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That is not to mean that this is to deny the correctness of Freud’s view of the transference, yet acting as a resistance is a matter of fact, in that the tendency of the patient to reestablish the original reference frame is precisely because he is afraid to experience the other person in a direct and unreserved way. He has organized his whole system of getting along in the world. Bad as that system might be, based on the original distortions of his personality and his subsequent vicissitudes. His capacity for spontaneous feeling and a ting has gone into hiding. Now it has to be sought. If some such phrases as the 'capacity for self-realizations' are substituted in place of Freud’s concept of the repressed libidinal impulse, much the same conclusions can be reached about the way in which the transference-manifestations appear in the analysis as resistance. It is just in the safest situation, where the spontaneous feeling might come out of hiding, that the patient develops intense feelings, sometimes of a hallucination character, that relate to the most dreaded experiences of the past. It is at this point that the nature and the use by the patient of the transference distortions have to be understood and correctly interpreted by the analyst. It is also here that the personality of the analyst modifies the transference reaction. A patient cannot feel close to a detached or hostile analyst and will therefore never display the full intensity of his transference illusions. The complexity of this process, by which the transference can be used as the therapeutic instrument and, while, as a resistance may be illustrated by an example through which a patient having had developed intense feelings of attachment to a father surrogate in his everyday life. The transference feelings toward this man were of great value in explaining his original problem with his real father. As the patient became more aware of his personal validity, he found his masochistic attachment to be weakening. This occasional acute feeling of anxiety, since his sense of independence was not yet fully established. At that point, he developed very disturbing feelings regarding the analyst, believing that she was untrustworthy and hostile, although before this, he has successes in establishing a realistically positive relationship to her. The feelings of untrustworthiness precisely reproduced an ancient pattern with his mother. He experienced them at this point in the analysis to retain and to justify his attachment to the father figure, the weakening of which attachment had threatened him so profoundly. The entire pattern was explained when it was seen that he was re-experiencing an ancient triangle, in which he was continuously driven to a submissive attachment to a dominating father, due to the utter untrustworthiness of his weak mother. If the transference character of his sudden feeling of untrustworthiness of the analyst had not been clarified, he would have turned again submissively to his father surrogate, which would have further postponed his development of independence? Nonetheless, the development of his transference to the analyst brought to light a new insight.
To the fundamental direction upon which Freud’s view of the so-called narcissistic neurosis, was that Freud felt that personality disorders called schizophrenia or paranoia cannot ne analysed because the patient is unable to develop a transference to the analyst. Yet nonetheless, it is viewed as that of a real difficulty in treating such disorders that the relationship is essentially nothing but transference illusions of reality. Nowhere in the realm of psychoanalysis can one find complete proof of the effect of early mention experience on the person that in attempting to treat these patients. Frieda Fromm-Reichmann has shown in her work with schizophrenics the necessity to realize the intensity of the transference reaction, which have become almost completely real to the patient. Yet, if one knows the correct interpretations, by actually feeling the patient’s needs, one can over years of time do the identical thing accomplished more quickly than is less dramatical with patients suffering some less severe disturbances within their own interpersonal relationships.
Just for this, yet a peculiar moment is to say of what reasons was that Freud took of his position that all subsequent experiences in normal life are merely a repetition of the original one. This love is experienced for someone today about the love felt for someone in the past that it is, nonetheless, to believe this to be exactly true. The child who had to repress certain aspects of his personality enters a new situation dynamically, not just as a repetition of it. Therefore there are constitutional differences with respect to the total capacity for emotional experience, just as they are with respect to the total capacity for intellectual experiences. Given this constitutional substrate, the child engages in personal relationships, not passively as a lump of clay waiting to be moulded, but most dynamically, bringing into play all his emotional potentialities. He might find someone later whose capacity for response is deeper than his mother’s. If he is capable of that greater depth, he experiences an expansion of himself. Many later in life met a “great” person and have felt a sense of newness in the relationship with certain described to others as “wonderful” which is regarded with a certain amount of awe. This is not a “transference” experience but represents a dynamic extension of the self to a new horizon.
Ours is to discuss hypnosis a little further in detail and to make by some attributive affordance as drawn upon a few remarks about its correlation with the transference phenomenon in psychoanalytic therapy.
According to White, the subject under hypnosis is a person striving to act like a hypnotized person as that state is continuously defined by the hypnotist. He also says that the state of being hypnotized is an “altered state of consciousness.” However, as Maslow points out, it is not an abnormal state. In everyday life transient manifestations of all the phenomena that occur in hypnosis can be seen. Such examples are cited as the trance-like state a person experiences when completely occupied with an absorbing book. Among the phenomena of the hypnotic state is the amnesia for the enchantment of a trance. The development of certain anaesthetics, such as insensitivity to pain, deafness to sounds other than the hypnotist’s voice, greater ability to recall forgotten events, loss of capacity to initiate activities spontaneously, and has the greater suggestibility. This heightened suggestibility in the trance state is the most important phenomenon of hypnosis. Changes in behaviour and feeling can be induced, such as painful or pleasant experiences, headaches, nausea, or feelings of well-being. Post-hypnotic behaviour can be influenced by suggestion, this being one of the most important aspects of experimental hypnosis for the clarifying of psychopathological problems.
The hypnotic state is induced by a combination of methods that may include relaxation, visual concentration and verbal suggestion. The methods vary with the personality of the experimenter and the subject.
Maslow has pointed the interpersonal character of hypnosis, which accounts for some different conclusions by different experimenters. Roughly, the types of experimenters may be divided into three groups - the dominant type, the friendly or brotherly type, and the cold, detached, scientific type. According to the inner needs of the subject, he can probably be hypnotized more readily by one type or the other. The brotherly hypnotizer cannot, for instance, hypnotize a subject whose inner need is to be dominated.
Freud believed that the relationship of the psychological subject to the hypnotist was that of an emotional, erotic attachment. He comments on the “uncanny” character of hypnosis and says that, “the hypnotist awakens in the subject part of his archaic inheritance that had also made him compliant to his parents.” What is thus awakened is the concept of “the dreaded primal father,” “toward whom, only a passive-masochistic attitude is possible. Toward whom one’s will has to be surrendered.”
Ferenczi considered the hypnotic state to be one in which the patient transferred onto the hypnotist his early infantile erotic attachment to the parents with the same tendency to blind belief and to uncritical obedience as obtained then. He calls attention to the paternal or frightening type of hypnosis and the maternal or gentle, stroking type. In both instances the situation tends to favour the “conscious and unconscious imaginary return to childhood.”
The only point of disagreement with these views is that one does not need to postulate an erotic attachment to the hypnotist or 'transference' of infantile sexual wishes. The sole necessity is a willingness to surrender oneself. The child whose parent wished to control it, by one way or another, is forced to do this. To be loved, or to at least be taken consideration of it. The patient transfers this willingness to surrender to the hypnotist. He will also transfer it to the analyst or the leader of a group. In any one of these situations the authoritative person, is the hypnotist, analyst or leader, promises because of great power or knowledge the assurance of safety, a cure or happiness, as the case may be. The patient, or the isolated person, regresses emotionally to a state of helplessness and lack of initiative similar to the child who has been dominated.
If it is asked how in the first place, the child is brought into a state of submissiveness, it may be discovered that the original situation of the child had certain aspects that already resemble a hypnotic situation. This depends upon the parents. If they are destructive or authoritarian they can achieve long-lasting results. The child is continuously subjected to being told how and what he is. Day in and day out, in the limited frame of reference of his home, he is subjected to the repetition, often again: “You are a naughty boy.” “You are a bad girl.” “You are just a nuisance and are always giving me trouble. “You are dumb,” “you are stupid,” “you are a little fool.” “You always make mistakes.” “You can never do anything right,” or “that’s right, I love you when you are a good boy.” “That’s the kind of boy I like.” “Mother lovers a good boy who does what she tells him.” “Mother knows best. Mother always knows best.” “If you would listen to mother, you would get along all right. Just listen to her.” “Don’t pay attention to those naughty children. Just listen to your mother.”
Over and again, with exhortations to say attention, to listen, to be good, the child is brought under the spell. “When you get older, never forget what I told you. Always remember what mother says, then you will never get into trouble.” These are like Post-hypnotic suggestions. “You will never come to a good end. You will always be in trouble.” “If you are not good, you will always be unhappy.” “If you don’t do what I say, you will regret it.” “If you do not live up to the right things - again, “right” as continuously defined by the mother - you will be sorry.”
Hypnotic experiments, according to Hull, for many reasons, including that of learning the uses and misuses of language, there is a marked rise of verbal suggestibility up to five years, with a sharp dropping off at around the eighth year. Ferenczi refers to the subsequent effects of threats or orders given in childhood as “having much in common with the Post-hypnotic command-automatisms.” Pointing out how the neurotic patient follows out, without being able to explain the motive, a command repressed long ago, just as in hypnosis a Post-hypnotic suggestion is carried out for which amnesia has been produced.
Unfortunately, having had no personal experience with hypnosis, I refer only to hypnosis in discussing the transference is to further a better understanding of the analytic relationship. The child may be regarded for being in a state of “chronic hypnosis,” as described, but with all sorts of Post-hypnotic suggestions thrown in during this period. This entire pattern - this entire early frame of reference - may be “transferred” to the analyst. When this has happened, the patient is in a highly suggestible stye. Due to many intrinsic and extrinsic factors, the analyst is now in the position of a sort of “chronic hypnotist.” First, due to his position of a doctor he has a certain prestige. Second, the patient comes to him, even if expressedly unwillingly, still if there were not something in the patient that was co-operative he would not come at all, or at least he would not stay. The office is relatively quietly, external stimuli relatively reduced. The frame of reference is limited. Many analysts maintain an anonymity about themselves. The attention is focussed on the interpersonal relationship. In this relatively undefined and unstructured field the patient can discover his “transference” feelings, since he has few reference points in the analytical situation by which to go. This is greatly enhanced by having the patient assume a physical position in the room under which he does not see the analyst. Thus, the ordinary reference points of facial expression and gestures are lacking. True enough, he can look around or get up and walk about. Nevertheless, for considerable periods he lies down - itself a symbolically submissive position. He does what is called “free association.” This is again, giving up - willingly, to be sure - the conscious control of his thoughts, that is, the willingness and cooperativeness of all these acts. That is precisely the necessary condition for hypnosis. The lack of immediate reference points permits the eruption into consciousness of the old patterns of feeling. The original frame of reference becomes more clearly outlined and felt. The power that the parent originally has to cast the spell is transferred to the analytical situation. Now it is the analyst who can do the same thing - placed there partly by the nature of the external situation, partly by the patient who comes to be freed from his suffering.
There is no such thing as an important analyst, nor is the idea of the analyst’s acting as a mirror anything more than the “neatest trick of the week.” Whether intentionally or not, whether conscious of it or not, the analyst does express, day in and day out, subtle or overt evidences of his own personality in relationship to the patient.
The analyst may express explicitly his wish not to be coercive, but if he has an unconscious wish to control the patient, analysing and to resolve the transference distortions is impossible for him correctly. The patient is thus not able to become free from his original difficulties and for lack of something better adopts the analyst as a new and less dangerous authority. Then the situation occurs in which it is not “my mother says” or “my father says,” but now “my analyst says.” The so-called chronic patients who need lifelong support and may benefit by such a relationship, however, that frequently the long-continued unconscious attachment - by which is not meant of any genuine affection or regard - is maintained because of a failure on the analyst’s part to recognize and resolve the sense of being uttered of a sort of hypnotic spell that originated in childhood.
To develop an adequate therapeutic interpersonal relationship, the analyst must be without those personal traits that tend to perpetuate the originally destructive or authoritative situation unconsciously. Besides this, he must be able, because of his training, to be aware of every evidence of the transference phenomena, and lastly, he must understand the significance of the hypnotic-like situation that analysis helps to reproduce. If, with the best of intentions, he unwittingly uses the enormous power with which he is endowed by the patient, he may certainly achieve something that looks like change. His suggestions, exhortations and pronouncements based on the patient’s revelation of himself, may be certainly makers an impression. The analyst may say, “You must not do this just because I say so.” That is a sort of Post-hypnotic command. The patient then strives to be “an analysed person acting on his own account” - because he was told to do so. He is still not really acting on his own.
It is to my firm conviction that the analysis is terminable. A person can continue to grow and expand all his life. The process of analysis, however, as an interpersonal experience, has a definite end. That an end is achieved when the patient has rediscovered his own self as an activity and independently functioning entity.
Transference problems concerning to most psychoanalytic authors maintain that schizophrenic patient cannot be treated psychoanalytically because they are too narcissistic to develop with the psychotherapist an interpersonal relationship that is sufficiently reliable and consistent for psychoanalytic work. Freud, Fenichel and other authors have recognized that a new technique of approaching patients psychoanalytically must be found if analysts are to work with psychotics. Among those who have worked successfully in recent years with schizophrenics, Sullivan, Hill, and Karl Menninger and his staff has made various modifications of their analytic approach.
We think of a schizophrenic as a person who has had serious traumatic experience in early infancy at a time when his ego and its ability to examine reality were not yet developed. These early traumatic experiences seem to furnish the psychological basis for the pathogenic influence of the frustrations of later years. Earlier the infant lives grandiosely in a narcissistic world of his own. His needs and desires may be taken care of by something vague and indefinite which he does not yet differentiate. As Ferenczi noted they are expressed by gestures and movements since speech is yet undeveloped. Frequently the child’s desires are fulfilled without any expression of them, a result that seems to him a product of his magical thinking.
Traumatic experiences in this early period of life will damage a personality more seriously than those occurring in later childhood such as are found in the history of psychoneurotic. The infant’s mind is more vulnerable the younger and less used it ha been, furthered, the trauma is a blow to the infant’s egocentricity. In addition early traumatic experience shortens the only period in life in which an individual ordinarily enjoys the moist security, thus endangering the ability to store up as it was a reasonable supply of assurance and self-reliance for the individual’s late struggle through life. Thus is such a child sensitized considerably more toward the frustrations of later life than by later traumatic experience. So many experiences in later life that would mean little to a ‘healthy’ person and not much to a psychoneurotic, mean a great deal of pain and suffering to the schizophrenic. His resistance against frustration is easily exhausted.
Once he reaches his limit of endurance, he escapes the unbearable reality of present life by attempting to reestablish the autistic, delusional world of the infant, but this is impossible because the content of his delusions and hallucinations are naturally coloured by the experiences of his whole lifetime.
How do these developments influence the patient’s attitude toward the analyst? The analyst’s approach to him?
Due to the very early damage and the succeeding chain of frustrations that the schizophrenic undergoes before finally giving in to illness, he feels extremely suspicious and distrustful of everyone, particularly of the psychotherapist who approaches him with the intention of intruding into his isolated world and personal life. To him the physician’s approach means the threat of being compelled to return to the frustrations of real life and to reveal his inadequacy to meet them, or - still worse - a repetition of the aggressive interference with his initial symptoms and peculiarities that he has encountered in his previous environment.
In spite of his narcissistic retreat, every schizophrenic has some dim notion of the unreality and loneliness of his substitute delusionary world. He longs for human contact and understanding, yet is afraid to admit it to himself or to his therapist for fear of further frustration.
That is why the patient may take weeks and months to test the therapist before being willing to accept him.
However, once he has accepted him, his dependence on the therapist is greater and he is more sensitive about it than is the psychoneurotic because of the schizophrenic’s deeply rooted insecurity; the narcissistic seemingly self-righteous attitude is but a defence.
Whenever the analyst fails the patient from reasons to be of mention - one severe disappointment and a repetition of the chain of frustrations the schizophrenic has previously endured.
To the primitive part of the schizophrenic’s mind that does not discriminate between himself and the environment, it may mean the withdrawal of the impersonal supporting forces of his infancy. Severe anxiety will follow this vital deprivation.
In the light of his personal relationship with the analyst it means that the therapist seduced the patient to use him as a bridge over which he might be led from the utter loneliness of his own world to reality and human warmth, only to have him discover that this bridge is not reliable. If so, he will respond helplessly with an outburst of hostility or with renewed withdrawal as may be seen most impressively in a catatonic stupor.
Through reasons of change, this withdrawal during treatment is a way the schizophrenic has of showing resistance and is dynamically comparable to the various devices the psychoneurotic uses to show resistance. The schizophrenic responds to alterations in the analyst’s defections and understanding by corresponding stormy and dramatic changes from love to hatred, from willingness to leave his delusional world to resistance and renewed withdrawal.
As understandable as these changes are, they nevertheless may come quite as a surprise to the analyst who frequently has not observed their source. This is quite in contrast to his experience with psychoneurotic whose emotional reactions during an interview he usually predicts. These unpredictable changes seem to be the reason for the conception of the unreliability of the schizophrenic’s transference reactions, yet they follow the same dynamic rules as the psychoneurotic’s oscillations between positive and negative transference and resistance. If the schizophrenic’s reactions are more stormy and seemingly more unpredictable than those of the psychoneurotic, perhaps this may be due to the inevitable errors in the analyst’s approach to the schizophrenic, of which he himself may be aware, than to him unreliability of the patient’s emotional response.
Why is it inevitable that the psychoanalyst disappoints his schizophrenic patients time and again?
The schizophrenic withdraws from painful reality and retires to what resembles the early speechless phase of development where consciousness is yet crystallized. As the expression of his feelings is not hindered by the conventions, he has eliminated, so his thinking, feeling, behaviour and speech - when present - obey the working rules of the archaic unconscious. His thinking is magical and does not follow logical rules. It does not admit any, and likewise no yes: There is no recognition of space and time, as ‘I’, ‘you’ and ‘they’ are interchangeable. Expression is by symbols, often by movements and gestures rather than by words.
As the schizophrenic is suspicious, he will distrust the words of his analyst. He will interpret them and incidental gestures and attitudes of the analyst according to his own delusional experience? The analyst may not even be aware of these involuntary manifestations of his attitudes, yet they proficiently mean much of the hypersensitive schizophrenic who uses them to orient himself to the therapist’s personality and intentions toward him.
In other words, the schizophrenic patient and the therapists are people living in different worlds and on different levels of personal development with different means of expressing and of orienting themselves. We know little about the language of the unconscious of the schizophrenic, and our access to it is blocked by the very process of our own adjustment to a world the schizophrenic has relinquished. So we should not be surprised that errors and misunderstandings occur when we undertake to communicate and strive for a rapport with him.
Another source of the schizophrenic’s disappointment arises from the following: Since the analyst accepts and does not interfere with the behaviour of the schizophrenics, his attitude may lead the patient to expect that the analyst will assist in carrying out all the patients’ wishes, though they might not be his interest, or to the analyst’s and the hospital’s in their relationship to society. This attitude of acceptance so different from the patient’s experiences readily fosters the anticipation that the analyst will try to carry out the patient’s suggestions and take his part, even against conventional society should give occasion to arise. Frequently, agreeing with the patient's wish to remain unbathed and untidy will be wise for the analyst until he is ready to talk about the reasons for his behaviour or to change spontaneously. At other times, he will unfortunately be unable to take the patient’s part without being able to make the patient understands and accept the reasons for the analyst’s position.
If, however, the analyst is not able to accept the possibility of misunderstanding the reactions of his schizophrenic patient and in turn of being misunderstood by him, it may shake his security with his patient. The schizophrenic, once accepted the analyst and wants to rely upon him, will sense the analyst’s insecurity. Being helpless and insecure himself - in spite of his pretended grandiose isolation - he will feel utterly defeated by the insecurity of his would-be helper. Such disappointment may furnish reasons for outbursts of hatred and rage that are comparable to the negative transference reactions of psychoneurotic, yet more intense than these since they are not limited by the restrictions of the actual world.
These outbursts are accompanied by anxiety, feelings of guilt, and fear of retaliation that in turn lead to increased hostility. Thus, is established a vicious circle: We disappoint the patient: He hates us, is afraid we hate him for his hatred and therefore continues to hate us. If in addition he senses that the analyst is afraid of his aggressiveness, it confirms his fear that he is actually considered dangerous and unacceptable, and this augments his hatred.
This establishes that the schizophrenic can develop strong relationships of love and hatred toward his analyst. After all, one could not be so hostile if it were not for the background of a very close relationship, once to emerge from an acutely disturbed and combative episode. In addition, the schizophrenic develops transference reaction in the narrower sense that he can differentiate from the actual interpersonal relationship.
What is the analyst’s further function in therapeutic interviews with the schizophrenic? As Sullivan has stated, he should observe and evaluate all of the patient’s words, gestures, changes of attitude and countenance, ad he does the associations of psychoneurotics. Every production - whether understood by the analyst or not - is important and makes sense to the patient. Therefore the analyst should try to understand, and let the patient feel that he tries. He should as a rule not attempt to prove his understanding by giving interpretations because the schizophrenic himself understands the unconscious meaning of his productions better than anyone else. Nor should the analyst ask questions when he does not understand, for he cannot know what trend of thought, far off dream or hallucination he may be interpreting. He gives evidence of understanding, whenever he does, by responding cautiously with gestures or actions appropriate to the patient’s communication, for example, by lighting his cigarette from the patient’s cigarette instead of using a match when the patient seems to show a wish for closeness and friendship.
What has been said against intruding into the schizophrenic’s inner world with superfluous interpretations also holds true for untimely suggestions? Most of them do not mean the same thing to the schizophrenic that they do to the analyst. The schizophrenic who feels comfortable with his analyst will ask for suggestions when he is ready to receive them. While he does not, the analyst does better to listen. Least of, the schizophrenic’s emotional reactions toward the analyst have to be met with extreme care and caution. The love that the sensitive schizophrenic feels as he first emerged, and his cautious acceptances of the analyst’s warmth of interest are really most delicate and tender things. If the analyst deals unadroitly with the transference reactions of a psychoneurotic, it is bad enough, though as a rule reparable, but if he fails with a schizophrenic in meeting positive feelings by pointing it out for instance before the patient suggests that he be ready to discuss it, he may easily freeze to death what had just begun to grow and so destroy any further possibility of therapy.
Sometimes the therapist’s frank statement that he wants to be the patient’s friend but that he is going to protect himself should he be assaulted may help in coping with the patient’s combativeness and relieve the patient’s fear of his own aggression. As, too, some analysts may feel that the atmosphere of complete acceptance and strict avoidance of any arbitrary denials that we recommend as a basic rule for the treatment of schizophrenics may not accord with our wish to guide them toward reacceptance of reality. This may not be as apparently so. Certain groups of psychoneurotics have to learn by the immediate experience of analytic treatment how to accept the denials life has in store for each of us. The schizophrenic has above all to be cured of the wounds and frustrations of his life before we can expect him to recover.
Other analysts may feel that treatment as we have outlined it is not psychoanalysis. The patient is not instructed to lie on a couch, he is not asked to give free associations (although frequently he does), and his productions are seldom interpreted other than by understanding acceptance. Freud says that every science and therapy that accept his teachings about the unconscious, about transference and resistance and about infantile sexuality, may be called psychoanalysis. According to this definition we believe we are practising psychoanalysis with our schizophrenic patients.’
Whether we call it analysis or not, successful treatment clearly does not depend on technical rules of any special psychiatric school but on the basic attitude of the individual therapist toward psychotic persons. If he meets them as strange creatures of another world whose productions are non-understandable to ‘normal’ beings, he cannot treat them. If he realizes, however, that the difference between himself and the psychotic is only one of degree and not to kind, he will know better how to meet him. He can probably identify himself sufficiently with the patient to understand and accept his emotional reactions without becoming involved in them.
Countertransference was once considered a hindrance to analytic work. Now, though controversies still exist about, what constitutes its optimal use, and though there are real dangers of misuse, countertransference is recognized by most of analysts not only as integral to the analytic relationship, whether or not it is in awareness, but as a potentially powerful and often crucial analytic tool. In some instances’ sensitivity to Countertransference nay be the only basis for tuning into the patient to be able to achieve an analytic possibility.
It seems, but not fully understood to why the belief that the problem of countertransference resistance itself not only precludes using countertransference data in facilitating ways in the analysis, but also increases the likelihood that countertransference will affect the work in less than optimal ways. It can constitute one of the gravest threats to analytic work.
Countertransference resistance often arises when awareness of countertransference requires us to face aspects of ourselves and our feelings that may be threatening. In this regard it is interesting that positive emotions can be as threatening as negative ones. Every bit as justly evident as in as early as of 1895 in Breuer’s treatment of patient Anna O.
Countertransference resistance includes, of course, resistance to awareness of collusive involvements. It can involve identification and reaction formation, or defences such as a detachment, resistance to awareness of one’s own affective reactions, or resistance to awareness of particular nuances of the transference-countertransference interaction. Occasionally, however, countertransference resistance may involve resistance not simply to awareness of one’s own reactions, but also to allowing any kind of emotional engagement with the patient. It might be that in such instances thinking of this kind of analyst is more accurate “detachments” as a form of countertransference itself.
Alternatively, Countertransference resistance may reflect the analyst’s basic assumptions about the analytic task - the principle of neutrality is understood as requiring no, or minimal, emotional responsiveness by the analyst, for others neutrality is defined in term s of how the analyst uses his or her reactions, the assumption being that these are inevitable. From the former perspective an analyst’s emotional response can be viewed as evidence of a failure to maintain the proper analytic stance. As for the latter, the taboo on affective experience is seen as preventing the analyst from using himself as a sensitive analytic instrument, and as precluding the kind of affective engagement that may be essential. The latter view draws upon Heimann’s (1950) observation that: The emotions roused in [the analyst] are much nearer to the central issue than his reasoning, or to put it in other words, his unconscious perception of the patient’s unconscious is more acute and before his conscious conception of the situation . . . the analyst’s emotional response to his patient within the analytic situation represents one of the most important tools for his work.
It seems that the analyst’s ability to respect and use his or her awareness of whatever is begun internally while the work becomes a source of power and strength. From this perspective, even when we know our own issues are involved, we still can gain important information if we consider why with this patient and not others, and why now with this patient and not this patient at other times.
A common example of this kind of countertransference resistance involves those moments when the analyst may be overcome with sleepiness and him or she never relates it to being with the patient. Sometimes we become alert to this the session following when we find to our great surprise that we are suddenly wide awake. Only then does the sleepy response in the prior session was apparently very specific to the earlier interaction. This, of course, allows us to see this awareness as a basis for structuring an analytic exploration.
We learn from these experiences that even when it may seem to us that our reactions are independent of the immediate context, which we are tired or distracted because of our own preoccupations, or that we are at the mercy of our own pathology, it is usually prudent to consider how our experience may be responsible to the interactive subtleties of the immediate moment.
Failure to consider that our feeling tired or distracted might be to some subtle development in the interaction may actually reflect a wish to avoid dealing with the anxieties of the moment or possible anxiety about being vulnerable to the patient’s impact. If this is the case then the real issue in such instances may actually be the countertransference resistance. In such instances tracking the interactive subtitles as they evolve between analyst and patient requires a collaborative engagement as it touches on aspects of the interaction that neither patient nor analyst could illuminate on his or her own - because patients tune into the analyst and the analyst into them, how the analyst deals with his own Countertransference obviously reveals a great deal about the analyst’s relation to his own experience and about his trustworthiness and authenticity, which also has impact. As early as 1915, Freud wrote: “ . . . Since we demand strict trustfulness from our patients, we jeopardize our whole authority if we let ourselves be caught out by them in a departure from the truth.” (1915)
In this regard, Ferenczi (1933) emphasized that patients: “show a remarkable, almost clairvoyant knowledge about the thoughts and emotions that go on in their analyst’s mind. To deceive a patient it seems hardly possible and if one tries to do so, it leads only to bad consequences.”
Lacan’s (1958) view is that “the inability to sustain a praxis in an authentic manner result as often happens with humans, in the exercise of power”:
Little (1951) approached the same issue from yet another angle, she wrote”: It is [the] question of a paranoid or phobic attitude toward the analyst’s own feelings that lay the groundwork for the greater danger and difficulty in countertransference. The very real; fear of being flooded with feelings of any kind, rage, anxiety, love, etc., in relation to the patient and of being passive to it and at its mercy leads to an unconscious avoidance or denial, honest recognition of such feeling is. Essential to the analytic process, and the analysand is naturally sensitive to any insincerity in his analyst and will inevitably respond to it with hostility. He will, identify with the analyst in it (by introjection ) for denying his own feelings and will exploit it generally in every way possible, to the detriment of his analyst.
The recognition that the patient tunes into what the analyst feels, whether the analyst is open about this or not, and therefore is sensitive to any kind of inauthenticity, and has been emphasized by analysts as diverse as Rank, 1929; Fromm, 1941; Rioch, 1943; Winnicott, 1949; Fromm-Reichmann, 1950, 1952; Gitelson, 1952, 1962; Fairbairn, 1958; Tauber, 1954, 1979; Nacht, 1957, 1962; Wolstein, 1959; Loewald, 1960; Searles, 1965, 1979; Guntrip, 1969; Feiner, 1970; Singer, 1971, 1977; Levenson, 1972, 1983; Ehrenberg, 1974, 1982, 1984, 1985a, 1990. From such a perspective the position of Alexander (1956), as well as of some contemporary analysts, that there is benefit in assuming a deliberately predetermined attitude toward the patient would be considered untenable and to undermine the treatment process. It would preclude an opportunity to use the immediate experience as analytic data, and as a means to clarify very subtle interactive patterns that would otherwise elude awareness.
Nevertheless, the issue is not simply as one for being 'authentic', there are ways of being authentic that can burden the patients unnecessarily and that can derail rather than advance the analytic process.
If we accept the idea that denial or resistances to awareness of countertransference reactions can be detrimental to the process, and that awareness presents us with options we do not otherwise have, we are still faced with the question of how best to users this awareness. Use of countertransference data in any direct way with the patient is clearly a delicate matter, unless handled judiciously, it can be counterproductive, even traumatizing. Any use of countertransference requires sensitivity, tact, and skill. This applies to active use and to decisions to remain silent, since there are times when silence can be as destructive, insensitive, or inappropriate as verbal intervention (Tauber, 1954, 1979).
It is critical, therefore, that we recognize that believing in the theoretical value - even necessarily - of using countertransference is different from having the ability to do so constructively. In this vein, knowing one’s own limits can be the better part of wisdom. Nonetheless, the alternative of suppressing our feelings out of fear of mishandling a situation or of being seduced out of an analytic role may prevent analytic engagement. This kind of countertransference resistance may be a countertransference enactment reflecting our fears. Often countertransference resistance reflects the analyst’s sensitivity to the dangers of misuse of countertransference with a particular patient. What is required is learning how to refine our ability to use this resistance itself as valuable data.
An example of how our theoretical assumptions influence our relation to our own countertransference experience involves identification. The analyst who believes identification contributes to an ability to be empathic may not see identification as a possible countertransference issue, since it might be viewed as in keeping with an alleged desirable analytic attitude. Nonetheless, just as identification of the patient can be defensive, the same may be true of the analyst. Identification by either may be an expression of unconscious fantasies of fusion, merger, or wishes for sexual union. It may reflect desires to control, dominate, appropriate for oneself, devour, cannibalize, destroy, rape, violate, or desires to protect oneself of others from these dangers (Widlocher, 1985). Identification can be a means to flatter, idealize, seduce, or impress, as it can be a way to avoid the analysis or experiences or fantasies of love, tenderness, hate, anger or any other emotion that night be aroused. In some instances’ identification may actually serve to avoid a real engagement, or to avoid provoking the anger of the other, or to avoid awareness of other aspects of reactions of oneself or of others that might be different, even traumatic, to acknowledge. It can also serve to avoid exposing the full extent and depth of the patient’s actual pathology. What becomes apparent is that we can fail its patient though our 'empathic' identification, the very response often equated with the caring analyst (Levenson, 1972, Beres and Arlow, 1974).
Still, and all, being alert to the possibility that any effort to attend to one set of transference-countertransference issues is important, however valid, can be an extremely subtle form of countertransference resistance regarding other issues, and a form of enactment of other aspects of countertransference. Similarly, any decision about how countertransference is to be used can be motivated by genuine analytic concerns or by countertransference impulses, such as impulses to retaliate, gratify, withhold, impress, protect or to avoid other issues.
Yet, there are aspects of our reaction that can be quite elusive, such as feelings of great satisfaction or of defensiveness, or intruding thoughts or fantasies, or experiences of destructibility or inattentiveness. In such instances it is not only the countertransference that is at issue, but also the countertransference resistance itself.
In those instances in which the patient evokes the very reactions that are being attributed to the analyst, countertransference resistance precludes the possibility of clarifying these interactive subtleties and their symbolic meaning, and does relate in this way on the part of the patient reveal wishes to control and dominate the other? Is there an erotic aspect to this kind of interaction? Is it a kind of symbolic rape and violation? What fears might the patient is defending against by relating in this way? To what extent might it be in the service of an effort on the patient’s part to cure himself or herself, or even the analyst?
Since countertransference resistance precludes understanding, we must gradually turn our attention to ways of becoming aware of it whatever its form. One way is to increase our sensitivity to shifts in our own sense of identity as we work (Grinberg, 1962, 1979 and Searle, 1965, 1979). Another is to attend to the patient’s experience and interpretations of the countertransference (Little, 1951, 1957, Langs, 1976 and Hoffman, 1983). In that if we were to consider that the development of the transference is always to some extent shaped by the participation of the analyst, then it follows that the transference itself can also be a clue to aspects of our own countertransference of which we ourselves might be unaware.
One could ask, would awareness of these possibilities to accelerate the analytic work, or to what extent is it possibilities that a mutual effort to address all the complexities of what was to go on between patient and analyst have happened if any proceeding difficulties were to be involved as could prove critical to the work. So, is my belief that reason-sensitivities to the dangers of countertransference resistance can help in the use of countertransference to greater analytic advance.
Despite increasing agreement about the importance of countertransference as a vital source of analytic data, there is much controversy about whether countertransference should be used in direct ways with the patient, and if so what constitutes optimal use. There are no questions that there are real dangers of misuse, Heimann’s (1950) warning against the analyst’s undisciplined discharge of feelings to avoid the evident dangers of acting out, wild analysis, manipulation, and the intrusive imposition of the analyst’s residual pathology are as valid now as it was then. She emphasized that the analyst must be able to “sustain the feelings stirred in him, as opposed to discharging them (as does the patient) to subordinate them to the analytic task.” Now, we also know that remaining silent about our experience can be as much a countertransference enactment as any other kind of analytic response. There is no way to avoid countertransference, and attempting to deny its power can be dangerous. The question at this point is not whether to use countertransference but how.
In considering how best to use countertransference, distinguishing it between the reactive dimension of countertransference is useful, which relates to what we find ourselves feeling in response to the patient that is often a surprise rather than a choice, and the kind of active response that takes into account this reactive response as data to be used toward informing a considered and deliberate clinical intervention. Silence, or any other reaction, can fall into either category.
The point is that active use of countertransference requires a thoughtful decision process about how to use awareness of one’s “reactive” countertransference response to inform that will then become a considered response.
Sometimes the analyst might actively decide to express the countertransference impulse in some direct way. In other instances an active decision may be made to remain silent. At times acknowledgement and discussion of a countertransference impulse, or of one’s own difficulties managing or understanding one’s reaction, or of the thought process involved in one’s deliberations about how to use countertransference data, are potentially constructive options.
The point here, is that the amount of overt activity that takes place is not indicative of whether the analyst is actively or passively responding to his or her impulse. In fact, the same overt response can reflect either kind of internal process.
That is, not to imply that every response must be a considered one. There are times when our inability to stay on top of our reactions - even our losing it with a patient - may be useful. As Winnicott (1949, 1969) notes. The unflappable analyst may be useless when knowing that he can make an impact is essential for the patient. He cautions that there are times when an implacable analyst may actually provoke destructive forms of acting out, including suicide.
Nor is it to imply that the analyst must “understand” his countertransference reactions to use them constructively. In some instances’ willingness to let the patient know what the analyst is experiencing, even if the analyst may not at the time understand his own reaction, can facilitate the analytic work, simply because of the kind of collaborative possibilities it structures. Even when the analyst feels at a loss, and when caution is appropriate, acknowledging that one feels at a loss can be an active use of countertransference. It emphasizes the necessity for a collaborative relationship and establishes a level of honesty and openness that can be significant in and of it. It also leaves the door open for a creative gesture from the patient and allows the patient to help clarify what the issues may be when the analyst may not have a clue. In some instances this is the only way to reach certain dimensions of experience and to realize the unique possibilities of the analytic moment.
This kind of process provides an opportunity to realize that expressing it is possible and experience feelings one may not understand and to get “close” without fear of losing control. As it adds a new dimension to the analytic interaction, it can lead to new levels of intimacy and to unexpected kinds of interactive developments. In addition, it establishes that understanding the significance of the experience of each may at times require the collaboration of the other.
The question here, is how to decide at any given moment what use of countertransference will best advance the work. At times the question also may be how to remain analytically effective and alive when we are in the grip of the kind of countertransference that seems to threaten our ability to do so, such as when the patient may have deadening impact on us, or when we may find ourselves involved in enactments without understanding how or why.
The analyst’s ability to use countertransference constructively, particularly in the face of more severe kinds of pathology, is often the factor that determines whether an analysis will have a chance of succeeding.
Using countertransference is in many ways as having inevitable structures as more than a personal kind of engagement than might occur otherwise. The impact of this cannot be overlooked. The patient is confronted with the analyst as a human being, with sensitivities, vulnerabilities and limitations. This allows the patient to recognize the necessity for his own active collaboration. The unique kind of intimacy that is so structured has effects beyond the content of what is exchanged, as these effects must be explored in what becomes an endless progression that continues to open on itself, often in very exciting and lively ways.
The emphasis is on process and experience, not on contentual representation, as instead of feeling limited by our subjectivity and trying to defend against it we begin to use it as a powerful source of data and as a basis for opening a unique analytic exploration that can lead to places neither patient nor analyst could have predicted beforehand which neither could possibly have reached alone.
Freud described transference as both the greatest danger and the best tool for analytic work. He refers to the work of making the repressed past conscious. Besides, these two implied meanings of transference, Freud gives it a third meaning: It is in the transference that the analysand may relive the past under better conditions and in this way rectify pathological decisions and destinies. Likewise three meanings of countertransference may be differentiated. It too may be the greatest danger and precisely when an important tool for understanding, an assistance to the analyst in his functions as interpreter. Moreover, it affects the analyst’s behaviour, it interferes with his action as object of the patient’s re-experience in that new fragment of life that is the analytic situation, in which the patient should meet with greater understanding and objectivity than he found in the reality or fantasy of his childhood. What have present-day writers to say about the problem of countertransference? Lorand writes mainly about the dangers of countertransference for analytic work. He also points out the importance of allowing for countertransference reactions, for they may indicate some important subject to be worked through with the patient. He emphasizes the necessity to the analyst’s being always aware of his countertransference, and discusses specific problems such as the conscious desire to heal, the relief analysis may afford the analyst from his own problems, and narcissism and the interference of personal motives in clinical purposes. He also emphasizes that fact that these problems of countertransference concern not only the candidate but also the experienced analyst.
Winnicott is specifically concerned with “objective and justified hatred” in countertransference, particularly in the treatment of psychotics. He considers how the analyst should manage this emotion: Should he, for example, bear his hatred in silence or communicate it to the analysand? Thus, Winnicott is concerned with a particular countertransference reaction insofar as it affects the behaviour of the analyst, who is the analysand’s object in his re-experience of childhood.
Little discusses countertransference as a disturbance to understanding and interpretation and as it influences the analyst’s behaviour with decisive effect upon the patient’s re-experience of his childhood. She stresses the analyst’s tendency to repeat the behaviour of the patient’s parents and to satisfy certain needs of his own, not those of the analysand. Once, again, Little emphasizes that one must admit one’s countertransference to the analysand and interpret it, and must do so not only in regarding to “objective” countertransference reaction (Winnicott) but also to “subjective” ones.
Annie Reich is chiefly interested in countertransference as a source of disturbances in analysis. She clarifies the concept of countertransference and differentiates ‘two types’ of “countertransference in the proper sense” and “the analyst’s using the analysis for acting-out purposes.” She investigates the cause of these phenomena, and seeks to understand the conditions’ that lead to good, excellent, or poor results in analytic activity.
Gitelson distinguishes between the analyst’s ‘reaction to the patient as a whole’ (the analyst’s ‘transference’) and the analyst’s ‘reaction to partial aspects of the patient’ (the analyst’s ‘countertransference’). He is concerned also with the problems of intrusion, when such intrusion occurs the countertransference should be dealt with by analyst and patient working together, thus agreeing with Little.
Weigert favours analysis of countertransference as far as it intrudes into the analytic situation, and she advises, in advanced stages of treatment, less reserve I the analyst’s behaviour and more spontaneous display of countertransference.
Noticeable proceeding will have their intent be to amplify specific remarks on countertransference as a tool for understanding the mental processes of the patient (including especially his transference reaction) - their content, their mechanisms, and their intensities. Awareness of countertransference helps one to understand what should be interpreted and when. Also, we are to consider the influence of countertransference upon the analyst’s behaviour toward the analysand - behaviour that affects decisively the position of the analyst as object of the re-experience of childhood, and affecting its process of a cure. First, the consideration based briefly countertransference in the history of psychoanalysis. We meet with a strange fact and a striking contrast. The discovery by Freud to countertransference and its great importance in therapeutic work produces the institution of didactic analysis that became the basis and centre of psychoanalytic training. The, countertransference received little scientific consideration over the next forty years. Only during the last few years has the situation changed, rather suddenly, and countertransference becomes a subject examined frequently and with thoroughness. How is one to explain this initial recognition, this neglect, and this recent change? Is there not reason to question the success of didactic analysis in fulfilling its function if this very problem, the discovery of which led to the creation of didactic analysis, has had so little scientific elaboration?
These questions are clearly important, and those who have personally witnessed a great part of the development of psychoanalysis in the last forty years have the best right to answer them. One suggestion would be to explain the lack of scientific investigation of countertransference must be due to rejections by analyst of their own countertransference - a rejection that represents unresolved struggles with their own primitive anxiety and quilt. These struggles are closely connected with those infantile ideals that survive because of deficiencies in the didactic analysis of just those transference problems that latter effect the analyst’s countertransference. These deficiencies in the didactic analysis are reciprocally in part due to countertransference problems insufficiently solved in the didactic analyst. Thus, we are in a vicious circle, but we can see where a breach must be made. In that, we must begin by revision of our feelings about our own countertransference and try to overcome our own infantile ideals more thoroughly, accepting more fully the fact that we are still children and neurotics even when we are adults and analysts. Only in this way by better overcoming our rejection of countertransference - can we achieve the same result in candidates.
The insufficient dissolution of these idealization and underlying anxieties and quilt feelings’ leads to special difficulties when the child becomes an adult and the analysand and analyst, for the analyst unconsciously requires of himself that he be fully identified with these ideals. Thus, and so that is at least partly so that the oedipus complex of the child toward its parents, and of the patient toward his analyst, has been so much more fully considered than that of the parents toward their children and of the analyst toward the analysand. For the same basic reason transference has been dealt with much more than countertransference.
The fact that countertransference conflicts determine the deficiencies in the analysis of transference becomes clear if we recall that transference is the expression of the internal object relations; for understanding of transference will depend on the analyst’s capacity to identify himself both with the analysand’s impulses and defences, and with his internal objects, and to be conscious of these identifications. This ability in the analyst will in turn depend upon the degree to which he accepts his countertransference, for his countertransference is also based on identification with the patient’s id and ego and his internal object. One might also say that transference is the expression of the patient’s relations with the fantasied and real countertransference of the analyst. For just as Countertransference is the psychological response to the analysand’s real and imaginary transferences, and in addition the transference response to the analyst’s imaginary and real countertransference. Analysis of the patient’s fantasies about countertransference, which in the widest sense constitute the cause and consequence of the transference, is an essential part of the analysis of the transference. Perception on the patient’s fantasies regarding countertransference will depend in turn upon the degree to which the analyst himself perceives his countertransference processes - on the continuity and depth of his conscious contact with himself.
Before any illumination is drawn upon these, statements, a brief's mention will appreciatively be to consider one of those ideals in its specifically psychoanalytic expression: The ideal of the analyst’s objectivity. No one, of course, denies the existence of subjective factors in the analyst and of countertransference, however, there seems to exist of an important difference between what is generally acknowledged in practice and the real state of affairs. The first distortion of truth in ‘the myth of the analytic situation; is that analysis, is an interaction between a sick person and an apparently healthy one? The truth is that it is an interaction between two personalities, in both of which the ego is under pressure from the id, the superego and the external world, each personality has its internal and external dependancies, anxieties, and pantological defences, each is also a child with its internal parents and each of these whole personalities - that of the analysand and that of the analyst - responds to every event of the analytic situation. Besides these similarities between the personalities of analyst and analysand, there also exist differences, and one of these are in “objectivity.” The analyst’s objectivity consists mainly in a certain attitude toward his own subjectivity and countertransference. The neurotic (obsessive) ideal of objectivity leads to repression and blocking of subjectivity and so the apparent fulfilment leads the myth of the ‘analyst without anxiety or anger’. The other neurotic extreme is that of ‘drowning’ in the countertransference. True objectivity is based upon a form of internal division that enables the analyst to make himself (his own countertransference and subjectivity) the object of his continuous observation and analysis. This position also enables him to be ‘objective’ toward the analysand.
The term countransference has been given various meanings. They may be summarized by the statement that for some authors’ countertransference includes everything that arises in the analyst as psychological response to the analysand, whereas for others not all this should be called countertransference. Some, for example, prefer to reserve the term for what is infantile in the relationship of the analyst with his analysand, while others make different limitations (Annie Reich and Gitelson). Therefore efforts to differentiate away from each other certain of the complex phenomena of Countertransference lead to confusion or to unproductive discussions of terminology. Freud invented the term countertransference in evident analogy to transference, which he defined as reimprisons or re-editions of childhood experiences, including greater or lesser modifications of the original experience. Therefore, one frequently uses the term transference for the entirety of the psychological attitude of the analysand toward the analyst. We know, to be sure, that really external qualities of the analytic situation in general and of the analyst in particular have important influence on the relationship of the analysand with the analyst, but we also know that all these present factors are experienced according to the past and fantasy, - according, that is to say, to a transference predisposition. As determinants of the transference neurosis and, overall, of the psychological situation of the analysand toward the analyst, we have both the transference predisposition and the present real and especially analytic experiences, the transference in its diverse expressions being the resultant of these two factors.
Analogously, in the analyst there is the countertransference predisposition and the present real, and especially analytic, experiences. The countertransference is the resultant. It is precisely this fusion of present and past, the continuo as an initiate connection of reality and fantasy, of external and internal, conscious and unconscious, that demands a concept embracing all the analysts' psychological responses, and renders it advisable, also, to keep for this totality of response the accustomed term countertransference. Where it is necessary for greater clarity one, might speak of ‘totality countertransference. Then differentiate the separate within it one aspect or another. One of its aspects consists precisely of what is transferred in countertransference; this is the part that originates in an earlier time and that is especially the infantile and primitive part within total countertransference. Another of these aspects - closely connected with the previous one - is what is neurotic in countertransference; its main characteristics are the unreal anxiety and the pathological defences. Under certain circumstances’ one may also speak of a countertransference neurosis.
To clarify better the concept of countertransference, one might start from the question of what happen, in general terms, in the analyst in his relationship with the patient. The first answer might be; Everything happens that can happen in one personality faced with another, but this says so much that it says hardly anything. We take a step forward by bearing in mind that in the analyst there is a tendency that normally predominates in his relationship with the patient; it is the tendency on his function to being an analyst that of understanding what is happening in the patient. With this tendency there exist toward the patient nearly all the other possible tendencies, fears, and other feelings that one person may have toward another. The intention to understand creates a certain predisposition, a predisposition to identify with the analysand, which is the basis of comprehension. The analyst may achieve this aim by identifying his ego with the patient’s ego or, to put it more clearly, although with a certain terminological inexactitude, by identifying each part of his personality with the corresponding psychological part in the patient - his id with the patient’s id, his ego with the ego, his superego with the superego, accepting these identifications in his consciousness. However, this does not always happen, nor is it all that happens. Apart from these identifications, which might be called concordant (or homologous) identifications, there exist also highly important identifications of the analyst’s ego with the patient’s internal objects, for example, with the superego. Adapting an expression from Helene Deutsch, they might be called complementary identifications. Here, in addition we may add the following notes.
1. The concordant identification is based on introjection and projection, or, in other words, on the resonance of the exterior in the interior, on recognition of what belongs to another as one’s own (‘this part of you is me’) and on the equation of what is one’s own with what belongs to another (‘this part of me is you’). The processes inherent in the complementary identifications are the same, but they refer to the patient’s objects. The greater the conflicts between the parts of the analyst’s personality, the greater are his difficulties in carrying out the concordant identifications in their entirety.
2. The complementary identifications are produced by the fact that the patient treats the analysts as an internal (projected) object, and in consequence the analyst feels treated as such; that is, he identifies himself with the destiny of the concordant identification; it seems that to the degree to which the analyst fails in the concordant identification and rejects them, certain complementary identifications become intensified. Clearly, rejection of a part or tendency in the analyst himself, - his aggressiveness, for instance, - may lead to a rejection of the patent’s aggressiveness (by which this concordant identification fails) and that such a situation leads to a greater complementary identification with the patient’s rejecting object, toward which this aggressive impulse is directed.
3. Current usage applies the term ‘countertransference’ to the complementary identifications only; that is to say, to those psychological processes in the analysis by which, because he feels treated as and partially identifies himself with an internal object of the patient, the patient becomes an internal (projected) object of the analyst. Usually excluded from the concept countertransference are the concordant identifications, - those psychological contents that arise in the analysts because of the empathy achieved with the patient and that really reflects and reproduce the latter’s psychological contents. Perhaps following this usage would be best, but there are some circumstances that make it unwise to do so. In the first place, some authors include the concordant identifications in the concept of countertransference. One is thus faced with the choice of entering upon a terminological discussion or of accepting the term in this wider sense. That these various reasons, the wider sense is to be referred. If one considers that their analyst’s concordant identifications (his ‘understanding’) are a sort of reproduction of his own oast processes, especially of his own infancy, and that this reproduction or re-experience is carried out as response to stimuli from the patient, one will be more ready to include the concordant identifications in the concept of countertransference. Moreover, the concordant identifications are closely connected with the complementary ones (and thus with ‘countertransference’ in the popular sense), and this fact renders advisably a differentiation but not a total separation of the terms. Finally, it should be borne in mind that the disposition of empathy, - that is, to concordant identification - springs largely from the sublimated positive countertransference, which love-wise relates empathy with countertransference in the wider sense. All this suggests, then, the acceptance of countertransference as the totality of the analyst’s psychological response to the patient. If we accept this broad definition of countertransference, the difference between its two aspects mentioned that it must still be defined. On the one hand we have the analyst as subject and the patient as object of knowledge, which in a certain sense annuls the 'object relationship'. Properly speaking, and that arises in its stead the approximate union or identity between the subject’s and the object’s parts (experiences, impulses, defences). The aggregate of the processes concerning that union might be designated, where necessary, ‘concordant Countertransference’. On the other hand we have an object relationship much like many others, a real ‘transference’; in which the analyst ‘repeats’ experiences, the patient representing internal objects of the analyst. The aggregate of these experiences, which also exist always ad continually, might be termed Complementary Countertransference.
A brief example may be opportune here. Consider a patient who threatens the analyst with suicide. In such situations there sometimes occurs rejection on the concordant identifications by the analyst and an intensification of his identification with the threatened object. The anxiety that such a threat can cause the analyst may lead to various reactions or defence mechanisms within him - for instance, annoyance with the patient. This - his anxiety and annoyance - would be content of the ‘complementary countertransference’. The perception of his annoyance may, in turn, originate quilt feelings in the analyst. These lead to desires for reparation and to intensifications of the ‘concordant’ identifications and ‘concordant countertransference.
Moreover, these two aspects of ‘total countertransference’ have their analogy in transference. Sublimated positive transference is the main and indispensable motive force for the patient’s work; it does not a technical problem. Transference becomes a ‘subject’, according to Freud’s words, mainly when “it becomes resistance,” when, because of resistance, it has become sexual or negative. Analogously, sublimated positive countertransference is the main and indispensable motive force in the analyst’s work (disposing him to the continued concordant identification), and countertransference becomes a technical problem or ‘subject’ mainly when it becomes sexual or negative. This occurs (to an intense degree) principally as a resistance - here, the analyst that is to say, as countertransference.
This leads to the problem of the dynamics of countertransference. We may already discern that the tree factors designated by Freud and determinant in the dynamics of transference (the impulse to repeat infantile clichés of experience, the libidinal needs, and resistance) are also decisive for the dynamics of Countertransference, however.
Every transference situation provokes a countertransference situation, which arises out of the analyst’s identification of himself with the analysand’s (internal) objects (this is the ‘complementary countertransference’). These countertransference situations may be repressed or emotionally blocked but probably they cannot be avoided; certainly they should not be avoided if full understanding is to be achieved. These countertransference reactions are governed by the laws of the general and individual unconscious. Among these the laws of talion is especially important. Thus, for example, every positive transference situation is answered by a positive countertransference; to every negative transference there responds, in one part of the analyst, a negative countertransference. It is important that the analyst is conscious of this law, for awareness of it is fundamental to avoid ‘drowning’ in the countertransference. If he is not aware of it he can avoid entering the vicious circle of the analysand’s neurosis, which will hinder or even prevent the work of therapy.
A simplified example: If the patient’s neurosis centres round a conflict with his introjected father, he will project the latter upon the analyst and treat him as his father; the analyst will feel treated as such - he will feel badly treated - and he will react internally, in a part of his personality, according to the treatment he receives. If he fails to be aware of this reaction, his behaviour will inevitably be affected by it, and he will renew the situation that, to a greater or lesser degree, helped to establish the analysand’s neurosis. Therefore, it is very important that the analyst develops within himself an ego observer of his countertransference reactions, which is, naturally, continuous. Perception of these countertransference reactions will help to become conscious of the continuous transference situations of the patient and interpret them rather than be unconsciously ruled by these reactions, as not as seldom to happen. A well-known example is the ‘revengeful silence’ of the analyst. If the analyst is unaware of these reactions there is danger that the patient will repeat, in his transference experience, the vicious circle brought about by the projection and introjection of ‘bad objects’ (in reality neurotic ones) and the consequent pathological anxieties and defences, but transference interpretation made possibly by the analyst’s awareness of his countertransference experience make it possible to open important breaches in this vicious circle.
To return to the previous example: If the analyst is conscious of what the projection of the father-imago upon him provokes in his own countertransference, he can more easily make the patient conscious of this projection and the consequent mechanisms. Interpretation of these mechanisms will show the patient that the present reality is not identical with his inner perceptions (for, it was, the analyst would not interpret and otherwise act as an analyst); the patient then introjects a reality better than his inner world. This sort of rectification does not take place when the analyst is under the sway of his unconscious countertransference.
Let us, least of mention, consider some application to these principles. To return to the question of what the analyst does during the session and what happens within him, one might reply, at first thought, that the analyst listens. Still, this is not completely true: He listens most of the time, or wishes to listen, but is variably doing so, Ferenczi refers to this fact and expresses the opinion that the analyst’s distractibility is unimportant, for the patient at such moments must intuitively be certainly in resistance. Ferenczi’s remark (which dates from the year 1918) sounds like an echo from the era wheen the analyst was mainly interested in the repressed impulses. Because now that we attempt to analyse resistance, the patient’s manifestations of resistance are as significant as any other of his productions. At any rate, Ferenczi here refers to a countertransference response and deduces from it the analysand’s psychological situation. He says “. . . we have unconsciously reacted to the emptiness and futility of the associations given now the withdrawal of the conscious charge.” The situation might be described as one of mutual withdrawal. The analyst’s withdrawal is a response to the analysand’s withdrawal - which, however, is a response to an imagined or really psychological position of the analyst. If we have withdrawn - if we are not listening but are thinking of something else - we may use this event in the service of the analysis like any other information we find. The quilt we may feel over such a withdrawal is just as utilizable analytically as any other countertransference reaction. Ferenczi’s next words, “the danger of the doctor’s falling asleep, . . . need not be regarded as grave because we awake at the first occurrence important for the treatment,” are clearly intended to appease this quilt. Nevertheless, to better than an allay than the analyst’s quilt would be to use it to promote the analysis - and so as to use the quilt would be the best way of alleviating it. In fact, we encounter here a cardinal problem of the relation between transference and countertransference, and of the therapeutic process in general. For the analyst’s withdrawal is only an example of how the unconscious of one person responds to the unconscious of another. This response seems in part to be governed, as far as we identify ourselves with unconscious objects of the analysand, siding the law of talion; and, as far as this; law unconsciously influences the analyst, there is danger of a vicious circle of actions between them, for the analysand as responds 'talionically' in his turn, and so on without end.
Looking more closely, we see that the 'talionic response' or 'identification with the aggressor' (the frustrating patient) is a complex process. Such a psychological process in the analyst usually starts with a feeling of displeasure or of some anxiety as a response to this aggression (frustration) and, because of this feeling, the analyst identifies himself with the 'aggressor'. By the term 'aggressor' we must designate not only the patient but also some internal object of the analyst (especially his own superego or the internal persecutor) now projected on the patient. This identification with the aggressor, or persecutor, causes a feeling of quilt; probably it always does so, although awareness of the quilt may be repressed. For what happens is, on a small scale, a process of melancholia, just as Freud described it: The object has partially abandoned us; we identify ourselves with the lost object, and then we accuse the introjected 'bad objects - in other words, we have quilt feedings. This may be sensed in Ferenczi’s remark quoted above, in which mechanisms are at work designed to protect the analyst against these quilt feelings: Denial of quilt (‘the danger is not grave’) and a certain accusation against the analysand for the 'emptiness' and 'futility' of his associations. Onto which this way becomes a vicious circle - a kind of paranoid ping-pong, has entered. The analytic situation.
Two situations will illustrate the frequent occurrence in both the complementary and the concordant identifications and the vicious circle that these simulations may cause.
(1). One transference situation of regular occurrences consists in the patient’s seeing in the analyst his own superego. The analyst identifies himself with the id and ego of the patient and with the patient’s dependence upon his superego. He also identifies himself with the same superego situation in which the patient places him - and experiences in this way the domination of the superego over the patient’s ego. The relation of the ego to the superego is, at bottom, as depressive and paranoid situations, the relation of the superego to the ego is, on the same plane, a manic one as far as this term may be used to designate the dominating, controlling, and accusing attitude of the superego toward the ego. In this sense we may broadly speak, that to a “depressive-paranoid” transference in the analysand there corresponds - as for the complementary identification - a “manic” countertransference in the analyst. This, in turn, may entail various fears and quilt feelings.
(2). When the patient, in defence against this situation, identifies himself with the superego, he may place the analyst in the situation of the dependent and incriminated ego. The analyst will not only identify himself with this position of the patient; he will experience the situation with the content the patient gives it; he will feel subjugated and accused, and may react to some degree with anxiety and quilt. To a “manic” transference situation (of the type called mania for reproaching) there corresponds, then - regarding the complementary identification - a “depressive-paranoid” countertransference situation.
The analyst will normally experience these situations with only a part of his being. Leaving another part free to take note of them in a way suitable for the treatment. Perception of such a countertransference situation by the analyst and his understanding of it as a psychological response to a certain transference situation will enable him the better to grasp the transference when it is active. It is precisely these situations and the analyst’s behaviour regarding them, and in particular his interpretations of them, that are important for the process of therapy, for they are the moments when the vicious circle within which the necrotic habitually move - by projecting his inner world outside and reintrojecting this world - is or is not interrupted. Moreover, at these decisive points the vicious circle may be re-enforced by the analyst, if he is unaware of having entered it.
A brief example: an analysand repeats with the analyst his “neurosis of failure,” closing himself up to every interpretation or repressing it at once, reproaching the analyst for the uselessness of the analysis, foreseeing nothing better in the future, continually declaring his complete indifference to everything. The analyst interprets the patient’s position toward him, and its origin, in its various aspects. He shows the patient his defence against the danger of becoming overly dependent, of being abandoned, or being tricked, or of suffering counter-aggression by the analyst, if he abandons his armour and indifference toward the analyst. He interprets to the patient his projection of bad internal objects and his subsequent sado-masochistic behaviour ion the transference; his need of punishment; his triumph and 'masochistic revenge' against the transferred patients; his defence against the 'depressive position' by means of schizoid, paranoid, and manic defences (Melanie Klein): And he interprets the patient’s rejection of a bond that in the unconscious has homosexual significance. Nevertheless, it may happen that all these interpretations, in spite of being directed to the central resistances and connected with the transference situation, suffer the same fate for the same reasons; they fall into the 'whirl in a void' of the 'neurosis of failure'. Now the decisive moments arrive. The analyst, subdued by the patient’s resistance, may begin to feel anxious over the possibility of failure and feel angry with the patient. When this occurs in the analyst, the patient feels it coming, for his own 'aggressiveness' and other reactions have provoked it; consequently he fears the analyst’s anger. If the analyst, threatened by failure, or to put in more precisively threatened by his own super-ego or by his owe archaic objects that have found an agent provocateur in the patient, acts under the influence of these internal objects and of his paranoid and depressive anxieties, the patient again finds himself confronting a reality like that of his real or fantasized childhood experiences and like that of his inner world. So the vicious circle continues and may even be re-enforced. Yet if the analyst grasps the importance of this situation, if, through his own anxiety or anger, he comprehends what is happening in the analysand, and if he overcomes, thanks to the new insight, his negative feelings and interprets what has happened in the analysand, being now in this new positive counter-transference situation, then he may have made a breach - be it large or small - in the vicious circle.
All the same, it continues to be considered that the phenomena of countertransference experiences are divided into two classes. One might be designed 'countertransference thought', the other 'transference positions' for example just cited may serve as illustration of this latter class: The essence of these example lies in the fact that the analyst feels anxiety and is angry with the analysand - that is to say, he is in a certain countertransference 'position'.
Further to explicate upon countertransference relations is that a potential patient is started of a session and wishes to pay his fees upfront. He gives the analyst a thousand-peso note and asks for change. The analyst happens to have his money in another room and goes out to fetch it, leaving the thousand pesos upon his desk. While between leaving and returning, the fantasy occurs to him that the analysand will take back the money and say that the analyst took it away with him. On his return he finds the thousand pesos where he left it. When the account has been settled, the analysand lies down and tells the analyst that when he was left alone he had fantasies of keeping the money, of kissing the note goodbye, and so on. The analyst’s fantasy was based upon what he already knew of the patient, who in previous sessions had expressed a strong distinction to pay up front. The identity of the analyst’s fantasy and the patient’s fantasy of keeping the money may be explained as springing from a connection between the two unconsciousness, a connection that might be regarded as a “psychological symbiosis” between the two personalities. To the analysand’s wish to take money from him (already expressed often), the analyst reacts by identifying himself both with this desire and with the object toward which the desire is directed. Hence appears his fantasy of being robbed. For these identifications to come about there must evidently exist a potential identity. One may presume that every possible psychological constellation in the patient also exists in the analyst, and the constellation that correspond to the patient’s is brought into play in the analyst. A symbiosis result, and now in the analyst spontaneously occur thoughts corresponding to the psychological constellation in the patient.
In fantasies of this type just described and in the example of the analyst angry with his patient, we are dealing with identifications with the id, with the ego, and with the object of the analysand: In both cases, then, it is a matter of Countertransference reactions. However, there is an important difference between one situation and the other, and this difference does not seem to lie only in the emotional intensity. Before elucidating this difference, it should be marked and noted that the Countertransference reaction that appears in the last example (the fantasy about the thousand pesos) should also be used as a means to further the analysis. It is, moreover, a typical example of those “spontaneous thoughts” to which Freud and others refer in advising the analyst to keep his attention “floating” and in stressing the importance of these thoughts for understanding the patient. The countertransference reactions exemplified by the story of the thousand pesos are characterized by the fact that they threaten no danger to the analyst’s objective attitude of an observer. That, the danger is rather than the analyst will not pay sufficient attention to these thoughts or will fail to use them for understanding and interpretation. The patient’s corresponding ideas are not always conscious, from his own Countertransference “thoughts” and feelings the analyst may guess what is repressed or rejected. Recalling again our usage of the term is important 'Countertransference', for many writers, perhaps the majority, means by not these thoughts of the analyst but rather than other class of reactions, the “Countertransference positions.” This is one reason that differentiating these two kinds of reaction is useful.
The outstanding difference between the two lies in the degree to which the ego is involved in the experience. In one case, the reactions are experienced as thoughts, free association, or fantasies, with no great emotional intensity and frequently as if they were moderately foreign to the ego. In the other case, the analyst’s ego is involved in the Countertransference experience. The experience is felt by him with greater intensity and as reality, and here danger of his “drowning” in this experience. In the former example of the analyst who gets angry because of the analysand’s resistances, the analysand is felt as really based by one part of the analyst (‘countertransference position’), although the latter does not express his anger. Now these two kinds of Countertransference reactions differ, because they have different origins. The reaction experienced by the analyst as thought or fantasy arises from the existence of an analogous situation in the analysand - that is, from his readiness in perceiving and communicating his inner situation (as happens with the thousand pesos) - whereas, the reaction experienced with great intensity, even as reality, by the analyst arises from acting out by the analysand (as with the ‘neurosis of failure’). Undoubtedly there are also the same analysts, he is a factor that helps to decide this difference. The analyst has, it seems, two ways of responding. He may respond to some situation by perceiving his reaction, while to others he responds by acting out (alloplastically or autoplastically). Which type of response occurs in the analyst depends partly on his own neurosis, on his inclination to anxiety, on his defence mechanisms, and especially on his tendencies to repeat (act out) instead of making conscious. It is here that we encounter a factor that determines the dynamics of countertransference. It is the one Freud emphasized as determining the special intensity of transference in analysis, and it is also responsible for the special intensity of countertransference.
The great intensity of certain countertransference reactions is to be explained by the existence in the analyst of pathological defences against the increase of archaic anxieties and unresolved inner conflicts. Transference, becomes intense not only because it serves as a resistance to remembering, as Freud says, but also because it serves as a defence against a danger within the transference experience itself. In other words, the “transference resistance” is frequently a repetition of defences that must be intensified lest a catastrophe is repeated in transference. The same is true of countertransference. Clearly, these catastrophes are related to becoming aware of certain aspects of one’s own instincts. Take, for instance, the analyst who becomes anxious and inwardly angry over the intense masochism of the analysand within the analytic situation. Such masochism frequently rouses old paranoid and depressive anxieties and guilt feelings in the analyst, who, faced with the aggression directed by the patient against his own ego, and faced with the effects of this aggression, finds himself in his unconscious confronted anew with his early crimes. It is often just this childhood conflict of the analyst, with their aggression, that led him into this profession in which he tries to repair the objects of the aggression and to overcome or deny his guilt. Because of the patient’s strong masochism, this defence, which consists of the analyst’s therapeutic action, fails and the analyst is threatened with the return of the catastrophe, the encounter with the destroyed object. In this way the intensity of the “negative countertransference” (the anger with the patient) usually increases because of the failure of the countertransference defence (the therapeutic action) and the analyst’s subsequent increase of anxiety over a catastrophe in the countertransference experience (the destruction of the object).
The 'abolition of rejection' in analysis determines the dynamics of transference and, in particular, the intensity of the transference of the 'rejecting' internal objects (in the first place, of the superego). The 'abolition of rejection' begins with the communication to the analysand, and here we have an important difference between his situation and that of the analysand and between the dynamics of transference and those of countertransference. However, this difference is not so great as might be at first supposed, for two reasons: First, because it is not necessary that the free associations be expressed for projections and transferences to take place, and secondly, because the analyst expresses of certain associations of a personal nature even when he does not seem to do so. These communications begin, one might say, with the plate on the front door that says Psychoanalysis or Doctor. What motive (about the unconscious) would the analyst have for wanting to cure if it were not he that made the patient ill? In this way the patient is already, simply by being a patient, the creditor, the accuser, the
'Superego' of the analyst, and the analyst is his debtor.
To what transference situation does the analyst usually react with a particular countertransference? Study of this question would enable one, in practice, to deduce the transference situations from the countertransference reactions. Next we might ask, to what imago or conduct of the object - to what imagined or real countertransference situation - does the patient respond with a particular transference? Many aspects of these problems have been amply studied by psychoanalysis, but the specific problem of the relation of transference and countertransference in analysis has received little attention.
The subject is so broad that we can discuss only a few situations and those incompletely, restricting ourselves to certain aspects. Therefore, we must choose for discussion only the most important countertransference situations, those that most disturb the analyst’s task and that clarify important points in the double neurosis, that arise in the analytic situation - a neurosis usually of very different intensity in the two participants.
1. What is the significance of countertransference anxiety?
Countertransference anxiety may be described in general and simplified terms as of depressive or paranoid character. In depressive anxiety the inherent danger consisted in having destroyed the analysand or made him ill. This anxiety may arise to a greater degree when the analyst faces the danger that the patient may commit suicide, and to a lesser degree when there is deterioration or danger of deterioration in the patient’s state of health. Yet the patient’s simple failure to improve and his suffering and depression may also provoke depressive anxieties in the analyst. These anxieties usually increase the desire to heal the patient.
In referring to paranoid anxieties differentiating it between is important “direct” and 'indirect' countertransference. In direct countertransference the anxieties are caused by danger of an intensification of aggression from the patient himself. Indirect Countertransference the anxieties are caused by danger of aggression from third parties onto whom the analyst has made his chief transference - for instance, the members of the analytic society, for the future of the analyst’s object relationship with the society is part determined by his professional performance. The feared aggression may take several forms, such as criticism, reproach, hatred, mockery, contempt, or bodily assault. In the unconscious it may be the danger of being killed or castrated or otherwise menaced in an archaic way.
The transference situations of the patient to whom the depressive anxieties of the analyst are a response are, above all, those in which the patient, through an increase in frustration (or danger of frustration) and in the aggression that it evokes, turns the aggression against himself. We are dealing, on one plane, with situations in which the patient defends himself against a paranoid fear of retaliation by anticipating this danger, by carrying out himself and against himself part of the aggression feared from the object transferred onto the analyst, and threatening to carry it out still further. In this psychological sense it is really the analyst who attacks and destroys the patient, and the analyst’s depressive anxiety corresponds to this psychological reality. In other words, the countertransference depressive anxiety arises, above all, as a response to the patient’s 'masochistic defence' - which also represents a revenge (‘masochistic revenge’) - and as a response to the danger of its continuing. On another plane this turning of the aggression against himself is carried out by the patient because of his own depressive anxieties; he turns it against himself to protect himself against re-experiencing the destruction of the objects and to protect these from his own aggression.
The paranoid anxiety in 'direct' countertransference is a reaction to the danger arising from various aggressive attitudes of the patient himself. The analysis of these attitudes shows that they are themselves defences against, or reactions to, certain aggressive imagos. These reactions and defences are governed by the law of talion or else, analogously to this, by identification with the persecutor. The reproach, contempt, abandonment, bodily assaults - all these attitudes of menace or aggression in the patient that causes countertransference paranoid anxieties - are responses to (or anticipation of) equivalent attitudes of the transferred object.
The paranoid anxieties in 'indirect' countertransference are of a more complex nature since the danger for the analyst originates in a third party. The patient’s transference situations that provoke the aggression of this “third party” against the analyst may be of various sorts. Commonly, we are dealing with transference situations (masochistic or aggressive) similar to those that provoke the 'direct' countertransference anxieties previously mentioned.
The common denominator of all the various attitudes of patients that provoke anxiety in the analyst is to be found, in the mechanism of 'identification with the persecutor', the experience of being liberated from the persecutor and of triumphing over him, implied in this identification, suggested our designating this mechanism as a manic one. This mechanism may also exist where the manifest picture in the patient is the opposite, namely in certain depressive states; for the manic conduct may be directed either toward a projected object or toward an introjected object, it may be carried out alloplastically or autoplastically. The 'identification with the persecutor' may even exist' in suicide, since this is a ‘mockery’ of the fantasized or real persecutors, by anticipating the intentions of the persecutors and by one’s own in what they wanted to do, as this ‘mockery’ is the manic aspect of suicide. The 'identification with the persecutor' in the patient is, then, a defence against an object felt as sadistic that tends to make the patient the victim of a manic feast. This defence is carried out either through the introjection of the persecutor in the ego, turning the analyst into the object of the 'manic tendencies', or through the introjection of the persecutor in the superego, taking the ego as the object of its manic trend. Still, what does this mean?
An analysand decides to take a pleasure trip to Europe. He experiences this as a victory over the analyst both because he will free himself from the analyst for two months and because he can afford this trip whereas the analyst cannot. He then begins to be anxious lest the analyst seeks revenge for the patient’s triumph. The patient anticipates this aggression by becoming unwill, developing fever and the first symptoms of influenza. The analyst feels slight anxiety because of this illness and fears, recalling certain experiences, a deterioration in the state of health of the patient, who still however continues to come to the sessions. Up to this point, the situation in the transference and countertransference is as follows. The patient is in a manic relation to the analyst, and his anxieties of preponderantly paranoid type. The analyst senses some irritation over the abandonment and some envy of the patient’s great wealth (feeling ascribed by the patient in his paranoid anxieties to the analyst), but while, the analyst feels satisfaction at the analysand’s real progress, which finds expression in the very fact that the trip is possible and that the patient has decided to make it. The analyst perceives a wish in part of his personality to bind the patient to himself and use the patient for his own needs. In having this wish he resembles the patient’s mother, and he is aware that he is in reality identified with the domineering and vindictive object with which the patient identifies him. Therefore, the patient’s illness seems, to the analyst’s unconscious, a result of the analyst’s own wish, and the analyst therefore experiences depressive (and paranoid) anxieties.
What object imago leads the patient to this manic situation? It is precisely this imago of a tyrannical and sadistic mother, to whom the patient’s frustrations constitute a manic feast. It is against these 'manic tendencies' in the object that the patient defends himself, first by identification (introjection of the persecutor in the ego, which manifests itself in the manic experience in his decision to take a trip) and then by using a masochistic defence to escape vengeance.
In brief, the analyst’s depressive (and paranoid) anxiety is his emotional response to the patient’s illness, and the patient’s illness is itself a masochistic defence against the object’s vindictive persecution. This masochistic defence also contains a manic mechanism in that it derides, controls, and dominates the analyst’s aggression. In the stratum underlying this, we find the patient in a paranoid situation in face of the vindictive persecution by the analyst - a fantasy that coincides with the analyst’s secret irritation. Beneath this paranoid situation, and causing it, is an inverse situation: The patient is enjoying a manic triumph (his liberation from the analyst by going on a trip), but the analyst is in a paranoid situation (he is in danger of being defeated and abandoned). Finally, beneath this we find a situation in which the patient is subjected to an object imago that wants to make of him the victim of its aggressive tendencies, but this time not to take revenge for intentions or attitudes in the patient, but merely to satisfy its own sadism of an imago that originates directly from the original suffering of the subject.
In this way, the analyst can deduce from each of his Countertransference sensations a certain transference situation, the analyst’s fear to deterioration in the patient’s health enabled him to perceive the patient’s need to satisfy the avenger and to control and restrain him, partially inverting (through the illness) the roles of victimizer and victim, thus alleviating his guilt feeling and causing the analyst to feel some of the guilt. The analyst’s irritation over the patient’s trip enabled him to see the patient’s need to free himself from a dominating and sadistic object, to see the patient’s guilt feelings caused by these tendencies, and to see his fear of the analyst’s revenge. By his feeling of triumph the analyst could detect the anxiety and depression caused in the patient by his dependence upon this frustrating, yet indispensable, object. Each of these transference situations suggested to the analyst the patient’s object imagoes - the fantasized or real Countertransference situation that determined the transference situations.
2. What is the meaning of countertransference aggression?
To what was previous, we have seen that the analyst may experience, besides countertransference anxiety, annoyances, recollection, desire for vengeance, hatred, and other emotions. What are the origin and meaning of these emotions?
Countertransference aggression usually arises in the face of frustration (or danger of frustration) of desires that may superficially be differentiated into “direct” and “indirect.” Both direct and indirect desires are principally wishes to get libido or affection. The patient is the chief object of direct desires in the analyst, who wishes to be accepted and loved by him. The object of the indirect desires of the analyst may be, for example, other analysts from whom he wishes to get recognition or admiration through his successful work with his patients, using the latter as means to this end. This aim to get love has, in general terms, two origins: An instinctual origin (the primitive needs of union with the object) and an origin of a defensive nature (the need of neutralizing, overcoming, or denying the rejections and other dangers originating from the internal objects, in particular from the superego). The frustrations may be differentiated, descriptively, into those of active type and those of passive type. Among the active frustrations is direct aggression by the patient, his mockery, deceit, and active rejection. To the analyst, active frustration means exposure to a predominantly “bad” object, the patient may become, for example, the analyst’s superego, which says to him “you are bad.” Examples of flustration of passive type are passive rejection, withdrawal, partial abandonment, and other defences against the bond with and dependence on the analyst. These signify flustrations of the analyst’s need of union with the object.
We may say then, that Countertransference aggression usually arises when there is frustration of the analyst’s desire that springs from Eros, both that arising from his “original” instinctive and affective drives and that arising from his need of neutralizing or annulling his own Thanatos (or the action in his internal ‘bad objects’) directed against the ego or against the external world. Owing partly to the analyst’s own neurosis (and to certain characteristics of analysis itself) these desires of Eros sometimes change the unconscious aim of bringing the patient to a state of dependence. Therefore countertransference aggression may be provoked by the rejection of this dependence by the patient who rejects any bond with the analyst and refuses to surrender to him, showing this refusal by silence, denial, secretiveness, repression, blocking, or mockery.
Taken to place next, we must establish what it is that induces the patient to behave in this way, to frustrate the analyst, to withdraw from him, to attack him. If we know this we might as perhaps know what we have to interpret when countertransference aggression arises in us, being able to deduce from the countertransference the transition of the transference situation and its cause. This cause is a fantasized countertransference situation or, more precisely, some actual or feared bad conduct from the projected object. Experience shows that, in meaningly general terms, this bad or threatening conduct of the object is usually an equivalent of the conduct of the patient (to which the analyst has reacted internally with aggression). We also understand why this is so: The patient’s conduct springs from that most primitive of reactions, the talion reaction, or from the defect by means of identification with the persecutor or aggressor. Sometimes, it is quite simple: The analysand withdraws from us, rejects us, abandons us, or derides us when he fears or suffers the same or an equivalent treatment from us. In other cases, it is more complex, the immediate identification with the aggression being replaced by another identification that is less direct. To exemplify: Some woman patients, upon learning that the analyst is going on holiday, remain silent a long while, she withdraws, through her silence, as a talion response to the analyst’s withdrawal. Deeper analysis shows that the analyst’s holiday is, to the patient, equivalent to the primal scene, and this is equivalent to destruction of her as a woman, and her immediate response must be a similar attack against the analyst. This aggressive (castrating) impulse is rejected and the result, her silence, is a compromise between her hostility and its rejection, it is a transformed identification with the persecutor.
The composite distribution accounted by ours, is the vertical mosaic: (a) The countertransference reactions of aggression (or, of its equivalent) occur in response to transference situations in which the patient frustrates certain desires of the analyst’s. These frustrations are equivalent to abandonment or aggression, which the patient carries out or with which he threatens the analyst, and they place the analyst, at first, in a depressive or paranoid situation. The patient’s defence is in one aspect equivalent to a manic situation, for he is freeing himself from a persecutor. (b) This transference situation is the defence against certain object imagoes. Existent associative objects persecute the subject sadistically, vindictively, or morally, or an object that the patient defends from his destructiveness by an attack against his own ego: In these, the patient attacks - as Freud and Abraham have shown in the analysis of melancholia and suicide - just when, the internal object and the external object (the analyst). The analyst who is placed by the alloplastic or autoplastic attacks of the patient in a paranoid or a depressive situation sometimes defends himself against these attacks by using the same identification with the aggressor or persecutor as the patient used. Then the analyst virtually becomes the persecutor, and to this the patient (insofar as he presupposes such a reaction from his internal and projected object) responds with anxiety. This anxiety and its origin are nearest to consciousness, and are therefore the first thing to interpret.
3. Countertransference guilt feelings are an important source of countertransference anxiety: The analyst fears his “moral conscience.” Thus, for instance, a serious deterioration in the condition of the patient may cause the analyst to suffer reproach by his own superego, and cause him to fear punishment. When such guilt feelings occur, but the superego of the analyst is usually projected upon the patient or upon a third person, the analyst being the guilty ego. The accuser is the one who is attacked, the victim of the analyst. The analyst is the accused, he is charged with being the victimizer. It is therefore the analyst who must suffer anxiety over his object, and dependence upon it.
As in other countertransference situations, the analyst’s guilt feeling may have either real causes or fantasized causes, or a mixture of the two. A real cause exists in the analyst who has neurotic negative feelings that exercise some influence over his behaviour, leading him, for example, to interpret with aggressiveness or to behave in a submissive, seductive, or unnecessarily frustrating way. Yet guilt feelings may also arise in the analyst over, for instance, intense submissiveness in the patient though the analyst had not driven the patient into such conduct by his procedure. Or he may feel guilty when the analysand becomes depressed or ill, although his therapeutic procedure was right and proper according to his own conscience. In such cases, the countertransference guilt feelings are evoked not by what procedure he actualizes by its use but by his awareness of what he might have done in view of his latent disposition. In other words, the analyst identifies himself in fantasy with a bad internal object of the patient’s and he feels guilty for what he has provoked in this role - illness, depression, masochism, suffering, failure. The imago of the patient then becomes fused with the analyst’s internal objects, which the analyst had, in the past, wanted (and perhaps managed) to frustrate, makes suffer, dominate, or destroy. Now he wishes to repair them. When this reparation fails, he reacts as if he had hurt them. The true cause of the guilt feelings is the neurotic, predominantly sado-masochistic tendencies that may reappear in countertransference: The analyst therefore quite rightly entertains certain doubts and uncertainties about his ability to control them completely and to keep them entirely removed from his procedure.
The transference situation to which the analyst is likely to react with guilt feelings is then, in the first place, a masochistic trend in the patient, which may be either of some 'defensives' (secondary) or of a 'basic' (primary) nature. If it is defensive, we know it to be a rejection of sadism by means of its 'turning against the ego', the principal object imago that imposes this masochistic defence is a retaliatory imago. If it is basic (‘primary masochism’) the object imago is ‘simply’ sadistic, a reflex of the pains (‘frustration’) originally suffered by the patient. The analyst’s guilt feelings refer to his own sadistic tendencies. He may feel as if he himself had provoked the patient’s masochism. The patient is subjugated by a ‘bad’ object so that it seems as if the analyst had satisfied his aggressiveness; now the analyst is exposed in his turn to the accusations of his superego. In short, the superficial situation is that the patient is now the superego, and the analyst the ego who must suffer the accusation, the analyst is in a depressive-paranoid situation, whereas the patient is, from one point of view, in a ‘manic’ situation (showing, for example, ‘mania for reproaching’). Nevertheless, on a deeper plane the situation is the reverse: The analyst is in a ‘manic’ situation (acting as vindictive, dominating, or ‘simply’ a sadistic imago), and the patient is in a depressive-paranoid situation.
4. Besides the anxiety, hatred, and quilt feelings in countertransference, most other countertransference situations may also be decisive points during analytic treatment, both because they may influence the analyst’s work and because the analysis of the transference situations that provoke such countertransference situations may represent the central problem of treatment, clarification of which may be indispensable if the analyst is to exert any therapeutic influence upon the patient.
Before closing, let us consider briefly two doubtful points. How much confidence should we place in countertransference as a guide to understanding the patient? As to the first question, I intuitively think by means of its existing certainty, by which is founded the mistake initiated of the countertransference reactions as an oracle, with blind faith to expect of them the pure truth about the psychological situations of the analysand. It is plain that our unconscious is a very personal ‘receiver’ and ‘transmitter’ and we must reckon with frequent distortions of objective reality. Still, it is also true that our unconscious is nevertheless “the best we have of its kind.” His own analysis and some analytic experience enable the analyst, as a rule, to be conscious of this personal factor and know his ‘personal equation.’ According to experience, the danger of exaggerated faith in the message of one’s own unconscious is, even when they refer to very ‘personal’ reactions. Less than the danger of repressing them and denying them any objective value.
It seems necessary that one must critically examine the deductions one makes from perception of one’s own countertransference. For example, the fact that the analyst feels angry does not simply mean (as is sometimes said) that the patient wishes to make him angry. It may mean rather than the patient has a transference feeling of guilt. What has been said concerning Countertransference aggression is relevant here.
The second question - whether the analyst should or should not ‘communicate’ or ‘interpret’ aspects of his countertransference to the analysand - cannot be considered fully at present. Much depends, of course, upon what, when, how, to whom, for what purpose, and in what conditions the analyst speaks about his countertransference. Probably, the purposes sought by communicating the countertransference might often (but not always) be better attained by other means. The principal other means is analysis of the patient’s fantasies about the analyst’s countertransference (and of the related transference) sufficient to show the patient the truth (the reality of the countertransference of his inner and outer objects): and with this must also be analysed the doubts, negations, and other defences against the truth, intuitively perceived, until they have been overcome. Nevertheless, the situations in which communication of the countertransference is of value for the subsequent course of the treatment. Without doubt, this aspect of the use of countertransference is of great interest: We need an extensive and detailed study of the inherent problems of communication of countertransference. Much more experience and study of countertransference need to be recorded.
Some discussion of a working definition of the term countertransference is necessary, since it is by no means agreed upon by analysts that it can be correctly considered the converse of transference. D. W. Winnicott, for instance, has recently written about the importance of attitudes of hate from an analyst too patient, particularly in dealing with psychotic and antisocial patients. He speaks mainly of ‘objective countertransference’. Meaning ‘the analyst’s love and hate in reaction to the actual personality and behaviour of the patient based on objective observation. However, he also mentions countertransference feelings that are under repression in the analyst and need countertransference feelings that are under repression in the analyst and need more analysis. His concept of ‘objective Countertransference’ will not be included under the term Countertransference if the latter are used as the converse of transference. Frieda Fromm-Reichmann has separated the reconverse of the psychoanalyst to the patient into those of a private and those responses of the psychoanalyst to the patient into those of a private and those of a professional person and recognizes the possibility of countertransference distortions occurring in both aspects. Franz Alexander has used the term to mean all of the attitudes of the doctor toward the patient, while Sandor Ferenczi has used it to cover the positive, affectionate, loving, or sexual attitudes of the doctor toward the patient. Michael Balint, looking at a different aspect, calls attention ti the fact that every human relation is libidinous, not only the patient’s relation to his analyst, but also the analyst’s relation to the patient. He says that no human being can in the end tolerate any relation that brings only frustration and that it is as true for the one as for the other. “The question is, therefore, . . . how much. What kind of satisfaction is needed by the patient on the one hand and by the analyst on the other, to keep the tension in the psycho-analytical situation as or near the optimal level.”
In developing his theory of interpersonal relations, Harry Stack Sullivan has defined the psychotherapeutic effort of the analyst as carried on by the method of participant observation. He says, “The expertness of the psychiatrist refers to his skill in participant observation of the unfortunate patterns of his own and the patient’s living, in contrast too merely participating in such unfortunate patterns with the patient.” In the use of the term unfortunate patterns Sullivan includes the concept of countertransference, or in his words 'parataxic distortions'.
In several important recent papers, Leo Berman, Paula Heimann, Annie Reich, Margaret Little, and Maxwell Gitelson have made a beginning in the attempt to clarify the concept and to formulate some dynamic principles regarding the phenomena included in this category. Berman is mainly concerned with defining the optimal attitude of the analyst to the patient, an attitude that he characterizes as “dedicated.” This description is based on the assumption that the analyst’s emotional responses to the patient will be quantitatively less than those of the average person and of shorter duration, as the result of being quickly worked through by self-analysis. This, then, would represent an ideal goal of minimizing and an easily handled countertransference response.
Heimann takes a step forward when she states that the analyst’s emotional response to his patient within the analytic situation represents one of the most important tools for his work, and that the analyst’s countertransference is an instrument of research into the patient’s unconscious. This important formulation is the basis upon which the study of the analyst’s part of the interaction with the patient should be built. Previously, the statement has frequently been made that the analyst’s unconscious understands the patient’s unconscious. However, it is presumed that much is already unconscious material as becoming available to awareness after a successful analysis, so that the understanding should theoretically not be only on an unconscious level but should be errorless in words.
Reich has classified most of countertransference attitudes of the analyst’s. She separates them into two main types: Those where the analyst acts out some unconscious need with the patient, and those where the analyst defends against some unconscious need. On the whole, countertransference responses are reflections of permanent neurotic difficulties of the analyst, in which the patient is often not a real object but is rather used as a tool by means of which some need of the analyst is gratified. In some instances, there may be sudden, acute countertransference responses that do not necessarily arises from neurotic character difficulties of the analyst. However, Reich points out that the interest in becoming an analyst is itself partially determined by unconscious motivation, such as curiosity about other people’s secrets, which is evidence that countertransference attitudes are some prerequisites for an analyst. The contrast between the healthy and neurotic analyst is that in the one the curiosity is desexualized and sublimated in character, while in the other it remains a method of acting out unconscious fantasies.
Margaret Little continues the search for an adequate definition of countertransference, concluding that it should be used primarily to refer to 'repressed elements', inasmuch as far as the unanalysed well-situated analyst, he attaches himself to the patient in the same way as the patient ‘transfers’ to the analyst effects, etc., belonging to his parents or to the object of his childhood: i.e., the analyst regards the patient (temporarily and varyingly) as he regarded his own parents. Even so, it is, Little who thinks that other aspects of the analyst’s attitudes toward the patient, such as some specific attitude or mechanism with which he meets the patient’s transference, or some of his conscious attitudes, should be considered Countertransference responses. She confirms Heimann’s statement that the use of countertransference may become an extremely valuable tool in psychoanalysis, comparing it in importance with the advances made when transference interpretations began to be used therapeutically. She sees transference and Countertransference as inseparable phenomena; both should become increasingly clear to both doctor and patient as the analysis progresses. To that end, she advocates judicious use of Countertransference interpretation by the analyst. “Both are essential to Psychoanalysis, and countertransference is no more to be feared or avoided than is transference: In fact it cannot be avoided it can only be looked out for, controlled to some extent, and perhaps ill-used.
Gitelson, in a comprehensive paper, continues to clarify the phenomena, he goes back to the original definition of countertransference used by Freud - the analyst’s reaction to the patient’s transference - and separates this set of responses from another set that he calls the transference attitudes of the analyst. These transference attitudes, which are the result of ‘’surviving neurotic transference potential’ in the analyst. Involve ‘total’ reactions to the patient -that is, overall feelings about and toward the patient - while the countertransference attitudes are ‘partial’ reactions to the patient - that is, emergency defence reactions elicited when the analysis touches upon unresolved problems in the analyst.
This classification, while valid enough, does not seem to forward investigation to any great extent. For example, Gitelson feels in general that the existence of ‘total’ or transference attitudes toward a patient is a contradiction for the analyst to work with that patient, whereas the partial responses are more amendable to working through the continuity of inertial momentum whereby the processes of a self-analysis. Yet, it seems extremely sceptical whether avoiding is possible for one ‘total’ reaction to a patient - that is, general feelings of liking for, dislike of, and responsiveness toward the patient, and so on, is present from the time of the first interview. These do vary in intensity; when extreme, they may indicate that a non-therapeutic relationship would result should be the two persons attempt working together. On the other hand, their presence in awareness may permit the successful scrutiny and resolution of whatever problem is involved, whereas their presence outside awareness would render this impossibly. In other words, it is not so much a question whether ‘total’ responses are present or not, but rather a question as to their amenability to recognition and resolution. Therefore, another type of classification would, in any case, be more useful for investigative purposes.
Least of mention, this by no mean a harbouring dispute over the validity of Gitelson’s criticism of the rationalization of much Countertransference acting-out under the heading of ‘corrective emotional experience’. He emphasizes that motherly or fatherly attitudes in the analyst are often character defences unrecognized as such by him. Although the analyst, according to Gitelson, to facilitate . . . can deny neither his personality nor its operation in the analytic situation as a significant factor, this does, however, mean that his personality is the chief instrument of the therapy. He also reports the observation that when the analyst appears as himself in the patient’s dreams, it is often the herald of the development of an unmanageably intenser transference neurosis, the unmanageability being the difficulty of the analyst’s situation. Similarly, when the patient appears as himself in the analyst’s dream, but it is often a signal of unconscious countertransference processes going on.
So then, we have seen that in recent studies on countertransference have included in their concepts attitudes of the therapist that are both conscious and unconscious; attitudes that are responses both too real and to fantasied attitudes of the patient; attitudes stimulated by unconscious needs of the analyst and attitudes stimulated by sudden outbursts of effect for the patient; attitudes that arise from responding to the patient as though he were some previously important person in the analyst’s life; and attitudes that do not use the patient as a real object but as a tool for the gratification of some unconscious requisite. This group of responses covers a tremendously wide territory, yet it does not include, of course, all of the analyst’s responses to the patient. On what common ground is the above attitudes singled out to be called countertransference?
It seems, nonetheless, that the common factor in the above responses is the presence of anxiety in the therapist - whether recognized in awareness or defended against and kept of our awareness. The contrast between the dedicated attitude described as the ideal attitude of the analyst - or the analyst as an expert on problems of living, as Sullivan puts it-and the so-called countertransference responses, is the presence of anxiety, arising from the variety of sources in the whole field of patient-therapist interrelationships.
If countertransference attitudes and behaviour were to be thought of as determined by the presence of anxiety in the therapist, we might have an operational definition that would be more useful than the more descriptive one based on identifying patterns in the analyst derived from importantly past relationships. The definition would, of course, have to include situations both or felt discomfort and those where the anxiety was out of awareness and replaced by a defensive operation? Such a viewpoint of countertransference would be useful in that it would include all situations where the analyst was unable to be useful to the patient because of difficulties with his own responses.
The definition might be precisely stated as follows: When, in the patient-analyst relationship, anxiety is aroused in the analyst with the effect that communication between him and is interfered with by some alternation in the analyst’s behaviour (verbal or otherwise), then Countertransference is present.
The question might be asked, if countertransference were defined in this way, would the definition hold well for transference responses also? It seems that on a very generalized level this might be so, but on the level of practical therapeutic understanding such a statement would not be enlightening. While it could safely be said of every patient that he appearance of his anxiety or defensive behaviour in the treatment situation was due to an impairment of communication with the analysts that in turn was due to his attributing to the analyst some critical or otherwise disturbing attitude that in its turn was originally derived from his experience with his parents - still this would disregard the fact that the patient’s whole life pattern and his relation to all of the important authority figures in it would show a similar stereotyped defensive response. So that the early stages of treatment and to a lesser extent in later stages, the anxiety responses of the patient are for the most part generalized and stereotyped than explained with special reference to his relationship with the analyst.
This, however, is not true of the analyst. Having been analysed himself, most of such anxiety-laden responses as he has experienced with others have entered awareness and many of them have been worked through and abandoned in favour of more mature and integrated responses. What remains, then, not automatically represent sibling rivals? While it is possible that a particular, unusually competitive patient may still represent a younger sibling to an analyst who had some difficulties in his own life with being the elder child.
To speak of the same thing from another point of view, the analyst is not working on his problems in the analysis; he is working on the patient’s. Therefore, while the patient brings his anxiety responses to the analysis as his primary concern, the fact that the analyst’s problems are not under scrutiny permits him a greater degree of detachments and objectivity. This is, to be sure, only a relative truth, since the analyst at times and under certain circumstances is bringing his problems into the relationship, and at times, at least in some analyses, the attention of both the patient and the analyst are directed to the analysts' problems. However, it is on the whole valid to describe the analytic situation as one designed to focus attention on the anxieties of the patient and to leave in the background the anxieties of the therapist, so that when these do appear they are of particular significance as for the relationship itself.
The associative set classifications of countertransference responses are to classify the situation in analysis when anxiety-tinged processes are operating in the analyst. This is to the set classification as not as clear-cut separation of situational anxieties, nor are any of the responses to be thought of as entirely free of necrotic attitudes of the therapist. Even in the most extremer examples of situational stress (where ordinarily the analyst’s response is thought of as an objective response to th stress rather than a neurotic response), personal, characterological factors will colour his response, as will also the nature of his relationship with the patient. Take, for instances, the situation where the analyst comes to his office in a state of acute tension as the result of a quarrel with his wife. With one patient he may remain preoccupied with his personal troubles throughout the hour, while with another he may be able shortly to bring hid attention to the analytic situation. Something in each patient’s personality and method of production, and in the analyst’s response to each, has affected the analyst’s behaviour.
Anxiety-arousing situations in the patient-analyst interaction have been classified as follows: (1) situational factors - that is, reality factors such as intercurrent events in the analyst’s life, and, social factors such as need for success and recognition as a competent therapist (2) unresolved neurotic problems of the therapist, and (3) communication of the patient’s anxiety to the therapist.
The response to situational factors is, of course, very much influenced by the character make-up of the doctor. How much has the quality of being necessitated for conformity to convention he retains will influence his response to the patient who shouts loudly during an analytic session? Nevertheless, the response will always be affected by the degree of which his office is soundproof, whether there is another patient in the waiting room, whether a colleague in an adjoining office can overhear, and so on. So that, even leaving out the private characterological aspect of the situation for the therapist, there remains a sizable set of reality needs that, if threatened, will lead to unanalytic behaviour on his part.
The greatest number of these relates to the physician’s role in our culture. There is a high value attached to the role of a successful physician. This is not, of course, confined to the vague group of people known as the public, it is also actively present in the professional colleagues. There is a reality need for recognition of his competence by his colleagues, which has a dollars and cents value and an emotional one. While it is true that his reputation will not be made or broken by one success or failure, it does not follow that a suicide or psychotic breakdown in the patient does not represent a reality threat to him. Consequently, he cannot be expected to handle such threatening crises with complete equanimity. Besides, some realities need to be known as competent by his colleagues and the public, there is potent and valid need on the doctor’s part for creative accomplishment. This appears in the therapeutic situation as an expectation of and a need to see favourable change in the patient. It is entirely impossible for a therapist to participate in a treatment situation where the goal is improvement or cure without suffering frustration, disappointment, and at times anxiety when his efforts result in no apparent progress. Such situations are at times handled by therapists with the attitude: “Let him stew in his own juices until he sees that he should change,” or by the belief that he, the doctor, must be making an error that he dies not understand and should redouble his efforts. Frequently, the resolution of such a difficulty can be achieved by the realization by the therapist that his reality fear of failure is keeping him from recognizing an important aspect of the patient’s neurosis having done with making the responsibility for his welfare on another’s shoulders. The reality fear of failure can . . . neither be ignored nor put up with, so to speak, since an attempt by the therapist to remove it by ‘making’ the patient gets well is bound to increase the chances of failure.
Further difficulties are introduced by the traditional cultural definition of the healer’s role - that is, according to the Hippocratic oath. The physician-healer is expected to play a fatherly or even god-like role with his patient, in which he both sees through him - knows mysteriously what is wrong with his insides - and takes responsibility for him. This magic-healer role has heavy reinforcement from many personal motivations of the analyst for becoming a physician and a psychotherapist. These range from need to know other people’s secrets, as mentioned by Reich, to needs to cure oneself vicariously by curing others, needs for magical power to cover up one’s own feedings of weakness and inadequacy, needs to do better than one’s own analyst. Unfortunately, some aspects of psychoanalytical educating have a tendency to reinforce the interpretation of the therapist as a magically powerful person. The admonition, for instance, to become a ‘mature character’, while excellent advice, still carries with it a connotation of perfect adjustment and perhaps bring pressure to bear on the trainee not to recognize his immaturites or deficiencies. Even such precepts as ti is a ‘mirror’ or a ‘surgeon’ or ‘dedicated’ emphasize the analyst’s moral power in relation to the patient and, still worse, makes it as good technique. Since the analyst’s power, it is regrettably easy for both persons to participate in a mutually gratifying relationship that satisfies the patient’s dependency and the doctor’s need for power.
The main situation in the patient-doctor relationship that undermines the therapeutic role and therefore may result in anxiety in the therapist can be listed as follows: (1) when the doctor is helpless to affect the patient’s neurosis, (2) when the doctor is treated consistently as an object of fear, hatred, criticism, or contempt, (3) when the patient calls on the doctor for advice or reassurance as evidence of his professional competence or interest in the patient, (4) when the patient attempts to establish a relationship of romantic love with the doctor, and (5) when the patient calls on the doctor for other intimacy.
Unresolved neurotic problems of the therapist are a subject on which it is very difficult to generalize since such problems will be different in every therapist. To be sure, there are large general categories into which most therapists can be classified, and so certain overall attitudes may be held in common, as for instance the categories of the obsessional therapists who retain remnants of a compulsive need to be in control, or the masochistically overcompensated therapist who compulsively makes reparation to the patient, as described by Little.
One may scrutinize all analysts, from the top of the ladder to the bottom, and, as is obvious, will find characteristic types of patients chosen and characteristic courses of analytic treatment in each case. Gitelson seems to undervalue this factor when he says that the analyst “can no longer . . . grow to worsen of neither his personality nor its operation in the analytic situation as a significant factor . . . This is far from saying, however, that his personality is the chief instrument of the therapy that we call psychoanalysis. There is a great difference between the selection and playing of a role and the awareness of the fact that ones' own person has found himself cast for a part. Conducting himself is important for the analyst so that the analytic process proceeds by what the patient brings to it.”
It is not the selection. Playing of a role that creates the Countertransference problem of the average, and healthy analyst, but the fact that one habitually and incessantly plays a role determined by one’s character structure, so that one is at times hindered from seeing and dealing with the role in which one is cast by the patient.
It does, however, seem apparent that, to deal with the distortions introduced by the patient, the doctor needs to be aware of the following things: (1) that he has an unambiguous expression on his face when the patient arrives five minutes late for the first hour of therapy, and (2) that he annoyed (made anxious) by the patient’s imputation of malice to him. If he were aware of (1), he would. Perhaps, can interpret the fearful apologies of the patient with a question about why the patent thinks he is angry. If he were unaware of (1) or did not think it wise to interpret, still if he were aware of his anxiety reaction (2), he can probably recognize that his annoyance at being apologized to was leading to a sulky silence on his part. Once this was within awareness, the annoyance could be expected to lift and the therapeutic needs of the situation could be handled on their own merits.
Communication of the patient’s anxiety to the therapist proves most interesting and some mysterious phenomenons exhibited on occasion - and perhaps more frequently than we realize - by both analyst and patient. It seems to have some relationship to the process described as empathy. It is a well-known fact that certain types of persons are literally barometers for the tension level of other persons with whom they are in contact. Apparently cues are picked up from small shifts in muscular tension plus changes in voice tone. Tonal changes are more widely recognized to provide such cues, as evidenced by the common expression, “It wasn’t what he said but the way he said it.” Yet there are numbers of instances where the posture of a patient while walking into the consulting room gave the cue to the analyst that anxiety was present, although there was no gross abnormality but merely a slight stiffness or jerkiness to be observed. A similar observation can be made in supervised analyses, where the supervised communicate to the supervisor that he is in an anxiety-arousing situation with the patient, not by the material he related, but by some appearance of increased tension in his manner of reporting.
It is a mood point whether anxiety responses of therapists in situations where the anxiety is ‘caught’ from the patient can be considered entirely free of personal conflict by the analyst. Probably, habitual alertness to the tension level of others, however desirable a trait in the analyst, must have had its origins in tension-laden atmospheres of the past, and therefore must have specific personal meaning to the analyst.
The contagious aspects of the patient’s anxiety have been most often mentioned concerning the treatment of psychotics. In dealing with a patient whose defences are those of violent counter-aggression, not of an analyst experience of both fear and/or anxiety. The fear is on a relatively rational basis - the danger of suffering physically hurt. The anxiety derives from (1) retaliatory impulses toward the attacker,
(2) wounded self-esteem that one’s helpful intent is so misinterpreted by the patient, and (3) a sort of primitive envy of or identification with the uncontrolled venting of violent feelings. It has been found by experience in attempting to treat such patients that the therapist can function at a more effective level if he is encouraged to be aware of and handle consciously his irrational responses to the patient’s violence.
A milder variant of this response can frequently be found in office practice. It can be marked and noted that when the affect of more than usual intensity enters a treatment situation the analyst tends to interpret the patient. This interpretation may take any one of a variety of forms, such as a relevant question, an interpretative remark, a reassuring remark, a change of subject. Whatever its content, it dilutes the intensity of feeling being expressed and/or shifting the trend of the associations. This, of course, is technically desirable in some instances, but when it occurs automatically, without awareness and therefore without consideration of whether it is desirable or not, its occurrence must be attributed to uneasiness in the analyst. Ruesch and Prestwood have studied the phenomenon of communication of patients’ anxiety to the therapist, in which they proved that the communication is much more positively correlated with the tonal and expressive qualities of speech than with the verbal content. Such factors as rate of speech, frequently of use of personal pronouns, frequently of expressions of feeling. So on, showed significant variations in the anxious parent as contrasted with either the relaxed or the angry patient. In this study, the subjective responses of most psychiatrists while listening to sections of recorded interviews varied significantly according to the emotional tone of the material. A relaxed interview elicited a relaxed response in the listening psychiatrist; the anxious interviews were responded to with a variety of subjective feelings, from being ill-at-ease to being disturbed or angry.
These uncomfortable responses, coupled with many types of avoidance behaviours by the analyst, such as those mentioned in another place, appear to occur much more frequently than has been previously realized. Detecting it is difficult then by an ‘ear witness’, since the therapist himself will usually be unable to report them following through its intermittence of time. They were noticed to occur frequently in a study of intensive psychotherapy by experienced analysts carried out by means of recorded interviews.
If one accepts the hypothesis that even successfully analysed therapists are still continually involved in countertransference attitudes toward their patients, the question arises: What can be done with such reactions in the therapeutic situation? Experience suggests that the less intense anxiety responses, where the discomfort is within awareness, can be quickly handled by an experienced but not to of a neurotic analyst. These are probably chiefly the situational or reality stimuli to anxiety. Nevertheless, where awareness is interfered with by the occurrence of a variety of defensive operations, is there anything to be done? Is the analyst capable of identifying such anxiety-laden attitudes in himself and proceeding to work them out? Certainly there are such extreme situations that the unaided analyst cannot handle them and must seek discussion with a colleague or further analytic help for himself. However, there is a wide intermediate ground where alertness to clues or signals that all is not well may be sufficient to start the analyst on a process of self-resolution of the difficulty.
The following is a tentative and necessarily incomplete list of situations that may provide a clue to the analyst that he is involved anxiously or defensively with the patient. It includes signals that have been found useful in a basic supervision that it probably could be added to by others according to their particular experience, as (1) The analyst has a reasoning dislike for the patient, (2) The analyst cannot identify with the patient, who seems unreal or mechanical. When the patient reports that he is upset, the analyst feels no emotional response. (3) The analyst becomes overemotional as for the patient’s troubles. (4) The analyst likes the patient excessively, feels that he is his best patient. (5) The analyst dreads the hours with a particular patient or is uncomfortable during them. (6) The analyst is preoccupied with the patient to an unusual degree in intervals between hours and may find himself fantasying questions or remarks to be made to the patient. (7) The analyst finds it difficult to pay attention to the patient. He goes to sleep during hours, becomes very drowsy, or is preoccupied with personal affairs. (8) The analyst is habitually late with a particular patient or shows other disturbance in the time arrangement, such as always running over the end of the hour. (9) The analyst gets into arguments with the patient. (10) The analyst becomes defensive with the patient or exhibits unusual vulnerability to the patient’s criticism. (11) The patient seems to misunderstand the analyst’s interpretations consistently or never agrees with them. This is, of course, quite correctly interpreted as resistance of the patient, but it may also be the result of a countertransference distortion by the analyst such that his interpretations are wrong. (12) The analyst tries to elicit effect from the patient - for instance, by provocative or dramatic statements. (14) The analyst is angrily sympathetic with the patient regarding his mistreatment by some authority figure. (15) The analyst feels impelled to do something active, and (16) The analyst appears in the patient’s dreams as himself, or the patient appears in the analyst’s dreams. No sooner that apparently to broaden the scope of psychoanalytic therapy, to expedite and make more efficiently the analytic process, and to increase our knowledge of the dynamics of interaction, methods of studying the transference-countertransference aspects of treatment need to be developed. In that this can best be accomplished by setting up the hypothesis that countertransference phenomena are present in every analysis. This agrees with the position of Heimann and Little. These phenomena are probably frequently either ignored or repressed, partly because of a lack of knowledge of what to do with them, partly because analysts are accustomed to dealing with them in various nonverbal ways, and partly because they are sufficiently provocative of anxiety in the therapist to produce one or another kind of defence reaction. However, since the successfully analysed psychotherapists have tools at his command for recognizing and resolving defensive behaviour via the development of greater insight. The necessity for suppressing or repressing countertransference responses is not urgent. Where the analyst deliberately searches for recognition and understanding of his own difficulties in the interrelationship, his first observation is likely to be that he has an attitude similar to one of those aforementioned. With this as a signal, he may then, by further noticing in the analytic situation what particular aspects of the patient’s behaviour stimulate such responses in him, eventually find a way of bringing such behaviour out into the open for scrutiny, communication, and eventual resolution. For instance, sleepiness in the analyst is very frequently an unconscious expression of resentment at the emotional bareness of the patient’s communication, perhaps springing from a feeling of helplessness by the analyst. When the analyst recognizes that he is sleepy as a retaliation for his patient’s uncommunicativeness, and that he is making this response because, up too now, he has been unable to find a more effective way of handling it, the precipitating factor - the uncommunicativeness - can be investigated as a problem.
Beyond this use of his responses as a clue to the meaning of the behaviour of the patient, the analyst is also constantly in need of using his observations of himself as a means to further resolution of his own difficulties. For instance, an analyst who had doubts of his intellectual ability habitually overvalued and competed with his more intelligent patients. This would become particularly accentuated when he was trying to treat patients whom they used intellectual achievement as protection against fears of being overpowered. Thus the analyst, as the result of these overestimations of such a patient’s capacity, would fail to make ordinary, garden-variety interpretations, believing that there must be obvious to such a bright person. Instead, he would exert himself to point out the subtle manifestations of the patient’s neurosis, so that there would be much interesting talk but little change in the patients.
This type of error can go unnoticed while the analyst learns eventually that he is unable to treat successfully certain types of patients. However, it can also be slowly and gradually rectified as the result of further experience. In such a case, the analyst is learning on a nonverbal level. Even so, some such signal as finding himself fantasying questions or remarks to put to the patient in the next session is noted by the analyst, he then has the means of expediting and bringing into full awareness the self-scrutiny that can lead to resolution.
It will be noted that the focus of attention of these remarks is on the analyst’s own self-scrutiny, both of his responses to the patient’s behaviour and of his defensive attitudes and actions. Much has been said by others (Heimann, Little, and Gitelson) regarding the pros and cons of introducing discussion of countertransference material into the analytic situation itself. That, however, is a question that is not possible to answer in the present state of our knowledge. Its intentional means are to improving the analyst’s awareness of his own participation in the patient-analyst interaction and of improving his ability to formulate this to himself (or to an observer) clearly. Devising techniques for using such material in the therapeutic situation seems more feasible after the area has been more precisely explored and studied - or, concurrently with further study and explanation.
One further point might be added regarding the contrast between the subjective experience of the analyst when anxiety is not present and when it is. When anxiety is not present, he may experience a feeling of being at ease, of accomplishing something, of grasping what the patient is trying to communicate. Certainly in periods when progress is being made, something of the same feeling is shared by the patient, although he may at the same time be working through troubled areas. Perhaps the loss of the feeling that communication is going in the most commonly used signal that starts the analyst on a search for what is going wrong.
In daily life and the early phases of the analysis, the transference is usually integrated with the actual total personality relationship. However, in the sense of something complex, thinking of it separately is better, unless specifically qualified, whether as a latent potentiality, or as an actual emergent ego-dystonic, or objectively inappropriate phenomena (Anna Freud, 1954). For, as far as the phenomenon is true transference, it retains unmistakeably its infantile character. However, much of the given early relationship may have contributed to the genuine adult pattern of relationship (via identification, imitation, acceptance of teaching for example), its transference derivative differs from the latter, approximately in the sense that Breuer and Freud (1895) assigned to the sequella of the pathogenic traumatic experience, which was abreacted neither as such nor associatively absorbed in the personality. Given an object who has a special transference valence, in a situation that provides a unique mixture of deprivation, intimacy and deprivation, with (obligatory!) unilateral communicative freedom, minimization of actual observation, and with certain elements of form and mechanics reminisce of the infantile state, the tendency to pristine re-emergence of talent transference drives, until now incorporated in everyday strivings, in symptoms, or in character structure, is enormously heightening. That the transference is treated in a unique way in the analytic process are assuredly true, and remains of prime significance. However, at one time, this ment of the analytic situation on the transference, as if its emergent integrated form in relation to any other physician would be essentially the same phenomenon. Considered as an actual functional phenomenon, as different from a latent potentiality (in a sense, Metapsychological concept), this is rarely the case. The unique emotional vicissitudes of the psychoanalytic situation plus the de-integrated effect of free association and the interpretative method restore an infantile quality and intensity to the psychoanalytic transference, which lead to the development of the transference neurosis. Thus, to turn Freud’s original reservations and admonitions in an affirmative direction: The question of what is the optimum transference neurosis, or whether and how nearly is much more as the optimal type of transference neurosis can be caused, has always been, and remains, an important and general problem of psychoanalytic technique. This is, to be sure, no simple matter. The modest hope implicit of our topic, in that it may offer a rationale and some suggestions toward the avoidance of spurious and unduly tenacious intensities. The transference neurosis, like other (simpler) elements in the psychoanalytic situation, has an intrinsically dialectical character and position (Free association, for example, facilitates both exposure and concealment, can occasion either gratification or suffering.) This dialectical quality can (in part) be explained by the concept of two separate, although potentially confluent streams of transference origin. In relation to the equivocal factor of intensity in the transference neurosis, in that there is a certain deductibility to reasonableness in the conception that the elements of abstinence augmenting transference intensity should derive preponderantly from the formal, i.e., explicitly technical factors (which include non-response to primitive transference wishes) rather than from excessively rigorous deficits in human response, which the patient may reasonably except or require, and where the technical valence of such deprivation may be minimal or altogether dubious as to demonstrability.
It is now all but axiomatic that the transference is the indispensable power of the analytic process, and the phenomenon on whose evolution the potentiality for ultimate therapeutic change rests in analysis. As distinguished from other psychotherapies, and resolution of the transference neurosis, and the dissolution or minimization of the transference(s) as such, is one of the distinctive final goals of the interpretative method, it's of the essence because it might be said that insights into dynamic and genetic elements in the unconscious, or the functional extension of the ego’s hegemony in relationship to the id and superego, or other germane concepts, are ultimately more important. Still, these are all, certainly in an operational sense, largely if not exclusively, contingent on the thorough analysis of the transference neurosis.
The term ‘minimization of the transference(s) is used here because of the amounting scepticism regarding the likelihood of complete dissolution or extinction of the transference. The specific personal misidentifications and the specific personally directed wishes and attitudes that usually occupy us in the analytic process (i.e., ‘the transference’) can, in a practical clinical sense, usually be brought to adequate resolution. However, at this point, it should be made to emphasize that pathogenic component of the transference complex that underlies and is anterior to these clinical phenomena. The ‘adequate resolution’ of the clinically significant aspect or fraction of the transference frees the basic practically universal element, if it is not itself severely distorted, for integration in socially acceptable enthusiasms held in common with most other human beings and thus, in a sense, a part of the individual’s environmental reality. The particularity of mind is the general latent craving for an omnipotent parent, renewed and specifically coloured with, indeed given form, by, the conflicts and vicissitudes of each phase of development and developmental separation, a craving of such primitive power that it can produce the profound physiologic alterations of hypnosis, or bring into abeyance an individual’s own perceptual capacities or capacities for rational inference, even based on fewer spectacular vehicles for suggestion. For clarity of a statement, as in the ‘primary transference’ presupposes the accomplished shift to an object, as opposed to Freud’s other [germane] use of the term, frequently elaborated by Loewald ([1960]). This phenomenon is already dramatically evident in the young (three to six-month) infants' reaction to any moving bearer of a face as mother
(‘ . . . the representative of that infant’s security’ [Spitz. 1956]). It permeates our whole social organization, is obvious in religious attitudes, in charismatic ideologists of any type. In its narrowest stronghold, in the intellectual avant-garde, it invests questions of scientific validity and rational or empirical demonstration, facilitating irrational and inappropriate attitudes of loyalty or antagonism toward scientific leaders. Human infallibility is attributed to others than the Popes, and the Anti-Christ have parallels in the world of science. Our own field has often been a conspicuous example of this tendency. In the end, scientific perceptual striving, whose autonomy is always relative at best, becomes secondarily burdened, and inevitably suffers, because of this type of ambivalent group euphoria.
If it is the entanglement with early objects that elicits the infantile neurosis and lays the ground for its later representation in the transference neurosis, it is the clinical neurosis, the usual motivation for treatment, that lies between them, and is related to both, in a sense a ‘resistance’ both to genetic reconstruction of the former, or to current involvement on the latter. This is, a variation of Freud’s statement regarding the transference neurosis as an accessible ‘artificial illness’. Perhaps suggesting that unconscious recognition of the unique transference potentiality of the psychoanalytic situation is intimately connected both with the violent irrational struggle against is not extravagant, and the sometimes fanatical acceptance of, analysis as therapy (i.e., the general and intrinsic fascination of a relationship to ‘the doctor who gives no medicine’) by the patient to whom it is recommended (and by many, before the fact). What is always fundamentally wanted, in the sense of a primal transferee, with rare (relative) exceptions, is the original physician, who most closely resembles the parent of earliest infancy. The ‘doctor who gives no medicine’ is in unconscious deductibility may be that the parent of the repetitive phases of separation. To what extent this unconscious constellation participated in the discovery or creation of psychoanalysis as such would be pure speculation. However, Freud’s capacity for transference in the attachments of daily life was abundantly evident (Freud 1887-1902, Jones 1953-1957), and the importance of the relationship with Fliess in his self-analysis was explicitly stated (Freud, 1887-1902) That it plays an important part in the emotional life of many contemporary working analysts is very likely, since all (at this time) have experienced the role of analysand (or analytic patient): The vast majority are physicians, all have been physicians’ patients in a traditional sense, and, certainly, all have been dependent and helpless children. Ferenczi (1919) described the evolution of the general psychoanalytic countertransference as for initial excessive sympathy, through reactive coldness (‘the phase of resistance against the counter-transference’), to mature balance. Lewin (1946) in referring to this formulation (to contrast it with the sequence of traditional medical training) attributes the first phase to the first of the analyst’s having only recently been a patient himself. While Lewin carefully separates the cadaver (the student’s first ‘patient’) as an ‘object’ (psychoanalytic sense) from its qualities, we may speculate that a species of retaliatory mastery of the parental object (perhaps in contrast with the role of a helpless child) is sometimes involved in this gratification, and that something of this quality was carried into the dialectic genesis of the psychoanalytic situation. When referring to the ‘dialectic genesis’ of the psychoanalytic situation, it is to infer to its genesis largely in the genius of a physician who experienced the training to which Lewin refers. The dialectic is epitomized exquisitely in the role of speech, the bridge for personal separation, rejected or distorted by children in their desperate clinging to more gratifying or more violent object drives, or, on the other hand, sought eagerly as the indispensable vehicle for alterative ego-syntonic development aspirations (Nunberg [1951], regarding the ‘Janus’ quality of transference.)
The transference neurosis, as distinguished from the initial transference, usually supervenes after the treatment has lasted for a varying length of time. Its emergence depends on the combined stress of the situational dynamics, and the pressure of the interpretative method. The latter tend to close off habitual repetitive avenues of expression, such as new symptom formation, acting out, flight from treatment, etc. the neurosis differs from the initial transference, in the sense that it tends to reproduce in the analytic and germane extra-analytic setting an infantile dramatis personae, a complex of transference, with the various conflicts and anxieties attendant on the restoration of attitudes and wishes parallelling their infantile prototypes. The initial transference (akin to the ‘floating’ transference of Glover [1955]?) is a relatively integrated phenomenon, allied to character traits, an amalgam or compromise of conflicting forces, that has become established as a habitual attitude, the best resultant of ‘multiple function’ of which the personality is capable, in the general type of relationship that now confronts it? It differs from its everyday counterpart only in its relative separation from its usual or substantiation, and - eventually - in the failure of elicitation of the gratifications or adaptive goals to which it is devoted. As time goes on, varying as to intervals before, and character of, emergence, with the nuances of the patient’s personality organization and the analyst’s technical and personal approach, the unconscious specific transference attitude will press free expression against the defences with which they have been previously integrated, in varying mixtures of associational derivatives, symptomatic acts, dreams, often ‘acting out’, and manifest feelings. At this point (or better, in this zone of a continuum), conflict involving the psychoanalytic situation becomes quasi-manifest, and the transference neurosis as this is incipient. If there be but a brief and over simply outline illustration it is only because there are various interpretations of these terms.
A male patient may adopt a characteristically obsequious although subtly sarcastic attitude toward his older male analyst, quite inappropriate to the situation, but thoroughly habitual in all relations with older men. As time goes on, his wife and business partner becomes connected in his dreams with the analytic situation, his wife in the role of mother, the analyst as father, his business partner as older brother, with corresponding and related anxieties and frustrations of functionally dynamic contributions, in his business and sexual life. Violently hostile or sexually submissive or guilty attitudes may appear in direct or indirect relation to the analyst, in the patient’s manifest activities, or in the analytic material, in dynamic and economic connection with changes in the patient’s other relationships. The entire development is not equally particular to be announced in diffuse resistance phenomena in the analytic situation and processes (Glover, 1955). The transference neurosis as such can, of course, is endlessly elaborated; when extended beyond the point of effectively demonstrable relevance to the central transference, its resistance function may be in the foreground. It must be remembered that the whole array of strongly cathected persons in the individual’s development, and the related variety of attitudes, is all distributed, so to speak, from a single original relationship, the relationship with a mother in earliest infancy. In all of them, there are elements of ‘transference’ from this relationship, most conspicuously and decisively, of course, the shifting of hostile or erotic drives from the mother to the father. In a sense, then, the entire complex of the transference neurosis is a direct, although paradoxically opposed derivative of the basic attachment and unrenounced craving, which arises in relation to the primal object, the more complicated drama having a relation to the original object attachment like that which Lewin (1946) assigns to the elements of the manifest drama in relation to the dream screen. (This is, of course, related to Lewin’s interpretation [1955] of the analytic situation in terms of dream psychology.) Because in the analytic situation, the patient is again confronted with a unique relationship, on which, via the instrumentality of communication by speech, all other relationships and experiences tend to converge, emotionally and intellectually. In this convergence, however, there is a conspicuous differential, due to the intellectual or cognitive lag. In the latter sphere, the analyst’s autonomous ego functions play a decisive operational role, via his interpretations. In the genesis of this lag, an important role must be assigned to the original (reverse) differentially. Which may establish itself between the centrifugal distribution of primal object libido and aggression and the relatively autonomous energies of perception (the ego’s ‘activity?’). The detachment of libido and aggression from the primal object will have the course be contingent not only on their original intensities but on the special vicissitudes of early gratifications. If we consider the limitless panpsychic scope and potentiality of free association, we must assume that some shaping tendency gives the associations a form or pattern reasonably accessible to our perceptive and interpretative skill. It seems likely that this is the latent inner preoccupation with the elements of the transference neurosis, the original transference of which it is self composed, and finally the derivative vicissitudes of the primal object relationship itself, the primal transference.
Insofar as an individual has achieved more than a physical-perceptual linguistic separation from the primal object, the latter elements (i.e., the actual manifestations of primal transference) may play little or no important role in the empirical realities of a given analysis. Except in certain ‘borderline’ (and allied) problems, they are of Metapsychological importance. The problems of the derivative phase and structural conflicts largely occupy us in the analysis of the neurosis. In an individual of unusually fortunate neurosis (!), the transference neurosis (thus the analysis) may not require deeper penetration than the relatively integrated conflict phenomena of the Oedipus complex. In speech, of course, there is at one time a powerful and versatile vehicle of direct object relationship, and at the same time the marvellously elaborated communicative-referential instrumentality that can convey from one individual to another the subjectively experienced parts or whole of an inner and outer world of endlessly multiplied things, persons, qualities, and relationships, in intelligible code. This code, furthermore, is one whose mastery was originally of profound importance (in conjunction with other crucial maturational phenomena, such as an independent locomotion) in enabling the physical separation from the first object (in continuing relationship), and the gradual physical and mental mastery of the rest of the environment.
With regard to the countertransference, is that it has the same important and narrowing distinction from the other aspects of the current relationship and should be made as in the case of the patient’s transference: For here, too, an individual is involved in a complicated relationship with another human being in which a triplet of separate but constantly interacting and sometimes integrated modalities can be discerned. In a sense, since the patient has at least a considerable freedom of verbal and emotional expression, the analyst’s emotional burden is a heavier one. This, however, is like saying that the patient’s responsibility is greater than the child’s, or (to turn back to an earlier page!) That the surgeon carries a greater burden than his comfortably anaesthetized patiently. The analyst is, or should be, better prepared for this burden than his patient. Still, if we remove this entire question from the realm of professional moralism, self-debasement, or self-pity, we can all the more genuinely appreciate the essential message of the frequently contributions on the countertransference in recent years, i.e., the reminder that no one is ‘completely; (or, as Freud [1937] preferred, ‘perfectly’) analysed, that even those who may have approximately this as closely as may reasonably be expected, have specific vulnerabilities to certain individuals or situations, that these may appear in milder form or ephemerally, but nonetheless importantly with others; that, in fact, a self-analysis for the specific ‘counter-transference neurosis’ (Tower, 1956) with each case is, to varying degrees, as silent counterpoint, an integral part of all good analytic work. This would be true whether the counter-transference played its traditional impeding role or its more subtle favourable (i.e., ‘catalytic’) role (Tower, 1956) in a given analysis. One never knows where the usefulness of an unanalyzed reaction may end, and difficulties begin. Another important contribution, not separate, except in terms of emphasis, is the growing appreciation of the countertransference as an affirmative instrument facilitating perception, whereby a sensitive awareness of one’s incipient reactions to the patient, fully controlled and appropriately analysed in an immediate sense, leads to a richer and more subtle understanding of the patient’s transference strivings (Racker 1957, Weigert 1954). This would be opposite yet cognate to the understanding by transitory empathic identification (Reich, 1960). There is also the important attention (Money-Kyrle, 1956) to the specific vicissitudes of the analyst’s peculiarly constricted and emotionally inhibited therapeutic effort, and the mutual projective and introjective identification that may occur between analyst and patient in crises of technical frustration, i.e., frustration of the analyst’s understanding. The operational primacy of the latter function must be stressed. That is, that this function and the germane emotional attitude constitute central and essential ‘gratification’ for the patient’s ‘mature transference’ strivings, enabling his toleration, even positive unitization of the principle of abstinence, in relation to primitive transference demands. Loewald’s views (1960) are importantly related to these, perhaps, in a sense, complementary to them. An important connotation of these countertransference studies is the diminution of the rigid status barrier between analyst and analysand. They point to the patient in the physician, the child in the parent (a sort of latent or potential ‘seesaw’, to modify Phyllis Greenacre’s [1854] ‘titled relationship’!). This intellectual tendency can be, and is often, overdone, just as the magical power of the countertransference to determine the course of treatment has become an almost euphoric overwrought mystical belief among certain younger therapists, and, as a concept, a formidable source of resistance in the technically informed patient. Such exaggerated views, when not of specific and immediate emotional geneses, or due to ignorance, may be connected with a general lack of conviction regarding the efficacy of the therapist’s own analysis, or os the effectiveness of the interpretative method. There may be of a general lack of awareness or acceptance of the power that the original ‘tilt’ lens to the patient’s transference. Finally it is this ‘tilt’ in the situation, and (very importantly) the actuality of its representation in the respective emotional and intellectual states of the participants, on which we must rely. If temperately considered, a view of the relationship that gives great weight to the countertransference, is productively important. It places the operational attitude and technique of the analysis in better perspective, as an integration of several important factors that always include the Countertransference, and it permits an examination of nuances of technical decision on a much more illuminating and genuinely dependable basis than pure precedent, or rule-of-thumb, or pseudo-mathematical certainty. Thus, too foreign a patient in pain some aspirin or not, to inspect his eye for a foreign body or not, to tell him promptly where one ids going on vacation or not, may be right or wrong in either alterative, depending on the analyst’s own specific motivation or anxiety, compared with the patient’s actual need, or their objective clinical indications of the moment, weighted against the continuing and rationally interpreted convenience of technique. It is less likely that any manoeuver, assuming the adherence to basic broad technical principles, will create significant analytic distortion, if executed with genuine and exclusively therapeutic intentions’ appropriate to the need, than a manoeuver or default of manoeuver, based entirely or largely on exhibitionistic or seductive or anxious or compulsive reasons, however respectable the latter may seem. These principles, of course, assume the general analytic framework, and the maintenance of the principle of abstinence, insofar as it does not conflict with overriding human requirements, or does not reach beyond the subtle limits that have been sought to earlier discussion (Scheunert’s, 1961). The issue of the increment of unanswered innocuous questions, of injudiciously withheld expressions of reasonable human interest, where the human relationship requires them. Still it is related to the emotional opposition of the analyst, for a ‘rule’ obviously has a different meaning to an anxious or sadistic or compulsive person than to an individual not thus burdened. The general problem is germane to the perennial interest in why (beyond the usual verities or clichés) an individual becomes a physician, and specifically why he then chooses this physically and emotionally inhibited specialty, which depends do largely on benignly purposive frustration of the patient, on occasional informed talking, and possibly even more on extended and perceptive listening. Assuming that is reasonable, with the myriad individual factors, some general or common countertransference element enters the over determination both of choice of the medical profession and of the specialty that holds a unique position in the minds of medical men and patients alike. The uniqueness of this position is perhaps best suggested by the remarkably frequent query of the naive patient: “Are you really an MD.?” or “Are you a medical doctor too?” This is in a different intellectual realm, but surely related to the more informed discussion as to whether analysis is a brach of medicine, or a special development in psychology, or an entirely independent discipline. It is to suggest that, apart from more usual considerations the fascination and strain of analytics works are related to the same phenomenon that evokes the deductibility of which the patient reaction to it. Having to a mindful purpose in that the state of separation and of infantile deprivations that are integral in the situation, and the effort to utilize these toward solutions more favourable than those originally evolved. Setting aside the specific phase problems and other quantitative aspects of individual Countertransference, there will still be quantitative individual variations, tending toward excessive deprivation or overindulgence (for example), revolving about the central and necessary principle of abstinence in the psychoanalytic situation, whose skilful administration is a part of the basic occupational commitment. Insofar as ‘weaning’ is the great focal prototype of abstinence or deprivation, bringing to our attention to the historical vicissitudes of the word wean (Oxford English Dictionary, Vol. 12 [1933]) in which even a secondary (non-etymologic) developments of the alternative meaning ‘deprivingly of one's sanctity' has become obsolete. This is no doubt intertwined with cultural consideration far beyond out present scope of interest. However, it is also symbolically related to the (obsolescent?) Technical moods, which are felt to be restored to analytic work, with advantage.
In addition, on the interface of the analyst-patient interaction is not yet as to have become as focussing on the patient or the analyst. It is the nature of the integration, the quality of contact, what goes on between, including what is enacted. What is communicated effectively and/or unconsciously, that is addressed.
The apparent edge-horizon that is to form a resolution about that which ideally becomes the point of maximum and acknowledged contact at any given moment in a relationship without fusion, without violation of the separateness and integrity of each participant. Attempting to relate at this point requires ceaseless sensitivity to inner changes in oneself and in the other, as well as to changes at the interface of the interaction as these occur in the context of the spiral of reciprocal impact. This kind of effort has a reflexive impact on both participants, and this in turn influences what goes on between them in a dialectical way.
The interchanging edge thus is never static but becomes the trace of a constantly moving locus. Each time this is identified it is also changed, and as it is re-identified it changes again. The analytic expanse is enlarged significantly as aspects of the relationship that are generally not explicitly acknowledged or addressed, as well as their vicissitudes over time, are identified and explored in an analytic way. The emphasis is on process, on engaging live experience, and on generating a new kind of live experience by so doing, in an ever expanding way.
In some ways the focus is on what Winnicott (1971) refers to as the “continuity-contiguity moment” in relatedness. What distinguishes the conceptualized necessity for acknowledgement and explicitness seems the process of acknowledgement for increases the moment’s dimensional change to natures experiential obtainability. What is? , However, achieved is not simply greater insight into what or was, but what should be, as but a new kind of evidential experience.
Working at the circumferential horizon soon creates a unique contest of safety and allows for maximum closeness precisely because it protects against the threat of intrusion or violation. Attending to the most elusive interactive subtleties and ‘opening the moment’ and thus actualizes upon a natural way to detoxify and subjectively field, every bit as dangers of mystification, seduction. Coercion, manipulation, or collusion is minimized (Levenson 1972, 1983; Ehrenberg 1974, 1982; Feiner 1979, 1983; Gill 1982, 1983; Hoffman 1983). In some instances this makes it possible for both participants to engage aspects of experience and pathology that otherwise might be threatening, even dangerous.
The protection of the kind of analytic rigour that attending to interactive subtleties provides allows for more intense levels of effective engagement without the kind of risk this might otherwise entail.
In its gross effect, the apparent circumferential horizon is not simply art the boundary between self and other, but the given directions developing interpersonal closeness in the relationship, it is also at the boundary of self-awareness. It is a particular point as occupying a positional state in space and time of self-discovery, at which one can become more ‘intimate’ with one’s own experience through the evolving relationship with the other, and then more intimates with the other as one becomes more attuned to self. Because of this kind of dialectical interplay, the apparent favourable boundary becomes the undergoing maturation of the relationship.
As moment-by-moment change over in quality, that the relatedness and experience between analyst and patient are studied, individual patterns of reaction and reason-sensitivities can be identified and explored. This allows for the sparking awareness of choice, as existential decisions to become increasingly involved, or to withdraw, as well as the persuasive influences may be responsively ado, in that they can be studied in process, and the feelings surrounding these can be closely scrutinized. The patient’s spontaneous associations to the immediate experience often not only become an avenue to effectively charged memories of past experiential encounters that might not have been previously accessible but also allow for the metaphoric articulation of unconscious hopes, fears, and expectations, least of mention, few than there are less, have to no expectation whatsoever, or as even not to expect from expectation itself.
Even when the circumferential edge horizon is missed and there is some kind of intrusion or some failure to meet due to overcautiousness, the process of aiming for it, the marginal but mutual focuses on the difficulties involved, can facilitate its obtainable achievement. The effort to study the qualities of mutually spatial experiences in a relationship, the interlocking of both participants, including an interchangeable focus on the failure to connect or inauthenticate, or perhaps into a collusion, can thus become the bridge to a more approximative encounter.
The circumferential edge horizon is, therefore. Not a given, but an interactive creation. It is always unique to the moment and for reason-sensitivities to posit of themselves the specific participants in relation to each other and reflects the participant’s subjective sense of what is most crucial or compelling about their interaction at that present of moments.
Focussing on the interactive nuances in this way often requires a shift in perspective as to what is a figure and what is ground. For example, where a patient drifts into a fantasy that figuratively takes him or her out of the room, perhaps the affirmation to what is in Latin projectio, yet the interactive meaning is as important as the actual content (if not more so). Exploring what triggered the fantasy, and what its immediate interactive function might be, may help the patient grasp some of the subtler patterns of his or her own experiential flame, inasmuch as to grasp to its thought. While the content of the fantasy can provide useful clues to its distributive contribution of its dynamical function, staying with content may be a way for both patient and analyst to collude in avoiding engaging the anxieties of the moment.
Where some form of collusion does occur, as at times it inevitably will, demystifying the collusion has internal repercussions as well. The clarification of patterns of self-mystification (Laing 1965) that this makes it a possibly that being often liberating. It can facilitate a shift on the part of the patient from feeling victimized or helpless, stuck without any options, too freshly experiencing his or her own power and responsibility in relation to multiple choices.
For example, one patient who had difficulty defining where she ended and the other began was invariable in a constant state of anger with others for what she perceived as their not allowing her feelings, as how this operated between us, she realized that no one could control her feelings and that it was her inordinate need for the approval of others that were controlling her. It was her need to control the other, to control the other’s reaction to her, that was defining her experience. The result was that she began to feel less threatened and paranoid. She also was able to begin to deal analytically with the unconscious dynamics of her needs for approval and for control, and to focus on her anxieties in a way not possibly earlier.
We must then, ask of ourselves, are the afforded efforts to control the given as the ‘chance’ to ‘change’, or the given ‘change’ to ‘chance’? As a neutral type of the therapist participation proves to be essential to the resolution of the schizophrenic patient’s basic ambivalence concerning individuation - his intense conflict, that is, between clinging and a hallucinatory, symbiotic mode of existence, in which he is his whole perceived world, or on the other hand relinquishing this mode of experience and committing himself to object-relatedness and individuality - too becoming, that is, a separate person in a world of other persons. Will (1961) points out that just as ‘In the moves toward closeness the person finds the needed relatedness and identification with another, in the withdrawal (often marked by negativism) he finds the separateness that favours his feelings of being distinct and self-identified, and Burton (1961) says that “In the treatment, the patient’s desire for privacy is respected and no encroachment is made. The two conflicting needs war with each other and it is a serious mistake for the therapist to take sides too early.” The schizophrenic patient has not as to the experience that commitment too object-relatedness still allows for separateness and privacy, and where Séchehaye (1956) recommends that one “make oneself a substitute for the autistic universe that helped to offer as of a given choice that must rest in the patient’s hands.” This regarded primeval area of applicability of a general comment by Burton (1961) that ”In the psychotherapy of every schizophrenic a point is reached where the patient must be confronted with his choice. . . .” Of Shlien’s (1961) comment that “Freedom means the widest scope of choice and openness to experience . . . .”
Only in a therapeutic setting where he finds the freedom to experience both these modes of relatedness with one and the same person can the patient become able to choose between psychosis and emotional maturity. He can settle for this later only in proportion as he realizes that both object-relatedness and symbiosis are essential ingredients of healthy human relatedness - that the choice between these modes amounts not to a once-for-all commitment, but that, to enjoy the gratification of human relatedness he must commit himself to either object-relatedness or symbiotic relatedness, as the chancing needs and possibilities that the basic therapeutics requires and permit.
Such, as to say, the problem is to reconcile our everyday consciousness of us as agents, with the best view of what science tells us that we are. Determinism is one part of the problem. It may be defined as the doctrine that every event has a cause. More precisely, for any event as ‘e’, there will be some antecedent state of nature ‘N’, and a law of nature. ‘L’, such that given to ‘L’, ‘N’, will be followed by 'e'. Yet if this is true of every event, it is true of events such as my doing something or choosing to do something. So my choosing or doing something is fixed by some antecedent state ‘N’ and the laws. Since determinism is universal these in turn are fixed, and so backwards to events, for which I am clearly not responsible (events before my birth, for example). So no events can be voluntary or free, where that means that they come about purely because of free willing them, as when I could have done otherwise. If determinism is true, then there will be antecedent states and laws already determining such events? : How then can I truly be said to be their author, or be responsible for them? Reactions to this problem are commonly classified as: (1) hard determinism. This accepts the conflict and denies that you have real freedom or responsibility. (2) Soft determinism or compatibility. Reactions in this family assert that everything you should want from a notion of freedom is quite compatible with determinism. In particular, even if your action is caused, it can often be true of you that you could have done otherwise if you had chosen, and this may be enough to render you liable to be held responsible or to be blamed if what you did was unacceptable (the fact that previous events will have caused you to choose as doing so and deemed irrelevant on this option). (3) Libertarianism. This is the view that, while compatibilism is inly an evasion, there is a more substantive, real notion of freedom that can yet be preserved in the face of determinism (or of in determinism). While the empirical or phenomenal self is determined and not free, the noumenal or rational self is capable of rational, free action. Nevertheless, since the noumenal self exists outside the categories of space and time, this freedom seems to be of doubtful value. Other libertarian avenues include suggesting that the problem is badly framed, for instance because the definition of determinism breaks down, or postulating a special category of uncaused acts of volition, or suggesting that there are two independent but consistent ways of looking at an agent, the scientific and humanistic. It is only through confusing them that the problem seems urgent. None of these avenues accede to exist by a greater than is less to quantities that seem as not regainfully to employ to any inclusion nontechnical ties. It is an error to confuse determinism and fatalism. Such that, the crux is whether choice, is a process in which different desires, pressures, and attitudes fight it out and eventually result in one decision and action, or whether in attitudinal assertions that there is a ‘self’ controlling the conflict, in the name of higher desires, reasons, or mortality? The attempt to add such a extra to the more passive picture (often attributed to Hume), and is a particular target not only of Humean, but also of much feminist and postmodernist writing.
Thus and so, the doctrine that every event has a cause infers to determinism. The usual explanation of this is that for every event, there is some antecedent state, related in such a way that it would break a law of nature for this antecedent state to exist, and as yet the event not to happen. This is a purely metaphysical claim, and carries no implications for whether we can in a principal product the event. The main interest in determinism has been in asserting its implications for ‘free will’. However, quantum physics is essentially indeterministic, yet the view that our actions are subject to quantum indeterminacies hardly encourages a sense of our own responsibility for them.
As such, these reflections are simulated by what might be regarded as naive surprise at the impact of the renewed emphasis on the ‘here-and-now’ in our technical work during the last few years, including the early interpretations of the transference. This emphasis has been argued most vigorously by Gill and Muslin (1976) and Gill (1979). It has at times been reacting to, as if it were a technical innovation, and, of course, making it clear, all the same, from the persistence and reiteration that characterize Gill’s contributions, that he believes the “resistance to the awareness of transference” to be a critically important and neglected area in psychoanalytic work, this may deserve further emphasis. In Gill’s latest contribution of which as before, he concedes that the recall or reconstruction of the past remains useful but that the working out of conflict in the current transference is the more important, i.e., should have priority of attention. In view of the centrality of issues and its interesting place in the development of psychoanalysis, the contributory works of Gill and Muslin (1976). Gill (1979) presents a subtle and searching review and analysis of Freud’s evolving views on the interrelationship between the conjoint problems of transference and resistance and the indications for interpretation. Repeating this painstaking work would therefore be superfluous. Our’s is for a final purpose to state for reason to posit of itself upon the transference and non-transference interpretation and beyond this, to sketch a tentative certainty to the implications and potentialities of the ‘here-and-now’.
In a sense, the current emphasis may be the historical ‘peaking’ of a long and gradual, if fluctuating, development in the history of psychoanalysis. We know that Freud’s first re-counted with the transference, the ‘false connection’, was its role as a resistance (Breuer and Freud 1893-1895). While Freud’s view of this complex phenomenon soon came to include its powerfully affirmative role in the psychoanalytic process, the basis importance of the ‘transference resistance’ remained. In the Dynamics of Transference (1912) stated in dramatic figurative terms the indispensable current functions of the transference: “For when all is said and done, destroying anyone in absentia or in effigies is impossible.” In fact, to some of us, the two manifestly opposing forces are two sides of the same coin. As, perhaps, the relationship is eve n more intimate, in the sense that the resistance is mobilized in the first place b the existence of (manifest or - often - latent) transference. It is spontaneous protective reaction against loss of love, or punishment, or narcissistic suffering in the unconscious infantile context of the process.
Historically, the effective reinstatement of his personal past into the patient’s mental life was thought to be the essential therapeutic vehicle of analysis and thus its operational goal. This was, of course, modified with time, explicitly or in widespread general understanding. The recollection or reconstruction of an experience, however critical its importance, evidently did not (except in relatively few instances) immediately dissolve the imposing edifice of structuralized reaction patterns to which it may have importantly y contributed, this (dissolution) might indeed occur - dramatically - in the case of relatively isolated, encapsulated, and traumatic experiences, but only rarely y in the chronic psychoneuroses whose genesis was usually different and far more complex. Freud’s (1914) discovery of the process of ‘working through’, along with the emphasis on its importance, was one manifestation of a major process of recognition of the complexity, persuasiveness, and tenacity of the current dynamics of personality, in relation to both genetic and dynamic factors of early or origin. Perhaps Freud’s (1937) most vivid figurative recognition of the pseudoparadoxical role of early genetic factors, If not understood as part of a complex continuum, was in his “lamp-fire” critique of the technical implications of Rank’s (1924) Trauma of Birth. The term pseudoparadoxical is used because the recovery of the past by recollection or reconstruction - if no longer the sole operational vehicle and goal of psychoanalysis - retains a unique intimate and individual explanatory value, essential to genuine insight into the fundamental issues of personality development and distortion.
When Ferenczi and Rank wrote The Development of Psychoanalysis in 1924, they proposed an enormous emphasis on emotional experience in the analytic process, as opposed to what was thought to be the effectively sterile intellectual investigation the n in vogue. Instead of the speedy reduction of disturbing transference experience by interpretation, these authors, in a sense, advised the elucidation and cultivation of emotional intensities. (As Alexander pointed out in 1925, however, the method was not clear.) These alone could lend a vivid sense of reality and meaningfulness to the basic dynamism of personality incorporated in the transference. Now it is to be masted and marked that in this work, too, there is no ‘repudiation’ of the past. Ultimately genetic interpretations were to be made. The intense transference experience, as mentioned, was intended to give body, reality, to the living past. Yet, the ultimate significance of construction was invoked, in the sense of ‘supplying’ those memories that might not be spontaneously available. It was felt that the crucial experiences of childhood had usually been promptly repressed and thus not experiences in consciousness in any significant degree. Therapeutic effectiveness of the process was attributed largely to the intensity of emotional experience, than to the depth and ramifications of detained cognitive insight. The fostering in of transference intensity, as, we can infer, was rather by withholding or scantiness of interpretations (as opposed to making facilitating interpretations) and, at times (as specifically stared), by mild confirming responses or attitudes in the affective sphere: These would tend to support the patient’s transference affects in interpersonal reality (Ferenczi and Rank 1024).
This is, of course, different from the recent emphasis on ‘early interpretation of the transference (Gill and Muslin 1976), which in a process in the cognitive sphere designed to overcome resistance to awareness of transference and thuds to mobilize the latter as an active participant in the analysis as soon as possible. What they have in common is an undeniable emphasis on current experience, explicitly in the transference. Also, in both tendencies there is an implicit minimization of the vast and rich territories of mind and feeling, which may become available and at times uniquely informative if fewer tendentious attitudes govern the analyst’s initial approach. Correspondingly, in both there is the hazard of stimulating resistance of a stubborn, well-rationalized maturity by the sheer tendentious of approachment, and similarly transference tendency pursued assiduously by the analyst.
The question of the moments entering a sense of conviction in the patient (a dynamically indispensable state) is, of course, a complex matter. However, if one is to think that few would doubt that immediate or closely proximal experience (‘today’ or ‘yesterday’) occasions grater vividness and sense of certainty than isolated recollection or reconstruction of the remote past. Thus the “here-and-now” in analytic work, the immediate cognitive exchange and the important current emotional experiences, and, under favourable conditions, contributes to other elements in the process, i.e., recovery or reconstruction of the past, a quality of vividness deriving from their own immediacy, which can infuse the past with life. Obviously, it is the experience of transference affect that largely engages our attention in this reference. However, we must not ignore the contrapuntal role of the actual adult relationship between patient and analyst. Corresponding is indeed the actual biological constellation that bings the transference itself into being. At the very least, a minimal element of ‘resemblance’ to primary figures of the past is a sine quo non for its emergence (Stone 1954).
Nonetheless, this contribution up to and including Gill’s, Muslin’s (1976) and Gill’s (1979) are highly-developed. However, did not introduce alternations in the fundamental conceptions of psychopathology and its essential responses to analytic techniques and process. Yet, there are, of course, varying emphases - namely quantitative - and corresponding positions as to their respective effectiveness. As Strachey states, "there is an approach to actual substantive modification in the keystone position assigned to introjective super-ego change as the essential phenomenons of analytic process - and possibly in the exclusive role assigned to transference interpretations as ‘mutative’.
A related or complementary tendency may be discerned in Gill’s (1979) proposal that “analytic situation residues” from the patient’s ongoing personal life, insofar as they are judged transferentially significant in free association, is brought into relation with the transference as soon as possible, even if the patient feels no prior awareness of such a relationship. It is as if all significant emotional experience, including extra-analytic experiences, could be viewed as displacement or mechanisms of concealed expression of his transference. That this is very frequently true of even the most trivial-seeming actual allusions to the analytic would, in that, the thoroughly extra-analytic references constitute a more subtle and different problems, ranging from dubiously interpretably minor issues to massive forms of destructive acting out connected with extreme narcissistic resistances and utterly without discernible 'analytic situation residues'. The massive forms are, of course, analytic emergencies, requiring interpretation. Still, such interpretation would usually depend on the awareness of the larger ‘strategic situations (Stone 1973), rather than on a detail of the free association communication (granting the latter’s usefulness, if present - and recognizable). However, the fact of the past or the historical as never entirely abandoned or nullified, becoming more even, the role assigned to it may be pale or secondary. That the preponderant emphasis on concealed transference may ultimately, constitute an “actually existing” change in technique and process, with its own intrinsic momentum.
The Ferenczi and Rank technique included, in effect, a deliberate exploitation of the transference resistance, especially in the sense of intense emotional display and discharged. While the polemical emphases of these authors are on (affective) experiences as the sine non of true analytic process - the living through of what was never fully experienced in consciousness in the past (with ultimate translation into ‘memories’, i.e., constructions) - the actual techniques (with a few exceptions) are not clearly specified in their book. For a detailed exposition of the techniques learned from Ferenczi, with wholehearted acceptance, as in the paper of De Forest (1942), which includes the deliberate building up of dramatic transference intensities by interpretative withholding and the active participation of the analyst as a reactive individual. Also included is the active directing of all extra-therapeutic experience into the immediate experiential stream if the analysis. The extreme emphasis on affective transference experience became at one time a sort of vogue, appearing almost as an end and measured by the vehemence of the patient’s emotional displays. In Gill’s own revival of and emphasis on a sound precept of classical techniques (preceded by the 1976 paper of Gill and Muslin), fundamentally different from that of Ferenczi and Rank in its emphasis, one discerns an increment of enthusiasm between the studied, temperate, and well-argued paper of (1979) and the later paper of the same year (1979), which includes similar ideas greatly broadened and extended ti a degree that is, in it's difficultly to accept.
Now, what is it that may actually be worked out in the present - (1) as a prelude to genetic clarification and reduction of the transference neurosis or (2) as a theoretical possibility in its own right without reliance on the explanatory power or specific reductive impact of insight into the past? First some general considerations of whether or not one is an enthusiastic proponent of ‘object relations theory’ in any of its elaborate forms, seems self-evident that all major developmental vicissitudes and conflicts have occurred in the context of important relations with important objects and that they or their effects continue to be reflected in current relationships with persons of similar or parallel importance. That we assume that the psychoanalytic situation (and its adjacent ‘ extended family’) provides a setting in which such problems may be reproduced in their essentials, both effectively and cognitively.
There is something deductively engaging in the idea that an individual must confront and solve his basic conflicts in their immediate setting in which they arise, regardless of their historical background. Certainly this is true in the patient’s (or anyone else’s) actual life situation. Some possible and sometimes state corollaries of this view would be that the preponderant resort to the past, whether by recollection or reconstruction, would be largely in the service of resistance, in the sense of a devaluation of the present and a diversion from its ineluctable requirements. It would be as if the United Kingdom and Ireland would undertake to solve the current problems in Ulster essentially by detailed discussion of Cromwell’s behaviour a few centuries ago. Granted that the latter might indeed illuminate the historical contribution of some aspects of the current sociopolitical dilemma, there are immediate problems of great complexity and intensity from which the Cromwell discussion might indeed by a diversion, if it were magnified beyond it's clear but very limited contribution, displacing in importance the problematical social-political-economic altercation of the present and the recent clearly accessible and still relevant past. As with so many other issues, Freud himself was the first to note that resort to the past may be involved by the patient to evade pressing and immediate current problems. In conservative technique, it has long been noted that some judicious alternations of focus between past and present, according to the confronting resistances trend, may be necessary (for example, Fenichel 1945). However, it was Horney (1939) who placed the greatest stress on the conflict and the greatest emphasis on the recollection trend as supporting resistance.
Now, from the classical point of view, the emphasis is quite different. The original conflict situation is intrapsychic, within the patient, though obviously engaging his environment and ultimately - most poignantly and productively - his analyst. This culminates in a transference neurosis that reproduces the essential problems of the object relationships and conflicts of his development. Thus, in principle, the vicissitudes of love or hate or fear, etc., do not require, or even admit of, ultimate solution in the immediate reality, perceived and construed as such. The problem is to make the patient aware of the distortions that he has carried into the present and of the defensive modes and mechanisms that have supported them. Obviously, the process (‘tactical’) resistances present themselves first for understanding; later there are the ‘strategic’ resistances (i.e., those not expressed in manifest disturbances of free association) (Stoner 1973). Insofar as the mobilization of the transference and the transference neurosis is accorded a uniquely central holistic role in all analyses, the ‘resistance to the awareness of transference’, becomes a crucial issue, the problem of interpretive timing on which a controversial matter from early. Ultimately the bedrock resistance, the true ‘transference resistance’, must be confronted and dissolved or reduced to the greatest possible degree. Such a reduction is construed as largely dependent on the effective reinstatement of the psychological prototype of current transference illusions, with an ensuing sense of the inappropriateness of emotional attitudes in the present and the resultant tendency toward their relinquishment. In a sense, the neurosis is viewed as an anachronistic but compelling investitures of the current scene within unresolved conflict of the past. When successfully reduced, this does appear to have been the accessibly demonstrable phenomenology.
What then may be carried into the analytic situation from the ‘hard-nosed’ paradigm of the struggle with every day, current reality, with advantage to the process? We have already made mention, in that the sense of conviction, or ‘sense of reality’ - affective and cognitive - which originates in th immediacy of process experience. It is our purpose and expectation that, with appropriate skill and timing, this quality of conviction may become linked too other, fewer immediate phenomena, at least in the sense of more securely felt perceptions, including first the fact of transference and ultimately its accessible genetic origins. What furthers? Insofar as the transference neurosis tends toward organic wholeness, a sort of conflict ‘summary’ by condensation, under observation in the immediate present, one may seek and find access in it, not only to the basic conflict mentioned, but to uniquely personal mode of defence and resistance, revealed in dreams, habits of free association, symptomatic acts, parapraxes, and the more direct modes of personal address and interaction that are evident in every analysis. Further, in this view, although not always as transparent as one would wish, this remarkable condensation of effect, impulse, defence, and temporary conflict solution adumbrates more dependably than any other analytic element (or grouping of elements) the essential outlines of the field of obligatory analytic work of a given period of the patient’s life. In it is the tightly knotted tangle deprived from the patient’s early or prehistoric life enmeshed in him actualities of the analytic situation and his germane and contiguous ongoing life situations.
Also, in the sphere of the “here-and-now,” and of extensive importance, is the role of actualities in the analytic situation. Whether in the patent’s everyday life or in the analytic relationship, the even-handed, open-minded attention to the patient’s emotional experience (especially his suffering or resentment) as to what may be actual, as opposed too ‘neurotic’ (i.e., illusory or unwittingly provoked) or specifically transferential, is not only epistemologically deductive for reason that is also a contribution to the affective soundness of the basic analytic relationship and thus of inestimable importance. At the risk of slight - very slight - exaggeration, in that with excepting instances of pathological neurotic submissiveness, as a patient who wholeheartedly accepted the significance his neurotic or transference-motivated attitudes or behaviour if he felt that ‘his reality’ was not given just due. Furthermore, even the exploration and evaluation of complicated neurotic behaviour must be exhaustive to the point where a spontaneous urge to look for irrational motivations is practically on the threshold of the patient ‘s awareness. Once, again, one must stress the impact of such a tendency on the total analytic relationship. For, not only are the quality and mood of utilization of interpretations, but ultimately the subtleties of transition from a transference relationship to their realities of the actual relationship depend, on a greater degree than has been made explicit, on the cognitive and emotional aspects of the ongoing experience in the actual sphere. Greenson (1971, 1972. Wexler 1969) devoted several of his last papers to this important subject. The subject, of course, includes the vast spheres of the analyst’s character structure and his countertransference. However, more than may be at first apparency, can reside in the sphere of conscious consideration of technique e and attitude in relation to a basic rationale.
However, apart from the immediate function of painstaking discrimination of realities and the impact of this attitude on the total situation, there remains the important question of whether important elements of true analytic process may not be immanent in such trends of inquiry. The vigorous exploration and exposure of distortions in object relations, via the transference or in the affective and behavioural patterns of everyday life, including defence functions, can conceivably catalyse important spontaneous changes in their own right. To further this end, the traditional techniques of psychoanalysis will, of course, be utilized. As an interim phenomenon, however, the patient struggle to deal with distortions, as one might with other error subject to conscious control or pedagogical correction. It is to reasons of conviction that such a tendency may be productive (both as such, and in its intrinsic c capacity to highlight neurotic or conflictive fractions) and has been insufficiently exploited. Nonetheless, there is no reason that the specific dynamic impact of th past is lost or neglected in its ultimate importance, in giving attention to a territory that is, in itself, of a great technical potentiality.
Practitioners and theorists such as Horney (1939) or Sullivan (1953) did not reject the significance of the past, even though its role and proportionate position, both in process and theoretical psychodynamics, was viewed differently. The persisting common features in these views would be a large emphasis on sociological and cultural forces and the focussing of technical emphasis on immediate interpretation transactions.
Granted that various technical recommendations of both dissident and ‘classical’ origin, including those on the nature and reduction of the transference, sometimes appear to devaluate the operational importance of the genetic factor, this devaluation is not supported by the clinical experience of most of those that were indeed of closely scrutinizing it as part of the confessio fidei of major deviationists. Certainly, both in theoretical principle and in empirical observation, this essential direction of traditional analytic process remains of fundamental importance. Conceding the power and challenge of cumulative developmental and experiential personality change and the undeniable impact of current factors, it remains true that the uniquely personal, decisive elements in neurosis, apart from constitution, originate in early individual experience. How to mobilize elements into an effectively mutual function is largely a technical problem and - in seeming paradox - relies to a considerable degree on the skilful handling of the “here-and-now.” The purposive technical pursuit of the past has not been clinically rewarding. That the ultimate effort to recover an integrated early material in dynamic understanding may not always be successful, especially in severe cases of early pathogenesis is, of course, evident (for example, Jacobson 1971). In such instances, while our preference would be otherwise, we may have to remain largely content with painstaking work in the “here-and-now,” illuminated to whatever degree possible by reasonable and sound, if necessarily broad, constructions dealing largely with ego mechanisms than primitive anatomical fantasies. In other events, sometimes after years of painstaking work, even large and challenging characterological behavioural trends that have been viewed, clarified, and interpreted in a variety of current transference, situational (even cultural) references will show striking rottenness in earl y experience, conflict, and conflict solution whose explanatory value then achieves a mutative force that remains uniquely among interpretative manoeuvres or spontaneous insights. To this end, the broader aspects of ‘strategic’ resistance (Stone 1973) must be kept in mind, a much subtle element of countertransference and counterresistance.
It would seem proper that at this point of giving to a summation of the current ferment regarding the “here-and-now” of which any number of valuable critique and theoretical and technical suggestions that may help us to improve the analytic effectiveness, it would seem that the emphasis on the “here-and-now” interpreting not only consistently with but also ultimately indispensable for genuine access to the critical dynamism deriving from the individual’s early development. Nor is this reflexive, assuming the technical sophistication - inconsistent with the understanding and analysis of continuing developmental problems, character crystallization and the influence of current stresses as such. Adequate attention to the character as a complex interpretational group permits the clear and useful emergence in or the analytic field of significant early material, as defined by the transference neurosis between the technical approaches and that of Gill (1979, 1979), apart from certain larger issues. Whereas Gill would apparently recommend searching out ‘day residues’ of probable transference in the patient’s responses to the analysis or analyst and in his account of his daily life and offer possible alternative explanations to the patient’s direct and simple responses to them as self-evident realities, first relying on the acceptance and exploration of the patient’s ‘reality’, with the possibility that this will incidently favour the relatively spontaneous precipitation of more readily available transference materials, this general Principle does not, of course, obviate or exclude the other alternatives as something preferable?
Consideration of the interaction between the two adult personalties in the analytic situation requires a mixture of common sense and interest in self-evident (although often ignored) elements, on the one hand, and abstrusely psychological and Metapsychological considerations, on the other.
Thus, if we set aside from immediate consideration questions regarding the ‘real relationship’ and accept as a given self-evident fact that the entire psychoanalytic drama occurs (without our question or permission) between two adults in the “here-and-now” the residual is due becomes the management of the transference, which has been a challenging problem since the phenomenon was first described. Let us assume, for purposes of brevity, that few would now adhere to the principle that the transference is to be interpreted only when it becomes a manifest resistance (Freud 1912). It is in fact always a resistance and at the same time a propulsive force (Stone 1962, 1967, 1073). It has long since been recognized that an undue delay of well-founded transference interpretations (regardless of the state of the patient’s free association) can seriously hinder progress in analysis, and further, it cas augment the dangers of acting out or neurotic flight from the analysis by the patient. The awareness of such danger has been clearly etched in psychoanalytic consciousness since e Freud’s (1905) insight into the end of the Dora case.
Apart from the hazzards inherent in technical default, nonetheless, there has developed over the years with increasing momentum, perhaps in some relations of the increasing stress on the transference neurosis as a nuclear phenomenon of process. The affirmative active address to the transference, i.e., to the analysis - or some by time is the active interpretative bypassing - of the ‘resistances to the awareness of transference
. . . operational emphasis on the countertransference, the tendency - in rational for a proportion - must be regarded as an important integral component of a progressively evolving psychoanalytic method. That individuals vary in their acceptance of technical devotion to this tendency is to be note (as indicated earlier), but its widespread practice by thoughtful analysts cannot be ignored, by the importance of its disregarded note of countransference among analysts, which would tend to restore n earlier emphasis digestedly approach to historical material and avoidance of early or excessive; transference historical material and the avoidance of earlier excessive’ transference interpretation.
A few words about our view on th relatively a circumscribed problem of transference interpretation. It is of the belief of longstanding conviction that the economic aspects of transference distribution are critically important, although largely ignored the seeking utilization of this consideration, a broad directional sense, by distinguishing between the potential transference of the analytic situation and those of the typical psychotherapeutic situation (as beyond that, the transference of everyday life. These varying their degree of emergence and their special investment of transference objects with the intensiveness of contact, with the structural emends of deprivation, and with the degree of regressive attention the operation of the rule of abstinence, which is, of course, most highly developed and consistently maintained in the traditional psychoanalytic situation (Stone 1961). Thus although subject to constant infirmed monitoring, the transference can be as medical, at least latently directed ultimately toward the analyst (compared with the cooperated persons in their environment).
Now, under what conditions and with what provisions should the awareness of such transference potentialities be actively mobilized? Obviously, the original precept regarding its emergence as resistance still trued in its implied affirmative aspect but is no longer exclusive. Further, there are, without question, early transference ‘emergences’ that must be dealt with by an active interpretive approach: For example, the early rapid and severe transference regression of borderline patients or the less common some timely seriously impeding erotic transference fulminations in neuronic patients. These are special instances in which the indications seem clear and obligatory.
The central situation, nonetheless, is the ‘average’ analysis (with apologies!), where the latent transferences tend to remain ego-dystopia, warded off, deploring slowly over periods, and manifesting themselves by a variety of derivative phenomena of variable intensity. Surely, dreams, parapraxes, and trends of free association will reveal basic transference directions very early. However, when should these be interrelated to the patient if he is effectively unaware of them? Again, ‘all things' being equal’, an old principle of Freud’s suggested for all interpretative interventions (as opposed, for example, to clarification), is applicable: That unconscious elements are interpreted only when the patient evidences a secure positive attachment the analyst. Yet, this would not obtain in the fact of the ‘emergencies’ of growing erotic or aggressive intensities, certainly of ‘acting out’ is incipient. The disturbing compilations (even in the ‘erotic’ sphere) occur most often when basic transferences are ambivalent (largely hostile) or coloured by intense narcissism. Therefore, in relation to Freud’s valuable precept, it may be understood that in certain cases, the interpretation of ambivalent hostile transferences may be obligatory prerequisite to the establishment o f the genuinely positive climate that required. In such instances of obligatory intervention, the manifestations that require them are usually quite explicit,
Again, then, what about the relatively uncomplicated case, the chronic neurotic, potentially capable of relatively mature relations to objects? Still, the coping with complications do not seem as in question. There are, a few essential conditions and one cardinal rule. First the patient’s sense of reality and his common sense must not be abruptly or excessively tax, lest, in untoward reaction, his constructive imaginative capacities become unavailable. Preliminary explanations and tentative preparatory ‘trail’ interventions should be freely employed to accustom him to a new view of the world. The traditional optimum for interpretation (when the patient is on the verge of perceiving its content himself [Freud 1940] is indeed best, although it must sometimes be neglected in favour of an active interpretative approach. Second, the patient’s sense that the vicissitudes and exigencies of his actual situation are understood and respected must be maintained
Beyond these considerations, the essential principle is quite simple. If it is assumed that - in the intensive, abstinent, traditional psychoanalytic situation (as differentiated from most psychotherapeutic situations) - the transference (ultimately the transference neurosis) is ‘pointing’ toward the unconscious trend is heavily weighted in this direction, there is still a manifest element of movement toward other currently significant objects. Thus, a latent economic problem assumes clinical form: Essentially, the growing magnitude of transference cathexes of the analyst’s person, as withdrawn to varying degree from important persons in the environment with whom most of the patient’s associations usually deal. There is a point, or a phase, in the evolution of transference in which analytic material (often priori to significant subjective awareness) indicates the rapidly evolving shift from extraanalytic objects to the analyst. In this interval (early in some, later in others) the analyst’s interventions, whether in direct substantive form or aimed at resistances to awareness of transference, often become obligatory and certainly most often successful in mobilizing affective emphasis into the “here-and-now” of the analytic situation. The vigorous anticipatory interpretations suggested by some may be helpful in many instances (at least as preparatory manoeuvres) if (1) the analyst is certain of his views, in terms of not only the substance but the quantitative (i.e., economic) situation (2) the patient’s state soundly receptive (according to well-established criteria) (3) neither the patient’s realities nor his sense of their realities are put to unjustified questions or implicit neglect (4)a sense of proportion regarding the centrality of issues, largely as indicated by the outline of the transference neurosis (of their adumbration), are maintained in a real consideration. This will avoid the superfluous multiplication of transference references that like the massing of scatted genetic interpretations (familiar in the past), can lead to a ‘chaotic situation’ resembling that against which Wilhelm Reich (1933) inveighed. This will be more striking with a compliant patient who can as readily become bemused with his transference as with his ‘Oedipus’ or his ‘anality.’
Once the affective importance of the transference is established in the analysis, a further (hardly new) question arises, with which some of us have sought to deal in a therapist. Even if some agrees that transference interpretations have a uniquely mutative impact, how exclusively must we concentrate on them? Moreover, to what degree and when are extraanalytic occurrences and relationships of everyday life to be brought into the scope of transference interpretation? With regard to the concentration of transference interpretation alone: a large, complex, and richly informative worlds of psychological experience are obviously attention if the patient ‘s extra therapeutic life is ignored. Further, if the transference situation is unique in an affirmative sense, it is also unique by deficit. To revile at the analyst, for example, is a different experience from reviling at an employer who might ‘fire’ the patient or from being snide to a co-worker who might punch him (Stone 1067 and Rangell 1979). Such experiences are also components if the “here-and-now” (granted that the “here”aspect is significantly vitiated), and they do merit attention and understanding in their own right, specially in the sphere of characterology. Certain complex reaction pasterns cannot become accessible in the transference context alone.
At the time of speaking it is true that many spectacular extraanalytic behaviours can, and should be seen as displacements (or ‘acting out’) of the analytic transference or in juxtaposed ‘extended family’ relation to it, especially where they involve consistent members of an intimate dramatis personae? While such ‘extra-therapeutic’ transference interpretations (often clearly Germaine to the conflicts of the transference neurosis) can be indispensable, the confronting vigour and definiteness with which they are advanced (as opposed to tentativeness) must always depend on the security of knowledge of preceding and current unconscious elements that invest the persons involved.
Finally, there are incidents, attitudes, and relationships to persons in the patient’s life experience who are not demonstrably involved in the transference neurosis, yet evoke importantly and characteristic responses whose clarification and interpretation may contribute importantly to the patient’s self-knowledge of defences, character structure, and allied matters. Nonetheless, such data may occasionally show a vitalizing direct relationship to historical materials. It would not seem necessary or desirable that such material be forced into the analytic transference if the patient does not respond to a tactful tentative trail in this connection, for example, the ‘alternative’ suggestion proposed by Gill (1979). For the economic considerations that often obtain, and it may be that certain concurrent transference cluster, not readily related to the mainstream of transference neurosis, retain their own original extra-therapeutic transference investment. In some instances, a closer, more available e relationship to the transference mainstream may appear later and lend itself to such interpretative integration. In so doing, happening is likely if obstinate resistances have not been simulated by unnecessary assault on the patients' sense of immediate reality, or his sense of his actual problems. As for metapsychology, one may recall also that all relationships, following varying degrees of development and conflict vicissitudes, are derived greatly from the original relationship to the primal object (Stone 1967), even if their representations are relatively free of the unique ‘unneutralized’ cathexes that characterize active transference (‘transfer’ verus ‘transference’: Stern 1957).
Caring for a better understanding, to what the concerning change, as seen in the psychotherapy of schizophrenic patient, and particularly in reference to the sense of personal identity, may to this place be clearly vitiated in material that relates to extra-therapeutic experience, whether this is seen ‘in its own right’ or as displaced transference. The direct transference experience occurs in relations an individual who knows his own position, i.e., knows ‘both sides’ as in no other situation. (Even where there are interposing countertransference. There are at least susceptible to a self-analysis). This can never be true in the analysis of an extra-therapeutic situation, as there is no inevitable cognitive deficit. For this we must try to compensate by exercising maximal judgement, by exploiting what is revealed about the patient himself in sometimes unique situations, and by being sensitive to the growing accuracy of his reporting as the analyst progresses. Epistemologic deficits' are intrinsic in the very nature of analytic work. This is but one important example.
We need to be alert to the respects in which the concepts and technique of our particular science may lend themselves to the repression, in us and our patients, of anxiety concerning change.
Our necessary delineation of the repetitive patterns between the transference and countertransference tends to become so preoccupying as to obscure the circumstance that, as Janet M. Rioch phrases it, “What is curative in the [analytic] process is that in tending to reconstruct in which the analyst that an atmospheric state that obtained in childhood, the patient effectively achieves something new” (Rioch 1943).
Our necessarily high degree of reliance upon verbal communication requires us to be aware of the extent to which grammatical patterns having a tendency to segment and otherwise render static our ever-flowing experience; this has been pointed out by Benjamin (1944); Bertrand Russell (1900), Whorf (1956) and others. The tendency among us to regard prolonged silence for being given to disruptiveness in the analytic process, or evidence per se of the patient’s resistance to it, may be due in part to our unconscious realization that profound personalty-change is often best simplified by silent interaction with the patient; therefore, we have an inclination to press forward toward the crystallization of change-inhibiting words.
What is more, our topographical views of the personality a being divisible into the area’s id, ego, and superego, are so inclined to shield us from the anxiety-fostering realization that, in a psychoanalytic cure, change is not merely quantitative and partial
as of “Where id was, there shall Ego be,” in Freud’s dictum, but qualitative and all-pervasive. Apparently such data system in a passage is to provide accompaniment for Freud, as he gives a picture of personality-structure, and of maturation, which leaves the inaccurate but comforting impression that at least a part of us - namely, a part of the id - is free from change. In his paper entitled Thought for the Times on War and Death. In 1915, he said, "the evolution of the mind shows a peculiarity that is present in no other process of development." When a village grows into a town, a child into a man, the village, and the child become submerged in the town and the man. . . . It is in other considerable levels that the accompaniment with the development of the mind . . . the primitive stage [of mental development] can always be re-established; the primitive mind is, in the fullest meaning of the word, imperishable (Freud 1915).
In Introductory Lectures on Psycho-Analysis, he says that “in psychoanalytic treatment. . . . By means of the work of interpretation, which transform what is unconscious into what is conscious, the ego is enlarged at the expense of this unconscious.” In the Ego and the Id, he said that, " . . . the ego is that part of the id modified by the direct influence of the external world . . . the pleasure-principle . . . reigns unrestricted by the id. . . . The ego represents what may be called reason and common sense, in contrast to the id, which contains the passions” (Freud 1923).
Glover, in his book on Technique published in 1955, states similarly that, . . .” A successful analysis may have uncovered a good deal of the repressed . . . [and] have mitigated the archaic censoring functions of the superego, but it can scarcely be expected to abolish the id” (Glover 1955).
Favorably to have done something to provide by some measure, conviction, feeling, mind, persuasion, sentiment used to form or be expressed of some modesty about the state of development of our science, and about our own individual therapeutic skills, should not cause us to undertake the all-embracing extent of human personality growth in normal maturation and in a successful psychoanalysis. Presumably we have all encountered a few fortunate instances that have made us wonder whether maturation really leaves any area of the untouched personality, leaves any steel-bound core within which the pleasure principle reigns immutably, or whether, instead, we have a genuine metamorphosis, from a former hateful and self-seeking orientation to a loving and giving orientation, quite as wonderful and thoroughgoing as the metamorphosis of the tadpole into the frog or that of the caterpillar into the butterfly.
Freud himself, in his emphasis upon the ‘negative therapeutic reaction’ (1923), the repetition compulsion, and the resistance to analytic insight that he discovered in his work with neurotic patients, has shown the importance, in the neurotic individual, of anxiety concerning change, and he agrees with Jung’s statement that ‘a peculiar psychic inertia, hostile to change and progress, is the fundamental condition of neurosis’ (Freud 1915). This is, even more true of the psychosis - so much so that only in very recent decades have psychotic patients achieved full recovery through modified psychoanalytic therapy. Also, it has instructively to explore and deal the psychodynamics of schizophrenia as for the anxiety concerning change which one encounters, in a particular intense degree, at work in these patients, and of ones own, inasmuch as for treating them. What the therapy of schizophrenia can teach us of the human being’s anxiety concerning change, can broaden and deepen our understanding of the non-psychotic individual also.
Further, we see that during his development years he lacks adequate models, in his parents or other parent-figures, with whom to identify about the acceptance of outer changes and the integration of inner change as personality-maturation throughout adulthood. Alternatively, these are relatively rigid persons who, over the years, either/or tenaciously resist change, if anything becomes progressively constricted, fostering him in the conviction that the change from a child into adult is more loss than gain - that, as one matures, fewer feelings and thoughts are acceptable, until finally one is to attain, or be confined to, the thoroughgoing sterility of adulthood. The sudden, unpredictable changes that puncture his parent’s rigidity, due to the eruption of masses of customarily-repressed material in themselves, make them appear to him, for the time being, like totally different persons from their usual selves, and this adds to his experience that personality-change is something that is not to be striving for, but avoided as frighteningly destructive and overwhelming.
We find evidence that he is reacting to, by his parents during his upbringing, predominantly concerning transference and projection, for being the reincarnation of some figure or figures from their own childhood, and the personification of repressed and projected personality-traits in themselves. Thus he is called upon by them, in an often unpredictably changing fashion, to fill various rigid roles in the family, leaving him little opportunity to experience change as something that can occur within himself, as a unique human individual, in a manner beneficial to himself.
When the parents are not relating to him in such a transference fashion they are, it appears, all too often narcissistically absorbed in them. In either instance, the child is left largely in a psychological vacuum, in that he has to cope essentially alone with his own maturing individuality, including the intensely negative emotions produced by the struggle for individuality in such a setting. Because his parents are afraid of the developing individual in him, he too fears this inner self, and his fear of what is heightening parenthetical parents within investing him with powers, based upon the mechanisms of transference and projection that by it's very nature does not understand, powers that he experiences as somehow flowing from himself and yet not an integral part of himself nor within his power to control. As the years bring tragedies to his family, he develops the conviction that he somehow possesses all ill-understood malevolence that is totally responsible for these destructive changes.
In as far as he does discover healthy maturational changes at work in his body and personality, changes that he realizes to be wonderful and priceless, he experiences the poignant accompanying realization that there is no one there to welcome these changes and to share his joy. The parents, if sufficiently free from anxiety to recognize such changes at all, have a tendency to accept them as evidence that their child is rejecting then by growing functionally. Also to be noted, in this connexion, is their lack of trust in him, their lack of assurance that he is elementally good and can be trusted to maturational bases of a good healthy adult. Instead they are alert to find, and warn him against, manifestations in him that can be construed as evidence that he is on a predestined, downward path into an adulthood of criminality, insanity, more at best ineptitude for living.
Moreover, he emergences change not as something within his own power to wield, for the benefit of himself and others but as something imposed from without. This is due not only to structures that the parents place upon his autonomy, but also to the process of increasing repression of his emotions and life as, such that when this latter manifest themselves, they do so in a projected expressive style, for being uncontrollable changed, inflicted upon him from the surrounding world? We see extreme examples of this mechanism later on. In the full-blown schizophrenic person who experiences sexual feelings not as such but as electric shocks sent into him from the outside world, and who experiences anger not as an emerging emotion directorially fittingly as in a way up from within, but a massive and sudden blow coming somehow from the outer world. In fewer extreme instances, in the life of the yet-to-become-schizophrenic youth, he finds repeatedly that when he reaches out to another person, the other suddenly undergoes a change in demeanour, from friendliness to antagonism, in reaction to an unwitting manifestation of the youths’ unconscious hostility. The youth himself, if unable to recognize his own hostility, can only be left feeling increased helplessness in face of an unpredictably changeable world of people.
The final incident that occurs before his admission to the hospital, giving him still further reason for anxiety as for change, is his experience of the psychotic symptoms as an overwhelming anxiety-laden and mysterious change. His own anxiety about this frightened away by the seismic disturbance and horror of the members of his family who finds hi ‘changed’ by what they see as an unmitigated catastrophe, a nervous or mental ‘breakdown’. Although the therapist can come to see, in retrospect, a potential positive element via this occurrence - namely, the emergence of onetime-repressed insights concerning the true state of affairs involving the patient and his family, none of those participants can integrate so radically changed a picture at that time. Over the preceding years the family members could not tolerate their child’s seeing himself and them with the eyes of a normally maturing offspring, and when repressed percepts emerge from repression in him, neither they nor he possesses the requisite ego-strength to accept them as badly needed changes in his picture of himself and of them. Instead, the tumult of depressed percepts foes into the formation of such psychotic phenomena as misidentifications, hallucinations, and delusions in which neither he nor the member of his family can discern the links to reality that we, upon investigation in individual psychotherapy with him, can find in these psychotic phenomena - links, that is, to the state of affairs that has really held sway in the family. Paretically, it should be marked and noted that the psychotic episode often occurs in such ac way as to leave the patient especially fearful of sudden change, for in many instances the de-repressed material emerges suddenly and leads him to damage, in the short space of a few hours or even moments, his life situation so grievously that repair can be affected only very slowly and painfully, over many subsequent months of treatment in the confines of a hospital.
It should be conveyed, in that the regression of the thought-processes, which occurs as one of the features of the developing schizophrenia, results in an experience of the world so kaleidoscopic as to make up still another reason for the individual’s anxiety concerning change. That is, as much as he has lost thee capacity to grasp the essentials of a given whole - to the extent that he has regressed to what Goldstein (1946) terms the ‘concrete attitude’ - he experiences any change, even if it is only in an insignificant (by mature standards) detail of that which he perceives, as a metamorphosis that leaves him with no sense of continuity between the present perception and that immediately preceding. This thought disorder, various aspects of which have been described also by Angyal (1946), Kasanin (1946), Zucker (1958), and others, is compared by Werner with the modes of thought that are found in members of so-called primitive cultures (and in healthy children of our own culture): . . . in the primitive mentality, particulars often as self-subsisting things that do not necessarily become synthized into larger entities. . . . The natives of the Kilimanjaro region do not have a word for the whole mountain range that they inhabit, only words for its peaks. . . . The same is reported of the aborigines of East Australia. From each twist and turn of a river has a name, but the language does not permit of a single all-embracing differentiation for the whole river. . . . [He] quotes Radin (1927) as saying that for the primitive man: “A mountain is not thought of as a unified whole. It is a continually changing entity’ . . . [and, Radin continues, such a man lives in a world that is] ‘dynamic and ever-changing . . . Since he sees the same objects changing in their appearance from day to day, the primitive man regards this phenomenon as definitely depriving them of immutability and self-subsistence’ (Werner 1957).
Langer (1942) has called the symbolic-making function ‘one of man’s primary activities, like eating, looking, or moving about. It is the fundamental process of his mind’, she says, as she terms the need of symbolization ‘a primary need in man, which other creatures probably do not have’. Kubie (1953) terms the symbolizing capacity ‘the unique hallmark of man . . . capacities’, and he states that it is in impairment of this capacity to symbolize that all adult psychopathology essentially consists.
As for schizophrenia, we find that since 1911 this disease was described by Bleuler (1911) as involving an impairment of the thinking capacities, and in the thirty years many psychologists and psychiatrists, including Vigotsky (1934) Hanfmann and Kasanin (1942) Goldstein (1946) Norman Cameron (1946) Benjamin (1946) Beck (1946) von Domarus (1946) and Angtal (1946) - to mention but a few - has described various aspects of this thinking disorder. These writers, agreeing that one aspect of the disorder consists in over -concreteness or literalness of thought, have variously described the schizophrenic as unable to think in figurative (including metaphorical) terms, or in abstractions, or in consensually validated concepts and symbols, mor in categorical generalizations. Bateson (1956) described the schizophrenic as using metaphor, but unlabelled metaphor.
Werner (1940) has understood this most accurately matter of regression to a primitive level of thinking, comparable with the found in children and in members of so-called primitive cultures, a level of thinking in which there is a lack of differentiation between the concrete and the metaphorical. Thus we might say that just as the schizophrenic is unable to think in effective, consensually validated metaphor, as too as he is unable to think in terms that are genuinely concrete, free from an animistic forbear of a so-called metaphorical overlay.
The defensive function of the dedifferentiation that in so characterized of schizophrenic experience, and one find that this fragmentation o experience, justly lends itself to the repression of various motions that are too intense, and in particular too complex, for the weak ego to endure, which must be faced as one becomes aware of change as involving continuity rather than total discontinuity.
That is, the deeply schizophrenic patient who, when her beloved therapist makes a unkind or stupid remark, experiences him now for being a different person from the one who was there a moment ago - who experiences that a Bad Therapist has replaced the Good Therapist - is by that spared the complex feeling of disillusionment and hurt, the complex mixture of love and anger and contempt that a healthier patient would feel then. Similarly, if she experiences it in tomorrow’s session - or even later in the same session - that another good therapist has now come on the scene. The bad therapist is now totally gone, she will feel none of the guilt and self-reproach that a healthier patient would feel at finding that this therapist, whom she has just now been hated or despising, is after all a person capable of genuine kindness. Likewise, when she experiences a therapist’s departure on vacation for being a total deletion of him from her awareness, this bit of discontinuity, or fragmentation, in her subjective experience spars her from feeling the complex mixture of longing, grief, separation-anxiety, rejection, rage and so on, which a less ill patient feels toward a therapist who is absent but of whose existence he continues to be only too keenly aware.
Finally, such repressed emotions as hostility and lust may readily be seen, as these feelings not easy to hear expressed, as, for instance, the woman, who, at the beginning of her therapy, had been encased for years I flint lock paranoid defenses, become able to express her despair by saying that “If I had something to get well for, it would make a difference,” her grief, by saying, “The reason I am afraid to be close to people is because I feel so much like crying”: Her loneliness, by expressing a wish that she would turn an insect into a person, so then she would have a friend. Her helplessness in face of her ambivalence by saying, to her efforts to communicate with other persons, “I feel just like a little child, at the edge of the Atlantic or Pacific Ocean, trying to build a castle - right next to the water. Something just starts to be gasped [by the other person], and then bang! It has gone - another wave. As joining the mainstream of fellow human beings.
In the compliant charge of bringing forward three hypotheses are to be shown, they're errelated or portray in words as their interconnectivity, are as (1) in the course of a successful psychoanalysis, the analyst goes through a phase of reacting to, and eventually relinquishing, the patient as his oedipal love-object, (2) in normal personality development, the parent reciprocates the child's oedipal love with greater intensity than we have recognized before, and (3) in such normal developments, the passing of the Oedipus complex is at least important a phase in ego-development as in superego-development.
While doing psycho-analysis, time and again patients who have progressed to, or very far toward, a thorough going analysis to cure, become aware of experiential romantic and erotic desires and fantasies. Such fantasizing and emotions have appeared in a usual but of late in the course of treatment, have been preset not briefly but usually for several months, and have subsided only after having experienced a variety of feelings - frustration, separation anxiety, grief and so forth - entirely akin to those that attended as the resolution of an Oedipus complex late in the personal analysis.
Psycho-analysis literature is, in the main. Such as to make one feel more, rather than less, troubled at finding in oneself such feelings toward one's patient. As Lucia Tower (1956) has recently noted, . . . Virtually every writer on the subject of countertransference . . . states unequivocally that no form of erotic reaction to a patient is to be tolerated . . .
Still, in recent years, many writers, such as P. Heimann (1950), M. B. Cohen (1952) and E. Weigert (1952, 1954), have emphasized how much the analyst can learn about the patient from noticing his own feelings, of whatever sort, in the analytic relationship. Weigert (1952), defining countertransference as emphatic identification with the analysand, has stated that . . . "In terminal phases of analyses the resolution of countertransference goes hand in hand with the resolution of transference."
Respectfully, these additional passages are shown in view of countertransference, in the special sense in which defines the analyst for being innate, inevitable ingredients in the psycho-analytic relationship, in particular, the feelings of loss that the analyst experiences with the termination of the analysis. However, case in point, that the particular variety of countertransference with which are under approach is concerned that of the analyst's reacting as a loving and protective parent to the analysand, reacted too as an infant: There are plausible reasons why in the last phase it is especially difficult to achieve and maintain analytic frankness. The end of analysis is an experience of loss that mobilizes all the resistances in the transference (and in the counter-transference too), for a final struggle. . . . Recently, Adelaide Johnson (1951) described the terminal conflict of analysis as fully reliving the Oedipus conflict in which the quest for the genitally gratifying parent is poignantly expressed and the intense grief, anxiety and wrath of its definitive loss are fully reactivated. . . . Unless the patient dares to be exposed to such an ultimate frustration he may cling to the tacit permission that his relation to the analyst will remain his refuge from the hardships of his libidinal cravings to an aim-inhibited, tender attachment to the analyst as an idealized parent, he can get past the conflicts of genital temptation and frustration.
. . . . The resolution of the counter-transference permits the analyst to be emotionally freer and spontaneous with the patient, and this is an additional indication of the approaching end of an analysis.
. . . . When the analyst observes that he can be unrestrained with the patient, when he no longer weighs his words to maintain as cautious objectivity, this empathic countertransference and the transference of the patient are in a process of resolution. The analyst can treat the analysand on terms of equality; he is no longer needed as an auxiliary superego, an unrealistic deity in the clouds of detached neutrality. These are signs that the patient's labour of mourning for infantile attachments nears completion.
In stressing the point, which before an analysis can properly bring to an end, the analyst must have experienced a resolution of his countertransference to the patient for being a deep beloved, and desired, figure not only on this infantile level that Weigert has emphasized valuably, but also on an oedipal-genital level. Weigeret's paper, which helped to formulate the views that are set down, that is, as expressing the total point that a successful psycho-analysis involves the analyst's deeply felt relinquishment of the patient both as a cherished infant, and for being a fellow adult who is responded to at the level of genital love?
The paper by L. E. Tower (1956) comes similarly close to the view that, unlike Weigert, limits the term counter-transference to those phenomena that are transferences of the analyst to the patient. It is much more striking, therefore, that she finds even this classification defined countertransference to be innate to the analytic process: . . . . That there is inevitably, naturally, and often desirable, many countertransference developments in every analysis (some evanescent - some sustained), which is a counterpart of the transference phenomena. Interactions (or transactions) between the transference of the patient and the countertransference of the analyst, going on at unconscious levels, may be - or perhaps are always - of vital significance for the outcome of the treatment. . . .
. . . . Virtually every writer on the subject of countertransference. States unequivocally that no form of erotic reaction to a patient is to be tolerated. This would suggest that temptations in this area are great, and perhaps ubiquitous. This is the one subject about which almost every author is very certain to state his position. Other 'counter-transference' manifestations are not routinely condemned. Therefore, it must be to assume that erotic responses to some extent trouble nearly every analyst. This is an interesting phenomenon and one that call for investigation; nearly all physicians, when they gain enough confidence in their analysts, report erotic feelings and imply toward their patients, but usually do so with a good deal of fear and conflict. . . .
Of our tending purposes, we are to pay close attention to the libidinal resources that are of our applicative theory, in that large amounts of resulting available libido are necessary to tolerate the heavy task of many intensive analyses. While, we deride almost every detectable libidinal investment made by an analyst in a patient . . . various forms of erotic fantasy and erotic countertransference phenomena of a fantasy and of an affective character are in some experiential ubiquitous and presumably normal. Which lead to suspect that in many - perhaps every - intensive analytic treatment there develops something like countertransference structures (perhaps even a 'neurosis') which are essential and inevitable counterparts of the transference neurosis. These countertransference structures may be large or small in their quantitative aspects, but in the total picture they may be of considerable significance for the outcome of the treatment. They function in the manner of a catalytic agent in the treatment process. Their understanding by the analyst may be as important to the final working through of the transference neurosis as is the analyst's intellectual understanding of the transference neurosis itself, perhaps because they are, so to speak, the vehicle for the analyst's emotional understanding of the transference neurosis. Both transference neurosis and countertransference structure seem intimately bound together in a living process and both must be considered continually in the work that is the psychoanalysis. . . .
. . . . Seemingly questionable, is any thorough working through a deep transference neurosis, in the strictest sense, which does not involve some form of emotional upheaval in which both patient and analysts are involved. In other words, there are both a transference neurosis and a corresponding Countertransference 'neurosis' (no matter how small and temporary) which are both analyzed in the treatment situation, with eventual feelings of a new orientation by both one another toward any other but themselves.
Freud, in his description of the Oedipus complex (1900, 1921, 1923), tended largely to give us a picture of the child as having an innate, self-determined tendency to experience, under the conditions of a normal home, feelings of passionate love toward the parent of the opposite sex; we get little hints, from his writings, that in this regard the child enters a mutual relatedness of passionate love with that parent, a relatedness in which the parent's feelings may be of much the same quality and intensity as those in the child (although this relatedness must be very important in the life of the developing child than it is in the life of the mature adult, with his much stronger, more highly differentiated ego and with his having behind him the experience of a successfully resolved oedipal experience during his own maturation).
Nevertheless, in the earliest of his publications concerning the Oedipus complex, namely The Interpretation of Dreams (1900), Freud makes a fuller acknowledgements of the parent's participation in the oedipal phase of the child's life than does in any of his later writings on the subject". . . a child's sexual wishes - if in their embryonic stage they deserve to be so described - awaken very early. . . . A girl's first affection is for her father and boy's first childish desires are for his mother. Accordingly, the father becomes a disturbing rival to the boy and the mother to the girl. The parents too give evidence as a rule of sexual partiality: A natural predilection usually sees to it that a man tends to spoil his little daughters, while his wife takes her sons' part; though both of them, where their judgement is not disturbed by the magic of sex, keep a strict eye upon their children's education. The child is very well aware of this patriality and turns against that one of his parents who is opposed to showing it. Being loved by an adult does not merely bring a child the satisfaction of a special need; it also means that he will get what he wants in every other respect as well. Thus, he will be following his own sexual instinct and while giving fresh strength to the inclination shown by his parents if his choice between them falls in with theirs (1900).
Theodor Reik, in his accounts of his coming to sense something of the depths of possessiveness, jealousy, fury at rivals, and anxiety in the face of impending loss, in himself regarding his two daughters, conveys a much more adequate picture of the emotions that genuinely grip the parent in the oedipal relationship than is conveyed by Freud's sketchy account, as Reik's deeply moving descriptions occupy a chapter in his Listening with the Third Ear (1949), written at the time when his daughters were twelve and six years of age; and a chapter in his The Secret Self (1952), when the oldest daughter was now seventeen.
Returning to a further consideration of the therapist's oedipal-love responses to the patient, it seems that these response flows from four different sources. In actual practice the responses from these four tributaries are probably so commingled in the therapists that it is difficult of impossible fully to distinguish one kind from another; the important thing is that he is maximally open to the recognition of these feelings in himself, no matter what their origin, for he can probably discern, in as far as is possible, from where they flow they signify, therefore, concerning the patient's analysis.
First among these four sources may be mentioned the analyst's feeling-responses to the patient's transference. This, when, as the analysis progresses and the patient enter an experiencing of oedipal love, ongoing, jealousy y, frustration and loss as for the analyst as a parent in the transference, the analyst will experience to at least some degree, response's reciprocally th those of the patient-responses, that is, such for being present within the parent in questions, during the patient's childhood and adolescence, which the parent presumably was not ably to recognize freely and accept within himself. Some writers apply the term 'counter-transference' to such analyst-responese to the patient's transference, unlike others some do not do so.
The second source consists in the countertransference in the classical sense in which this term is most often used: The analyst's responding to the patient about transference-feelings carried over from a figure out of the analyst 's own earlier years, without awareness that his response springs predominantly from this early-life, rather than being based mainly upon the reality of the patient analyst-patient relationship. It is this source, of course, which we wish to reduce to a minimum, by means of thoroughgoing personal analysis and ever-continuing subsequent alertness for indications that our work with a patient has come up against, in us, unanalyzed emotional residues from our past. This source is so very important, in fact, as to make the writing of such a paper as a somewhat precarious venture. Must expect that some readers will charge him with trying to portray, as natural and necessary to the annalistic process generally, certain analyst-responese that in actuality is purely the result of an unworked-through? Oedipus' complex in himself, which are dangerously out of place in his own work with patients that have no place in the well-analysed analyst's experience with his patient.
It can only be surmised that although this source may play an insignificant role in the responses of a well-analysed analyst who has conducted many analyses through to completion - to an intensified inclusion as a thoroughgoing resolution of the patient's Oedipus complex - it is probably to be found, in some measure, in every analyst. This is, it seems that the nature and conflictual feeling-experience in this regard - a fostering of his deepest love toward the fellow human being with whom she participates in such prolonged and deeply personal work, and a simultaneous, unceasing, and rigorous taboo against his behavioural expression of any of the romantic or erotic components of his love - as to require almost any analyst's tending to relegate the deepest intensities of these conflictual feelings to his own unconscious mind, much as were the deepest intensities of his oedipal strivings toward a similar beloved, and similarly unobtainable and rigorously tabooed, parent in particular, and in the hope of the remaining in the analyst's unconscious. That is hoping that this will help analysts - in particular, to a lesser extent-experienced analyst - whereas to some readers awareness, and by that diminution, of this countertransference feeling, as justly dealing with other kinds of countertransference feelings, by such as those wrote by P. Heumann (1950, M. B., Cohen (19520 and E. Weigert (1952?)
A third source is to be found in the appeal that the gratifyingly improving patient makes to the narcissistic residue in the analyst's personality, the Pygmalion in him. He tends to fall in love with this beautifully developing patient, regarded at this narcissistic level as his own creation, just as Pygmalion fell in love with the beautiful statu e of Galatea that he had sculptured. This source, like the second one that we can expect to holds little sways in the well-analysed practitioner of long experience, but it, too, is probably never absent of great experience and professional standing, than we may like to think. Particularly in articles and books that describe the author's new technique or theoretical concept as an outgrowth of the work with a particular patient, or a very few patients, do we see this source very prominently present in many instances.
The fourth source, based on the genuine reality of the analyst-patient situation, consists in the circumstance that nearly becomes, per se, a likeable, admirable and insightfully speaking lovable, human being from whom the analyst will soon become separated. If he is not himself a psychiatrist, the analyst may very likely never see him again. Even if he is a professional colleague, the relationship with him will become in many respects far more superficial, far less intimate, than it has been. This real and unavoidable circumstance of the closing analytic work tends powerfully to arouse within the analyst feelings of painfully frustrated love that deserve to be compared with the feelings of ungratifiable love that both child and parent experience in the oedipal phase of the child's development. Feelings from this source cannot properly be called countertransference. They may flow from the reality of the present circumstances but they may be difficult or impossible e to distinguish fully from countertransference.
There are, then four essentially powerful sources having to promote of the tendency toward the feelings of deep love with romantic and erotic overtones, and with accompanying feelings of jealousy, anxiety, frustration-rage, separation-anxiety, and grief, in the analyst about the patient. These feelings come to him, like all feelings, without tags showing from where they have come, and only if he is open and accepting to their emergence into his awareness does he have a chance to set about finding out their origin and thus their significance in his work with the patient.
Finally, with which the considerations have been presented so far, a few remarks concerning the passing of the Oedipus complex in normal development and in a successful psycho-analysis.
In the Ego and the Id (1923) we find italicized a passage in which Freud stresses that the oedipus phase results in the formation of the superego; we find that he stresses the patient's opposition to ther child's oedipal swosh, and lastly, we see this resultant suprerego to be predominantly a severe and forbidding one: The broad general outcome of the sexual phase dominated by the Oedipus complex may, therefore, be taken to be the forming of a precipitating in the ego . . . This modification of the ego
. . . comforts the other contents of the ego as an ego ideal or super-ego.
. . . . The child's parents, and especially his father, were perceived as the obstacle to verbalizations of his Oedipus wishes, so his infantile ego fortified itself for the carrying out of the repression by building this obstacle within itself. It borrowed the strength to do this, so to seek, from the father, and this loan was an extraordinarily nonentous act. The super-ego retains the character of the father, while the more powerful the Oedipus complex was and the more rapid succumbed to repression (under the influence of authority, religious teachings, schooling and reading), this strictly will be the domination of the super-ego over the ego later on - as conscience or perhaps of an unconscious sense of guilt. . . .
The subject dealt within the subjective matter through which generative pre-oedipal origins are to be found of the superego, on which has been dealt by M. Klein (1955). E. Jacobson (1954) and others, also apart from that subject, a regard for Freud's above-quoted description as more applicable to the child who later becomes neurotic or psychotic, than to the 'normal'; child. Since we can assume that there is virtually a wholly complimentary neurotic difficulty, we may then have in assuming that Freud's formation holds true to some degree in every instance. Still, to the extent that a child's relationships with his parents are healthy, he finds the strength to accept the unrealizibilityy of his oedipal strivings, not mainly through the identification with the forbidding rival-parent, but mainly, as an alternative, the ego-strengthening experiences of finding the beloved parent reciprocate his love - responds to him, that is, for being a worthwhile and loveable individual, for being, a conceivably desirable love-partner - and renounces him only with an accompanying sense of loss on the parent's own part. The renunciation, again, something that is mutual experience for the chid and parent, and is made in deference to a recognizedly greater limiting realty, a reality that includes not only the taboo maintained by the rival-parent, but also the love of the oedipal desired parent toward his or her spouse - a love that undeterred the child's birth and a love to which, in a sense, he owes his very existence?
Out of such an oedipal situation the child emerges, with no matter how deep and painful sense of loss at the recognition that he can never displace the rival-parent and posses the beloved on e in a romantic-and-erotic relationship, in a state differently from the ego-diminished, superego-domination state that Freud described. This child that his love, however unrealized, is reciprocated. Strengthened, too, out of the realization, which his relationship with the beloved parent has helped him to achieve, that he lives in a wold in which any individual's strivings are encompassed by a reality much larger than he: Freud, when he stressed that the oedipal phase normally results mainly in the formations of a forbidding superego, and if it is resulting mainly in enchantments of the ego's ability to test both inner and outer reality.
All experiences with both neurotic and psychotic patients had shown that, in every individual instance, in as far as the oedipal phase was entered the course of their past elements, it led to ego impairment rather than ego functioning as primarily because the beloved parent had to repress his or her reciprocal desire for the child, chiefly through the mechanism of unconscious denial of the child's importance to the parent. More often than not, in these instancies, that suggested that the parent would unwittingly act out his or her repressed desires in the unduly seductive behaviour toward the child; yet whenever the parents come close to the recognition of such desires within him, he would unpredictably start reacting to the child as unlovable - undesirable.
With many of these parents, appears that, primarily because of the parent's own unresolved Oedipus complex, his marriage proved too unsatisfying, and his emotional relationship to his own culture too tenuous, for him to dare to recognize the strength of his reciprocal feelings toward his child during the latter's oedipal phase of development. The child is reacting too as a little mother or father transference-figure to the parent, a transference-figure toward whom the parent's repressed oedipal love feelings are directed. If the parent had achieved the inner reassurance of a deep and enduring love toward his wife, and a deeply felt relatedness with his culture including the incest taboos to which his culture adheres, he would have been able to participate in as deeply felt, but minimally acted out, relationship with the chid in a way that fostered the healthy resolutions of the child's Oedipus complex. Instead, what usually happens in such instances, in that the child's Oedipus complex remains unresolved because the child stubbornly - and naturally - refuses to accept defeat within these particular family circumstances, whereas the acceptance of oedipal defeat is tantamount to the acceptance of irrevocable personal worthlessness and unlovability.
It seems much clearer, then this former child, now neurotic or psychotic adult, requires from us for the successful resolution to his unresolved Oedipus complex: Not such a repression of desire, acted-out seductiveness, and denial of his own worth as he met in the relationship with his parent, but a maximal awareness on our part of the reciprocal feelings while we develop in response to his oedipal strivings. Our main job remains always, of course, to further the analysis of his transference, but what might be described seems to be the optimal feeling background in the analyst for such analytic work.
Formidably, when applied not to a moderate degree found in the background of the neurotic person but invested with all the weight of actual biological attributes, have much ado with the person's unconscious refusal to relinquish, in adolescence and young adulthood, his or her fantasied infantile omnipotence in exchange for a sexual identity of - in these-described terms - a 'man' or a 'woman'. It would be like having to accept only certain dispensations as well as salvageable sights, if ony to see the whole fabric ruined into the bargin. A person cannot deeply accept an adult sexual identity until he has been able to find that this identity can express all the feeling-potentialities of his comparatively boundless infancy. This implies that he has become able to blend, for example, his infantile - dependent needs into his more adult erotic strivings, than regard these as mutually exclusive in the way that the mother of the future patient or the persons infant frighteningly feels that her lust has been placed in her mothering. Another difficult facet of this situation resides in a patient's youngful conviction, based on his intrafamiliar experiences, which he can win parental love only if he can become or, perhaps, at an unconscious level remain - a girl; accepting her sexuality as a woman is equated with the abandonment of the hope of being loved.
Concerning the warped experiences their persons have and with the oedipal phase of development, calls to our attention of two features. First, the child whose parents are more narcissistic than truly object-related in faced with the basically hopeless challenge of trying to compete with the mother's own narcissistic love for herself, and with the father's similar love for himself, than being presented with a competitive challenge involving separate, flesh-and-blood human beings. Secondly, concerning warped oedipal experiences, in, as far as the parents succeeded in achieving object-relatedness, this has often become only weakly established as a genital level, so that it remains much more prominently at the mother-infant level of ego-development. Thus, the mother, for example, is much more able to love her infant son than her adult husband, and the oedipal competition between husband and son are in terms of who can better become, or remain, the infant whom the mother is capable of loving. When the infant becomes chronologically a young man, having learned that one wins a woman not through genial assertiveness but through regression, he is apt to shy away from entering into true adult genitality, and is tempted to settle for what amounts to 'regressive victory' in the oedipal struggle
We write much about the analyst’s or therapist’s being able to identify or empathize with the patient for helping in the resolution of the neurotic or psychotic difficulties. Such writings always portray a merely transitory identification, an empathic sensing of the patient’s conflicts, an identification that is of essentially communicative value only. However, it should be seen that we inevitably identify with the patient another fashion also, we identify with the healthy elements in him, in a way that entails enduing, constructive additions to our own personality. Patients - above all schizophrenic patients - need and welcome our acknowledgement, simply and undemonstratively, that they have contributed, and are contributing, in some such significant way, to our existence.
Increasing maturity involves increasing ability not merely to embrace change in the world around one, but to realize that one is oneself in a constant state of change. By contrast, the recovering, maturing patiently becomes less and less dependent upon any such sharply delineated, static self-image or even a constellation of such images, the answer to the question, “Who are you?” is almost as small, solid, and well defined as a stone, but is a larger, fluid, richly-laden, and sniffingly outlined as an ocean? As the individual becomes well, he comes to realize that, as Henri Bergson (1944) outs it, “reality is a perpetual growth, a creation pursued without end. . . . A perpetual becoming,” and to the extent that he can actively welcome change and let it become part of him, he comes to know that - again in Bergson’s phrase - “to exist is to change, to change is too mature, to mature is to go on creating oneself endlessly.”

PLEXUITY of TRANSFERENCE By: richard j.kosciejew

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