference will further this expansion.
There are important resistances of both patient and analyst to awareness of the transference. On the patient’s part, this is because of the difficulty in recognizing erotic and hostile impulses toward the very person to whom they have to be mentioned. On the analyst’s part, this is because the patient is likely to attribute the very attitudes that he is most likely to cause him discomfort. The attitudes the patient believes that the analyst has toward him, are often the ones the patient is least likely to voice, in a general sense because of a feeling that it is impertinent for him to concern himself with the analyst’s feelings, and in a more specific sense because the attitude the patient ascribes to the analyst is often the attitude the patient feels the analyst will not like and be uncomfortable about having ascribed to him? The id, consequently that the analyst must be especially alert to the attitudes the patient believes he has, not only to the attitudes the patient does have toward him. If the analyst can see himself as a participant in an interaction, as he will become much more attuned to this important area of transference, which might otherwise escape him.
The investigation of the attitudinal values ascribed to the analyst, who investigation the intrinsic factors in the patient that played a role in such ascriptions. For example, the exposure of the fact that the patient ascribes sexual interest in him to the analyst, and genetically to the parent, makes undemanding the subsequent exploration of the patient’s sexual wish toward the analyst, and genetically the parent.
The resistances to the awareness of these attitudes are responsible for their appearing in various disguises in the patient’s manifest associations and for the analyst’s reluctance to unmask the disguise. The most commonly recognized disguise is by displacement, but identification is an equally important one. In displacement, the patient’s attitudes are narrated as toward a third party. In identification, the patient attributes to himself attitudes are believed the analyst has toward him.
To encourage the expansion of the transference within the analytic situation, the disguises in which the transference appears have to be interpreted. With displacement the interpretation will be of allusions to the transference in associations not manifestly about the transference. This is a kind of interpretation every analyst makes. For identification, the analyst interprets the attitude the patient ascribes to himself as an identification with an attitude he attributes to the analyst. Lipton has recently described this form of disguised allusion to the transference with illuminating illustrations.
Many analysts believe that transference manifestations are infrequent and sporadic at the beginning of an analysis and the patient’s associations are not dominated by the transference unless a transference neurosis has developed. Other analysts believe that the patient’s associations have transference meanings from the beginning and throughout. That is, that those who believe otherwise are failing to recognize the persuasiveness of direct allusions to the transference - that is, what is called a resistance to the awareness of the transference.
In his autobiography, Freud wrote: “The patient remains under the influence of the analytic situation although he is not directing his mental activities onto a particular subject. We will be justified in assuming that nothing will occur to him that has not some reference to that situation.” Since associations are obviously often not directly about the analytic situation, the interpretation of Freud’s remark rests on what he meant by the “analytic situation.”
Freud’s meaning can be clarified by reference to a statement he made in The Interpretation of Dreams. He said that when the patient is told to say whatever comes into his mind, his associations become directed by the “purposive ideas inherent in the treatment” and that there are two such inherent purposive themes, one relating to the illness and the other - concerning which, Freud said, “The patient has “no suspicion”
- relating to the analyst. If the patient has 'no suspicion' of the theme relating to the analyst, the clear implication is that the theme appears only in disguise in the patient’s associations.” Perhaps, Freud’s remark not only specifies the themes inherent in the patient’s associations, but also means that the associations are simultaneously directed by these two purposive ideas, not sometimes by one and sometimes by the other.
One important reason that the early and continuing presence of the transference is not always recognized is that it is considered absent in the patient who is talking freely and apparently without resistances. As Muslin pointed out in a paper on the early interpretation of transference (Gill and Muslin, 1976), resistance to the transference is probably present from the beginning, even if the patient is talking apparently freely. The patient might be talking mostly of some issues not manifestly about the transference that are nevertheless, also allusions to the transference. Nevertheless, the analyst has to be alert to the persuasiveness of such allusions to discern them.
The analyst should continue the working assumption, then, that the patient’s associations have transference implications pervasively. This assumption is not to be confused with denial or neglect of the current aspects of the analytic situation. Giving precedence to a transference interpretation is theoretically always possible if one can discern it through its disguise by resistance. This is not to dispute the desirability of learning as much as one can about the patient, if only to be able to make correct interpretations of the transference. One therefore does not interfere with an apparently free flow of associations, especially early, unless the transference threatens the analytic situation to the point where its interpretation is mandatory rather than optional.
With the recognitions that even the apparently freely associating patient may also be showing resistance to awareness of the transference, the unformidable formulations that one should not interfere if useful information is being gathered should replace Freud’s dictum that the transference should not be interpreted until it becomes a resistance.
Most certain, all analysts would doubtless agree that there are both current and transferential determinants of the analytic situation, and probably no analyst would argue that a transference idea can be expressed without contamination, as it was without any connection to anything current in the patient-analyst relationship. Nevertheless, it would be to believe the implications of this fact for technique are often neglected in practice? Several authors (e.g., Kohut, 1959, Loewald, 1960) have pointed out that Freud’s early use of the term transference in The Interpretation of Dreams, in a connection not immediately recognizable as related to the present-day use of the term, reveals the fallacy of considering that transference can be expressed free of any connection to the present. The early use was to refer to the fact that an unconscious idea cannot be expressed as such, but only as it becomes connected to a preconscious or conscious content. In the phenomenon with which Freud was concerned, the dream, transference took place from an unconscious wish to a day residue. In the Interpretation of Dreams, Freud used the term transference both for the general rule that an unconscious content is expressible only as it becomes transferred to a preconscious or conscious content and for the specific application of this rule to a transference to the analyst. Just as the day residue is the point of attachment of the dream wish, so must there be an analytic-situation residue, though Freud did not use that term, as the point of attachment of the transference.
Analysts have always limited their behaviour, both in variety and intensity, to increase the extent to which the patient’s behaviours are determined by his idiosyncratic interpretation of the analyst’s behaviour. In fact, analysts unfortunately sometimes limit their behaviour so much, as compared within Freud’s mindful intentions, were those in apprehension that are even to any understanding of the entire relationship with the patient is a matter of technique, with no nontechnical personal relations, as Lipton (1977) has pointed out.
However, no matter how far the analyst attempts to carry this limitation of his behaviour, the very existence of the analytic situation gives the patient innumerable cues that inevitably become his rationale for his transference responses. In other words, the current situation cannot be made to disappear - that is, the analytic situation is real. Forgetting this truism in one’s zeal to diminish the role of the current situation in determining the patient’s responses is easy. One can try to keep past and present determinants of been perceptible from one-another, but one cannot obtain either in 'pure culture'. Just as Freud wrote: “I insist on this procedure [the couch], however, for its purpose and result are to prevent the transference from mingling with the patient’s association imperceptibly, to isolate the transference and to allow it to come forwards indue courses sharply defined as a resistance.” Even 'isolate' is too strong a word in the light of the inevitable intertwining of the transference with the current situation.
If the analyst remains under the illusion that the current cues he provides to the patient can be reduced to the vanishing point, he may be led into a silent withdrawal, which is not too distant from the caricature of an analyst as someone who does indeed refuse to have any personal relationship with the patient. What happens then it is the silence that has become a technique rather than merely an indication that the aneled are listening. The patient’s responses under such conditions can be mistaken for uncontaminated transference when they are in fact transference adaptations to the actuality of the silence.
The recognition that all transference must have some relation to the actual analytic situation, from which it takes its point of departure, as it was within a crucial implication for the technique of interpreting resistance to the awareness of transference.
If the analyst becomes persuaded of the centrality of transference and the importance of encouraging the transference to expand within the analytic situation, he has to find the presenting and plausible interpretations of resistance to the awareness of transference he should make? Here, his most reliable distribution of the cues offered by what is going on in the analytic situation: On the one hand, the events of the situation, such as change in time of session, or an interpretation made by the analyst, and, on the other hand, the patient via experiencing the situation as reflected in explicit remarks about it, however fleeting these may be. This is a primary yield for technique of the recognition that any transference must have a link to the actuality of the analytic situation. The cue points to the nature of the transference, just as the day residue for a dream may be a quick pointer to the latent dream thoughts. Attention to the current stimulus for a transference elaboration will keep the analyst from making mechanical transference interpretations, in which he interprets that there are allusions to the transference in associations not manifestly about the transference, but without offering any plausible basis for the interpretation. Attention to the current stimulus also offers some degree of protection against the analyst’s inevitable tendency to project his own views onto the patient, either because of countertransference or because of a preconceived theoretical bias about the content and hierarchical relationship in psychodynamics.
The analyst may be very surprised at what in his behaviour the patient finds important or unimportant, for the patient’s responses will be idiosyncratically determined by the transference. The patient’s response may be something the patient and the analyst considers trivially, because, as in displacement to a trivial aspect of the day residue of a dream, displacement can better serve resistance when it is to something trivial. Because it is connected to conflict-laden materials, the stimulus to the transference may be difficult to find. It may be quickly disavowed. The patient may also gain insight into how it repeats a disavowal earlier in his life. In his search for the present stimulus that the patient is responding to transferential, the analyst must therefore remain alert to both fleeting and apparently trivial manifest reverences to himself and to the events of the analytic situation.
If the analyst interprets the patient’s attitudes in a spirit of seeing their possible plausibility in the light of what information the patient does have, than in the spirit of either affirming or denying the patient’s view, the way is open for their further expression and elucidation. The analyst will be respecting the patient’s effort to be plausible and realistic, than insuring him as manufacturing his transference attitudes out of whole cloth.
To allow of its belief, making a transference interpretation plausible to the patient as for a current state of affairs that is so important, if the analyst is persuaded that the manifest content has an important implication for the transference but he is unable to see a current stimulus for the attitude, he should explicitly say so if he decides to make the transference interpretation anyway. The patient himself may then be able to say what the current stimulus is.
It is sometimes argued that the analyst’s attention to his own behaviour as a precedent for the transference will increase the patient’s resistance to recognizing the transference. On the contrary, the inevitable interrelationship of the current and transferential determinants, it is only through interpretation that they can be disentangled.
It is also argued that one must wait until the transference has reached optimal intensity before it can be advantageously interpreted. It is true that too hasty and interpretation of the transference can serve a defensive function for the analyst and deny him the information he needs to make a more appropriate transference interpretation. Nevertheless, it is also true that delay in interpreting runs the risk of allowing an unmanageable transference to develop. It is, again, trued that deliberate delay can be a manipulation in the service of the abreaction rather than the analyst and, like silence, can lead to a response to the actual situation mistaken for uncontaminated transference. Obviously important issues of timing are involved. Justly, as an important clue to when a transference interpretation is aptly which one to make lies in whether intolerable and patient virtues can make the interpretation plausibly about the determinants current analytic situations.
A critic of an earlier version of these issues was in saying, that all the analysts need do is to interpret the allusion to the transference. Nevertheless, that, least of mention, leaves one in not because interpretation of why the transference had to be expressed by allusion than directly is also necessary, of course, that is to say, when the analyst approaches the transference in the spirit of seeing how it appears plausibly realistic to the patient, it paves the way toward its furthering elucidation and expression.
Freud’s emphasis on remembering as the goal of the analytic work implies that remembering is the principle avenue to the resolution of the transference. Yet his delineation of the successive steps in the development of analytic technique makes clear that he saw this development as a change from an effort to reach memories directly to the use of the transference as the necessary intermediary to reaching the memories.
In contrast to remembering as the way negativity ad positivity has resolved the transference, Freud also described Resistances as primarily overcome in the transference, with remembering following easily after that: ‘From the repetition reactions exhibited in the transference regainfully to employ of what has led us along the familiar paths to the awakening of the memories, which appear without difficulty, and as it was, after the resistance has been overcome’, and ‘This revision of the process of repression can be accomplished only in part concerning the memory traces of the process that led to repression. The decisive part of the work is achieved by creating in the patient’s relation to the doctor - in the ‘transference’ - new editions of the old conflicts . . . Thus the transference becomes the battlefield on which all the mutually struggling forces should meet another. This is primary insight Styrachey (1934) cast off light on out in his seminal paper on the therapeutic action of the psychoanalysis.
There are two main ways in which resolution of the transference can take place through work with the transference before us and now. The first lies in the clarification of what are the cues in the current situation that are the patient’s point of departure for a transference elaboration. The exposure of the current point of departure at once raises the question of whether it is adequate to the conclusion drawn from it. The relating of the transference to a current stimulus is, after all, parts of the patient’s effort to make the transference attitude plausibly determined by the present. The reserve and ambiguity of the analyst’s behaviour are what increases the ranges of apparently plausible conclusions the patient may draw. If an examination of the basis for the conclusion makes clear that the actual situation to which the patient responds is subject to other meanings than the one the patient has reached, he will more readily consider his pre-existing bias, that is, his transference.
Another critic of an earlier version suggestively sights that in speaking of the current relationship and the relation between the patient’s conclusions and the information on which they seem plausibly based is to imply of some absolute conception of what is real in the analytic situation, of which the analyst is the final arbiter. This is not so. In what the patient must come to see is that the information he has is subject to other possible interpretations implies the contrariety to an absolute conception of reality. In fact, analyst and patient engage in a dialogue in the spirit of attempting to arrive at a consensus about reality, not about some fictitious absolute reality.
The second way in which resolution of the transference can take place within the work with the transference in the here-and-now is that in the very interpretation of the transference the patient has a new experience. He is being treated differently from how he expected to be. Analysts seem reluctant to emphasize this new experience, as though it endangers the role of insight and argues for interpersonal influence as the significant factor in change. Strachey’s emphasis on the new experience in the mutative transference interpretation has unfortunately been overshadowed by his views on introjection, which have been mistakes to advocate manipulating the transference, Styrachey meant introjection of the more benign superego of the analyst only as a temporary step on the road toward insight. Not only is the new experience not to be confused with the interpersonal influence of a transference gratification, but the new experience occurs with insight into both the patient’s biassed expectation and the new experience. As Styrachey points out, what is unique about the transference interpretation is that insight and the new experience take place in relation to the very person who was expected to behave differently, and it is this that gives the work in the transference its immediacy and effectiveness. While Freud did stress the affective immediacy of the transference, he did not make the new experience explicit.
Recognizing that transference is not a matter of experience is important, in contrast to insight, but a joining of the two together. Both are needed to cause and maintain the desired changes in the patient. It is also important to recognize that no new techniques of intervention are required to provide the new experience. It is an inevitable accompaniment of interpretation of the transference in the here-and-now. It is often overlooked that, although Styrachey said that only transference interpretation was mutative, he also said with approval, that most of all interpretations are outside the transference.
In a further explication of Strachey’s paper and entirely consistent with his position, Rosenfeld (1972) has pointed out that clarification of material outside the transference is often necessary to know what is the appropriate transference interpretation, and that both genetic transference interpretations and extra-transference interpretations play an important role in working through. Styrachey said little about working through, but surely nothing against the need for it, and him explicitly recognized a role for recovery of the past in the resolution of the transference.
Following, a needed explanation is to emphasis, and the role of the analysis of the transiency in the here-and-now, both in interpreting resistance to the awareness of transference and in working toward its resolution by relating to the actuality of the situation, one must pay heed to that of an extra-transference and genetic transference interpretations and, of course, working through is important too. The matter is one of emphasis in the interpretation of resistance to awareness of the transference and should figure in most of sessions, and that if this is done by relating the transference to the actual analytic situation, the very same interpretation is a beginning of work to the resolution of the transference. To justify this view more persuasively would require detailed case material.
It may be considered that siding with the Kleinians who, many analysts feel, are in error of giving the analysis of the transference too great if not even an exclusive role in the analytic process. It is true that Kleinians emphasize the analysis of the transference more, in his writings at least, than does the general run of analysts. Indeed, Anna Freud’s (1968) complaint that the concept of transference has become overexpanded may be directed against the Kleinians. One of the reasons the Kleinians consider themselves the true followers of Freud in techniques are precisely because of the emphasis they put on the analysis of the transference. Hanna Segal (1967), for example, writes as follows: ‘To say that all communications are seen as communications about the patient’s phantasy and current external life is equivalent to saying that all communications contain something used for the transference situation. In Kleinian technique, the interpretations of the transference are often more central than in the classical technique’.
Despite their disclaimer to the contrary, many Kleinian case materials directively lead one to agree with what is believed is the general view that Kleinian transference interpretations often deal with so-called deep and genetic material without adequate connection to the current features of the present analytic situation and thus differ sharply from the kinds of transference interpretations advocated in present case.
The insistence on exclusive attention to any particular aspect of the analytic process, like the analysis of the transference in the here-and-now, can become a fetish. However, in that other kinds of interpretations should not be made, but in feeling to an emphasis on the transference interpretations within the analytic situation needs to be increased, or at the least reaffirmed, and that we need more clarification and specification on just when other kinds of interpretations are in order.
Of course, making a transference interpretation is sometimes tactless. Surely two reasons that would be included in a specification of the reasons for not making a particular transference interpretation, even if one seems to the analyst, would be preoccupation with an important extra-transference event and an inadequate degree of rapport, to user Freud’s term, to sustain the sense of criticism, humiliation, or other painful feeling the particular interpretation might engender, though the analyst had no intention of evoking such a response. The issue may be, however, not of whether or not an interpretation of resistance to the transference should be made, but whether the therapist can find that transference interpretation that in the light of the total situation, both transferential and current, the patient can hear and benefit from primarily as the analyst intends it.
Transference interpretations, like extra-transference interpretations, are, indeed, like any behaviour on the analyst’s part, can affect the transference, which in turn needs to be examined if the result of an analysis is to depend as little as possible on unanalyzed transference. The result of any analysis depends on the analysis of the transference, persisting effects of unanalysed transference, and the new experience as the unique merit of transference interpretation in the here-and-now. Remembering this is especially important lest one’s zeal to search out the transference itself becomes an unrecognized and objectionable actual behaviour on the analyst’s part, with its own repercussions on the transference.
The emphasis placed on the analysis of resistance to the transference could easily be misunderstood as implying that recognizing the transference is always easy as disguised by resistance or that analysis would go on without a hitch if only such interpretations are made. However, to imply of neither, but rather than the analytic process will have the best chance of success if correct interpretation of resistance to the transference and work with the transference in the here-and-now are the core of the analytic practicality is of less than is a meaningful term as an academic term.
These points mentioned are not new, however, they are present in varying degrees of clarity and emphasis throughout our literature, but like so many other aspects of psychoanalytic theory and practice, they fade in and out of prominence and are rediscovered repeatedly, possibly occasionally in the accompaniment with some modest conceptual advance, but often with a newness attribution only to ignorance of past contributive dynamic functions. Yet, our investigations are to occupy a certain position of continency.
Although, few current problems are concerning the problem of transference that Freud did not recognize either implicitly or explicitly in the development of this theoretical and clinical framework. For all essential purposes, moreover, his formulations, in spite of certain shifts in emphasis, remain integral to contemporary psychoanalysis theory and practice. Recent developments mainly concern the impact of an ego-psychological approach: The significance of object relations, both current and infantile, external and internal, the role of aggression in mental life, and the part played by regression and the repetition compulsion in the transference. Nevertheless, analysis of the infantile Oedipal situation in the setting of a genuine transference neurosis is still considered a primary goal of psychoanalysis procedure.
Originally, transference was ascribed to displacement onto the analyst of repressed wishes and fantasies derived from early childhood. The transference neurosis was viewed as a compromise formation similar to dreams and other neurotic symptoms. Resistance, defined as the clinical manifestation of resistance, could be diminished or abolished by interpretation mainly directed toward the content of the repressed. Transference resistance, both positive and negative, was ascribed to the threatened emergence of repressed unconscious material in the analytic situation. Soon, with the development of a structural approach, the superego-described as the heir to the genital Oedipal situation was also recognized as playing a leading part in the transference situation. The analyst was subsequently viewed not only as the object by displacement of infantile incestuous fantasies, but also as the substitute by projection for the prohibiting parental figures internalized as the definitive superego. The effect of transference interpretation in mitigating undue severity of the superego has, therefore, been emphasized in many discussions of the concept of transference.
Certain expansions in the structural approach directly to increased recognition of the role of early object relations in the development of both ego and superego has affected current concepts of transference. As for this, the significance of the analytic situation as a repetition of the early mother-child relationship has been stressed from different points of view. An equally important development relates to Freud’s revised concept of anxiety which not only led to theoretical developments in the field of ego psychology, but also caused related clinical changes in the work of many analysts. As a result, attention was no longer mainly focussed on the content of the unconscious. In addition, increasing importance was attributed to the defensive processes by means of which the anxiety that would be engendered if repression and other related mechanisms were broken down, was avoided in the analytic situation. Differences in the interpretation of the role of the analyst and the nature of transference developed from emphasis, on the one hand, on the importance of early object relations, and on the other, from primary attention to the role of the ego and its defences. These defences first emerged clearly in discussion of the technique of child analysis, in which Melanie Klein and Anna Freud, the pioneers in this field, played leading roles.
From a theoretical point of view, discussion foreshadowing the problems that faced up today was presented in 1934 in well-known papers by Richard Sterba and James Styrachey, and further elaborated at the Marienbad Symposium at which Edward Bibring made an important contribution. The importance of identification with, or introjection of, the analyst in the transference situation was clearly imitated. Therapeutic results were attributed to the effect of this process in mitigating the need for pathological defences. Styrachey, however, considerably influenced by the work of Melanie Klein, regarded transference as essentially a projection onto the analyst of the patient’s own superego. The therapeutic process was attributed to subsequent introjection of a modified superego because of ‘mutative’ transference interpretation. Sterba and Bibring, on the other hand, intimately involved with development of the ego-psychological approach, emphasized the central role of the ego, postulating a therapeutic split and identification with the analyst as an essential feature of transference. To some extent, this difference of opinion may be regarded as semantic. If the superego is explicitly defined as the heir of the genital Oedipus conflict, then earlier systemic conflicts within the ego, although they may be related retrospectively to the definitive superego, must, nevertheless, is defined as contained within the ego, although they may be related retrospectively to the definitive superego, must, nevertheless, be defined as contained within the ego. Later divisions within the ego of the type suggested by Sterba and very much expanded by Edward Bibring in his concept of therapeutic alliance between the analyst and the healthy part of the patient’s ego, must also be excluded from superego significance. In contrast, those who attribute pregenital intra-system conflicts within the ego primarily to the introjection of objects, consider that the resultant state of internal conflict appears similar in all dynamic respect the situation seen in later conflicts between ego and superego. They, therefore, believe that these structures develop simultaneously and suggest that no sharp distinction should be made between pre-oedipal, oedipal, and a post-oedipal superego.
The differences, however, are not entirely verbal, since those who attribute superego formation to the early months of life tend to attribute some significance too early object relations that differ from the conception of those who stress control and neutralization of instinctual energy as primary functions of the ego. This theoretical difference necessarily implies some disagreement as to the dynamic situation both in childhood and in adult life, inevitably reflected in the concept of transference and in hypotheses as to the nature of the therapeutic process. From one point of view, the role of the ego is central and crucial at every phase of analysis. A differentiation is made between transference as therapeutic alliance and the transference neurosis, which, is considered as the manifestation of resistance. Effective analysis depends on a sound therapeutic alliance, a prerequisite for which is the existence, before analysis, of a degree of mature ego functions, the absence of which in them certain severely disturbed patiently and in young children may preclude traditional psychoanalytic procedure. Whenever indicated, interpretation must deal with transference manifestation, which mans, in effect, that the transference must be analysed. The process of analysis, however, is not exclusively ascribed to transference interpretations. Other interpretations of unconscious material, whether related to defence or too early fantasy, will be equally effective provided they are accurately timed and provided a satisfactory therapeutic alliance has been made. Those, in contrast, who stress the importance of early object relations emphasize the crucial role of transference as an object relationship, distorted though this may be by a variety of defences against primitive unresolved conflicts. The central role of the ego, both in the early stages of development and in the analytic process, are definitely accepted, the nature of the ego is, however, considered determined by its external and internal objects. Therapeutic progress indicated by changes in ego function results, therefore, primarily from a change in object relations through interpretation of the transference situation. Less differentiation is made between transference as therapeutic alliance and the transference neurosis as a manifestation of resistance. Therapeutic progress depends almost exclusively on transference interpretation. Other interpretations, although indicated at times, are not, in general, considered an essential feature of the analytic process. From this point of view, the pre-analytic maturity of the patient’s ego is not stressed as a prerequisite for analysis: Children and relatively disturbed patients are considered potentially suitable for traditional psychoanalytic procedure.
These differences in theoretical orientation are not only reflected in the approach to children and disturbed patients. They may also be recognized in significant variations of technique in respect to all clinical groups, which inevitably affect the opening phases, understanding of the inevitable regressive features of the transference neurosis, and handling of the terminal phases of analysis. The unavoidedly derailed discussions of controversial theory, its natures of early ego development are arbitrary in the differentiations between those who related ego analysis and the analysis of defences and those who stress the primary significance of object relations are referred in the transference, and in the developments inferred as the definitive structure of the ego. Of course, this involves some oversimplifications, least of mention, which will importantly to an analysis of patient suitability toward the classical analytic procedure.
- the transference neurosis. Those who emphasis the role of the ego and the analysis of defence, not only maintain Freud’s conviction that analysis should continue from a surface to depth, but also consider that early materials in the analytic situation drives, usually, from defensive processes than from displacements onto the analyst of early instinctual fantasies. Deep transference interpretation in the early phases of analysis will, therefore, be meaningless to thee patient since its unconscious significance is so inaccessible either, or, if the defence’s ae precarious, will lead to premature and possibly intolerable anxiety. Premature interpretation of the equally unconscious automatic defensive processes by means of which instinctual fantasy has been kept unconsciously is also ineffective and undesirable. There are, however, differences of opinion within this group, about how far analysis of defence can be separated from analysis of contents. Waelder, for example, stresses the impossibility of such separation. Fernichel, however, considered that at least theocratical separation should be made and shown that, as far as possible, analysis of defence should precede analysis of unconscious fantasy. It is, nevertheless, generally agreed that the transference neurosis develops, as a rule, after ego defences have been sufficiently undermined to mobilize previously handled instinctual conflict. During both the early stages, and at frequent points after the development of the transference neurosis, defence against the transference will become a main feature of the analytic situation.
This approach, is based on certain definite premises regarding the nature and dynamic function of the ego in respect to the control and neutralization of instinctual energy and unconscious fantasy. While the importance of early object relations is not neglected, the conviction that early transference interpretation is ineffective and potentially dangerous is related to the hypothesis that the instinctual energy available to the mature ego has been neutralized and is, for all effective purposes, relatively or absolutely divorced from its unconscious fantasy meaning at the beginning of analysis. In contrast, there are many analysts of differing theoretical orientation who do not view the development of the mature ego as a relative separation of ego functions from unconscious sources, but consider that unconscious fantasy continues to operate in all conscious mental activity. This analyst also tends to emphasize the crucial significance of primitive fantasy in respect to the development of the transference situation. The individual entering analysis will inevitably have unconscious fantasies concerning the analyst derived from primitive sources. This material, although deep in one sense, is, nonetheless, strongly current and accessible to interpretation. Mrs. Klein, in addition, relates the development and definitive structure of both ego and superego to unconscious fantasy determined by the easiest phases of object relationships. She emphasis the role of early introjective and projective processes in relation to primitive anxiety ascribed to the death instinct and related aggressive fantasies. The unresolved difficulties and conflict of the earliest period continue to colour object relations throughout life. Failure to achieve an essentially satisfactory object relationship in this early period, and failure to master relative loss of that object without retaining its good internal representative, will not only affect all object relations and definitive ego function, but more specifically determine the nature of anxiety-provoking fantasies on entering the analytic situation. According to this point of view, therefore, early transference interpretation, though it may relate to fantasies derived from an early period of life, should result not in an increased, but a decrease of anxiety.
In considering next problems of transference in relation to analysis of the transference neurosis, two main points must be kept in mind. First: Those who emphasize the analysis of defence tend to make a definite differentiation between transference as therapeutic alliance and the transference neurosis as a compromise formation that serves the purposes of resistance. In contrast, those who emphasize the importance of early object relations view the transference primarily as a revival or repetition, sometimes attributed to symbolic processes of early struggles in respect to objects. Yet, no sharp differentiations are made between the early manifestations of transference and the transference neurosis. In view, moreover, of the weight given to the role of unconscious fantasy and internal objects in every phase of mental life, healthy and pathological functions, though differing in essential respects, do not differ as for their direct dependence on unconscious sources.
In the second place, the role of regression in the transference situation is subject to wide differences of opinion. It was, of course, one of Freud’s earliest discoveries that regression to earlier points of fixation is a cardinal feature, not only in the development of neurosis and psychosis, but also in the revival of earlier conflicts in the transference situation. With the development of the psychoanalysis and its application of experience, an ever increasing range of disturbed personalities, the role of regression in the analytic situation had received increased attention. The significance of the analytic situation for fostering regression as a prerequisite for the therapeutic work has been emphasized by Ida Macalpine in a recent paper of differing opinions as to the significance, value, and technical handling of regressive manifestations from the basis of important modifications of analytic technique, in respect, however, to the transference neurosis, the view recently expressed by Phyllis Greenacre, in that regression, an indispensable feature of the transference situation, is to be resolved by traditional technique would be generally accepted. It is also a matter of general agreement that a prerequisite for successful analysis is revival and repetition in the analytic situation of the struggles of primitive stages in the developmental distributives of contributory dynamic functionalities. Those who bring out defence analysis, however, tend to view regression as a manifestation of resistance: As a primitive mechanism of defence employed by the ego in the setting of the transference neurosis. Analysis of these regressive manifestations with their dangers depends on the existing and continued functioning of adequate ego strength to maintain therapeutic alliance at an adult level, those, by contrast, who stress the significance of transference as a revival of the early mother-child relationship does not place emphasis on regression as an indication of resistance or defence. The revival of these primitive experiences in the transference situation is, in fact, regarded as an essential prerequisite for satisfactory psychological maturation and true genitality. The Kleinian schools, as already showed, stress the continued activity of primitive conflicts in determining essential features of the transference at every stage of analysis. Their increasingly overt revival in the analytic situation, therefore, signifies a deepening of the analysis, and in general, is regarded as an indication of diminution than an increase of resistance. The dangers involved according to this point of view are determined more by failure to mitigate primitive anxiety by suitable transference interpretation, than by failure to achieve, in the early phases of analysis, a sound therapeutic alliance based on the maturity of the patient’s essential ego characteristics.
Briefly considering the terminal phases of analysis. Many unresolved problems concerning the goal of therapy and definition of a completed psychoanalysis must be kept in mind. Distinction must also be made between the technical problems of the terminal phase and evaluation of transference resolution after the analysis has been ended. There is widespread agreement as to the frequent revival in the terminal phases of primitive transference manifestations apparently resolved during the earthly phase of analysis? Balint, and those accept Ferenczi’s concept of primary passive love, suggest that some gratifications of primitive passivity need be the essentially successive in succeeding by its end. To Mrs. Klein the terminal phases of analysis also represent a repetition of important features of the early mother-child relationship. According to her point of view, this point represents, in essence, a revival of the early weaning situation. Completion depends on a mastery of early depressive struggles culminating in successful introjection of the analyst as a good object. Although, as for this, emphasis differs considerably, it should be noted that those in whom stress the importance of identification with the analyst as a basis for therapeutic alliance, also accept the inevitability of some permanent modifications of a similar nature. Those, however, who make a definite differentiation between transference and the transference neurosis stress the importance of analysis and resolution of the transference neurosis as a main prerequisite for a successful end. The identification based on therapeutic alliance must be interpreted and understood, particularly about the reality aspects of the analyst’s personality. In spite, therefore, of significant important differences, there are, as already showed about the earlier papers of Sterba and Styrachey, important points of agreement in respect to the goal of the psychoanalysis.
Differences already considered, as far as discussions have permitted of a limited variation within the framework of a traditional technique, nonetheless, we are drawn to consider problems related to overt modifications in due consideration as a preliminary to classical psychoanalyses, and modification based on changes in basic approach, lead to significant alterations regarding both the method and to the aim of therapy.
It is generally agreed, that some variations of technique are shown in the treatment of certain character neurosis, borderline patients, and the psychoses. The nature and meaning of such changes are, however, viewed differently according to the relative emphasis placed on the ego and its defences, on underling unconscious conflicts, and on the significance and handling of regression in the therapeutic situation. In Analysis Terminable and Interminable, Freud suggested, that certain ego attributes may be inborn or constitutional and, therefore, probably inaccessible to psychoanalytic procedure. Hartmann has suggested that beyond these primary attributes, other ego characteristics, originally developed for defensive purposes, and the related neutralized instinctual energy at the disposal of the ego, may be relatively or absolutely divorced from unconscious fantasy. This not only explains the relative inefficacy of early transference interpretation, but also hints on the possible limitations in the potentialities of analysis attributable to secondary autonomy of the ego considered being irreversible. In certain cases, moreover, it is suggested that analysis of precarious or seriously pathological defences - particularly those concerned with the control of aggressive impulses - may not only be ineffective, but dangerous. The relative failures of ego development in such cases not only preclude the serious regressive, often predominantly hostile transference situations. In certain cases, therefore, a preliminary period of psychotherapy is recommended to explore the capacities of the patient to tolerate a traditional psychoanalysis. In others, as Robert Knight, in his paper on borderline states, and as many analysts working with psychotic patient has suggested. Psychoanalytic procedure is not considered applicable. Instead, a therapeutic approach based on analytic understanding that, in essence, uses an essentially implicit positive transference for reinforcing, than analysing the precarious defences of the individual, is advocated.
In contrast, Herbert Rosenfeld has approached even severely disturbed psychotic patients with small modifications of psychoanalytic technique. Only changes that the severity in therapy is not emphasized since primitive fantasy is considered active under all circumstances. The most primitive period is viewed as early object relations with special stress on prosecutory anxiety related to the death instinct. Interpretations of this primitive fantasy in the transference situation, is considered to diminish rather than to increase psychotic anxiety and offer the best opportunity of strengthening the severely threatened psychotic ego. Other analysts, Dr. Winnicott, for example, an attribute psychosis mainly to severe traumatic experiences, particularly of deprivation in early infancy. According to this view, profound regression offers an opportunity to fulfil, in the transference situation, primitive needs that had not been met at the appropriate level of development. Similar suggestions have been proposed by Margolin and others, in the concept of anaclitic treatment of serious psychosomatic disease. This approach is also based on the premise that the inevitable regression shown by certain patients should be used in therapy, for gratifying, in an extremely permissive transference situation, demands that had not been met in infancy. It must, for this, be of note, that the gratifications recommended in the treatment of severely disturbed patients are determined by the conviction that these patients are incapable of developing transference as we understand it in connection with neurosis and must therefore be handled by a modified technique?
The opinions so far considered, is, nonetheless a great deal more than they may differ in certain respects, are nonetheless all based on the fundamental premise that an essential difference between analysis and other methods of therapy depends on whether interpretation of transference is an integral feature of technical procedure. Results based on the effects of suggestion are to be avoided, as far as possible, whenever traditional technique is employed. This goal has, nonetheless, proved more difficult to achieve. Freud expected when he first discerned the significance of symptomatic recovery based on positive transference. The importance of suggestion, even in the most strict analytic methods, has been repeatedly stressed by Edward Glover and others. Widespread and increasing emphasis as to the part played by the analyst’s personality in determining the nature of the individual transference also implies recognition of unavoidable suggestive tendencies in the therapeutic process. Many analysts today believe that the classical conception of analytic objectivity and anonymity cannot be maintained. Instead, thorough analysis of reality aspects of the therapists personality and point of view are able prerequisite for the dynamic changes already discussed in relation to the end of analysis. It thus remains the ultimate of the psychoanalysis, whatever their theoretical orientation, to avoid, as far as is humanly possible, results based on the unrecognized or unanalysed action of suggestion, and to maintain, as a primary goal, the resolution of such results through consistent and careful interpretation.
There are, however, many therapists, both within and outside the field of the psychoanalysis, who consider that the transference situation should not be handled only or mainly as a setting for interpretation even in the treatment or analysis of neurotic patients. Instead, they advocate use of the transference relationship for the manipulation of corrective emotional experience. The theoretical orientation of those using this concept of transference may be closer to, or more distant form, a Freudian point of view according to the degree to which current relationships are seen as determined by past events. At one extreme, current aspects and cultural factors are considered very important: At the other, mental development is viewed to inherent limitations of the analytic method rather than to essentially changed conceptions of the early phases of mental development. Of this group, Alexander is perhaps the best example. It is thirty years since, in his Salzburg paper, he suggested the tendency for patients to regress, even after apparently successful transference analysis of the oedipal situation to narcissistic dependent pregenital levels that prove stubborn nd refractory to transference interpretation, in his more recent work, the role of regression in the transference situation has been increasingly stressed. The emergence and persistence of dependent, pregenital demands’ in a very wide range of clinical conditions, it is arguably suggested that the encouragement of a regressive transference situation is undesirable and therapeutically ineffective. The analyst, therefore, should when threatens adopt a definite role explicitly differing from the behaviour of the parents in early childhood on order to cause therapeutic results through a corrective emotional experience in the transference situation. This, it is suggested, will prevent the tendency to regression, thus curtailing the length of treatment and improving therapeutic results. Limitation of regressive manifestations by active steps modifying traditional analytic procedure in a variety of ways is also frequently suggested, according to this point of view.
To those who clearly maintain the conviction that interpretation of all transference manifestation remain an essential feature of the psychoanalysis, the type of modification presently described, though based on a Freudian reconstruction of the early phases of mental development, represents as major modification. It is determined by a conviction that psychoanalysis, as a therapeutic method, has limitations related to the tendency to regression, which cannot be resolved by traditional technique. Moreover, the fundamental premise on which the conception of corrective emotional experience is based minimizes the significance of insight and recall. It is, essentially, suggested that corrective emotional experience alone may cause qualitative dynamic alternations in mental structure, which can lead to a satisfactory therapeutic goal. This implies a definite modification of the analytic hypothesis those current problems are determined by the defences against instinctual impulses and internalized objects that had been set up during the decisive periods of early development. An analytic result therefore is depending on the revival, repetition and mastery of early conflicts if the current experience on the transference situation with insight an indispensable feature of an analytic goal.
Since certain important modifications are applicable concepts latent upon the regression of the transference situation, it should be to believe that to consider this concept in relation to the repetition compulsion, that transference is essentially a revival of earlier emotional experiences, much of which can be related as a manifestation of the repetition compulsion that is generally accepted. Distinguishing it between repetition on compulsion as an attempt to master traumatic experience and repetition compulsion as an attempt to return to a real or fantasied earlier state of rest or gratification is, however, necessary. Lagache, in a recent paper, announced that the repetition compulsions to an inherent need to regress back to any problem that had previously been left unsolved, in that, from this point of view, the regressive aspects of the transference situation are to be regarded as a necessary preliminary to the mastery of unresolved conflict. From the second point of view, however, the regressive aspects of transference are mainly attributed to a wish to return to an earlier state of rest or narcissistic gratification, to the maintenance of the status quo instead of any progressive action, and finally, to Freud’s original conception of the death instinct. There is a good deal to suggest that both aspects of the repetition compulsion may be seen in the regressive aspects of every analysis. To those who feel that regressive self-destructive forces tend to be stronger than progressive libidinal impulses, the potentialities of the analytic approach will be limited. Those, by contrast, who regard the reappearance in the transference situation of earlier conflicts as an indication of tendencies to master and progress will continue to feel that the classical analytic method remains the optimal approach to psychological illness wherever it is applicable.
In the attemptive efforts in trying to show an outline in some current problems of transference both in relation to the history of psychoanalytic thought and in relation to the theoretical premises on which they are based. In that, regarding contemporary views that advocate serious modifications of analytic technique, it cannot be to improve in the remarks made by Ernest Jones, in his Introduction to the Salzburg Symposium thirty years ago. Depreciation of the Freudian (infantile) factors at the expense of the pre-Freudian, 'pre-infantile' and 'post-infantile', is a highly characteristic manifestation of the general human resistance against the former, being usually a flight from the Oedipus conflict that is the centre of infantile factors. We also can note that in the practice to showing a psychoanalysis it really does not always insure immunity from this reaction. With regard, to the important problems that arise from genuine scientific differences within the framework of traditional technique, the focussing of issues for discussion by emphasizing as objectively as possible divergence rather than agreement. All of which, by which the primary importance of transference analysis may have accepted as significant modifications of traditional technique as either shortening analysis or accepting a modified analytic goal, as to the basic importance of understanding the significance and dangers of countertransference manifestations. Unfortunately, however, this vitally important unconscious reaction is not limited to the individual analytic situation. It may also be aroused in respect to scientific theories both within and outside our special fields of knowledge. Therefore, resolutions of the individual transference situation depend on the analyst’s understanding of his own countertransference, so too, similar insight and objectivity on a wider scale may determine of the problems outlined above.
In a balanced way, we, once, again, point out Freud’s statement, as he writes regarding transference resistance: Thus, the solution of the puzzle is that transference to the doctor is suitable for resistance to the treatment only in as far as it is a negative transference or a positive transference of repressed erotic impulses. If we ‘remove’ the transference by making it conscious, we are detaching only those two components of the emotional set from the person of the doctor, the other component, which is admissible consciousness and unobjectionably, persists and is the vehicle of success in the psychoanalysis exactly as it is in other methods of Treatment (1912).
The “negative transference” and “positive transference of repressed impulses” have generally been accepted as sources of resistance, although we have come to recognize that “removing” they by making them conscious are much more difficult than it sounds. However, most of us have no doubts about the necessity of resolving them to a considerable extent, even if we are not so optimistic about being able to ‘remove’ them. How often we do all we can in this respect is open to question.
Strictly speaking, our attentions will personify to what Freud called ‘the other component', which is admissible to consciousness and unobjectionable, persists and is the vehicle of success in analysis. . . . “On the face of it, assuming that there is some is reasonable enough factors that allow the patient to begin work and to continue to cooperate during analysis, and that this factor bears some relation to the positive transference, without, however, being clearly based on ‘repressed erotic impulses.”
Inevitably, this brings us to question how we are first to cultivate this component, which is essential for the success of the analysis, what is to be done with it as the analysis ends, and how we may recognize and understand the origins, development, and meaning of this useful, even essential component. The answer to the latter question, is basically by no clear means. This positive component has hardly been neglected in the literature and in clinical work, but we may question whether it has been subjected to the same degree of analytic scrutinies as have other elements of the transference. It has been exploited most obviously by those who developed the concept of the 'alliance' between patient and analyst, for example, Greenson (1967) and Zetzel (1970). Greenson emphasized that the working alliance is indeed part of the transference, just when contrasting it with the full-blown transference neurosis, also he sees them as parallel antithetical forces in the analysis. Elsewhere, he refers to ‘transference reactions, a working alliance and [the] real relationship’.
Greenson and Zetzel are not alone or even in a minority in considering some concept such as the working alliance integral to our understanding of the therapeutic process in analysis. There are many variants: Erikson’s (1959) ‘basic trust’, many references to ‘rapport’, and the like. One way or another they all are related to Freud’s “unobjectionable” component, although we may conclude that their true sources are far more ancient.
For appropriate reasons, the terms working alliance and therapeutic alliance have entered the common idiomatic expression of analysis and perhaps make more even the variants of analysis classed as psychotherapy. A positional claim to which it can seem as generally stated that an adequate alliance is a prerequisite for successful therapy, which on them face of it might seem unquestionable. Of course, the patient must be willing to manage to do his best to conform to the behavioural demands of the treatment, to come to the analyst’s office with some regularity, to talk as transparently honest as he can, to make a payment of his bills and generally to show that he and the analyst have some goals in common. If, on the other hand, he behaves in a way that made the analysis impossible, we could lay claim to an adequate alliance that was never established or, if it were, not maintained. Nevertheless, if all goes smoothly, we might congratulate ourselves onto the support of a good working alliance.
A finer calibrated accompaniment with Brenner (1979) and Curtis (1979), and others a serious concern about the usefulness of the concept and the adherent direction and, even more, about its capacity to be misleading by encouraging the blurring of important transference elements and impeding our search for the nature of the ‘unobjectionable’ component, to which, Freud referred.
In particular, when patients express, as they go on expressing their transference to feelings, predominantly positive, respectful, and sometimes affectionate, employ the very effective devices of selfly limited and only rarely deeply disturbing episodic events to experiences, often dispose of their necrotic symptoms within a few months of beginning analysis, and they go on annualizing just as eagerly as before. Resistance is expressed with silences, usually not at all, to a very prolonged, on one side of a complaint, not factually insufferable, or by acting out, not particularly disruptive. One condition, however, does not change. These attractive people may be married or single, living with a lover or alone. Nevertheless, they are not in love and doubt the capacity for passionate sexuality. There may be affectionate, but sexual intensities seem strangely distant and lacking in these otherwise sensitive and often loving individuals.
In them, at any rate, the transference neurosis is very highly developed, taking on distinctly oedipal forms: It is powerfully defended by these patients, who show in their characteristics of brilliant, charming, and precocious children, who of a superficial level appear very mature. The main current of their sexuality becomes directed into the analysis, turning the process into a kind of exciting, yet innocent, liaison. When this transference neurosis is brought to these patients’ attention, that is, interpreted for what it is, the reaction is likely to be dramatic: Most often they become anxious and depressed, experience great difficulty in associating, stop remembering dreams, and may be inclined to engage in acting out. This may be the one area of interpretation that produces a distinct reaction of anger and some distress. The analysis is no longer such an unalloyed pleasure, and one almost regrets having introduced the subject. After all, the machine had been running so smoothly.
The commonality is that of a highly intelligible combination of developed ego and super-ego organization, the use of sophisticated and effective defences and a history of having established a well-developed oedipal organization, and difficulty in achieving resolution of the conflicts arising out of the phase type of transference neurosis. Assiduously, to evoke complications and complexities in the reactions in the analyst, stimulating his own transference neurosis or, as it is more a comfortable situation dominated by mutual reciprocity, appreciative and intellectual competition. It is likely, therefore, that such patients will evoke of the analyst what corresponds to the “unobjectionable” component of the transference. He finds himself regarding the patient as if he or she were a favourite child, going out of his way to be kindly and protectively considerate, in that of the appreciating patient’s accomplishments, and so on.
Although such attitudes are kept strictly within the bounds of analytic propriety, these patient types are too sensitive to allow otherwise, their subtle effects may, nonetheless, be hostile to the analytic process, perpetuating infantile patterns by the analysand, and making it very difficult for both parties to cause a proper cancellation. In this respect the analysis of the ‘good’ patient offers difficulties that, while they are less upsetting than determinants responsible laded upon the status quo and it's fractional determinates. As, presented by others, more challenging as, if, by conquest, are the patients who are justly as important to a resolution by which any inexhaustible force of attentions weave themselves into the transference resistance concealed by the overpowering attributions by making some presents on one side.
The emphasis placed upon the role in the resistance of such as rationality, intelligence, and the capacity for cooperative efforts should not be construed as a denigration of their vital part in making analysis at all possible, components of any mature, not to say civilized, behaviour. All the same, however, reminding ourselves from time to time that even the essential may be necessary and finely construct instruments are double-edged, and these aspects of character are no exception. We are simply less likely to perceive the same as their function and not only in resolving, but in maintaining neurosis, and they may operate by seducing the analyst into the self-satisfying belief that he has accomplished far more than is in fact the case. Sadly, therefore, we must confront and analyse unsparingly those traits we are most likely to admire, least of mention, that the same principles and problems would apply if the structure of the neurosis had been more firmly rooted in pre-oedipal than in oedipal conflict. The difficulties would simply have been more severe for both analyst and patient.
During the intervening time, as to solving the problem of analysing the transference neurosis, necessary for more than purely abstract reasons, would have a justifiable impossible. Following Freud’s (1913) principle, which of his earlier statement he had not only described this unobjectionable part of the transference, but went further: ‘while the patient’s communications and ideas run in without any obstruction, the theme of transference should be left untouched’ working alliance and, while not quoted by Kohut (1971), may have contributed to his specific advice to delay interpreting positively, idealizing statements made by the narcissistic analysand.
If we examine Freud’s statement more closely, we are struck by many difficulties. First, what is meant by ‘admissible to consciousness’? In 1912, it implied that this transference component was part of the system PcsCs. Since during this period interpretation consisted in essence of making conscious that which had been unconscious, it would in any case have been irrelevant, if not conceptually impossible, to do more than is depicted by the patient’s attention (hyper-cathexis) to it, but there could be no question of unconscious elements playing an important role.
With patients to whom of many derivatives of oedipal fantasies, may be largely within awareness. Nonerotic or de-erotised admiration and affection may be conscious from the first, and their role in the analytic process may be quite clear. What is generally obscure is the role of this positive, overtly Nonerotic transference in maintaining a powerful resistance, not only to the resolution of inhibitions, but also to the analytic exploration of hidden springs of defiance and revenge. What looks accessible to consciousness may be so only in part: What seems free of suppressed erotic impulses may be not so in fact, and what seemed altogether unobjectionable may after a time constitutes the most difficult aspect of the transference neurosis. What appears on the surface to be so very positive may also be the screen for stubborn aggressive elements, in that respect a persistent obstacle to analytic resolution.
To return to Freud’s 1912 formulation, we need to be reminded that he never regarded consciousness as a simple matter, but always conceived of it as fluid and uncertain of definition. This is evident in The Interpretation of Dreams and is elaborated in his brilliant little paper, A Note upon the Mystic Writing-Pad (1925) in which he presents a view of consciousness as not simply a passive receptor, but bring dependent on an active function: This agrees with a notion that has long since been at work the method by which the perceptual apparatus of our mind functions, which I have as yet kept to myself.
Its theory is that cathectic innervations are sent out, withdrawn in rapid peridotic impulses from within into the completely pervious system Pcpty.-Cs. If that system is cathected in this manner, it receives perceptions (which are accompanied by consciousness) and passes the excitation onto the unconscious anemic system, but as soon. As the cathexis is withdrawn, consciousness is extinguished. The functioning. Of the system comes to a standstill. It is as though the unconscious stretches. Out feelers, through the medium of the system Pcpty.-Cs. Toward the external world and hastily withdraws them when they have sampled the excitations coming from it.
Freud might have been describing a kind of psychic radar, an ingenious device by which the mind tests external reality. In any casse, a careful reading of his work from the Project (1895) to the New Introductory Lectures (1933) gives no comfort to those who would see a simple definition of what was meant by ‘admissible to consciousness’. How accessible, how fleeting, under what conditions, are all open questions, the answer to which are not determined in any simple way.
By 1937, when Freud published, Analysis Terminable and Interminable, it was evident of how much of his views had developed. He no longer insisted on the existence of a relatively simple Nonerotic or de-erotised conscious positive transference that required no analysis. Now, with some regret, he emphasized the presence of conflictual elements that were inaccessible to analysis not because they were conscious and ‘unobjectionable’, but because they were latent or inactive during the treatment. They could, in fact, be very objectionable indeed. Not the least of these conflicts were those centred on the transference that, unanalyzed, could so often predispose to future difficulties.
These latent conflicts, he decided, could not be brought into the analysis by the analyst, either by verbal intrusions or by active manipulation, manoeuvres he regarded as both ineffective and potentially damaging. Yet in the same paper he stated what is a contradiction, in his disavowal of the principle of ‘letting sleeping dogs lie’. He went further: ‘Analytic experience has taught us that the better is always the enemy of good and that in every phase of the patient’s recovery we fight against his inertia, which is ready to be content with an incomplete solution’ (Freud, 1937).
Defining it precisely what would justify that we are to regarding a conflict as an inactive or latent and therefore inaccessible to analysis is difficult. Undoubtedly, some conflicts are so heavily defended from analysis that as good as we suspect their presence, but we are baffled to uncover them, much less to analyse them. We may become aware of them only when the patient returns to us for further help or when he enters analysis with a colleague and lets us know of his decision. Achieving some comfort by convincing ourselves that condition had not been propitious is possible, for example, that the patient was a candidate in training, was caught in a difficult marriage or in another situation that favoured stubborn resistances. No doubt this is often the case - still, was that the only reason? Could we and should we have done more?
The analyst, by his very presence and his willingness to listen, sets up a relationship described by Bird (1972) as ‘false’ transference', to become in effect ‘the worst enemy of the transference’. To some analysts are agreeable with this assessment of the complications inherent in this necessary, early development of the analytic situation, however, the inclining inclination of being ‘false’ is regarded as controversial, it is often manifested before the first visit, sometimes even in transparent dreams, and as such it reflects the wishes and fantasies of the patient rather than that his recognition of the reality of the situation.
Questioning ourselves would be wise, therefore, as to the nature of this response, to ask which conflicts are being expressed and concealed by it, and to what extent it is dependent on the reality of the analytic situation, the patient’s conviction that the person he consults is benign, wise, and helpful is, we hope, justified by the reality. Yet we know well enough that a patient may experience extreme distrust of an analyst who is in fact perfectly trustworthy, and conversely he may place his implicit confidence in one who deserves it not at all. The personal success of so many charlatans in the mental health field is evidence enough.
This positive response to the analyst corresponds in part at least to Freud’s unobjectionable component, and in its more developed phases it may be called the working alliance. Yet though it is necessary and useful for initiating and maintaining the analysis, we are hardly justified in concluding that it is altogether accessible to consciousness, nor that it is by its unobjectable nature. In fact, it carried a particular heavy load of unconscious conflict, much of which has to be repressed in order for the treatment to begin, and its long-term effects often highly objectionable. Eventually, therefore, we need to understand this phenomenon as thoroughly as any other we encounter in analysis. If we accept that eventually it must be interpreted, we accept also that we must study it in detail. But, nonetheless how?
Listening carefully to a patient’s first impressions of us is instructive. They may consist of apparently diverse observations about the furniture of the office, of personal idiosyncrasies, and the like. Just when there is a neglect of such matters as whether or not we are relaxed and confident, youthful or aged in appearance and manner, and other factors we regard as far more significant.
This is not to say that these latter details are not perceived and stored in memory, quite the contrary. However, they are often repressed and subject to distortion, to appear later in the analysis in various forms. Often the patient will question, for example, whether I wear glasses, although he has seen me a hundred times or more, never without them, or he will be wildly wrong in estimating my age, or astonishing becoming aware of a picture that has been facing the couch for years. Such familiar phenomena may, with some effort, be understood and analysed: It is to be believed that they contain the clues that can help us solve the mystery of the unobjectionable element.
The patient’s reaction to and impressions of the analyst are built up of many determinants. They are first and most profoundly the needs and desires he brings to the analysis, the unconscious wishes that seek to be gratified. Superimpose on these are his early impressions of the analyst, derived from a host of perceptions, for example, the mode of referral, the initial telephone call, early impressions of appearance and manner, discussions of indications and conditions for the analysis, including hours and fees. An entry in a new world, it often takes on aan overwhelming quality - far too much to be dealt within a few sessions. Inevitably its effects are manifested throughout even a very long analysis, often in forms that make their sources difficult to detect. Yet before us, is the material of much of the transference, especially of the unobjectionable component.
This aspect is not so willingly scrutinized with the same intensity with which we approach other phenomena. The reasons are, upon examination, not so obscure. For one thing, the trusting, positive attitude of the analysand does allow the analysis to continue, and it is comfortable for the two parties - unless the analyst forces himself to put aside that comfort. Secondly, it seems free of conflict. Third, it seems to make sense, to be entirely rational, that one person should admire and trust another who is so worthy of it. Finally, we are influenced by the dictum that we analyse the transference only when it serves the resistance, advice that would be easy to follow if we could always be sure when that took place. Suspicions are that without much difficulty prescience is a very rare gift. If we resist the temptation to take the positive transference for granted, therefore, we must find some way of analysing a component that on the surface looks unanalyzable.
In 1955 Lewin wrote Dream Psychology and the Analytic Situation, a work that has been insufficiently recognized for its theoretical and technical importance. It described the analyst as fulfilling a double role, first as one who encourages the patient to allow himself to regress, to suspend criticism, to associate freely, to put himself into his past, to allow himself to feel helpless and to restrain his impulses toward physical change of position, although not to oral communication. Lewis pointed out the analogy with hypnosis, with the analyst as inducer of quasi-sleep and dreaming states, in which the wish to analyse is substituted for the wish to sleep.
The encouragement of regression is fundamental to the analytic process, but it is hardly the analyst only function, a fact that may be ignored in many therapeutic innovations. The analyst must also become the one who rouses the ‘dreaming patient’, who interprets, who encourages and guides the process of self-observation. By this token, he is the one who awakens, who insists on the substitution of secondary for primary process. Of higher ego functions for more archaic ones. Inevitably he becomes the transference representative of that agency most often responsibly for insomnia, the conscience.
Perhaps, its venture that the loving, conscious, unobjectionable part of the transference is directed toward the analyst as the one who soothes, who induces sleep and allows the patient to feel less frightened, for he is ‘safe’, but not for a long time can this love be directed toward the one who accomplishers the awakening. Conducting a long treatment is possible, of course, while maintaining one’s role as the inducer of sleep and dreams, to accomplish a good deal in the way of symptom relief, and thus be rewarded by expressions of gratitude. Whether, without fulfilling one’s role as awakener, one may be rewarded by having accomplished effective analysis is another matter.
To employ Lewin’s striking metaphor, it might be taken care of, in that we mindfully experiment in treating the patient’s demands on the analyst as if these were derivative of unconscious wishes expressed in a dream, and that we consider the various perceptions stored and used from time to time as if they were the memories and day residues employed by the dream work. By this device we may treat the patient’s overtly expressed altitudes as if they corresponded to a manifest dream. We make the assumptions that there are unconscious wishes that seek gratification, that such wishes are subject to conflict and must attain expression in disguised forms. To achieve expression, memory traces of percept, including a day residue, are used both to afford a vehicle for the wish fulfilment and to disguise, as far as necessary, their true purpose. Thus, these wishes are allowed to reach consciousness in some form in spite of disapproval by other agencies, e.g., by evading the (preconscious) censorship according to the model described in The Interpretation of Dreams (Freud, 1900), or the (larger unconscious) repressive functions of the ego and superego according to the later structure model.
The patient’s wishes and fantasies may be worked over further, brought into more rational, logical, organized form by a process analogous to secondary revisions: In the topographic model this depends on the preconscious system, in the structural model it would be considered a manifestation of the synthetic function of the ego. The description of secondary revision, described by Freud in 1900, may be regarded as one of the earliest precursors of the structural model of the ego.
To pursue further the analogies between this aspect of transference and secondary revision of dreams let us look upon the Freudian say-so, atop which Freud wrote, ‘because of its efforts, the dream loses its appearance of absurdity and disconnectedness and approximates to the model of an intelligible experience. The connection of secondary revision with daydreams may also be extended to transferences, how much of the patient’s attitudes is based on fantasies of what the ideal patient-analyst relationship should be? A respectful, finial attitude, an eager pupil-teacher re-enactment, an innocent liaison with no threat os consummation? These are so appropriate, so sensible, so truly helpful to the analysis that we tend to forget how much of the wild aspects of this analysis are thus ‘moulded’ into a kind of daydream.
In what is admittedly a highly simplified fashion, we might consider the case of these patients who treat their analysts as if they were kindly, intelligent, benign, and in a good manner, trained and disciplined, rightly interested and even fond of them, but not a danger in any erotic sense. It seems of reasonable enough description of the actual situation if one does not examine its unconscious components.
Rather than taking this at face value as an intelligent patient’s evaluation of the reality of the analytic situation, accepting gratefully a fine working alliance or an unobjectionable component, if instead we insist upon the arduous and possibly disagreeable task of analysing beliefs and attitudes, we find something very different, far more conflicted, complex, and not altogether benign. The patient has been a model analysand, working hard, associating well, bringing gifts of associations and dreams. For example, she may be charming without being erotically seductive, and faithful to the point of causing concern for both of us. It may be entirely rational, justified by the reality of the situation. It is, of course, much too good to be true, for it is not accompanied by progress in the most urgent therapeutic goals, for example, that of achieving a gratifying sexual life and an ultimately satisfying career. There are also likely to be curious distortions and self-deceptions displayed, for example, when a patient talks of herself as obnoxious and without friends, statements that are manifestly false whatever their unconscious truth. Young women’s patients particularly complain of the usual distortions of a body image so common in them, to being fat and ugly, all of which being quite aware of the contrary. They may be fishing for compliments, but that is not all. These analyses, smooth as they are most of the time, do not altogether result in untroubled ‘sleep’. Sometimes without understanding why, patients become frightened, agitated, and depressed, as if repressed impulses had broken through, like a bad dream.
We might now try the experiment of treating this material as if it were a manifest dream, consisting of a childlike, innocent, and highly educational liaison under the name of analysis. The underlying wishes that have emerged contain erotic fantasies about the parents, combined usually with violent impulses to destroy them both. Behind the befittingly-behaved and rational person may be the image of a lustful, destroying angel, who would kill without mercy in a kind of oedipal rage. To allow these wishes to achieve any kind of expression, they must be made more acceptable for the patient by allowing her to assume such desires without a penalty whose weakness is such that she need not fear of destroying the beloved parents. Or they may be expressed more openly by an ironic stance, which allows them to be proclaimed, and to be disowned.
These memory traces may again be compared to how they are dealt within the dream work. The patient may recall; being a great favourite of many older people and always having a teacher’s pet at school, always loved: These generally seem accurate. They often recall at least one and perhaps more screen memories that include some early sexual experience’s h a parent, fantasies that may have been related to horseplay with siblings and even to a greater extent to medical procedures later in childhood. Most of the childhood memories reported in the analysis are generally quite plausible and subject to relatively little obvious distortion, except the inevitable effects of the passage of time. There is little of the bizarre and strange about them, reflecting both the powerful reality sense of these patients and the highly organized structure of their intelligent and well-disciplined families.
Whatever is observed in the analytic environment, the patient uses as a day residue, as material to carry fantasies. Yet the whole is likely to be so sensible, so rationalized, so free of manifest erotic or violent elements, that we must assume that a powerful synthesized ego function is at work, like a very effective secondary revision of an otherwise bizarre and disturbing dream, with few breakthroughs of incongruous ideation and affect.
This process, again by analogy, “protects sleep.” That is, it helps the ego to maintain a comfortable regressive state of affairs in analysis, in which the patient is apparently a sensible, conscious, and sophisticated adult and an erotically excited, vengeful child. To ‘awaken’ her, that is, to interpret, would be to lead her to recognize her unconscious wishes for what they are, to help her deal with her repressive and ironic defences that have allowed the neurosis to continue and the analysis to go on without much real impact on the most important problem. To continue in a sleep-like state, on the other hand, permits her to act both roles and to continue to play out the surprising contradictions in her personality.
If we suppose that interpretation ‘removes’ the transference, as Freud suggested in 1912, we should be hesitant to bring it to consciousness before it has produced a resistance - assuming we are so prescient as to be able to detect the moment at which that latter event occurs. Still, we are not sure any more that transference is so easily ‘removed’ by interpretation. It seems certain that Freud no longer believed this when he wrote Analysis Terminable and Interminable.
How and when to interpret phenomena such as these make up a really reasonable dilemma. Kohut (1971), for example, approaching his patients with a theory that emphasizes a developmental view and puts’ aside conflictual considerations, would ‘accept’, possibly for a long period, even the most highly idealized expressions of admiration for himself. He warns against ‘premature interpretation’ of such positive expressions, especially in the cases he classifies as narcissistic character disorders.
Many years earlier, Phyllis Greenacre (1954), employing a different point of view, cautioned against early transference interpretations with narcissistic patients who are prone to acting out, since such interventions might result in at least temporary impairments of certain defensive controls and result in episodes of destructive behaviour. She made it clear that she was discussing a limited group of patients and her remarks were not confined to the ‘unobjectionable’ component. She was very much concerned with the development of a fix in a firm manner of over-idealizing attitudes toward the analyst and the problems engendered by these.
Without question interpreting the patient’s good-nature appears rarely advisable, cooperative attitude during the early part of analysis. Being inadvisable is not merely likely: It is worse than that, because during the first few weeks or months we could not possibly understand the unconscious components of this phenomenon. Early interpretations may remarkably be possible in a quickening notation that may prove sufficiently used for a vivid notable in characterizing its mark of notoriety, out of luck or intuition, but during the phase when we hardly know the patient venturing definite statements of meaning would be foolhardier.
We need not interpret early, therefore, and could not if we would. Nevertheless, there is a vast difference in accepting a phenomenon as reality-based, conflict-free, representing only itself, and, on the other hand, treating it more properly as a surface manifestation of a complex set of opposing forces, most of which operate outside conscious awareness, which require explanation eventually in analysis.
The questions we encounter are like those addressed to a particularly good manner of defending its dream, in that, taken on a superficially reasonable form. A good example would be Freud’s Dream of the Botanical Monograph. Repeating is brief enough: “I had written a monograph ion a certain plant. The book lay before me and I was just over a folded coloured plate. Bound up in each copy there was a dried specimen of the plant, as though it had been taken from a herbarium” (1900). Jumping to the conclusion would have been easy, by no incorrect means, that the dream expressed the wish that the yet incomplete monograph intended to make his reputation was already published and on display. How reasonable and easy to understand. Freud was, fortunately, not so easily satisfied. He discovered, in his analysis of the dream. References to matters ranging from his experiments with cocaine back to infantile sexual investigations, to which he understandably only eluded.
Similarly, if the patient imagines that his analyst is a fine and helpful person, he is expressing a wish, which on the face of it is perfectly reasonable. He is, we hope, correct in his expectations. We are certainly not obliged to contradict him, any more than we contradict the statements of a manifest dream. However, we are obliged to ask ourselves questions, not only about the origins of this wish, which may make an impression on us both obvious and universal, but also about a complex of different wishes and defensive operations that may lie concealed beneath this understandable and benign phenomenon. To what extent is it seductive? To what degree masochistic and tricky? Is it possible that the patient harbours a deeply passive wish that says in effect, “You are so great, my fate lies in your hand, do, your best and I shall yet defeat you?”
These probe need not be spoken aloud, but neither need they are entirely some secrets from the patient. The latter, when deeply engaged in the analytic process, are likely to be especially sensitive to nuances in the analyst’s state of mind, especially with respect to emotionally charged attitudes, a phenomenon commonly observed in children and present to a disconcerting degree in certain paranoid individuals. In the analysis of neurotic patients it varies with the state of regression encouraged by use of the couch and of free association.
Complex as it is, there is nothing necessarily mysterious about it. While the patient does not during the session itself see, the analyst’s facial expression, he is generally keenly aware of his minimal responses, his tone of voice, movements, and the like. Furthermore, he has the opportunity to pick up clues from the latter’s expression at the beginning and end of the session. That he may draw some quite inaccurate conclusions is to be expected, and these misinterpretations themselves become material for the analysis. Some patient sense quite quickly and often accurately, for example, whether the analyst responds to expressions of appreciation by a warm glow of satisfaction or by a questioning attitude, the latter signifying a willingness to wait until the phenomenon can be understood in depth.
Whether the analyst reacts by ‘acceptance’ or by questioning makes considerable difference in the future course of the treatment. What has often been taken for granted as an ‘empathic’ approach tends to reduce emphasis on the importance of questioning, treating the patient’s appreciation, for example, as if it were simply genuine, taking it at face value, justifying this by the need to establish the kind of transference situation that is believed essential for the progress of the treatment.
Such an approach has its own appeal: It seems humane, understanding, and protective, it is often regarded as a manifestation of a loving attitude by the analyst, which is perfectly appropriate - a counterpart, it would seem, of the unobjectionable component of the patient. Nevertheless, that we must raise questions whether its usefulness may not ultimately be outweighed by its cost.
The failure to maintain a questioning attitude, an active curiosity about the unconscious dynamics and meaning of this type of response, is likely to favour the persistence of troublesome misunderstanding as to the true nature of the transference. This may in turn lead to serious errors in attempts to place too great an emphasis on an introspective-empathic response at the expense of thoughtful questioning and evacuations of all types of detained by observation of the analytic situation. One of the risks of the former approach is that patient and analyst may find them existing in a state of mutual narcissistic regression, a kind of near-erotic mutual sleep. This can be a very gratifying experience for both: Its prototype was the sleep therapy employed by the Greeks at Epidaurus and Pergamum, which provided symptomatic relief. We need not decry it, if it is recognized.
Analysis, however, requires regular ‘arousal’ in Bertram Lewin’s sense, accomplished by the analyst’s activity, by questioning and interpretation, which may be explicit and verbalized or silent, expressed by a less intrusive means, e.g., by gesture, look and tone. Only in this way are we likely to achieve some understanding of the function and the origins of the ‘unobjectionable’ component and the other factors in the transference with which being joined is likely.
Establishing some hypotheses to account for the origins of this phenomenon of transference would seem important that at this point. This is not so easily accomplished, and must wait for further exploration. Up too now, our efforts have been partial at best, and for the most part has failed to take into account such factors as genetic endowment, at the one extreme, and late childhood, adolescent, and adult experiences at the other. Its genetic sources have been sought for largely in the experiences of early childhood, the neonatal and preverbial phases by choice, concentrating especially on mother-child exchanges. Denying the importance of early mothering in this regard would be rash, but being persuaded by those who would make it the one crucial determinant is difficult, as if good mothering were not only the earliest, but also the only essential genetic factor in the capacity to develop this aspect of transference.
It is too-simple if appealing explanation, and too dependent upon treating the manifest phenomenon as the whole article, as if the patient’s trust and cooperation were a direct reflection of the trust and cooperation he learned at his mother’s breast, and on the other hand, as if it reflected the need to replace a disappointing “unemphatic” mother by a new and more reliable object - or, “self-object,” to employ Kohut’s (1971) term.
Primordial explanations are understandably popular. Those historical events that are most deeply buried in the distant past are the most difficult to evaluate and thus the more apt for myth-making. Even the most meticulous hypotheses about the psychic developments of preverbial children require influences based on giant steps that become even larger when we attempt to extend them into explanations of behaviour and symptoms in adults. It is undeniable that very early experiences contribute significantly to the nature and severity of adult psychopathology, and the more we know about them the better. Still, to know them is not nearly enough. It is essential that we undertake the arduous task of tracing the effects of such experiences through later childhood, adolescence, and adult life, thus establishing the coherent chain of historical events that is indispensable for a soundly based sense of conviction. It is only by accomplishing this that we may be able to precent psychological explanations from deteriorating into a series of appealing fantasies, a kind of pseudo history based on presumed prehistoric events, which tends to operate as a defence against the discovery of something close to the genuine article.
Gill (1979) has described some of the difficulties in the tendency to interpret transference by a too-ready resorted to early genetic factors rather than by recognizing the immediate context of the analytic situation. We need to go all the way with him in his emphasis on the ‘here-and-now’ in the analysis of the transference, to recognize the relevance of its argument.
Here-and-now work with transference materials is an emotionally potent experience for both patient and therapist. Anxieties and misunderstandings in both patient and therapist may lead them to resist this focus. Transference can be a powerful therapeutic tool: being aware of impediments to effective intervention is important, Freud (1905) once commented that ‘transference, which seemed ordained to be the greatest obstacle to the psychoanalysis, becomes its most powerful ally, if its presence can be detected each time and explained to the patient’. Leading to conclude that ‘In psychoanalysis therapy, the phenomenon of projection of feelings, thoughts, and wishes onto the analyst, who has come to represent an object from the patient’s past’ also, that ‘the patient sees in the analyst the return - the reincarnation - of some important figure out of his childhood or past, and consequently transfers onto him feelings and reactions that undoubtedly applied to this model’. Analysis of transference in the here-and-now opens the way to new object relations through a step-by-step removal of implements to such relations as represented by the transference. As the patient can understand and work through distortions resulting from transference attitudes, he begins to see others starting with the therapist, in a new way. The goal of here-and-now is to establish more realistic object relations. First with the therapist, then with others: The therapist strives to help the patient develop more successful interaction within the therapy relationship than was experienced in the past. A focus on transference is intended to remove obstacles that interfere with the patient’s ability to deal with the therapist in a relatively mature, rational, and a non-conflictual manner. If transference is a preexisting perceptual and emotional bias, resolution of the transference helps the patient add flexibility and decrease constriction to the manner in which the therapeutic situation is viewed. Both the therapist and patient attempt to work out a relationship that is a realistic reflection of the present and without excess baggage from the past: The message to be conveyed is that relationships are not conflict-free, and that the therapist is willing to continue, with openness and purpose, toward resolution of conflict with others.
Yet, the analysis of the transference is generally acknowledged to be the central feature of analytic technique. Freud regarded transference and resistance as facts of observation, not as conceptual inventions. He wrote: “ . . . the theory of psychoanalysis is an attempt to account for two striking and unexpected facts of observation that emerge whenever an attempt is made to trace the symptoms of neurotic backs their sources in the past life, the facts of transference and of resistance . . . anyone who takes up other sides of the problem while avoiding these hypotheses will hardly escape a charge of misappropriation of property by attempted impersonation, if he persists in calling himself a psychotherapist.” Rapaport (1967) argued, in his posthumously published paper on the methodology of psychoanalysis, that transference and resistance inevitably follow from the fact that the analytic situation is interpersonal.
Despite this general agreement on the centrality of transference and resistance in technique, its impressions drawn from ones experience as to observe of the transference that is not to pursue as systematically and comprehensively compensable state of one how would imaginatively think of what really should be. The relative primacy in which psychoanalysts work makes it possible for one or one’s state to view as anything more than its own impression. On the assumptions that even if we were wrong, reviewing issues in the analysis of the transference will be useful and to state many reasons to posit of itself as an important aspect of the e analysis of the transference, namely, resistence to the awareness of the transference, is especially often slightly in analytic practice that one or one’s reasons to acknowledge these issues and of what really should be.
Seemingly, the first gaiting steps of which did not originate with a big-bang but forwarded forthright through a whimpering between two types of interpretations of the transference. The one is an interpretation of resistance to the awareness of transference. The other is an interpretation of resistances to the resolution of transference. The distinction, however, had been best explained in the literature by Greenson (1967) and Stone (1967). The first kind of resistance may be called defence transference. Although that terminology is mainly employed to refer to a phase of analysis characterized by a general resistance to the transference of wishes. The second whimpering overture of resistance is usually called transference resistance. With some oversimplification, one might say that in resistance to the awareness of transference, the transference is what is resisted, whereas in resistance to the resolution of transference, the transference is but the withstanding resistance.
Yet, another descriptive way of stating this distinction between resistance and the awareness of transference and resistance to the resolution of transference is between implicit and indirect reference to the transference and explicit or direct references to the transference, the interpretation of resistance to awareness of the transference in intended to make the implicit transference explicit, while the interpretation of resistance to the resolution of transference is intended to make the patient realize that the already explicit transference does include a determinant from the past.
It is also important to distinction between the general concept of an interpretation of resistance to the resolution of transference and a particular variety of such an interpretation, namely, a genetic transference interpretation - that is, in the interpretation of how an attitude in the present is an inappropriate carry-over from the past. While there is a tendency among analysts to deal with explicit references to the transference primarily by a generic transference interpretation, there are other ways of working toward a revolution of the transference. It will be argued that not only is it not enough of an emphasis being given to interpretation of the transference in the here-and-now, that is, to the interpretation of implicit manifestations of the transference, but also that interpretations intended to resolve the transference as manifested in explicit references to the transference should be primarily in the here-and-now, rather than genetics transference interpretation.
A patient’s statement that he feels the analyst is harsh, for example, is, at least to begin with, likely best dealt with not by interpreting that this is a displacement from the patient’s feeling that his father was harsh but by an elucidation of another aspect of his here-and-now attitude, such as what has gone on in the analytic situation that is the patient to justify his feedings or what as the anxiety that made it so difficult for him to express his feelings. How the patient experiences the actual situation is an example of the role of the actual situation in a manifestation of transference, which will be one point contributive to both the transference in the here-and-now and genetic transference interpretations valid and constitute a sequence. We presume that a resistance that transference ultimately rests on the displacement onto the analyst of altitudes from the past.
Transference interpretations in the here-and-now and genetic transference interpretations are of course, exemplified in Freud’s writings and are in the repertoire of every analyst, but they are not distinguished sharply enough.
Because Freud’s case histories focus much more on the yield of analysis than on the details of the process, they are readily but perhaps incorrectly construed as emphasizing work outside the transference much more than work with the transference, and, even within the transference, emphasizing genetic transference interpretations much more than work with the transference in the here-and-now (Muslin and Gill 1978). The example of Freud’s case reports may have played a role in what is to be considered as a common maldistribution of emphasis in these two respects - not enough on the transference and, within the transference, not enough on the here-and-now, least of mention, is a primary reason for a failure to deal adequately with the transference. It is that work with the transference is that aspect of analysis that involves both analyst and patient in the apprised affect-laden and potentially disturbing interactions that by participants in the analytic situation are motivated to avoid these interactions. Flight away from the transference and to the past can be a relief to both patient and analyst.
The importance of transference interpretations will surely be agreeing to by all analysts, the greater effectiveness of transference interpretations than interpretations outside the transference will be agreeing to by many, and that of the relative roles of interpretation of the transference and interpretation outside the transference?
Freud can be read either as saying that the analyst of the transference is auxiliary to the analysis of the neurosis or that the analyst of the transference is equivalent to the analysis of the neurosis. The first position is stated in his saying (1913) that the disturbance of the transference has to be overcome by the analysis of transference resistance to get on with the work of analysing the necrosis. It is also implied in his reiteration that the ultimate task of analyses is to remember the past, to fill the gaps in memory. The second position is stated in his saying that the victory must be won on the field of the transference (1912) and that the mastery of the transference neurosis ‘coincides with getting rid of the illness that was originally brought to the treatment’(1917). In this second view, he says that after the resistances are overcome, memories appear without difficulty (1914).
These two different positions also find expression in the two very different ways in which Freud speaks of the transference. In Dynamics of Transference, he refers to the transference, on the one hand, as ‘the most powerful resistances to the treatment’ (1912) but, on the other hand, as doing us ‘the inestimable service of masking the patient’s . . . impulses immediate and manifest. For when all is said and done, destroying anyone in an absentia or in effigies’ is impossible (1912).
One or one’s mindful purposes of incitation can draw from its demonstration that his principal emphasis falls on the second position. He wrote once, in summary: “Thus our therapeutic work falls into two phases. In the first, all libidos are forced from the symptoms into the transference and concentrated there, in the second, the struggle is waged around this new object and the libido is liberated from it” (1917).
Yet, the detailed demonstration that he advocated that the transference should be encouraged to expand as much as possible within the analytic situation lies in clarifying that resistance is primarily expressed by repetition, that repetition takes place both within and outside the analytic situation, but that the analyst seeks to deal with it primarily within the analytic situation, that repetition cannot be only in the motor sphere (acting) but also in the physical sphere, and that the physical sphere is not confined to remembering but includes the present, too.
Freud’s emphasis that the purpose of resistance is to precent remembering can obscure his point that resistance shows itself primarily by repetition, whether inside or outside the analytic situation: “The greater the resistance, the more extensive will acting out (repetition) replaces remembering” (1914). Similarly, in The Dynamics of Transference, Freud said, that the main reason that the transference is so well suited to serve the resistance is that the unconscious impulses “do not want to be remembered . . . but, endeavour to reproduce themselves . . ." (1912). The transference is a resistance primarily insofar as it is a repetition.
The point can be restated as to the relations between transference and resistances. The resistance expresses itself in repetition, that is, in transference both inside and outside the analytic situation. To deal with the transference, therefore, is equivalent to dealing with the resistances. Freud emphasized transference within the analytic situation so strongly that it has come to mean only repetition within the analytic situation, even though, conceptually speaking, a repetition outsider the analytic situation is transference too, and Freud once used the term that way: “We soon perceive that the transference is itself only a piece of repetition, and that the repetition is a transference of the forgotten past not only on the doctor but also on all other aspects of the current situation. We . . . find . . . the compulsion to repeat, which now replaces the impulsion to remember, not only in his personal attitude to his doctor but also in every other activity and relationships that may occupy his life at the time . . . " (1914).
Realizing that the expansion of the repetition inside the analytic situation is important, whether or not in a reciprocal relationship to repetition outside the analytic situation, is the avenue to control the repetition: “The main instrument . . . for curbing the patient’s compulsion to repeat and for turning it into a motive for remembering lies in the handling of the transference. We render the compulsion harmless, and really useful, by giving it the right to assert itself in a definite field” (1914).
Kanzer has discussed this issue well in his paper on The Motor Sphere of the Transference, (1966). He writes on a ‘double-pronged stick-and-carrot’ technique by which the transference is fostered within the analytic situation and discouraged outside the analytic situation. The ‘stick’ is the principle of abstinence as exemplified in the admonition against masking important decisions during treatment, and the ‘carrot’ is the opportunity afforded the transference to expand within the treatment “in almost complete freedom” as in a ‘playground’ (Freud, 1914). Freud writes: “Provided only that the patient shows compliance enough to respect the necessary conditions of the analysis, we regularly succeed in giving all the symptoms of the illness a new transference meaning and in replacing his ordinary neurosis by a ‘transference neurosis’ of which he can be cured by the therapeutic work” (1914).
The reason that being expressed within the treatment is desirable for the transference is that there, it “is at every point accessible to our intervention” (1914). In a later statement he made the same point this way: “We have followed this new edition [the transference-neurosis] of the old disorder from its start, we have observed its origin and growth, and we are especially well able to find our way about in it since, as its object, we are situated at it’s very centre” (1917). It is not that the transference is forced onto the treatment, but that it is spontaneously but implicitly present and is encouraged to expand there and become explicit.
Freud emphasized ‘acting’ in the transference so strongly that one can overlook the repetition in the transference providing it does not necessarily mean it is enacted. Repetition need not go as far as motor behaviours. It can also be expressed in attitudes, feelings, and intentions, and, the repetition often takes such form rather than motor action. Such repetition is in the physical rather than the motor sphere. The importance of making this clear is that Freud can be mistakenly read to mean that repetition in the physical sphere can only mean remembering the past, as when he writes that the analyst “is prepared for a perpetual struggle with his patient to keep in the physical sphere all the impulses that the patient would like to direct into the motor sphere, and he celebrates it as a triumph for the treatment if he can bring it about that something the patient wishes to discharge in action are disposed of through the work of remembering” (1914),
Still, it is true that the analyst’s efforts are to convert acting in the motor sphere into an intuitive awareness upon the certainty of which the physical sphere of transference, however, transference may be in the physical sphere to begin with, even if disguised. The physical sphere includes those of an awakened spheres of awareness through which the transference is just as well as to remembering.
An objection one hears, from both analyst and patient, to a heavy emphasis on interpretation of associations about the patient’s real life primarily about the transference is that it means the analyst is disregarding the importance of what goes on in the patient’s real life. The criticism is not justified. To emphasize the transference meaning is not to deny or belittle other meanings, but to focus on the one of several meanings of the contentual representations set forth, that is most important for the analytic process.
Another way in which interpretations of resistance to the transference can be, or at least appear to the patient as to be belittling of the importance of the patient’s outside life is to make the interpretation as though the outside behaviour is primarily an acting out of the transference. The patient may undertake some actions in the outside world as an expression of and resistance to the transference, that is, acting out. Til now, the interpretation of associations about actions in the outside world as having implications for the transference needs mean only that the choice of outside action to figure in the associations in co-determined needs to express of the transference indirectly. It is because of the resistance to awareness of the transference that the transference has to be disguised. When the disguise is unmasked by interpretations, despite the inevitable differences between the outside situations and the transference situation, the content is clearly the same for the analytic work. Therefore, the analysis of the transference and the analysis of the neurosis coincide. Particularly because some critics of earlier versions of our agreement that in its advocating the analysis of the transference for its own sake rather than in overcoming the neurosis. Freud wrote, “that the mastering of the transference neurosis ‘coincides with getting rid of the illness that was originally brought to the treatment” (1917).
The transference is encouraged to develop within the analytic situation, toward fostering this development of attitudes with primary determinants in the past, i.e., transferences. The analyst’s reserve gives the patient few and equivocal cues. The purpose of the analytic situation fosters the development of strong emotional responses, and the very fact that the patient has a neurosis means, as Freud said, that
“ . . . It is a perfectly normal and intelligible thing that the libidinal cathexis [we would now add negative feelings] of someone who is partly unsatisfied, a cathexis held readily in anticipation, should be directed as well to the figure of the doctor” (1912).
There is important resistance for both patient and analyst to awareness of the transference. On the patient’s part, this is because of the difficulty in recognizing erotic and hostile impulses toward the very person to whom they have to be revealed. On the analyst’s part, this is because the patient is likely to attribute the very attitudes to himself, in that causing him discomfort is most likely. The attitudes the patient believes that the analyst has toward him are often the ones the patient is least likely to voice, in a general sense because of a feeling that it is impertinent for him to concern himself with the analyst’s feelings. In a more specific sense because the attitudes that the patient ascribes of the analyst are often attitudes the patient feels the analyst will not like and be uncomfortable about having ascribed to him. It is so that the analyst must be especially alert to the attitudes the patient believes he has, not only to the attitudes the patient does have toward him. If the analyst can see himself as a participant in an interaction, as he will become much more attuned to this important area of transference, which might otherwise escape him.
The investigation of the attitudes ascribed with the analyst makes easier the subsequent investigation of the intrinsic factors in the patient that played a role in such ascriptions. For example, the exposure of the fact that the patient ascribes sexually, an interest in him to the analyst, and genetically to the patient, easily makes the subsequent exploration of the patient’s sexual wish toward the analyst, and genetically the parent.
The resistance to the awareness of these attitudes is responsible for their appearing in various disguises in the patient’s manifest associations and for the analyst’s reluctance to unmask the disguise. The most commonly recognized disguise is by displacement, but identification is an equally important one. On displacement, the patient’s attitudes are narrated for being a third party. In identification, the patient attributes to himself attitudes he believes the analyst has toward him.
To encourage the expansion of the transference within the analytic situation, the disguises in which the transference appears have to be interpreted. In displacement the interpretation will be of allusions to the transference in association not manifestly about the transference. This is a kind of interpretation every analyst often makes. With identification, the analyst interprets the attitude the patient ascribes himself as an identification with which attitudes he attributes toward the analyst. Lipton (1977) has recently described this form of disguised allusion to the transference with illuminating illustrations.
Many analysts believe that transference manifestations are infrequent and sporadic at the beginning of an analysis and the patient’s associations are not dominated by the transference unless a transference neurosis has developed. Other analysts believe that the patient’s associations have transference meanings from the beginning and throughout. That is to say, if one is to think of those who believe otherwise are failing to recognize the persuasiveness of indirect allusions to the transference - that is, what is called the resistance to the awareness of the transference.
In his autobiography, Freud wrote: “The patient remains under the influence of the analytic situation abounding in even if he is not directly his mental activity onto a particular subject. We will be justified in assuming that nothing will occur to him that has not some reference to that situation” (1925). Since associations are obviously often not directly about the analytic situation, the interpretation of Freud’s remark rests on what he meant by the 'analytic situation'.
Trusting of what, Freud’s meaning can be clarified by reference to a statement he made in The Interpretation of Dreams. He said that when the patient is told to say whatever comes into his mind, his associations become directed by the ‘purposive ideas inherent in the treatment’ and that there are two such inherent purposive themes, one relating to the illness and the other - concerning which, Freud said, the patient had ‘no suspicion’ - relating to the analyst (1900). If the patient has ‘no suspicion’ of the theme relating to the analyst, the clear implication is that the theme appears only in disguise in the patient’s association. Its following interpretation is that Freud’s remark not only specifies the themes inherent in the patient’s associations, but also means that the associations are simultaneously directed by these two purposive ideas, not sometimes by one and sometimes by the other.
One important reason that the early and continuing presence of the transference is not always recognized is that it is considering being absent in the patient who is talking freely and apparently without resistance. As Muslin and others have pointed out on the early interpretation of transference (Gill and Muslin, 1976), resistance to the transference is probably present from the onset, even if the patient is talking apparently freely. The patient might be talking about issues not manifestly about the transference that are nevertheless also allusions to the transference. Nevertheless, the analyst has to be alert to the percussiveness of such allusions to discern them.
The analyst should continue the working assumption, to assert that the patient’s associations have transference implications pervasively. This assumption is of course, not to be confused with denial or neglect of the current aspects of the analytic situation. Giving precedence to a transference interpretation is theoretically always possible if one can only discern it through its disguise by resistance. This is not to dispute the desirability of learning as much as one can about the patient, if only to be a position to make correct interpretations of the transference. It therefore does not interfere with an apparently free flow of associations, especially early, unless the transference threatens the analytic situation to the point where its interpretation is mandatory rather than optional.
With the recognitions that even the apparently freely associating patient may also be showing reluctance to awareness of the transference, in that, the formularisation of one should not interfere if useful information is being gathered should replace Freud’s dictum that the transference should not be interpreted until it becomes a resistance (1913).
It may be argued of all transference manifestations with something in the actual analytic situation has some connection to some aspect of the current analytic situation, in that, all the determinants of the transference are current in the sense that past can exert an influence only because it exists in the present. What, however, the distinguishing is, of its current reality of the analytic situation, that is, what goes on between patient and analyst in the present, from how the patient is currently formed as of his past.
All analysts would doubtless agree that there are both current and transferential determinants of the analytic situation, and probably no analyst would argue that a transference idea can be expressed without contamination, as it was, that is, without any connection to anything current in the patient-analyst relationship. Nevertheless, the applicable implication of this fact for techniques is often neglected in practice and is believed that it will be dealt among them as past-present point references.
After-all, several authors (e.g., Kohut 1959, Loewald 1060) have pointed out that Freud’s early use of the term transference in The Interpretation of Dreams, in a connection not immediately recognized as related to the present-day user of the term, reveals the fallacy of considering that transference can be expressed free of any connection to the present. That early use was to refer to the fact that an unconscious ideas cannot be expressed as such, but only as it becomes connected to a preconscious or conscious representation of content. Thus holding to contentual representations in the phenomenon with which Freud was then concerned, the dram, transference took place from an unconscious wish to a day residue. In the Interpretation of Dreams Freud used the term transference both for the general rule that an unconscious content is expressible only as it becomes transferred to a preconscious or conscious content and for the specific application of this rule to a transference to the analyst. Just as the day residue is the point of attachment of the dream wish, so must there be an analytic-situation residue, though Freud did not use that term, as the point of attachment of the transference.
Analysts have always limited their behaviour, both in variety and intensity, to increase the extent to which the patient’s behaviour is determined by his idiosyncratic interpretation of the analyst’s behaviour. In fact, analysts unfortunately sometimes limit their behaviour so much, as compared with Freud’s practice, that they even conceptualize the entire relationship with the patient a matter of technique, with no nontechnical personal relation, as Lipton (1977) has pointed out.
Nonetheless, no matter how far the analyst attempts to carry this limitation of his behaviour, the very existence of the analytic situation gives the patient innumerable cues that inevitably become his rationale for his transference response. In other words, the current situation cannot be made to appear - that is, the analytic situation is real. It is say to forget this truism in one’s zeal to diminish the role of the current situation in determining the patient’s responses. One can try to keep past and present determinants as a step-by-step perceptible form of one and another, but one cannot obtain either in ‘pure culture’. Freud wrote: “Insist on this procedure [the couch], however, for its purpose and result are to prevent the transference from mingling with the patient’s associations imperceptibly, to isolate the transference and to allow it to come forwards in due courses sharply defined as a resistance.” Even ‘isolate’ is too strong a word in the light of the inevitable intertwining of the transference with the current situation.
If the analyst remains under the illusion that the current cues he provides to the patient can be reduced to the vanishing point, he may be led into a silent withdrawal, which is not too distant from the caricature of an analyst as someone who does indeed refuse to have any personal relationship with the patient. What happens then is that silence has become a technique rather than merely an indication that the analyst is listening. The patient’s responses under such conditions can be mistaken for uncontaminated transference when they are in fact transference adaption to the actuality of the silence.
The recognition that all transferences must have some relation to the actual analytic situation, from which it takes its point of departure, as it was, has a crucial implication for the technique of interpreting resistance to the awareness of transference, to which the analyst becomes persuaded of the certainty of transference and the importance of encouraging the transference to expand within the analytic situation, he has to find the presenting and plausible interpretations of resistance to the awareness of transference he should make. At this point, his most reliable asset is the cues offered by what will go on in the analytic situation: On the one hand, the events of the situation, such as change in time of session, or an interpretation made by the analyst, and, on the other, however, the patient is experiencing the situation as reflected in explicit remarks about it, however fleeting these may be. This is the primary yield for technique of the recognition that any transference must have a link to the actuality of the analytic situation. The cue points to the nature of the transference, just as the day residue for a dream may be a quick pointer to the latent dream thoughts. Attention to the current stimulus for a transference elaboration will keep the analyst from making mechanical transference interpretation, in which he interprets that there are allusions to the transference in associations not manifestly about the transference, but without offering any plausible basis for the interpretation. Attention to the current stimulus also offers some degree of protection against the analyst’s inevitable tendency to project his own views onto the patient, either because of countertransference or because of a preconceived theoretical bias about the content and hierarchical relationship in psychodynamics.
The analyst may be very surprised at what in his behaviour the patient finds important or unimportant, for the patient’s responses will be idiosyncratically determined by the transference. The patient’s response may be something the patient and the analyst considers trivially, because, as in displacement to a trivial aspect of the day residue of a dream, displacement can better serve resistance when it is to something trivial. Because it is connected to conflict-laden material, the stimulus to the transference may be difficult to find. It may be quickly disavowed, so that its presence in awareness s only transitory. With the discovery of the disavowed, the patient may also gain insight into how it repeats a disavowal earlier in his life. In his search for the present stimulus that the patient is responding to transferentially, the analyst must therefore remain alert to both fleeting and apparently trivial manifest calls himself well as the events of the analytic situation.
It is sometimes argued that the analyst’s attention to his own behaviour as a precipitant for the transference will increase the patient’s resistance to recognizing the transference. On the contrary, is that because of the inevitable interrelationship of the current and transferential determinants, it is only through interpretation that they can be disentangled - in that it is also argued that one must wait until the transference has reached optimal intensity before it can be advantageously interpreted. It is true that too hasty the interpretation of the transference can serve a defensive function for the analysts and deny him the information he needs to make a more appropriate transference interpretation. However, it is also true that delay in interpreting runs the risk of allowing an unmanageable transference to develop. It is also true that deliberate delay can be a manipulation in the service of an abreaction rather than analysis and, like silence, can lead to a response to the actual situation mistaken for uncontaminated transference. Obviously important issues of timing are involved as an important clue to when a transference interpretation is given that one to make lies in whether the interpretation can be made plausible concerning the determinant stresses, namely, something in the current analytic situation. Of course, with other aspects of the transference attitude in saying that when the analyst approaches the transference in the spirit of seeing how it appears plausibly realistic to the patient, it paves the way toward its further elucidation and expression.
Freud’s emphasis on remembering as the goal of the analytic work implied that remembering is the principal avenue to the resolution of the transference. Yet his delineation of the successive steps in the development of analytic technique makes clear that he saw this development as a change from an effort to reach memories directly to the use of the transference as the necessary intermediary to reaching the memories.
By contrast alone, a remembering as the way the transference is resolved, Freud also described resistance for being primarily overcomes in the transference, with remembering following easily thereafter: “From the repetitive reactions exhibited in the transference we are led along the familiar paths to the awakening of the memories, which appear without difficulty, as it was, after the resistance has been overcome” (1914). “This revision of the process of repression can be accomplished only in part concerning the memory traces of the process that led to repression. The decisive part of the work is achieved by creating in the patient’s relations to the doctor - in the 'transference' - new editions of the old conflicts . . . Thus, the transference becomes the battlefield on which all the mutually struggling forces should meet one-another” (1917). This is the primary insight Strachey (1934) clarified in his seminal paper on the therapeutic action of the psychoanalysis.
Accedingly, there are two main ways in which resolution of the transference can take place through work with the transference in the here-and-now. The first lies in the clarification of what are the cues in the current situation that are the patient’s point of departure for a transference elaboration. The exposure of the current point of departure at once raises the question of whether it is adequate to the conclusion drawn from it. The relating of the transference to a current stimulus is, after all, parts of the patient’s effort to make the transference attitude plausibly determined by the present. The reserve and ambiguity of the analyst’s behaviour are what increases the ranges of apparently plausible conclusions the patient may draw. If an examination of the basis for the conclusion makes clear that the actual situation to which the patient responds is subject to other meanings than the one the patient had reached, he will more readily consider his pre-existing bias - that is, his transference.
A decisive summation would include that, in speaking of the current relationship and the relation between the patient’s conclusions and the information on which they seem plausibly based, may as to imply of some absolute conception of what is real in the analytic situation, of which the analyst is the final arbiter. That is not the case. Seemingly, what the patient must come to see is that the information he has is subject to other possible interpretations implies the very contrary to an absolute conception of reality. In fact, analyst and patient engage in a dialogue in a spirit of attempting to arrive at a consensus about reality, not about some staged out-and-out reality.
The second way in which resolution of the transference can take place within the work with the transference in the here-and-now is that in the very interpretation of the transference the patient had a new experience. He is being treated differently from how he expected to be. Analysts seem reluctant to emphasis this new experience, ads though it endangers the role of insight and argues for interpersonal influence as the significant factor in change. Strachey’s emphasis on the new experience in the mutative transference interpretation has unfortunately been overshadowed by his views on introjection, which have been mistaken to advocate manipulating the transference. Strachey meant introjection of the more benign superego of the analyst only as a temporary step on the road toward insight. Not only is the new experience nit to be confused with the interpersonal influence of a transference gratification, but the new experience occurs with insight into both the patient's-based expectation and the new experience. As Strachey points out, what is unique about the transference interpretation is that insight and the new experience take place in relation to the very person who was expected to behave differently, and it is this that gives the work in the transference its immediacy and effectiveness. While Freud did stress the affective immediacy of the transference, he did not make the new experience explicit.
Recognizing that transference interpretation is not a matter of experience is important, in contrast to insight, but a joining of the two together. Both are needed to cause and maintain the desired changes in the patient. It is also important to recognize that no new techniques of intervention are required to provide the new experience. It is an inevitable accomplishment of interpretation of the transference in the here-and-now. It is often overlooked that, although Strachey said that only transference interpretations were mutative, he also said with approval that most interpretations were outside the transference.
In a further explication of Strachey’s paper and entirely consistent with Strachey’s position, Rosenfeld (1972) has pointed out that clarification of material outside the transference is often necessary to know what is the appropriate transference interpretation, and that both genetic transference interpretation and extratransference interpretations play an important role in working through. Strachey said relatively little about working through, but surely nothing against the need for it, yet made so explicitly to a recognized role for recovery of the past in the resolution of the transference.
The holding position is to emphasis the role of the analysis of the transference in the here-and-now, both in interpreting resistance to the awareness of transference and in working toward its resolution by relating it to the actuality of the situation. Believing that the interpretation of resistance to awareness of the transference should figure in most of sessions, and that if this is done by relating the transference to the actual analytic situation, the very same interpretation is a beginning of work to the resolution of the transference. To justify this view more persuasively would require detailed case material.
One might be taken in some specified state as siding with the Kleinians whom, many analysts feel, are in error in giving the analysis of the transference too great if not even an exclusive role in the analytic process. It is true that Kleinians emphasize the analysis of the transference more, in their writings at least, than do the overall run of analysts. Anna Freud’s (1968) complaint that the concept of transference has become overexpanded is directed against the Kleinians. One reason the Kleinians consider themselves the true followers of Freud in technique is precisely because of the emphasis they put on the analysis of the transference. Hanna Segal (1967), for example writes as follows: “To say that all communications are seen as communications about the patient’s phantasy plus current external life is equivalent to saying that all communications contain something used for the transference situation. In Kleinian technique, the interpretation of the transference is often more central than in the classical technique.”
Yet, it is nonetheless, the insistence on exclusive attention to any particular aspect of the analytic process. Like the analysis of the transference in the here-and-now, can become a fetish. In that other kinds of interpretation should not be made, but the emphasis on transference interpretation within the analytic situation needs to be increased or at the least reaffirmed, and that we need more clarification and specification of just when other kinds of interpretations are in order.
Of course making a transference interpretation is sometimes tactless. Surely two reasons that would be included in a specification of the reasons for not making a particular transference interpretation, even if one seems apparent to the analyst, would be preoccupation with an important extratransference event and an inadequate degree of rapport, to use Freud’s term, to sustain the sense of criticism, humiliation, or other painful feelings the particular interpretation might engender, though the analyst had no intention of evoking such a response. The issue might be, however, not of whether or not an interpretation of resistance to the transference should be made, but whether the therapist can find that transference interpretation that in the light of the total situation, both transferential and current, the patient can hear and benefit from primarily as the analyst intends it.
Transference interpretations, like extratransference interpretations, indeed like any behaviour on the analyst’s part, can affect the transference, which in turn needs to be examined if the result of an analysis is to depend as little as possible on the unanalyzed transference. The result of any analysis depends on the analysis of the transference, persisting effects of unanalyzed transference, and the new experience that particularly have in emphasizing as the unique merit of a transference interpretation in the here-and-now. Remembering this less one’s zeal to ferret out the transference itself becomes is especially important an unrecognized and objectionable actual behaviour on the analyst’s part, with its own repercussions on the transference.
The emphasis that is of placing on the analysis of resistance to the transference could easily be misunderstood as implying that recognizing the transference is always easy as disguised by resistance or that analysis would go without a hitch if only such interpretations were made. If not only to imply of neither, but rather than the analytic process will have the best chance of success if correct interpretation of resistance to the transference and work with the transference in the here-and-now are the core of analytic work.
However it remains, that the significance of the transference phenomenon impressed Freud so profoundly that he continued through the years to develop his ideas about it. His classical observations on the patient Dora formed the basis for his first formulation of this concept. He says, “What is the transference? They are the new edition or facsimiles of the tendencies and phantasies aroused and made consciously during the progress of the analysis. However, they have this peculiarity, which is characteristic for their species, that they replace some earlier person by the person of the physician. To put it another way: A whole series of psychological experiences is revived, not as belonging to the past, but as applying to the person of the physician currently.”
According to Freud’s view, the process of a psychoanalytic cure depends mainly upon the patient’s ability to remember that which is forgotten and repressed, and thus to gain conviction that the analytical conclusions arrived at being correct. However, “the unconscious feelings derive to avoid the recognition that the cure demands,” they seek instead, emotional discharge, despite the reality of the situation.
Freud believed that these unconscious feelings that the patient strives to hide are made up of that part of the libidinal impulse that has turned away from consciousness and reality, due to the frustration of a desired gratification. Because the attraction of reality has wakened, the libidinal energy is still maintained in a state of regression attached to the original infantile sexual object, although the reasons for the recoil from reality have disappeared.
Freud states that in the analytic treatment, the analyst pursues this part of the libido to its hiding place, “aiming always at unearthing it, making it accessible to consciousness at last serviceable to reality.” The patient tries to achieve an emotional discharge of this libidinal energy under the pressure of the compulsion to repeat experiences repeatedly again rather than to become conscious of their origin, but he uses the method of transferring to the person of the physician past psychological experiences and reacting to this, at times, with all the power of hallucination. The patient vehemently insists that his impression of the analyst be true for the immediate present, in this way avoiding the recognition of his own unconscious impulses.
Thus, Freud regarded the transference-manifestations as a major problem of the resistance. However, Freud says, “It must not be forgotten that they (the transference-manifestations) and they only, render the invaluable service of making the patient’s buried and forgotten love-emotions and manifestations.”
Freud regards the transference-manifestations as having two general aspects
- positive and negative. The negative, was at first regarded as having no value in psychoanalytic cures and only something to be 'raised' into consciousness to avoid interference with the progress of the analysis. He later accorded it a place of importance in the therapeutic experience. The positive transference he concluded to be ultimately sexual in origin, since Freud says, “To begin with, we knew none but sexual objects.” However, he divides the positive transference into two components - one, the repressed erotic component, which is used in the service of resistance, the other, the friendly and affectionate component, which, although originally sexual, is the 'unobjectionable' aspect of the positive transference, and is involved with that “causation of a successful result on the psychoanalysis, as in all other remedial methods.” Freud refers here to the element of suggestion in psychoanalytic therapy.
Although not agreeing with the view of Freud that human behaviour depends ultimately on the biological sexual drives, and that it would be a mistake to deny the importance of his formulations regarding transference phenomena, I differ on certain points with Freud. However, I do not differ with the formulation that early impressions acquired during childhood is revived in the analytical situation, and are felt as immediate and real - that they form paternally the greatest obstacles to analysis, if unnoticed and, as Freud puts it, the greatest ally of the analysis when understood. Agreeing that the main work of the analysis consists in analysing the transference phenomena, although differing about how this results in a cure -that the transference is a strictly interpersonal experience. Freud gives the impression that under the stress of the repetition-compulsion the patient is bound to repeat the identical pattern, despite the other person. Thus and so, I believe that the personality of the analyst tends to decide the character of the transference illusion, and especially to figure out whether the attempt at analysis will result in a cure. Horney has shown that there is no valid reason for assuming that the tendency to repeat experiences repeatedly has an instinctual basis. The particular character of the person requires that he integrate with any given situation according to the necessities of his character structure - and the implications of in the psychoanalytic therapy.
Transference, and its use in therapy, has now become necessary to begin at the beginning, and to point out in a very schematic way how a person finds his particular orientation to himself and the world - which one might call his character structure.
The infant is born without a frame of reference, as far as interpersonal experience goes. He is already acquainted with the feelings of bodily movement - with sucking and swallowing - but, among other things, he has had no knowledge of the existence of another person in relationship of himself. Although I do not wish to draw any particular conclusions from this analogy, however, to mention a simple phenomenon, described by Sherif, connected with the problem of the frame of reference. If you have a completely dark room, with no possibility of any light being seen, and you then turn on a small-pin-point of light, which is kept stationary, this light will be moving about. It is certainty with which many of you have noticed that this phenomenon when gazing at a single star. The light seems to move, and it does so, apparently, because there is no reference point in relation to which one can establish it at a fixed place in space and time. It just wanders around. If, however, one can at the same time see some light as a fixed object in the room, the light immediately becomes stationary - its reference point becomes the centre of a fixed frame reference from which its orientation from a pin-of-light, soon becomes the reference point in which has been established, and there is no longer any uncertainty of wandering of the spot of light. It is fixed. The pinned-point of light wandering in the dark room is symbolic of the original attitude of the person to himself, undetermined, unstructured, with no reference points.
The new-born infant probably perceives everything in a vague and uncertain way, including himself. Gradually, reference points are established that a connection begins to occur between hunger and breast, between a relief of bladder tension and a wet diaper, between plating with his genitals and a smack on the hand. The physical boundaries and potentialities of the self are explored. One can observe the baby investigating the extent, shape and potentialities of his body. He finds that the realm of him and his other will come, or will not come, in that he will in spite hold his breath. Everything will get excited that he can smile and speak lovingly? People will be enchanted, or just the opposite? The nature of the emotional reference points that the determiner depends upon the environment. By that still unknown quality called “empathy,” he discovers the reference points that help to figure out his emotional attitude toward himself. If his mother did not want him, is disgusted with him, treats him with utter disregard, he comes to look upon himself as a thing-to-be-disregarded. With the profound human drive to make this rationally, he gradually builds up a system of “reasons why.” Underneath all these “reasons” is a basic sense of worthlessness, undetermined and undefined, related directly to the origin reference frame. Another child discovers that the state of being regarded is dependent upon specific factors - all is well if one does not act spontaneously, since one is not a separate person, since one is good, as the state of being good is continuously defined by the parents. Under these conditions, and these only, this child can feel a sense of self-regard.
Other people are encountered with the original reference frame in mind. The child tends to carry over into later situations the patterns he first learned to know. The rigidity with which these original patterns are retained depends upon the nature of the child’s experience. If this had been a traumatic character so that spontaneity has been blocked and further emotional development has been inhibited, the original orientation will tend to persist. Discrepancies may be rationalized or repressed. Thus, the original impression of the hostile mother may be retained, while the contact with the new person is rationalized to fit the original reference frame. The new person encountered acts differently, but probably that is just a pose. She is just being pleasant because she does not know me. If she really knew me, she would act differently. Or, the original impressions are so out of line with the present actuality, that they remain unconscious, but make themselves apparently inappropriate in behaviour or attitudes, which remain outside the awakening awareness of the person concerned.
The incongruity of the behaviour, or of the attitude, may be a souse of astonishment to the other person involved. Sullivan provides insight into the process by the elucidation of what he calls the “parataxic distortions.” He points out that in the development of the personality, certain integrative patterns are organized in response to the important persons in the child’s past. There is a “self-in-relation-to-A” pattern, or “self-in-relation-to -B” pattern. These patterns of response become familiar and useful. The person learns to get along as a “self-in-relation-to A” or B, C, D and E, depending on the number of important people to whom he had to adjust during his early development. For example, a young woman, who had a severely dominating mother and a weak, kindly father, learned a pattern of adjustment to her mother that could be briefly described as submissive, mildly rebellious in a secret way, but mostly lacking in spontaneity. Toward the father she developed loving, but contemptuous attitude. When she encountered other people, whatever sex, she oriented herself to them partly as the real people they were, and partly as she had learned to respond to her mother and father in the past. She thus was feeling toward the real person involved as if she were dealing with two people at once. However, since it is very necessary for people to behave as rational persons, she suppressed the knowledge that some of her reactions were inappropriate to the immediate situation, and wove an intricate mesh of rationalizations, which permitted her to believe that the person with whom she was dealing really was someone either to be feared and submitted to, as her mother, or to be contemptuous of, as her father. To a greater extent, the real person fitted the original picture of the mother and father, the easier it was for her to maintain that the original “self-in-reflation-to-A-or-B” was the real and valid expression of herself.
It happened, however, that this woman had, had a kindly nurse who was not a weak person, although occupying an inferior position in the household. During the many hours when she was with this nurse, she can experience a great deal of undeserved warmth, and of freedom for self-realization, no demands for emotional conformity were made on her or his relationship. Her own capacities for love and spontaneous activity could flourish. Unfortunately, the contact with this nurse was all too brief. Still, they’re remained, despite the necessity for the rigid development of the patterns toward the mother and father, a deeply repressed, but still vital experience of self, which most closely approximated the fullest realization of her potentialities. This, which one might call her “real self,” although “snowed under” and impeded by all the distortions incurred by her relationship to the parents, was finally able to emerge and become again active in analysis. In this treatment, she learned how much her reactions to people were “transference” reactions, or as Sullivan would say, “parataxic distortions.”
Of course, a deliberate schematization was made to illustrate the earliest frames of reference and then, least of mention, the parents are not overlooked as to other possible reference frames. Also, one has to realize that one pattern connects with another - the whole making a tangled mass that only years of analysis may buoyantly unscramble. Also, an attemptive glimpse into what has not taken of its time to outline the compensative drives that the neurotic person has to develop to handle his life situation. Each compensatory manoeuver causes some change in his frame of reference, since the development of a defensive trait in his personality sets off a new set of relationships to those around him. The little child who grows ever more negativistic, because of injuries and frustrations, evokes more hostility in his environment. However, and this is important, the basic reactions of hostility by the parents, which originally induced his negativism, are still there. Thus, the pattern does not change much in character, and it just gets worse in the same direction. Those persons whose later life experiences perpetuate the original; frames of reference are more severely injured. A young child, who has a hostile mother, may then have a hostile teacher. If, by good luck, she got a kind teacher and if his own attitude was not already badly warped, so that he did not induce hostility in this kind teacher, he would be introduced into a startlingly new and pleasant frame of reference. His personality might not suffer too greatly, especially if a kindly aunt or uncle happened to be around. Surely, that if the details of the life histories of healthy people were studied, it would be found that they had some very satisfactory experiences early enough to establish in them a feeling of validity as persons. The profoundly sick people have been so early injured, in such a rigid and limited frame of reference, that they are not able to use kindliness, decency or regard when it does come their ways. They meet the world as if it were potentially menacing. They have already developed defensive traits entirely appropriate to their original experience, and then carry them out in completely inappropriate situations, rationalizing the discrepancies, but never daring to believe that people are different to the ones they early learned to distrust and hate. Because of bitter early experience, they learn to let their guards down, never to permit intimacy, lest at that moment the death blow would be dealt to their already partly destroyed sense of self-regard. Despairing of real joy in living, they develop secondary neurotic goals that a pseudo-satisfaction. The secondary gains at first glance might be what the person was really striving for - revenge, powerfulness and exclusive possession. Actually, these are but the expressions of the deep injuries sustained by the person. They cannot be fundamentally cured until those interpersonal relationships that caused the original injury are brought back to consciousness in the analytic situation. In stages, each phase of the long period of emotional development is exposed, by no means chronologically, the interconnectivity in overlapping reference frames is made conscious, those points at which a distortion of reality, or a repression of part of the self had to occur, are uncovered. The reality gradually becomes 'undistorted', the self, refound, in the personal relationship between the analyst ant the patient. This personal relationship with the analyst is the situation in which the transference distortions can be analysed.
In Freud’s view, the transference was either positive or negative, and was related in an isolated way to a particular person in the past. Perhaps, the transference is the experiencing in the analytic situation the entire pattern of the original reference frames, which include at every moment the relationship of the patient to himself, to the important persons, and to others, as he experienced them at the time, in the light of his interrelationships with the important people.
The therapeutic aim in this process is not to uncover childhood memories that will then lend themselves to analytic interpretation - the important difference to Freud’s view. Fromm has pointed this out in a recent lecture. Psychoanalytic cure is not the amassing of data, either from childhood, or from the study of the present situation. Nor does cure resolve itself from a repetition of the original injuries’ experience in the analytic relationship. What is curative in the process is that in tending to reconstruct with the analyst the atmosphere that obtained in childhood, the patient achieves something new. He discovers that part of himself that had to be repressed at the time of the original experience. He can only do this is an interpersonal relationship with the analyst, which is suitable to such a rediscovery. To illustrate this point, If a patient had a hostile parent toward whom he was required to show deference, he would have to repress certain of his own spontaneous feelings. In the analytical situation, he tends to carry over his original frame of reference and again tends to feel himself to be in a similar situation. If the analyst’s personality in addition contains elements of a need for deference that need will be the unconscious implication as imparted to the patient, who will, therefore ease the repressive magnitude of his spontaneity as previously he was the same benevolence. True enough, he may act or try to act as if analysed, since by definition, that is what the analyst is attempting to accomplish. Nevertheless, he will never have found his repressed self, because the analytical relationship contains for him elements actually identical with his original situation. Only if the analyst provides a genuinely new frame of reference - that is, if he is truly non-hostile, and truly not in need of deference - can this patient discover, and it is a real discovery, the repressed elements of his own personality. Thus, the transference phenomenon is used so that the patient will completely re-experience the original frames of reference, and himself within those frames, in a truly different relationship with the analyst, to the end that can discover the invalidity of his conclusions about himself and others.
That is not to mean that this is to deny the correctness of Freud’s view of the transference, yet acting as a resistance is a matter of fact, in that the tendency of the patient to reestablish the original reference frame is precisely because he is afraid to experience the other person in a direct and unreserved way. He has organized his whole system of getting along in the world. Bad as that system might be, based on the original distortions of his personality and his subsequent vicissitudes. His capacity for spontaneous feeling and a ting has gone into hiding. Now it has to be sought. If some such phrases as the 'capacity for self-realizations' are substituted in place of Freud’s concept of the repressed libidinal impulse, much the same conclusions can be reached about the way in which the transference-manifestations appear in the analysis as resistance. It is just in the safest situation, where the spontaneous feeling might come out of hiding, that the patient develops intense feelings, sometimes of a hallucination character, that relate to the most dreaded experiences of the past. It is at this point that the nature and the use by the patient of the transference distortions have to be understood and correctly interpreted by the analyst. It is also here that the personality of the analyst modifies the transference reaction. A patient cannot feel close to a detached or hostile analyst and will therefore never display the full intensity of his transference illusions. The complexity of this process, by which the transference can be used as the therapeutic instrument and, while, as a resistance may be illustrated by an example through which a patient having had developed intense feelings of attachment to a father surrogate in his everyday life. The transference feelings toward this man were of great value in explaining his original problem with his real father. As the patient became more aware of his personal validity, he found his masochistic attachment to be weakening. This occasional acute feeling of anxiety, since his sense of independence was not yet fully established. At that point, he developed very disturbing feelings regarding the analyst, believing that she was untrustworthy and hostile, although before this, he has successes in establishing a realistically positive relationship to her. The feelings of untrustworthiness precisely reproduced an ancient pattern with his mother. He experienced them at this point in the analysis to retain and to justify his attachment to the father figure, the weakening of which attachment had threatened him so profoundly. The entire pattern was explained when it was seen that he was re-experiencing an ancient triangle, in which he was continuously driven to a submissive attachment to a dominating father, due to the utter untrustworthiness of his weak mother. If the transference character of his sudden feeling of untrustworthiness of the analyst had not been clarified, he would have turned again submissively to his father surrogate, which would have further postponed his development of independence? Nonetheless, the development of his transference to the analyst brought to light a new insight.
To the fundamental direction upon which Freud’s view of the so-called narcissistic neurosis, was that Freud felt that personality disorders called schizophrenia or paranoia cannot ne analysed because the patient is unable to develop a transference to the analyst. Yet nonetheless, it is viewed as that of a real difficulty in treating such disorders that the relationship is essentially nothing but transference illusions of reality. Nowhere in the realm of psychoanalysis can one find complete proof of the effect of early mention experience on the person that in attempting to treat these patients. Frieda Fromm-Reichmann has shown in her work with schizophrenics the necessity to realize the intensity of the transference reaction, which have become almost completely real to the patient. Yet, if one knows the correct interpretations, by actually feeling the patient’s needs, one can over years of time do the identical thing accomplished more quickly than is less dramatical with patients suffering some less severe disturbances within their own interpersonal relationships.
Just for this, yet a peculiar moment is to say of what reasons was that Freud took of his position that all subsequent experiences in normal life are merely a repetition of the original one. This love is experienced for someone today about the love felt for someone in the past that it is, nonetheless, to believe this to be exactly true. The child who had to repress certain aspects of his personality enters a new situation dynamically, not just as a repetition of it. Therefore there are constitutional differences with respect to the total capacity for emotional experience, just as they are with respect to the total capacity for intellectual experiences. Given this constitutional substrate, the child engages in personal relationships, not passively as a lump of clay waiting to be moulded, but most dynamically, bringing into play all his emotional potentialities. He might find someone later whose capacity for response is deeper than his mother’s. If he is capable of that greater depth, he experiences an expansion of himself. Many later in life met a “great” person and have felt a sense of newness in the relationship with certain described to others as “wonderful” which is regarded with a certain amount of awe. This is not a “transference” experience but represents a dynamic extension of the self to a new horizon.
Ours is to discuss hypnosis a little further in detail and to make by some attributive affordance as drawn upon a few remarks about its correlation with the transference phenomenon in psychoanalytic therapy.
According to White, the subject under hypnosis is a person striving to act like a hypnotized person as that state is continuously defined by the hypnotist. He also says that the state of being hypnotized is an “altered state of consciousness.” However, as Maslow points out, it is not an abnormal state. In everyday life transient manifestations of all the phenomena that occur in hypnosis can be seen. Such examples are cited as the trance-like state a person experiences when completely occupied with an absorbing book. Among the phenomena of the hypnotic state is the amnesia for the enchantment of a trance. The development of certain anaesthetics, such as insensitivity to pain, deafness to sounds other than the hypnotist’s voice, greater ability to recall forgotten events, loss of capacity to initiate activities spontaneously, and has the greater suggestibility. This heightened suggestibility in the trance state is the most important phenomenon of hypnosis. Changes in behaviour and feeling can be induced, such as painful or pleasant experiences, headaches, nausea, or feelings of well-being. Post-hypnotic behaviour can be influenced by suggestion, this being one of the most important aspects of experimental hypnosis for the clarifying of psychopathological problems.
The hypnotic state is induced by a combination of methods that may include relaxation, visual concentration and verbal suggestion. The methods vary with the personality of the experimenter and the subject.
Maslow has pointed the interpersonal character of hypnosis, which accounts for some different conclusions by different experimenters. Roughly, the types of experimenters may be divided into three groups - the dominant type, the friendly or brotherly type, and the cold, detached, scientific type. According to the inner needs of the subject, he can probably be hypnotized more readily by one type or the other. The brotherly hypnotizer cannot, for instance, hypnotize a subject whose inner need is to be dominated.
Freud believed that the relationship of the psychological subject to the hypnotist was that of an emotional, erotic attachment. He comments on the “uncanny” character of hypnosis and says that, “the hypnotist awakens in the subject part of his archaic inheritance that had also made him compliant to his parents.” What is thus awakened is the concept of “the dreaded primal father,” “toward whom, only a passive-masochistic attitude is possible. Toward whom one’s will has to be surrendered.”
Ferenczi considered the hypnotic state to be one in which the patient transferred onto the hypnotist his early infantile erotic attachment to the parents with the same tendency to blind belief and to uncritical obedience as obtained then. He calls attention to the paternal or frightening type of hypnosis and the maternal or gentle, stroking type. In both instances the situation tends to favour the “conscious and unconscious imaginary return to childhood.”
The only point of disagreement with these views is that one does not need to postulate an erotic attachment to the hypnotist or 'transference' of infantile sexual wishes. The sole necessity is a willingness to surrender oneself. The child whose parent wished to control it, by one way or another, is forced to do this. To be loved, or to at least be taken consideration of it. The patient transfers this willingness to surrender to the hypnotist. He will also transfer it to the analyst or the leader of a group. In any one of these situations the authoritative person, is the hypnotist, analyst or leader, promises because of great power or knowledge the assurance of safety, a cure or happiness, as the case may be. The patient, or the isolated person, regresses emotionally to a state of helplessness and lack of initiative similar to the child who has been dominated.
If it is asked how in the first place, the child is brought into a state of submissiveness, it may be discovered that the original situation of the child had certain aspects that already resemble a hypnotic situation. This depends upon the parents. If they are destructive or authoritarian they can achieve long-lasting results. The child is continuously subjected to being told how and what he is. Day in and day out, in the limited frame of reference of his home, he is subjected to the repetition, often again: “You are a naughty boy.” “You are a bad girl.” “You are just a nuisance and are always giving me trouble. “You are dumb,” “you are stupid,” “you are a little fool.” “You always make mistakes.” “You can never do anything right,” or “that’s right, I love you when you are a good boy.” “That’s the kind of boy I like.” “Mother lovers a good boy who does what she tells him.” “Mother knows best. Mother always knows best.” “If you would listen to mother, you would get along all right. Just listen to her.” “Don’t pay attention to those naughty children. Just listen to your mother.”
Over and again, with exhortations to say attention, to listen, to be good, the child is brought under the spell. “When you get older, never forget what I told you. Always remember what mother says, then you will never get into trouble.” These are like Post-hypnotic suggestions. “You will never come to a good end. You will always be in trouble.” “If you are not good, you will always be unhappy.” “If you don’t do what I say, you will regret it.” “If you do not live up to the right things - again, “right” as continuously defined by the mother - you will be sorry.”
Hypnotic experiments, according to Hull, for many reasons, including that of learning the uses and misuses of language, there is a marked rise of verbal suggestibility up to five years, with a sharp dropping off at around the eighth year. Ferenczi refers to the subsequent effects of threats or orders given in childhood as “having much in common with the Post-hypnotic command-automatisms.” Pointing out how the neurotic patient follows out, without being able to explain the motive, a command repressed long ago, just as in hypnosis a Post-hypnotic suggestion is carried out for which amnesia has been produced.
Unfortunately, having had no personal experience with hypnosis, I refer only to hypnosis in discussing the transference is to further a better understanding of the analytic relationship. The child may be regarded for being in a state of “chronic hypnosis,” as described, but with all sorts of Post-hypnotic suggestions thrown in during this period. This entire pattern - this entire early frame of reference - may be “transferred” to the analyst. When this has happened, the patient is in a highly suggestible stye. Due to many intrinsic and extrinsic factors, the analyst is now in the position of a sort of “chronic hypnotist.” First, due to his position of a doctor he has a certain prestige. Second, the patient comes to him, even if expressedly unwillingly, still if there were not something in the patient that was co-operative he would not come at all, or at least he would not stay. The office is relatively quietly, external stimuli relatively reduced. The frame of reference is limited. Many analysts maintain an anonymity about themselves. The attention is focussed on the interpersonal relationship. In this relatively undefined and unstructured field the patient can discover his “transference” feelings, since he has few reference points in the analytical situation by which to go. This is greatly enhanced by having the patient assume a physical position in the room under which he does not see the analyst. Thus, the ordinary reference points of facial expression and gestures are lacking. True enough, he can look around or get up and walk about. Nevertheless, for considerable periods he lies down - itself a symbolically submissive position. He does what is called “free association.” This is again, giving up - willingly, to be sure - the conscious control of his thoughts, that is, the willingness and cooperativeness of all these acts. That is precisely the necessary condition for hypnosis. The lack of immediate reference points permits the eruption into consciousness of the old patterns of feeling. The original frame of reference becomes more clearly outlined and felt. The power that the parent originally has to cast the spell is transferred to the analytical situation. Now it is the analyst who can do the same thing - placed there partly by the nature of the external situation, partly by the patient who comes to be freed from his suffering.
There is no such thing as an important analyst, nor is the idea of the analyst’s acting as a mirror anything more than the “neatest trick of the week.” Whether intentionally or not, whether conscious of it or not, the analyst does express, day in and day out, subtle or overt evidences of his own personality in relationship to the patient.
The analyst may express explicitly his wish not to be coercive, but if he has an unconscious wish to control the patient, analysing and to resolve the transference distortions is impossible for him correctly. The patient is thus not able to become free from his original difficulties and for lack of something better adopts the analyst as a new and less dangerous authority. Then the situation occurs in which it is not “my mother says” or “my father says,” but now “my analyst says.” The so-called chronic patients who need lifelong support and may benefit by such a relationship, however, that frequently the long-continued unconscious attachment - by which is not meant of any genuine affection or regard - is maintained because of a failure on the analyst’s part to recognize and resolve the sense of being uttered of a sort of hypnotic spell that originated in childhood.
To develop an adequate therapeutic interpersonal relationship, the analyst must be without those personal traits that tend to perpetuate the originally destructive or authoritative situation unconsciously. Besides this, he must be able, because of his training, to be aware of every evidence of the transference phenomena, and lastly, he must understand the significance of the hypnotic-like situation that analysis helps to reproduce. If, with the best of intentions, he unwittingly uses the enormous power with which he is endowed by the patient, he may certainly achieve something that looks like change. His suggestions, exhortations and pronouncements based on the patient’s revelation of himself, may be certainly makers an impression. The analyst may say, “You must not do this just because I say so.” That is a sort of Post-hypnotic command. The patient then strives to be “an analysed person acting on his own account” - because he was told to do so. He is still not really acting on his own.
It is to my firm conviction that the analysis is terminable. A person can continue to grow and expand all his life. The process of analysis, however, as an interpersonal experience, has a definite end. That an end is achieved when the patient has rediscovered his own self as an activity and independently functioning entity.
Transference problems concerning to most psychoanalytic authors maintain that schizophrenic patient cannot be treated psychoanalytically because they are too narcissistic to develop with the psychotherapist an interpersonal relationship that is sufficiently reliable and consistent for psychoanalytic work. Freud, Fenichel and other authors have recognized that a new technique of approaching patients psychoanalytically must be found if analysts are to work with psychotics. Among those who have worked successfully in recent years with schizophrenics, Sullivan, Hill, and Karl Menninger and his staff has made various modifications of their analytic approach.
We think of a schizophrenic as a person who has had serious traumatic experience in early infancy at a time when his ego and its ability to examine reality were not yet developed. These early traumatic experiences seem to furnish the psychological basis for the pathogenic influence of the frustrations of later years. Earlier the infant lives grandiosely in a narcissistic world of his own. His needs and desires may be taken care of by something vague and indefinite which he does not yet differentiate. As Ferenczi noted they are expressed by gestures and movements since speech is yet undeveloped. Frequently the child’s desires are fulfilled without any expression of them, a result that seems to him a product of his magical thinking.
Traumatic experiences in this early period of life will damage a personality more seriously than those occurring in later childhood such as are found in the history of psychoneurotic. The infant’s mind is more vulnerable the younger and less used it ha been, furthered, the trauma is a blow to the infant’s egocentricity. In addition early traumatic experience shortens the only period in life in which an individual ordinarily enjoys the moist security, thus endangering the ability to store up as it was a reasonable supply of assurance and self-reliance for the individual’s late struggle through life. Thus is such a child sensitized considerably more toward the frustrations of later life than by later traumatic experience. So many experiences in later life that would mean little to a ‘healthy’ person and not much to a psychoneurotic, mean a great deal of pain and suffering to the schizophrenic. His resistance against frustration is easily exhausted.
Once he reaches his limit of endurance, he escapes the unbearable reality of present life by attempting to reestablish the autistic, delusional world of the infant, but this is impossible because the content of his delusions and hallucinations are naturally coloured by the experiences of his whole lifetime.
How do these developments influence the patient’s attitude toward the analyst? The analyst’s approach to him?
Due to the very early damage and the succeeding chain of frustrations that the schizophrenic undergoes before finally giving in to illness, he feels extremely suspicious and distrustful of everyone, particularly of the psychotherapist who approaches him with the intention of intruding into his isolated world and personal life. To him the physician’s approach means the threat of being compelled to return to the frustrations of real life and to reveal his inadequacy to meet them, or - still worse - a repetition of the aggressive interference with his initial symptoms and peculiarities that he has encountered in his previous environment.
In spite of his narcissistic retreat, every schizophrenic has some dim notion of the unreality and loneliness of his substitute delusionary world. He longs for human contact and understanding, yet is afraid to admit it to himself or to his therapist for fear of further frustration.
That is why the patient may take weeks and months to test the therapist before being willing to accept him.
However, once he has accepted him, his dependence on the therapist is greater and he is more sensitive about it than is the psychoneurotic because of the schizophrenic’s deeply rooted insecurity; the narcissistic seemingly self-righteous attitude is but a defence.
Whenever the analyst fails the patient from reasons to be of mention - one severe disappointment and a repetition of the chain of frustrations the schizophrenic has previously endured.
To the primitive part of the schizophrenic’s mind that does not discriminate between himself and the environment, it may mean the withdrawal of the impersonal supporting forces of his infancy. Severe anxiety will follow this vital deprivation.
In the light of his personal relationship with the analyst it means that the therapist seduced the patient to use him as a bridge over which he might be led from the utter loneliness of his own world to reality and human warmth, only to have him discover that this bridge is not reliable. If so, he will respond helplessly with an outburst of hostility or with renewed withdrawal as may be seen most impressively in a catatonic stupor.
Through reasons of change, this withdrawal during treatment is a way the schizophrenic has of showing resistance and is dynamically comparable to the various devices the psychoneurotic uses to show resistance. The schizophrenic responds to alterations in the analyst’s defections and understanding by corresponding stormy and dramatic changes from love to hatred, from willingness to leave his delusional world to resistance and renewed withdrawal.
As understandable as these changes are, they nevertheless may come quite as a surprise to the analyst who frequently has not observed their source. This is quite in contrast to his experience with psychoneurotic whose emotional reactions during an interview he usually predicts. These unpredictable changes seem to be the reason for the conception of the unreliability of the schizophrenic’s transference reactions, yet they follow the same dynamic rules as the psychoneurotic’s oscillations between positive and negative transference and resistance. If the schizophrenic’s reactions are more stormy and seemingly more unpredictable than those of the psychoneurotic, perhaps this may be due to the inevitable errors in the analyst’s approach to the schizophrenic, of which he himself may be aware, than to him unreliability of the patient’s emotional response.
Why is it inevitable that the psychoanalyst disappoints his schizophrenic patients time and again?
The schizophrenic withdraws from painful reality and retires to what resembles the early speechless phase of development where consciousness is yet crystallized. As the expression of his feelings is not hindered by the conventions, he has eliminated, so his thinking, feeling, behaviour and speech - when present - obey the working rules of the archaic unconscious. His thinking is magical and does not follow logical rules. It does not admit any, and likewise no yes: There is no recognition of space and time, as ‘I’, ‘you’ and ‘they’ are interchangeable. Expression is by symbols, often by movements and gestures rather than by words.
As the schizophrenic is suspicious, he will distrust the words of his analyst. He will interpret them and incidental gestures and attitudes of the analyst according to his own delusional experience? The analyst may not even be aware of these involuntary manifestations of his attitudes, yet they proficiently mean much of the hypersensitive schizophrenic who uses them to orient himself to the therapist’s personality and intentions toward him.
In other words, the schizophrenic patient and the therapists are people living in different worlds and on different levels of personal development with different means of expressing and of orienting themselves. We know little about the language of the unconscious of the schizophrenic, and our access to it is blocked by the very process of our own adjustment to a world the schizophrenic has relinquished. So we should not be surprised that errors and misunderstandings occur when we undertake to communicate and strive for a rapport with him.
Another source of the schizophrenic’s disappointment arises from the following: Since the analyst accepts and does not interfere with the behaviour of the schizophrenics, his attitude may lead the patient to expect that the analyst will assist in carrying out all the patients’ wishes, though they might not be his interest, or to the analyst’s and the hospital’s in their relationship to society. This attitude of acceptance so different from the patient’s experiences readily fosters the anticipation that the analyst will try to carry out the patient’s suggestions and take his part, even against conventional society should give occasion to arise. Frequently, agreeing with the patient's wish to remain unbathed and untidy will be wise for the analyst until he is ready to talk about the reasons for his behaviour or to change spontaneously. At other times, he will unfortunately be unable to take the patient’s part without being able to make the patient understands and accept the reasons for the analyst’s position.
If, however, the analyst is not able to accept the possibility of misunderstanding the reactions of his schizophrenic patient and in turn of being misunderstood by him, it may shake his security with his patient. The schizophrenic, once accepted the analyst and wants to rely upon him, will sense the analyst’s insecurity. Being helpless and insecure himself - in spite of his pretended grandiose isolation - he will feel utterly defeated by the insecurity of his would-be helper. Such disappointment may furnish reasons for outbursts of hatred and rage that are comparable to the negative transference reactions of psychoneurotic, yet more intense than these since they are not limited by the restrictions of the actual world.
These outbursts are accompanied by anxiety, feelings of guilt, and fear of retaliation that in turn lead to increased hostility. Thus, is established a vicious circle: We disappoint the patient: He hates us, is afraid we hate him for his hatred and therefore continues to hate us. If in addition he senses that the analyst is afraid of his aggressiveness, it confirms his fear that he is actually considered dangerous and unacceptable, and this augments his hatred.
This establishes that the schizophrenic can develop strong relationships of love and hatred toward his analyst. After all, one could not be so hostile if it were not for the background of a very close relationship, once to emerge from an acutely disturbed and combative episode. In addition, the schizophrenic develops transference reaction in the narrower sense that he can differentiate from the actual interpersonal relationship.
What is the analyst’s further function in therapeutic interviews with the schizophrenic? As Sullivan has stated, he should observe and evaluate all of the patient’s words, gestures, changes of attitude and countenance, ad he does the associations of psychoneurotics. Every production - whether understood by the analyst or not - is important and makes sense to the patient. Therefore the analyst should try to understand, and let the patient feel that he tries. He should as a rule not attempt to prove his understanding by giving interpretations because the schizophrenic himself understands the unconscious meaning of his productions better than anyone else. Nor should the analyst ask questions when he does not understand, for he cannot know what trend of thought, far off dream or hallucination he may be interpreting. He gives evidence of understanding, whenever he does, by responding cautiously with gestures or actions appropriate to the patient’s communication, for example, by lighting his cigarette from the patient’s cigarette instead of using a match when the patient seems to show a wish for closeness and friendship.
What has been said against intruding into the schizophrenic’s inner world with superfluous interpretations also holds true for untimely suggestions? Most of them do not mean the same thing to the schizophrenic that they do to the analyst. The schizophrenic who feels comfortable with his analyst will ask for suggestions when he is ready to receive them. While he does not, the analyst does better to listen. Least of, the schizophrenic’s emotional reactions toward the analyst have to be met with extreme care and caution. The love that the sensitive schizophrenic feels as he first emerged, and his cautious acceptances of the analyst’s warmth of interest are really most delicate and tender things. If the analyst deals unadroitly with the transference reactions of a psychoneurotic, it is bad enough, though as a rule reparable, but if he fails with a schizophrenic in meeting positive feelings by pointing it out for instance before the patient suggests that he be ready to discuss it, he may easily freeze to death what had just begun to grow and so destroy any further possibility of therapy.
Sometimes the therapist’s frank statement that he wants to be the patient’s friend but that he is going to protect himself should he be assaulted may help in coping with the patient’s combativeness and relieve the patient’s fear of his own aggression. As, too, some analysts may feel that the atmosphere of complete acceptance and strict avoidance of any arbitrary denials that we recommend as a basic rule for the treatment of schizophrenics may not accord with our wish to guide them toward reacceptance of reality. This may not be as apparently so. Certain groups of psychoneurotics have to learn by the immediate experience of analytic treatment how to accept the denials life has in store for each of us. The schizophrenic has above all to be cured of the wounds and frustrations of his life before we can expect him to recover.
Other analysts may feel that treatment as we have outlined it is not psychoanalysis. The patient is not instructed to lie on a couch, he is not asked to give free associations (although frequently he does), and his productions are seldom interpreted other than by understanding acceptance. Freud says that every science and therapy that accept his teachings about the unconscious, about transference and resistance and about infantile sexuality, may be called psychoanalysis. According to this definition we believe we are practising psychoanalysis with our schizophrenic patients.’
Whether we call it analysis or not, successful treatment clearly does not depend on technical rules of any special psychiatric school but on the basic attitude of the individual therapist toward psychotic persons. If he meets them as strange creatures of another world whose productions are non-understandable to ‘normal’ beings, he cannot treat them. If he realizes, however, that the difference between himself and the psychotic is only one of degree and not to kind, he will know better how to meet him. He can probably identify himself sufficiently with the patient to understand and accept his emotional reactions without becoming involved in them.
Countertransference was once considered a hindrance to analytic work. Now, though controversies still exist about, what constitutes its optimal use, and though there are real dangers of misuse, countertransference is recognized by most of analysts not only as integral to the analytic relationship, whether or not it is in awareness, but as a potentially powerful and often crucial analytic tool. In some instances’ sensitivity to Countertransference nay be the only basis for tuning into the patient to be able to achieve an analytic possibility.
It seems, but not fully understood to why the belief that the problem of countertransference resistance itself not only precludes using countertransference data in facilitating ways in the analysis, but also increases the likelihood that countertransference will affect the work in less than optimal ways. It can constitute one of the gravest threats to analytic work.
Countertransference resistance often arises when awareness of countertransference requires us to face aspects of ourselves and our feelings that may be threatening. In this regard it is interesting that positive emotions can be as threatening as negative ones. Every bit as justly evident as in as early as of 1895 in Breuer’s treatment of patient Anna O.
Countertransference resistance includes, of course, resistance to awareness of collusive involvements. It can involve identification and reaction formation, or defences such as a detachment, resistance to awareness of one’s own affective reactions, or resistance to awareness of particular nuances of the transference-countertransference interaction. Occasionally, however, countertransference resistance may involve resistance not simply to awareness of one’s own reactions, but also to allowing any kind of emotional engagement with the patient. It might be that in such instances thinking of this kind of analyst is more accurate “detachments” as a form of countertransference itself.
Alternatively, Countertransference resistance may reflect the analyst’s basic assumptions about the analytic task - the principle of neutrality is understood as requiring no, or minimal, emotional responsiveness by the analyst, for others neutrality is defined in term s of how the analyst uses his or her reactions, the assumption being that these are inevitable. From the former perspective an analyst’s emotional response can be viewed as evidence of a failure to maintain the proper analytic stance. As for the latter, the taboo on affective experience is seen as preventing the analyst from using himself as a sensitive analytic instrument, and as precluding the kind of affective engagement that may be essential. The latter view draws upon Heimann’s (1950) observation that: The emotions roused in [the analyst] are much nearer to the central issue than his reasoning, or to put it in other words, his unconscious perception of the patient’s unconscious is more acute and before his conscious conception of the situation . . . the analyst’s emotional response to his patient within the analytic situation represents one of the most important tools for his work.
It seems that the analyst’s ability to respect and use his or her awareness of whatever is begun internally while the work becomes a source of power and strength. From this perspective, even when we know our own issues are involved, we still can gain important information if we consider why with this patient and not others, and why now with this patient and not this patient at other times.
A common example of this kind of countertransference resistance involves those moments when the analyst may be overcome with sleepiness and him or she never relates it to being with the patient. Sometimes we become alert to this the session following when we find to our great surprise that we are suddenly wide awake. Only then does the sleepy response in the prior session was apparently very specific to the earlier interaction. This, of course, allows us to see this awareness as a basis for structuring an analytic exploration.
We learn from these experiences that even when it may seem to us that our reactions are independent of the immediate context, which we are tired or distracted because of our own preoccupations, or that we are at the mercy of our own pathology, it is usually prudent to consider how our experience may be responsible to the interactive subtleties of the immediate moment.
Failure to consider that our feeling tired or distracted might be to some subtle development in the interaction may actually reflect a wish to avoid dealing with the anxieties of the moment or possible anxiety about being vulnerable to the patient’s impact. If this is the case then the real issue in such instances may actually be the countertransference resistance. In such instances tracking the interactive subtitles as they evolve between analyst and patient requires a collaborative engagement as it touches on aspects of the interaction that neither patient nor analyst could illuminate on his or her own - because patients tune into the analyst and the analyst into them, how the analyst deals with his own Countertransference obviously reveals a great deal about the analyst’s relation to his own experience and about his trustworthiness and authenticity, which also has impact. As early as 1915, Freud wrote: “ . . . Since we demand strict trustfulness from our patients, we jeopardize our whole authority if we let ourselves be caught out by them in a departure from the truth.” (1915)
In this regard, Ferenczi (1933) emphasized that patients: “show a remarkable, almost clairvoyant knowledge about the thoughts and emotions that go on in their analyst’s mind. To deceive a patient it seems hardly possible and if one tries to do so, it leads only to bad consequences.”
Lacan’s (1958) view is that “the inability to sustain a praxis in an authentic manner result as often happens with humans, in the exercise of power”:
Little (1951) approached the same issue from yet another angle, she wrote”: It is [the] question of a paranoid or phobic attitude toward the analyst’s own feelings that lay the groundwork for the greater danger and difficulty in countertransference. The very real; fear of being flooded with feelings of any kind, rage, anxiety, love, etc., in relation to the patient and of being passive to it and at its mercy leads to an unconscious avoidance or denial, honest recognition of such feeling is. Essential to the analytic process, and the analysand is naturally sensitive to any insincerity in his analyst and will inevitably respond to it with hostility. He will, identify with the analyst in it (by introjection ) for denying his own feelings and will exploit it generally in every way possible, to the detriment of his analyst.
The recognition that the patient tunes into what the analyst feels, whether the analyst is open about this or not, and therefore is sensitive to any kind of inauthenticity, and has been emphasized by analysts as diverse as Rank, 1929; Fromm, 1941; Rioch, 1943; Winnicott, 1949; Fromm-Reichmann, 1950, 1952; Gitelson, 1952, 1962; Fairbairn, 1958; Tauber, 1954, 1979; Nacht, 1957, 1962; Wolstein, 1959; Loewald, 1960; Searles, 1965, 1979; Guntrip, 1969; Feiner, 1970; Singer, 1971, 1977; Levenson, 1972, 1983; Ehrenberg, 1974, 1982, 1984, 1985a, 1990. From such a perspective the position of Alexander (1956), as well as of some contemporary analysts, that there is benefit in assuming a deliberately predetermined attitude toward the patient would be considered untenable and to undermine the treatment process. It would preclude an opportunity to use the immediate experience as analytic data, and as a means to clarify very subtle interactive patterns that would otherwise elude awareness.
Nevertheless, the issue is not simply as one for being 'authentic', there are ways of being authentic that can burden the patients unnecessarily and that can derail rather than advance the analytic process.
If we accept the idea that denial or resistances to awareness of countertransference reactions can be detrimental to the process, and that awareness presents us with options we do not otherwise have, we are still faced with the question of how best to users this awareness. Use of countertransference data in any direct way with the patient is clearly a delicate matter, unless handled judiciously, it can be counterproductive, even traumatizing. Any use of countertransference requires sensitivity, tact, and skill. This applies to active use and to decisions to remain silent, since there are times when silence can be as destructive, insensitive, or inappropriate as verbal intervention (Tauber, 1954, 1979).
It is critical, therefore, that we recognize that believing in the theoretical value - even necessarily - of using countertransference is different from having the ability to do so constructively. In this vein, knowing one’s own limits can be the better part of wisdom. Nonetheless, the alternative of suppressing our feelings out of fear of mishandling a situation or of being seduced out of an analytic role may prevent analytic engagement. This kind of countertransference resistance may be a countertransference enactment reflecting our fears. Often countertransference resistance reflects the analyst’s sensitivity to the dangers of misuse of countertransference with a particular patient. What is required is learning how to refine our ability to use this resistance itself as valuable data.
An example of how our theoretical assumptions influence our relation to our own countertransference experience involves identification. The analyst who believes identification contributes to an ability to be empathic may not see identification as a possible countertransference issue, since it might be viewed as in keeping with an alleged desirable analytic attitude. Nonetheless, just as identification of the patient can be defensive, the same may be true of the analyst. Identification by either may be an expression of unconscious fantasies of fusion, merger, or wishes for sexual union. It may reflect desires to control, dominate, appropriate for oneself, devour, cannibalize, destroy, rape, violate, or desires to protect oneself of others from these dangers (Widlocher, 1985). Identification can be a means to flatter, idealize, seduce, or impress, as it can be a way to avoid the analysis or experiences or fantasies of love, tenderness, hate, anger or any other emotion that night be aroused. In some instances’ identification may actually serve to avoid a real engagement, or to avoid provoking the anger of the other, or to avoid awareness of other aspects of reactions of oneself or of others that might be different, even traumatic, to acknowledge. It can also serve to avoid exposing the full extent and depth of the patient’s actual pathology. What becomes apparent is that we can fail its patient though our 'empathic' identification, the very response often equated with the caring analyst (Levenson, 1972, Beres and Arlow, 1974).
Still, and all, being alert to the possibility that any effort to attend to one set of transference-countertransference issues is important, however valid, can be an extremely subtle form of countertransference resistance regarding other issues, and a form of enactment of other aspects of countertransference. Similarly, any decision about how countertransference is to be used can be motivated by genuine analytic concerns or by countertransference impulses, such as impulses to retaliate, gratify, withhold, impress, protect or to avoid other issues.
Yet, there are aspects of our reaction that can be quite elusive, such as feelings of great satisfaction or of defensiveness, or intruding thoughts or fantasies, or experiences of destructibility or inattentiveness. In such instances it is not only the countertransference that is at issue, but also the countertransference resistance itself.
In those instances in which the patient evokes the very reactions that are being attributed to the analyst, countertransference resistance precludes the possibility of clarifying these interactive subtleties and their symbolic meaning, and does relate in this way on the part of the patient reveal wishes to control and dominate the other? Is there an erotic aspect to this kind of interaction? Is it a kind of symbolic rape and violation? What fears might the patient is defending against by relating in this way? To what extent might it be in the service of an effort on the patient’s part to cure himself or herself, or even the analyst?
Since countertransference resistance precludes understanding, we must gradually turn our attention to ways of becoming aware of it whatever its form. One way is to increase our sensitivity to shifts in our own sense of identity as we work (Grinberg, 1962, 1979 and Searle, 1965, 1979). Another is to attend to the patient’s experience and interpretations of the countertransference (Little, 1951, 1957, Langs, 1976 and Hoffman, 1983). In that if we were to consider that the development of the transference is always to some extent shaped by the participation of the analyst, then it follows that the transference itself can also be a clue to aspects of our own countertransference of which we ourselves might be unaware.
One could ask, would awareness of these possibilities to accelerate the analytic work, or to what extent is it possibilities that a mutual effort to address all the complexities of what was to go on between patient and analyst have happened if any proceeding difficulties were to be involved as could prove critical to the work. So, is my belief that reason-sensitivities to the dangers of countertransference resistance can help in the use of countertransference to greater analytic advance.
Despite increasing agreement about the importance of countertransference as a vital source of analytic data, there is much controversy about whether countertransference should be used in direct ways with the patient, and if so what constitutes optimal use. There are no questions that there are real dangers of misuse, Heimann’s (1950) warning against the analyst’s undisciplined discharge of feelings to avoid the evident dangers of acting out, wild analysis, manipulation, and the intrusive imposition of the analyst’s residual pathology are as valid now as it was then. She emphasized that the analyst must be able to “sustain the feelings stirred in him, as opposed to discharging them (as does the patient) to subordinate them to the analytic task.” Now, we also know that remaining silent about our experience can be as much a countertransference enactment as any other kind of analytic response. There is no way to avoid countertransference, and attempting to deny its power can be dangerous. The question at this point is not whether to use countertransference but how.
In considering how best to use countertransference, distinguishing it between the reactive dimension of countertransference is useful, which relates to what we find ourselves feeling in response to the patient that is often a surprise rather than a choice, and the kind of active response that takes into account this reactive response as data to be used toward informing a considered and deliberate clinical intervention. Silence, or any other reaction, can fall into either category.
The point is that active use of countertransference requires a thoughtful decision process about how to use awareness of one’s “reactive” countertransference response to inform that will then become a considered response.
Sometimes the analyst might actively decide to express the countertransference impulse in some direct way. In other instances an active decision may be made to remain silent. At times acknowledgement and discussion of a countertransference impulse, or of one’s own difficulties managing or understanding one’s reaction, or of the thought process involved in one’s deliberations about how to use countertransference data, are potentially constructive options.
The point here, is that the amount of overt activity that takes place is not indicative of whether the analyst is actively or passively responding to his or her impulse. In fact, the same overt response can reflect either kind of internal process.
That is, not to imply that every response must be a considered one. There are times when our inability to stay on top of our reactions - even our losing it with a patient - may be useful. As Winnicott (1949, 1969) notes. The unflappable analyst may be useless when knowing that he can make an impact is essential for the patient. He cautions that there are times when an implacable analyst may actually provoke destructive forms of acting out, including suicide.
Nor is it to imply that the analyst must “understand” his countertransference reactions to use them constructively. In some instances’ willingness to let the patient know what the analyst is experiencing, even if the analyst may not at the time understand his own reaction, can facilitate the analytic work, simply because of the kind of collaborative possibilities it structures. Even when the analyst feels at a loss, and when caution is appropriate, acknowledging that one feels at a loss can be an active use of countertransference. It emphasizes the necessity for a collaborative relationship and establishes a level of honesty and openness that can be significant in and of it. It also leaves the door open for a creative gesture from the patient and allows the patient to help clarify what the issues may be when the analyst may not have a clue. In some instances this is the only way to reach certain dimensions of experience and to realize the unique possibilities of the analytic moment.
This kind of process provides an opportunity to realize that expressing it is possible and experience feelings one may not understand and to get “close” without fear of losing control. As it adds a new dimension to the analytic interaction, it can lead to new levels of intimacy and to unexpected kinds of interactive developments. In addition, it establishes that understanding the significance of the experience of each may at times require the collaboration of the other.
The question here, is how to decide at any given moment what use of countertransference will best advance the work. At times the question also may be how to remain analytically effective and alive when we are in the grip of the kind of countertransference that seems to threaten our ability to do so, such as when the patient may have deadening impact on us, or when we may find ourselves involved in enactments without understanding how or why.
The analyst’s ability to use countertransference constructively, particularly in the face of more severe kinds of pathology, is often the factor that determines whether an analysis will have a chance of succeeding.
Using countertransference is in many ways as having inevitable structures as more than a personal kind of engagement than might occur otherwise. The impact of this cannot be overlooked. The patient is confronted with the analyst as a human being, with sensitivities, vulnerabilities and limitations. This allows the patient to recognize the necessity for his own active collaboration. The unique kind of intimacy that is so structured has effects beyond the content of what is exchanged, as these effects must be explored in what becomes an endless progression that continues to open on itself, often in very exciting and lively ways.
The emphasis is on process and experience, not on contentual representation, as instead of feeling limited by our subjectivity and trying to defend against it we begin to use it as a powerful source of data and as a basis for opening a unique analytic exploration that can lead to places neither patient nor analyst could have predicted beforehand which neither could possibly have reached alone.
Freud described transference as both the greatest danger and the best tool for analytic work. He refers to the work of making the repressed past conscious. Besides, these two implied meanings of transference, Freud gives it a third meaning: It is in the transference that the analysand may relive the past under better conditions and in this way rectify pathological decisions and destinies. Likewise three meanings of countertransference may be differentiated. It too may be the greatest danger and precisely when an important tool for understanding, an assistance to the analyst in his functions as interpreter. Moreover, it affects the analyst’s behaviour, it interferes with his action as object of the patient’s re-experience in that new fragment of life that is the analytic situation, in which the patient should meet with greater understanding and objectivity than he found in the reality or fantasy of his childhood. What have present-day writers to say about the problem of countertransference? Lorand writes mainly about the dangers of countertransference for analytic work. He also points out the importance of allowing for countertransference reactions, for they may indicate some important subject to be worked through with the patient. He emphasizes the necessity to the analyst’s being always aware of his countertransference, and discusses specific problems such as the conscious desire to heal, the relief analysis may afford the analyst from his own problems, and narcissism and the interference of personal motives in clinical purposes. He also emphasizes that fact that these problems of countertransference concern not only the candidate but also the experienced analyst.
Winnicott is specifically concerned with “objective and justified hatred” in countertransference, particularly in the treatment of psychotics. He considers how the analyst should manage this emotion: Should he, for example, bear his hatred in silence or communicate it to the analysand? Thus, Winnicott is concerned with a particular countertransference reaction insofar as it affects the behaviour of the analyst, who is the analysand’s object in his re-experience of childhood.
Little discusses countertransference as a disturbance to understanding and interpretation and as it influences the analyst’s behaviour with decisive effect upon the patient’s re-experience of his childhood. She stresses the analyst’s tendency to repeat the behaviour of the patient’s parents and to satisfy certain needs of his own, not those of the analysand. Once, again, Little emphasizes that one must admit one’s countertransference to the analysand and interpret it, and must do so not only in regarding to “objective” countertransference reaction (Winnicott) but also to “subjective” ones.
Annie Reich is chiefly interested in countertransference as a source of disturbances in analysis. She clarifies the concept of countertransference and differentiates ‘two types’ of “countertransference in the proper sense” and “the analyst’s using the analysis for acting-out purposes.” She investigates the cause of these phenomena, and seeks to understand the conditions’ that lead to good, excellent, or poor results in analytic activity.
Gitelson distinguishes between the analyst’s ‘reaction to the patient as a whole’ (the analyst’s ‘transference’) and the analyst’s ‘reaction to partial aspects of the patient’ (the analyst’s ‘countertransference’). He is concerned also with the problems of intrusion, when such intrusion occurs the countertransference should be dealt with by analyst and patient working together, thus agreeing with Little.
Weigert favours analysis of countertransference as far as it intrudes into the analytic situation, and she advises, in advanced stages of treatment, less reserve I the analyst’s behaviour and more spontaneous display of countertransference.
Noticeable proceeding will have their intent be to amplify specific remarks on countertransference as a tool for understanding the mental processes of the patient (including especially his transference reaction) - their content, their mechanisms, and their intensities. Awareness of countertransference helps one to understand what should be interpreted and when. Also, we are to consider the influence of countertransference upon the analyst’s behaviour toward the analysand - behaviour that affects decisively the position of the analyst as object of the re-experience of childhood, and affecting its process of a cure. First, the consideration based briefly countertransference in the history of psychoanalysis. We meet with a strange fact and a striking contrast. The discovery by Freud to countertransference and its great importance in therapeutic work produces the institution of didactic analysis that became the basis and centre of psychoanalytic training. The, countertransference received little scientific consideration over the next forty years. Only during the last few years has the situation changed, rather suddenly, and countertransference becomes a subject examined frequently and with thoroughness. How is one to explain this initial recognition, this neglect, and this recent change? Is there not reason to question the success of didactic analysis in fulfilling its function if this very problem, the discovery of which led to the creation of didactic analysis, has had so little scientific elaboration?
These questions are clearly important, and those who have personally witnessed a great part of the development of psychoanalysis in the last forty years have the best right to answer them. One suggestion would be to explain the lack of scientific investigation of countertransference must be due to rejections by analyst of their own countertransference - a rejection that represents unresolved struggles with their own primitive anxiety and quilt. These struggles are closely connected with those infantile ideals that survive because of deficiencies in the didactic analysis of just those transference problems that latter effect the analyst’s countertransference. These deficiencies in the didactic analysis are reciprocally in part due to countertransference problems insufficiently solved in the didactic analyst. Thus, we are in a vicious circle, but we can see where a breach must be made. In that, we must begin by revision of our feelings about our own countertransference and try to overcome our own infantile ideals more thoroughly, accepting more fully the fact that we are still children and neurotics even when we are adults and analysts. Only in this way by better overcoming our rejection of countertransference - can we achieve the same result in candidates.
The insufficient dissolution of these idealization and underlying anxieties and quilt feelings’ leads to special difficulties when the child becomes an adult and the analysand and analyst, for the analyst unconsciously requires of himself that he be fully identified with these ideals. Thus, and so that is at least partly so that the oedipus complex of the child toward its parents, and of the patient toward his analyst, has been so much more fully considered than that of the parents toward their children and of the analyst toward the analysand. For the same basic reason transference has been dealt with much more than countertransference.
The fact that countertransference conflicts determine the deficiencies in the analysis of transference becomes clear if we recall that transference is the expression of the internal object relations; for understanding of transference will depend on the analyst’s capacity to identify himself both with the analysand’s impulses and defences, and with his internal objects, and to be conscious of these identifications. This ability in the analyst will in turn depend upon the degree to which he accepts his countertransference, for his countertransference is also based on identification with the patient’s id and ego and his internal object. One might also say that transference is the expression of the patient’s relations with the fantasied and real countertransference of the analyst. For just as Countertransference is the psychological response to the analysand’s real and imaginary transferences, and in addition the transference response to the analyst’s imaginary and real countertransference. Analysis of the patient’s fantasies about countertransference, which in the widest sense constitute the cause and consequence of the transference, is an essential part of the analysis of the transference. Perception on the patient’s fantasies regarding countertransference will depend in turn upon the degree to which the analyst himself perceives his countertransference processes - on the continuity and depth of his conscious contact with himself.
Before any illumination is drawn upon these, statements, a brief's mention will appreciatively be to consider one of those ideals in its specifically psychoanalytic expression: The ideal of the analyst’s objectivity. No one, of course, denies the existence of subjective factors in the analyst and of countertransference, however, there seems to exist of an important difference between what is generally acknowledged in practice and the real state of affairs. The first distortion of truth in ‘the myth of the analytic situation; is that analysis, is an interaction between a sick person and an apparently healthy one? The truth is that it is an interaction between two personalities, in both of which the ego is under pressure from the id, the superego and the external world, each personality has its internal and external dependancies, anxieties, and pantological defences, each is also a child with its internal parents and each of these whole personalities - that of the analysand and that of the analyst - responds to every event of the analytic situation. Besides these similarities between the personalities of analyst and analysand, there also exist differences, and one of these are in “objectivity.” The analyst’s objectivity consists mainly in a certain attitude toward his own subjectivity and countertransference. The neurotic (obsessive) ideal of objectivity leads to repression and blocking of subjectivity and so the apparent fulfilment leads the myth of the ‘analyst without anxiety or anger’. The other neurotic extreme is that of ‘drowning’ in the countertransference. True objectivity is based upon a form of internal division that enables the analyst to make himself (his own countertransference and subjectivity) the object of his continuous observation and analysis. This position also enables him to be ‘objective’ toward the analysand.
The term countransference has been given various meanings. They may be summarized by the statement that for some authors’ countertransference includes everything that arises in the analyst as psychological response to the analysand, whereas for others not all this should be called countertransference. Some, for example, prefer to reserve the term for what is infantile in the relationship of the analyst with his analysand, while others make different limitations (Annie Reich and Gitelson). Therefore efforts to differentiate away from each other certain of the complex phenomena of Countertransference lead to confusion or to unproductive discussions of terminology. Freud invented the term countertransference in evident analogy to transference, which he defined as reimprisons or re-editions of childhood experiences, including greater or lesser modifications of the original experience. Therefore, one frequently uses the term transference for the entirety of the psychological attitude of the analysand toward the analyst. We know, to be sure, that really external qualities of the analytic situation in general and of the analyst in particular have important influence on the relationship of the analysand with the analyst, but we also know that all these present factors are experienced according to the past and fantasy, - according, that is to say, to a transference predisposition. As determinants of the transference neurosis and, overall, of the psychological situation of the analysand toward the analyst, we have both the transference predisposition and the present real and especially analytic experiences, the transference in its diverse expressions being the resultant of these two factors.
Analogously, in the analyst there is the countertransference predisposition and the present real, and especially analytic, experiences. The countertransference is the resultant. It is precisely this fusion of present and past, the continuo as an initiate connection of reality and fantasy, of external and internal, conscious and unconscious, that demands a concept embracing all the analysts' psychological responses, and renders it advisable, also, to keep for this totality of response the accustomed term countertransference. Where it is necessary for greater clarity one, might speak of ‘totality countertransference. Then differentiate the separate within it one aspect or another. One of its aspects consists precisely of what is transferred in countertransference; this is the part that originates in an earlier time and that is especially the infantile and primitive part within total countertransference. Another of these aspects - closely connected with the previous one - is what is neurotic in countertransference; its main characteristics are the unreal anxiety and the pathological defences. Under certain circumstances’ one may also speak of a countertransference neurosis.
To clarify better the concept of countertransference, one might start from the question of what happen, in general terms, in the analyst in his relationship with the patient. The first answer might be; Everything happens that can happen in one personality faced with another, but this says so much that it says hardly anything. We take a step forward by bearing in mind that in the analyst there is a tendency that normally predominates in his relationship with the patient; it is the tendency on his function to being an analyst that of understanding what is happening in the patient. With this tendency there exist toward the patient nearly all the other possible tendencies, fears, and other feelings that one person may have toward another. The intention to understand creates a certain predisposition, a predisposition to identify with the analysand, which is the basis of comprehension. The analyst may achieve this aim by identifying his ego with the patient’s ego or, to put it more clearly, although with a certain terminological inexactitude, by identifying each part of his personality with the corresponding psychological part in the patient - his id with the patient’s id, his ego with the ego, his superego with the superego, accepting these identifications in his consciousness. However, this does not always happen, nor is it all that happens. Apart from these identifications, which might be called concordant (or homologous) identifications, there exist also highly important identifications of the analyst’s ego with the patient’s internal objects, for example, with the superego. Adapting an expression from Helene Deutsch, they might be called complementary identifications. Here, in addition we may add the following notes.
1. The concordant identification is based on introjection and projection, or, in other words, on the resonance of the exterior in the interior, on recognition of what belongs to another as one’s own (‘this part of you is me’) and on the equation of what is one’s own with what belongs to another (‘this part of me is you’). The processes inherent in the complementary identifications are the same, but they refer to the patient’s objects. The greater the conflicts between the parts of the analyst’s personality, the greater are his difficulties in carrying out the concordant identifications in their entirety.
2. The complementary identifications are produced by the fact that the patient treats the analysts as an internal (projected) object, and in consequence the analyst feels treated as such; that is, he identifies himself with the destiny of the concordant identification; it seems that to the degree to which the analyst fails in the concordant identification and rejects them, certain complementary identifications become intensified. Clearly, rejection of a part or tendency in the analyst himself, - his aggressiveness, for instance, - may lead to a rejection of the patent’s aggressiveness (by which this concordant identification fails) and that such a situation leads to a greater complementary identification with the patient’s rejecting object, toward which this aggressive impulse is directed.
3. Current usage applies the term ‘countertransference’ to the complementary identifications only; that is to say, to those psychological processes in the analysis by which, because he feels treated as and partially identifies himself with an internal object of the patient, the patient becomes an internal (projected) object of the analyst. Usually excluded from the concept countertransference are the concordant identifications, - those psychological contents that arise in the analysts because of the empathy achieved with the patient and that really reflects and reproduce the latter’s psychological contents. Perhaps following this usage would be best, but there are some circumstances that make it unwise to do so. In the first place, some authors include the concordant identifications in the concept of countertransference. One is thus faced with the choice of entering upon a terminological discussion or of accepting the term in this wider sense. That these various reasons, the wider sense is to be referred. If one considers that their analyst’s concordant identifications (his ‘understanding’) are a sort of reproduction of his own oast processes, especially of his own infancy, and that this reproduction or re-experience is carried out as response to stimuli from the patient, one will be more ready to include the concordant identifications in the concept of countertransference. Moreover, the concordant identifications are closely connected with the complementary ones (and thus with ‘countertransference’ in the popular sense), and this fact renders advisably a differentiation but not a total separation of the terms. Finally, it should be borne in mind that the disposition of empathy, - that is, to concordant identification - springs largely from the sublimated positive countertransference, which love-wise relates empathy with countertransference in the wider sense. All this suggests, then, the acceptance of countertransference as the totality of the analyst’s psychological response to the patient. If we accept this broad definition of countertransference, the difference between its two aspects mentioned that it must still be defined. On the one hand we have the analyst as subject and the patient as object of knowledge, which in a certain sense annuls the 'object relationship'. Properly speaking, and that arises in its stead the approximate union or identity between the subject’s and the object’s parts (experiences, impulses, defences). The aggregate of the processes concerning that union might be designated, where necessary, ‘concordant Countertransference’. On the other hand we have an object relationship much like many others, a real ‘transference’; in which the analyst ‘repeats’ experiences, the patient representing internal objects of the analyst. The aggregate of these experiences, which also exist always ad continually, might be termed Complementary Countertransference.
A brief example may be opportune here. Consider a patient who threatens the analyst with suicide. In such situations there sometimes occurs rejection on the concordant identifications by the analyst and an intensification of his identification with the threatened object. The anxiety that such a threat can cause the analyst may lead to various reactions or defence mechanisms within him - for instance, annoyance with the patient. This - his anxiety and annoyance - would be content of the ‘complementary countertransference’. The perception of his annoyance may, in turn, originate quilt feelings in the analyst. These lead to desires for reparation and to intensifications of the ‘concordant’ identifications and ‘concordant countertransference.
Moreover, these two aspects of ‘total countertransference’ have their analogy in transference. Sublimated positive transference is the main and indispensable motive force for the patient’s work; it does not a technical problem. Transference becomes a ‘subject’, according to Freud’s words, mainly when “it becomes resistance,” when, because of resistance, it has become sexual or negative. Analogously, sublimated positive countertransference is the main and indispensable motive force in the analyst’s work (disposing him to the continued concordant identification), and countertransference becomes a technical problem or ‘subject’ mainly when it becomes sexual or negative. This occurs (to an intense degree) principally as a resistance - here, the analyst that is to say, as countertransference.
This leads to the problem of the dynamics of countertransference. We may already discern that the tree factors designated by Freud and determinant in the dynamics of transference (the impulse to repeat infantile clichés of experience, the libidinal needs, and resistance) are also decisive for the dynamics of Countertransference, however.
Every transference situation provokes a countertransference situation, which arises out of the analyst’s identification of himself with the analysand’s (internal) objects (this is the ‘complementary countertransference’). These countertransference situations may be repressed or emotionally blocked but probably they cannot be avoided; certainly they should not be avoided if full understanding is to be achieved. These countertransference reactions are governed by the laws of the general and individual unconscious. Among these the laws of talion is especially important. Thus, for example, every positive transference situation is answered by a positive countertransference; to every negative transference there responds, in one part of the analyst, a negative countertransference. It is important that the analyst is conscious of this law, for awareness of it is fundamental to avoid ‘drowning’ in the countertransference. If he is not aware of it he can avoid entering the vicious circle of the analysand’s neurosis, which will hinder or even prevent the work of therapy.
A simplified example: If the patient’s neurosis centres round a conflict with his introjected father, he will project the latter upon the analyst and treat him as his father; the analyst will feel treated as such - he will feel badly treated - and he will react internally, in a part of his personality, according to the treatment he receives. If he fails to be aware of this reaction, his behaviour will inevitably be affected by it, and he will renew the situation that, to a greater or lesser degree, helped to establish the analysand’s neurosis. Therefore, it is very important that the analyst develops within himself an ego observer of his countertransference reactions, which is, naturally, continuous. Perception of these countertransference reactions will help to become conscious of the continuous transference situations of the patient and interpret them rather than be unconsciously ruled by these reactions, as not as seldom to happen. A well-known example is the ‘revengeful silence’ of the analyst. If the analyst is unaware of these reactions there is danger that the patient will repeat, in his transference experience, the vicious circle brought about by the projection and introjection of ‘bad objects’ (in reality neurotic ones) and the consequent pathological anxieties and defences, but transference interpretation made possibly by the analyst’s awareness of his countertransference experience make it possible to open important breaches in this vicious circle.
To return to the previous example: If the analyst is conscious of what the projection of the father-imago upon him provokes in his own countertransference, he can more easily make the patient conscious of this projection and the consequent mechanisms. Interpretation of these mechanisms will show the patient that the present reality is not identical with his inner perceptions (for, it was, the analyst would not interpret and otherwise act as an analyst); the patient then introjects a reality better than his inner world. This sort of rectification does not take place when the analyst is under the sway of his unconscious countertransference.
Let us, least of mention, consider some application to these principles. To return to the question of what the analyst does during the session and what happens within him, one might reply, at first thought, that the analyst listens. Still, this is not completely true: He listens most of the time, or wishes to listen, but is variably doing so, Ferenczi refers to this fact and expresses the opinion that the analyst’s distractibility is unimportant, for the patient at such moments must intuitively be certainly in resistance. Ferenczi’s remark (which dates from the year 1918) sounds like an echo from the era wheen the analyst was mainly interested in the repressed impulses. Because now that we attempt to analyse resistance, the patient’s manifestations of resistance are as significant as any other of his productions. At any rate, Ferenczi here refers to a countertransference response and deduces from it the analysand’s psychological situation. He says “. . . we have unconsciously reacted to the emptiness and futility of the associations given now the withdrawal of the conscious charge.” The situation might be described as one of mutual withdrawal. The analyst’s withdrawal is a response to the analysand’s withdrawal - which, however, is a response to an imagined or really psychological position of the analyst. If we have withdrawn - if we are not listening but are thinking of something else - we may use this event in the service of the analysis like any other information we find. The quilt we may feel over such a withdrawal is just as utilizable analytically as any other countertransference reaction. Ferenczi’s next words, “the danger of the doctor’s falling asleep, . . . need not be regarded as grave because we awake at the first occurrence important for the treatment,” are clearly intended to appease this quilt. Nevertheless, to better than an allay than the analyst’s quilt would be to use it to promote the analysis - and so as to use the quilt would be the best way of alleviating it. In fact, we encounter here a cardinal problem of the relation between transference and countertransference, and of the therapeutic process in general. For the analyst’s withdrawal is only an example of how the unconscious of one person responds to the unconscious of another. This response seems in part to be governed, as far as we identify ourselves with unconscious objects of the analysand, siding the law of talion; and, as far as this; law unconsciously influences the analyst, there is danger of a vicious circle of actions between them, for the analysand as responds 'talionically' in his turn, and so on without end.
Looking more closely, we see that the 'talionic response' or 'identification with the aggressor' (the frustrating patient) is a complex process. Such a psychological process in the analyst usually starts with a feeling of displeasure or of some anxiety as a response to this aggression (frustration) and, because of this feeling, the analyst identifies himself with the 'aggressor'. By the term 'aggressor' we must designate not only the patient but also some internal object of the analyst (especially his own superego or the internal persecutor) now projected on the patient. This identification with the aggressor, or persecutor, causes a feeling of quilt; probably it always does so, although awareness of the quilt may be repressed. For what happens is, on a small scale, a process of melancholia, just as Freud described it: The object has partially abandoned us; we identify ourselves with the lost object, and then we accuse the introjected 'bad objects - in other words, we have quilt feedings. This may be sensed in Ferenczi’s remark quoted above, in which mechanisms are at work designed to protect the analyst against these quilt feelings: Denial of quilt (‘the danger is not grave’) and a certain accusation against the analysand for the 'emptiness' and 'futility' of his associations. Onto which this way becomes a vicious circle - a kind of paranoid ping-pong, has entered. The analytic situation.
Two situations will illustrate the frequent occurrence in both the complementary and the concordant identifications and the vicious circle that these simulations may cause.
(1). One transference situation of regular occurrences consists in the patient’s seeing in the analyst his own superego. The analyst identifies himself with the id and ego of the patient and with the patient’s dependence upon his superego. He also identifies himself with the same superego situation in which the patient places him - and experiences in this way the domination of the superego over the patient’s ego. The relation of the ego to the superego is, at bottom, as depressive and paranoid situations, the relation of the superego to the ego is, on the same plane, a manic one as far as this term may be used to designate the dominating, controlling, and accusing attitude of the superego toward the ego. In this sense we may broadly speak, that to a “depressive-paranoid” transference in the analysand there corresponds - as for the complementary identification - a “manic” countertransference in the analyst. This, in turn, may entail various fears and quilt feelings.
(2). When the patient, in defence against this situation, identifies himself with the superego, he may place the analyst in the situation of the dependent and incriminated ego. The analyst will not only identify himself with this position of the patient; he will experience the situation with the content the patient gives it; he will feel subjugated and accused, and may react to some degree with anxiety and quilt. To a “manic” transference situation (of the type called mania for reproaching) there corresponds, then - regarding the complementary identification - a “depressive-paranoid” countertransference situation.
The analyst will normally experience these situations with only a part of his being. Leaving another part free to take note of them in a way suitable for the treatment. Perception of such a countertransference situation by the analyst and his understanding of it as a psychological response to a certain transference situation will enable him the better to grasp the transference when it is active. It is precisely these situations and the analyst’s behaviour regarding them, and in particular his interpretations of them, that are important for the process of therapy, for they are the moments when the vicious circle within which the necrotic habitually move - by projecting his inner world outside and reintrojecting this world - is or is not interrupted. Moreover, at these decisive points the vicious circle may be re-enforced by the analyst, if he is unaware of having entered it.
A brief example: an analysand repeats with the analyst his “neurosis of failure,” closing himself up to every interpretation or repressing it at once, reproaching the analyst for the uselessness of the analysis, foreseeing nothing better in the future, continually declaring his complete indifference to everything. The analyst interprets the patient’s position toward him, and its origin, in its various aspects. He shows the patient his defence against the danger of becoming overly dependent, of being abandoned, or being tricked, or of suffering counter-aggression by the analyst, if he abandons his armour and indifference toward the analyst. He interprets to the patient his projection of bad internal objects and his subsequent sado-masochistic behaviour ion the transference; his need of punishment; his triumph and 'masochistic revenge' against the transferred patients; his defence against the 'depressive position' by means of schizoid, paranoid, and manic defences (Melanie Klein): And he interprets the patient’s rejection of a bond that in the unconscious has homosexual significance. Nevertheless, it may happen that all these interpretations, in spite of being directed to the central resistances and connected with the transference situation, suffer the same fate for the same reasons; they fall into the 'whirl in a void' of the 'neurosis of failure'. Now the decisive moments arrive. The analyst, subdued by the patient’s resistance, may begin to feel anxious over the possibility of failure and feel angry with the patient. When this occurs in the analyst, the patient feels it coming, for his own 'aggressiveness' and other reactions have provoked it; consequently he fears the analyst’s anger. If the analyst, threatened by failure, or to put in more precisively threatened by his own super-ego or by his owe archaic objects that have found an agent provocateur in the patient, acts under the influence of these internal objects and of his paranoid and depressive anxieties, the patient again finds himself confronting a reality like that of his real or fantasized childhood experiences and like that of his inner world. So the vicious circle continues and may even be re-enforced. Yet if the analyst grasps the importance of this situation, if, through his own anxiety or anger, he comprehends what is happening in the analysand, and if he overcomes, thanks to the new insight, his negative feelings and interprets what has happened in the analysand, being now in this new positive counter-transference situation, then he may have made a breach - be it large or small - in the vicious circle.
All the same, it continues to be considered that the phenomena of countertransference experiences are divided into two classes. One might be designed 'countertransference thought', the other 'transference positions' for example just cited may serve as illustration of this latter class: The essence of these example lies in the fact that the analyst feels anxiety and is angry with the analysand - that is to say, he is in a certain countertransference 'position'.
Further to explicate upon countertransference relations is that a potential patient is started of a session and wishes to pay his fees upfront. He gives the analyst a thousand-peso note and asks for change. The analyst happens to have his money in another room and goes out to fetch it, leaving the thousand pesos upon his desk. While between leaving and returning, the fantasy occurs to him that the analysand will take back the money and say that the analyst took it away with him. On his return he finds the thousand pesos where he left it. When the account has been settled, the analysand lies down and tells the analyst that when he was left alone he had fantasies of keeping the money, of kissing the note goodbye, and so on. The analyst’s fantasy was based upon what he already knew of the patient, who in previous sessions had expressed a strong distinction to pay up front. The identity of the analyst’s fantasy and the patient’s fantasy of keeping the money may be explained as springing from a connection between the two unconsciousness, a connection that might be regarded as a “psychological symbiosis” between the two personalities. To the analysand’s wish to take money from him (already expressed often), the analyst reacts by identifying himself both with this desire and with the object toward which the desire is directed. Hence appears his fantasy of being robbed. For these identifications to come about there must evidently exist a potential identity. One may presume that every possible psychological constellation in the patient also exists in the analyst, and the constellation that correspond to the patient’s is brought into play in the analyst. A symbiosis result, and now in the analyst spontaneously occur thoughts corresponding to the psychological constellation in the patient.
In fantasies of this type just described and in the example of the analyst angry with his patient, we are dealing with identifications with the id, with the ego, and with the object of the analysand: In both cases, then, it is a matter of Countertransference reactions. However, there is an important difference between one situation and the other, and this difference does not seem to lie only in the emotional intensity. Before elucidating this difference, it should be marked and noted that the Countertransference reaction that appears in the last example (the fantasy about the thousand pesos) should also be used as a means to further the analysis. It is, moreover, a typical example of those “spontaneous thoughts” to which Freud and others refer in advising the analyst to keep his attention “floating” and in stressing the importance of these thoughts for understanding the patient. The countertransference reactions exemplified by the story of the thousand pesos are characterized by the fact that they threaten no danger to the analyst’s objective attitude of an observer. That, the danger is rather than the analyst will not pay sufficient attention to these thoughts or will fail to use them for understanding and interpretation. The patient’s corresponding ideas are not always conscious, from his own Countertransference “thoughts” and feelings the analyst may guess what is repressed or rejected. Recalling again our usage of the term is important 'Countertransference', for many writers, perhaps the majority, means by not these thoughts of the analyst but rather than other class of reactions, the “Countertransference positions.” This is one reason that differentiating these two kinds of reaction is useful.
The outstanding difference between the two lies in the degree to which the ego is involved in the experience. In one case, the reactions are experienced as thoughts, free association, or fantasies, with no great emotional intensity and frequently as if they were moderately foreign to the ego. In the other case, the analyst’s ego is involved in the Countertransference experience. The experience is felt by him with greater intensity and as reality, and here danger of his “drowning” in this experience. In the former example of the analyst who gets angry because of the analysand’s resistances, the analysand is felt as really based by one part of the analyst (‘countertransference position’), although the latter does not express his anger. Now these two kinds of Countertransference reactions differ, because they have different origins. The reaction experienced by the analyst as thought or fantasy arises from the existence of an analogous situation in the analysand - that is, from his readiness in perceiving and communicating his inner situation (as happens with the thousand pesos) - whereas, the reaction experienced with great intensity, even as reality, by the analyst arises from acting out by the analysand (as with the ‘neurosis of failure’). Undoubtedly there are also the same analysts, he is a factor that helps to decide this difference. The analyst has, it seems, two ways of responding. He may respond to some situation by perceiving his reaction, while to others he responds by acting out (alloplastically or autoplastically). Which type of response occurs in the analyst depends partly on his own neurosis, on his inclination to anxiety, on his defence mechanisms, and especially on his tendencies to repeat (act out) instead of making conscious. It is here that we encounter a factor that determines the dynamics of countertransference. It is the one Freud emphasized as determining the special intensity of transference in analysis, and it is also responsible for the special intensity of countertransference.
The great intensity of certain countertransference reactions is to be explained by the existence in the analyst of pathological defences against the increase of archaic anxieties and unresolved inner conflicts. Transference, becomes intense not only because it serves as a resistance to remembering, as Freud says, but also because it serves as a defence against a danger within the transference experience itself. In other words, the “transference resistance” is frequently a repetition of defences that must be intensified lest a catastrophe is repeated in transference. The same is true of countertransference. Clearly, these catastrophes are related to becoming aware of certain aspects of one’s own instincts. Take, for instance, the analyst who becomes anxious and inwardly angry over the intense masochism of the analysand within the analytic situation. Such masochism frequently rouses old paranoid and depressive anxieties and guilt feelings in the analyst, who, faced with the aggression directed by the patient against his own ego, and faced with the effects of this aggression, finds himself in his unconscious confronted anew with his early crimes. It is often just this childhood conflict of the analyst, with their aggression, that led him into this profession in which he tries to repair the objects of the aggression and to overcome or deny his guilt. Because of the patient’s strong masochism, this defence, which consists of the analyst’s therapeutic action, fails and the analyst is threatened with the return of the catastrophe, the encounter with the destroyed object. In this way the intensity of the “negative countertransference” (the anger with the patient) usually increases because of the failure of the countertransference defence (the therapeutic action) and the analyst’s subsequent increase of anxiety over a catastrophe in the countertransference experience (the destruction of the object).
The 'abolition of rejection' in analysis determines the dynamics of transference and, in particular, the intensity of the transference of the 'rejecting' internal objects (in the first place, of the superego). The 'abolition of rejection' begins with the communication to the analysand, and here we have an important difference between his situation and that of the analysand and between the dynamics of transference and those of countertransference. However, this difference is not so great as might be at first supposed, for two reasons: First, because it is not necessary that the free associations be expressed for projections and transferences to take place, and secondly, because the analyst expresses of certain associations of a personal nature even when he does not seem to do so. These communications begin, one might say, with the plate on the front door that says Psychoanalysis or Doctor. What motive (about the unconscious) would the analyst have for wanting to cure if it were not he that made the patient ill? In this way the patient is already, simply by being a patient, the creditor, the accuser, the
'Superego' of the analyst, and the analyst is his debtor.
To what transference situation does the analyst usually react with a particular countertransference? Study of this question would enable one, in practice, to deduce the transference situations from the countertransference reactions. Next we might ask, to what imago or conduct of the object - to what imagined or real countertransference situation - does the patient respond with a particular transference? Many aspects of these problems have been amply studied by psychoanalysis, but the specific problem of the relation of transference and countertransference in analysis has received little attention.
The subject is so broad that we can discuss only a few situations and those incompletely, restricting ourselves to certain aspects. Therefore, we must choose for discussion only the most important countertransference situations, those that most disturb the analyst’s task and that clarify important points in the double neurosis, that arise in the analytic situation - a neurosis usually of very different intensity in the two participants.
1. What is the significance of countertransference anxiety?
Countertransference anxiety may be described in general and simplified terms as of depressive or paranoid character. In depressive anxiety the inherent danger consisted in having destroyed the analysand or made him ill. This anxiety may arise to a greater degree when the analyst faces the danger that the patient may commit suicide, and to a lesser degree when there is deterioration or danger of deterioration in the patient’s state of health. Yet the patient’s simple failure to improve and his suffering and depression may also provoke depressive anxieties in the analyst. These anxieties usually increase the desire to heal the patient.
In referring to paranoid anxieties differentiating it between is important “direct” and 'indirect' countertransference. In direct countertransference the anxieties are caused by danger of an intensification of aggression from the patient himself. Indirect Countertransference the anxieties are caused by danger of aggression from third parties onto whom the analyst has made his chief transference - for instance, the members of the analytic society, for the future of the analyst’s object relationship with the society is part determined by his professional performance. The feared aggression may take several forms, such as criticism, reproach, hatred, mockery, contempt, or bodily assault. In the unconscious it may be the danger of being killed or castrated or otherwise menaced in an archaic way.
The transference situations of the patient to whom the depressive anxieties of the analyst are a response are, above all, those in which the patient, through an increase in frustration (or danger of frustration) and in the aggression that it evokes, turns the aggression against himself. We are dealing, on one plane, with situations in which the patient defends himself against a paranoid fear of retaliation by anticipating this danger, by carrying out himself and against himself part of the aggression feared from the object transferred onto the analyst, and threatening to carry it out still further. In this psychological sense it is really the analyst who attacks and destroys the patient, and the analyst’s depressive anxiety corresponds to this psychological reality. In other words, the countertransference depressive anxiety arises, above all, as a response to the patient’s 'masochistic defence' - which also represents a revenge (‘masochistic revenge’) - and as a response to the danger of its continuing. On another plane this turning of the aggression against himself is carried out by the patient because of his own depressive anxieties; he turns it against himself to protect himself against re-experiencing the destruction of the objects and to protect these from his own aggression.
The paranoid anxiety in 'direct' countertransference is a reaction to the danger arising from various aggressive attitudes of the patient himself. The analysis of these attitudes shows that they are themselves defences against, or reactions to, certain aggressive imagos. These reactions and defences are governed by the law of talion or else, analogously to this, by identification with the persecutor. The reproach, contempt, abandonment, bodily assaults - all these attitudes of menace or aggression in the patient that causes countertransference paranoid anxieties - are responses to (or anticipation of) equivalent attitudes of the transferred object.
The paranoid anxieties in 'indirect' countertransference are of a more complex nature since the danger for the analyst originates in a third party. The patient’s transference situations that provoke the aggression of this “third party” against the analyst may be of various sorts. Commonly, we are dealing with transference situations (masochistic or aggressive) similar to those that provoke the 'direct' countertransference anxieties previously mentioned.
The common denominator of all the various attitudes of patients that provoke anxiety in the analyst is to be found, in the mechanism of 'identification with the persecutor', the experience of being liberated from the persecutor and of triumphing over him, implied in this identification, suggested our designating this mechanism as a manic one. This mechanism may also exist where the manifest picture in the patient is the opposite, namely in certain depressive states; for the manic conduct may be directed either toward a projected object or toward an introjected object, it may be carried out alloplastically or autoplastically. The 'identification with the persecutor' may even exist' in suicide, since this is a ‘mockery’ of the fantasized or real persecutors, by anticipating the intentions of the persecutors and by one’s own in what they wanted to do, as this ‘mockery’ is the manic aspect of suicide. The 'identification with the persecutor' in the patient is, then, a defence against an object felt as sadistic that tends to make the patient the victim of a manic feast. This defence is carried out either through the introjection of the persecutor in the ego, turning the analyst into the object of the 'manic tendencies', or through the introjection of the persecutor in the superego, taking the ego as the object of its manic trend. Still, what does this mean?
An analysand decides to take a pleasure trip to Europe. He experiences this as a victory over the analyst both because he will free himself from the analyst for two months and because he can afford this trip whereas the analyst cannot. He then begins to be anxious lest the analyst seeks revenge for the patient’s triumph. The patient anticipates this aggression by becoming unwill, developing fever and the first symptoms of influenza. The analyst feels slight anxiety because of this illness and fears, recalling certain experiences, a deterioration in the state of health of the patient, who still however continues to come to the sessions. Up to this point, the situation in the transference and countertransference is as follows. The patient is in a manic relation to the analyst, and his anxieties of preponderantly paranoid type. The analyst senses some irritation over the abandonment and some envy of the patient’s great wealth (feeling ascribed by the patient in his paranoid anxieties to the analyst), but while, the analyst feels satisfaction at the analysand’s real progress, which finds expression in the very fact that the trip is possible and that the patient has decided to make it. The analyst perceives a wish in part of his personality to bind the patient to himself and use the patient for his own needs. In having this wish he resembles the patient’s mother, and he is aware that he is in reality identified with the domineering and vindictive object with which the patient identifies him. Therefore, the patient’s illness seems, to the analyst’s unconscious, a result of the analyst’s own wish, and the analyst therefore experiences depressive (and paranoid) anxieties.
What object imago leads the patient to this manic situation? It is precisely this imago of a tyrannical and sadistic mother, to whom the patient’s frustrations constitute a manic feast. It is against these 'manic tendencies' in the object that the patient defends himself, first by identification (introjection of the persecutor in the ego, which manifests itself in the manic experience in his decision to take a trip) and then by using a masochistic defence to escape vengeance.
In brief, the analyst’s depressive (and paranoid) anxiety is his emotional response to the patient’s illness, and the patient’s illness is itself a masochistic defence against the object’s vindictive persecution. This masochistic defence also contains a manic mechanism in that it derides, controls, and dominates the analyst’s aggression. In the stratum underlying this, we find the patient in a paranoid situation in face of the vindictive persecution by the analyst - a fantasy that coincides with the analyst’s secret irritation. Beneath this paranoid situation, and causing it, is an inverse situation: The patient is enjoying a manic triumph (his liberation from the analyst by going on a trip), but the analyst is in a paranoid situation (he is in danger of being defeated and abandoned). Finally, beneath this we find a situation in which the patient is subjected to an object imago that wants to make of him the victim of its aggressive tendencies, but this time not to take revenge for intentions or attitudes in the patient, but merely to satisfy its own sadism of an imago that originates directly from the original suffering of the subject.
In this way, the analyst can deduce from each of his Countertransference sensations a certain transference situation, the analyst’s fear to deterioration in the patient’s health enabled him to perceive the patient’s need to satisfy the avenger and to control and restrain him, partially inverting (through the illness) the roles of victimizer and victim, thus alleviating his guilt feeling and causing the analyst to feel some of the guilt. The analyst’s irritation over the patient’s trip enabled him to see the patient’s need to free himself from a dominating and sadistic object, to see the patient’s guilt feelings caused by these tendencies, and to see his fear of the analyst’s revenge. By his feeling of triumph the analyst could detect the anxiety and depression caused in the patient by his dependence upon this frustrating, yet indispensable, object. Each of these transference situations suggested to the analyst the patient’s object imagoes - the fantasized or real Countertransference situation that determined the transference situations.
2. What is the meaning of countertransference aggression?
To what was previous, we have seen that the analyst may experience, besides countertransference anxiety, annoyances, recollection, desire for vengeance, hatred, and other emotions. What are the origin and meaning of these emotions?
Countertransference aggression usually arises in the face of frustration (or danger of frustration) of desires that may superficially be differentiated into “direct” and “indirect.” Both direct and indirect desires are principally wishes to get libido or affection. The patient is the chief object of direct desires in the analyst, who wishes to be accepted and loved by him. The object of the indirect desires of the analyst may be, for example, other analysts from whom he wishes to get recognition or admiration through his successful work with his patients, using the latter as means to this end. This aim to get love has, in general terms, two origins: An instinctual origin (the primitive needs of union with the object) and an origin of a defensive nature (the need of neutralizing, overcoming, or denying the rejections and other dangers originating from the internal objects, in particular from the superego). The frustrations may be differentiated, descriptively, into those of active type and those of passive type. Among the active frustrations is direct aggression by the patient, his mockery, deceit, and active rejection. To the analyst, active frustration means exposure to a predominantly “bad” object, the patient may become, for example, the analyst’s superego, which says to him “you are bad.” Examples of flustration of passive type are passive rejection, withdrawal, partial abandonment, and other defences against the bond with and dependence on the analyst. These signify flustrations of the analyst’s need of union with the object.
We may say then, that Countertransference aggression usually arises when there is frustration of the analyst’s desire that springs from Eros, both that arising from his “original” instinctive and affective drives and that arising from his need of neutralizing or annulling his own Thanatos (or the action in his internal ‘bad objects’) directed against the ego or against the external world. Owing partly to the analyst’s own neurosis (and to certain characteristics of analysis itself) these desires of Eros sometimes change the unconscious aim of bringing the patient to a state of dependence. Therefore countertransference aggression may be provoked by the rejection of this dependence by the patient who rejects any bond with the analyst and refuses to surrender to him, showing this refusal by silence, denial, secretiveness, repression, blocking, or mockery.
Taken to place next, we must establish what it is that induces the patient to behave in this way, to frustrate the analyst, to withdraw from him, to attack him. If we know this we might as perhaps know what we have to interpret when countertransference aggression arises in us, being able to deduce from the countertransference the transition of the transference situation and its cause. This cause is a fantasized countertransference situation or, more precisely, some actual or feared bad conduct from the projected object. Experience shows that, in meaningly general terms, this bad or threatening conduct of the object is usually an equivalent of the conduct of the patient (to which the analyst has reacted internally with aggression). We also understand why this is so: The patient’s conduct springs from that most primitive of reactions, the talion reaction, or from the defect by means of identification with the persecutor or aggressor. Sometimes, it is quite simple: The analysand withdraws from us, rejects us, abandons us, or derides us when he fears or suffers the same or an equivalent treatment from us. In other cases, it is more complex, the immediate identification with the aggression being replaced by another identification that is less direct. To exemplify: Some woman patients, upon learning that the analyst is going on holiday, remain silent a long while, she withdraws, through her silence, as a talion response to the analyst’s withdrawal. Deeper analysis shows that the analyst’s holiday is, to the patient, equivalent to the primal scene, and this is equivalent to destruction of her as a woman, and her immediate response must be a similar attack against the analyst. This aggressive (castrating) impulse is rejected and the result, her silence, is a compromise between her hostility and its rejection, it is a transformed identification with the persecutor.
The composite distribution accounted by ours, is the vertical mosaic: (a) The countertransference reactions of aggression (or, of its equivalent) occur in response to transference situations in which the patient frustrates certain desires of the analyst’s. These frustrations are equivalent to abandonment or aggression, which the patient carries out or with which he threatens the analyst, and they place the analyst, at first, in a depressive or paranoid situation. The patient’s defence is in one aspect equivalent to a manic situation, for he is freeing himself from a persecutor. (b) This transference situation is the defence against certain object imagoes. Existent associative objects persecute the subject sadistically, vindictively, or morally, or an object that the patient defends from his destructiveness by an attack against his own ego: In these, the patient attacks - as Freud and Abraham have shown in the analysis of melancholia and suicide - just when, the internal object and the external object (the analyst). The analyst who is placed by the alloplastic or autoplastic attacks of the patient in a paranoid or a depressive situation sometimes defends himself against these attacks by using the same identification with the aggressor or persecutor as the patient used. Then the analyst virtually becomes the persecutor, and to this the patient (insofar as he presupposes such a reaction from his internal and projected object) responds with anxiety. This anxiety and its origin are nearest to consciousness, and are therefore the first thing to interpret.
3. Countertransference guilt feelings are an important source of countertransference anxiety: The analyst fears his “moral conscience.” Thus, for instance, a serious deterioration in the condition of the patient may cause the analyst to suffer reproach by his own superego, and cause him to fear punishment. When such guilt feelings occur, but the superego of the analyst is usually projected upon the patient or upon a third person, the analyst being the guilty ego. The accuser is the one who is attacked, the victim of the analyst. The analyst is the accused, he is charged with being the victimizer. It is therefore the analyst who must suffer anxiety over his object, and dependence upon it.
As in other countertransference situations, the analyst’s guilt feeling may have either real causes or fantasized causes, or a mixture of the two. A real cause exists in the analyst who has neurotic negative feelings that exercise some influence over his behaviour, leading him, for example, to interpret with aggressiveness or to behave in a submissive, seductive, or unnecessarily frustrating way. Yet guilt feelings may also arise in the analyst over, for instance, intense submissiveness in the patient though the analyst had not driven the patient into such conduct by his procedure. Or he may feel guilty when the analysand becomes depressed or ill, although his therapeutic procedure was right and proper according to his own conscience. In such cases, the countertransference guilt feelings are evoked not by what procedure he actualizes by its use but by his awareness of what he might have done in view of his latent disposition. In other words, the analyst identifies himself in fantasy with a bad internal object of the patient’s and he feels guilty for what he has provoked in this role - illness, depression, masochism, suffering, failure. The imago of the patient then becomes fused with the analyst’s internal objects, which the analyst had, in the past, wanted (and perhaps managed) to frustrate, makes suffer, dominate, or destroy. Now he wishes to repair them. When this reparation fails, he reacts as if he had hurt them. The true cause of the guilt feelings is the neurotic, predominantly sado-masochistic tendencies that may reappear in countertransference: The analyst therefore quite rightly entertains certain doubts and uncertainties about his ability to control them completely and to keep them entirely removed from his procedure.
The transference situation to which the analyst is likely to react with guilt feelings is then, in the first place, a masochistic trend in the patient, which may be either of some 'defensives' (secondary) or of a 'basic' (primary) nature. If it is defensive, we know it to be a rejection of sadism by means of its 'turning against the ego', the principal object imago that imposes this masochistic defence is a retaliatory imago. If it is basic (‘primary masochism’) the object imago is ‘simply’ sadistic, a reflex of the pains (‘frustration’) originally suffered by the patient. The analyst’s guilt feelings refer to his own sadistic tendencies. He may feel as if he himself had provoked the patient’s masochism. The patient is subjugated by a ‘bad’ object so that it seems as if the analyst had satisfied his aggressiveness; now the analyst is exposed in his turn to the accusations of his superego. In short, the superficial situation is that the patient is now the superego, and the analyst the ego who must suffer the accusation, the analyst is in a depressive-paranoid situation, whereas the patient is, from one point of view, in a ‘manic’ situation (showing, for example, ‘mania for reproaching’). Nevertheless, on a deeper plane the situation is the reverse: The analyst is in a ‘manic’ situation (acting as vindictive, dominating, or ‘simply’ a sadistic imago), and the patient is in a depressive-paranoid situation.
4. Besides the anxiety, hatred, and quilt feelings in countertransference, most other countertransference situations may also be decisive points during analytic treatment, both because they may influence the analyst’s work and because the analysis of the transference situations that provoke such countertransference situations may represent the central problem of treatment, clarification of which may be indispensable if the analyst is to exert any therapeutic influence upon the patient.
Before closing, let us consider briefly two doubtful points. How much confidence should we place in countertransference as a guide to understanding the patient? As to the first question, I intuitively think by means of its existing certainty, by which is founded the mistake initiated of the countertransference reactions as an oracle, with blind faith to expect of them the pure truth about the psychological situations of the analysand. It is plain that our unconscious is a very personal ‘receiver’ and ‘transmitter’ and we must reckon with frequent distortions of objective reality. Still, it is also true that our unconscious is nevertheless “the best we have of its kind.” His own analysis and some analytic experience enable the analyst, as a rule, to be conscious of this personal factor and know his ‘personal equation.’ According to experience, the danger of exaggerated faith in the message of one’s own unconscious is, even when they refer to very ‘personal’ reactions. Less than the danger of repressing them and denying them any objective value.
It seems necessary that one must critically examine the deductions one makes from perception of one’s own countertransference. For example, the fact that the analyst feels angry does not simply mean (as is sometimes said) that the patient wishes to make him angry. It may mean rather than the patient has a transference feeling of guilt. What has been said concerning Countertransference aggression is relevant here.
The second question - whether the analyst should or should not ‘communicate’ or ‘interpret’ aspects of his countertransference to the analysand - cannot be considered fully at present. Much depends, of course, upon what, when, how, to whom, for what purpose, and in what conditions the analyst speaks about his countertransference. Probably, the purposes sought by communicating the countertransference might often (but not always) be better attained by other means. The principal other means is analysis of the patient’s fantasies about the analyst’s countertransference (and of the related transference) sufficient to show the patient the truth (the reality of the countertransference of his inner and outer objects): and with this must also be analysed the doubts, negations, and other defences against the truth, intuitively perceived, until they have been overcome. Nevertheless, the situations in which communication of the countertransference is of value for the subsequent course of the treatment. Without doubt, this aspect of the use of countertransference is of great interest: We need an extensive and detailed study of the inherent problems of communication of countertransference. Much more experience and study of countertransference need to be recorded.
Some discussion of a working definition of the term countertransference is necessary, since it is by no means agreed upon by analysts that it can be correctly considered the converse of transference. D. W. Winnicott, for instance, has recently written about the importance of attitudes of hate from an analyst too patient, particularly in dealing with psychotic and antisocial patients. He speaks mainly of ‘objective countertransference’. Meaning ‘the analyst’s love and hate in reaction to the actual personality and behaviour of the patient based on objective observation. However, he also mentions countertransference feelings that are under repression in the analyst and need countertransference feelings that are under repression in the analyst and need more analysis. His concept of ‘objective Countertransference’ will not be included under the term Countertransference if the latter are used as the converse of transference. Frieda Fromm-Reichmann has separated the reconverse of the psychoanalyst to the patient into those of a private and those responses of the psychoanalyst to the patient into those of a private and those of a professional person and recognizes the possibility of countertransference distortions occurring in both aspects. Franz Alexander has used the term to mean all of the attitudes of the doctor toward the patient, while Sandor Ferenczi has used it to cover the positive, affectionate, loving, or sexual attitudes of the doctor toward the patient. Michael Balint, looking at a different aspect, calls attention ti the fact that every human relation is libidinous, not only the patient’s relation to his analyst, but also the analyst’s relation to the patient. He says that no human being can in the end tolerate any relation that brings only frustration and that it is as true for the one as for the other. “The question is, therefore, . . . how much. What kind of satisfaction is needed by the patient on the one hand and by the analyst on the other, to keep the tension in the psycho-analytical situation as or near the optimal level.”
In developing his theory of interpersonal relations, Harry Stack Sullivan has defined the psychotherapeutic effort of the analyst as carried on by the method of participant observation. He says, “The expertness of the psychiatrist refers to his skill in participant observation of the unfortunate patterns of his own and the patient’s living, in contrast too merely participating in such unfortunate patterns with the patient.” In the use of the term unfortunate patterns Sullivan includes the concept of countertransference, or in his words 'parataxic distortions'.
In several important recent papers, Leo Berman, Paula Heimann, Annie Reich, Margaret Little, and Maxwell Gitelson have made a beginning in the attempt to clarify the concept and to formulate some dynamic principles regarding the phenomena included in this category. Berman is mainly concerned with defining the optimal attitude of the analyst to the patient, an attitude that he characterizes as “dedicated.” This description is based on the assumption that the analyst’s emotional responses to the patient will be quantitatively less than those of the average person and of shorter duration, as the result of being quickly worked through by self-analysis. This, then, would represent an ideal goal of minimizing and an easily handled countertransference response.
Heimann takes a step forward when she states that the analyst’s emotional response to his patient within the analytic situation represents one of the most important tools for his work, and that the analyst’s countertransference is an instrument of research into the patient’s unconscious. This important formulation is the basis upon which the study of the analyst’s part of the interaction with the patient should be built. Previously, the statement has frequently been made that the analyst’s unconscious understands the patient’s unconscious. However, it is presumed that much is already unconscious material as becoming available to awareness after a successful analysis, so that the understanding should theoretically not be only on an unconscious level but should be errorless in words.
Reich has classified most of countertransference attitudes of the analyst’s. She separates them into two main types: Those where the analyst acts out some unconscious need with the patient, and those where the analyst defends against some unconscious need. On the whole, countertransference responses are reflections of permanent neurotic difficulties of the analyst, in which the patient is often not a real object but is rather used as a tool by means of which some need of the analyst is gratified. In some instances, there may be sudden, acute countertransference responses that do not necessarily arises from neurotic character difficulties of the analyst. However, Reich points out that the interest in becoming an analyst is itself partially determined by unconscious motivation, such as curiosity about other people’s secrets, which is evidence that countertransference attitudes are some prerequisites for an analyst. The contrast between the healthy and neurotic analyst is that in the one the curiosity is desexualized and sublimated in character, while in the other it remains a method of acting out unconscious fantasies.
Margaret Little continues the search for an adequate definition of countertransference, concluding that it should be used primarily to refer to 'repressed elements', inasmuch as far as the unanalysed well-situated analyst, he attaches himself to the patient in the same way as the patient ‘transfers’ to the analyst effects, etc., belonging to his parents or to the object of his childhood: i.e., the analyst regards the patient (temporarily and varyingly) as he regarded his own parents. Even so, it is, Little who thinks that other aspects of the analyst’s attitudes toward the patient, such as some specific attitude or mechanism with which he meets the patient’s transference, or some of his conscious attitudes, should be considered Countertransference responses. She confirms Heimann’s statement that the use of countertransference may become an extremely valuable tool in psychoanalysis, comparing it in importance with the advances made when transference interpretations began to be used therapeutically. She sees transference and Countertransference as inseparable phenomena; both should become increasingly clear to both doctor and patient as the analysis progresses. To that end, she advocates judicious use of Countertransference interpretation by the analyst. “Both are essential to Psychoanalysis, and countertransference is no more to be feared or avoided than is transference: In fact it cannot be avoided it can only be looked out for, controlled to some extent, and perhaps ill-used.
Gitelson, in a comprehensive paper, continues to clarify the phenomena, he goes back to the original definition of countertransference used by Freud - the analyst’s reaction to the patient’s transference - and separates this set of responses from another set that he calls the transference attitudes of the analyst. These transference attitudes, which are the result of ‘’surviving neurotic transference potential’ in the analyst. Involve ‘total’ reactions to the patient -that is, overall feelings about and toward the patient - while the countertransference attitudes are ‘partial’ reactions to the patient - that is, emergency defence reactions elicited when the analysis touches upon unresolved problems in the analyst.
This classification, while valid enough, does not seem to forward investigation to any great extent. For example, Gitelson feels in general that the existence of ‘total’ or transference attitudes toward a patient is a contradiction for the analyst to work with that patient, whereas the partial responses are more amendable to working through the continuity of inertial momentum whereby the processes of a self-analysis. Yet, it seems extremely sceptical whether avoiding is possible for one ‘total’ reaction to a patient - that is, general feelings of liking for, dislike of, and responsiveness toward the patient, and so on, is present from the time of the first interview. These do vary in intensity; when extreme, they may indicate that a non-therapeutic relationship would result should be the two persons attempt working together. On the other hand, their presence in awareness may permit the successful scrutiny and resolution of whatever problem is involved, whereas their presence outside awareness would render this impossibly. In other words, it is not so much a question whether ‘total’ responses are present or not, but rather a question as to their amenability to recognition and resolution. Therefore, another type of classification would, in any case, be more useful for investigative purposes.
Least of mention, this by no mean a harbouring dispute over the validity of Gitelson’s criticism of the rationalization of much Countertransference acting-out under the heading of ‘corrective emotional experience’. He emphasizes that motherly or fatherly attitudes in the analyst are often character defences unrecognized as such by him. Although the analyst, according to Gitelson, to facilitate . . . can deny neither his personality nor its operation in the analytic situation as a significant factor, this does, however, mean that his personality is the chief instrument of the therapy. He also reports the observation that when the analyst appears as himself in the patient’s dreams, it is often the herald of the development of an unmanageably intenser transference neurosis, the unmanageability being the difficulty of the analyst’s situation. Similarly, when the patient appears as himself in the analyst’s dream, but it is often a signal of unconscious countertransference processes going on.
So then, we have seen that in recent studies on countertransference have included in their concepts attitudes of the therapist that are both conscious and unconscious; attitudes that are responses both too real and to fantasied attitudes of the patient; attitudes stimulated by unconscious needs of the analyst and attitudes stimulated by sudden outbursts of effect for the patient; attitudes that arise from responding to the patient as though he were some previously important person in the analyst’s life; and attitudes that do not use the patient as a real object but as a tool for the gratification of some unconscious requisite. This group of responses covers a tremendously wide territory, yet it does not include, of course, all of the analyst’s responses to the patient. On what common ground is the above attitudes singled out to be called countertransference?
It seems, nonetheless, that the common factor in the above responses is the presence of anxiety in the therapist - whether recognized in awareness or defended against and kept of our awareness. The contrast between the dedicated attitude described as the ideal attitude of the analyst - or the analyst as an expert on problems of living, as Sullivan puts it-and the so-called countertransference responses, is the presence of anxiety, arising from the variety of sources in the whole field of patient-therapist interrelationships.
If countertransference attitudes and behaviour were to be thought of as determined by the presence of anxiety in the therapist, we might have an operational definition that would be more useful than the more descriptive one based on identifying patterns in the analyst derived from importantly past relationships. The definition would, of course, have to include situations both or felt discomfort and those where the anxiety was out of awareness and replaced by a defensive operation? Such a viewpoint of countertransference would be useful in that it would include all situations where the analyst was unable to be useful to the patient because of difficulties with his own responses.
The definition might be precisely stated as follows: When, in the patient-analyst relationship, anxiety is aroused in the analyst with the effect that communication between him and is interfered with by some alternation in the analyst’s behaviour (verbal or otherwise), then Countertransference is present.
The question might be asked, if countertransference were defined in this way, would the definition hold well for transference responses also? It seems that on a very generalized level this might be so, but on the level of practical therapeutic understanding such a statement would not be enlightening. While it could safely be said of every patient that he appearance of his anxiety or defensive behaviour in the treatment situation was due to an impairment of communication with the analysts that in turn was due to his attributing to the analyst some critical or otherwise disturbing attitude that in its turn was originally derived from his experience with his parents - still this would disregard the fact that the patient’s whole life pattern and his relation to all of the important authority figures in it would show a similar stereotyped defensive response. So that the early stages of treatment and to a lesser extent in later stages, the anxiety responses of the patient are for the most part generalized and stereotyped than explained with special reference to his relationship with the analyst.
This, however, is not true of the analyst. Having been analysed himself, most of such anxiety-laden responses as he has experienced with others have entered awareness and many of them have been worked through and abandoned in favour of more mature and integrated responses. What remains, then, not automatically represent sibling rivals? While it is possible that a particular, unusually competitive patient may still represent a younger sibling to an analyst who had some difficulties in his own life with being the elder child.
To speak of the same thing from another point of view, the analyst is not working on his problems in the analysis; he is working on the patient’s. Therefore, while the patient brings his anxiety responses to the analysis as his primary concern, the fact that the analyst’s problems are not under scrutiny permits him a greater degree of detachments and objectivity. This is, to be sure, only a relative truth, since the analyst at times and under certain circumstances is bringing his problems into the relationship, and at times, at least in some analyses, the attention of both the patient and the analyst are directed to the analysts' problems. However, it is on the whole valid to describe the analytic situation as one designed to focus attention on the anxieties of the patient and to leave in the background the anxieties of the therapist, so that when these do appear they are of particular significance as for the relationship itself.
The associative set classifications of countertransference responses are to classify the situation in analysis when anxiety-tinged processes are operating in the analyst. This is to the set classification as not as clear-cut separation of situational anxieties, nor are any of the responses to be thought of as entirely free of necrotic attitudes of the therapist. Even in the most extremer examples of situational stress (where ordinarily the analyst’s response is thought of as an objective response to th stress rather than a neurotic response), personal, characterological factors will colour his response, as will also the nature of his relationship with the patient. Take, for instances, the situation where the analyst comes to his office in a state of acute tension as the result of a quarrel with his wife. With one patient he may remain preoccupied with his personal troubles throughout the hour, while with another he may be able shortly to bring hid attention to the analytic situation. Something in each patient’s personality and method of production, and in the analyst’s response to each, has affected the analyst’s behaviour.
Anxiety-arousing situations in the patient-analyst interaction have been classified as follows: (1) situational factors - that is, reality factors such as intercurrent events in the analyst’s life, and, social factors such as need for success and recognition as a competent therapist (2) unresolved neurotic problems of the therapist, and (3) communication of the patient’s anxiety to the therapist.
The response to situational factors is, of course, very much influenced by the character make-up of the doctor. How much has the quality of being necessitated for conformity to convention he retains will influence his response to the patient who shouts loudly during an analytic session? Nevertheless, the response will always be affected by the degree of which his office is soundproof, whether there is another patient in the waiting room, whether a colleague in an adjoining office can overhear, and so on. So that, even leaving out the private characterological aspect of the situation for the therapist, there remains a sizable set of reality needs that, if threatened, will lead to unanalytic behaviour on his part.
The greatest number of these relates to the physician’s role in our culture. There is a high value attached to the role of a successful physician. This is not, of course, confined to the vague group of people known as the public, it is also actively present in the professional colleagues. There is a reality need for recognition of his competence by his colleagues, which has a dollars and cents value and an emotional one. While it is true that his reputation will not be made or broken by one success or failure, it does not follow that a suicide or psychotic breakdown in the patient does not represent a reality threat to him. Consequently, he cannot be expected to handle such threatening crises with complete equanimity. Besides, some realities need to be known as competent by his colleagues and the public, there is potent and valid need on the doctor’s part for creative accomplishment. This appears in the therapeutic situation as an expectation of and a need to see favourable change in the patient. It is entirely impossible for a therapist to participate in a treatment situation where the goal is improvement or cure without suffering frustration, disappointment, and at times anxiety when his efforts result in no apparent progress. Such situations are at times handled by therapists with the attitude: “Let him stew in his own juices until he sees that he should change,” or by the belief that he, the doctor, must be making an error that he dies not understand and should redouble his efforts. Frequently, the resolution of such a difficulty can be achieved by the realization by the therapist that his reality fear of failure is keeping him from recognizing an important aspect of the patient’s neurosis having done with making the responsibility for his welfare on another’s shoulders. The reality fear of failure can . . . neither be ignored nor put up with, so to speak, since an attempt by the therapist to remove it by ‘making’ the patient gets well is bound to increase the chances of failure.
Further difficulties are introduced by the traditional cultural definition of the healer’s role - that is, according to the Hippocratic oath. The physician-healer is expected to play a fatherly or even god-like role with his patient, in which he both sees through him - knows mysteriously what is wrong with his insides - and takes responsibility for him. This magic-healer role has heavy reinforcement from many personal motivations of the analyst for becoming a physician and a psychotherapist. These range from need to know other people’s secrets, as mentioned by Reich, to needs to cure oneself vicariously by curing others, needs for magical power to cover up one’s own feedings of weakness and inadequacy, needs to do better than one’s own analyst. Unfortunately, some aspects of psychoanalytical educating have a tendency to reinforce the interpretation of the therapist as a magically powerful person. The admonition, for instance, to become a ‘mature character’, while excellent advice, still carries with it a connotation of perfect adjustment and perhaps bring pressure to bear on the trainee not to recognize his immaturites or deficiencies. Even such precepts as ti is a ‘mirror’ or a ‘surgeon’ or ‘dedicated’ emphasize the analyst’s moral power in relation to the patient and, still worse, makes it as good technique. Since the analyst’s power, it is regrettably easy for both persons to participate in a mutually gratifying relationship that satisfies the patient’s dependency and the doctor’s need for power.
The main situation in the patient-doctor relationship that undermines the therapeutic role and therefore may result in anxiety in the therapist can be listed as follows: (1) when the doctor is helpless to affect the patient’s neurosis, (2) when the doctor is treated consistently as an object of fear, hatred, criticism, or contempt, (3) when the patient calls on the doctor for advice or reassurance as evidence of his professional competence or interest in the patient, (4) when the patient attempts to establish a relationship of romantic love with the doctor, and (5) when the patient calls on the doctor for other intimacy.
Unresolved neurotic problems of the therapist are a subject on which it is very difficult to generalize since such problems will be different in every therapist. To be sure, there are large general categories into which most therapists can be classified, and so certain overall attitudes may be held in common, as for instance the categories of the obsessional therapists who retain remnants of a compulsive need to be in control, or the masochistically overcompensated therapist who compulsively makes reparation to the patient, as described by Little.
One may scrutinize all analysts, from the top of the ladder to the bottom, and, as is obvious, will find characteristic types of patients chosen and characteristic courses of analytic treatment in each case. Gitelson seems to undervalue this factor when he says that the analyst “can no longer . . . grow to worsen of neither his personality nor its operation in the analytic situation as a significant factor . . . This is far from saying, however, that his personality is the chief instrument of the therapy that we call psychoanalysis. There is a great difference between the selection and playing of a role and the awareness of the fact that ones' own person has found himself cast for a part. Conducting himself is important for the analyst so that the analytic process proceeds by what the patient brings to it.”
It is not the selection. Playing of a role that creates the Countertransference problem of the average, and healthy analyst, but the fact that one habitually and incessantly plays a role determined by one’s character structure, so that one is at times hindered from seeing and dealing with the role in which one is cast by the patient.
It does, however, seem apparent that, to deal with the distortions introduced by the patient, the doctor needs to be aware of the following things: (1) that he has an unambiguous expression on his face when the patient arrives five minutes late for the first hour of therapy, and (2) that he annoyed (made anxious) by the patient’s imputation of malice to him. If he were aware of (1), he would. Perhaps, can interpret the fearful apologies of the patient with a question about why the patent thinks he is angry. If he were unaware of (1) or did not think it wise to interpret, still if he were aware of his anxiety reaction (2), he can probably recognize that his annoyance at being apologized to was leading to a sulky silence on his part. Once this was within awareness, the annoyance could be expected to lift and the therapeutic needs of the situation could be handled on their own merits.
Communication of the patient’s anxiety to the therapist proves most interesting and some mysterious phenomenons exhibited on occasion - and perhaps more frequently than we realize - by both analyst and patient. It seems to have some relationship to the process described as empathy. It is a well-known fact that certain types of persons are literally barometers for the tension level of other persons with whom they are in contact. Apparently cues are picked up from small shifts in muscular tension plus changes in voice tone. Tonal changes are more widely recognized to provide such cues, as evidenced by the common expression, “It wasn’t what he said but the way he said it.” Yet there are numbers of instances where the posture of a patient while walking into the consulting room gave the cue to the analyst that anxiety was present, although there was no gross abnormality but merely a slight stiffness or jerkiness to be observed. A similar observation can be made in supervised analyses, where the supervised communicate to the supervisor that he is in an anxiety-arousing situation with the patient, not by the material he related, but by some appearance of increased tension in his manner of reporting.
It is a mood point whether anxiety responses of therapists in situations where the anxiety is ‘caught’ from the patient can be considered entirely free of personal conflict by the analyst. Probably, habitual alertness to the tension level of others, however desirable a trait in the analyst, must have had its origins in tension-laden atmospheres of the past, and therefore must have specific personal meaning to the analyst.
The contagious aspects of the patient’s anxiety have been most often mentioned concerning the treatment of psychotics. In dealing with a patient whose defences are those of violent counter-aggression, not of an analyst experience of both fear and/or anxiety. The fear is on a relatively rational basis - the danger of suffering physically hurt. The anxiety derives from (1) retaliatory impulses toward the attacker,
(2) wounded self-esteem that one’s helpful intent is so misinterpreted by the patient, and (3) a sort of primitive envy of or identification with the uncontrolled venting of violent feelings. It has been found by experience in attempting to treat such patients that the therapist can function at a more effective level if he is encouraged to be aware of and handle consciously his irrational responses to the patient’s violence.
A milder variant of this response can frequently be found in office practice. It can be marked and noted that when the affect of more than usual intensity enters a treatment situation the analyst tends to interpret the patient. This interpretation may take any one of a variety of forms, such as a relevant question, an interpretative remark, a reassuring remark, a change of subject. Whatever its content, it dilutes the intensity of feeling being expressed and/or shifting the trend of the associations. This, of course, is technically desirable in some instances, but when it occurs automatically, without awareness and therefore without consideration of whether it is desirable or not, its occurrence must be attributed to uneasiness in the analyst. Ruesch and Prestwood have studied the phenomenon of communication of patients’ anxiety to the therapist, in which they proved that the communication is much more positively correlated with the tonal and expressive qualities of speech than with the verbal content. Such factors as rate of speech, frequently of use of personal pronouns, frequently of expressions of feeling. So on, showed significant variations in the anxious parent as contrasted with either the relaxed or the angry patient. In this study, the subjective responses of most psychiatrists while listening to sections of recorded interviews varied significantly according to the emotional tone of the material. A relaxed interview elicited a relaxed response in the listening psychiatrist; the anxious interviews were responded to with a variety of subjective feelings, from being ill-at-ease to being disturbed or angry.
These uncomfortable responses, coupled with many types of avoidance behaviours by the analyst, such as those mentioned in another place, appear to occur much more frequently than has been previously realized. Detecting it is difficult then by an ‘ear witness’, since the therapist himself will usually be unable to report them following through its intermittence of time. They were noticed to occur frequently in a study of intensive psychotherapy by experienced analysts carried out by means of recorded interviews.
If one accepts the hypothesis that even successfully analysed therapists are still continually involved in countertransference attitudes toward their patients, the question arises: What can be done with such reactions in the therapeutic situation? Experience suggests that the less intense anxiety responses, where the discomfort is within awareness, can be quickly handled by an experienced but not to of a neurotic analyst. These are probably chiefly the situational or reality stimuli to anxiety. Nevertheless, where awareness is interfered with by the occurrence of a variety of defensive operations, is there anything to be done? Is the analyst capable of identifying such anxiety-laden attitudes in himself and proceeding to work them out? Certainly there are such extreme situations that the unaided analyst cannot handle them and must seek discussion with a colleague or further analytic help for himself. However, there is a wide intermediate ground where alertness to clues or signals that all is not well may be sufficient to start the analyst on a process of self-resolution of the difficulty.
The following is a tentative and necessarily incomplete list of situations that may provide a clue to the analyst that he is involved anxiously or defensively with the patient. It includes signals that have been found useful in a basic supervision that it probably could be added to by others according to their particular experience, as (1) The analyst has a reasoning dislike for the patient, (2) The analyst cannot identify with the patient, who seems unreal or mechanical. When the patient reports that he is upset, the analyst feels no emotional response. (3) The analyst becomes overemotional as for the patient’s troubles. (4) The analyst likes the patient excessively, feels that he is his best patient. (5) The analyst dreads the hours with a particular patient or is uncomfortable during them. (6) The analyst is preoccupied with the patient to an unusual degree in intervals between hours and may find himself fantasying questions or remarks to be made to the patient. (7) The analyst finds it difficult to pay attention to the patient. He goes to sleep during hours, becomes very drowsy, or is preoccupied with personal affairs. (8) The analyst is habitually late with a particular patient or shows other disturbance in the time arrangement, such as always running over the end of the hour. (9) The analyst gets into arguments with the patient. (10) The analyst becomes defensive with the patient or exhibits unusual vulnerability to the patient’s criticism. (11) The patient seems to misunderstand the analyst’s interpretations consistently or never agrees with them. This is, of course, quite correctly interpreted as resistance of the patient, but it may also be the result of a countertransference distortion by the analyst such that his interpretations are wrong. (12) The analyst tries to elicit effect from the patient - for instance, by provocative or dramatic statements. (14) The analyst is angrily sympathetic with the patient regarding his mistreatment by some authority figure. (15) The analyst feels impelled to do something active, and (16) The analyst appears in the patient’s dreams as himself, or the patient appears in the analyst’s dreams. No sooner that apparently to broaden the scope of psychoanalytic therapy, to expedite and make more efficiently the analytic process, and to increase our knowledge of the dynamics of interaction, methods of studying the transference-countertransference aspects of treatment need to be developed. In that this can best be accomplished by setting up the hypothesis that countertransference phenomena are present in every analysis. This agrees with the position of Heimann and Little. These phenomena are probably frequently either ignored or repressed, partly because of a lack of knowledge of what to do with them, partly because analysts are accustomed to dealing with them in various nonverbal ways, and partly because they are sufficiently provocative of anxiety in the therapist to produce one or another kind of defence reaction. However, since the successfully analysed psychotherapists have tools at his command for recognizing and resolving defensive behaviour via the development of greater insight. The necessity for suppressing or repressing countertransference responses is not urgent. Where the analyst deliberately searches for recognition and understanding of his own difficulties in the interrelationship, his first observation is likely to be that he has an attitude similar to one of those aforementioned. With this as a signal, he may then, by further noticing in the analytic situation what particular aspects of the patient’s behaviour stimulate such responses in him, eventually find a way of bringing such behaviour out into the open for scrutiny, communication, and eventual resolution. For instance, sleepiness in the analyst is very frequently an unconscious expression of resentment at the emotional bareness of the patient’s communication, perhaps springing from a feeling of helplessness by the analyst. When the analyst recognizes that he is sleepy as a retaliation for his patient’s uncommunicativeness, and that he is making this response because, up too now, he has been unable to find a more effective way of handling it, the precipitating factor - the uncommunicativeness - can be investigated as a problem.
Beyond this use of his responses as a clue to the meaning of the behaviour of the patient, the analyst is also constantly in need of using his observations of himself as a means to further resolution of his own difficulties. For instance, an analyst who had doubts of his intellectual ability habitually overvalued and competed with his more intelligent patients. This would become particularly accentuated when he was trying to treat patients whom they used intellectual achievement as protection against fears of being overpowered. Thus the analyst, as the result of these overestimations of such a patient’s capacity, would fail to make ordinary, garden-variety interpretations, believing that there must be obvious to such a bright person. Instead, he would exert himself to point out the subtle manifestations of the patient’s neurosis, so that there would be much interesting talk but little change in the patients.
This type of error can go unnoticed while the analyst learns eventually that he is unable to treat successfully certain types of patients. However, it can also be slowly and gradually rectified as the result of further experience. In such a case, the analyst is learning on a nonverbal level. Even so, some such signal as finding himself fantasying questions or remarks to put to the patient in the next session is noted by the analyst, he then has the means of expediting and bringing into full awareness the self-scrutiny that can lead to resolution.
It will be noted that the focus of attention of these remarks is on the analyst’s own self-scrutiny, both of his responses to the patient’s behaviour and of his defensive attitudes and actions. Much has been said by others (Heimann, Little, and Gitelson) regarding the pros and cons of introducing discussion of countertransference material into the analytic situation itself. That, however, is a question that is not possible to answer in the present state of our knowledge. Its intentional means are to improving the analyst’s awareness of his own participation in the patient-analyst interaction and of improving his ability to formulate this to himself (or to an observer) clearly. Devising techniques for using such material in the therapeutic situation seems more feasible after the area has been more precisely explored and studied - or, concurrently with further study and explanation.
One further point might be added regarding the contrast between the subjective experience of the analyst when anxiety is not present and when it is. When anxiety is not present, he may experience a feeling of being at ease, of accomplishing something, of grasping what the patient is trying to communicate. Certainly in periods when progress is being made, something of the same feeling is shared by the patient, although he may at the same time be working through troubled areas. Perhaps the loss of the feeling that communication is going in the most commonly used signal that starts the analyst on a search for what is going wrong.
In daily life and the early phases of the analysis, the transference is usually integrated with the actual total personality relationship. However, in the sense of something complex, thinking of it separately is better, unless specifically qualified, whether as a latent potentiality, or as an actual emergent ego-dystonic, or objectively inappropriate phenomena (Anna Freud, 1954). For, as far as the phenomenon is true transference, it retains unmistakeably its infantile character. However, much of the given early relationship may have contributed to the genuine adult pattern of relationship (via identification, imitation, acceptance of teaching for example), its transference derivative differs from the latter, approximately in the sense that Breuer and Freud (1895) assigned to the sequella of the pathogenic traumatic experience, which was abreacted neither as such nor associatively absorbed in the personality. Given an object who has a special transference valence, in a situation that provides a unique mixture of deprivation, intimacy and deprivation, with (obligatory!) unilateral communicative freedom, minimization of actual observation, and with certain elements of form and mechanics reminisce of the infantile state, the tendency to pristine re-emergence of talent transference drives, until now incorporated in everyday strivings, in symptoms, or in character structure, is enormously heightening. That the transference is treated in a unique way in the analytic process are assuredly true, and remains of prime significance. However, at one time, this ment of the analytic situation on the transference, as if its emergent integrated form in relation to any other physician would be essentially the same phenomenon. Considered as an actual functional phenomenon, as different from a latent potentiality (in a sense, Metapsychological concept), this is rarely the case. The unique emotional vicissitudes of the psychoanalytic situation plus the de-integrated effect of free association and the interpretative method restore an infantile quality and intensity to the psychoanalytic transference, which lead to the development of the transference neurosis. Thus, to turn Freud’s original reservations and admonitions in an affirmative direction: The question of what is the optimum transference neurosis, or whether and how nearly is much more as the optimal type of transference neurosis can be caused, has always been, and remains, an important and general problem of psychoanalytic technique. This is, to be sure, no simple matter. The modest hope implicit of our topic, in that it may offer a rationale and some suggestions toward the avoidance of spurious and unduly tenacious intensities. The transference neurosis, like other (simpler) elements in the psychoanalytic situation, has an intrinsically dialectical character and position (Free association, for example, facilitates both exposure and concealment, can occasion either gratification or suffering.) This dialectical quality can (in part) be explained by the concept of two separate, although potentially confluent streams of transference origin. In relation to the equivocal factor of intensity in the transference neurosis, in that there is a certain deductibility to reasonableness in the conception that the elements of abstinence augmenting transference intensity should derive preponderantly from the formal, i.e., explicitly technical factors (which include non-response to primitive transference wishes) rather than from excessively rigorous deficits in human response, which the patient may reasonably except or require, and where the technical valence of such deprivation may be minimal or altogether dubious as to demonstrability.
It is now all but axiomatic that the transference is the indispensable power of the analytic process, and the phenomenon on whose evolution the potentiality for ultimate therapeutic change rests in analysis. As distinguished from other psychotherapies, and resolution of the transference neurosis, and the dissolution or minimization of the transference(s) as such, is one of the distinctive final goals of the interpretative method, it's of the essence because it might be said that insights into dynamic and genetic elements in the unconscious, or the functional extension of the ego’s hegemony in relationship to the id and superego, or other germane concepts, are ultimately more important. Still, these are all, certainly in an operational sense, largely if not exclusively, contingent on the thorough analysis of the transference neurosis.
The term ‘minimization of the transference(s) is used here because of the amounting scepticism regarding the likelihood of complete dissolution or extinction of the transference. The specific personal misidentifications and the specific personally directed wishes and attitudes that usually occupy us in the analytic process (i.e., ‘the transference’) can, in a practical clinical sense, usually be brought to adequate resolution. However, at this point, it should be made to emphasize that pathogenic component of the transference complex that underlies and is anterior to these clinical phenomena. The ‘adequate resolution’ of the clinically significant aspect or fraction of the transference frees the basic practically universal element, if it is not itself severely distorted, for integration in socially acceptable enthusiasms held in common with most other human beings and thus, in a sense, a part of the individual’s environmental reality. The particularity of mind is the general latent craving for an omnipotent parent, renewed and specifically coloured with, indeed given form, by, the conflicts and vicissitudes of each phase of development and developmental separation, a craving of such primitive power that it can produce the profound physiologic alterations of hypnosis, or bring into abeyance an individual’s own perceptual capacities or capacities for rational inference, even based on fewer spectacular vehicles for suggestion. For clarity of a statement, as in the ‘primary transference’ presupposes the accomplished shift to an object, as opposed to Freud’s other [germane] use of the term, frequently elaborated by Loewald ([1960]). This phenomenon is already dramatically evident in the young (three to six-month) infants' reaction to any moving bearer of a face as mother
(‘ . . . the representative of that infant’s security’ [Spitz. 1956]). It permeates our whole social organization, is obvious in religious attitudes, in charismatic ideologists of any type. In its narrowest stronghold, in the intellectual avant-garde, it invests questions of scientific validity and rational or empirical demonstration, facilitating irrational and inappropriate attitudes of loyalty or antagonism toward scientific leaders. Human infallibility is attributed to others than the Popes, and the Anti-Christ have parallels in the world of science. Our own field has often been a conspicuous example of this tendency. In the end, scientific perceptual striving, whose autonomy is always relative at best, becomes secondarily burdened, and inevitably suffers, because of this type of ambivalent group euphoria.
If it is the entanglement with early objects that elicits the infantile neurosis and lays the ground for its later representation in the transference neurosis, it is the clinical neurosis, the usual motivation for treatment, that lies between them, and is related to both, in a sense a ‘resistance’ both to genetic reconstruction of the former, or to current involvement on the latter. This is, a variation of Freud’s statement regarding the transference neurosis as an accessible ‘artificial illness’. Perhaps suggesting that unconscious recognition of the unique transference potentiality of the psychoanalytic situation is intimately connected both with the violent irrational struggle against is not extravagant, and the sometimes fanatical acceptance of, analysis as therapy (i.e., the general and intrinsic fascination of a relationship to ‘the doctor who gives no medicine’) by the patient to whom it is recommended (and by many, before the fact). What is always fundamentally wanted, in the sense of a primal transferee, with rare (relative) exceptions, is the original physician, who most closely resembles the parent of earliest infancy. The ‘doctor who gives no medicine’ is in unconscious deductibility may be that the parent of the repetitive phases of separation. To what extent this unconscious constellation participated in the discovery or creation of psychoanalysis as such would be pure speculation. However, Freud’s capacity for transference in the attachments of daily life was abundantly evident (Freud 1887-1902, Jones 1953-1957), and the importance of the relationship with Fliess in his self-analysis was explicitly stated (Freud, 1887-1902) That it plays an important part in the emotional life of many contemporary working analysts is very likely, since all (at this time) have experienced the role of analysand (or analytic patient): The vast majority are physicians, all have been physicians’ patients in a traditional sense, and, certainly, all have been dependent and helpless children. Ferenczi (1919) described the evolution of the general psychoanalytic countertransference as for initial excessive sympathy, through reactive coldness (‘the phase of resistance against the counter-transference’), to mature balance. Lewin (1946) in referring to this formulation (to contrast it with the sequence of traditional medical training) attributes the first phase to the first of the analyst’s having only recently been a patient himself. While Lewin carefully separates the cadaver (the student’s first ‘patient’) as an ‘object’ (psychoanalytic sense) from its qualities, we may speculate that a species of retaliatory mastery of the parental object (perhaps in contrast with the role of a helpless child) is sometimes involved in this gratification, and that something of this quality was carried into the dialectic genesis of the psychoanalytic situation. When referring to the ‘dialectic genesis’ of the psychoanalytic situation, it is to infer to its genesis largely in the genius of a physician who experienced the training to which Lewin refers. The dialectic is epitomized exquisitely in the role of speech, the bridge for personal separation, rejected or distorted by children in their desperate clinging to more gratifying or more violent object drives, or, on the other hand, sought eagerly as the indispensable vehicle for alterative ego-syntonic development aspirations (Nunberg [1951], regarding the ‘Janus’ quality of transference.)
The transference neurosis, as distinguished from the initial transference, usually supervenes after the treatment has lasted for a varying length of time. Its emergence depends on the combined stress of the situational dynamics, and the pressure of the interpretative method. The latter tend to close off habitual repetitive avenues of expression, such as new symptom formation, acting out, flight from treatment, etc. the neurosis differs from the initial transference, in the sense that it tends to reproduce in the analytic and germane extra-analytic setting an infantile dramatis personae, a complex of transference, with the various conflicts and anxieties attendant on the restoration of attitudes and wishes parallelling their infantile prototypes. The initial transference (akin to the ‘floating’ transference of Glover [1955]?) is a relatively integrated phenomenon, allied to character traits, an amalgam or compromise of conflicting forces, that has become established as a habitual attitude, the best resultant of ‘multiple function’ of which the personality is capable, in the general type of relationship that now confronts it? It differs from its everyday counterpart only in its relative separation from its usual or substantiation, and - eventually - in the failure of elicitation of the gratifications or adaptive goals to which it is devoted. As time goes on, varying as to intervals before, and character of, emergence, with the nuances of the patient’s personality organization and the analyst’s technical and personal approach, the unconscious specific transference attitude will press free expression against the defences with which they have been previously integrated, in varying mixtures of associational derivatives, symptomatic acts, dreams, often ‘acting out’, and manifest feelings. At this point (or better, in this zone of a continuum), conflict involving the psychoanalytic situation becomes quasi-manifest, and the transference neurosis as this is incipient. If there be but a brief and over simply outline illustration it is only because there are various interpretations of these terms.
A male patient may adopt a characteristically obsequious although subtly sarcastic attitude toward his older male analyst, quite inappropriate to the situation, but thoroughly habitual in all relations with older men. As time goes on, his wife and business partner becomes connected in his dreams with the analytic situation, his wife in the role of mother, the analyst as father, his business partner as older brother, with corresponding and related anxieties and frustrations of functionally dynamic contributions, in his business and sexual life. Violently hostile or sexually submissive or guilty attitudes may appear in direct or indirect relation to the analyst, in the patient’s manifest activities, or in the analytic material, in dynamic and economic connection with changes in the patient’s other relationships. The entire development is not equally particular to be announced in diffuse resistance phenomena in the analytic situation and processes (Glover, 1955). The transference neurosis as such can, of course, is endlessly elaborated; when extended beyond the point of effectively demonstrable relevance to the central transference, its resistance function may be in the foreground. It must be remembered that the whole array of strongly cathected persons in the individual’s development, and the related variety of attitudes, is all distributed, so to speak, from a single original relationship, the relationship with a mother in earliest infancy. In all of them, there are elements of ‘transference’ from this relationship, most conspicuously and decisively, of course, the shifting of hostile or erotic drives from the mother to the father. In a sense, then, the entire complex of the transference neurosis is a direct, although paradoxically opposed derivative of the basic attachment and unrenounced craving, which arises in relation to the primal object, the more complicated drama having a relation to the original object attachment like that which Lewin (1946) assigns to the elements of the manifest drama in relation to the dream screen. (This is, of course, related to Lewin’s interpretation [1955] of the analytic situation in terms of dream psychology.) Because in the analytic situation, the patient is again confronted with a unique relationship, on which, via the instrumentality of communication by speech, all other relationships and experiences tend to converge, emotionally and intellectually. In this convergence, however, there is a conspicuous differential, due to the intellectual or cognitive lag. In the latter sphere, the analyst’s autonomous ego functions play a decisive operational role, via his interpretations. In the genesis of this lag, an important role must be assigned to the original (reverse) differentially. Which may establish itself between the centrifugal distribution of primal object libido and aggression and the relatively autonomous energies of perception (the ego’s ‘activity?’). The detachment of libido and aggression from the primal object will have the course be contingent not only on their original intensities but on the special vicissitudes of early gratifications. If we consider the limitless panpsychic scope and potentiality of free association, we must assume that some shaping tendency gives the associations a form or pattern reasonably accessible to our perceptive and interpretative skill. It seems likely that this is the latent inner preoccupation with the elements of the transference neurosis, the original transference of which it is self composed, and finally the derivative vicissitudes of the primal object relationship itself, the primal transference.
Insofar as an individual has achieved more than a physical-perceptual linguistic separation from the primal object, the latter elements (i.e., the actual manifestations of primal transference) may play little or no important role in the empirical realities of a given analysis. Except in certain ‘borderline’ (and allied) problems, they are of Metapsychological importance. The problems of the derivative phase and structural conflicts largely occupy us in the analysis of the neurosis. In an individual of unusually fortunate neurosis (!), the transference neurosis (thus the analysis) may not require deeper penetration than the relatively integrated conflict phenomena of the Oedipus complex. In speech, of course, there is at one time a powerful and versatile vehicle of direct object relationship, and at the same time the marvellously elaborated communicative-referential instrumentality that can convey from one individual to another the subjectively experienced parts or whole of an inner and outer world of endlessly multiplied things, persons, qualities, and relationships, in intelligible code. This code, furthermore, is one whose mastery was originally of profound importance (in conjunction with other crucial maturational phenomena, such as an independent locomotion) in enabling the physical separation from the first object (in continuing relationship), and the gradual physical and mental mastery of the rest of the environment.
With regard to the countertransference, is that it has the same important and narrowing distinction from the other aspects of the current relationship and should be made as in the case of the patient’s transference: For here, too, an individual is involved in a complicated relationship with another human being in which a triplet of separate but constantly interacting and sometimes integrated modalities can be discerned. In a sense, since the patient has at least a considerable freedom of verbal and emotional expression, the analyst’s emotional burden is a heavier one. This, however, is like saying that the patient’s responsibility is greater than the child’s, or (to turn back to an earlier page!) That the surgeon carries a greater burden than his comfortably anaesthetized patiently. The analyst is, or should be, better prepared for this burden than his patient. Still, if we remove this entire question from the realm of professional moralism, self-debasement, or self-pity, we can all the more genuinely appreciate the essential message of the frequently contributions on the countertransference in recent years, i.e., the reminder that no one is ‘completely; (or, as Freud [1937] preferred, ‘perfectly’) analysed, that even those who may have approximately this as closely as may reasonably be expected, have specific vulnerabilities to certain individuals or situations, that these may appear in milder form or ephemerally, but nonetheless importantly with others; that, in fact, a self-analysis for the specific ‘counter-transference neurosis’ (Tower, 1956) with each case is, to varying degrees, as silent counterpoint, an integral part of all good analytic work. This would be true whether the counter-transference played its traditional impeding role or its more subtle favourable (i.e., ‘catalytic’) role (Tower, 1956) in a given analysis. One never knows where the usefulness of an unanalyzed reaction may end, and difficulties begin. Another important contribution, not separate, except in terms of emphasis, is the growing appreciation of the countertransference as an affirmative instrument facilitating perception, whereby a sensitive awareness of one’s incipient reactions to the patient, fully controlled and appropriately analysed in an immediate sense, leads to a richer and more subtle understanding of the patient’s transference strivings (Racker 1957, Weigert 1954). This would be opposite yet cognate to the understanding by transitory empathic identification (Reich, 1960). There is also the important attention (Money-Kyrle, 1956) to the specific vicissitudes of the analyst’s peculiarly constricted and emotionally inhibited therapeutic effort, and the mutual projective and introjective identification that may occur between analyst and patient in crises of technical frustration, i.e., frustration of the analyst’s understanding. The operational primacy of the latter function must be stressed. That is, that this function and the germane emotional attitude constitute central and essential ‘gratification’ for the patient’s ‘mature transference’ strivings, enabling his toleration, even positive unitization of the principle of abstinence, in relation to primitive transference demands. Loewald’s views (1960) are importantly related to these, perhaps, in a sense, complementary to them. An important connotation of these countertransference studies is the diminution of the rigid status barrier between analyst and analysand. They point to the patient in the physician, the child in the parent (a sort of latent or potential ‘seesaw’, to modify Phyllis Greenacre’s [1854] ‘titled relationship’!). This intellectual tendency can be, and is often, overdone, just as the magical power of the countertransference to determine the course of treatment has become an almost euphoric overwrought mystical belief among certain younger therapists, and, as a concept, a formidable source of resistance in the technically informed patient. Such exaggerated views, when not of specific and immediate emotional geneses, or due to ignorance, may be connected with a general lack of conviction regarding the efficacy of the therapist’s own analysis, or os the effectiveness of the interpretative method. There may be of a general lack of awareness or acceptance of the power that the original ‘tilt’ lens to the patient’s transference. Finally it is this ‘tilt’ in the situation, and (very importantly) the actuality of its representation in the respective emotional and intellectual states of the participants, on which we must rely. If temperately considered, a view of the relationship that gives great weight to the countertransference, is productively important. It places the operational attitude and technique of the analysis in better perspective, as an integration of several important factors that always include the Countertransference, and it permits an examination of nuances of technical decision on a much more illuminating and genuinely dependable basis than pure precedent, or rule-of-thumb, or pseudo-mathematical certainty. Thus, too foreign a patient in pain some aspirin or not, to inspect his eye for a foreign body or not, to tell him promptly where one ids going on vacation or not, may be right or wrong in either alterative, depending on the analyst’s own specific motivation or anxiety, compared with the patient’s actual need, or their objective clinical indications of the moment, weighted against the continuing and rationally interpreted convenience of technique. It is less likely that any manoeuver, assuming the adherence to basic broad technical principles, will create significant analytic distortion, if executed with genuine and exclusively therapeutic intentions’ appropriate to the need, than a manoeuver or default of manoeuver, based entirely or largely on exhibitionistic or seductive or anxious or compulsive reasons, however respectable the latter may seem. These principles, of course, assume the general analytic framework, and the maintenance of the principle of abstinence, insofar as it does not conflict with overriding human requirements, or does not reach beyond the subtle limits that have been sought to earlier discussion (Scheunert’s, 1961). The issue of the increment of unanswered innocuous questions, of injudiciously withheld expressions of reasonable human interest, where the human relationship requires them. Still it is related to the emotional opposition of the analyst, for a ‘rule’ obviously has a different meaning to an anxious or sadistic or compulsive person than to an individual not thus burdened. The general problem is germane to the perennial interest in why (beyond the usual verities or clichés) an individual becomes a physician, and specifically why he then chooses this physically and emotionally inhibited specialty, which depends do largely on benignly purposive frustration of the patient, on occasional informed talking, and possibly even more on extended and perceptive listening. Assuming that is reasonable, with the myriad individual factors, some general or common countertransference element enters the over determination both of choice of the medical profession and of the specialty that holds a unique position in the minds of medical men and patients alike. The uniqueness of this position is perhaps best suggested by the remarkably frequent query of the naive patient: “Are you really an MD.?” or “Are you a medical doctor too?” This is in a different intellectual realm, but surely related to the more informed discussion as to whether analysis is a brach of medicine, or a special development in psychology, or an entirely independent discipline. It is to suggest that, apart from more usual considerations the fascination and strain of analytics works are related to the same phenomenon that evokes the deductibility of which the patient reaction to it. Having to a mindful purpose in that the state of separation and of infantile deprivations that are integral in the situation, and the effort to utilize these toward solutions more favourable than those originally evolved. Setting aside the specific phase problems and other quantitative aspects of individual Countertransference, there will still be quantitative individual variations, tending toward excessive deprivation or overindulgence (for example), revolving about the central and necessary principle of abstinence in the psychoanalytic situation, whose skilful administration is a part of the basic occupational commitment. Insofar as ‘weaning’ is the great focal prototype of abstinence or deprivation, bringing to our attention to the historical vicissitudes of the word wean (Oxford English Dictionary, Vol. 12 [1933]) in which even a secondary (non-etymologic) developments of the alternative meaning ‘deprivingly of one's sanctity' has become obsolete. This is no doubt intertwined with cultural consideration far beyond out present scope of interest. However, it is also symbolically related to the (obsolescent?) Technical moods, which are felt to be restored to analytic work, with advantage.
In addition, on the interface of the analyst-patient interaction is not yet as to have become as focussing on the patient or the analyst. It is the nature of the integration, the quality of contact, what goes on between, including what is enacted. What is communicated effectively and/or unconsciously, that is addressed.
The apparent edge-horizon that is to form a resolution about that which ideally becomes the point of maximum and acknowledged contact at any given moment in a relationship without fusion, without violation of the separateness and integrity of each participant. Attempting to relate at this point requires ceaseless sensitivity to inner changes in oneself and in the other, as well as to changes at the interface of the interaction as these occur in the context of the spiral of reciprocal impact. This kind of effort has a reflexive impact on both participants, and this in turn influences what goes on between them in a dialectical way.
The interchanging edge thus is never static but becomes the trace of a constantly moving locus. Each time this is identified it is also changed, and as it is re-identified it changes again. The analytic expanse is enlarged significantly as aspects of the relationship that are generally not explicitly acknowledged or addressed, as well as their vicissitudes over time, are identified and explored in an analytic way. The emphasis is on process, on engaging live experience, and on generating a new kind of live experience by so doing, in an ever expanding way.
In some ways the focus is on what Winnicott (1971) refers to as the “continuity-contiguity moment” in relatedness. What distinguishes the conceptualized necessity for acknowledgement and explicitness seems the process of acknowledgement for increases the moment’s dimensional change to natures experiential obtainability. What is? , However, achieved is not simply greater insight into what or was, but what should be, as but a new kind of evidential experience.
Working at the circumferential horizon soon creates a unique contest of safety and allows for maximum closeness precisely because it protects against the threat of intrusion or violation. Attending to the most elusive interactive subtleties and ‘opening the moment’ and thus actualizes upon a natural way to detoxify and subjectively field, every bit as dangers of mystification, seduction. Coercion, manipulation, or collusion is minimized (Levenson 1972, 1983; Ehrenberg 1974, 1982; Feiner 1979, 1983; Gill 1982, 1983; Hoffman 1983). In some instances this makes it possible for both participants to engage aspects of experience and pathology that otherwise might be threatening, even dangerous.
The protection of the kind of analytic rigour that attending to interactive subtleties provides allows for more intense levels of effective engagement without the kind of risk this might otherwise entail.
In its gross effect, the apparent circumferential horizon is not simply art the boundary between self and other, but the given directions developing interpersonal closeness in the relationship, it is also at the boundary of self-awareness. It is a particular point as occupying a positional state in space and time of self-discovery, at which one can become more ‘intimate’ with one’s own experience through the evolving relationship with the other, and then more intimates with the other as one becomes more attuned to self. Because of this kind of dialectical interplay, the apparent favourable boundary becomes the undergoing maturation of the relationship.
As moment-by-moment change over in quality, that the relatedness and experience between analyst and patient are studied, individual patterns of reaction and reason-sensitivities can be identified and explored. This allows for the sparking awareness of choice, as existential decisions to become increasingly involved, or to withdraw, as well as the persuasive influences may be responsively ado, in that they can be studied in process, and the feelings surrounding these can be closely scrutinized. The patient’s spontaneous associations to the immediate experience often not only become an avenue to effectively charged memories of past experiential encounters that might not have been previously accessible but also allow for the metaphoric articulation of unconscious hopes, fears, and expectations, least of mention, few than there are less, have to no expectation whatsoever, or as even not to expect from expectation itself.
Even when the circumferential edge horizon is missed and there is some kind of intrusion or some failure to meet due to overcautiousness, the process of aiming for it, the marginal but mutual focuses on the difficulties involved, can facilitate its obtainable achievement. The effort to study the qualities of mutually spatial experiences in a relationship, the interlocking of both participants, including an interchangeable focus on the failure to connect or inauthenticate, or perhaps into a collusion, can thus become the bridge to a more approximative encounter.
The circumferential edge horizon is, therefore. Not a given, but an interactive creation. It is always unique to the moment and for reason-sensitivities to posit of themselves the specific participants in relation to each other and reflects the participant’s subjective sense of what is most crucial or compelling about their interaction at that present of moments.
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