Freud divides positive transference into sympathetic and positive transference. The relation between the two is not clearly defined, and sympathetic transference is sometimes called analytic rapport. Do the two merge, or remain distinct: Is sympathetic transference resolved with positive and negative transference? Discussions in the importance of positive transference are the beginning of analysis and as carrier of the whole analysis had lately been revived among child analysts. This has extended to the question of whether or not a transference neurosis in children is desirable or even possible. While this dispute touches on the fundamentals of psychoanalytic theory, the definitions offered as a basis for the discussion are not very precise.
The contradictions in the literature about transference could be multiplied, but as exemplifying the conspicuous absence of a unified conception they will suffice. Alexander’s make to comment that ‘Although it is agreed that the central dynamic functional problem in psychoanalytic therapy is the handling of transference, there is a good deal of confusion about what transference really means’. He comes to the conclusion that the transference relationship becomes identical with a transference neurosis, except that the transient neurotic transference reactions are not usually dignified with the name of “transference neurosis.” He thus questions the need for the term transference neurosis together. As to the transference neurosis itself, there is a similar haziness of the conception. Definitions usually begin with “When symptoms loosen up . . . ,” or “When conflict is reached . . . ,” or “When the productivity of illness becomes centred round one place only, the relation to the analyst . . . ,” yet, strictly speaking, such pronouncements are descriptions, not definitions. Freud’s definition of transference neurosis implicitly and explicitly refers only to the neurotic person, so that one is left with the impression that only neurotics form a transference neurosis. Sachs, on the contrary,’ . . . found the difference between the analyses of training candidates and of negligent neurotic patients.
It may be historically held that many contradictions in the literature are largely semantic, which in enumerating them haphazardly, discrepancies’ brought into false relief. A truer picture, it may be argued, would have been given is historical periods had been made the principle. Developmental stages in a psychoanalysis were of course reflected in current concepts of transference.
In the very first allusion (1895) to what developed into the notion of transference, Freud says that the patient made ‘a false connection’ to the person of the analyst, when an effect became conscious which related to memories that were still unconscious. This connection Freud thought to be due to ‘the associative force prevailing in the conscious mind’. It is interesting that with this first observation Freud had already noted that the effect precedes the factual material emerging from repression. He adds that nothing is disquieting in this because “ . . . the patients gradually come to appreciate that in these transferences onto the person of the physician they are subject to a compulsion and a misrepresentation, which vanquishes with the cancellation of analysis.”
In 1905 Freud stresses the sexual nature of these impulses felt toward the physician. What, he said, are transferences? “They are new editions or facsimiles of the tendencies and fantasies aroused and made consciously during the progress of the analysis . . . Fantasies now added to affect. If one goes into the theory of analytic technique,” he continues, “transference is evidently an inevitable necessity.” At this historic point Freud established the fundamental importance of transference in the psychoanalysis with its specific technical meaning. The importance of this passage is confirmed by a footnote added on 1923. It is noteworthy that Freud mentions in its passage that transference impulses are not only sympathetic or affectionate, but that they can be hostile.
About 1906 transferences were regarded as a displacement of effect. Analysis was largely interested in unearthing forgotten Traumata and in searching for complexities. Much of the theory was still influenced by the cathartic method. The psychoanalysis was then, says Freud,‘ . . . the next aim was to compel the patient to confirm the reconstruction through his own memory. In this endeavour the chief emphasis was on the resistance of the patient: The art now lay in unveiling these when possible, in calling the patient’s attention to them . . . and teaching him to abandon this resistance. It then became increasingly clear, however, that the bringing into consciousness of unconscious material was not fully attainable by this method either. The patient cannot recall all that lies repressed . . . and so gains no conviction the reconstruction is correct. He is obliged to repeat as a current experience what is repressed instead of recollecting it as a part of the past’. The importance of resistance as acting out is now introduced (repetition compulsion).
Beyond the Pleasure Principle (1920) was followed by Group Psychology and the Analysis of the Ego (1921) and The Ego and the Id (1923). The new concepts introduced were the superego, and the more specific function of the ego, and the conception of the id as containing not only repressed material, but also as a reservoir of instincts. Resistance was extended to ego and superego and it resistance. This caused some confusion, because it can be used as meaning the resistance of one psychic instance to analysis, or the resistance of one psychic instance, say the ego, to another psychic instance, say the id, but the term resistance has been used chiefly as resistance to the progress of analysis generally. The id was shown to offer no resistance, but to lead to acting out, which in turn, however, is a resistance to recollection. At times, the unconscious can only be recovered in action, and while it is therefore “material” in the strict sense of the word, it is still resistance to verbalized recollection.
The mechanisms considered operatives in transference were displacement, projection and introjection, identification, compulsion to repeat. The importance of “working through” was stressed. In 1924 discussions took place about the relative values of intellectual insight versus affective re-experiencing as the essence of analytic experience, an issue very important in interpreting the transference to the patient.
In the period following, this added knowledge was gradually integrated, but with overemphasis on some new aspects as they first arose. Without a comprehensive critical survey of the subject, authors found it necessary to explain what they meant when they used the term “transference.”
With this integration new factors of confusion arose. Viewed arbitrarily form, lets us say 1946, the conception of transference has been influenced by (1), child analysis, (2), undertaking at treating psychotics, (3) psychosomatic medicine, and (4) the disproportions between the number of analysts and the growing number of patients seeking analysis, leading to attempts to shorten the process of analysis.
Direct interpretation of unconscious content is again being stressed by some analysts of children so that the methods are reminiscent of the beginning of psychoanalysis. Yet on closer examination, there may be a difference in principle: Unconscious material that presents itself in play is given a direct transference meaning from the beginning. The therapist interprets forward, as it was. The interpretation is not from current material, but from the allegedly presented unconscious material to an alleged immediacy of the transference significance. This, it should be noted, is a mental process of the therapist and not of the patient, therefore in the strict scientific sense, it is a matter of countertransference than of transference. Something similar takes place in the classical technique when forced transference interpretations are given, the important difference being that these are used in the classical method only sparingly and never until the transference neurosis is well established, and analysis has become a compulsion. It is precisely at this theoretical, that the dispute is centred among child analysts about the possibility or existence of a transference neurosis among children.
In the treatment of psychotics the idea of transference is developing a new orientation. In some of these techniques the therapist interprets to himself the meaning of the psychotic fantasy and joins the patient in acting out. Strictly speaking, this is active countertransference.
In psychosomatic medicine, particularly in ‘short therapy’, transference is either discounted as an actively manipulated way that, from a theoretical point of view, amounts to an abandonment of Freud’s “spontaneous” manifestations.
All and all, changes in the idea of transference are not constructively progressive. Critical attention needs to be drawn to the fact that not only is there no consensus about the concept of transference, but there cannot be until transference is comprehensively studied as a branch of knowledge and as a functional dynamic process. The lack of precision is to some extent due to a disregard of its historical development. Nor can there be a consensus while the relation of transference manifestations to the three stages of analysis is neglected, it is to the detriment of scientific exactitude that divergent groups do not sharply define but as an alternative, it glosses over fundamental differences, there is a tendency to claim orthodoxy, and to hide the deviation behind one tendentiously and arbitrarily selected quotation from Freud.
In the face of such divergent opinions on the nature and manifestations of transference, one might expect many hypotheses and opinions about how these manifestations come about. However, this is not so. On the contrary, there is the nearest approach to full unanimity and accord throughout the psychoanalysis literature on this point. Transference manifestations are held to arise within the analysand spontaneously. ‘This peculiarity of the transference is not, therefore, says Freud, “to be placed to the account of psychoanalytic treatment, but is to be ascribed to the patient’s neurosis itself.” Elsewhere, he makes to point out: “In every analytic treatment, the patient develops, without any activity by the analyst, and intense affective relation to him . . . It must not be assumed that analysis produces the transference. . . . The psychoanalytic treatment does not produce the transference, it only unmasks it?” Ferenczi, in discussing the positive and negative transference says: “. . . . It has particularly to be stressed that this process is the patient’s own work and is hardly ever produced by the analyst.” “Analytic transference appears spontaneously, and the analysts need only take care not to disturb this process.” As states, “The analyst did not deliberately set out to affect this new artificial formation (the transference neurosis), merely observed that such a process took place and forthwith used it for his own purposes.” Freud further states: “The fact of the transference appearing, although either desired or induced by either physician or patient, in every neurotic who comes under treatment . . . has always seemed as . . . ‘ proof that the source of the propelling forces of neurosis lies in the sexual life.”
There is, however, a reference by Freud from which one has to infer that he had in mind another factor in the genesis of transference apart from spontaneity-in fact, some outside influence, the analyst ‘ must recognize that the patient’s falling in love in induced by the analytic situation . . . ’. He (the analyst) has evoked this love by undertaking analytic treatment in other to cure the neurosis, for him, it is an unavoidable consequence of the medical situation . . . ’. Freud did not amplify or specify what importance he attached to this causal remark.
Anna Freud states that the child’s analyst has to woo the little patient to gain its love and affection before analysis can continue, and she says, parenthetically, that something similar takes place in the analysis of adults. Another reference to the effect that transference phenomenon is not completely spontaneous is found in a statement by Glover summarizing the effects of inexact interpretation. He says that the artificial phobic and hysterical formulations resulting from incomplete or inexact interpretations are not an entirely new conception. Hypnotic manifestation has long since been considered “an induced hysteria” and Abraham considered that states of autosuggestion were induced obsessional systems? He continues . . . “ and of course, the induction or development of a transference neurosis during analysis is regarded as an integral part of the process,” one is entitled from the context to assume that Glover commits himself to the view that some outside factors are operative which induce the transference neurosis. Nevertheless, it is hardly a coincidence that it is no more than a hint.
The impression gained from the literature is that the spontaneity of transference is considered established and generally accepted. In fact, this opinion seems jealously guarded for reasons referred to.
A psychoanalysis developed from hypnosis: A study of the older psychotherapeutic methods, therefore, may still yield data that are applicable to the understanding psychoanalysis: One cannot overestimate the significance of hypnotism in the development of the psychoanalysis. Theoretically and therapeutically, the psychoanalysis is the trustee of hypnotism. It is in comparing hypnotic and analytic transference that the writer believes the clue to the phenomenon and the production of transference may be found. It was only after hypnosis had been practised empirically for a long time that its mechanism was given explanations by Bernheim, Freud, and Ferenczi. Freud showed that the hypnotist suddenly assumed a role of authority that Standley transformed the relationship for the patient (by way of Traumata) into a parent-child relationship. Radó investigating hypnosis, came to the conclusion that.”
. . . the hypnotist is promoted from being an object of the ego to the position of an ‘a parasitic superego.” Freud stated, “No one can doubt that the hymnodist has stepped into the place of the “ego-ideal.” Later he was to say that “ . . . the hypnotic relation is the devotion of someone in love to an unlimited degree but with sexual satisfaction excluded. In other place’s Freud stressed repeatedly and with great emphases that in hypnosis factors of a “coarsely sexual nature” were at work, and that the qualities of the libido.” Psychoanalysis like hypnosis began empirically, one may speculate that analytic transference is a derivative of hypnosis, and motivated by instinctual (libidinal) drives and, substituting new terms, produced in a way comparable to the hypnotic trance.
When one compares hypnosis and transference, it appears that hypnotic ‘rapport’ contains the elements of transference condensed or superimposed. If what makes the patient go to the hypnotist is called sympathetic transference, hypnosis can be said to embrace positive transference and the transference neurosis, and when the hypnotic “rapport” is broken, the manifestations of negative transference. The analogy of course ends when transference is not resolved in hypnosis as it is in analysis, but is allowed to persist. To look upon it from another angle, analytic transference manifestations are some slow motion pictures of hypnotic transference manifestations, they take some time to develop, unfold slowly and gradually, and not at once as in hypnosis. If the hypnotist becomes the patients’ “parasitic superego,” similarly, the modification of the analysand’s superego has for some time been considered a standard feature of psychoanalyses.
Styrachey sees in the analyst “an auxiliary superego.” Discussing this and examining projection and introjection of archaic superego formations to the analyst, he says: The analyst’ . . . hopes, in short, that he himself will be introjected by the patient as a superego, introjected, however, not at a single gulp and as an archaic object, whether good or bad, but little by little, and as a real person. Another possible similarity between the modes of action of hypnosis and analytic transference is to be found in the state of hysterical dissociation in hypnosis, in the psychoanalysis a splitting of the ego into an experiencing and an observable care that takes its part (which follows the procreation of the superego to the analyst), and takes place. Sterba, stressing the usefulness of interpretation of transference resistance, shows that this takes place through a kind of dissociation of the ego just when these transferences are interpreted. Both in hypnosis and psychoanalysis libidos are mobilized and concentrated in the hypnotic and analytic situation, in hypnosis again condensed in one short experience, while the psychoanalysis at which a constant flow of a libido in the analytic situation is aimed. Ferenczi’s ‘active therapy’ was intended to increase or keep steady this libidinal flow. Freud first encountered positive transference (love), and only later discovered the negative transference. This sequence is the trued in analysis, and in this there is another analogy to hypnosis. Finally, it is generally recognized that the same type of patient responds to hypnosis as to psychoanalysis, in fact, the hypnotizability of hysterics gave Freud the impetus to develop the psychoanalytic technique, and hysterics are still the paradigms for classical psychoanalytic technique.
It is comparatively easy today to get a bird’s-eye view of the development of analytic transference from hypnotic reactions, and make a comparison between the two. Freud, who had to find his was gradually toward the creation of a new technique, was completely taken by surprise when he first encountered transference in his new technique. He stressed repeatedly and emphatically that these demonstrations of love and of hate emanate from the unaided patients, which they are part and parcel of the “neurotic,” and that they have to be considered a “new edition” of the patient’s neurosis. He maintained that these manifestations appear without the analyst’s endeavour, but their obtainability is in spite of him (as they represent resistance), and that nothing will prevent their occurrence. Freud’s view is still undisputed in psychoanalytic literature: Thus arose the conception that the analyst did nothing to evoke these reactions, in a marked contradistinction to the hypnotist’s direct activities, the analyst offered himself tacitly as a superego in contrasts to the noisy machination of the hypnotist.
Transference was, in the early days of psychoanalysis, believed to be a characteristic and pathognomonic sign of hysteria. This was a heritage from hypnosis. Later, these same manifestations were found in other neurotic conditions, in the psychoneuroses, or the transference neuroses. When in time psychoanalyses was applied to an ever-widening circle of cases, it was found that students in psychoanalytic training, who did not openly fall into any of these categories, formed transference in the same way? This was explained by the fact that between ‘normal’ and ‘neurotic’ there is a gradual transition, which in fact we are all potentially neurotic. In this way, historically, the onus of responsibility for the appearance of transference was shifted imperceptibly from the hysteric to the psychoneurotic, and then to the normal personality. When this stage was reached, transference was held to be one many ways in which the universal mental mechanism of displacement was at work. The capacity to “transfer” or “displace” was shown to operate in everybody to a greater or lesser degree: Its use became looked upon as a normal, in fact, an indispensable mechanism. The significance of this shift of emphasis from a hysterical trait to a universal mechanism as the source of transference has, however, not received due attention. It has not aroused much comment nor an attempt to revive the fundamental principles underlying psychoanalytic procedure and understanding.
Transference is still held to arise spontaneously from within the analysand, just as when psychoanalytic experience embraced only hysterics. It is generally taught that the duty of the analyst is, at best, to allow sufficient time for transference to develop, and not to disturb this ‘natural’ process by early interpretation. This role of the analyst is well illustrated in the similes of the analyst as ‘catalyst’ (Ferenczi), or as a ‘mirror’ (Fernichel).
It is all the same that if transference is an example of a universal mental mechanism (displacement), or if, in Abraham’s sense, it is equated with a capacity for adaption of which everybody is capably which everybody employs at times in varying degrees, why does it invariably occur with such great intensity in every analysis? The answer to this question may be that transference is induced from without in a manner comparable to the production of transfixed hypnosis. The analysand brings, in varying degrees, an inherent capacity, a readiness to form transference, and this readiness is met by something that converts it into an actuality. In hypnosis the patient’s inherent capacity to be hypnotized is induced by the command of the hypnotist, and the patient submits instantly. In the psychoanalysis it is neither achieved in one session nor it a matter of obeying. Psychoanalytic technique creates an infantile setting, of which the “neutrality” of the analyst is but one feature among others. To this infantile setting the analysand-if he is, analysable-has to adapt, even if by regression. In their aggregate, these factors, which go to make up this infantile setting, amount to a reduction of the analysand’s object world and denial of objects relations in the analytic room. To this deprivation of object relation he responds by curtailing conscious ego functions and giving himself over to the pleasure principle: And following his free association, he is by that sent along the trek into infantile reactions and Mental attitude. The term free-association as defined by Freud are the trends of thought or chains of ideas that spontaneously arise when restraint and censorship upon logical thinking are removed and the individual orally reports everything that passes through his mind. This fundamental technique of advancing the psychoanalysis is assuming that when relieved of the necessity of logical thinking and reporting verbally everything going through his mind, the individual will bring forward basic psychic material and thus make it available to analytic interpretation. As forwarded by hypnotism, in which its theory and practice of inducing hypnosis or a state resembling sleep as induced by physical means.
Before discussing in detail the factoring constitution of an infantile analytic setting, of which the analysand is uncovered and appreciating the fact that finding the analytic situation is necessarily is common in psychoanalytic literature called one to which the analysand reacts as if it were an infantile one, once, again, Freud describes the infantile expression as that which is maintained by psychoanalysts that ‘this period of life, during which a certain degree of directly sexual pleasure is produced by the stimulation of various cutaneous areas (erotogenic zones), by the activity of certain biological impulses and as an accompanying excitation during many affective states, is designated by an expression introduced by Havelock Ellis as the period of autoerotism. It is, nonetheless, generally understood that the analysand is alone responsible for this attitude? As an explanation of why he should regard it always as an infantile situation, one mostly finds the explanation that the security, the absence of adverse criticism, the encouragements derived from the analyst’s neutrality, the allaying of fears and anxieties, create an atmosphere that is conducive to regression, that is to say, the actions of his returning to some earlier level of adaption. Up to the present time, it is usually established in the literature as it is far from being the rule that the analytic couch allays anxieties, nor is the analytic situation always felt as a place of security: The projection of an essentially severe superego onto the analyst is not conducive to allaying fears. Many patients first react with increased anxieties, and analysis is frequently felt by the analysand as fraught with danger both from within and without. Many patients from the start have mutilation and castration anxieties, and at times analysis is equated in the analysand’s mind with a sexual attack. The analyst’s task is to overcome this resistance, but the analytic situation per se, does not bring it about. In fact, the security of analysis as an explanation of the regression is paradoxical: As in life, security makes for stability, whereas stress, frustration, and insecurity initiate regression. This trend of thought does not run counter to accepted and current psychoanalytic teachings, but it is instead an exposition of Freud’s established principles about the conception of neurosis. As used today, this term is interchangeable with the term psychoneurosis. At one time it was used to refer to any somatic disorder of the nerves (the present-day term for this meaning is neuropathy) or to any disorder of nerve function. In psychoanalytic terminology, neurosis is often used more broadly to include all physical disorder: Thus Freud spoke of actual neuroses (Neurasthenia, including hypochondriasis, and anxiety-neurosis): Transference or psychoneuroses (Anxiety-hysteria, conversion-hysteria, obsessional and compulsive neurosis . . . ), narcissistic neuroses (the schizophrenias and manic-depressive psychoses) and traumatic neuroses are each given to psychoanalytical literature, and treatment is aside. The self-contradictory statement, that the security of analysis induces the analysand to regress. It is carried uncritically from one psychoanalysis publication to another.
These infantile settings are manifold, and they have been described singly by various authors at various times. It is not pretended, that anything new is to add to them but as far as the aggregate has never been described an amounting to a decisive outside influence on the patient. These factors are in this context given in an outline. If only to establish the features of the standardization of their psychoanalytic technique as to (1) Curtailment of an object world. External stimuli are reduced to a minimum (Freud at first asked his patients even to keep their eyes shut). Relaxation on the couch has also to be valued as a reduction of inner stimuli, and as an elimination of any gratification from looking or being looked at. The position on the couch approximates the infantile posture. (2) The constancy of environment, which stimulates fantasy. (3) The fixed routine of the analytic 'ceremonial', the 'discipline' to which the analysand has to conform which is reminiscent of a strict infantile routine. (4) The single factor of not receiving a reply from the analyst is likely to be felt by the analysand as a repetition of infantile situations. The analysand-uninitiated in the technique-will not merely be an anticipatorial answer to his question but he will expect conversation, help, and encouragement and criticism? (5) The timelessness of the unconscious. (6) Interpretations on an infantile level stimulate infantile behaviour. (7) Ego function is reduced to a state intermediate between sleeping and waking. (8) Diminished personal responsibility in analytic sessions. (9) The analysand will approach the analyst in the first place much in the same way as the patient with an organic disease consults his physician: This relationship contains a strong element of magic, a strong infantile element. (10) Free association, liberating unconscious fantasy from conscious control. (11) Authority of the analyst ( parent ): This projection is a loss, or severe restriction of object relations to the analyst, and the analysand is thus forced to fall back on fantasy. (12) In this setting, and having the full sympathetic attention of another being, the analysand will be led to expect, which according to the reality principle he is entitled to do, that he is dependent on and loved by the analyst. Disillusionment is quickly followed by regression. (13) The analysand art first gains an illusion of complete freedom, which he will be unable to select or guide his thoughts at will is one facet of infantile frustration. (14) Frustration of every gratification repeatedly mobilizes the libido and initiates further regressions to deeper levels. The continual denial of all gratification and object relations mobilizes the libido for the recovery of memories. However, its significance lies also in the fact that frustration as this is a repetition of infantile situations, and to the highest degree and likely the most important single factor. Saying that we grow up by frustration would be true. (15) Under these influences, the analysand becomes ever more divorced from the reality principle, and falls under the sway of the pleasure principle.
These depictions are well implicated to features that exemplify the sufficiencies that the analysand is exposed to an infantile setting in which he is led to believe that he has perfect freedom, which he is loved, and that he will be helped in a way he expects. The immutability of a constant passive environment forces him to adapt, i.e., to regress to infantile levels. The reality value to the analytic session lies precisely in its unchanging unreality, and in its unyielding passivity lies the “activity,” the influence that the analytic atmosphere experts. With this unexpected environment, the patient-if he has, any adaptivity-has to come to terms, and he can do so only by regression. Frustration of all gratifications pervades the analytic work. Freud comments: “As far as his relations with the physician are concerned, the patient must have unfulfilled wishes in abundance. It is expectient to deny him precisely those satisfactions that he needs most intensively and expresses most importunately.” This is a description of the denial of object relation in the analytic room. The present thesis stresses the significance not only of the loss of object relation, but, as a constituent of at least equals importance, the loss of an object world in the analytic room, the various factors of which are set out in above-mentioned-remarks.
Evidently, all these factors working together from a definite environment under which his loss of an object world, including its surrounding surface and emotional influences, he is subject to a rigid and most sternful environment, not by any direct activity of the analyst, but by the analytic technique. This conception is far removed from the current teaching of complete passivity by the analyst. One may legitimately go one step further and call to mind what Freud said about the etiology of the neuroses:
‘. . . relational causes of disease people fall ill of a neurosis when the possibility of satisfaction for their libido is denied them-they are quickening the ill infringements that is influential to inconsequential ‘frustrations’-and that their symptoms are substitutes for the missing satisfactions’.
Regression in the analysand is initiated and kept up by this selfsame mechanism and if, in actual life, a person falls ill of a neurosis because “reality frustrates all gratification,” the analysand likewise responds to the frustrating infantile setting by regressing and by developing a transference neurosis. In hypnosis the patient is suddenly confronted with a parent figure to which he instantly submits. Psychoanalysis places and keeps the analysand in an infantile setting, both environmental and emotional, and the analysand adapts to it gradually in reserve to regression.
The same may be said to be true of all psychotherapy, yet it appears peculiar to the psychoanalysis that such an infantile setting is systematically created and its influence exerted on the analysand throughout the treatment. Unlikely any other therapist, the analyst remains outside the play that the analysand is enacting, he watches and observes the analysand’s reactions and attitudes in isolation. To have created such an instrument of investigation may be looked upon as the most important stroke of Freud’s genius.
It can no longer be maintained that the analysand’s reactions in analysis occur spontaneously. His behaviour is a response to the rigid infantile settings to which he is exposed. This poses many problems for a significantly enlarged investigation. One of these is, how does it react on the patient? He must know it, consciously or unconscious mind. It would be interesting to follow up whether perhaps the frequent feeling of being in danger, of losing something, of being coerced, or of being attacked, is a feeling provoked in the analysand in response to the emotional and environmental pressure exerted on him. If this creates a negative transference would be feasible, and as positive transference must exist as well (otherwise treatment would be stopped), a subsequent state of ambivalence must follow. Here one might look for an explanation why ambivalent attitudes are prevalent in analysis. These are generally looked upon as spontaneous manifestations of the analysand’s neurosis. Following that this double attitude of the analysand, the positive feelings toward the analyst and analysis, and a negative response to the pressure exerted on him by continual frustration and loss of object-world and object-relations, could be looked upon as the normal sequitur of analytic technique. It would not make up ambivalence in its strict sense, because the patient is reacting to two different objects simultaneously and has not as in true ambivalence two attitudes to the same object. The common appearance of this pseudo ambivalence can then no longer be adduced as evidence of the existence or part of a pre-analytic neurosis.
The patient comes to analysis with the hope and expectation of bringing helped. He thus expects gratification of some kind, but none of his expectations are fulfilled. He gives confidence and gets none in return, he works hard and expects praise in vain. He confesses his sins without absolution given or punishment proffered. He expects analysis to become a partnership, but he is left alone. He projects onto the analyst his superego and, least of mention, desirously builds them to the expectations from his guidance and control; of his instinctual drives in exchange, but he finds this hope, is illusory and that he himself has to learn to exercise these powers. It is quite true, assessing the process as a whole, that the analysand is misled and hoodwinked as analysis proceeds. The only safeguard he is given against rebelling and stopping treatment is the absolute certainty and continual proof that this procedure, with all the pressure and frustration it imposes, is necessary for his own good, and that it is an objective method with the sole aim of benefiting him and for no other purpose than his own. In particular, the disinterestedness of the analyst must assure the patient that no subjective factors enter it. In this light, the moral integrity of the analyst, so often stressed, becomes a safeguard for the patient to continue with analysis, it is a technical driving force of analysis and not a moral precept.
A word might be added about the driving force of analysis in the light of this essay. The libido necessary for continual regression and memory work is looked upon by Freud as derived from the relinquished symptoms. He says that the therapeutic task has two phases: “In the first, libido is forced away from the symptoms into the transference and there concentrated: And in the second phase the battle rages round the new object and the libido is again disengaged from the transference object.” As so often in Freud’s statements, this description applies to clinical neurosis, but the psychoanalysis takes the same trends in non-neurotics. The main driving force may be considered derived in every analysis from such libidos as is continually freed by the denial of object-world and by the frustration of libidinal impulses.
If the conception is accepted that analytic transference is actively induced on a ‘transference-ready’ analysand by exposing him to an infantile setting to which he has gradually to adapt by regression, certain conclusions must be encouraged.
Its first state being the initial period, in which the analysand gradually adapts to an infantile setting. Regressive, infantile reactions and attitudes manifest themselves with gathering momentum during what might be described as the induction of the transference neurosis. This stage corresponds to what Glover has called the stage of “floating transferences.” A second stage suggests of itself that when his regression is well established and the analysand represents the infant at various stages of development with such intensity that all his action’s-in and out of analysis-are imbued with reactivated infantile reactions. Consciously or unconsciously. During this period, under constant pressure of analytic frustration, he withdraws progressively too earlier, ‘safer’ infantile patterns of behaviour, and the level of his conflict is inevitably reached. Reaching the level; of his conflict is not, however, the touchstone of the existence of a transference neurosis. Further, the analysands transfer not only onto the analyst, but onto the situation as a whole: He not only transfers effectual causation, although these may be the most conspicuous, but in fact his whole mental development. This conception makes it easier to understand with what alacrity analysands fasten their love and hate drives onto the analyst despite sex and whatever suitability as an object.
The transference neurosis may be defined as the stage in analysis when the analysand has so far adapted to the infantile analytic setting-the main features of which are the denials of object relations and continual libidinal frustration-that his regressive trend is well established, and the various developmental levels, relived, and worked through.
A third, or terminal, stages represent the gradual retracting of the way back into adulthood toward newly won independence, unimprisoned from an archaic superego and weaned from the analytic superego. However great the distance from maturity back into childhood at the commencement of analysis, the duration of the first and second stages of analysis is as long and takes as much time as the return journey back into maturity and independence. Only part of this way back from infantile levels to maturity falls within the time limit of analysis in its third stage: The rest and the full adaption to adulthood are most often competing by the analysand after the cancellation of analysis. In this last post-analytic stage great improvements often occur. In this conception the answer may be found to the often discussed and not fully explained problems of improvements after its Cancellation of analysis. Pointing out that these stages are theoretical is superfluous, as in reality they never occur neatly separated but always overlap.
The initial aim of analysis is to induce regression. Whatever impedes it is a resistance. If instead of such a movement there occurs a standstill (whether in acting out or of direct transference gratification), or if the movement instead of being regressive turns in the direction of apparent maturity (flight into health), one can speak of a resistance. Theoretically, acing out is a formidable variety of resistance because the analysand mistakes the unreality of the analytic relationship for reality and attempts to establish reality relations with the analyst. In this attitude he stultifies the analytic procedure for the time being, as he throws the motor force of analysis-the denial of all object relations in the analytic room and of the gratification of the libido derived from it-out of action. In cases in which early “transference successes” are won and the patient quickly relinquishes his symptoms. The analysis is in danger of terminating at this point. The mechanism of these transference successes is in a way the counterpart of acting out. The patient regresses rapidly to childhood, and forms an unconscious fantasy of a mutual child-parent relationship. He mistook such reality and object relations as exists as a basis in the analytic relationship wholly for an infantile one and unconsciously obeyed (spites or obliges) the parent imago. What happens in these cases is in fact that the analysand has in fantasy formed a mutual hypnotic transference relation with the analyst: Analytic interpretation was not either quick enough to prevent it, or the analysand’s transference readiness was too strong. He could not be made to adapt gradually to the infantile setting. In other words, the analysand faced with the stimulus of infantile situation issuing by way of autosuggestion (or indirect suggestion) to rid himself of a symptom.
Transference has resistance value in as far as it impedes the recovery of memories and so stops the regressive orientation. Per se, it is the only possible vehicle for unconscious content to come to consciousness. Transference should therefore not be indiscriminately equated with resistance as Fernichel did.
The analyst himself is also subjected to the infantile setting of which he is a part. In fact, the infantile setting to which he is exposed contains another important infantile factor, the regressing analysand. The analyst’s ego is also split into an observing and experiencing one. The analyst has had his own thorough analysis and knows what to expect, and furthermore, unlike the analysand, is in an authoritative position. Whereas, it is the analysand’s task to adapt actively to the infantile setting by regression, remaining resistant to such adaptation is necessary for the analyst? While the analysand has to experience the past and observe the present, the analyst has to experience the present and observe the past, he must resist any regressive trend within himself. If he fall victim to his own techniques, and experience the past instead of observing it, he is subject to counter resistance. The phenomenon of counter transference may be best described by paraphrasing Fernichel’s simile: The analyst misunderstands the past about the present.
To respond to the classical analytic technique, analysands must have some object relations intact, and must have at their disposal enough adaptability to meet the infantile analytic setting by further regression. For both hypnosis and psychoanalysis there is a sliding scale from the hysteric to the schizophrenic. Abraham said: “The negativism of dementia praecox is the most thorough antithesis of transference. In contrast to hysteria these patients are only to a very slight degree accessible to hypnosis. In attempting to psychoanalyse them we notice the absence of transference again.” The high degree of suggestibility, i.e., the capacity to form transferences, is extensively known as a leading feature of hysteria. Hysteria, and the whole group belonging to the transference neurosis are distinguished by an impaired and immature adjustment to reality, these reactions are mingled with infantile attitudes and mechanisms. Therefore under pressure from the infantile analytic milieu they respond freely and quickly with increased infantile behaviour to the loss of object world and object relations. The neurotic character responds not much easily and to a lesser extent in a free manner, because its object relations are firmly established (for instance, well-functioning sublimations), and therefore are harder to resolve analytically. The denial of object relations and libidinal gratification in analysis is frequently parried by reinforced sublimations, but before analysis can continue this ‘sublimated object relationship’ must be reversed.
Psychotics are refractory to the classical technique, accordingly, because their object relations are deficient and slender, and nothing therefore remains of which the analytic pressure of the classical technique could deprive these patients, or their object relations are too slight for their denial to make any difference. Freud said, that
” . . . from our clinical observations of these patients we stated that they must have abandoned the investment of objects with the libido, and transformed the object libido into an ego libido.” As the core of the classical technique is the denial of object relations of the patient through his exposure to an infantile milieu, the narcissistic regressive must consequently prove inaccessible to the classical approach. This does not, of course, exclude them from analytic methods that deviate from the classical form. The main change of approach for them must be an adjustment of the technique in the early stages of analytic treatment, this aspect has a bearing also on the problems of transference and particularly on the transference neurosis that are in dispute among child analysts.
If a person with a certain degree of inherent suggestibility is subject to a suggestive stimulus and reacts to it, he can be said to be under the influence of suggestion. To arrive at a definition of analytic transference, introducing an analogous term for suggestibility in hypnosis is necessary first and speaks of a person’s inherent capacity or readiness to form transference. This readiness is precisely the same factor and may be defined in the same way as suggestibility, namely, a capacity to adapt by regression. Whereas, in hypnosis the precipitating factor is the suggestive stimulus, followed by suggestion, in the psychoanalysis the person’s adaptability by regression is met by the outside stimulus (or precipitating factors) of the infantile analytic setting. In psychoanalyses it is not followed by suggestion from the analyst, but by continued pressure to further regression through the exposure to the infantile analytic setting. If the person reacts to it, he will form a transference relationship, i.e., he will regress and form relations to early imagos. Analytic transference may thus be defined as a person’s gradual adaptation by regression to the infantile analytic setting.
Transference cannot be regarded as a spontaneous neurotic reaction. It can be said to be the resultant of two sets of forces: The analysand’s inherent readiness for transference, and the external stimulus of the infantile setting. There are, then, to be distinguished in the mechanism of analytic transference intrinsic and extrinsic factors: The response to the analytic situation will vary in intensity with different types of analysands. The capacity to form a transference neurosis was found inherent-varying only in quality-in all analysands who could be analysed at all, whether they were neurotic if not. To account for this, the term ‘neurotic’ was extended until it lost most of its meaning because the precipitating factor, the infantile setting, was not perceived.
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.
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