While the relationship between analyst and patient does not possess the structure, scientist-scientific subject, and is not characterized by neutrality in that sense by the analyst, the analyst may become a scientific observer to the extent to which he can observe objectively the patient and himself in interaction. The interaction itself, however, cannot be adequately represented by the model of scientific neutrality. Using this model is unscientific, based on faulty observation? The confusion about the issue of countertransference relates to this. It hardly needs to be pointed out that such a view in no way denies or reduces the role scientific knowledge, understanding, and methodology play in the analytic process, nor does it have anything to do with advocating an emotionally-charged attitude toward the patient or ‘role-taking’. In that a showing attempt to disentangle the justified and requirement of objectivity and neutrality from a model of neutrality that has its origin in propositions that may be untenable.
One of these is that therapeutic analysis is an objective scientific research method, of a special nature to be sure, but falling within the general category of science as an objective, detached study of natural phenomena, their genesis and interrelations. The ideal image of the analyst is that of a detached scientist. The research method and the investigative procedure in themselves, carried out by unspecified scientists, are said to be therapeutic. It is not self-explanatory why a research project should have a therapeutic effort on the subject of study. The therapeutic effect appears to have something to do with the requirement, in analysis, that the subject, the patient himself, gradually becomes an associate, as it was, in the research work, that he himself becomes increasingly engaged in the ‘scientific project’ which is, of course, directed art himself. We speak of the patient’s observing ego on which we need to be able to rely to a certain extent, which we attempt to strengthen and with which we collaborate among ourselves. We encounter and make to some functional applicability of what is known under the general title, ‘identification’. The patient and the analyst acknowledge the fact for being equally increasing to the evolving principles that govern the political nature as deployed to the accessorial evolution for a better and mutually actualized understanding, if the analysis proceeds, in their ego-activity of scientifically guided self-scrutiny.
If the possibility and gradual development of such identification are, as is always claimed, a requirement for a successful analysis, this introduces the component factor from which has nothing to do with scientific detachments and the neutrality of a mirror (‘mirror’ in this sense, is meant as having been for the most part used to denote the ‘properties’ of the analyst as a ‘scientific instrument’. (A psychodynamic understanding of the mirror as it functions in human life may reestablish it as an appropriate description of at least certain aspects of the analyst’s function). This identification does relate to the development of a new object-relationship of which is the foundation for it.
The transference neurosis takes places in the influential presence of the analyst and, as the analysis progresses, ever more ‘in the presence’ and under the eyes of the patient’s observing ego. The scrutiny, carried out by the analyst and by the patient, is an organizing, ‘synthetic’ ego-activity. The development of an ego function is dependent on interaction. Neither the self-scrutiny, nor the freer, healthier development of the psychic apparatus whose resumption is contingent upon such scrutiny, takes place in the vacuum of scientific laboratory conditions. They take place in the presence of a favourable environment, by interaction with it. One could say that in the analytic process this environmental element, as happens in the original development, becomes increasingly internalized as what we are to call; the observing ego of the patient.
There is another aspect to this issue. Involved in the insistence that the analytic activity is a strictly scientific one (not merely using scientific knowledge and methods) is the notion of the dignity of science. Scientific man is considered by Freud as the most advanced form of human development. The scientific stage of the development of man’s conception of the universe has its counterpart in the individual’s state of maturity, according to Totem and Taboo. Scientifically self-understanding, to which the patient is helped, is in and by itself therapeutic, following this view, since it implies the movement toward a stage of human evolution not previously reached. The patient is led toward the maturity of scientific man who understands himself and external reality not animistic or religious terms but as to objective science. There is little doubt that what is called the scientific exploration of the universe, including the self, may lead to greater mastery over it (within certain limits of which we are becoming painfully aware). The activity of mastering it, however, is not itself a scientific activity. If scientific objectivity is assumed to be the most mature stage of man’s understanding of the universe, showing the highest degree of the individual’s state of maturity, we may have a personal stake in viewing psychoanalytic therapy as a purely scientific activity and its effects as due to such scientific objectivity. Beyond the issue of an investment, to be, as necessary and timely to question the assumption, handed to us from the nineteenth century, that the scientific approach to the world and the self represents a higher and more mature evolutionary stage of man than the religious way of life. However, its questioning pursuit will not be for us to pursue.
Though the objective interpretation of the analyst and the transference distortion, it increasingly becomes available to the patient as a new object. This not primarily in the sense of an object not previously met, but the newest consists in the patient’s rediscovery of the early paths of the development of object-relations leading to a new way of relating to objects and of being oneself. Though all the transference distortions the patient reveals rudiments at least of that core (of himself and ‘objects’) which has been distorted. It is this core, rudimentary and vague as it may be, to which the analyst has reference when he interprets transferences and defences, and not one abstract idea of reality or normality, if he is to reach the patient. If the analyst keeps his central focus on this emerging core, he avoids moulding the patient in the analyst’s own image or imposing on the patient his own concept of what the patient should become. It requires objectivity and neutrality the essence of which is love and respect for the individual and for individual development. This love and respect represent that counterpart in ‘reality’. In interaction with which the organization and reorganization of ego and psychic apparatus take place.
The parent-child relationship can serve as a model, in that the parent ideally is in an empathic relationship of understanding the child’s particular stage in development, yet ahead in his vision of the child’s future and mediating this vision to the child in his dealing with him. This vision, informed by the parent’s own experience and knowledge of growth and future, is, ideally, a more articulate and more integrated version of the core of being which the child presents to the parent. This ‘more’ that the parent sees and knows, he mediates to the child so that the child in identification with it can grow. The child, by internalizing aspects of the parents, also internalizes the parent’s image of the child-an image mediated to the child in the thousand different ways of being handled, bodily and emotionally. Early identification as part of ego-development, built up through introjection of maternal aspects, includes introjection of the mother’s image of the child. Part of what is introjected is the image of the child as seen, felt, smelled, heard, touched by the mother. Adding that what happens would perhaps be correct is not wholly a process of introjection, if introjection is used as a term for an intrapsychic activity. The bodily handling of and concern with the child, the manner in which the child is fed, touched, cleaned, the way it is looked at, talked to, called by name, recognized and re-recognized-all these and many other ways of communicating with the child, and communicating to him his identity, sameness, unity, and individuality, shape and mould him so that he can begin to identify himself, to feel and recognize himself as one and as separate from others yet with others. The child begins to experience himself as a central unit by being centred along.
In analysis, if it is to be a process leading to structural changes, interactions of a comparable nature have to take place. At this point, only to suggest, by sketching these interactions during early development, the positive nature of the neutrality required, which includes the capacity for mature object-relations as manifested in the parents by his or her ability to follow and simultaneously be ahead of the child’s development?
Mature object-relations are not characterized by a sameness of relatedness but by an optimal range of relatedness and by the ability to relate to different objects according to their particular levels of maturity. In analysis, a mature object-relationship is maintained with a given patient if the analyst relates to the patient in a tune with the shifting levels of development manifested by the patient at different times, but always from the viewpoint of potential growth, that is, from the viewpoint of the future. It is the fear of moulding the patient in one’s own image that has prevented analysis from coming to grips with the dimension of the future in analytic theory and practice, a strange omission considering the fact that growth and development are at the centre of all psychoanalytic concern. A fresh and deeper approach of the superego problem cannot be taken without facing the issue.
The afforded efforts to say that the activities of the analyst, and specifically his interpretations and the ways in which they are integrated by the patient, need to be considered and understood as for the psychodynamics of the ego. Such psychodynamics cannot be worked out without proper attention to the functioning of integrative processes in the ego-reality field, beginning with such processes as introjection, identification, projection (of which we know something), and progressing to their genetic derivatives, modifications, and transformations in later life-stages (of which we understand very little, except in as far as they are used for defensive purposes). The more intact the ego of the patient, the more of this integration taking place in the analytic process occurs without being noticed or at least without being considered and conceptualized as an essential element in the analytic process. ‘Classical’ analysis with ‘classical’ cases easily leaves unrecognized essential elements of the analytic process, not because they suit the purpose of non-presence, but because they are as different to see in such cases as becoming aware of what was different, ‘classical’ psychodynamics in average citizenries. Cases with obvious ego defects magnify what also occurs in the typical analysis of the neuroses, just as in neurotics we see exaggerated in the psychodynamics of human beings overall. However, this is not to say, that there is no difference between the analysis of the classical psychoneuroses and the cases with obvious ego defects. In the latter, especially in borderline cases and psychoses, processes such as explained in the child-parent relationship take place in the therapeutic situation on levels proportionally close and similar to those of the early child-parent relationship. The further we move away from gross ego defect cases, the more do these integrative processes take place on higher levels of sublimation and by modes of communication which show much more complex stages of organization.
The elaboration of the structural point of view in psychoanalytic theory has caused the danger of isolating the different structures of the psychic apparatus from one another. It may look nowadays as though the ego is a creature of and functioning with external reality, whereas the area of the instinctual drives, of the id, ids as such unrelated to the external world. To use Freud’s archeological simile, it is as though the functional relationship between the deeper strata of an excavation and their eternal environment were denied because these deeper strata are not in a functional relationship with the present-day environment, as though it were maintained that the architectural structures of deeper, earlier strata are due too purely ‘internal’ processes, in contrast to the functional interrelatedness between present architectural structures (higher, later strata) and the external environment that we see and live in. The id, however-in the archeological analogy being comparable to some deeper, earlier strata-as such integrates with its comparable ‘early’ external environment as much as the ego integrates with the ego’s more ‘recent’ external reality. The id deals with and is a creature of ‘adaption’ just as much as the ego-but on a very different level of organization.
Having already confronted us, it related to the conception of the psychic apparatus as a closed system, and in addition that this view has a bearing on the traditional notion of the analyst’s neutrality and of his function as a mirror. It is in this context of the concept of instinctual drives, particularly as for their relation to objects, as formulated in psychoanalytic theory. Freud writes: “The true beginning of scientific activity consists . . . in describing phenomena and then in proceeding to group, classify and correlate them." Even at the stage of description avoiding applying certain abstract ideas to the material in hand is not possible, ideas derived from somewhere or other but not from the new observations alone. Such ideas-which will later become the basic concepts of the science-are still more indispensable as the material is further worked over. They must at first necessarily posses some degree of indefiniteness: There can be no question of any clear delimitation of their content. If they remain in this condition, we come to an understanding about their meaning by making repeated references to the material of observation from which they appear to have been derived, but upon which, in fact, they have been imposed. Thus, strictly speaking, they are like conventions-although everything depends on their not being arbitrarily chosen but determined by there having significant relations to the empirical material, relations that we seem to sense before we can clearly recognize and discover them. It is only after more thorough investigation of the field of observation that we can formulate its basic scientific concepts with increased precision, and progressively to modify those that become serviceable and consistent over a wide area. Then, the time may have come to confine them in definitions. The advance of knowledge, however, does not tolerate any rigidity even in definitions. Physics furnishes an excellent illustration of the way in which even ‘basic concepts’ established in definitions are constantly being altered in their content. The concept of instinct (Trieb), Freud goers on to say, in such a basic concept, “conventional but still partially obscure,” and thus open to alterations in its content.
Freud defines instinct as a stimulus: A stimulus not arising in the outer world but ‘from within the organism’. He adds that “a better term for an instinctual stimulus is a need," and says, that such “stimuli are the sign of an internal world.” Freud lays explicit stress on one functional implication of his whole consideration of instincts, namely that it implies the concept of purpose in what he calls a biological postulate. This postulate runs as follows: The nervous system is an apparatus that has the function of getting rid of the stimuli that reach it, or of reducing them to the lowest possible level. An instinct is a stimulus from within reaching the nervous system. Since an instinct as an id impulse is a stimulus arising within the organism and acting ‘always as a constant force’, it obliges ‘the nervous system to renounce its ideal intention of keeping off stimuli’ and compels it ‘to undertaking to involve and interconnected activity by which the external world it so changed as to afford satisfaction to the internal source of stimulation'.
Instinct being an inner stimulus reaching the nervous apparatus, the object of an instinct is ’the thing concerning which or through which the instinct is abler to achieve its aim’, this aim being satisfaction. The object of an instinct is further described as ‘what is most variable about an instinct’, ‘not originally connected with it’, and as becoming ‘assigned to it only in consequence of being peculiarly fitted to make satisfaction possible’. It is, that we see instinctual drives being conceived as an ‘intrapsychic’, or originally not related to objects.
In his later writing Freud gradually moves away from this position. Instincts are no longer defined as (inner) stimuli with which the nervous apparatus deals according to the scheme of them reflex arc, but instinct in, Beyond the Pleasure Principle, it is as seen, 'an urge inherent in organic life to restore an earlier state of things that the living entity has been obliged to abandon under the pressure of external disturbing forces'. Freud describes, in that instinct in terms equivalent to the terms he used earlier in describing the function of the nervous apparatus itself, the nervous apparatus, the ‘loving entity’, in its interchange with ‘external disturbing forces’. Instinct impulses of an id have no longer an intrapsychic stimulus, but an expression of the function, the ‘urge’ of the nervous apparatus ton deal with environment. The intimate and fundamental relationships of instincts, especially in as far as libido (sexual instincts, Eros) is concerned, with objects, is more clearly brought out in The Problem of Anxiety, until finally, in An Outline of Psycho-Analysis, ‘the aim of the first of these basic instincts [Eros] is to establish ever greater unities and to preserve them thus-in short, to bind together'. Making that is noteworthy not only the relatedness to objects is implicit: The aim of the instinct Eros is no longer formulated as to some contentless ‘satisfaction’, or satisfaction in the sense of abolishing stimuli, but the aim is clearly seen through integration. It is ‘to bind together’. While Freud feels that applying his earlier formula is possible, ‘to the effect that instincts tend toward a return to an earlier [inanimate] stare’. To the descriptive or death instinct, ‘we are unable to apply the formula to Eros (the love instinct).
The basic concept Instinct has thus changed its content since Freud wrote, Instincts and Their Vicissitudes. In his later writing he does not take as his starting point and model the reflex-arc scheme of a self-contained, closed system, but bases his considerations on a much broader, more modern biological framework. It should be clear from the last quotation that it is not the ego alone to which he assigns the function of synthesis, of binding together. Eros, one of the two basic instincts, is itself an integrating force. This is following his concept of primary narcissism as first formulated in, On Narcissism, an Introduction, and further elaborated in his writings, notably in Civilization and Its Discontents, where objects, reality, far from being originally not connected with the libido, are seen as becoming gradually differentiated from a primary narcissistic identity of ‘inner’ and ‘outer’ world.
In his conception of Eros, Freud moves away from an opposition between instinctual drives and ego, and toward a view according to which instinctual drives become moulded, channelled, focussed, tamed, transformed, and sublimated in and by the ego organization, an organization that is more complex and more sharply elaborated and articulated than the drive-organization called the id. In whatever way, the ego is an organization that continues, much more than it is opposing, the inherent tendencies of the drive-organization, the concept Eros encircles one term one of the two basic tendencies or ‘purposes’ of the psychic apparatus as manifested on both levels of organization.
As a whole, with such a perspective, instinctual drives are as primarily related to ‘objects’, to the ‘external world’ as the ego is. The organization of this outer world, of these ‘objects’, corresponds to the drive-organization than of ego-organization. In other words, instinctual drives organize environment and are organized by it no less than is true for the ego and its reality. It is the mutuality of organization, in the sense of organizing each other, which forms the inextricable interrelatedness of ‘inner and an outer world’. It would be justified to speak of primary and secondary processes not only concerning the psychic apparatus but also about the outer world is for its psychological structure. The qualitative difference between the two levels of organization might terminologically be said by speaking of environment as correlative to drives, and of reality as correlative to ego. Instinctual drives can be seen as originally not connected with objects only in the sense that ‘originally’, the world is not organized by the primitive psychic apparatus so that objects are differentiated. Out of an ‘undifferentiated stage’ emerge what has been termed part-objects or object-nuclei. A more appropriate term for such pre-stages of an object-world might be the noun ‘shape’: In the sense of configurations of an indeterminate degree and a fluidity of organization, and without the connotation of object-fragments.
The preceding excursion into some problems of instinct-theory is intended to were that the issue of object-relations in psychoanalytic theory has suffered from a formulation of the instinct-concept according to which instincts, as inner stimuli, are contrasted with outer stimuli, both, although in different ways, affecting the psychic apparatus. Inner and outer stimuli, terms for inner and an outer world on a certain level of abstraction, are thus conceived as originally unrelated or even opposed to each other but running parallel, as it was, in their relation to the nervous apparatus. While, as Freud in his general trend of thought and in many formulations moved away from this framework, psychoanalytic theory has remained under its sway except in the realm of ego-psychology. The development of ego-psychology unfortunately had to take place in relative isolation from instinct-theory. It is true that our understanding of instinctual drives has also progressed. Yet the extremely fruitful concept of organization (the two aspects of which are integration and differentiation) has been insufficiently, if in a at all, applied to the understanding of instinctual drives, and instinct-theory has remained under the aegis of the antiquated stimulus-reflex-arc conception model-a mechanistic frame of reference far removed from modernly psychological and biological thought. The scheme of the reflex-arc, as Freud says in, Instincts and Their Vicissitudes have been given to us by physiology. Nevertheless, this was the mechanistic physiology of the nineteenth century. Ego-psychology began its development in a quite different climate already, as is clear from Freud’s biological reflections in, Beyond the Pleasure Principle. Thus it has come about that the ego is seen as an organ of adaption to and integration and differentiation with and of the outer world, whereas instinctual drives left behind in the realm of stimulus-reflex physiology. This, and specifically the conception of instinct as an ‘inner’ stimulus impinging on the nervous apparatus, has affected the formulations concerning the role of ‘objects’ in libidinal development and, by extension, has vitiated the understanding of the object-relationship between patient and analyst in psychoanalytic treatment.
In discussing aspects of the analytic situation and the therapeutic process in analysis, dwelling further on the dynamics of interaction in the early stages of development will be useful.
The mother recognizes and fulfils the need of the infant. Both recognition and fulfilment of a need are at first beyond the ability of the infant, not merely the fulfilment. The understanding recognition of the infant’s needs for the mother represents some form of accumulating together, and yet undifferentiated urges of the infant, urges which in the acts of recognition and fulfilment by the mother undergo a first organization into some direct drive. In a remarkable passage in the ‘Project for a Scientific Psychology’, in a chapter called The Experience of Satisfaction, Freud discusses this constellation in its consequences for the further organization of the psychic apparatus and in its significance as the origin of communication. Gradually, both recognition and satisfaction of the need coming within the range of the growing infant itself. The processes by which this occurs are generally subsumed under the headings identification and introjection. Accesses to them have to be made available by the environment, here the mother, who performs this function in the acts of recognition and fulfilment of the need. These acts are not merely necessary for the physical survival of the infant but necessary while for its psychological development in as far as they organize, in successive steps, the infant’s uncoordinated urge. The whole complex dynamic constellation one of mutual responsiveness where nothing is introjected by the infant that is not brought to it by the mother, although brought by her often unconsciously. A prerequisite for introjection and identification is the gathering mediation of structure and direction by the mother in her caring activities. As the mediating environment conveys, structure begins to gain structure and direction in the experience of that entity: The environment begins to ‘taker shape’ in the experience of the infant. It is now that identification and introjection plus projection emerge as more defined processes of organization of the psychic apparatus and of environment.
In agreement, . . . the organization of the psychic apparatus, beyond discernible potentialities at birth (comprising undifferentiated urges and Anlagen of ego-facilities, goes by way of mediation of higher organization by the environments to the infantile organism. In one of the same act, in the same breath and the same sucking of milk, drive direction, and organization of environment into shapes or configurations begin, and they Are continued into ego-organization and object-organization, by methods such as identification, introjection, projection? The higher organizational stage of the environment is indispensable for the development of the psychic apparatus and, in early stages, has to be brought to it actively. Without such a ‘differential’ between organism and environment no development takes place.
The patient, who comes to the analyst for help through increasingly evidently self-understanding, is led to this self-understanding by the understanding he finds in the analyst. The analyst operates on various levels of understanding. Whether he verbalizes his understanding to the patient on the level of clarifications of conscious material, whether he suggests or reiterates his intent of understanding, restates the procedure to be followed, or whether he interprets unconscious, verbal or other, material, and especially if he interprets transference and resistance-the analyst structures and articulates, or works toward structuring and articulating, the material and the productions offered by the patient. If an interpretation of unconscious meaning is timely, the words by which this meaning is expressed are recognizable to the patient as expressions of what he experiences. They organize for him was previously less organized and thus give him the ‘distance’ from himself that enable him to understand, to see, to put into words and to ‘handle’ what was previously not visible, understandable, speakable, tangible. A higher stage of organization, of both himself and his environment, is thus reached, by way of the organizing understanding which the analyst provides. The analyst functions as a representative of a higher stage of organization and mediates this to the patient, in as far as the analyst’s understanding is attuned of what is, and the way in which it is, in need of organization.
These are experiences of interaction (earlier called integrative experiences), comparable in their structure and significance to the early understanding between mother and child. The latter are some models, and as such always of limited value, but a model whose usefulness has recently been stressed by several analysts (for instance René Spitz) which in its full implications and in its perspective is a radical departure from the classical ‘mirror model’.
Interactions in analysis take place on much higher levels of organization. Communication is carried on predominantly by way of language, an instrument of and fort secondary processes. The satisfaction involved in the analytic interaction is a sublimated one, in increasing degree as the analysis progresses. Satisfaction now has to be understood, not about abolition or reduction of stimulation leading back to a previous state of equilibrium, but as for absorbing and integrating ‘stimuli’. Leading to higher levels of equilibrium. This, it is true, is often achieved by temporary regression to an earlier level, but this regression is 'in the service of the ego', that is, in the service of higher organization. Satisfaction, in the creation of an identity of experiences in two ‘systems’, two psychic apparatuses of different levels of organization, thus containing the potential of growth. This identity is achieved by overcoming a differential. Properly speaking, there is no experience of satisfaction and no integrative experience where there is no differential to be overcome, where identity is simply ‘given’, that is existing rather than to be created by interaction. An approximate model of a giving existent identity is perhaps provided in the intra-uterine saturation, and decreasingly the early months of life in the symbiotic relationship of mother and infant.
Analytic interpretations represent, on higher levels of interaction, the mutual recognition involved in the creation of identity of experience in two individuals of different levels of ego-organization. Insight gained in such interaction is an integrative experience. The interpretation represents the recognition and understanding which is driven to consumable patients as previously unconscious material. ‘Making it available to the patient’ means lifting it to the level of the preconscious system, of secondary process, by the operation of certain types of secondary processes by the analyst. Material organized on or close to drive-organization, of the primary process, and isolated from the preconscious system, is made available for organization on the level of the preconscious system by the analyst’s interpretation, a secondary process operation that mediates to the patient secondary process organization. Whether this mediation is successful or not depends, among other things, on the organizing strength of the patient’s ego attained through earlier steps in ego-integration, in previous phases of the analysis. Ultimately in his earlier life. To the extent to which such strength is lacking, analysis-organizing interaction by way of language communication-becomes less feasible.
An interpretation can be said to comprise two elements, inseparable from each other. The interpretation takes with the patient the step toward true regression, compared with the neurotic compromise formation, thus clarifying for the patient his true regression-level covered and made unrecognizable by defensive operations and structures. Secondary, by this very step it mediates to the patient the higher integrative level to be reached. The interpretation thus creates the possibility for freer interplay between the unconscious and preconscious systems, under which the preconscious regains its originality and intensity, lost to the unconscious in the repression, and the unconscious retains access to land capacity for progression in the direction of higher organization. Put with Freud’s Metapsychological language: The barriers between unconscious and preconscious, consisting of the archaic cathexis (repetition compulsion) of the unconscious and the warding-off anticathexis of the preconscious, are temporarily overcome. This process may be seen as the internalized version of the overcoming of a differential in the interaction process described earlier as an integrative experience. Internalization itself is dependent on interaction and is made possible again in the analytic process. The analytic process then consists in certain integrative experiences between patient and analyst as the foundation for the internal version of such experiences: Reorganization of ego, ‘structural change’.
The analyst in his interpretation reorganizes, reintegrates unconscious material for himself and for the patient, since he has to be attuned to the patient’s unconscious, using his own unconscious as a tool, to arrive at the organizing interpretation. The analyst has to move freely between the unconscious and the organization of its thought and language, for and with the patient. If this is not so-a good example is most instances of the use of technical language-language is used as a defence against leading the unconscious material into ego-organization, and ego-activity is used as a defence against integration. It is the weakest of the ‘strong’ ego-strong in its defences-that it guides the psychic apparatus into excluding the unconscious (for instance by repression or isolation) than into lifting the unconscious to higher organization and, simultaneously, holding it available for replenishing regression to it.
Language, when not defensively used, is employed by the patient for communication that attempts to reach the analyst on his presumed or actual level of maturity to achieve the integrative experience longed for. The analytic patient, while striving for improvement as to inner reorganization, is constantly tempted to seek improvement about unsubliminated satisfaction through interaction with the analyst on levels closer to the primary process, rather than concerning internalization of integrative experience as it is achieved in the process that Freud has described as: Where there was id there will be ego. The analyst, in his communication through language, mediates higher organization of material as far as less, higher organized, to the patient. This can occur only if two conditions are fulfilled as in, (1) the patient, through sufficiently strong ‘positive transference’ to the analyst, becomes again available for integrative work with himself and his world, compared with defensive warding-off of psychic and external reality manifested in the analytic situation in resistance, and (2) The analyst must be in tune with the patient’s productions, that is, he can regress within himself to the organization on which the patient is stuck, and to help the patient, by the analysis of defence and resistance, to realize this regression. This realization is prevented by the compromise formations of the neurosis and is boomed potentially plausibly by dissolving them into the proper structural composite components as characterized by a subjugated unconscious and superimposed preconscious. By an interpretation, both the unconscious experience and a higher organisational level of that experience are made available to the patient: Unconscious and preconscious are joined in the act of interpretation. In a well-going analysis the patient increasingly becomes enabled to perform this joining himself.
Language, in its most specific function in analysis, as interpretation, is thus a creative act similar to that in poetry, where language is found for phenomena, contents, connexions, experiences not previously known and speakable. New phenomena and new experience are made available because of reorganization of material according to this point of unknown principles, contexts, and connexions.
Ordinarily we operate with material organized on high levels of sublimation as ‘given reality’. In an analysis the analyst has to retrace the organizational steps that have led to such a reality-level so that the organizing process becomes available to the patient. This is regression in the service of the ego, in the service of reorganization-a regression against which there is resistance in the analyst plus in the patient. As an often necessary defence against the unorganized power of the unconscious, we have a tendency toward an automatization higher in organizational levels and resist regression out of fear lest we may not find the way back to higher organization. The fear of reliving the past is fear of toppling off a plateau we have reached, and fear of more archaic cuckoos' nest of past experiential insensitivities not only in the sense of past content not more essentially of past, fewer stable stages of organization of experience, whose genuine reintegration requires new integrative tasks and the risk of losing what had been secured. In analysis such fear of the future may be manifested in the patient’s defensive clinging to regressed, but seemingly safe levels.
Once the patient can speak, nondefinely, from the true level of regression that he has been helped to reach by analysis of defences, he himself, by putting his experience into words, begins to use language creatively, that is, begins to create insight. The patient, by speaking to the analyst, attempts to reach the analyst as a representative of higher stages of ego-reality organization, and thus may be said to create insight for himself in the process of language-communication with the analyst as such a representative. Such communication by the patient is possible if the analyst, by way of his communications, is revealing himself to the patient as a more mature person, as a person who can feel with the patient what the patient experiences and how he experiences it, and who understands it as something more than it has been for the patient. It is this something more, not necessarily more in content but more in organization and significance, that ‘external reality’, here represented and mediated by the analyst, had to offer to the individual and for which the individual is striving. The analyst in doing his part of the work, experiences the cathartic effect of ‘regression in the service of the ego’ and performs a piece of self-analysis or re-analysis. Freud has remarked that his own self-analysis went on by way of analysing patients, and that this was necessary to gain him psychic distance required for any such work.
The primordial transference as considered would be literally and essentially derive from the effort to master the series of crucial separations from the mother, beginnings with the reactions to birth, as noted by Freud, and, in his own inimitable way, much earlier, by the poet William Blake (1757-1827). This in mention to Freud’s sense of original traumatic situations (1926) and with due cognizance of his and other’s disavowal of the fallacious psychological adaptation of the concept, notably in the one-time therapeutic system of Rank. This drive is present thence forward, and participates importantly in all of the detailed complexities of each infantile phase experience, with their inevitable context of warmth complexities of each infantile phase experience, with their inevitable contexts of warmth ful pressure, skin, special sense, and speech contacts, in the problems of object relationship, separation and individuation, the manifold of some determined crisis of adolescence, the specific neuroses, and many ‘normal’ involvements and solutions to the conventionally healthy individual. One may assertively simulate the important hesitiorially as participators that are embodied, that even if nonmanifest, in castration anxiety, also in ‘aphanisis’ (Jones 1929). The striving, in short, is to establish at least symbolic bodily reunion with the mother. Further, the striving is to substitute this relationship for the kaleidoscopic system of relationships that have, in good part and inevitably, replaced it. This is a transference to the extent that actual and concrete.
- later, intrapsychic-barriers prohibit even part or derivative manifestations of this drive, in reflation to the mother, requiring that, in varying modes and degrees, it be displaced to other individuals, sometimes even their undergoing secondary repression or otherwise warded off. In the instance where the drive actualization remains attached to the person of the actual mother, it is a primitive symbolic urge, only a potentiality in relation to transference. This does of course exist clinically in very sick children (Mahler 1952). It is rare, in its explicitly primitive modalities, in adults, although not at all infrequent in its psychological expressions. That such striving may come about in a narcissistic solution (or more primitive regressive state, such as autism or primary identification) is inescapably true, then only fundamental anaclitic strivings will persist, in psychotic states, even these may disappear. For the moment, if one is to ask indulgence for the tentative concept that both erotic and aggressive strivings may, in various ways, express ease, or subserve this basic organismic personality, apart from the empirical fact that disturbances in these spheres may be observed to initiate or augment it. One may think of the original urge as having an undifferentiated or oscillating instinctual quality, like the bodily approaches described for psychotic children (Mahler 1952), or it may find more mature expression in the neutralized need for closeness that causes the normal toddler, at a certain point, to recoil from his own adventurous achievement (Mahler 1965). While it is a universal ingredient of human personality, in tremendous range and variety of expressive dialectic discourse will decisively influence the quality and quantity of this reaction, apart from innate elements, by earlier vicissitudes, faultlessly in the neonatal experience with the mother, possibly in the organismic experiences of birth itself (Greenacre 1941, 1945).
The primordial transference only rarely appears as such in our clinical work. When it does appear, it leaves an impression not readily forgotten. This is the case when the underlying (as opposed too symptomatic) transference of the psychotic patient appears, displacing his symptoms, if only transitorily, or at times interpretations conjunction with them. However, in the usual neuroses or character disorders with them. However, in the usual neuroses or character disorders, even most so-called ‘borderlines’, this transference is in the sphere of influence, closest to the surface in the separation experience of termination, or in earlier interpretations, or in periods of extreme regression. It may be implied at times in inveterate avoidance of transference emotion, in extreme and anxious exploitation of the formalized routines of analysis, or in inveterate acting out. Seemingly enough, we have usually dealt with what, in the working transference and the transference neurosis, are the phase representations and integrations of this phenomenon, and the large and more subtle complexes of emotional experience clustering around them? Only some types of psychological need (or, demand) which sometimes assumes resemblance to original anaclitic requirements (for example, to exhibit indirectly the wish-rarely, to state it explicitly-that the analyst, in effect, think for the patient, and would be attested to frequently, and often demonstrably allied to the original struggle against separation.
In a great majority of instances, the operational transference will come to display an intimater and crucial relationship to the Oedipus complex. For the primordial transference finds and especially important phase specification. The oedipus transference repeats, in terms appropriate to the child’s state of psycho-physiological maturation, the invertebracy. The urge to kill if need be, to cling to the original object as the source of a basic gratification, which b comprehends residual elements of past libidinal phases in its organization as such, intimately bound with complex attitudes of object constancy in a large sense. It is, of course, the infantile prototype of the most general and comprehensive adult solution of the problem of separation, i.e., the institution of marriage. That this usually occurs in the birth of children tends to close a circle in unconscious fantasy, by way of identification with the children. Obviously, in the healthy parent, this plays a small economic role, comparable to that of the residual and repressed incest in the oedipal striving that are collaboratively given up, in varying degree, referring to its persists unconscious fractionate major energetic sources of everyday dream and infant life, neurosis, or creative achievement. It is also used for the general thesis to suggest that the important positions of the Oedipus complex in reflation too unconscious, the dream, provide a link between this climactic experience of childhood separation and the most primitive psycho-physiological separation. It has been shown that the neurophysiological phenomenons that are the objective correlates of dreaming are of striking high development in the neonatal period (Fisher 1965). The recently established prevalence of dream erection (Fisher 1966) awakened memories of and further reflections on Ferenczi’s Thalassa (1938), at least in its ontogenetic aspects. At this point, one might ask: “What of the young woman whom, development brings favourably, turns to her father with comparable striving?” If we recognize the important element of biologically determined faute de mieux in the girl’s psychosexual development, i.e., the castration complex, and the multiple intrinsic and environmental factors usually favouring heterosexual orientation, in that this represents one of the early focal instances of reality-syntonic transference, which becomes integrated in healthy development. This is the other side in which the boy’s displacement of unneutralized hostility from his mother, as the first frustrating authority (even in relations to his access to her person), to his father? In optimal instances (again, allowing for inevitable unconscious residues), such reorientations become the dominant conscious and unconscious realities of further development.
This type of reality-syntonic development displacement is to be distinguished from the primordial transference problem, which is ubiquitous in the very beginning of relations to proto-objects, i.e., the question of whether perceptual and linguistic displacement (or deployment) is accompanied by merely ‘token’ displacement of libido and aggression away from the psychic representation of the original object, as opposed to genuine and proportionate shifts of a cathexis. In other terms, is the ‘new object’ really a person other than the mother who is loved and hated (to tinctorius simplicity), or is the other person literally a substitute for the original object, a mannikin for that object’s psychic representation? In the latter instance, the father is given cognitive status s a father. What is sought and sometimes found in him is a mother. This may be strikingly evident in the oral sphere, and may be maintained for a lifetime. This is true transference (of primordial type), not ‘transfer’, (to borrow the word tentatively from Max Stern [1957]), or ‘normal developmental transference’, or ‘reality-syntonic transference’. This deficit of varying degree, in instinctual and affective investment of the new and presenting real object, finds its mirror-image problem in the analytic situation, where a cognitive cover with lagging, must be repaired by the analyst’s interpretative activity, especially in the anticipatory transference interpretation. By this latter activity, recognition of the persisting importance of the original object, rediscovered in the analyst, can be established in consciousness, in relation to his current or developing affective-instinctual importance.
It remains beyond the complication and complexities in the mother-infant reciprocal symbiosis that may be thought to exacerbate the primordial transference tendency, however, the matter remains complicated, oversimplification is to be avoided. The same is even more true of reconstructions from adult (or even the child) analytic work. The analytic work does provide a certain access to the residues of subjective experience in the period of infancy. Probably the eventual synthesis of the two will permit more dependable clarification. Obviously the relationship to a mother has many facets, even within each developmental phase, each can, to varying degree, introduces further complications, sometimes new solutions, furthermore, the life of an individual, beginning very soon after birth, will include other individuals, conspicuously the father, usually siblings, often adult parental surrogates, who can decisively influence development for good or ill. However, these considerations do not disestablish the general and critical primacy of the original symbiosis with the mother. In relation to the primordial transference striving (in the sense that we have mentioned), by which the relevant reconstructive inferences from adult analyses point with an overall consistency but only to the persistence of a variety of anaclitic needs and diffuse bodily libidinal needs (or, cause to result of demands) accompanied by or permeated with augmented aggressive impulses and fantasies. These, apart from innate infantile disposition, seem likely that something like the Zeigarnik Effect, stressed by Lagache (1953) regarding transference usually, operate from earlier infancy? Thus the mother who responds inadequately, or who interrupts gratification prematurely or traumatically, is sought repeatedly in others, in the drive to settle ‘unfinished business’. That an opposite or very different tendency may sometimes appear to have prevailed in certain segments of relationship (oversimplification, seduction, satiation, and sudden disappointment, for example) or perhaps, represent the demonstrably complex spheres of the object relationship (parental possessiveness, undue demands, capricious harshness, failure to meet maturational development requirement, or myriad subtle variants) testifies only to the challenging complexity of the problem. Intuitively its certainty drawn upon the phenomenon of regression, on the one hand from the oedipal conflicts, or-possibly more often than realized-from parental failures to meet the complex problems of proportionally ‘neutralized’ spheres of development, often contributes importantly to the clinical manifestations. Still, the anterior elements must be, conceded at least a logical priority in shaping the child and his contributions to the pattern of later conflict.
The same, degree to which there is actual deployment of a cathexis from the original object to other environmental objects, including the inanimate, determine (inversely) the power and tenacity of the primordial transference and probably deals with the basic predispositions to emotional health and illness, respectively. In other words, if there is true transfer of interest and expectation to the environment, with its growing perceptual (and ultimately linguistic) clarity, it exists for the infant largely in its own right, along with the primary object, the mother, whose unique importance is never entirely lost, in the development of most individuals. That there is also an organismic drive toward the outer environment is most assuredly true, and this contributes to what is ‘mature transference.’ Based on resemblances which progress from extreme primitiveness to varying grades of derail, the original object or part objects are sought by the primordial transference and often ‘found’; in other aspects of the environment. It may be in some specified condition for that this urge provides an important dynamic element in primary process, and in the mature universal symbolic faculty. In any case, it is the actual power of this regressive drive, fraught at every step with conflict and anxiety, down to the ultimate fear of loss of ‘selfness’, which can determine (in the light of other factors) whether the transference neurosis, and the given Oedipus complex itself, or the involvement in life in general, is a play of shadow-shades or a system of proportionally genuine reactions to real persons, perceived largely in their own right? That is to say, that in comparing this latent (dyadic) sides of the transference neurosis-its ‘primordial transference’ aspect-with Lewin’s ‘dream screen’ (1946), which really achieves full ascendancy only in the ‘black dream’.
Emphasizing that the primordial transference includes the actual or potential duality of body and mind within it is important own scope, and the distinction is of great psychodynamic, sometimes nosologic importance. However, it is deservingly taken to as seceding of the therapeutic transference (a specification, a derivative of the primordial transference) may have been analysed, there is, for practical purposes (at least, an unimpeachable exception), an inevitable residue of longing, of the research for the equivalent of some omnipotent, sapient, all-providing, and equally yielding of a parent. The important issue for the individual’s health and productiveness is that the critique of accurate perceptions and other autonomous functions is as actively participant as possible and that the social representations of this urge are as constructive and as consistent with successful adaptation as possible. The capacity to translate original bodily strivings into mental representations of relations with an original object, as literal needs are met in other ways, at least opens the endless realm of symbolic activities for possible gratification of the residual and irreducible primordial transference strivings. The anterior requirement, regarding affirmative viability, is that such strivings, in their literal anaclitic reference, are detached from literal transference subrogates and carried over to appropriate materials functionally, processes, individuals, and transactions, the responsibility for their direction or execution essentially assumed by the individuated dividual, in early ego identification with the original object. As for sexual gratification, the persistent clinging to the primordial object or to literal transference surrogates (in the sense previously specified) leads through the pregenital conflicts to the peak development of the Oedipus complex, and (apart from other more specific factors) to its probable failure of satisfactory resolution.
If sexual interest is genuinely deployed to other objects, even as unconscious representations, to the extent usually achieved, it remains nonetheless an important fact that bodily gratification is sought, usually by both individual and social preference, with another person who, at least in a generic organic sense, resembles the original incestuous object, most often including cultural-national ‘kinship’. This holds a dual interest, as (1) the general acceptance of the principle of symbolic ‘return’ to the original object, if no father (or a mother) must be thereby destroyed, or such aggression suggested by close blood kinship and (2) the paradoxical relation to the centrifugal tendency of the taboo on cannibalism. The latter, of course, with the advance of civilization, finds persistent representation only in symbolic ritual. In relation to the actual eating of flesh, the taboo tends to spread, not only to protect human enemies but also to include other animals with whom man may have an ‘object-relationship’, conspicuously the dog and horse. ‘Vegetarianism’, of course, includes all animal life. There is no reason to doubt that the mother is the original object of cannibalistic impulse and fantasy, as she is the first object of the search for genital gratification. In the infantile cannibalistic impulse, the physiological urge of hunger, the drive for summary union, and the prototype of relatively extensively-determinantal fixated oral erotic and destructive drives may find conjoint expression. That energies and fantasies derived from this impulse contributes importantly to the phallic organization was an early opinion of Freud (1905), which may be profoundly true. Except where severe pregenital disturbances have infused the phallic impulse as such with impulses (subjectively) dangerous to the object, the latter are not only not menaced with destruction (as in the cannibalistic impulse), but preserved, even enhanced. No doubt the critical difference in the cultural evolution of the two great taboos lies in the problem of the preservation of the object, as opposed to his or her destruction.
The Oedipus complex, in a pragmatic analytic sense, retains its position as the ‘nuclear complex’ of the neuroses. For reasons that the climatic organizing experience of early childhood, apart from its own vicissitudes, can under favourable circumstances provide certain solutions for pregenital conflicts, or in the suffering from them, in any case, include them in its structure. Only when the precursor experiences have been of great severity is acherontic in the organically determined new ‘frame of reference’, which hardly has independent and decisive significance of its own. Nonetheless, its attendant phallic conflicts must be resolved in their own right, in the analytic transference. From the analyst (or his current ‘surrogate’ in the outer world), thus from the psychic representation of the parent, the literal, i.e., bodily, sexual wishes must be withdrawn and genuinely displaced to appropriate objects in the outer world. The fraction of such drive elements that can be transmuted to friendly, tender feeling toward the original object or too other acceptable (neutralized?) Variants, will have course influence the economic problem involved. This genuine displacement is opposed to the sense of ‘acting out’, where other objects are perceptually different substitutes for the primary object (thus for the analyst). This may be thought to follow automatically on the basic process of coming to terms with (‘accepting’) the childhood incestuous wishes and its paricidal connotations. Such assumptions do not do justice to the dynamic problem implicit in tenaciously persistent wishes. To the extent that these wishes are to be genuinely disavowed or modified, rather than displaced, a further important step is necessary: The thorough analysis of the functional meaning of the persistent wishes and the special etiologic factors entering their tenacity, as reflected in the transference neurosis. Thus, in principle, the lateral accuracy of the concept phrased by Wilhelm Reich (1933), “transference of the transference,” as the final requirement for dissolving the erotic analytic transference, although the clinical discussion, which is its context, is useful. This expression would imply that the object representation that largely determines the distinctive erotic interests in the analyst can remain essentially the same, while the actual object changes. Though a semantic issue may be involved to some degree, it is one that impinges importantly on conceptual clarity. Yet the truth is that the fortunate ‘average man’, who has, even in his unconscious, yielded his sexual claim to his mother and father’s prerogative, can, if he very much admires his mother’s physical and mental traits, seek someone like her. The neurotic cannot do this, and may fail in his sexual striving (in its broadest sense), even when the subject is disguised by the other appearance e of remote race or culture.
It is nevertheless, that the patient, being recognized by the analyst as something more than he is at present, can attempt to reach this something more by his communications to the analyst that may establish a new identity with reality. To varying degrees patients are striving for this integrative experience, through and despite their remittances. To varying degrees patients have given up this striving above the omnipotent, magical identification, and to that extent are less available for the analytic process. The therapist, depending on the mobility and potential strength of integrative mechanisms in the patient, has to be mostly explicit and ‘primitive’ in his ways of communicating to the patient his availability as a mature object and his own integrative processes. Yet, we call analysis that kind of organizing, reconstructuring interaction between patient and therapist that is predominantly performed on the level of language communication. It is likely that the development of language, as meaningful and coherent communicating with ‘objects’, is related to the child’s reaching, at least in a first approximation, the oedipal stage of psychosexual development. The inner connexions between the development of language, the formation of ego and of object, and the oedipal phase of psychosexual development, is still to be explored. If such connexions exist, then it is not mere arbitrariness to distinguish analysis proper from more primitive means of integrative interaction. To set up rigid boundary lines, however, is to ignore or deny the complexities of the development and of the dynamics of the psychic apparatus.
In contrast to trends in modern psychoanalytic thought and narrow the term transference down to a very specific limited meaning, an attemptive efforts to regain the original richness of interrelated phenomena and mental mechanisms that the concept encompasses, and to contribute to the clarification of such interrelations is afforded when Freud speaks of transference neuroses in a contradistinction to narcissistic neuroses, and two meanings of the term transference are involved as in: (1) The transfer of a libido, contained in the ‘ego’, to objects, in the transference neuroses, while in the narcissistic neuroses the libido remains in or is taken back into the ‘ego’, not ‘transferred’ to objects. Transference in this sense is virtually synonymous with object-cathexis. To quote from an important early paper on transference: “The first loving and hating are transference of autoerotic pleasant and unpleasant feelings onto the objects that evoke these feelings. The first ‘object-love’ and the first ‘object-hate is, so top speak, the primordial transference. . . .” (1) And (2), the second meaning of transference, when distinguishing transference neuroses from narcissistic neuroses, is that of transfer of relations with infantile objects onto later objects, and especially to the analyst in the analytic situations.
The second meaning of the term is today the one most frequently referred to, the exclusion of other meanings. Two recent representative papers on the subject of transferences are such that Waelder, in his Geneva Congress paper, Introduction to the Discussion on Problems of Transference, saying: “Transference may be said to be an attempt of the patient to revive and re-enact, in the analytic situation and in relation to the analyst, situations and phantasies of his childhood.” Hoffer, in his paper, presented at the same Congress, on Transference and Transference Neuroses states: “The term ‘transference’ refers to the generally agreed facts that people when entering any form of object-relationship. . . . Transfer upon their objects. Those images that they encountered during previous infantile experience . . . The term ‘transference’, stressing an aspect of the influence our childhood has on our life as a whole, thus refers to those observations in which people in their constants with objects, which may be real or imaginary (or unreal), positive, negative, or ambivalent, ‘transfer’ their memories of significant experiences and thus ‘change the reality’ of their objects, invest them with qualities from the past. . . . ’
The transference neuroses, thus, are characterized by the transfer of the libido to external objects compared with the attachment of the libido to the ‘ego’ in the narcissistic affections, and, secondly, by the transfer of libidinal cathexes (and defences against them), originally related to infantile objects, onto contemporary objects.
Transference neurosis as distinguished from narcissistic neuroses is a nosological term. Just when, the term ‘transference neurosis’ is used in a technical sense to designate the revival of the infantile neurosis in the analytic situation. In this sense of the term, the accent is on the second meaning of transference, since the revival of the infantile neurosis is due to the transfer of relations with infantile objects on the contemporary object, the analyst? It is, however, only based on transfer of the libido to (external) objects in childhood that libidinal attachment to infantile objects can be transferred to contemporary objects. The first meaning of transference, therefore, is implicit in the technical concept of transference neurosis.
The narcissistic neuroses were thought to be inaccessible to psychoanalytic treatment because of the narcissistic libido cathexis. The psychoanalysis was considered feasible only where a ‘transference relationship’ with the analyst could be established: In that group of disorders, in other words, where emotional development had taken place to the point that transfer of the libido to external objects had occurred significantly. If today we consider schizophrenics capable of transference, we hold (1) that they do relate in some way to ‘objects’, i.e., to pre-stages of objects that are less ‘objective’ than oedipal objects (narcissistic and object libidos, ego. Objects are not yet clearly differentiated. (This implies the concept of primary narcissism in its full sense). We hold (2) that schizophrenics transfer this early type of relatedness onto contemporary ‘objects’, which objects thus become less objective. If ego and objects are not clearly differentiated, if ego boundaries and object boundaries are not clearly established, the character of transference also is different, in as much as ego and objects are still largely merged: Objects-‘different objects’-are not yet clearly differentiated one from the other, and especially not early from contemporary ones. The transference is much more primitive and ‘massive’ one. Thus, as for child-analysis, at any rate before the latency period, it has been questioned whether one can speak of transference in the sense in which adult neurotic patients manifest it. The conception of such a primitive form of transference is fundamentally different from the assumption of an unrelatedness of ego and objects as is implied in the idea of a withdrawal of the libido from objects into the ego.
The modification of our view on the narcissistic affections in this respect, based on clinical experience with schizophrenics and on deepened understanding of early ego-development, leads to a broadened conception of transference in the first-mentioned meaning of that term. To be more precise, transference in the sense of transfer of the libido to objects is clarified genetically, it develops out of a primary lack of differentiation of ego and objects and thus may regress, as in schizophrenia, to such a pre-stage. Transference does not disappear in the narcissistic affections, by ‘withdrawal of libido cathexes into the ego’. It's propositioned undifferentiated regressive is direction toward its origin in the ego-object identity of primary narcissism.
An apparently relational narrative conjuncture from which their unrelated meanings of transference are well founded in Freud's, The Interpretation of Dreams, gave a discussion of the importance of day residues in dreams. Since this last meaning of transference is fundamental for a deeper understanding of the phenomenon of transference, it may prove to some significance to quote the relevant passages. “We learn from the psychology of the neuroses that an unconscious idea is as such quite incapable of entering the preconscious and that it can only exercise any effect there by establishing a connection with an idea that already belongs to the preconscious, by transferring its intensity onto it and by getting itself ‘covered’ by it. In this context, the fact of ‘transference' from which provides an explanation of so many striking phenomena in the mental life of neurotics? The preconscious idea, which thus finding an undeserved degree of intensity, may be left either unaltered by the transference, or it may have a modification forced upon it, derived from the content of the idea that affects the transference.” Once, again, referring to a day residue, '. . . . That the fact that recent elements occur with such regularity points to the existence of a need for transference. “It will be seen, then, that the day’s residue . . . not only borrows something from the Ucs when they succeed in taking a share in the formation of the dream-namely the instinctual force that is at the disposal of the repressed wish-but that they also offer the unconscious something indispensable-namely, the necessary points of attachment for transference? If we wished to penetrate more deeply at this point into the processes of the mind, we should have to throw more light upon the interplay of excitations between the preconscious and the unconscious-a subject toward which the study of the psychoneuroses draws us, but upon which, as it happens, dreams have no help to offer.”
One parallel between this meaning of transference and the one mentioned under (2) transference of infantile object-cathexes to contemporary objects-emerges: The unconscious ideas, transferring its intensity to a preconscious idea and getting itself ‘coveted’ by it, corresponds to the infantile object-cathexis, whares the preconscious idea corresponds to the contemporary object-relationship to which the infantile object-cathexis are transferred.
Transference is described in detail by Freud in the chapter on psychotherapy in Studies on Hysteria. It is seen there as due to the mechanism of ‘false (wrong) connection’. Freud discusses this mechanism in Chapter two of Studies on Hysteria where he refers to a ‘compulsion to associate’ the unconscious complex with one that is conscious and reminds us that the mechanism of compulsive ideas in compulsion neurosis is of a similar nature. In the paper on The Defence Neuro-Psychoses, the ‘false connection’, of course, is also involved in the explanation of screen memories, where it is called displacement. The German term for screen memories, “Deck-Erinnerungen,” uses the same word ‘decken’, to cover, which is used in the above quotation from The Interpretation of Dreams where the unconscious idea gets itself ‘covered’ by the preconscious idea.
While these mechanisms involved in the ‘interplay of excitations between the preconscious and the unconscious’ have reference to the psychoneuroses and the dream and were discovered and described in those contexts, they are only the more or less pathological, magnified, or distorted versions of normal mechanisms. Similarly, the transfer of the libido to object and the transfers of infantile object-relationships to contemporary ones are normal processes, seen in neurosis in pathological modifications and distortions.
The compulsion to associate the unconscious complex with one that is conscious is the same phenomenon as the need for transference in the quotation from the Interpretation of Dreams. It relates to the indestructibility of all mental acts that are truly unconscious. This indestructibility of unconscious mental acts is compared by Freud to the ghosts in the underworld of the Odyssey-‘ghosts that awoke to new life when they tasted blood’, the blood of conscious-preconscious life, the life of ‘contemporary’ present-day objects. It is a short step from here to the view of transference as a manifestation of the repetition compulsion-a line of thought that we cannot follow up connectively. The transference neurosis, in the technical sense of the establishment and resolution of it in the analytic process, is due to the blood of recognition that the patient’s unconscious is given to taste-so that the old ghosts may awaken to life. Those who know ghosts tell us that they long to be released from their ghost-life and led to rest as ancestors. As ancestors they live forth in the present generation, while as ghosts they are compelled to haunt th present generation with their shadow-life. Transference is pathological in as far as the unconscious is a crowd of ghosts, and this is the beginning of the transference neurosis in analysis Ghosts of the unconscious, imprisoned by defences but haunting the patient in the dark of hides defences and symptoms, is allowed to taste blood, are let loose. In the daylight of analysis the ghosts of the unconscious are laid and led to rest as ancestors whose power is taken over and transformed into the newer intensity of present life, of the secondary process and contemporary objects.
In the development of the psychic apparatus the secondary process, preconscious organization, are the manifestation and result of interaction between additional primitivities as organized psychic apparatus and the secondary process activity of the environment: Through such interaction the unconscious gains highly organization. Such ego-development, arrested or distorted in neurosis, is resumed in analysis. The analyst helps to revive the repressed unconscious of the patient by his recognition of it: Though interpretation of transference and resistance, through the recovery of memories and through reconstruction, the analyst, in the analytic situation, offers himself to the patient as a contemporary object. As such he revives the ghosts of the unconscious for the patient by fostering the transference neurosis, which comes about in the same organizational root-direction from which the dream comes about: Through the mutual attraction of unconscious and ‘recent’, ‘day residue’ elements. Dream interpretation and interpretation of transference have this function in common: both attemptive efforts to re-establish the lost connexions, th buried interplay, between the unconscious and the preconscious.
Transference studied in neurosis and analysed in therapeutic analysis are the diseased manifestations of the life of that indestructible unconscious whose ‘attachments’ to ‘recent elements’, by way of transformation of primary into secondary processes, constitute growth. There is no greater misunderstanding of the full meaning of transference than the one most clearly expressed in a formulation by Silverberg, but shared by many analysts. Silverberg, in his paper of the Concept of Transference, writes: “The wide prevalence of the dynamism of transference among human beings is a mark of man’s immaturity, and it may be expected in ages to come that, as man progressively matures, . . . transference will gradually vanish from his psychic repertory.” Nevertheless, surreally from being, as Silverberg puts it, “the enduring monument of man’s profound rebellion against reality and his stubborn persistence in the ways of immaturity,” transference is the ‘dynamism’ by which the instinctual life of man, the id, becomes ego and by which reality becomes integrated and maturity is achieved. Without such transference-of the intensity of the unconscious, of the infantile ways of experiencing life that has no language and little organization, but the indestructibility and power of the origins of life
- to preconscious and to present-day life and contemporary objects-without such transference, or to the extent to which such transference, miscarries, human life becomes sterile and an empty shell. On the other hand, the unconscious needs present-day external reality (objects) and present-day psychic reality (the preconscious) for its own continuity, least it is condemned to live the shadow-life of ghosts or to destroy life.
Earlier, that in the development of preconscious mental organization-and this is resumed in the analytic process-transformation of primary into secondary process activity is contingent upon a differential, a (libidinal) tension-system between primary and secondary process organization, that is, between the infantile organism, its psychic apparatus, and the more structured environment: Transference in the sense of an evolving relationship with ‘objects’. This interaction is the basis for what has been called in the ‘integrative experience’. The relationship is a mutual one-as is the interplay of excitations between unconscious and preconscious-since the environment not only has to make itself available and move in a regressive direction toward the more primitively organized psychic apparatus, the environment also needs the latter as an external representative of its own unconscious levels of organization with which communication is to be maintained. The analytic process, in the development and resolution of the transference neurosis, is a repetition-with essential modifications because taking place on another level-of such a libidinal tension-system between a different primitivists and a more maturely organized psychic apparatus.
The differential, implicit in the integrative experience, as the tension-system making up the interplay of excitations between the preconscious and the unconscious, we are to postulate thus, internalization of an interaction-process, not simply internalization of ‘objects’, as an essential element in ego-development and in the resumption of it in analysis. The double aspect of transference, the fact that transference refers to the interaction between psychic apparatus and object-world and to the interplay between the unconscious and the preconscious within the psychic apparatus, thus becomes clarified. The opening of barriers between unconscious and preconscious, as it occurs in any creative process, is then to be understood as an internalized integrative experience-and is in fact experienced as such.
The intensity of unconscious processes and experiences is transferred to preconscious-conscious experiences. Our present, current experiences have intensity and depth to the extent to which they are in communication (interplay) with the unconscious, infantile, experiences representing the indestructible matrix of all subsequent experiences. Freud, in 1897, was well aware of this. In a letter to Fliess he writes, after recounting experiences with his younger brother and his nephew between the ages of one and two years: “My nephew and younger brother determined, not only the neurotic side of all my friendships, but also their depth.”
The unconscious suffers under repression because its need for transference is inhibited. It finds an outlet in neurotic transference: ‘Repetition’ which fails to achieve higher integration (‘wrong connections’). The preconscious suffers no less from repression since it has no access to the unconscious intensities, the unconscious prototypical experiences that give current experiences their full meaning and emotional depth. In promoting the transference neurosis, we are promoting a regressive movement by the preconscious (ego-regression) from the unconscious and to allow the unconscious to recathect, tendencies of interaction with the analyst, preconscious ideas and experiences so that higher organization of mental life can come essentially. The mediator of this interplay of transference is the analyst who, as a contemporary object, offers himself to be the patient’s unconscious as a necessary point of attachment for transference. As a contemporary object, the analyst represents a psychic apparatus whose secondary process organization is stable and capable of controlled regression so that he is optimally in communication with both his own and the patient’s unconscious, to serve as a reliable mediator and partner of communication, of transference between unconscious and preconscious, and thus a higher, interpreting organization of both
The integration of ego and reality consists in, and the continued integrity of ego and reality depends on, transference of unconscious processes and ‘contents’ on to new experiences and objects of contemporary life. In pathological transference the transformation of primary into secondary processes and the continued interplay between them have been replaced by superimpositions of secondary on primary processes, so that they exist side by side, isolated from each other. Freud had described this constellation in his paper on The Unconscious: “In effect, there is no lifting of the repression until the conscious ideas, after the resistances have been overcome, have entered connection with the unconscious memory-trace. It is only through the making conscious of the latter itself that success is achieved.” In an analytic interpretation ‘the identity of the information given to the patient with whom hide’ a repressed memory, id is only apparent. To have heard something and to have experienced something is in their psychological nature two different things, although the content of both is the same. Later, in the same paper, Freud speaks of the thing-cathexes of objects in the Ucs, whereas the ‘conscious presentation comprises the presentation of the thing [cathexis] further: “The system Pcs come about by this thing-presentation being hyper-cathected through being linked with the word-presentations corresponding to it. These are the hyper-cathexes, we may suppose, that causes a higher psychical organization and make it possible for the primary process to be succeeded by the secondary process that is dominant in the Pcs. Now, too, we are unable to state precisely what it is that repression goes unchallenged boundless to the presentational id of the transference neurosis: What it denies to the presentation bin translation into words that will remain attached to the object.”
The correspondence of verbal ideas to concrete ideas, which is to thing-cathexes in the unconscious, is mediated to the developing infantile psychic apparatus by the adult environment. The hyper-cathexes which ‘cause a higher psychical organization’, consisting in linking of unconscious memory traces with verbal ideas corresponding to them, are, in early ego-development, due to the organizing interaction between primary process activity of the infantile apparatus and secondary process activity of the child’s environment. The terms ‘differential’ and ‘libidinal tension-system’ which designate energy-aspects of this interaction, sources of energy of such hyper-cathexes are clearly approached by Freud's awakening problem of interaction between psychic apparatuses of different levels of organization when he spoke of the linking up of concrete ideas in the unconscious with verbal ideas as been the hyper-cathexes which ‘cause a higher psychical organization’. For this ‘linking up’ id the same phenomenon of the mediation of higher organization, of preconscious mental activity, by the child’s environment, to the infantile psychic apparatus. Verbal ideas represent preconscious activity, representatives of special importance because of the special role language plays in the higher development of the psychic apparatus, but they are, of course, not the only ones. Such linking up occurring in the interaction process becomes increasingly internalized as the interplay and communication between unconscious and preconscious within the psychic apparatus. The need for resumption of such mediating interaction in analysis, so that new internalisation may become possible and internal interaction b e reactivated, results from the pathological degree of isolation between unconscious and preconscious, or-to speak as for a later terminology-from the development of defence processes of such propositions that the ego, rather than maintaining or extending its organization of the realm of the unconscious, excluded ever more from its reach.
Transference and the so-called ‘real relationship’ between patient and analysts have been said that one should distinguish transference (and countertransference) and an analyst in the analytic situation from the ‘realistic’ relationship between the two. That is well known, however, it is implied in such statements that the realistic relationship between patient and analyst has nothing to do with transference. (Keeping in mind that there is neither such a thing as reality nor a real relationship, without transference). Any ‘real relationship’ involves transfer of unconscious imagines to present-day objects. In fact, present-day objects are objects, and thus ‘real’, in the full sense of the word (which comprises the unity of unconscious memory traces and preconscious idea) only to the extent that this transference, in the sense of transformational interplay between unconscious and preconscious, is realized. The ‘resolution of the transference’ at the termination of analysis means resolution of the transference neurosis, and in that way of the transference distortions. This includes the recognition of the limited nature of any human relationship and of the special limitations of the patient-analyst relationship. However, the new object-relationship attuned with the analyst, which is gradually being built during the analysis and constitutes the real relationship between patient and analyst. Which serves as a focal point for the establishment of healthier object-relations in the patient’s ‘real’ life, is not without transference in the sense clarification, . . . to the extent to which the patient developed a ‘positive transference’ (not in the sense of transference as resistance, but in the sense of the ‘transference’ which carries the whole process of analysis) he keeps this potentiality of a new object-relationship alive through all the various stages of resistance. This meaning of positive transference tends to be discredited in modern analytic writing and teaching, although not in treatment itself.
Freud, like any other man who does not sacrifice the complications and complexity of life to the deceptive simplicity of rigid concepts, has said many contradictory things. He can be quoted in support of many different ideas, which is to say, in writing to Jung on 6 December, 1906: “It would not have escaped you that our cures come about through attaching the libido reigning in the subconscious (transference) . . . Where this fails the patient will not attempt or else does not listen when we translate his material to him. It is in essence a cure through love. Moreover, it is transference that provides the strongest proof, the only unassailable one, for the relationship of neuroses to a lover. He writes to Ferenczi, on the 10th, of January 1910: “I will present you with some theory that has occurred to me while reading your analysis [referring to Ferenczi’s self-analysis of a dream]. It seems to me that in our influencing of the sexual impulses we cannot achieve anything other than exchanges of the sexual placements, never renunciation, relinquishment or the resolution of a complex (Strictly secret!). When someone brings out his infantile complexes, he has saved part of them (the effect) in a current form (transference). He has shed a skin and leaves it for the analyst. God forbid that he should now be naked, without a skin."
One of Freud’s proudest achievements was the transformation of the therapeutic relationship that takes place in psychoanalysis into a tool of scientific investigation. Freud also believed that “the future will probably attribute far greater importance to psychoanalysis as the science of the unconscious than as a therapeutic procedure” (Freud, 1926). Nevertheless in recent years the importance of clinical research has been underestimated and a growing cleavage has developed between the researcher and the clinician. Scientific investigation, in common with all other forms of human group endeavours, is subject to moods and to whom the impetus of fashion, and this has led to some disappointment with the contribution of psychoanalytic psychiatry to the problem of schizophrenia, which has resulted in a turning away from the investigation of the psychology of schizophrenia, with the hope that biochemistry and neurophysiology will solve its riddle.
This imploring us to consider the relation between clinical research in psychiatry and the investigations of basic science. Every generation of psychiatrists seems to have faced this problem. C. Macfie Campbell (1935) was in saying that, “the prestige attached to research dealing with the impersonal process of diseases leads some to hold that further progress in psychiatry investigation must await advances in the basic sciences.” Taking this dependent attitude toward the solution of its special problems is dangerous, however, for psychiatry and to demand too much from other disciplines . . . Human nature cannot be adequately analysed by methods of chemistry and physiology and general biology.
Some knowledge of the history of science in general, and of medicine in particular, is useful, since it puts these issues in their proper perspective. We, in our vanity, trend to believe that the problems of our day are unique. It is understandable that we are impressed with the rapid expansion of biochemistry in its application to medicine, which in a short time has transformed some aspects of medicine from an art to a science. However, suppose that biochemistry had achieved its present state of maturity when medical knowledge was no further advanced than it was in the eighteenth century, when the description and differentiation of clinical syndromes as we know them today were just beginning. Had biochemistry been available to the clinician of that day, it could not have been applied, since the medical syndromes themselves had not yet been sorted out. It would have been as if botany had adopted a physical-chemistry theory of living organisms before it had established a systematic typology (Nagel, 1961). In some respects’ psychiatry is at a stage comparable to medicine in the eighteenth century, in that modern clinical observation is still in its infancy, as it was born with the work of Kraepelin, Bleuler, and Freud. The application of basic science is possible only when there is clinical knowledge. It would be serious indeed if the clinician were to relinquish his investigative role to the basic scientist.
The tendency to undervalue and neglect clinical research is only part of the problem. As there has been some discouragement with psychoanalytic therapy s an investigative method, and this has resulted in premature attempts to substitute the methods of the more precise disciplines. The history of science documents the phenomenon on the awe of the mature sciences experienced by those whose own discipline is less precise. The awe of success is something with which we are all familiar in our own lives: Science, and the individual, adopts a similar response-imitation of the more mature. Nagel (1961) notes the adverse effect of the attempt to reduce prematurely the less advanced to the more precise science, since this diverts needed energies away from what are the crucial problems at a particular period in a discipline’s expansion. To provide for an example as of: Newton’s influence on the chemistry of his day was catastrophic (Bronowski and Mazlish, 1960), for mathematics became the model of all sciences, and chemistry, in their attempt to imitate Newton, dropped their own more appropriate techniques. Advances in chemistry in England came entirely from outside the Royal Society, because the scientists within the Society attempted to apply mathematic problems that could not yet be dealt within that way.
The inspiring awe of Newton’s systematic description of the physical universe influenced medicine as well. For shortly after Newton’s discoveries, it became fashionable to construct speculative systematic explanations of diseases that were sterile since they were divorced from direct clinical observation (Garrison, 1929, and Guthrie, 1946).
Within the last few decades, physics has undergone a second major revolution, and those of us whose disciplines are less mature have been subjected to similar influences. We are bedevilled with the trend toward quantification before we know what we are quantifying or have the instruments with which to measure. The theoretical achievements of physics are imitated in our day, as in Newton’s, by the development of highly abstract theoretical systems that tend to become a form of scholasticism as the abstractions become increasingly removed from observation. Psychoanalysis also has not been entirely immune from these dispositional tendencies.
Schizophrenia is not a disease entity, but represent a symptom complex that could be considered ‘a final common pathway’, that is, the outcome of variety of pathological conditions (Jackson, 1960). In this sense schizophrenia is comparable to the eighteenth-century diagnosis of dropsy. To apply the more precise techniques of te biological sciences to the problem of schizophrenia things must first be sorted out. The derailed clinical observations that are the daily work of the psychoanalytic psychiatrist should help to sort out the variety of clinical syndromes that we call schizophrenia. Careful psychological observations of the schizophrenias and related disorders may uncover clues about where a purely psychogenic rationale and a purely biological hypothesis fall down. It is therefore, that analytic psychiatry must prepare the way for the application of the more precise techniques of biological investigation. To paraphrase what has been said in another text. , Although clinical description fails to satisfy the standards of precision achieved by modern physics, it is prepared to prevent inconclusive evidence than no evidence at all (Somerhoff, 1950).
For the past three decades, psychoanalysts have become increasingly better acquainted with the group of patients who fall between the designation of neurosis and that of a psychosis. Calling these patients borderline cases is customary. These individuals display a variety of symptom complexes: They may be eccentric, withdrawn people who could be properly called schizoid, or they may be depressed, addicted, or perverted, or any combination of it. One might question to whether many differing symptomatic syndromes can be brought together under a single heading. If we are to consider the issuer, not as presenting symptoms but as for the similar nature of their object relationships, wee find many threads uniting these seemingly disparate disorders.
The conflicts of these people in relation to external objects bear a striking similarity to those observed in the schizophrenic patient. As wit the schizophrenic patient, there is a significant disorder in the sense of reality. This tends, in the borderline case, to be more subtle than and not so advanced as in schizophrenia. Nevertheless, for these principle reasons are we to considering this group to be homogeneous is that they develop a consistent and primitive form of object relationship in the transference. For the moment, let us say that it more closely resembles the transference of the schizophrenic than that of the neurotic patient. As to be learnt, more of psychopathology, we should expect to find that nosological entities will be based not so much on overt symptomatogy, but more upon the less overt psychopathological structure and not a symptomatic diagnosis.
The differences between the group and the schizophrenias also need to be emphasized: For in them, unlike most schizophrenic patients, we do not observe widely fluctuating ego states. There is, however, evidence of a certain stability of character and, as Gitelson (1058) has emphasized, their defences operate exceedingly well. They may at times regress into psychosis, but as a rule this is a circumstance’s psychosis: It does not involve the total personality. They may, for example, develop ideas of reference, but they do not develop a major schizophrenic syndrome as described by Bleuler (1911) with a relative abandonment of object relationships. Although their difficulties’ wit other people are serious, they tend to retain their ties to objects and, as Gitelson has expressed it, they ‘place themselves in the way of object relations’. It should bar to mind, that using the term ‘borderline’; not, as it has sometimes been used (Knight, 1953 and Zilboorg, 1941), to refer to incipiently or early schizophrenia.
The fact that the pathologies of borderline cases are relatively stable and that they maintain the object relationships that make it more possible to use the transference relationship as an investigative tool. It is both their closeness to and their difference from the schizophrenias that provides a certain contrast that may prove illumination.
Hendrick and Helene Deutsch were among the first to explore psychoanalytically this group of warping disorders. Both authors were aware that they were observing a group of character disorders that may be more closely related to schizophrenia than to neurosis. Although their clinical material was by no identical means of both what is believed in that they were observing a developmental disorder of the ego that placed a special strain on the processes of identity and identification. Helene Deutsch’s (1942) description of the ‘as if’ personality has become a classic. She described a group of people who superficially seem normal but whose life lack’s genuine feeling. They can form relationships, but these are based more on identification that on love. As such that their object relationships have a primitive quality corresponding to the child’s tendency to imitate. Their sense to identify is borrowed from the partner, so that their emotional life lacks genuineness. Not for all borderline mechanistic procedures as for: When we as to assume that the ‘as if’ traits' are a syndrome within the borderline designation. Deutsch was not certain whether she was describing a personality type predisposed to schizophrenia or whether the symptoms were rudimentary symptoms of schizophrenia itself.
Hendrick (1936) described three different character types-the schizoid, the passive feminine man, and the paranoid character. He stressed the fact that these three had an elementally different ego structure that was closer to schizophrenia than to the neurosis? He understood this structural pathology to result from a failure of the normal maturational process. He noted the prominence of primitive destructive phantasies that interfere with the ego’s executant functions, and offered an explanation confronted by recent observation. Hendrick speculated that these primitive, infantile, aggressive phantasies would normally have been terminated by a process of identification that had failed to occur.
Using the term borderline to refer to a symptomatically heterogeneous group of patients who nevertheless form a nosological entity because of their similar transference relationships. In older literature the term ‘schizoid personality’ was employed to designate a similar nosological group, placed somewhere between neurosis and psychosis. This character type was considered most predisposed to develop schizophrenia. The schizoid individual is one who is described as aloof, irritable, and unable to form close relationships. It was further believed that such an individual was unable to form the transference. However, we now know that this view is incorrect. The withdrawal, an aloof person is only one of the many personality types who may become borderline. These patients do form a transference relationship, which is frequently extremely intense, but differs significantly from that formed by neurotic patients. This transference has specific features recognized as a useful operational method of diagnosing the borderline patient.
The relationships established by these people are of a primitive order, like the relationship of a child to a blanket or teddy-gear, yet they owe their lives, so to speak, to processes arising within the individual. Their objects are not perceived according to the ‘true’ or ‘realistic’ qualities. (As borrowed from Winnicott’s concept of the transitional object, which he applied to the child’s relation to these inanimate objects (Winnicott, 1951), from which having applied this designation to the borderline patient’s relation to his human objects). The relationship is transitional in the sense that the therapist is perceived as an object outside the self, yet as someone who is not fully recognized as existing as a separate individual, but invested almost entirely with qualities emanating from the patient. Thus and so, that as placed of this object relationship midway between the transference of the neurotic (where the object is perceived as outside the self, whose qualities also disported by phantasies arising from the subject. However, the object exists as a separate individual). The experience of certain schizophrenics, who are unable to perceive that there is something outside the self. For these reason’s posit of the term transitional to be accurate, as it truly designates a transitional stage.
With that, a further description describing this state of affairs in the borderline patient will now be acknowledged. The relationship of the borderline patient to his physician is analogous to that of a child to a blanket or a teddy bear. We can observe that there is a uniform, almost monotonous, regularity to the transference phantasies, especially in the opening phases of treatment. The therapist is perceived invariably as one endorsed with magical, omnipotent qualities, who will, merely by his contact with the patient, affects a cure without the necessity for the patient himself to be active and responsible. We may question why this should be considered characteristic of the borderline patient, since most people attributes to their physicians certain omnipotent powers, especially if their need is great. The wish for an omnipotent protector may exist in everyone: The difference resides in the fact that the borderline patient really believes the wish can be gratified. Finding that the borderline patient’s belief in the physician’s omnipotence corresponds to a belief in his own omnipotent powers, for he thinks that he can transform the world by means of a wish or a thought without the necessity for taking action, that is, without the need for actual work. He said, in contrast to the neurotic patient, unable to perceive that after all the physicians are only a human being like himself: The idiosyncrasies of the physician’s personality, which make the physician a separate individual, do not seem to register. This intuitive awareness causing the certainty that many borderline patients share with some schizophrenics an uncanny ability to perceive accurately some aspects, mistakes the part for the whole, as these patients are not able to place what they note in its proper context. For example, Hendrick (1936) observed that the paranoid is correct in perceiving the hostility in others, but that is all he can perceive. It is striking that, no matter the many different personality types represented by a group of residents treading these patients, this phantasy of omnipotence uniform remains. It is soon found that the patient is unable to perceive the therapist as he is, for he is unable to perceive himself as he is. The omnipotent therapist corresponds to the omnipotence of his self-image, so that although the therapist is perceived as outside the self, he is endowed with qualities identical with those of the self, and the distinction between self and object is only partial.
The therapist is endorsed with qualities that are according to the patient’s own primitive and undifferentiated self-image composed in part of both omnipotently creative and omnipotently destructive portions. There is then constant danger that the omnipotently benevolent and protective physician may be transformed into his opposite. These people’s experience the harrowing dilemma of extreme dependence adjoined with an intense fearfulness of closeness. It is the familiar central conflict in both borderline and schizophrenic patients. The differences between these groups lie not so much in the content of the conflict as in the psychic structure available to mediate the conflict.
If one faces the belief that one’s safety in the world depends on another human being, and this is coupled with the conviction that closeness to this other person will be mutually destructive, the solution lies in maintaining the proper distance. This dilemma is beautifully illustrated by Schopenhauer’s famous simile of the freezing porcupines, quoted by Freud in his Group Psychology (1921?): ‘A company of porcupines crowded them very close together on a cold winter’s day to profit from one anther’s warmth and to save themselves from being frozen to death. Nevertheless, soon they felt one another’s quills, which induced them to separate again, and the second evil arose again. So that they were driven backwards and forwards from one trouble to the other, until they discovered a mean distance at which they could most tolerably exist.
The quills of the porcupine correspond to the anger of these patient, which is, like the quills most defensive. Although mutual destruction is feared, when we examine their anxiety closely we recognize that the true danger arises not so much from their aggression, as from the more tragic fact that they fear that their love is destructive (Fairbairn, 1940). Fairbairn observed that phantasy that can be easily confirmed: To give love is to impoverish ones' self-and to love the other person is to drain him. What is of not is that the hostility is expressed easily. It is only after a long and successful treatment that we can observe the genuine expression of positive or tender feedings.
It may be thought that to certain extent this is present in all of us, that a fear of closeness may be part of the human condition. This would appear to weaken the case that it is a specific characteristic of transitional relationships. If we grant that what has been described is part of the transitional object relation, and if what may have some
understanding agreement to have the quality of being a representative for the observation of all human beings, then how can it be maintained that transference based on a transitional object is diagnostic of the borderline group? So if that is, to resolve this question: The growth of object love is a development process co-determined by the development both of the instincts and of the ego (Anna Freud, 1952). There are three phases of object love that have been implicit in this discussion. We assume that the earliest phase exists in the young infant who responds to the mother but is yet unable to make any psychological distinction between the self and the object: The middle stage has been described as the stage of the transitional object relation: The more mature stage of object love is the stage where there is a distinct separation between self and object. This is, of course, a condensed and oversimplified view, but it should suffice to give a demonstration of a developmental sequence in the growth of object relations. This view is not merely implied from the observation of adults, but is also based on the direct observation of children. For example, Mahler (1955) has convincingly shown that in the developed of the normal child there is a continuing phase where self and object are imperfectly differentiated? The stage that she has described as symbiotic corresponds in a general way o what we have described as the transitional object. Further evidence that the stage of the transitional object is an advance beyond the earliest stage of object relations is presented by Provence and Ritvo (1961). They are able to confirm the observations of Piaget and others (Rochlin, 1953) that the child’s relationship to inanimate projective objects covering the interior of latitudinal liberation finds to his relation to the human object: Infants who were institutionalized and deprived of mothering did not develop transitional objects. Their observations suggest that some certain degrees of gratification from the material object have to be present for the child to reach the stage of the transitional object: The stage of the transitional object is not therefore the earliest stage of object relations. Freud wrote (1930) ": . . In mental; life, nothing that has once been formed can perish [that] everything is somehow preserved and [that] in suitable circumstances (when, for instance, regression continues back far enough) it can again be brought to light."
If applicable, we would then have in been as the remnants of earlier, more primitive stages of object relations are present in all of us to a greater or less degree. The difference between the borderline and the neurotic patient resides in the fact that for the most part the psychic development of the former became arrested at the stage of the transitional object, whereas the neurotic patient has passed through this stage, to develop love for objects who are perceived as separate from the self. It is true that, in the neurotic, remnants of these earlier stage may be found, and this is especially so when we look at certain creative processes where we can observer feelings of fusion and merging of the self with an object similar to those described in borderline patients. This is also the true religious experience, as Freud noted (1930), the experience of religious ecstasy may be sensed as an appreciable fusion and may exist in otherwise normal persons. William James (1902) describes the conviction of the religious person as a belief that no harm can befall him if he maintains his relation to God. This relation is also experienced as a partial fusion and mingling of identities, which seems quite similar to our description of a transitional object reflation.
We cannot avoid using the concepts of fixation and regression. Freud’s analogy of the deployment of an advancing army, used to describe instinctual fixation and regression (Knight, 1953), is particularly apt for in describing the deployment of an army we introduce a quantitative factor, that is, where are most of the troops-are they in the forward, middle, or rear positions? In the borderline cases we would say that most of the troops are at the position of the transitional object, though a few may have achieved a more advanced position. In the neurotic individual, most of the troops have advanced beyond the position of the transitional object, though a few may be left behind.
Nevertheless, to what measure is played of the relation of these clinical observations to their problem of schizophrenia. Earlier reflections have stated that observations of the borderline patient may help to clarify certain nosological issues and may show where purely psychological or pure biological explanations fail. We have to consider the above material by this larger problem.
Clinical observations suggest that a nosological distinction be made between two groups of patients: One consists of those individuals whose defences are unstable, who display fluctuating ego-states, who appear to posses a capacity to suspend or abandon relations to external objects, as occurs normally in infantile fixational states of sleep. We would say that in these cases the illness appears to involve almost the total personality. In the contrasting group, of which the borderline patients form a portion, psychotic illness appears to occur only a part of the personality, and the defences of the ego are more stable: These patients might be unable to suspend or abandon their relations to external objects in a total sense. Their relation to external objects is impaired and distorted but somehow maintained.
The presence of psychosis is loss of ability to test reality. We know that the failure to deal; with reality is a consequence of an altered ego function (Hendrick, 1939), it is the consequence and not the cause of a psychotic deficiency (Federn, 1943), we know that the testing of reality depends upon the fact that the ego’s growth distinction, and has been made between self and object (Freud, 1925). It is only when this distinction has been made that there can be a differentiation of what arises from within from what arises from without. In an earlier paper (Modell, 1961) as it is presented of many clinical observations that suggest that there are degrees of alteration of this function of testing reality hat correlate with the degree to which self and object can be differentiated. Self-object discrimination is a dynamic process with no absolute fixed points. The borderline transference is based on a transitional object relation where there is some self-object discrimination, but where this discrimination is imperfect. That is, the therapist is perceived as something outside the self, but is invested with qualities that are identical with the patient’s own archaic self-image. Reality testing, then, is a process where degrees of alteration of functioning can be observed. If the definition of psychotics is based on the loss of the capacity to test reality, it would then follow that the points at which we designate a phenomenon as psychotic is not a fixed point but a broader area.
The dynamic that is the mobile nature, of this process needs to be emphasized. For example, borderline individuals may at certain times in their dealings with others can maintain a sense of reality. In the transference relationship this function may undergo a regression that may last only during the therapeutic hour. In these instances, the distinction between self and object that has ben maintained, although imperfectly, becomes obliterated. When this occurs the patient could be said to be technically psychotic in the transference situation. This dynamic regressions observed in the transferences is intermittently timed, in that they are unfortunately not limited to the treatment hour, and may extend into the patient’s life. When this occurs we should judge the patient to be not only technically but clinically psychotic. The step backward that some borderline patient needs to take to be judged clinically psychotic are a short one. This step may be adequately understood as for a dynamic and structural psychological regression involving a further loss of self-object differentiation. If the etiology of what we call psychosis results from a further loss of self-object differentiation, there is no need to introduce the hypothesis that the induction of psychosis in these patients is the result of a neurochemical process that operates at the point in time at which the psychosis becomes manifest. The crucial etiological issue is that there is no emergence of psychosis, but those factors that have interfered with the growth of the ego, which in turn have resulted in the imperfect self-object differentiation. For the etiology of psychosis in the borderline group would appear to result from a developmental disorder of character that leads to an arrest of object relationships at the stage of the transitional object.
We know that the growth of object relations is the result of the interaction of two broad forces: The one relates to the quality of mothering: And the other to the child’s biological equipment. Now it is conceivable that inherited or prenatally acquired variations in the biological equipment may significantly interfere. For example, it has been observed that some infants may be born with an unusual sensitivity of their perceptual apparatus. It is conceivable that such an oversensitive child would find the stimulation of nursing less pleasurable than a normal child. If this were true, a biological factor in this instance could conceivably interfere with the child’s capacity to form his first object relationship. This is similar to Hartmann’s (1952) suggestion that neutralization of instinctual energy is a biologically determined process, and an inherited impairment of this process could also lead to an impaired capacity to form object relationships. Jones (Zetzel, 1949) proposed that some individuals have a relative incapacity to tolerate frustration and anxiety. He thought that this might be an inherited feature similar to intelligence. Others, such as Greenacre (1941), have suggested that the operation of biological processes may not be transmitted in the chromosomes but may be the result of specific prenatal or birth experiences. She suggested that a traumatic birth experience may lead to an excessive level of anxiety in the development of the child.
It must be to admit that all these proposals, while plausible, remain unproved. However, they suggest that if we do establish a biological etiology in the borderline psychotic group, it will refer to those factors that interfere with the establishment of object relations in infancy and therefore lead to an arrest of ego development. Although those biological factors that interfere with the growth of object relations remain unproven-though probable-there is considerable clinical observation tending to support the view that some failure in maternal care is present in all those casers where there has been an arrest of the growth of the ego. This failure may take many forms. It may be actual loss of the mother or separation from the mother, as Bowlby (1961) has emphasized. However, from clinical experiences it does not seem to have been actual physical loss of the mother that took more subtle forms. Occasionally the mothers were unable to contact their children, as they themselves were severely depressed or even psychotic. In others reconstructing the fact that there had been significant absence of the usual amount of holding and cuddling was possible. In still other patients the physical care appeared to have been adequate, but there was a profound distortion in the mother’s attitude toward the child. For example, mothers' incapacity to perceive the child as a separate person may induce a relative incapacity on the child’s part to differentiate a self form object. We are not, however, able to state that these deficiencies of mothering will in themselves, without the contribution of other biological factors form within the child, lead to an arrest of the ego’s growth at the stage of the transitional object.
It may prove important to emphasize that the crucial issue in the borderline patient and the related group of circumscribed psychoses is not the onset of the psychosis or psychotic-like condition, but is the developmental arrest that results in the impaired differentiation of self form objects. A loss of reality testing that defines the onset of psychosis is but a slight further accentuation, or regression, of an already impaired characterological formation.
The difference between the group that we have in describing and to those ‘other schizophrenias’ appears in a certain instability of defences that followed a fluctuating ego state, and the culmination in the ability to suspend relations with objects in a manner analogous to dreaming while in the waking state. It's evolving impression that these two groups are separate nosological entities, and that a member of one does not become a member of the other. It's interpretation that this observation is to suggest the fact that something must be added to permit an individual to sever his relations to the external world by means of a dream-like withdrawal. As Campbell (1935) stated it,
- “I prefer to think of the schizophrenic as belonging to a Greek letter society for which the conditions for admission remain obscure.” In that the capacity to suspend relations to external objects, which the borderline group does not posses, is determined by the presence of something that is unknown, and something that may be of biological and not of psychological origin. Some can gain admission to this fraternity, and others simply cannot, no matter how hard they try.
A biological hypothesis seems as to be unnecessary to explain the onset of psychosis in the group whose defences are stable, that is, in the borderline group, however, something must be added to develop a ‘major schizophrenia’, and, yet, that the differences between the borderline and schizophrenic groups have been explained about the strength of the defence structure operating in the former group. For example, Federn (1947) has suggested that the schizoid personality protect the person from becoming a schizophrenic? Glover (1932) believed that a perversion that may frequently be observed in the borderline group also acts as a prophylaxis against psychosis and is, in his words, ‘the negative of certain psychotic formation’. If we could assume that the strength of defences was entirely psychologically determined, we would have no need to introduce a biological hypothesis. The argument that certain defensive structures protect against a greater calamity seems reasonable, but to believe that such an assertion begs the issue. For the remaining is the question to why these defences are effective: What is it that permits such defences to be maintained? If we wished to maintain the argument for a purely psychological determination, we might say that the strength of the defences is simply the consequence of the degree to which the ego has matured. The gist of this argument would be that the difference between the schizophrenic and the borderline is the result of the fact that the arrest in ego development is more extensive in the schizophrenic patient, perhaps because of an even greater disturbance in the early mother-child relationship. This may be a plausible argument: But the fact that many schizophrenics do not develop until mature adult life negates this hypothesis. For observation does not show that ego development in the schizophrenic is necessarily more primitive or more severely arrested than that of the borderline patient. We know that individuals who develop schizophrenia can come to the conclusion in adjoined agreement: often they have distinguished careers before the onset of their illness. It is inconceivable that such accomplishments could be possible in an individual whose growth had been arrested at the earliest levels. Schreber (Freud, 1911) was a distinguished jurist and was thirty-seven years old at the time of his first illness. There is, in that way, no evidence that the ego-arrest of schizophrenic patients is in all instances greater than in borderline actions. So, the possibility is not to assume of any difficulty of explaining the differences between the borderline and the schizophrenic group on purely psychological grounds.
Clinical observations suggest that we are dealing with at least two separate problems. One is a problem of character formation, which is a consideration of those factors that have interfered with the ego’s growth so that love relationships become arrested at the stage of traditional objects. The other is probably a biological problem,
- What is it added to permit an individual to suspend his relations to his love objects? Whether the character development of the borderline and schizophrenic patient proceeds along separate or similar lines is a question that awaits further exploration. Its representation of a suspended emphasis would continue from what can be reconstructed from the history of schizophrenic patients that their love relationships from the history of schizophrenic patients that their love relationships went no further than that of the transitional object: That is, it is quite likely that they are unable to make a complete separation between themselves and their love objects. There is undoubtedly wide individual variation concerning the age at which ‘that certain biological something’ is added. It is likely that the early presence of this hypothesized biological process in the schizophrenic group would produce certain divergences in character development as compared with the borderline group. The consulting psychiatrist, however, rarely has an opportunity to see a schizophrenic patient before the onset of his psychosis, so that there are few clinical data that can be used to clarify these questions.
Although we are unable to state to what extent the pre-psychotic development of the schizophrenic is similar to or different from that of the borderline patient, and it is likely that an arrest of the development of object relations at the transitional level is predisposing the factors for the development of schizophrenia. We might hypothesize that the unknown biological something that must be added will result in schizophrenia only where the ground has been prepared, that is, only whee there has been some arrest in the ego’s growth. To state it another way: Transitional self-transactional object modulation is a necessary but not a sufficient cause of schizophrenia.
Placing special emphasis on the ‘ability to suspend relations to objects’, in using an analogy of a normal state of sleep. This analogy is, however, inaccurate, at an important point. In sleep do not find substitutes for relations to objects suspended to show elsewhere (Modell, 1958) that auditory hallucinations serve as substitutes for the ‘real objects’ lost, although in a certain sense, as Rochlin (1961) has emphasized, objects are never entirely relinquished. It is very important to know whether these objects are other human beings or are, in Schreber’s terms, ‘cursorily improvised. The capacity to conjure up substitutes for other human beings is one that we do not all posses.
Lastly, to gather up some loose strands of our argument. Psychoanalytic exploration of the borderline states suggests the hypothesis that they represent a syndrome separate from the major schizophrenia. The essential difference rests in their lack of capacity to suspend or abandon relations to external objects. It is possible that this capacity is the result of a biological variation of the central nervous system and is not psychologically determined. In their character development, individuals who develop the major schizophrenias hare with the borderline group the fact that their object relations tend in the main to be arrested at the stage of their transitional object. Whether the pre-schizophrenic and borderline character disorders can be further distinguished from each other is question that we are not prepared to answer. This hypothesis suggests at least two different orders of possible biological determinants in schizophrenia: The one relates to an impaired capacity to develop mature object relations and is presumably operative from birth onwards: The other concerns the capacity to suspend relations with objects, and this anomaly could become apparent at varying ages in the life of an individual, in some instances not too full maturity or middle age. The arrest of ego development at the level of transitional objects is a necessary but not a sufficient determinant for the development of major schizophrenia.
If our nosological criteria are based on the capacity to suspend object relations and enter a dreamlike state, it can be seen that the concepts of reactive and process schizophrenia need to be re-evaluated. Our hypothesis suggests that the distinction between psychological and biological factors in the development of schizophrenia relate to the outcome or prognosis. For example, following Kraepelin has been customary (1919) in the belief that the more severe and deteriorating disorders are organic in origin, while the transient schizophrenias are psychogenic or reactive. This way of thinking receives no support from medicine, where an acknowledged organic disorder may run the gamut from mild and transient to severe and debilitating without leading one to assume differing etiologies. Therefore, no reason to link chronicity with the biologic, and transient states with the psychogenic, although we can discern that an individual may enter transient schizophrenic turmoil because of reality identifiable psychological Traumata, we should not therefore assume that the schizophrenia itself is explainable on purely psychological grounds. Whether such a person recovers, may also be observed to be again the outcome of psychological factors, i.e., whether the environment affords him any real satisfaction: This observation, however, should not lead us to conclude that the disorder is entirely psychogenic, for in medicine we know of many instances where recovery from organic illness influenced by environmental factors. We can further note that psychoanalytic observation of character disorders provides no support for the notion that what is transient is psychogenic and what is stable or unchanging is of biological origin. For psychoanalysis is well acquainted with a variety of extremely rigidly, unmodifiable character disorders that do not require, because of their poor prognosis, the introduction of a special biological hypothesis. There is no reason to connect a prognosis with etiology. From this pint of view the individual with a circumscribed paranoid character development who may have the poorest prognosis might have a considerably purer psychogenic disorder as compared with an acute but transient schizophrenic turmoil state. So, that our hypothesis would explain the paradox that Jackson (1960) noted, namely that the chronic paranoid who has nearly as bad a prognosis as the simplex patient shows the least variation from the norm in psychological terms, in weight and intactness of intelligence, dilapidation of habit patterns, etc.
So that our argument is that psychological knowledge has a certain priority over the biological, a priority in the sense of sequence of observation, that is, that the more all-inclusive, imprecise psychological observations must precede the less inconclusive, more precise biological observations. The psychoanalytic psychiatrist has first to sort things out so that the biologist may know where to look. This hypothesis is one that is not proved, but is still, quite testable.
The term ‘borderline state’ has achieved almost no official status in psychiatric nomenclature, and conveys no diagnostic illumination of a case other than the implication that the patient is quite sick but not frankly psychotic. In the few psychiatric textbooks where the term is to be found at all in the index, it is used in the text to apply to those cases in which the decision is difficult about whether the patients in question are neurotic or psychotic, since both neurotic and psychotic phenomena are observed to be present. The reluctance to make a diagnosis of psychosis on the one hand, in such cases, is usually based on the clinical estimate that these patients have not yet ‘broken with reality?’: On the other hand the psychiatrist feels that the severity of the maladjustment and the presence of ominous clinical signs preclude the diagnosis of a psychoneurosis. Thus the label ‘borderline state’ when used as a diagnosis, conveys more information about the uncertainty and indecision of the psychiatrist than it does about the condition of the patient.
Indeed the term and its equivalents have been frequently attacked in psychiatric and psychoanalytic literature. Rickman (1928) wrote: “hearing of a case in which a psychoneurosis is common in the discretionary phraseology of a Mental Out Patient Department ‘masks’ a psychosis, using the term with inward misgiving, there should be no talk of masks if a case is fully understood and is intuitively not so, having not received a tireless examination-except, of course, as a brief descriptive term comparable too ‘shut-in’ or ‘apprehensive’ which carry our understanding of the case no further.” Similarly, Edward Glover (1932) wrote “I find the term ‘borderline’ or ‘pre’-psychotically, as generally used, unsatisfactory. If a psychotic mechanism is present at all, it should be given a definite label. If we merely suspect the possibility of a breakdown of repression, this can be shown in the term ‘potential’ psychotic (more accurately a ‘potentially clinical’ psychosis). As for larval psychoses, we are all larval psychotics and have been such since the age of two.” Again, Zilboorg (1941) wrote: “The despicable base advanced cases (of schizophrenia) have been noted, but not seriously considered. When of recent years such cases engaged the attention of the clinician, they were usually approached with the euphemistic labels of bonderising cases, incipient schizophrenias, schizoid personalities, mixed manic-depressive psychoses, schizoid maniacs, or psychopathic personalities. Such an attitude is untestable either logically or clinically" . . . ,. Zilboorg goes on to declare that schizophrenia should be recognized and diagnosed when its characteristic psychopathology is present, and suggests the term ‘ambulatory schizophrenia’ for that type of schizophrenia in which the individual is able for the most part, to conceal his pathology from the public.
It is not to be wished to defend the term ‘borderline state’ as a diagnosis, however, it leaves room to discuss the clinical conditions usually connoted by this term, and especially to call attention to the diagnostic, psychopathological, and therapeutic problems involved in these conditions. Therefore this is the limit of which the functional psychiatric conditions where the term is usually applied, and more particularly to those conditions that involve schizophrenic tendencies of some degree.
Thus and so, it s the common experience of psychiatrists and psychoanalysts to see and treat, in open sanitariums or even in office practice, many patients whom they regard, in a general sense, as borderline cases. Often these patients have been referred as cases of psychoneuroses of severe degree who have not responded to treatment according to the usual expectations associated with the supposed diagnosis. Most often, perhaps, they have been called severe obsessive-compulsive cases: Sometime an intractable phobia has been the outstanding symptom: Occasionally an apparent major hysterical symptom or anorexia nervosa dominates the clinical picture, and at times it is a question of depression, or of the extent and ominousness of paranoid trends, or of the severity of a character disorder.
What remains is the unsatisfactory state of our nosology that contributes to our difficulties in classifying these patients diagnostically, and we legitimately wonder at a touch of schizophrenia; is of the same order as a ‘touch of syphilis or a ‘touch of pregnancy?’. Consequently, we flounder so that all of such pronouncing correspondent terms as footing of latent or incipient (or ambulatory) schizophrenia, or accentuate in that of its severe obsessive-compulsive neurosis or depression, adding full coverage, ‘with paranoid trends’ or ‘with schizoid manifestations’. Concerns for the most part, we are quite familiar with the necessary of recognizing the primary symptoms of schizophrenia and not waiting for the secondary ones of hallucinations, delusions, stupor and the like.
Freud (1913) made us alert to the possibly of psychosis underlying a psychoneurotic picture in his warning: “Often enough, when one sees a case of neurosis with hysterical or obsessional symptoms, mild in character and of short duration (just the type of case, that is, which one would see as suitably for the treatment) a doubt that must not be overlooked arises whether the case may not be one of the so-called incipient dementia praecox, so-called (schizophrenia, according to Bleuler), and may not eventually develop well-marked signs of this disease.” Many authors in recent years, among them Hoch and Polatin (1949). Stern (1945), Miller (1940), Pious (1950), Melitta Schmideberg (1947), Fenichel (1945), H. Deutsch (1942), Stengel (1945), and others. Have called attention to types of cases that belong in the borderline band of the psychopathological spectrum, and have commented on the diagnostic and psychotherapeutic problems associated with these cases.
In attempting to make the precise diagnosis in a borderline case there is three often used criteria, or frames of reference, which are to lead to errors if they are used exclusively or uncritically. One of these, which stems from traditional psychiatry, is the question of whether or not there has been a ‘break with reality’: The second is the assumption that neurosis is neurosis, psychosis is psychosis, and never the twain will be met: A third, contributed by psychoanalysis, is the series of stages of development of the libido, with the conception of fixation, regression, and typical defence mechanisms for each stage. 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 whom hae worked successfully in recent years with schizophrenics, Sullivan, Hill, and Karl Menninger and his staffs have 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 flustrations of later years. Earlier the infant lives grandiosely in a narcissistic world of his own. Something may take his needs and desires care of 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 have been in furthering 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. Therefore 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 and 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 that one may be seen as most impressively in catatonic stupors.
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 to the conclusion of quite 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 may 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 the 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 to 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 mean a great deal of the hypersensitive schizophrenic who uses them for orienting 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 the spoken exchange 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, although 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. As to carry out the patient’s suggestions as to take upon his dispense ways, even against the established controversial change in a society of which should 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 analysts’ 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 he-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, lay the groundwork for 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 effectively considered dangerous and unacceptable, and this augments his hatred.
This establishes that the schizophrenic is capable of developing 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 the entire patient's words, gestures, changes of attitude and countenance, and he does the associations of psychoneurosis. 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 to preclude and 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 say a wish for closeness and friendship.
What has been said against intruding into the schizophrenic’s inner world with superfluous interpretation's also holds unswerving 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. If he does not, the analyst does better to listen, least of mention, 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 uncleverly with the transference reactions of a psychoneurotic, it is bad enough, though as a rule is separable but if he fails with a schizophrenic in meeting positively feeling by pointing it out for instance before the patient shows that he is 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 him 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, and 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 met him. He can probably identify himself sufficiently with the patient to understand and accept his emotional reactions without becoming involved in them.
Amid the welter of competing or complementary theories that have characterized psychoanalysis over the century of its existence, the concept of transference and the conviction so important in the therapeutic process may be a unifying theme. None of Freud’s epochal discoveries-the power of the dynamic unconscious, the meaningfulness of the dream, the universality of intrapsychic conflict, the critical role of repression, the phenomena of infantile sexuality-is more heuristically productive or more clinically valuable than his demonstration that humans regularly and inevitably repeat with the analyst and with other important figures in their current lives patterns of relationship, of fantasy, and of conflict with the crucial figures in their childhood-primarily their parents.
Even for Freud, however, the awareness of this phenomenon and the understanding of its specific significance in the analytic situation itself came only gradually. The flamboyant transference events for Anna O and the unfortunate outcome with Dora served to consolidate in Freud’s mind a view of transference as a resistance phenomenon, as an obstacle to the recollection of early traumatic events that, in his view at the time, formed the true essence of the psychoanalytic process. Emphasis in this early period, thus, was on the 'management' of the transference, on finding ways to prevent its interference with the proper business of the analysis-recognizing, always, the inevitability of its occurrence. Freud was most concerned about the interference generated by the 'negative' (i.e., hostile) and the erotised transference; the 'positive' transference he considered 'unobjectionable', “the vehicle of success in the psychoanalysis.”
Freud was also concerned to distinguish the analytic transference from the effects of suggestion in the hypnotic treatment he had learned in France and that gad been the forerunner of his own psychoanalytic technique. He, and his early followers and students, were at great pains to define the transference as a spontaneous product of the analytic situation, emerging from the patient rather than imposed by the analyst. Ultimately, Freud came to view as essentially for an analytic cure the development of a new mental structure, the “transference neurosis”-a re-creation of the original neurosis in the analytic situation itself, with the patient experiencing the analyst as the object of his or her infantile wishes and the focus of his or her pathogenic conflicts, the crucial importance of the transference neurosis-it's very reality as a clinical phenomenon-has been and continues to be a matter of debate among psychoanalysts to this day.
Over the resulting decades several themes appear and reappear. One to which Freud eluded is that of the uniqueness versus the ubiquity of transference; is it a special creation of the analytic situation or is it an inevitable and universal aspect of all human relations? To a considerable degree, are transference phenomena always based on a repetition of experiences? More central and perhaps more heated is the continuing debate about the primacy of transference interpretation in what Strachey has called the 'mutative' effects of analysis-for example, whether such interpretations are simply more convincing than others or are the only kinds that are truly effective therapeutically. Echoes of this debate resound through the years and are to the spoken exchange in some of most recent literature. Finally, are all the patients’ reactions to the analyst in the analytic situation to have the quality of being construed as transference or do some partake of the “real,” “non-neurotic” relationship or of the “working alliance.”
The theoretical explanation of the transference and transference phenomena have undergone significant changes over the years. The transference has become a sort of projective device, a vessel into which each commentator poured the essence of his or her approach to the clinical situation and to the understanding of what unique interactional process that forms the analytic situation.
The introductory group (1909-36) that of the pioneers, shows the afforded efforts of Freud and his early followers to grasp and deal with the powerful phenomenon they were only beginning to recognize and to attempt to understand. The middle period (1936-60) reflects the consolidation of therapeutic technique and he attempts of both European and American analysts to bring the concept of transference into consonance with the increasingly important constructs of ego psychology. In the latest period of which (1960-87), basis the groundwork for a balance between reassertion of traditional views and various revisionist statements and reconsiderations of some classical positions.
Freud’s awareness of the actuality of transference phenomena-that is, of the development in the patient of powerful feelings and wishes toward the therapist in the “talking cure”-began when he first learned from Joseph Breuer of the events that occurred in his treatment of Anna O. It was not, however, until the debacle with Dora that they brought the full force of this phenomenon home to him-if not of his own countertransference feelings as well. Transferences are, Freud said, “new editions or facsimiles of the impulses and fantasies aroused and made consciously during the progress of the analysis; up to the present time they have this peculiarity, . . . that they replace some earlier person by the person of the physician.” “Psychoanalytic treatment does not create transference, but it merely brings them to light like so many other hidden psychical factors.”
Freud did not again deal in detail with the subject of transference until 1912, in The Dynamics of Transference. In fact, the first paper devoted specifically upon its subject matter was in Ferenczi’s “Introjection and Transference,” and published in 1909. Ferenczi offered an exposition on the topic, drawing his stimulus from Freud’s reference to “transferences” in The Interpretation of Dreams and the Dora case. Transference, he states, is a special case of the mechanism of displacement, is ubiquitous in life but especially pronounced in neurotics, and makes explicitly the form of an appearance in the relationship of patient to the physician-in or outside the psychoanalysis. He relates the transference to other psychic mechanisms, most particularly projection and introjection, and defends the psychoanalysis against accusations of improperly generating transference reactions in its patients. “The critics who look on these transferences as dangerous should.” He says, “condemn the non-analytic modes of treatment more severely than the psychoanalytic method, since the former really intensifies the transference, while the later shrives to uncover and to resolve them when possible.”
It was not until 1912, in The Dynamics of Transference, that Freud returned to the subject. Here he explains about libido economy, and given that the topographical model of the mind the inevitable emergence of the transference in the analytic situation and its role as an all-important crucial mode of resistance. “The transference-idea penetrated into consciousness in front of any other possible association because it satisfies the resistance, but only if it is a negative or erotic transference. The analyst’s role is to ‘control’ or’ ‘remove’ the transference resistance. It is, Freud said, “on that field that we must be win the victory?”
We have substantially explored the problem posed by the erotic transference on Observations on Transference-Love. Freud speaks systematically about the dangers of unregulated countertransference, and he admonishes his colleagues on the need to maintain analytic neutrality in the face of the patient’s importunate demand for fulfilment of the erotic longings. Here, again, he coins the much-debated aphorism, they must carry “the treatment out in abstinence.” He makes it clear that “transference lover” is not to occupy the inescapable position by some spatial moment of the some insignificant or deviant, as it draws on the same infantile well-springs as the love of everyday life. It is the analyst’s business to deal with it analytically rather than by gratifying or rejecting it.
Freud’s illumination of the phenomenon of transference although, little appeared in the literature bearing specifically on the topic for several of years. Yet it seems that,
as Strachey points out, this was due to the preoccupation of most analysts, particularly in the rise of ego psychology, with the analysis of resistance and of character traits. It was, therefore, not until 1934 that the most important and, to this day, the most influential post-Freudian contribution to the analysis of transference appeared -. Strachey’s “Nature of the Therapeutic Action of Psycho-Analysis.” Strongly reflecting the influence of Melanie Klein, Strachey outlines the notion that the central analytic task is the resolution of archaic superego elements in the structure of the mind, and that the definitive instrument for affecting this is what he terms “mutative interpretation.” Such an interpretation must, he says, “be emotionally immediate” and “directed to the point of urgency’; “the point of regency is nearly always to be found in the transference.” "Therefore, only transference interpretations are likely to be mutative. Conversely, we are still hearing the reverberations of this shot today.”
Freud’s early view of the transference as Sterba echoed and exemplified a resistance to the analytic work by Sterba, in his report of a case that obviously derived from his European experiences, for example, the description of goose stuffings. Here he explains technical measures for the dissolution of such resistances, which include explanations similarly that “the hostility toward his father, . . . may not have had the quality of being analysed if he developed the unconscious hostility and consequent anxiety toward the analyst that he formally had for his father” In other words, they essentially enjoined the transference, rather than analysed, by appealing to what Sterba came to calling the “observing ego,” as opposed to the “experiencing ego.”
Among the first to apply psychoanalytic principles outside the consulting room was August Aichhorn? Trained as an educator, Aichhorn undertook to work with delinquent adolescents in Vienna and established the first therapeutic school based on psychoanalytic principles; in this setting, he became the mentor for a generation of child analysts, including Erikson, Blos, Ekstein, Redl, and others. In his classical text, Wayward Youth, Aichhorn displayed some extraordinary techniques he devised for treating dissocial adolescents-in particular, ways of manipulating the transference to establish a positive relationship at the outset of treatment.
The appearance in 1936 of Anna Freud’s the Ego and the Mechanisms of Defence represented a landmark in the evolution of psychoanalytic theory and technique. Ms. Freud’s specific codification of the defensive apparatus and her emphasis on the necessity of analysing not merely the id elements but the ego elements of the mind signalled major changes in the way analysts thought about and carried on their clinical work. Nonetheless, her observations on the role of transference analysis, trenchant as they were, remain within the framework of the traditional view of transference phenomena as “repetitions and not new creations.” The function of the analysis of transference is to put the “transferred effective impulse . . . back into its place in the past.” Ms. Freud drew the valuable distinction among the transferences of “libidinal” impulses, the transference of defence, and acting in the transference. Her contribution emphasized the critical value of the analysis of defence transference, which, ads she explained, is far more difficult than that of transferred drive impulses because the patient experiences it as ego-syntonic.
The dominant trend in early discussions was the presumption that the transference is an “autogenous” product of the patient induced, no doubt, by the special character of the analytic situation but emerging out of the patient’s own needs and unfulfilled infantile wishes. Bibring-Lehner (later simply as Bibring) was unitarily to suggest those particular characteristics of the analyst or his or her behaviour can so shape the emerging transference as to create an impenetrable resistance that might. Require a change of analysts. In particular, Bibring-Lehner addressed the matter of the gender of the analyst, but clearly other factors might suffice to blur the patient’s distinction between transference and reality and thus to create an unanalysable stalemate. She spoke, too, of the necessity of a “predominantly positive transference based on confidence, without whose help we cannot overcome the transference neurosis,” this clearly prefigured the concept of the “therapeutic” or “working” alliance that later becomes a focus on controversy.
During the interval (1936-1960), the concerns of those who contributed to the ongoing discussions of transference and its place in analytic theory and technique, in which time this period was to relate its phenomenological growth in understanding of the ego, both in its defensive and (Hartmanns) 'autonomous' aspects, to new theories of early development and to a growing concern in some quarters with “interpersonal” as opposed too purely “intrapsychic” aspects of personality function. A subsequent stimulus was Alexander’s (1946) advocacy of active role playing by the analyst to give the patient a “corrective emotional experience,” at least in psychoanalytic psychotherapy if not in analysis proper.
Of a well-oriented paper, Greenacre emphasizes the distinction, first stated by Freud, between the analytic transference and that which characterizes other modes of therapy. All manipulation, exploitation, we have excluded all use of transference for “corrective emotional experience” from the psychoanalytic situation, which relies exclusively on interpretation to achieve its therapeutic goal. Greenacre’s view of the analyst’s role in analysis and in the world outside as ascetically in agreement; she would preclude the analyst from publicly participating in social or political activities that might have a possessive tendency to reveal aspects of the analyst’s person that would contaminate the transference. Like Freud, Stone, and others she distinguishes between a “basic,” essentially non-conflictual transference derived from the early mother-child relationship and the analytic transference proper, which involves projection onto the analyst of unconscious conflictual material, yet, others (for example, Brenner) challenge this distinction.
It is, however, echoed in Elizabeth Zetzel’s masterful review of what were, the dominant trends in the field. She proposed, following the usage of Edward Bibring, the concept of the “therapeutic alliance,” derived, as was Greenacre’s “basic transference,” from the positive aspects of the mother-child relationship. Like most other commentators she asserted the centrality of transference interpretation in the analytic process, but she resorts by a schismatically oriented sharping detail of some differences in the form and content of such interpretations between Freudian and Kleinian analysis-that is, between those who are concerned with the role of the ego and the analysis of defence and those who emphasize the importance of early object relations and primitive instinctual fantasy.
Like Greenacre and Zetzel, Greenson distinguishes between what he calls the “working alliance” sand the “transference neurosis.” He contends that without the development of the former they cannot analyse the latter effectively. The “working alliance” depends not only on the patient’s capacity to establish adequate object ties and to assess reality. However, also on the analyst’s assumption of an attitude that permits such an alliance to emerge, and, also to Greenson who advocates an analytic stance that, while holding fast to the rule of abstinence, allows for more “realistic” gratification that is no less ascetical than Greenacre would encourage. Gill will later challenge Greenson’s definition of transference-that it always represents a repetition of experiences and that it is always “inappropriate to the present,”-who contends that transference reactions may be appropriate responses to aspects of the analytic situation of which both patient and analysts are not necessarily aware.
In contrast to these views, Brenner categorically rejects the notions of “therapeutic” and “working” alliances as distinct from the analytic transference, and with them the admonition to the analyst to be “human” or “empathic” to encourage such states. In his view, “both refer to aspects of the transference that neither deserve a special name nor require special treatment.” “In analysis,” he says, “it is best for the patient if one approaches everything analytically. It is as important to understand why they have closely ‘allied a patient’ with his analyst . . . as, it is to understand why there is no ‘alliance’ at all.”
In an extremely thoughtful, systematic exploration of the topic, Macalpine argues that the infantile situation induces transference in patients in which the analysis, by its rightfully hidden nature, places them. As do hypnotic subjects, analysands adapt by regression and, if we have predisposed them to do so, will experience the present as to their infantile past. What distinguishes analysis from hypnosis is the nonparticipation of the analyst in the process-that is, the analyst’s avoidance, by the management of his or her countertransference, of active suggestion. “The analytic transference relationship had respectably spoken not as to make up the relationship between analysand and analyst, but more precisely as the analysand’s relations to his analyst.” In these Macalpine stands apart from more recent object relations theorists who stress the mutual dyadic aspect of the analytic situation.
Nurnberg, too, analogizes the analytic situation to that of hypnosis, in its induction of a regressive state in which the patient submits to the analyst’s implicit parental power and authority. The patient then projects onto the analyst his or her unconscious representation of the parent, seeking to achieve an “identity of perception” between the two images. Primarily it is the superego, he contents, that is in such a way projected, and it is through the analysis of these projections that we have enabled the patient to deal more effectively with reality. It must be of note that in Nunberg’s tendency to denote the source of the superego as exclusively presented as “the father” and the transference projection as that of the “father image.”
They have rooted Melanie Klein’s approach to the transference, of course, in her conception of the developmental process and the role of early object relations, which, she maintains, exists from the beginning of life. The transference represents the displacement of not only the actual aspects of parents but also of split-off projected and introjected part-object representations from early infancy-prosecutory “bad” objects or benevolent “good” ones. Like Gill, Klein both emphasizes the importance of attending to and interpreting subtle or disguised references to the analyst and maintains that therapeutic necessity of relating all associative content to transference fantasies and wishes, with special emphasis on the negative transference (another lucid exposition that of his, a Kleinian approach to the transference is that of Paula Heimann [1956] ).
Under the influence of Mrs. Klein many British analysts, D. W. Winnicott among them, have undertaken to analyse patients with what Americans would speak of as severe ego disturbances-borderline and psychotic in nature. Winnicott’s too repressed at the time of the original experience, she appears to anticipate Winnicott’s ideas about “true” and “false” selves.
Freud distinguished between the “transference neuroses” and the “narcissistic neuroses,” which included schizophrenia. He contended that patients in the latter group did not establish transferences and thus were inaccessible to psychoanalytic therapy. Like Winnicott, Fromm-Reichmann, from her experience with schizophrenics at Chestnut Lodge, challenges this dictum. Though clearly not adaptable to the conventional analytic situations, such patients do, she contends, from intense. Transference reactions and are susceptible too analytically informed, though often unorthodox, therapeutic intervention. Though many would question the ultimate effectiveness for such a therapy that pose to pass on (McGlashan 1984), Fromm-Reichmann’s description of her special techniques for establishing contact with persons in profound states of narcissistic regression and for understanding their transference reactions are impressive and are still of value.
Recent decades have witnessed a resurgence of interest in the transference in its aspects-theoretical and technical. Stimulated by new analytically perceptive both in Europe and the United States and by influences stemming from linguistics and philosophy, several commentators have sought to reconsider traditional viewpoints and to satisfy new observational data.
In his long, densely written paper Stone undertakes a comprehensive statement of his views on the varied aspects of the transference from developmental and clinical perspectives. In particular, he sets forth a distinction between the “primordial” and the “mature” transference “from which,” he says, we have derived “the various clinical and demonstrable forms,” where they have “derived the “primordial” transference from the effort to master the series of crucial separations from the mother,” the mature transference “encompasses . . . the wish to understand, and to be understood” and “in its peak development, . . . the wish for increasingly accurate interpretations.” The “mature” transference draws then on autonomous ego functions and is a “dynamic and integral part of the ‘therapeutic alliance.’” Stone also deals in extensor with the Stracheyian question of the special “mutative” value of transference interpretation, while not devaluing these, he argues persuasively for the importance of the patient’s real life experiences and the analytic value of interpretations related to them.
One of the most forceful statements of the centrality of the transference to the analytic experience is that of Brian Bird. In his view, there is something unique about the analytic transference; for him, everything that occurs in the analysis for both patient and analyst partakes of transference elements. Yet for Bird, what is essential for the therapeutic effect is not merely the analysis of transference “feeling” but the evolution and analysis of a full-blown transference neurosis. He asserts, the quintessence of the transference neurosis is an analytic stalemate, in which one’s interpersonal replaced be as an intrapsychic conflict involving the patient and a split-off aspect of his or her neurosis assigned to the analyst. The true work and the “hardest part” of analysis go on, and it is in the interpretation and resolution of such stalemates-including a rigorous analysis of the patient’s hostile, destructive wishes.
Gill, in basic agreement, carries the argument even in a major way. He distinguishes between the patient’s resistance to awareness of transference and the resistance to the resolution of the transference. It is the former, where transference experiences are largely unconscious and ego-syntonic, that is the more difficult. It is the analyst’s task to allow the transference to evolve and flourish so that we can make the patient aware of it. To do so, the analyst must be alert to interpret indirect and veiled allusions to the transference and, to a considerable degree, seek out those elements of the analytic situation, including the analyst’s own behaviour, that serve as the “day-residue” for such transference responses. Gill strongly advocates a focus on the here-and-now factors, allowing genetic determinants to emerge on their own rather than interpreting them.
The distinction between what has been called the “basic” transference, or the “therapeutic alliance” or the “working alliance,” on the one hand and the analytic transference or transference neurosis in the other has been a staple of controversy. Stein, reflecting on Freud’s term “the unobjectionable part of the transference,” takes issue with this distinction. Insisting of the entire transference phenomena that he so then encourages the forethought against the practice of leaving the “unobjectionable” or “basic” transference unanalysed: They are, he says, “the manifest resultant of a complex web of unconscious conflicts that must be, and are unably effective of being, sought and described.” The speculative assumption was that they were to personify of some underlain realization as rooted merely in early infant development as he believes unwarranted.
From his reassessment of basic psychoanalytic concepts, Schafer, influenced by British analytic philosophers, provides a revised view of transference and transference interpretation-in particular, of the character of transference as “repetition.” As Schafer sees it, transference experiences are new ones, created by the analytic situation. It is the act of analytic interpretation that forms them as repetition. More properly they can see them as metaphoric communications; thus, “they represent movement forward, not backward.” Interpretation does not merely recover or uncover old meanings; it creates new meanings that help the patient to make sense-psychoanalytic sense-of his or her life and modes of relating to others. Transference, Schafer says, is “the emotional experiencing of the past as it is now remembering,” not as it “really” happened.
Loewald considers the status of the transference neurosis in the setting of contemporary practice, in which the modal patient suffers from a character neurosis rather than from the “classical” symptom neuroses of an earlier era. Given the more diffuse developmental etiology of the character disturbances, transference manifestations are so inclined as to be modestly definite and less focussed; a transference neurosis in the classical sense may not appear at all. Thus, “transference neurosis is not so much an entity to be found in the patient, but an operational concept, . . . a creature of the analytic situation.” Even where a full-blown transference neurosis does not develop, however, we can accomplish much? “The repercussion of what has occurred,” Loewald states, “may turn out to be deeper and more extensive than anticipated.”
Strachey’s pivotal advocacy of the exclusively “mutative” value of transference interpretation has led to one major controversy in the literature. In its extreme form, the position taken was not only that transference interpretations were crucial but that interpretations addressed to extra-transferential experiences were in principle ineffective and useless. Leites, a non-clinician, survey the literature to argue strongly for the other side-for the view, that is, that the analysis of current and experiences with others can be as effective and meaningful as can the unifocal address to the transference. Without reducing the special impact of transference interpretations, Leites seeks to undo the dogmatism and rigidity he sees inherently in what he calls “Strachey’s Law.”
In the evolution of what came to his “psychology of the self,” Heinz Kohut demarcated a topology of transference reactions that were, in his view, characteristic of patients with narcissistic personality disorders. This, the “idealizing” and “mirror” transferences, reflected specific types of deprivation in early parent-child interactions that generated a persistent need for special types of what came to call “self-object” attachments-in and out of the analytic situation. Kohut’s meticulous descriptions of these transference phenomena and of their analytic management were a source of stimulation and instruction to many analysts, even to those who were unwilling to follow some later developments in his theoretical and technical thinking.
Of recent commentators, perhaps the most gnomic, the least penetrable, and the most devoted to paradoxes were Jacques Lacan. Here, he takes exception to what he regards as the “American” concept of appealing, through the therapeutic alliance, to the “mature” portion of or (anathema to him) the “autonomous functions.” Lacan does share the general view that the transference is central to the analytic experience and seems to echo Freud in conceiving it primarily as a resistance-as, “closing” of the unconscious, and is characteristically by obscurity and linguistic play and leaves one uncertain as to his actual technical approach, but the central thread of his focus on language as the basic element in the structure of mental life,-we have structured “the unconscious like language”-is affirmatively defended by Lacan, 1978.
They couch Kernberg’s reflections on the transference through his “ego psychological-object relations” though sharing the recent emphasis on here-and-now aspects of transference interpretation. He regards the links with infantile precursors, conceived in early internalized object relations, as essential. He urges openness of mind and tolerance of uncertainty, however, rather than imposing on the patient preconceived ideas about etiology and pathogenesis. In particular, he distances himself from what he regards as the restrictive concepts of “self-psychology,” especially regarding the role of aggression. What is more, while attending closely to all aspects of communication in the session, Kernberg aligns himself with those who regard both extra-analytic and intra-analytic experience as valid material for interpretation.
The alternative views of transference as a repetition of infantile experience and as a new creation in the setting of the analytic situation have evidently formed the basis of a continuing debate from the earliest years. In his assessment of current ideas of transference, Cooper calls these respectively the “historical” and the “modernist” views attributing recent interest able to changing philosophical concepts of reality and the rise to prominence of object relations theories in analysis. Cooper comes down squarely for the “modernist” views, maintaining, like Gill, that the actuality of the analyst’s individuation and behaviour are a powerful determinant of the patient’s transference reactions and need be accorded to the attention of at least the equal to that any given reconstructed infantile determinant, for he admixtures for a “synchronic” rather than a “diachronic” view of the transference and like Spence (1982), Schafer (1983). Others question the possibility of re-creating from the analysis of the transference or from anything else a “true” version of the life history.
Still, they must remember it, that it was as a therapeutic procedure that psychoanalyses originated. It is in the main as a therapeutic agency that it exists today. It may be of a surprise to us, in that the per capita of equal measure prove equivalent to the minor preposition of psychoanalytical literature of which is concerned with the mechanisms by which they achieve its therapeutic effects. They have accumulated a very considerable quantity of data during the last thirty or forty years that throw light upon the nature and workings of the human mind: we have made perceptible progress in the task of classifying and subsuming such data into a body of generalized hypotheses or scientific laws. Nevertheless, there has been a remarkable hesitation in applying these findings in any great detail to the therapeutic process itself. Seemingly probable, one cannot help feeling that this hesitation has been responsible for the fact that so many discussions upon the practical details of analytic technique seem to leave us at cross-purposes and at an inconclusive end. How, for instance, can we expect to agree upon the vexed question of whether and when we should give a “deep interpretation,” while we have no clear ideas of what we mean by a “deep interpretation,” while, we have no exactly formulated view of the idea of ‘interpretation’ itself, no precise knowledge of what interpretation’ is and what effect it has upon our patients? We should gain much, least of mention, from a clearer grasp of problems such as this. If we could arrive at a more detailed understanding of the workings of the therapeutic process, we show; if be less prone to those occasional feelings of utter disorientation that few analysts are fortunate enough to escape, and the analytic movement itself might be less at the mercy of proposals for abrupt alterations in the ordinary technical procedure-proposals that derive much of their strength from the prevailing uncertainty as to the exact nature of the analytic therapy. At present, it is a tentative attack upon this problem, and although it should turn out that they cannot maintain its very doubtful conclusions. Some analysts, however, are anxious to draw attention to the agency of the problem itself. Sometimes, however, make clear that what follows is not a practical discussion upon psychoanalytic technique. Because, its impending bearings are merely theoretical, since the considerable individual deviation that we would generally regard as the various sorts of procedures. As within the limits of ‘orthodox’ psychoanalysis and various sorts of effects which observation shows that the applications of such procedures bring to a trend about having set up a hypothesis which endeavours to explain almost coherently why these particular procedures cause this effectiveness and if possible it hypotheses about the nature of the therapeutic action of a psychoanalysis are valid, certain implications follow from it that might serve as criteria in forming a justifiable judgement of the probable effectiveness of any particular type of procedure?
It will be the object, nonetheless, that exaggeration and the novelty of its topic, are after all, it leaves to be said, “we do understand and have long understood the main principles that governs the therapeutic action of analysis.” To this, of course, is, the start of what I having as shortly as possible the accepted views upon the subject. For this purpose, we must go back to the period between the years 1912 and 1917 during which Freud gave us the greater part of what he has written directly on the therapeutic side of the psychoanalysis, namely the series of papers on technique and the twenty-seventh and twenty-eight chapters of the Introductory Lectures.
The systematic application characterized this period of the method known as ‘resistance analysis’. The method in question was hardly a new one even. It was based upon ideas that had long been implicit in analytic theory, and in particular upon one of the earliest of Freud’s views of the dynamic function of neurotic symptoms. According to that view (which was computably essential to the study of hysteria) the function of the neurotic symptom was to defend the patient’s personality against an unconscious tread of thought that was unacceptable to it, while simultaneously gratifying the trend up to a certain point. It seems to follow, therefore, that if the analyst were to investigate and discover the unconscious trend and make the patient aware of it-if he were to make what was unconsciously conscious-the whole raison d̀être of the symptom would cease and it must automatically disappear. Two difficulties arose, however. In the first place some part of the patient’s mind was found to raise obstacles to the process, to offer resistance to the analyst when he tried to discover the unconscious trend, and it was easy to conclude that this was the same part of the patient’s mind as had originally repudiated the unconscious trend and had thus necessitated the creation of the symptom. But, in the second place, even when this obstacle might be surmounted, even when the analyst had succeed in guessing or deducing the nature of the unconscious trend, had drawn the patient’s attention to it and had apparently made him fully aware of it-even then, it would often happen that the symptom persisted unshaken. The realization of Difficultness has led to important results both theoretically and practically. Theoretically, there were evidently two senses in which a patient could become conscious of an unconscious trend, and the analyst could make him aware of it in some intellectual sense without becoming ‘really’ conscious of it. To make this state of things more intelligible, Freud devised a kind of pictorial allegory. He imagined the mind as a kind of map. They pictured the original objectionable trend as moved to one region of this map and the newly discovered information about it, expressed to the patient by the analyst, in another. It was only if these two impressions could be “brought together.” Whatever exactly that might mean, in that the unconscious trend would be “really” made conscious. What prevented this from happening was a force within the patient, a barrier-once, again, evidently the same “resistance” which had opposed the analyst’s attempts at investigating the unconscious trend that had contributed to the original production of the symptom. The removal of this resistance was the essential preliminary to the patient’s becoming “really” conscious of the unconscious trend. It was at this point that the practice lesson emerged: As pertained to the psychoanalysis the main task is not so much to investigate the objectionable unconscious trend as to get rid of the patient’s resistance to it.
Still, how are we to set about this task of demolishing the resistance? Once, again, by the same process of investigation and explanation that we have already applied to the unconscious trend. However, this time such difficulties do not face us as before, for the forces that are keeping up the regression, although they are to some extent unconscious, do not belong to the unconscious, in the systematic sense, they are a part of the patient’s ego, which is co-operating with us, and are thus more accessible. Nonetheless, the existing state of equilibrium will not be upset. The ego will not be induced to do the work of readjustment required of it, unless we are able by our analytic procedure to mobilize some fresh force upon our side.
What forces can we count upon? The patient’s will to recovery, in the first place, which led him to embark upon the analysis, are again of an intellectual consideration that we can bring to his notice. We can make him understand the structure of his symptom and the motives for his repudiation of the objectionable trend. We can point out the fact that these motives are out-of-date and no longer valid: That they may have been reasonable when he was a baby, but are no longer so now that he is grown up. Finally, we can insist that this original solution of the difficulty has only led to illness, while the new one that we propose remains in a certain state ousting of the prospect of health. Such motives these may play a part in inducing the patient to abandon his resistance, nevertheless, it is from an entirely deafened quarter that the decisive factor emerges. This factor, need be, is that of the transference.
Although from very early times Freud had called attention to the fact that transference manifest of itself in two ways-negatively and positively, a good deal less was said or known about the negative transference than about the positive. This, of course, corresponds to the circumstance that interest in the destructive and aggressive impulses overall, is only a comparatively recent development. They regarded transference predominantly as a ‘libidinal’ phenomenon. They suggested that in everyone there subsisting to several unsatisfied libidinal impulses, and that whenever some new person came upon the scene these impulses were ready to attach them to him. This was the account of transference as a universal phenomenon. In neurotics, owing to the abnormally large quantities of unattached libido presents in them, the tendency to transference would be correspondingly greater, and the peculiar circumstances of the analytic situation would further increase it. It was evidently the existence of these feelings of love, thrown by the patient upon the analyst, that provided the necessary extra force to induce his ego to give up its resistances, undo the repressions and adopt a fresh solution of its ancient problems. This instrument, without which no therapeutic result could be obtained, was at once seen to be no stranger: It was in fact the familiar peer of suggestion, which had ostensibly been abandoned long in advance. Now, however, it was being employed in a very different way, in fact in a contrary direction. In pre-analytic days it had aimed at cause an increase in repression, now overcoming the resistance of the ego was put-upon, that is to say, to allow the repression to be removed.
However, the situation became ever more complicated as more facts about transference became known. In the first place, the feelings transferred turned on to be as various sorts, besides the loving ones there were the hostile ones, which were naturally far from helping the analyst’s efforts. Nevertheless, even apart from the hostile transference, the libidinal feelings themselves fell into two groups: Friendly and affectionate feelings that could be conscious, and purely erotic ones that have usually to remain unconscious. These latter feelings, when they became too powerful, stirred up the repressive forces of the ego and thus increased its resistances instead of diminishing them, and in fact produced a state of things that was not easily distinguishable from the damaging negative transference. Beyond all this, in that respect arises in the entireness in the question in a deficiency of permanence of all suggestive treatments. Did not the existence of the transference threaten to leave the analytic patient in that same? In that, by the unending dependence is reliant upon the analyst?
The discovery that the transference itself could be analysed got over these difficulties. Its analysis, was soon found the most important part of the whole treatment. Making consciously its roots in the repressed unconscious was just possible as making conscious any other repressed material was possible-that is, by inducing the ego to abandon its resistance-and there was nothing self-contradictory in the fact that the force used for resolving the transference was the transference itself. Once it had been made conscious, its unmanageable, infantile, permanent characteristics disappeared: What was left was like any other “real” human relationship. Still, the necessity for constantly analysing the transference became still more apparent from another discovery. It was found that as work went on the transference tended, as it was, to eat up the entire analysis. Often of the patient’s libido became concentrated upon his relation to the analyst, the patient’s original symptoms were drained of their cathexis, and there appeared instead an artificial neurosis to which Freud gave the name the 'transference neurosis'. The original conflicts, which have on the onset of neurosis, begun to be
re-enacted in the relations to the analyst. Now this unexpected event is far from being the misfortune that at first sight it might be. In fact it gave us our great opportunity. Instead of having to deal as best we may with conflicts of the remote past, which are concerned with dead circumstances and mummified personalities, whose outcome is already determined, we find ourselves involved in an actual and immediate situation, in which we and the patient are the principle character and the development of which is to some extent at least under our control. Yet if we bring it about that in this revivified transference conflict the patient choses a new situation instead of the old one, a solution in which behaviour more replaces the primitive and unadaptable method of repression in contact with reality, then, even after his detachment from the analysis, he can fall back into his former neurosis. The solution of the transference conflict implies the simultaneous solution of the infantile conflict of which it is a new edition. “The change,” says Freud in his Introductory Lectures, is made possible by alternations in the ego occurring consequently of the analyst’s suggestions. At the expense of the unconscious, the ego becomes wider by the work of interpretation that brings the unconscious material into consciousness: Through education it becomes reconciled to the libido and is made willing to grant it a certain degree of satisfaction, and its horror of the claims of its libido is lessoned in sublimation. The additional are nearly the courses of the treatment that corresponds with this ideal description, and the greater will be the success of the psychoanalytic therapy. At the time Freud had written these words, was made quite clear that in writing this script he held that the ultimate factor in the therapeutic action of the psychoanalysis was suggestion by the analyst acting upon the patient’s ego in a way that makes it more tolerant of the libidinal trends.
In the years that have passed since he wrote this passage Freud was to produce an extremely small bearing that had been directly on the subject, and that little goes to show that he has not altered his views on the main principles involved. However, it is, nonetheless, the additional lectures published most recently that he explicitly states that he has nothing to add to the theoretical discussion upon therapy given in the original lectures fifteen years earlier. While there has in the interval been a considerable further development of his theoretical opinions, and especially in the region of ego-psychology. He had, in particular, formulated the idea of the super-ego. The restatement in super-ego terms of the principles of therapeutics that he laid down in the period of resistance analysis may not involve many changes. It is, nevertheless, the anticipating that information about the super-ego will be of special interest from our give directions to orient the view as is reasonable: And in two ways. In the first place, it would at first sight seem highly probable that the super-ego should play an important part, direct or indirect, in the setting-up and maintaining of the repressions and resistances the demolition of which has been the chief aim of analysis? An examination confirms this of the classification of the various kinds of resistance made by Freud in Hemmung Symptom und Angst (1926). Of the five sorts of resistance there mentioned it is true that only one is attributed to the direct intervention of the super-ego, but two of the ego-resistances-the repression-resistance and the transference-resistance-although originating from the ego, are as a rule set up by it out of fear of the super-ego? It seems likely enough therefore that when Freud wrote the words that have been of a quotation, to the effect that the favourable change in the patient is made possible by alternations in the ego, he was thinking, in part at all events, of that portion of the ego that he subsequently separated off into the super-ego. Quite apart from this, moreover, to a greater extent Freud’s most recently published works, the Group Psychology (1921), there are passages that suggest a different point-namely, that it may be largely through the patient’s super-ego that the analyst could influence him. These passages occur in his Discussions on the nature of hypnosis and suggestion. He definitely rejects Bernheim’s view that all hypnotic phenomena are traceable to the factor of suggestion, and adopts the alterative theory that suggestion is a partial manifestation of the state of hypnosis. The state of hypnosis, again, is found in certain respects to resemble the state of being in love. There is “the same humble subjection, but the same compliance, the same absence of criticism toward the hypnotist as toward the loved object,” in particular, there can be no doubt that the hypnotist, like the loved object. “Having become abounding with the place of the subject’s ego-ideal, in the sense that it's most recent of suggestions is a partial form of hypnosis and of suggestion. In that it seems to follow that the analyst owes his effectiveness, at all events in some respect, to his having stepped into the place of the patient’s super-ego. Thus, there are two convergent lines of argument that point to the patient’s super-ego as occupying a key position in analytic therapy: It is a part of the patient’s mind in which a favourable alteration would be likely to lead to an overall improvement, and it is a part of the patient’s mind that is especially subject to the analyst’s influence.
Such plausible notions are they followed these up almost immediately after the super-ego made its first debut. Ernest Jones developed them, for instance, in his paper on The Nature of Auto-Suggestion. Soon afterwards Alexander launched his theory that the principle; aim of all psychoanalytic therapy must be the complete demolition of the super-ego and the assumption of its functions by the ego. According to his account, the treatment falls into two phases. Its first phase asserts that they have handed over the function of the patient’s super-ego to the analyst, and in the second phase they are passed back again to the patient, but this time to his ego. The super-ego, according to this view of Alexander’s (though he explicitly limits his use of the word to the unconscious parts of the ego ideal). Is some fundamental apparatus that is essentially primitive, out of date? And out of touch with reality, which is incapable of adapting itself, which operates automatically, with the monotonous uniformity of a reflex? Any useful functions that it takes measures to put into effect the ego can carry out an action that, and there is therefore nothing to be done with it but to scrap it. This wholesale attack upon the super-ego might be of questionable validity. Its abolishment would probably become more even if that were pragmatically political, and would involve the abolition of most highly desirable mental activities. However, the idea that the analyst temporarily takes over the functions of the patient’s super-ego during the treatment and by doing in some way alters it agrees with the tentative remarks that have already been of mention.
So, too, do some passages in a paper by Radó upon The Economic Principle in Psycho-Analytic Technique. The second part of this paper, which was to have dealt with the psychoanalysis, has unfortunately never been published, but the first one, on hypnotism and cantharis, contains much that is of interest. It includes a theory that the hypnotic subject introjects the hypnotist if the form of what Radó calls a “parasitic super-ego,” which draws off the energy and takes over the functions of the subject’s original super-ego. One feature of the situation brought out by Radó is the unstable and temporary nature of this whole arrangement. If, for instance, the hypnotist gives a command that is too much opposing the subject’s original super-ego, the parasite is promptly extruded. In any case, when the state of hypnosis ends, the sway of the parasite super-ego also ends and the original super-ego resumes its dynamical function.
However debatable may be the details of Radó’s description, it not only emphasizes again the notion of the super-ego as the fulcrum of psychotherapy, but it draws attention to the important distinction between the effects of hypnosis and analysis concerning permanence. Hypnosis acts essentially in a temporary way, and Radó’s theory of the parasitic super-ego, which does not really replace the original one but merely throws it out of action, gives a very good picture of its apparent workings. Analysis, on the other hand, in so as far as it seeks to affect the patient’s super-ego, aims at something very much more afar in reaching and becoming permanent-namely, at an integral change like the patient’s super-ego itself. Some even more recent developments in psychoanalytic theory give a hint, so it seems, in that of the kind of line of reasoning, along which we might agree of the question.
This latest growth of theory has been very much occupied with the destructive impulses and has brought them for the first time into the centre of interest: And attention has art the same time been concentrated on the correlated problems of guilt and anxiety. Especially, are those influenced by such of an idea depicting the elaborate development of the super-ego and recently developed in retaining Melanie Klein and the importance that she displays the attributes that the narrative and cognitive process of introjection and projection in the development of the personality. The individual, she holds, is perpetually introjecting and projecting the object of its impulses, and the character of the introjected objects depends on the character of the id-impulses directed toward the external object. Thus, for instance, during the stage of a child’s libidinal development in which feelings of oral aggression dominate it, its feelings toward its external object will be orally aggressive, and it will then introject the object, and the introjected object will now act (in the manner of a super-ego) in an oral aggressiveness toward the child’s ego. The next event will be the projection of this orally aggressive introjective object back onto the external object, which will now in its turn may be orally aggressive. The fact of the external object being thus felt as dangerous and destructive withal lead to the id-impulse as to adopt an even more aggressive and destructive attitude toward the object in a self-defence. They thus establish a vicious circle. This process seeks to account for the extreme severity of the super-ego in small children, and for their unreasonable fear of outside objects. During the development of the normal individual, his libido eventually reaches the genital stage, at which the positive impulses predominate. His attitude toward his external objects will thus become more friendly, and accordingly his introjected objects (or, the super-ego) will become less severe and his ego’s contact with reality will be less distorted. In the neurotic, however, for various reasons-whether because of frustration or of an incapacity of the ego to tolerate id-impulses, or of an inherent excess of the destructive components-development to the genital stage does not occur. However, the individual remains of a savage id on the one hand and a correspondingly savage super-ego on the other, and the vicious circle distinguish its perpetuation. The hypothesis as stated may be useful in helping us to form a visualization upon which not only of the mechanism of a neurosis but also of the mechanism of its cure. There is, nonetheless, nothing new in regarding a neurosis as essentially an obstacle or deflecting force in the path of normal development: Nor is there anything new in the belief that a psychoanalysis, owing to the peculiarity of the analytic situation can reassign the obstacle and so allow the normal development to continue. That being said, it is, nonetheless, in lead to appear of intentions to make our conception a little more precise by assuming the pathological obstacle to the neurotic individuals’ further growth is like a vicious circle of the kind the same. If a breach could somehow or other be made in the vicious circle, they would preview the processes of development upon their normal course. If, for instance, they could make the patient less frightened of his super-ego or introjected object, he would project less terrifying imagos onto the outer object and would therefore have less need to feel hostile toward it: The object that he then introjected would in turn be less savage in its pressure upon the id-impulses, which could probably lose something of their primitive ferocity. In short, a benign circle would be set up instead of a vicious one, and ultimately the patient’s libidinal development would go on to the genital level, however? As with a normal adult, his super-ego will be comparatively mild and his ego will have a proportionally undistorted contact with reality.
Nonetheless, at what point in the vicious circle is the breach to be made and how is it to be effected? Altering the character of a person’s super-ego is easier said is obvious that than done. Nevertheless, the quotations from earlier discussions have in suggesting that the super-ego will be found to play an important part in the solution of our problem. However, presumption qualities are yet to quantities imputed in the positing affirmation in which they have described considering not to a greater extent then besides a closer nature of what as the analytic-situation will be necessary, the relation between the two persons concerned in it is a highly complex one, and for our present purposes, we are to isolate two elements in it. In the first place, the patient in analysis has of a tendency to centralize the whole of his id-impulses upon the analyst, all the same, no further comment upon this fact or its implications, since they are so immensely familiar, but only to emphasize upon their vital importance to all that follows and go at once to the second element of the analytic situation, which, again will be of an isolate. The patient in analysis tends to accept the analyst in some way or other as a substitute for his own super-ego. At this point, to imitate with a slight difference the convenient phase with which Radó used in his account of hypnosis and to say that in analysis the patient has a propensity to put forth the analyst into an “auxiliary super-ego.” This phrase and the relation decided by it evidently require some explanation.
When a neurotic patient meets a new object in ordinary life, according to our underlying hypothesis he will be inclined to project onto it his introjected archaic objects and the new object will surmount the extent of an illusory object. It is to be presumed that his introjected objects are essentially separated out into two groups, which function as a 'good' introjected object (or, a mild super-ego) and a 'bad' introjected object (or, a harsh super-ego). According to the degree to which his ego maintains contacts with reality, will project the "good" introjected object onto benevolently real outside objects and the?"bad" one onto malignantly real outside objects. Since, however, he is by hypothesis neurotic, the 'bad' introjected object will predominate, and will lean heavily toward an externalization of that of which have projected the "good" one, and there will further be a tendency, even where to the generative began with the 'good' object, for the 'bad' one after a time to take its place. Consequently, saying that usually the neurotic’s phantasy objects in the outside world will be predominantly dangerous and hostile will be true. Moreover, since even his 'good' introjected objects will be 'good' according to an archaic and infantile standard, and will be to some extent maintained simply for counteracting the ‘bad’ object, even his ‘good’ phantasy objects in the outer world and its containing surrounding surfaces will be very much out of touch with reality. Going back now to the moment when our neurotic patient meets a new object in real life and supposing (as will is the more usual case) that he projects his 'bad' introjected object onto it-the phantasy external object will then seem to him to be dangerous, he will be frightened of it and, to defend himself against it, will become more angry. Thus, when he introjects this new object in turn, it will merely be adding another terrifying imago to those he has already introjected. The new introjected imago will in fact simply be a duplicate of the original archaic ones, and his super-ego will remain almost exactly as it was. The same will be also true with the necessary changes made where he begins by projection with which his “good” introjected object onto the new external object he has met. No doubt, as a result, there will be a slight strengthening of his kind super-ego at the expense of his harsh one, and to that extent from which will improve his condition. Burt there will be no qualitative change in his super-ego, for the new “good” object introjected will only be a duplicate of an archaic original and will only reinforce the archaic “good” super-ego already present?
The effect when the neurotic patient contacts a new object in analysis is from the first moment to create a different situation. His super-ego is in any case either homogeneous or well organized: we have previously oversimplified the account we have given of it and schematic. Effectively, it has derived the introjected imago that goes to make it up from a variety of stages of his history and function to some extent independently. Now, owing to the peculiarities of the analytic circumstance and of the analyst’s behaviour, the introjected imago of the analyst tends in part to be quite definitely separated off from the rest of the patient’s super-ego. (This, of course, presupposes a certain degree of contact with reality on his part. Here we have one fundamental criterion of accessibility to analytic treatment: Another, which we have already implicitly noticed, is the patient’s ability to attach his id-impulses to the analyst.) This separation between the imago of the introjected analyst and the rest of the patient’s super-ego becomes evident at quite an early stage of the treatment, for instance, about the fundamental rule of free-association. The new bit of super-ego tells the patient that benevolent characteristics have allowed him to say anything that may come into his head. This works satisfactorily for a little, but soon there comes a conflict between the new bit and the rest, for the original super-ego says: “You must not say this, for, if you do, you will be using an obscene word or betraying so-ans-so’s confidences.” The separation off the new but-we have generally called what the “auxiliary” super-ego-as been inclined to persevere the very reason that it usually operates in a different direction from the rest of the super-ego. This is true not only of the “harsh” super-ego but also of the “mild” one. For, though the auxiliary super-ego is in fact kindly, it is not kindly in the same archaic way as the case’s patients introjected “good” imagos. The most important characteristic of the auxiliary super-ego is that its advice to the ego is consistently based upon real and contemporary considerations and this serves to differentiate it from the greater part of the original super-ego.
In spite of this, the situation is nonetheless extremely insecure. There is a constant tendency for the whole distinction to break down. The patient is liable at any moment to project this terrifying imago onto the analyst just as though he were anyone else he might have met in his life. If this happens, the introjected imago of the analyst will be wholly incorporated into the rest of the patient’s harsh super-ego, and the auxiliary super-ego will disappear. Even when the content of the auxiliary super-ego’s advice is realized as different from or contrary to that of the original super-ego, very often its quality will be felt for being the one. For instance, the patient may feel that the analyst has said to him: “If you do not say whatever comes into your head, I will give you an unconnective cause to end,” or “If you do not become conscious of this piece of the unconscious I will turn you out of the room.” Nevertheless, labile though it is, and limited as its authority, this peculiar relation between the analyst and the patient’ s ego seems to preserve the analyst’s appreciation upon that of his main instrument in helping the development of the therapeutic process. What is this main weapon in the analyst’s armoury? Its name springs at once to our lips. The weapon is, of course, interpretation.
What, then, is interpretation? How does it work? Extremely little may be known about or more than is less likened to it, but this does not present an almost universal belief in its remarkable efficacy as a weapon: Interpretation has, it must be confessed, many qualities of a magic weapon. It is, of course, felt as such by many patents. Some of them spend hours at a time in providing interpretations of their own-often ingeniously, illuminating, correct. Others, again, derive a direct libidinal gratification from being given interpretations and may even develop something parallel to a drug addition to them. In non-analytical circles interpretation is usually either scoffed at as something ludicrous, or being revealed of some raging or as a frightening danger. This attitude is shared, in many more tan is often realized, by most analysts. This was particularly revealed by the reactions shown in many quarters when the idea of giving interpretations to small children was first turned over by Melanie Klein. Nonetheless, saying that analysts are inclined to feel interpretation as something extremely powerful whether for good or ill would be true in an overall census, as, perhaps, of our feelings about interpretation as distinguished from our reasoning beliefs. There may be many grounds for thinking that out beliefs seem superficially to be contradictory, and the contradictions do not always spring from different schools of thought. Nevertheless, are manifest of sometimes held simultaneously by one individual. By that, we are told that if we interpret too soon or too rashly, we run the risk of losing a patient: That unless we interpret promptly and deeply we run the risk of losing a patient: That interpretation may cause intolerable and unmanageable outbreaks of anxiety by “liberating” it, that interpretation is the only way of enabling a patient to cope with an unmanageable outbreak of anxiety by ‘resolving’ it, which interpretations must always refer to material on the very point of emerging into consciousness, that the most useful interpretations are really deep ones? : “Be cautious with your interpretations” says one voice: “When is doubt, interpreted” says another? Nevertheless, although there is evidently a good deal of confusion in all of this, but it is nonetheless, that the various pieces of advice that may turn out to refer to different circumstances and different cases and to imply in the different uses of the word 'interpretation'.
For the word is evidently used in more than one sense. It is, after all, perhaps, only a synonym for the experienced form as we have already come across-“making what is unconsciously conscious,” and it shares all of that phrase’s ambiguities. For in one sense, if you give a German-English dictionary to someone who knows no German, you will be giving him a collection of interpretations, and this, is the kind of sense in which the nature of interpretation has been discussed in a recent paper by Bernfeld. Such descriptive interpretations have evidently no relevance to our present topic. We will continue without much ado to define as clearly as made possible the particular yet peculiar sort of interpretation, of which seems significantly relevant as an actively fundamental instrument of psychoanalytic therapy and to which for convenience makes known by name of 'mutative' interpretations.
It seems at first glace to give but a schematized outline of what is understood by a mutative interpretation, leaving the details to be filled afterwards, and, with a view to clarify of expositional purposes as an instance the interpretation of a hostile impulse. By virtue of his power (his strictly limited powers) as auxiliary super-ego, the analyst gives permission for a certain small quantity of the patient’s id-energy (in our instance, as an aggressive impulse) to become conscious. Since the analyst is also, from the nature of things, the object of the patient’s id-impulses, the quantity of these impulses that is now released into consciousness will become consciously directed toward the analyst. This is the critical point. If all goes well, the patient’s ego will become aware of the contrast between the aggressive character of his feelings and the real nature of the analyst, who does not behave comparably as the patient’s “good” or “bad” archaic object? The patient, which is to say, will become aware of a distinction between his archaic phantasy object and the really external object. The interpretation has now become a mutative one, since it has produced a breach in the neurotic vicious circle. For the patient, having become aware of the lack of aggressiveness in the really external object, can probably diminish his own aggressiveness: The new object that he introjected will be less aggressive, and consequently the aggressiveness of his super-ego will also be diminished. As a further corollary to these events, and simultaneously with them, the patient will obtain access to the infantile materials by which is being re-experienced by him in his relation to the analyst.
This is the overall scheme of the mutative interpretation. You will hold of notice that in its accountable process in the appearance that fall into two phases. For descriptive purposes it may, or perhaps may be to exceed the question of whether these two phases are in temporal sequence or whether they may not really be two simultaneous aspects of a single event, nonetheless, dealing with them is easier as though they were successive. First, then, there is the phase in which the patient becomes conscious of a particular quantity of id-energy as directed toward the analyst, and secondly, there is the phase in which the patient becomes aware that this id-energy is directed toward an archaic phantasy object and not toward a real one.
The first phase of a mutative interpretation-that in which part of the patient’s id-relation to the analyst is made conscious in virtue of the latter’s emplacements as auxiliary super-ego-is complicated and complex. In the classical model of an interpretation, the patient will first be made aware of a state of tension in his ego, will next be made aware that there is a repressive factor at work (that his super-ego is threatening him with punishment), and will only they are made aware of the id-impulse that has stirred upon the protests of his super-ego and so lead to the anxiety in his ego. This is the classical scheme. In actual practice, the analyst finds himself working from all three sides at once, or in irregular succession. At one moment a small portion of the patient’s super-ego may be revealed to him in all its savagery, at another the shrinking defencelessness of his ego, yet another form of his attentions may be directed to the attempt that he is making maybe at compensating for his hostility occasionally a fraction of id-energy may even be directly encouraged to break its way through the last remains of an already weakened resistance. There is, however, one characteristic that all these various operations have in common, they are essentially upon a small scale. For the mutative interpretation is inevitably governed by the principle of minimal doses. It is, probably, a commonly agreed clinical fact that alternations in a patient under analysis appear usually to be extremely gradual: We are inclined to suspect sudden and large changes as an indication that suggestive rather than psychoanalytic processes ate at work, the gradual nature of the changes caused in the psychoanalysis will be explained if, in at all, those changes are the result of the summation of most minute steps, each of which correspond to a mutative interpretation. The smallness of each step is in turn imposed by the very nature of the analytic situation. For each interpretation involves the release of a certain quantity of id-energy, and as if by a deficiency of possibilities, the quantity released is too large, the higher unstable of equilibrium that enables the analyst top function as the patient’s auxiliary super-ego is bound to be upset. The whole analytic situation will be imperilled, since it is only in virtue of the analyst’s acting auxiliary super-ego that these releases of id-energy can occur at all.
The analyst’s attemptive efforts toward consciousness of all at once bring too crucially a quantity of id-energy into the patient’s consciousness as a total elucidation that sometime the given juncture that nothing may bechance, or on the other hand there may be an unmanageable result: But in either event will be a mutative interpretation has been effected. In the former case (in which there is apparently no effect) the analyst’s power as auxiliary super-ego will not have been strong enough for the job he has set himself. Still, this again, may be for two very different reasons. It can be that the id-impulses he was trying to bring out were not in fact sufficiently urgent at the moment of relative incidence: For, after all, the emergence of an id-impulse depends on two factors-not only on the permission endorsed of the super-ego, but also on the urgency (the degree of cathexis) of the id-impulse itself. This, then, may be one cause of an apparent negative response to an interpretation, and evidently a harmless one. Still, the same apparent result may also be due to something else, in spite of the id-impulse being really urgent, their strength of the patient’s own repressive forces (the repression) may have been too great to allow his ego to listen to the persuasive voice of the auxiliary super-ego. Now here we have a situation dynamically identical with the next one we have to consider, though economically different. This next situation is one in which the patient accepts the interpretation, that is, allows the id-impulse into his consciousness, but is immediately overwhelmed with anxiety. This may show itself in several of ways: For instance, the patient may produce some manifest anxiety-attacks, or he may exhibit signs of 'real' anger with the analyst with complete lack of insight, or he may break off the analysis. In any of these cases, the analytic situation will, for the moment at least, have broken down. The patient will be behaving just as the hypnotic subject behaves when, having been ordered by the hypnotist to perform an action too much at variances with his own conscience, he breaks off the hypnotic relations and wakes up from his trance. This stare of things, which is manifest where the patient responds and to render, with which an actual outbreak of anxiety or one of its equivalents, may be latent was it for the patient to show no response. This latter case may be the more awkward of the two, since it is masked, and it may sometimes, be the effect of a greater overdoes of the interpretation than where manifest anxiety arises (though obviously other factors will be determining importance here and in particular the nature of the patient’s neurosis). In ascribing this threatened collapse of the analytic situation to an overdose of interpretation, might be more accurate in some ways to ascribe it to an insufficient dose. For what happened is that the second phase of the interpretation process has not occurred: The phase in which the patient becomes aware that his impulse is directed toward an archaic phantasy object and not toward a real one.
In the second phase of a competed interpretation, therefore, a crucial part is played by the patient’s sense of reality, for the successful outcome of that phase depends upon his ability, at the critical moment of the emergence into consciousness of the released quantity of id-energy, to distinguish between his phantasy object and the real analyst. The problem is closely related to one of the extremely liable of the analyst’s position as auxiliary super-ego, as the analytic situation is convoked as the time threatening to generate into a ‘real’ situation. Nonetheless, this means the opposite of what it appears to the naked eye. It means that the patient is all the time on the brink of turning the ‘real’ external object (the analyst) into the archaic one: That is to say, he is on the threshold of projecting his primitive introjected imagos onto him. As far as, the patient effectively does this, the analysts become correspondingly to anyone else that he meets in real life-a phantasy object. The analyst then ceases to posses the peculiar advantage derived from the analytic situation, he will introject like all other phantasy objects into the patient’s super-ego, and will no longer be able to function in the particular yet peculiar ways that are essential to the effecting of a mutative interpretation, in this difficulty the patient’s sense of reality is an indispensable but a very feeble ally: Yet finds of an improvement in it are on of the things that we hope the analysis will cause. Not submitting it to any unnecessary strain is significantly important, therefore, and that is the fundamental reason that the analyst must avoid any real behaviour that is likely to confirm the patient’s view of him as a 'bad' or a 'good' phantasy object. This is perhaps more obvious regarding to the 'bad' object. If, for instance, the analyst were to a shrew that he was really shocked or frightened by one of the patient’s id-impulses, the patient would immediately treat him in that respect as a dangerous object and introject him into his archaic severe super-ego. Thereafter, on the one hand, there would be a diminution in the analyst’s power to function as an auxiliary super-ego and to allow the patient’s ego to become conscious of his id-impulses-that is to say, in his power to cause the first phase of a mutative interpretation, and, on the other hand, he would, as a real object, become sensibly less distinguishable from the patient’s ‘bad’ phantasy objects and to that extent the carrying through of the second phase of a mutative interpretation would also be made more difficult? Once, again, there are accessorial cases. Supposing the analyst behaves in an opposite way and actively urges the patient to give a free rein to his id-impulses. There is then a possibility of the patient confusing the analyst with the imago of a treacherous parent whose initiatory anticipation encourages him to seek gratification, and then suddenly turns and punishes him. In such a case, the patient’s ego may look for defence by itself sudden turning upon the analyst as though he were his id, and treating him with all the severity of which his privileged position. Yet acting really in a way that encourages the patient to project his may be equally unwise for the analyst ‘good’ introjected object onto him. For the patient will then experience a tendency to regard him and a good object in an archaic sense and will incorporate him with his archaic 'good' imagos and will use him s a protection against his “bad” ones. In that way, his infantile positive impulses and his negative ones may escape analysis, for there may no longer be a possibility for his ego to make a comparison between phantasies external objects than there is real one. It will perhaps be argued that, with the best will in the world, the analyst, however, careful he may be, will be unable to prevent the patient from projecting these various imagos onto him. This is of course, indisputable, and the whole effectiveness of analysis depends upon its being so. The lesson of these difficulties is merely to remind us that the patient’s sense of reality having the narrowest limit. It is a paradoxical fact that the best way of ensuring that his ego will be abler to distinguish between phantasy and reality is to withhold reality from him as much as possible. What is more, it is true. His ego is so weak-so much of the mercy of his id and super-ego-that he can only cope with reality if it is administered in minimal doses. These doses are in fact what the analyst gives him, as interpretation.
It appears more than possible that an approach to the twin practical problems of interpretation and reassurance may be simplified by this distinction between the two phases of interpretation. Both procedures may, it would appear, be useful or even essential in certain circumstances and inadvisable or even dangerous in others. With interpretation, the first of our hypothetical phases may be said to 'liberate' anxiety, and the second to 'resolve' it. Where a quantity of anxiety is already present or on the point of breaking out, an interpretation, owing to the efficacy of its second phase, may enable the patient to recognize the unreality of his terrifying phantasy object and so to reduce his own hostility and consequently his anxiety. On the other hand, to induce the ego to allow a quantity of id-energy into consciousness is obviously to court an outbreak of anxiety in a personality with a harsh super-ego. This is precisely what the analyst does in the first phase of an interpretation. Regarding “reassurance,” Briefly some problems that arise are in the belief that it is an incidental term in need to be defined as almost as urgently as ‘interpretation’, and that it covers several different mechanisms. Nevertheless, in the present connection reassurance may be regarded as behaviour by the analyst calculated making the patient regard him as a 'good' phantasy object rather than as a reason. It might, however, be supposed at first sight that the adoption of some generally felt procedures that are sometimes psychotic cases, nonetheless, an attitude by the analyst might directly favour the prospects of making a mutative interpretation. Yet it is believed that it will be seen on reflection that this is not in fact the case: For precisely, as far as the patient regards the analyst as his phantasy object, the second phase of the interpretation effects that do not happen-since it is of the essence of that phase that in it the patient should make a distinction between his phantasy object and the real one? It is true that his anxiety may be reduced: But, this result will not have been achieved by a method that involves a permanent qualitative change in his super-ego. Thus, whatever tactical importance reassurances may be posses. It cannot claim to any regarded as an ultimate operative factor in psychoanalytic therapy.
Still, it must in this place be of notice, that certain other sorts of behaviour by the analyst may be dynamically equivalent to the giving of a mutative interpretation, or to one or other of the two phases of that process. For instance, an ‘active’ injunction of the kind contemplated by Ferenczi may amount to an example of the first phase of an interpretation: The analyst is using his peculiar positions to induce the patient to become conscious in an exceptionally self-asserting way of distinct id-impulses that one objection to this form of procedure must be expressed by saying that the analyst has very little control over the dosage of the id-energy that is thus released, and very little guarantees that the second phase of interpretation will follow. He may therefore be unwittingly precipitating one of those critical situations that are always liable to arise, for an incomplete interpretation. Incidently, the same dynamic pattern may arise when the analyst requires the patient to produce a ‘forced’ phantasy or even (particular at an early given direction in an analysis) when the analyst asks the patient a question. Here, again, the analyst is in effect giving a blindfold interpretation, which it may prove impossible to carry beyond its first phase. On a different deal in, situations’ constantly arising during an analysis in which the patient becomes conscious of small quantities of id-energy without any direct provocation by the analyst. An anxiety situation might then develop, if it were not that the analyst, by his behaviour or, one might say, absence of behaviour, enables the patient to mobilize his sense of reality and make the necessary distinction between an archaic object and a real one. What the analyst is doing before we are equivalent to cause the second phase of an interpretation, and the whole episode may amount to the kind of mutative interpretation. Estimating what proportion of the therapeutic changes that occur during analysis may not be is difficult due too implicit mutative interpretation of this kind. Incidentally, this type of situation seems sometimes to be regarded, incorrectly as an example of reassurance.
A mutative interpretation can only be applied to an id-impulse that is in a state of bearing down, or of a cathexis. This seems self-evident, for the dynamic changes in the patient’s mind inferred by a mutative interpretation can only be caused by the operation of a charge of energy originating in the patient himself: The function of the analyst is merely to ensure that the energy will flow along one channel rather than along another. It follows from this that the purely informative ‘dictionary’ type of interpretation will be non-mutative. However, useful it may be as a prelude to mutative interpretations, and this leads to several practical inferences. Each must be emotionally “immediate,” the patient must experience it s something actual. This requirement, that the interpretation must be 'immediate', may be expressed in another way by saying that interpretations must always represent a directed point of urgency'? At any given moment noticeable of a particular id-impulse will be in activity, this is the impulse that is susceptible of mutative interpretation then, and no other one. It is, no doubt, neither possible nor desirable to giving mutative interpretations at the time, as Melanie Klein has pointed out, it is a most precious quality in an analyst to be able to be at any moment to pick out the point of urgency.
Still, the facts that every mutative interpretation must deal with an ‘urgent’ impulse take us back another to the commonly felt fear of the explosive possibilities of interpretation, and particularly of what is vaguely called “deep” interpretation. The ambiguity of the term, however, need not bother us. It describes, no doubt, the interpretation of material that is either genetically early and historically distant from the patients experience or under an especially heavy weight of repression-material, in any case, which is to arrive at the normal course of things exceedingly inaccessible to his ego and remote from it. There seems reason to believe, moreover, that the anxiety that is liable to be aroused by the approach of intensified material is consciousness and may be of peculiar severity. The question is whether its ‘safe’ to interpret such material will, as usual, mainly depend upon whether the second phases of the interpretation can be carried through. In the ordinary run of case, the material that is urgent during the earlier stages of the analysis in not deep. We have to deal first with only the essentially far-going displacements of the deep impulses, and the deep material itself are only reached later and by degree, so that no sudden appearance of unmanageable quantities of anxiety is to be anticipated. In exceptional cases, least of mention, are owing to some peculiarity in the structure of the neurosis, deep impulses may be urgent at some very early stages of the analysis. We are then faced by a dilemma. If we give an interpretation of this deep material, the anxiety produced in the patient may be so great that his sense of reality may not be sufficient to permit of the second phase being accomplished, and the whole analysis may be jeopardised. Nonetheless, it must not be the thought that, in such critical cases as we are now considering, the gruelling necessarily being to an excessive degree avoid the simple but not giving any interpretation or by giving more superficial interpretations of non-urgent materiel or by attempting reassurances. It seems probable, in fact, that these alternative procedures may do little or nothing to avoid the trouble, on the contrary, they may even exacerbate the tension created by the urgency of the deep impulses that are the actual cause of the threatening anxiety. Thus, the anxiety may break out in spite of these palliative efforts and, if so, it will be doing so under the most unfortunate conditions, that is to say, outside the mitigating influences afforded by the mechanisms of interpretation, it is possible, therefore, that, of the two alterative procedures that are open to the analyst faced by such difficultly, the interpretation of the urgent id-impulses, deep though they may be, will be the safer.
A mutative interpretation must be 'specific', which is to say, detailed and concrete. This is, in practice, a matter of degree. When the analyst embarks upon a given theme, his interpretations cannot always avoid being vague and general to begin with, but working out will be necessary eventually and interpret all the details of the patient’s phantasy system. In proportion as this is done, the interpretations will be mutative, and must have the necessity fort apparent repetitions of interpretations already made is readily to be explained by the need for filling the details. So, then, it is possible that some delays which despairing analyst’s attribute to the patient’s id-resistance could be traced to this source. Apparently vagueness in interpretation gives the defensive forces of the patient’s ego the opportunity, for which they are always on the lookout, of baffling the analyst’s attempt at coaxing an imploring id-impulse into consciousness, a similarity blunting effect can be produced by certain forms of reassurance, such as the tacking onto an interpretation of an ethnological parallel or of a theoretical explanation: A procedure that may at the last moment turn a mutative interpretation into a non-mutative one. The apparent effect may be highly gratifying to the analyst, but later experience may show that nothing of permanent use has been achieved or even that the patient has been given an opportunity for increasing the strength of his defences. On the face of it, Glover is to argue that, whereas a blatantly inexact interpretation is likely to have no effect at all, an inexact one may have a therapeutic effect of a non-analytic, or anti-analytic, kind by enabling the patient to make a deeper d more efficient repression. He uses this a possible explanation of a fact that has always seemed mysterious, namely, that in the earlier days of analysis, when much that we know of the characteristics of the unconscious was still undiscovered, and when interpretation must therefore have often been inexact, therapeutic results were nevertheless obtained.
The possibility that Glover argues to serve, is to remind ‘us’ more generally of the difficulty of being certain that the effects that follow any given interpretation are genuinely the effects of interpretation a non-transference phenomenon or one kind of another. Reiteratively, it has already confronted us, that many patients derive direct libidinal gratification from interpretation as such: Also, that some striking signs of an abreaction that occasionally follows an interpretation ought not necessarily to be accepted by the analyst as evidence of anything more than that the interpretation has gone home in a libidinal sense.
The problem is, nonetheless, that of the relation of an abreaction to the psychoanalysis in which is a disputed one. Its therapeutic results seem, up to a point, undeniable. It was from them, that the analysis was born, and even today there are psychotherapists who rely on it almost exclusively. During the War [World War I], in particular, its effectiveness was widely confined in cases of “shell-shock.” It has also been argued often enough that it plays a leading part in cause the results of the psychoanalysis. Rank and Ferenczi, for instance, declared that in spite of all advances in our knowledge abreaction remained the essential agent in analytic therapy. More recently, Reik has supported a similar view in maintaining that “the element of surprise is the most important part of analytic techniques.” A great deal less extreme mental attitude is taken abreactions as one component factor in analysis and in two ways. In the first place, Nunberg in the chapter upon therapeutics in his textbook of the psychoanalysis. However, he, too, regards that the improvement caused by abreaction in the ususal sense of the word, which he plausibly attributes the relief of endo-psychic tensions as due to a discharge of accumulated affect. In the second, he points to a similar relief of tinstone upon a small arising from the actual process of becoming conscious of something previously unconscious, basing himself upon a statement of Freud’s that the act of becoming conscious involves a discharge of energy. Yet, Radó appears to regard abreactions as opposed in its function to analysis. He asserts that the therapeutic effect of catharsis is top be attributed to the fact that (with other forms of non-analytic psychotherapy) it offers the patient an artificial neurosis in exchange for his original one, and that the phenomena observable when abreactions occur are akin to those of a hysterical attack. A consideration of the views of these various authorities suggests that what we describe as ‘abreaction’ may cover two different processes: One is to a completed discharge as when a dismantling of other libidinal gratifications is first of these that might be regarded (like various other procedures) as an occasional adjunct to analysis, sometimes, no doubt, a useful one, and possibly even as an inevitable accompaniment of mutative interpretations? : Whereas, the second process might be viewed with more suspicion, as an event likely to impede analysis-especially if its true nature were unrecognized. Nevertheless, with either form there seems good reason to believe that the effects of an abreaction are permanent only in cases in which the predominant aetiological factor is an external event: That is to say, that it does not cause any radical qualitative alternation in the patient’s mind. Whatever part it may play arriving at the analysis is thus unlikely to be of anything more than an ancillary nature.
. . . Is it to be understood that no extra-transference interpretation can set in motion the chain of events suggested as the essence of psych-analytic therapy? That is one objective opinion to send forth the relief-what has, of course, already been observed, but never, with enough explicitness-the dynamic distinctions between transference and extra-transference interpretations. These distinctions may be grouped adjoining two heads. The first, extra-transference interpretations are far less likely to be given at the point of urgency. This must necessarily be so, since during an extra-transference interpretation the object of the id-impulse brought into consciousness is not the analyst and is not immediately present, whereas, apart from the earliest stages of an analysis and other exceptional circumstances, the point of urgency is nearly always to be found in the transference. It follows that extra-transference interpretations are proved of being concerned with impulses that are distant both in time and space and are thus likely to be without immediate energy. In extreme instances, they may approach very closely to what has already been described as the handling-over to the patient of a German-English dictionary. However, in the second place, when far since the object of the id-impulse is not existently present, becoming directly aware of the distinction between the real object and the phantasy object is less easy for the patient, extending to emerge of an extra-transference interpretation. Thus it would appear that, with extra-transference interpretations, on the one hand what in having been described as the first phase of a mutative interpretation is less likely to occur, and on the other hand, if the first phase does occur, but the second phase is less likely to follow? In other fields, an extra-transference interpretation is liable to be both less effective and more risky than a transference one. Each of these points deserves a few words of separate examination.
It is, of course, a matter of common experience among analysts that it is possible with certain patients to continue undefinedly giving interpretations without producing an apparent effect whatever. There is an amusing criticism of this kind of “interpretation-fanaticism” in the excellent historical chapter of Rank and Ferenczi. However, it is clear from their words that what they have in mind are essential extra-transference interpretations, for the burden of their criticism is that such a procedure implies neglect of the analytic situation. This is the simplest of cases, where some wastes off time and energy ids the main result. Still, there are other occasions, on which a policy of giving strings of extra-transference interpretations are apt to lead the analyst into more positive difficulties. Attention was drawn by Reich a few yeas ago in some technical discussions in Vienna to a tendency among inexperienced analysts to get into trouble by eliciting from the patient great quantities, are carried to such lengths that the analysis is brought to an irremediable state of chaos. He pointed out very truly that the material we have to deal; with is stratified and that it is highly important in digging it out not to interfere more than we can help with the arrangement of the strata. He had in mind, of course, the analogy of an incompetent archaeologist, whose clumsiness may obliterate the possibility of reconstructing the history of an important excavation site. Pessimism about the results inwardly imbounding of a clumsy analysis, since there are the essential differences that our material is alive and well, as it was, re-stratify itself of its own accord if it is given the opportunity: That is to say, in the analytic situation. While, some analysts agree as to the presence of the risk, and it may be particularly likely to occur where extra-transference interpretation is excessively or exclusively resorted to. The means of preventing it, and the remedy if it has occurred, lie in returning to transference interpretation at the pint of urgency. For if we can become aware of which of the material is 'immediate' in the sense described, the problem of stratification is automatically solved, and it is a characteristic of most extra-transference material that it has no immediacy and that consequently it is stratification is far more difficult to decipher. The measures suggested by Reich himself for preventing the occurrences of this state of chaos are consistent with or to reassemble of abounding orderly fashion for he stresses the importance of interpreting resistance every bit as the antipathetical essential essence of the id-impulses themselves-and this. It is substantially a policy laid down at an early stage in the history of analysis. Nonetheless, it is, of course, characterized as a resistance that rise up in relation to the analyst: Thus, the interpretation of a resistance will almost inevitably be a transference interpretation.
Nonetheless, the most serious risks that arise from the making of extra-transference interpretations are due to the inherent difficulty in completing their second phase or knowing whether their second phase has been completed or not. They are from their nature unpredictable in their effects. There seems, to be a special risk of the patient not carrying through the second phase of the interpretation but of projecting the id-impulse made consciously to the analyst. This risk, no doubt, applies to some extent also to transference interpretations. However, the situation is less likely to arise when the object of the id-impulse is to actualize the present and is moreover the same person as the maker of the interpretation. (We may again recall the problem of ‘deep’ interpretation, and point out that its dangers, even in the most unfavourable circumstances, are greatly diminished if the interpretation in question is a transference interpretation.). Moreover, there is more chance of this whole process occurring silently and so being overly looked of an imbounding extra-transference interpretation, particularly in the earliest stages of an analysis. Therefore, being it specially on the alert for transference complications seem important after giving an extras-transference interpretation. This last peculiarity of extras-transference interpretations is in a sense that one of an explicitly important faculty from which is a practical point of view. Because of an account of it that they can be made to act as 'feeders' for the transference situation, and so to pave the way for mutative interpretations. In other fields, by giving an extra-transference interpretation, the analyst can often provoke a situation in the transference of which he can then give a mutative interpretation.
It must be supposed that because of its attributing qualities to transference interpretations, is therefore maintaining that no others should be made, on the contrary, most of our interpretations are probably outside the transference-though it should be added that it often happens that when on is ostensibly giving an extra-transference interpretation one is implicitly giving a transference one. A cake cannot be made of nothing but currants, and, though it is true that extra-transference interpretations are not for the most mutative parts, and do not of themselves bring a decline about the crucial results that involve a permanent change in the patient’s mind, they are not much more than are essential. As to analogy, the acceptance of a transference interpretation corresponds to the capture of a key position, while the extra-transference interpretations correspond to the general advance and to the consolidation of a fresh line of descent made possibly by the capture of the key position. However, when this general advance goes beyond a certain point, there will be another check, and the capture of a further key position will require the progress of its own resuming statue. An oscillation of this kind between transference and extra-transference interpretations will represent the normal course of events in an analysis.
Although the giving of mutative interpretations may occupy a small portion of psychoanalytic treatment, it will, upon its hypothesis, be the most important part from the point of view of deeply influencing the patient’s mind. It may be of interest to consider how a moment that is important to the patient affects the analyst himself. Mrs. Klein has suggested that there must be some quite special internal difficulty to be overcome by the analysts in giving interpretations. This, applies particularly to the giving of mutative interpretations. Showing in their avoidance by psychotherapists of non-analytic schools, but many psychoanalysts will be aware of traces of the same tendency in themselves. It may be rationalized into the difficulty of deciding whether or not the particular moment has come for making an interpretation. However, behind this there is sometimes a lurking difficulty in the actual giving of the interpretation, for in that respect it may be a constant temptation for the analyst to do something else instead. He may ask questions, or he may give reassurances or advice or discourse upon theory, ir he may give interpretations-but, interpretations that are not mutative, extra-transference, interpretations that is non-immediate, or ambiguous, or inexact-or, he may give two or more alternative interpretations simultaneously, or he may give interpretations and show his own scepticism about them. All of this strongly suggests and for the patient, and that he is exposing himself to some great danger in doing so. This in turn, will become intelligible when we reflect that at the here-and-now of interpretation that the analysis is in fact deliberately evoking a quantity of the patient’s id-energy while it is aware and factually unambiguous and aimed directly at himself. Such a moment must above all others put to the test, and his relations with being own unconscious impulses.
In his Fragments of an Analysis of a Case of Hysteria, Freud defines the transference situation in the following major way: “What are transferences?" They are new editions or simulations in the tendencies. Phantasies aroused and made consciously during the progress of the analysis. However, they have this peculiarity, which is characteristic for the species, that they replace some earlier person by the person of the physician. To put it another way: A whole series of psychological experiences is revived, not as belonging to the past, but as applying to the physician presently.
In some form or other transference operates first from the last price of life and influence’s all human relation, but here I am only concerned with the manifestations of transference in psych-analysis. It is characteristic of psychoanalysis procedure that, as it begins to open roads into the patient’s unconscious, his past (in its conscious and unconscious aspects) is gradually being revived. By that his urge to transfer his early experiences, object-relations and emotions, is reinforced and they come to focus on the psychoanalyst: This implies that the patient deals with the conflicts and anxieties reactivated, by making use of the same mechanisms and defences as in earlier situations.
It follows that the deeper we can penetrate into the unconscious and the further back we can take the analysis, the greater will be our understanding of the transference. Therefore, a brief summary of conclusions about the earliest stages of development is mostly the immediate surface of our field of study.
The first form of anxiety is of a prosecutory nature. The working of the death instinct within-which according to Freud is directed against the organism-causes the fear of annihilation, and this is the primordial cause of prosecutory anxiety. Furthermore, from the beginning of post-natal life (our concerns are with pre-natal processes) destructive impulses against the object stir up fear of retaliation. Painful external experiences intensify these prosecutory feelings from inner sources, for, from the earliest days onward, frustration and discomfort arouse in the infant the experienced by the infant at birth and the difficulties of adapting him entirely new conditions give to prosecutory anxiety. The comfort and care given after birth, particularly the first feeding experience, are left to come from good forces. In speaking of 'forces', it use is as an alternative adult word for what the young infant dimly conceives of as objects, either good or bad. The infant directs his feelings of gratification and love toward the “good” breast, and his destructive impulses and feelings of persecution toward what he feels to be frustrating, i.e., the 'bad' breast. At this stage splitting processes are at their height, and love and hatred and the good and bad aspects of the breast are largely kept apart from one another. The infant’s relative security is based on turning the good object into an ideal one as a protection against the dangerous and persecuting object. This processes-that is to say splitting, denial, omnipotence and idealization-are prevalent during the first three or four-month of life, which we can term the 'paranoid-schizoid position', in these ways at a very early stage prosecutory anxiety and its corollary, idealization, elementally influence object relations.
The primal processes of projection and introjection, being inextricably linked with the infants’ emotions and anxieties, initiate object-relations, by projecting, i.e., deflecting libido and aggression on the mother’s breast, and on this given occasion has on achieving to establish the basis for object-relations, by introjecting the object, first the breast, relations to internal objects come into being. The use of the term 'object-relations' is based on the contention that the infant has from the beginning of post-natal life a relation to the mother (although focussing primarily on her breast) which is imbued with the fundamental elements of an object-relation, i.e., loves, hatred, phantasies, anxieties and defences.
The introjection of the breast is the beginning of superego formation that extends over years. We have grounds for assuming that from the first feeding experience onward, and the infant introjects the breast in its various aspects. The core of the superego is thus the mother’s breast, both good and bad. Owing to the simultaneous operation of introjection and projection, relations to external and internal objects interact. The father too, who in a short while plays a role in the child’s life, quickly becomes part of the infant’s internal world. It is characteristic of the infant’s emotional life that there are rapid fluctuations between love and hate: Between external and internal situations: Between perception of reality and the phantasies relating to it, and, accordingly, an interplay between prosecutory anxiety and idealization-both refereeing to inherent or representations of internal and external objects, the idealized object being a corollary of the prosecutory, extremely bad one.
The ego’s growing capacity for integration. Synthesis leads ever more, even during these first few months, to states in which love and hatred, and correspondingly the good and bad aspects of objects, are being synthesized. This gives to the second form of anxiety-depressive anxiety-for the infant’s aggressive impulses and desires toward the bad breast (mother) is now felt to be a danger to the good breast (mother) as well. In the second quarter of the first year they have reinforced these emotions, because at this stage the infant increasingly perceives and introjects the mother as a person. In this, are the unduly influences that are most intensified of depressive anxiety, for the infant feels he has destroyed or is destroying a whole object by his greed and uncontrollable aggression. Moreover, owing to the growing syntheses of his emotions, he now feels that these destructive impulses are directed against a loved person, just as the interchangeable relation to the father and other members of the family. These anxieties and corresponding defences are the “depressive position,” which comes to a head about the middle of the first year whose essence is the anxiety and guilt relating to the destruction and loss of the loved internal and external objects.
It is at this stage, and bound up with the depressive position, that the Oedipus complex sets in. Anxiety and guilt add a powerful impetus toward the beginning of the Oedipus complex. For anxiety and guilt increase the need to externalize (project) bad figures and to internalize (introject) good ones: To attach desire, love, feelings of guilt, and reparative tendencies to some objects, and dislikened intensely and anxiety too other, to find representatives for internal figures in the external world. It is, however, not only the search for new objects that dominates the infant’s needs, but also to drive toward new aims: Away from the breast toward the penis, i.e., from oral, desires toward genital ones. Many factors contribute to these developments, the forward drive of the libido, the growing integration of the ego, physical and mental skills and progressive adaptation to the external world. These trends are bound up with the process of symbol formation, which enables the infant to transfer not only interest, but also emotions and phantasies, anxiety and guilt, from one object to another.
The process described is linked with another fundamental phenomenon governing mental life. It is believed that the pressure exerted by the earliest anxiety situation agrees of the constituent causing to find repetition compulsion. However, its first conclusions about the earliest stages of infancy are a continuation of Freud’s discoveries, on certain points, however, divergencies have arisen, one of which is irrelevant to our topic of discussion. I am referring to the contention that object-relations are operative from the beginning of post-natal life.
Believing it in that the view that autoerotism and narcissism are in the young infant contemporaneous with the first relation to objects-external and internalized may be feasible. Briefly, autoerotism and narcissism include the love for and relation with the internalized good object with which in phantasy forms part of the loved body and self. It is to this internalized object that in autoerotic gratification and narcissistic states a withdrawal takes place? Concurrently, from birth onward, a relation to objects, primarily the mother (her breast) is present. This hypothesis contradicts Freud’s notion of autoerotic and narcissistic stages that preclude an object-relation. However, the difference between Freud’s view in this is that the statements on this issue are equivocal. In various contexts he explicitly and implicitly expressed opinions that suggest a relation to an object, the mother’s breast, preceding autoerotism and narcissism. One reference must suffice, in the first of two Encyclopaedia articles, Freud said? : “In the first instance the oral component instinct finds satisfaction by attaching Itself to the sating of the desire for nourishment, and its object is the mother’s breast? It then detaches itself, becomes independent. Just when autoerotic, that is, it finds an object in the child’s own body.”
Freud’s use of the term object is to some extent quite different from its usage of its same term, however, Freud is referring to the object of an instinctual aim, while, otherwise, in addition, an object-reaction involving the infant’s emotions, fantasises, anxieties and defences are nevertheless, in the sentence referred to, Freud clearly speaks of a libidinal attachment to an object, the mother’s breast, which precedes auto-ergotism and narcissism.
Additionally, in this context, Freud’s findings are about early identification. In the Ego and the Id, speaking of abandoned object cathexes, Freud said,‘ . . . the effect of the first identification in earliest childhood will be profound and lasting. This leads us back to the origin of the ego-idea . . . '. Wherefrom, Freud then defines the first and most important identifications that lie hidden behind the ego-ideal as the identification with the father, or with the parents, and places them. As he expressed it, in the ‘prehistory of every person’. These formulations come close to what is at first, the introjected object, for by definition identifications is the result of introjection. From the statement, least of mention, and passage quoted from the Encyclopaedia article we that can deduce that Freud, although he did not pursue this line of thought further, did assume that in earliest infancy both an object and introjective processes play a part.
That is to say, as for autoerotism and narcissism we meet with an inconsistency in Freud’s views. Too so extreme a degree of inconsistences that exist on sufficiently acceptable points of theory clearly show, which on these particular issues Freud had not yet decided. In respect of the theory of anxiety he sated this explicitly in Inhibitions, Symptoms and Anxiety. His speaking also exemplifies his realization that much about the early stages of development was still unknown or obscure to him of the first years of the girl’s life “as, . . . lost in a past so dim and shadowy.”
I do not know Anna Freud’s view about this aspect of Freud’s work. Yet as for the question of autoerotism and narcissism, she seems only to have taken into account Freud’s conclusion that autoerotic. Some narcissistic stages precede object-relations, and not to have allowed for the other possibilities implied in some of Freud’s statements such as the ones referred to above. This is one reason that the divergence between Anna Freud’s conception as compared among others, concerning notions of early infancy in which are far greater than that between Freud’s views, taken as a whole, it may be to mention, because clarifying the extent and nature of the differences between the two schools of psychoanalysis thought represented by Anna Freud and those of the representational statements in visual attractive features implied to this paper is essential. Perhaps, entertaining, but such clarification is required in the interests of psychoanalytic training and because it could help to open fruitful discussions between the psychoanalysis and by that contribute to a greater general understanding of the fundamental problems of early infancy, however.
The hypothesis at a stage extending over several months precedes object-relations implies-but the libido attached to the infant’s own body-impulses, phantasies, anxieties. Defences are either not present in him, or not related to an object, that is to say they would operate in vacua. The analysis of very young children has taught us that there is no instinctual urge, no anxiety situation, no mental process that does not involve objects, external or internal, in other words, object-relations are at the centre of emotional life? Furthermore, love and hatred, phantasies, anxieties and defences are also operative from the beginning of and is Eudunda initio indivisibly linked with object-relations. This insight shows the attractive attention of a new light from which these phenomena are illuminated.
The immediate conclusion on which the present paper rests holds that transference originates in the same processes that in the earlier stages determine object-relations. Therefore, we have to go back repeatedly in analysis to the fluctuations between objects, love and hatred, external and internal, which dominate early infancy. We can fully appreciate the interconnection between positive and negative transference only if we explored the early interplay between love and hated, and the vicious circle of aggression, anxieties, feelings of guilt and increased aggression, and the various aspects of objects toward whom the conflicting emotions and anxieties are directed. On the other hand, through exploring these early processes it seems convincing that the analysis of the negative transference, which had received proportionally little attention in psychoanalysis technique, is a precondition for analysing the deeper layers of the mind. The analysis of the negative with of the positive transference and of their interconnection is, as analysts have held for many years, an indispensable principle for the treatment of all types of patients, children and adults alike.
This approach, which in the past made possible the psychoanalysis of very young children, has in recent years proved extremely fruitful for the analysis of schizophrenic patients, until about 1920 the general assumption was assumed that schizophrenic patients were incapable of forming the transference and therefore could not be psychoanalysed. Since then, various techniques had attempted the psychoanalysis of schizophrenics. The most radical change of view in this respect, however, has occurred more recently and is closely connected with the greater knowledge of the mechanisms, anxieties, and defences operative in earliest infancy. Since some of these defences, evolved in primal object relations against love and hatred, have been discovered, the fact that schizophrenic patients can develop both a positive and a negative transference had flowered through its own actualization under which were founded in all its blossoming obtainments, in that of its achieving a better understanding that came into the transference: This finding is confirmed if we consistently apply in the treatment of schizophrenic patients the principle that it is as necessary to analyse the negative as the positive transference, which in fact the one cannot be analysed without the other.
Retrospectively it can be seen that Freud's discovery of the Life and Death instinct supports these considerable advances in technique in psychoanalytic theory, which has advanced beyond the understanding of the origin of ambivalence. Because the Life and Death instincts, and therefore love and hate, are at bottom in the closed interaction, as we have simply interlinked negative and positive transference.
The understanding of earliest object-relations and the processes they imply has essentially influenced technique from various angles. It has long been known that the psychoanalyst in the transference situation may stand for mother, father, or other people, that he is also at times playing in the patient’s mind the part of the superego, at other times that of the id or the ego. Our present knowledge enables us to penetrate to the specific details of the various roles allotted by the patient to the analyst. There are in fact very few people in the young infant‘s life, but he feels them to be enough objects because they appear to him in different aspects. Accordingly, the analyst may at a given moment represent a part of the self, of the superego or any one of a wide range of internalized figures. Similarly it does not put into effect as far enough if we realize that the analyst stands for the actual father or mother, unless we understand which aspect of the parents has been revered. The picture of the parents in the patient’s mind has in varying degrees undergone distortion through the infantile processes of projection and idealization, and has often retained much of its fantastic nature. Although, in the young infant’s mind every external experience is interwoven with his phantasies and on the other hand every phantasy contains elements of experience, and is only by analysing the transference situation to its depth that we can discover the past both in its realistic and fantastic aspects. It is also the origin of these fluctuations in easiest infancy that accounts for their strength in the transference, and for the swift changes-sometimes even within one session-between father and female parents, between omnipotently kind objects and dangerous persecutors, between internal and external figures. Sometimes the analyst appears simultaneously to express indirectly of the patient’s parents -. There often in a hostile alliance against the patient, under which the negative transference finds great intensity. What has then been revived or has become manifest in the transference in the mixture in the patient’s phantasy of the parents as one figure, the “combined parent figure,” results as the phantasy formations characteristics of the earliest stages of the Oedipus complex that, if maintained in strength, are detrimental both to object-relations and sexual development. The phantasy of the combined parents draws its force from another element of early emotional life -, i.e., from the powerful envy associated with flustrational oral desires. Through the analysis of such early situations we learn that in the baby’s mind when he is frustrated (or, dissatisfied from inner causes) his frustration is coupled with the feeling that another object (soon represented by the father), is to its line of descent from proceeding from the mother, the coveted gratification and love denied to themselves at that minute. In this context is one root of the phantasies that has combined the parents in an everlasting mutual gratification of an oral, anal, and genital nature. Having then, been regainfully employed as having been viewed in this enlightened manner, is presumptuously the prototype of situations of both envy and jealousy.
For many years-and this is up to a point still true today-transference was understood as to direct transferences to the analyst in the patient’s material. My conception of transference as rooted in the earliest stages of development and in deep layers of the unconscious is much wider and entails a technique by which from the whole material presented the unconscious elements of the transference are deduced. For instance, reports of patients about their everyday life, relations, and activities not only give an insight into the functioning of the ego, but also reveal-if we explode their unconscious content-the defences against the anxieties stirred up in the transference situation. For the patient is bound to deal with conflicts and anxieties’ re-experience toward the analyst by the same methods used in the past, which is to say, he turns away from the analyst as he attempted to turn away from his primal objects: He tries to split the relation to him, keeping him either as a good or a bad figure: He deflects some feelings and attitudes experienced toward the analyst onto other people in his current life, and this is part of ‘acting out’.
It is at this time that the earliest experiences, situations, and emotions from which transference springs. On these foundations, however, are built the later object-relations and the emotional and intellectual developments that require the analyst’s attention no less than the earliest ones, that is to say, our field of investigation covers all that lies between the current situation and the earliest experiences. In fact finding access to earliest emotions and object-relations exclude by examining their vicissitudes in the light of later developments is not likely. Its possibilities are only by linking repeatedly (That it means hard and patient work) later experiences with earlier ones and vice versa, it is only by consistently exploring their interplay, that present and past can come together in the patient’s mind. This is one aspect of the process of integration that, as the analysis progresses, encompasses the whole of the patient’s mental life. When anxiety and guilt diminish and love and hate can be better synthesized, “splitting processes”-a fundamental defensive structure against anxiety-and repression’s lesson while the ego gains in strength and coherence: The cleavage between the idealized and prosecutory objects diminishes, the fantastic aspects of objects lose in strength, all of which implies that unconscious phantasy life-less sharply divided off from the unconscious part of the mind-can be better used in ego activities, with a consequently general enrichment of the personality. These differences-as contrasted with the similarities-between transference and the first object-relations cause the repetition compulsion as the pressure put into action by the earliest anxiousness of some situations. When prosecutory and depressive anxiety and guilt diminishes, there is less urge to repeat fundamental experiences over and again, and therefore early patterns and modes of feelings are maintained with less tenacity. These fundamental changes come about through the consistent analysis of the transference: They are bound up with a deep-reaching revision of the earliest object-relations and are reflected in the patient’s current life plus the altered attitudes toward the analyst.
It is however, that we have used the term “transference” several times, and in the last case we attributed the therapeutic results to the transference without further definition of the word. Transference is an integral part of the psychoanalysis. A vast, widely scattered, literature exists on the subject. In most contributions on any psychoanalytic theme there is to be found, often tucked away from easy access, some reference to it. It forms of necessity the main topic of papers and treatises on psychoanalytic technique, but" . . . it is amazing how small some very extensive psychoanalytic literature is devoted to psychoanalytic technique’, states Fenichel, “and how much less to the theory of technique.” No single contribution comprehends all the facts known and the various opinions. This is much more remarkable as differing opinions are held about the mechanism of transference, and its mode of production seems particularly little understood. Without a comprehensive critical evaluation, the student might be bewildered at finding that most authors, before getting to their subject matter, deem it necessary to give their personal interpretations of what they mean by ‘transference’ and ‘transference neurosis’. This is well illustrated by Fernichel’s book on the theory of the neurosis, which containing more than one thousand six hundred and forty references, quotes only one reference in the sections is on Transference.
During a psychoanalytic treatment, the patient allows the analyst to play a predominating a role in his emotional life. This is a great import analytic process, after the treatment is over, this situation is changed. The patient builds up feelings of affection for and resistence to his analyst that, in their ebb and flow, so exceed the normal degree of feeling that the phenomenon has long attracted the theoretical interest of the analyst. Freud studied this phenomenon thoroughly, explained it, and gave it the name “transference.”
All the same, the lack of knowledge of the causation of transference appears largely to have gone unnoticed. It seems tacitly to be assumed that the subject is fully understood. Fernichel for instance, writes Freud was at first surprised when he met with the phenomenon of transference, today, Freud’s discoveries make it easy to understand it theoretically. The analytic situation induces the development of derivatives of the repressed, and simultaneously a resistance is operative against, . . . the patient misunderstands the present as to the past. If one scrutinizes this frequently quoted reference, one realizes that it does not explain the factors that produce transference. However, illuminating and pointed this and other similes may be, they are descriptive rather than explanatory. The causes of the limited understanding of transference are historical, inherent in the subject matter, and psychological.
Historically, psychoanalyses developed, a natural way of striving to differentiate it from hypnosis, its precursor, similarities between the two and having to a tendency to be overlooked. The modes of production and the emergence of the transference (positive, negative, and the transference neurosis) were considered and entirely new phenomenon peculiar to the psychoanalysis, and altogether distinct from what occurred in hypnosis.
In this differentiation from hypnosis, psychoanalysis had to come to terms with the idea of “suggestion.” Many psychoanalytic writers, and more particularly others, have complained about the inaccurate ands inexact use of this term. The greater impetus toward research into “suggestion” came from the study of hypnosis. With the appearance (1886) of Bergheim’s book, hypnosis ceased to be considered a symptom of hysteria, the nucleus of hypnosis was established as the effect of suggestion, and it is Bergheim’s merit that he showed that all people are subject to the influence of suggestion and that the hysterias differ chiefly in his abnormal susceptibility to it. This seemed to Freud a great advance in recognizing the importance of a mental mechanism in the production of disease. In the introduction he wrote (1888) to his translation into German of Bergheim’s book, which is of historical interest because it is believed to be Freud’s first publication on a psychological subject. Freud emphasizes the distinguishable importance of Bernheim’s, . . . insistence upon the fact that hypnosis. Hypnotic suggestion can be applied, not only to hysterics and to seriously neuropathic patients, but also to most of healthy persons, and his belief that this ‘is calculated to extend the interest of physicians in this therapeutic method far beyond the narrow circle of neuropathologists. The significance of suggestion was thus established, but its meaning had yet to be clarified. Freud tried to find a link between the psychological (somatic) and mental (psychological) phenomena in hypnosis: “I think,” he stated, “the shifting and ambiguous use of the word “suggestion" lend to this antithesis a decretive sharpness that it does not in reality posses.” He then set out to give a definition of suggestion to embrace both its psychological and mental manifestations. Considering what it is worthwhile we can legitimately call a 'suggestion'. No doubt some kind of mental influence is implied by the term, and should correspondingly be put forward the view that what distinguishes the suggestion from other kinds of mental influence, such as a command or the giving of a piece of information or instruction, is that with a suggestion an idea is aroused on another person’s brain that is not examined as for its origin but is accepted just as though it had arisen spontaneously in the grain. Freud did not succeed in giving the term a clear and unequivocal definition.
The psychological phenomena (vascular, muscular, etc.) have yet to be brought under the roof of suggestion, if hypnosis and hysteria were to be claimed for psychology. Psychology functions not subject to conscious control, and Freud’s earlier definition of suggestion, did not cover them, so, in this pre-analytic paper, Freud widens the meaning of suggestion by introducing “indirect suggestion.” He says, “Indirect suggestions, in which a series of intermediate linked out of the subject’s own activity are implied between the external stimulus and the result, are none the less mental posses, but they are no longer exposed to the full light of consciousness that falls upon direct suggestion.” Noting that the factor of an unconscious operation of suggestion is now introduced for the first time in Freud's whitings is important. If, for example, it is suggested to a patient that he close his eyes, and if then he falls asleep, he has added his own association (sleep follows closing of the eyes) to the initial stimulus. The patient is then said to be subjected to ‘indirect suggestion’ because the suggestive stimulus opened the door for a chain of associations in the patient’s mind, in other words, the patient reacts to the suggestive stimulus by a series of autosuggestions Freud in his paper, and later, uses the “indirect suggestion” as synonymous with “autosuggestions.”
When suggestion was found by Bernheim to be the basis of hypnosis, it remained to be explained why most but not all persons could be hypnotized, or were susceptible to suggestion, and why some was more readily hypnotizable than others: Thus, besides the activity of the hypnotist, a factor inherent in the patient was established and had to be examined. The factor was called the patient’s suggestibility. The nature of what went on in the patient’s mind during hypnosis was soon made the subject of extensive psychological process. Ferenczi showed that the hypnotist when giving a command is relacing the subject’s parental imagos and, more important, is so accepted by the patient. Freud concluded that hypnosis is a mutual libidinal tie. He found that the mechanism by which the patient becomes suggestible is a splitting from the ego of the ego-ideal transferred to the suggesters. As the ego-ideal normally has the function of testing reality, this faculty is greatly diminished in hypnosis, and this accounts both for the patient’s credulity and his further regression from reality toward the pleasure principle. According to Freud, the degree of a person’s ego and ego-ideal, from which to the greater extent is readily an identification with authority. Thus, we find that in the understanding of hypnosis and suggestion the subject’s suggestibility came to outweigh the suggesters activities. Earnst Jones, showed that there is no fundamental difference between autosuggestion and allosuggestion, and both make up libidinal regression to narcissism. Abraham, in his paper on Coué, shows that the subjects of this form of autosuggestion regressed to states of obsessional neurosis. McDougal speaks of “the subject’s attitude of submissiveness as suggestibility.” As the common factor brought out by all these investigations is regression, defining suggestibility as adaptability by regression seems justifiable.
In the investigations of hypnosis, the stress has been placed at different times on extrinsic factors (The implanting of an idea or the hypnotist’s activities) or on intrinsic factors, i.e., the patient’s suggestibility. In fact, whereas the ‘implantation’ of a foreign idea, independent of any factors operative within the patient, was first considered to form the whole process of suggestion, the pendulum soon swung to the others extremer, and the endo-psychic process (capacity to regress ) were considered the essence of hypnosis. Through this historical development “suggestion” and “suggestibility” became confused, although suggestibility clearly distinctly infers a state or readiness as opposed to the actual process of suggestion. Unfortunately, however, these two terms have crept into psychoanalytic literature as having the same meaning. It is in part due to this fact that the transference phenomenons became considered as a spontaneous manifestation to the neglect of precipitating factors. These ambiguities have never been overcome, moreover, they are to same extent responsible for the lack of understanding of the genesis and nature of transference.
To differentiate the new psychoanalytic technique from hypnosis there was a repudiation of suggestion in the psychoanalysis. Later, however, this was questioned, and the term, suggestion, was reintroduced into psychoanalysis terminology. Freud says that,“ . . . and we have to admit that we have only abandoned hypnosis in our methods to discover suggestion again in the shape of transference,” and, in another paper, “Transference is equivalent to the force called “suggestion.” Still later, “It is quite true that a psychoanalysis, like other psychotherapeutic methods, works by means of suggestion, the difference being, however, that it (transference or suggestion) is not the decisive factor.” While Freud equates here transference and suggestion, he says a little earlier in the same paper: “One easily recognizes in transference the same factors that the hypnotists have called “suggestibility. Which is the carrier of the hypnotic rapport?” In his Introductory Lectures, Freud also uses transference and suggestion interchangeably, equally it recognizes that sometimes a given guarantee upon its meaning of suggestion in psychoanalyses by stating that ‘direct suggestion’ was abandoned in the psychoanalysis, and that it is used only to uncover instead of covering it, Ernest Jones states that suggestion covers two processes ‘ . . . This, taken for granted is given to the spoken exchange of which is persuasively an “affective suggestion,” of which the latter are the more primary and are necessary for the action of the former. “Affective suggestion” is a rapport that depends on the transference (Übertragung) of certain positive affective processes in the unconscious region of the subject’s mind . . . Suggestion plays a part in all methods of treatment of the psychoneurosis except the psychoanalytic one.” This new terminology does not seem clear. “Affective suggestion” obviously represents “suggestibility.” In the way it is expressed it plainly contradicts Freud’s statement about the role of ‘suggestion’ in psychoanalysis Freud and Jones was probably in full agreement about what they meant. Nevertheless, this confusing and haphazard use of terms could not but influence adversely the full understanding of analytic transference. One might even take it as proof that transference is not fully understood: If it were, it could be stated simply and clearly.
That Freud was dissatisfied about the definition of transference and suggestion is confirmed by his statement: “Having kept away from the riddle of suggestion for thirty years, I find on approaching it again that there is no change in the situation . . . The word is finding an ever more extended use, and a looser and looser meaning.” He introduces yet another differentiation of suggestion “as used in the psychoanalysis” from suggestion in other psychotherapies. As used in psychoanalyses argued Freud-and one is tempted to say by way through the fact that transference is continually analysed in a psychoanalysis and so resolved, inferring that the effects of suggestion are by that undone. This statement found its way into psychoanalysis literature in many places, and gained acceptance as a standard valid argument: The factor of suggestion is held to be eliminated by the resolution of the transference, and this is regarded as the essential difference between the psychoanalysis and all other psychotherapies. However, including it in the definition of suggestion is dubiously scientific, the subsequent relations between therapist and patient, neither is it scientifically precise to qualify ‘suggestion’ by its function: Whether the aim of suggestion is that of covering up or uncovering, it is either suggestion or it is not. Little methodological advantage could be gained by using “suggestion” to fit the occasion, and then to treat the terms “suggestion,” “suggestibility,” and “transference” as synonymous. It is therefore not surprising that the understanding of analytic transference has suffered from this persisting inexact and unscientific formulation.
One must agree with Dalbiez, when he said, “The Freudians” deplorable habit (which they owe, to Freud himself) of identifying transference with suggestion has largely contributed to discrediting psychoanalytic interpretations. The truth is that positive transference causes the most favourable conditions for the intervention of suggestion, but it is hardly identical with it. Dalbiez, gives definition to suggestion as
“ . . . unconscious and involuntary realization of the content of a representation.” This neatly condenses the factors that Freud postulated, namely, autosuggestion, direct and indirect suggestion, and their unconscious operation.
In this historical review, it may be stated, despite ambiguities, it may be generally accepted that in the classical technique of psychoanalysis, suggestion so defined is used only to induce the analysand to realize that he can be helped and that he can remember.
An important factor responsible for the neglect of the theory of transference was the early preoccupation of analysts with showing the various mechanisms involved in transference. Interest in the genesis of transference was sidetracked by focussing research on the manifestations of resistance and the mechanisms of defence. These mechanisms were often explained as the phenomenon of transference, and their operation was taken to explain its nature and occurrence.
The neglect of this subject may in part be the result of the personal anxieties of analysis. Edward Glover comments on the absence of open discussion about psychoanalytic technique, and considers the possibility of subjective anxieties.
": . . Seemingly much more likely in that so much technical discussion centres round the phenomena of transference and countertransference, both positive and negative.” There may in addition reach and unconscious endeavour to avoid any active “interference” or, more exactly, to remove any suspicion of methods reminiscent of the hypnotist.
A survey of the literature within the strict limits of psychoanalysis would simply summarize what has been said about the causation of psychoanalytic transference. Nevertheless, although this can be done, however, it is of doubtful value without a survey first of the literature about transference manifestoes in general, and without a survey of what transference is held to be and to mean. Many and varying differences of opinion obviously coexist and as a result, many differing interpretations would have been to give. However, unfortunately, without a comprehensive critical survey of the subject, in fact, would prove impossible because there are no clear-cut definitions and many differences of opinion about what transference is. This is in part attributable to the state of a growing science and to the fact that most authors approach the subject from one angle only.
To begin with, there is no consensus about the use of the term “transference” which is called variously 'the transference' 'transference' 'transferences' 'transference state' sometimes as 'analytic rapport.'
Does transference embrace the whole affective relationship between analyst and analysand, or the more restricted ‘neurotic transference’ manifestation? Freud used the term in both senses. To this fact Silverberg recently drew attention, and argued that transference should be limited to ‘irrational’ manifestations, maintaining that if the analysand says ‘good morning’ to his analyst, including such behaviour under the term transference is unreasonable. The contrary view is expressed: That transference, after the opening stage, is everywhere, and the analysand’s every naturally formed process can be given a transference interpretation.
Can transference be adjusted to reality, or are transference and reality mutually exclusive, so that some action can only be either the one or the other, or can they coexist so that behaviour in accord with reality can be given a transference meaning as on forced transference interpretation? Alexander comes to the conclusion that they are’ . . . truly mutually exclusive, just as the more general notion “neurosis” is quite incompatible with that of reality adjusted behaviour.
Freud divided transference into positive and negative. Fernichel asks this subdivision, arguing that, “Transference forms in neurotics are mostly ambivalent, or positive and negative simultaneously.” Fernichel states further that manifestations of transference ought to be valued by their “resistance value,” noting that “ . . . positive transference, although acting as a welcome motive for overcoming resistance, must be looked upon as a resistance in as far as it is transference.” Ferenczi, on the contrary, after stating that a violent positive transference is, especially in the early stages of analysis, as it is often nothing but resistance, emphasizes that in other cases, and particularly in the later stages of analysis, it is essentially the vehicle by which unconscious striving can reach the surface. Most often the inherent ambivalence of transference manifestations is stresses and looked upon as a typical exhibition of the neurotic personality.
The next query arises from one special aspect of transference, ‘acting out’ in analysis. Freud introduced the term “repetition compulsion” and he says: “for a patient in analysis . . . it is plain that the compulsion to repeat in analysis the occurrence of his infantile life disregards the in bounding in every way the pleasure principle.” In a comprehensive critical survey of the subject, Kubie comes to the conclusion that the whole conception of a compulsion to repeat for the sake of repetition is of questionable value as a scientific idea, and were better eliminated. He believes the conception of “repetition compulsion” involves the disputed death instinct, and that the term is used in psychoanalytic literature with such widely differing connotations that it has lost most, if not all, of its original meaning. Freud introduced the term for the one variety of transference reaction called acting out, but it is, in fact, applied to all transference manifestations. Anna Freud defines transference as: ‘. . . in all, those impulses experienced by the patient in his relation with the analyst that are not newly created by the objective analytic situation but have their sources in early . . . early relations and are now merely revived under the influence of the repetition compulsion. Ought, then, the term “repetition compulsion” be rejected or retained and, if retained, as it applicable to all transference reaction, or to acting out only?
This leads to the question of whether transference manifestations are essentially neurotic, as Freud most often maintained: “The striking peculiarity of neurotics to develop affectionately and hostile feelings toward their analyst are called ‘transference.” Other authors, however, treat transference as an example of the mechanism of displacement, and hold it to be a “normal” mechanism. Abraham considers a capacity for transference identical with a capacity for adaption that is ‘sublimited sexual transference’, and he believes that the sexual impulse in the neurotic is distinguishable from the normal only by its excessive strength. Glover states: ‘Accessibility to human influence depends on the patient’s capacity to establish transference, i.e., to repeat undulate current situations . . . Attitudes developed in early family life’. Is transference, then, consequent to trauma, conflict, and repression, and so exclusively neurotic, or is it normal?
In answer to the question, is transference rational or irrational, Silverberg maintains that transference should be defined as something having the two essential qualities: That it is ‘irrational and disagreeable to the patient’. Fernichel agrees that ‘transference is bound up with the fact that a person does not react rationally to the influence of the outer world’. Evidently, no advantage or clarification of the term ‘transference’ has followed its assessment, justly as ‘rational’ or otherwise. Unfortunately, the antithesis, ‘rational’ versus irrational’, was introduced, as it was precisely a psychoanalysis that protested that rational behaviour can be traced to “irrational” roots. What is transferred? Affects, emotions, ideas, conflict, attitudes, experiences? Freud says only effect of love and hate is included. Nevertheless, Glover finds that “Up to that date [1937] discussion of transference was influenced for the most part by the understanding of one unconscious mechanism only, that of displacement.” He concludes “that an adequate conception of transference must reflect all the individuals' development . . . he takes upon the place of the analysts, not merely affects and idealizes but all he has ever learned or forgotten throughout his metal development.” Are these transferred to the person of the analyst, or also to the analytic situation? Is extra-analytic behaviour to be classed as transference?
Are positive and negative transference felt by the analysand to be an “intrusive foreign body,” as Anna Freud states, in discussing the transference of libidinal impulses, or are they agreeable to the analysand, a gratification so great that they serve as resistance? Alexander concludes that transference gratifications are the greatest source of unduly prolonging analysis, he reminds his readers that whereas Freud initially had the greatest difficulty in persuading his patients to continue analysis, he soon had equally great difficulty in persuading them to give it up.
Freud divides positive transference into sympathetic and positive transference. The relation between the two is not clearly defined, and sympathetic transference is sometimes called analytic rapport. Do the two merge, or remain distinct: Is sympathetic transference resolved with positive and negative transference? Discussions in the importance of positive transference are the beginning of analysis and as carrier of the whole analysis had lately been revived among child analysts. This has extended to the question of whether or not a transference neurosis in children is desirable or even possible. While this dispute touches on the fundamentals of psychoanalytic theory, the definitions offered as a basis for the discussion are not very precise.
The contradictions in the literature about transference could be multiplied, but as exemplifying the conspicuous absence of a unified conception they will suffice. Alexander’s make to comment that ‘Although it is agreed that the central dynamic functional problem in psychoanalytic therapy is the handling of transference, there is a good deal of confusion about what transference really means’. He comes to the conclusion that the transference relationship becomes identical with a transference neurosis, except that the transient neurotic transference reactions are not usually dignified with the name of “transference neurosis.” He thus questions the need for the term transference neurosis together. As to the transference neurosis itself, there is a similar haziness of the conception. Definitions usually begin with “When symptoms loosen up . . . ,” or “When conflict is reached . . . ,” or “When the productivity of illness becomes centred round one place only, the relation to the analyst . . . ,” yet, strictly speaking, such pronouncements are descriptions, not definitions. Freud’s definition of transference neurosis implicitly and explicitly refers only to the neurotic person, so that one is left with the impression that only neurotics form a transference neurosis. Sachs, on the contrary,’ . . . found the difference between the analyses of training candidates and of negligent neurotic patients.
It may be historically held that many contradictions in the literature are largely semantic, which in enumerating them haphazardly, discrepancies’ brought into false relief. A truer picture, it may be argued, would have been given is historical periods had been made the principle. Developmental stages in a psychoanalysis were of course reflected in current concepts of transference.
In the very first allusion (1895) to what developed into the notion of transference, Freud says that the patient made ‘a false connection’ to the person of the analyst, when an effect became conscious which related to memories that were still unconscious. This connection Freud thought to be due to ‘the associative force prevailing in the conscious mind’. It is interesting that with this first observation Freud had already noted that the effect precedes the factual material emerging from repression. He adds that nothing is disquieting in this because “ . . . the patients gradually come to appreciate that in these transferences onto the person of the physician they are subject to a compulsion and a misrepresentation, which vanquishes with the cancellation of analysis.”
In 1905 Freud stresses the sexual nature of these impulses felt toward the physician. What, he said, are transferences? “They are new editions or facsimiles of the tendencies and fantasies aroused and made consciously during the progress of the analysis . . . Fantasies now added to affect. If one goes into the theory of analytic technique,” he continues, “transference is evidently an inevitable necessity.” At this historic point Freud established the fundamental importance of transference in the psychoanalysis with its specific technical meaning. The importance of this passage is confirmed by a footnote added on 1923. It is noteworthy that Freud mentions in its passage that transference impulses are not only sympathetic or affectionate, but that they can be hostile.
About 1906 transferences were regarded as a displacement of effect. Analysis was largely interested in unearthing forgotten Traumata and in searching for complexities. Much of the theory was still influenced by the cathartic method. The psychoanalysis was then, says Freud,‘ . . . the next aim was to compel the patient to confirm the reconstruction through his own memory. In this endeavour the chief emphasis was on the resistance of the patient: The art now lay in unveiling these when possible, in calling the patient’s attention to them . . . and teaching him to abandon this resistance. It then became increasingly clear, however, that the bringing into consciousness of unconscious material was not fully attainable by this method either. The patient cannot recall all that lies repressed . . . and so gains no conviction the reconstruction is correct. He is obliged to repeat as a current experience what is repressed instead of recollecting it as a part of the past’. The importance of resistance as acting out is now introduced (repetition compulsion).
Beyond the Pleasure Principle (1920) was followed by Group Psychology and the Analysis of the Ego (1921) and The Ego and the Id (1923). The new concepts introduced were the superego, and the more specific function of the ego, and the conception of the id as containing not only repressed material, but also as a reservoir of instincts. Resistance was extended to ego and superego and it resistance. This caused some confusion, because it can be used as meaning the resistance of one psychic instance to analysis, or the resistance of one psychic instance, say the ego, to another psychic instance, say the id, but the term resistance has been used chiefly as resistance to the progress of analysis generally. The id was shown to offer no resistance, but to lead to acting out, which in turn, however, is a resistance to recollection. At times, the unconscious can only be recovered in action, and while it is therefore “material” in the strict sense of the word, it is still resistance to verbalized recollection.
The mechanisms considered operatives in transference were displacement, projection and introjection, identification, compulsion to repeat. The importance of “working through” was stressed. In 1924 discussions took place about the relative values of intellectual insight versus affective re-experiencing as the essence of analytic experience, an issue very important in interpreting the transference to the patient.
In the period following, this added knowledge was gradually integrated, but with overemphasis on some new aspects as they first arose. Without a comprehensive critical survey of the subject, authors found it necessary to explain what they meant when they used the term “transference.”
With this integration new factors of confusion arose. Viewed arbitrarily form, lets us say 1946, the conception of transference has been influenced by (1), child analysis, (2), undertaking at treating psychotics, (3) psychosomatic medicine, and (4) the disproportions between the number of analysts and the growing number of patients seeking analysis, leading to attempts to shorten the process of analysis.
Direct interpretation of unconscious content is again being stressed by some analysts of children so that the methods are reminiscent of the beginning of psychoanalysis. Yet on closer examination, there may be a difference in principle: Unconscious material that presents itself in play is given a direct transference meaning from the beginning. The therapist interprets forward, as it was. The interpretation is not from current material, but from the allegedly presented unconscious material to an alleged immediacy of the transference significance. This, it should be noted, is a mental process of the therapist and not of the patient, therefore in the strict scientific sense, it is a matter of countertransference than of transference. Something similar takes place in the classical technique when forced transference interpretations are given, the important difference being that these are used in the classical method only sparingly and never until the transference neurosis is well established, and analysis has become a compulsion. It is precisely at this theoretical, that the dispute is centred among child analysts about the possibility or existence of a transference neurosis among children.
In the treatment of psychotics the idea of transference is developing a new orientation. In some of these techniques the therapist interprets to himself the meaning of the psychotic fantasy and joins the patient in acting out. Strictly speaking, this is active countertransference.
In psychosomatic medicine, particularly in ‘short therapy’, transference is either discounted as an actively manipulated way that, from a theoretical point of view, amounts to an abandonment of Freud’s “spontaneous” manifestations.
All and all, changes in the idea of transference are not constructively progressive. Critical attention needs to be drawn to the fact that not only is there no consensus about the concept of transference, but there cannot be until transference is comprehensively studied as a branch of knowledge and as a functional dynamic process. The lack of precision is to some extent due to a disregard of its historical development. Nor can there be a consensus while the relation of transference manifestations to the three stages of analysis is neglected, it is to the detriment of scientific exactitude that divergent groups do not sharply define but as an alternative, it glosses over fundamental differences, there is a tendency to claim orthodoxy, and to hide the deviation behind one tendentiously and arbitrarily selected quotation from Freud.
In the face of such divergent opinions on the nature and manifestations of transference, one might expect many hypotheses and opinions about how these manifestations come about. However, this is not so. On the contrary, there is the nearest approach to full unanimity and accord throughout the psychoanalysis literature on this point. Transference manifestations are held to arise within the analysand spontaneously. ‘This peculiarity of the transference is not, therefore, says Freud, “to be placed to the account of psychoanalytic treatment, but is to be ascribed to the patient’s neurosis itself.” Elsewhere, he makes to point out: “In every analytic treatment, the patient develops, without any activity by the analyst, and intense affective relation to him . . . It must not be assumed that analysis produces the transference. . . . The psychoanalytic treatment does not produce the transference, it only unmasks it?” Ferenczi, in discussing the positive and negative transference says: “. . . . It has particularly to be stressed that this process is the patient’s own work and is hardly ever produced by the analyst.” “Analytic transference appears spontaneously, and the analysts need only take care not to disturb this process.” As states, “The analyst did not deliberately set out to affect this new artificial formation (the transference neurosis), merely observed that such a process took place and forthwith used it for his own purposes.” Freud further states: “The fact of the transference appearing, although either desired or induced by either physician or patient, in every neurotic who comes under treatment . . . has always seemed as . . . ‘ proof that the source of the propelling forces of neurosis lies in the sexual life.”
There is, however, a reference by Freud from which one has to infer that he had in mind another factor in the genesis of transference apart from spontaneity-in fact, some outside influence, the analyst ‘ must recognize that the patient’s falling in love in induced by the analytic situation . . . ’. He (the analyst) has evoked this love by undertaking analytic treatment in other to cure the neurosis, for him, it is an unavoidable consequence of the medical situation . . . ’. Freud did not amplify or specify what importance he attached to this causal remark.
Anna Freud states that the child’s analyst has to woo the little patient to gain its love and affection before analysis can continue, and she says, parenthetically, that something similar takes place in the analysis of adults. Another reference to the effect that transference phenomenon is not completely spontaneous is found in a statement by Glover summarizing the effects of inexact interpretation. He says that the artificial phobic and hysterical formulations resulting from incomplete or inexact interpretations are not an entirely new conception. Hypnotic manifestation has long since been considered “an induced hysteria” and Abraham considered that states of autosuggestion were induced obsessional systems? He continues . . . “ and of course, the induction or development of a transference neurosis during analysis is regarded as an integral part of the process,” one is entitled from the context to assume that Glover commits himself to the view that some outside factors are operative which induce the transference neurosis. Nevertheless, it is hardly a coincidence that it is no more than a hint.
The impression gained from the literature is that the spontaneity of transference is considered established and generally accepted. In fact, this opinion seems jealously guarded for reasons referred to.
A psychoanalysis developed from hypnosis: A study of the older psychotherapeutic methods, therefore, may still yield data that are applicable to the understanding psychoanalysis: One cannot overestimate the significance of hypnotism in the development of the psychoanalysis. Theoretically and therapeutically, the psychoanalysis is the trustee of hypnotism. It is in comparing hypnotic and analytic transference that the writer believes the clue to the phenomenon and the production of transference may be found. It was only after hypnosis had been practised empirically for a long time that its mechanism was given explanations by Bernheim, Freud, and Ferenczi. Freud showed that the hypnotist suddenly assumed a role of authority that Standley transformed the relationship for the patient (by way of Traumata) into a parent-child relationship. Radó investigating hypnosis, came to the conclusion that.”
. . . the hypnotist is promoted from being an object of the ego to the position of an ‘a parasitic superego.” Freud stated, “No one can doubt that the hymnodist has stepped into the place of the “ego-ideal.” Later he was to say that “ . . . the hypnotic relation is the devotion of someone in love to an unlimited degree but with sexual satisfaction excluded. In other place’s Freud stressed repeatedly and with great emphases that in hypnosis factors of a “coarsely sexual nature” were at work, and that the qualities of the libido.” Psychoanalysis like hypnosis began empirically, one may speculate that analytic transference is a derivative of hypnosis, and motivated by instinctual (libidinal) drives and, substituting new terms, produced in a way comparable to the hypnotic trance.
When one compares hypnosis and transference, it appears that hypnotic ‘rapport’ contains the elements of transference condensed or superimposed. If what makes the patient go to the hypnotist is called sympathetic transference, hypnosis can be said to embrace positive transference and the transference neurosis, and when the hypnotic “rapport” is broken, the manifestations of negative transference. The analogy of course ends when transference is not resolved in hypnosis as it is in analysis, but is allowed to persist. To look upon it from another angle, analytic transference manifestations are some slow motion pictures of hypnotic transference manifestations, they take some time to develop, unfold slowly and gradually, and not at once as in hypnosis. If the hypnotist becomes the patients’ “parasitic superego,” similarly, the modification of the analysand’s superego has for some time been considered a standard feature of psychoanalyses.
Styrachey sees in the analyst “an auxiliary superego.” Discussing this and examining projection and introjection of archaic superego formations to the analyst, he says: The analyst’ . . . hopes, in short, that he himself will be introjected by the patient as a superego, introjected, however, not at a single gulp and as an archaic object, whether good or bad, but little by little, and as a real person. Another possible similarity between the modes of action of hypnosis and analytic transference is to be found in the state of hysterical dissociation in hypnosis, in the psychoanalysis a splitting of the ego into an experiencing and an observable care that takes its part (which follows the procreation of the superego to the analyst), and takes place. Sterba, stressing the usefulness of interpretation of transference resistance, shows that this takes place through a kind of dissociation of the ego just when these transferences are interpreted. Both in hypnosis and psychoanalysis libidos are mobilized and concentrated in the hypnotic and analytic situation, in hypnosis again condensed in one short experience, while the psychoanalysis at which a constant flow of a libido in the analytic situation is aimed. Ferenczi’s ‘active therapy’ was intended to increase or keep steady this libidinal flow. Freud first encountered positive transference (love), and only later discovered the negative transference. This sequence is the trued in analysis, and in this there is another analogy to hypnosis. Finally, it is generally recognized that the same type of patient responds to hypnosis as to psychoanalysis, in fact, the hypnotizability of hysterics gave Freud the impetus to develop the psychoanalytic technique, and hysterics are still the paradigms for classical psychoanalytic technique.
It is comparatively easy today to get a bird’s-eye view of the development of analytic transference from hypnotic reactions, and make a comparison between the two. Freud, who had to find his was gradually toward the creation of a new technique, was completely taken by surprise when he first encountered transference in his new technique. He stressed repeatedly and emphatically that these demonstrations of love and of hate emanate from the unaided patients, which they are part and parcel of the “neurotic,” and that they have to be considered a “new edition” of the patient’s neurosis. He maintained that these manifestations appear without the analyst’s endeavour, but their obtainability is in spite of him (as they represent resistance), and that nothing will prevent their occurrence. Freud’s view is still undisputed in psychoanalytic literature: Thus arose the conception that the analyst did nothing to evoke these reactions, in a marked contradistinction to the hypnotist’s direct activities, the analyst offered himself tacitly as a superego in contrasts to the noisy machination of the hypnotist.
Transference was, in the early days of psychoanalysis, believed to be a characteristic and pathognomonic sign of hysteria. This was a heritage from hypnosis. Later, these same manifestations were found in other neurotic conditions, in the psychoneuroses, or the transference neuroses. When in time psychoanalyses was applied to an ever-widening circle of cases, it was found that students in psychoanalytic training, who did not openly fall into any of these categories, formed transference in the same way? This was explained by the fact that between ‘normal’ and ‘neurotic’ there is a gradual transition, which in fact we are all potentially neurotic. In this way, historically, the onus of responsibility for the appearance of transference was shifted imperceptibly from the hysteric to the psychoneurotic, and then to the normal personality. When this stage was reached, transference was held to be one many ways in which the universal mental mechanism of displacement was at work. The capacity to “transfer” or “displace” was shown to operate in everybody to a greater or lesser degree: Its use became looked upon as a normal, in fact, an indispensable mechanism. The significance of this shift of emphasis from a hysterical trait to a universal mechanism as the source of transference has, however, not received due attention. It has not aroused much comment nor an attempt to revive the fundamental principles underlying psychoanalytic procedure and understanding.
Transference is still held to arise spontaneously from within the analysand, just as when psychoanalytic experience embraced only hysterics. It is generally taught that the duty of the analyst is, at best, to allow sufficient time for transference to develop, and not to disturb this ‘natural’ process by early interpretation. This role of the analyst is well illustrated in the similes of the analyst as ‘catalyst’ (Ferenczi), or as a ‘mirror’ (Fernichel).
It is all the same that if transference is an example of a universal mental mechanism (displacement), or if, in Abraham’s sense, it is equated with a capacity for adaption of which everybody is capably which everybody employs at times in varying degrees, why does it invariably occur with such great intensity in every analysis? The answer to this question may be that transference is induced from without in a manner comparable to the production of transfixed hypnosis. The analysand brings, in varying degrees, an inherent capacity, a readiness to form transference, and this readiness is met by something that converts it into an actuality. In hypnosis the patient’s inherent capacity to be hypnotized is induced by the command of the hypnotist, and the patient submits instantly. In the psychoanalysis it is neither achieved in one session nor it a matter of obeying. Psychoanalytic technique creates an infantile setting, of which the “neutrality” of the analyst is but one feature among others. To this infantile setting the analysand-if he is, analysable-has to adapt, even if by regression. In their aggregate, these factors, which go to make up this infantile setting, amount to a reduction of the analysand’s object world and denial of objects relations in the analytic room. To this deprivation of object relation he responds by curtailing conscious ego functions and giving himself over to the pleasure principle: And following his free association, he is by that sent along the trek into infantile reactions and Mental attitude. The term free-association as defined by Freud are the trends of thought or chains of ideas that spontaneously arise when restraint and censorship upon logical thinking are removed and the individual orally reports everything that passes through his mind. This fundamental technique of advancing the psychoanalysis is assuming that when relieved of the necessity of logical thinking and reporting verbally everything going through his mind, the individual will bring forward basic psychic material and thus make it available to analytic interpretation. As forwarded by hypnotism, in which its theory and practice of inducing hypnosis or a state resembling sleep as induced by physical means.
Before discussing in detail the factoring constitution of an infantile analytic setting, of which the analysand is uncovered and appreciating the fact that finding the analytic situation is necessarily is common in psychoanalytic literature called one to which the analysand reacts as if it were an infantile one, once, again, Freud describes the infantile expression as that which is maintained by psychoanalysts that ‘this period of life, during which a certain degree of directly sexual pleasure is produced by the stimulation of various cutaneous areas (erotogenic zones), by the activity of certain biological impulses and as an accompanying excitation during many affective states, is designated by an expression introduced by Havelock Ellis as the period of autoerotism. It is, nonetheless, generally understood that the analysand is alone responsible for this attitude? As an explanation of why he should regard it always as an infantile situation, one mostly finds the explanation that the security, the absence of adverse criticism, the encouragements derived from the analyst’s neutrality, the allaying of fears and anxieties, create an atmosphere that is conducive to regression, that is to say, the actions of his returning to some earlier level of adaption. Up to the present time, it is usually established in the literature as it is far from being the rule that the analytic couch allays anxieties, nor is the analytic situation always felt as a place of security: The projection of an essentially severe superego onto the analyst is not conducive to allaying fears. Many patients first react with increased anxieties, and analysis is frequently felt by the analysand as fraught with danger both from within and without. Many patients from the start have mutilation and castration anxieties, and at times analysis is equated in the analysand’s mind with a sexual attack. The analyst’s task is to overcome this resistance, but the analytic situation per se, does not bring it about. In fact, the security of analysis as an explanation of the regression is paradoxical: As in life, security makes for stability, whereas stress, frustration, and insecurity initiate regression. This trend of thought does not run counter to accepted and current psychoanalytic teachings, but it is instead an exposition of Freud’s established principles about the conception of neurosis. As used today, this term is interchangeable with the term psychoneurosis. At one time it was used to refer to any somatic disorder of the nerves (the present-day term for this meaning is neuropathy) or to any disorder of nerve function. In psychoanalytic terminology, neurosis is often used more broadly to include all physical disorder: Thus Freud spoke of actual neuroses (Neurasthenia, including hypochondriasis, and anxiety-neurosis): Transference or psychoneuroses (Anxiety-hysteria, conversion-hysteria, obsessional and compulsive neurosis . . . ), narcissistic neuroses (the schizophrenias and manic-depressive psychoses) and traumatic neuroses are each given to psychoanalytical literature, and treatment is aside. The self-contradictory statement, that the security of analysis induces the analysand to regress. It is carried uncritically from one psychoanalysis publication to another.
These infantile settings are manifold, and they have been described singly by various authors at various times. It is not pretended, that anything new is to add to them but as far as the aggregate has never been described an amounting to a decisive outside influence on the patient. These factors are in this context given in an outline. If only to establish the features of the standardization of their psychoanalytic technique as to (1) Curtailment of an object world. External stimuli are reduced to a minimum (Freud at first asked his patients even to keep their eyes shut). Relaxation on the couch has also to be valued as a reduction of inner stimuli, and as an elimination of any gratification from looking or being looked at. The position on the couch approximates the infantile posture. (2) The constancy of environment, which stimulates fantasy. (3) The fixed routine of the analytic 'ceremonial', the 'discipline' to which the analysand has to conform which is reminiscent of a strict infantile routine. (4) The single factor of not receiving a reply from the analyst is likely to be felt by the analysand as a repetition of infantile situations. The analysand-uninitiated in the technique-will not merely be an anticipatorial answer to his question but he will expect conversation, help, and encouragement and criticism? (5) The timelessness of the unconscious. (6) Interpretations on an infantile level stimulate infantile behaviour. (7) Ego function is reduced to a state intermediate between sleeping and waking. (8) Diminished personal responsibility in analytic sessions. (9) The analysand will approach the analyst in the first place much in the same way as the patient with an organic disease consults his physician: This relationship contains a strong element of magic, a strong infantile element. (10) Free association, liberating unconscious fantasy from conscious control. (11) Authority of the analyst ( parent ): This projection is a loss, or severe restriction of object relations to the analyst, and the analysand is thus forced to fall back on fantasy. (12) In this setting, and having the full sympathetic attention of another being, the analysand will be led to expect, which according to the reality principle he is entitled to do, that he is dependent on and loved by the analyst. Disillusionment is quickly followed by regression. (13) The analysand art first gains an illusion of complete freedom, which he will be unable to select or guide his thoughts at will is one facet of infantile frustration. (14) Frustration of every gratification repeatedly mobilizes the libido and initiates further regressions to deeper levels. The continual denial of all gratification and object relations mobilizes the libido for the recovery of memories. However, its significance lies also in the fact that frustration as this is a repetition of infantile situations, and to the highest degree and likely the most important single factor. Saying that we grow up by frustration would be true. (15) Under these influences, the analysand becomes ever more divorced from the reality principle, and falls under the sway of the pleasure principle.
These depictions are well implicated to features that exemplify the sufficiencies that the analysand is exposed to an infantile setting in which he is led to believe that he has perfect freedom, which he is loved, and that he will be helped in a way he expects. The immutability of a constant passive environment forces him to adapt, i.e., to regress to infantile levels. The reality value to the analytic session lies precisely in its unchanging unreality, and in its unyielding passivity lies the “activity,” the influence that the analytic atmosphere experts. With this unexpected environment, the patient-if he has, any adaptivity-has to come to terms, and he can do so only by regression. Frustration of all gratifications pervades the analytic work. Freud comments: “As far as his relations with the physician are concerned, the patient must have unfulfilled wishes in abundance. It is expectient to deny him precisely those satisfactions that he needs most intensively and expresses most importunately.” This is a description of the denial of object relation in the analytic room. The present thesis stresses the significance not only of the loss of object relation, but, as a constituent of at least equals importance, the loss of an object world in the analytic room, the various factors of which are set out in above-mentioned-remarks.
Evidently, all these factors working together from a definite environment under which his loss of an object world, including its surrounding surface and emotional influences, he is subject to a rigid and most sternful environment, not by any direct activity of the analyst, but by the analytic technique. This conception is far removed from the current teaching of complete passivity by the analyst. One may legitimately go one step further and call to mind what Freud said about the etiology of the neuroses:
‘. . . relational causes of disease people fall ill of a neurosis when the possibility of satisfaction for their libido is denied them-they are quickening the ill infringements that is influential to inconsequential ‘frustrations’-and that their symptoms are substitutes for the missing satisfactions’.
Regression in the analysand is initiated and kept up by this selfsame mechanism and if, in actual life, a person falls ill of a neurosis because “reality frustrates all gratification,” the analysand likewise responds to the frustrating infantile setting by regressing and by developing a transference neurosis. In hypnosis the patient is suddenly confronted with a parent figure to which he instantly submits. Psychoanalysis places and keeps the analysand in an infantile setting, both environmental and emotional, and the analysand adapts to it gradually in reserve to regression.
The same may be said to be true of all psychotherapy, yet it appears peculiar to the psychoanalysis that such an infantile setting is systematically created and its influence exerted on the analysand throughout the treatment. Unlikely any other therapist, the analyst remains outside the play that the analysand is enacting, he watches and observes the analysand’s reactions and attitudes in isolation. To have created such an instrument of investigation may be looked upon as the most important stroke of Freud’s genius.
It can no longer be maintained that the analysand’s reactions in analysis occur spontaneously. His behaviour is a response to the rigid infantile settings to which he is exposed. This poses many problems for a significantly enlarged investigation. One of these is, how does it react on the patient? He must know it, consciously or unconscious mind. It would be interesting to follow up whether perhaps the frequent feeling of being in danger, of losing something, of being coerced, or of being attacked, is a feeling provoked in the analysand in response to the emotional and environmental pressure exerted on him. If this creates a negative transference would be feasible, and as positive transference must exist as well (otherwise treatment would be stopped), a subsequent state of ambivalence must follow. Here one might look for an explanation why ambivalent attitudes are prevalent in analysis. These are generally looked upon as spontaneous manifestations of the analysand’s neurosis. Following that this double attitude of the analysand, the positive feelings toward the analyst and analysis, and a negative response to the pressure exerted on him by continual frustration and loss of object-world and object-relations, could be looked upon as the normal sequitur of analytic technique. It would not make up ambivalence in its strict sense, because the patient is reacting to two different objects simultaneously and has not as in true ambivalence two attitudes to the same object. The common appearance of this pseudo ambivalence can then no longer be adduced as evidence of the existence or part of a
pre-analytic neurosis.
The patient comes to analysis with the hope and expectation of bringing helped. He thus expects gratification of some kind, but none of his expectations are fulfilled. He gives confidence and gets none in return, he works hard and expects praise in vain. He confesses his sins without absolution given or punishment proffered. He expects analysis to become a partnership, but he is left alone. He projects onto the analyst his superego and, least of mention, desirously builds them to the expectations from his guidance and control; of his instinctual drives in exchange, but he finds this hope, is illusory and that he himself has to learn to exercise these powers. It is quite true, assessing the process as a whole, that the analysand is misled and hoodwinked as analysis proceeds. The only safeguard he is given against rebelling and stopping treatment is the absolute certainty and continual proof that this procedure, with all the pressure and frustration it imposes, is necessary for his own good, and that it is an objective method with the sole aim of benefiting him and for no other purpose than his own. In particular, the disinterestedness of the analyst must assure the patient that no subjective factors enter it. In this light, the moral integrity of the analyst, so often stressed, becomes a safeguard for the patient to continue with analysis, it is a technical driving force of analysis and not a moral precept.
A word might be added about the driving force of analysis in the light of this essay. The libido necessary for continual regression and memory work is looked upon by Freud as derived from the relinquished symptoms. He says that the therapeutic task has two phases: “In the first, libido is forced away from the symptoms into the transference and there concentrated: And in the second phase the battle rages round the new object and the libido is again disengaged from the transference object.” As so often in Freud’s statements, this description applies to clinical neurosis, but the psychoanalysis takes the same trends in non-neurotics. The main driving force may be considered derived in every analysis from such libidos as is continually freed by the denial of object-world and by the frustration of libidinal impulses.
If the conception is accepted that analytic transference is actively induced on a ‘transference-ready’ analysand by exposing him to an infantile setting to which he has gradually to adapt by regression, certain conclusions must be encouraged.
Its first state being the initial period, in which the analysand gradually adapts to an infantile setting. Regressive, infantile reactions and attitudes manifest themselves with gathering momentum during what might be described as the induction of the transference neurosis. This stage corresponds to what Glover has called the stage of “floating transferences.” A second stage suggests of itself that when his regression is well established and the analysand represents the infant at various stages of development with such intensity that all his action’s-in and out of analysis-are imbued with reactivated infantile reactions. Consciously or unconsciously. During this period, under constant pressure of analytic frustration, he withdraws progressively too earlier, ‘safer’ infantile patterns of behaviour, and the level of his conflict is inevitably reached. Reaching the level; of his conflict is not, however, the touchstone of the existence of a transference neurosis. Further, the analysands transfer not only onto the analyst, but onto the situation as a whole: He not only transfers effectual causation, although these may be the most conspicuous, but in fact his whole mental development. This conception makes it easier to understand with what alacrity analysands fasten their love and hate drives onto the analyst despite sex and whatever suitability as an object.
The transference neurosis may be defined as the stage in analysis when the analysand has so far adapted to the infantile analytic setting-the main features of which are the denials of object relations and continual libidinal frustration-that his regressive trend is well established, and the various developmental levels, relived, and worked through.
A third, or terminal, stages represent the gradual retracting of the way back into adulthood toward newly won independence, unimprisoned from an archaic superego and weaned from the analytic superego. However great the distance from maturity back into childhood at the commencement of analysis, the duration of the first and second stages of analysis is as long and takes as much time as the return journey back into maturity and independence. Only part of this way back from infantile levels to maturity falls within the time limit of analysis in its third stage: The rest and the full adaption to adulthood are most often competing by the analysand after the cancellation of analysis. In this last post-analytic stage great improvements often occur. In this conception the answer may be found to the often discussed and not fully explained problems of improvements after its Cancellation of analysis. Pointing out that these stages are theoretical is superfluous, as in reality they never occur neatly separated but always overlap.
The initial aim of analysis is to induce regression. Whatever impedes it is a resistance. If instead of such a movement there occurs a standstill (whether in acting out or of direct transference gratification), or if the movement instead of being regressive turns in the direction of apparent maturity (flight into health), one can speak of a resistance. Theoretically, acing out is a formidable variety of resistance because the analysand mistakes the unreality of the analytic relationship for reality and attempts to establish reality relations with the analyst. In this attitude he stultifies the analytic procedure for the time being, as he throws the motor force of analysis-the denial of all object relations in the analytic room and of the gratification of the libido derived from it-out of action. In cases in which early “transference successes” are won and the patient quickly relinquishes his symptoms. The analysis is in danger of terminating at this point. The mechanism of these transference successes is in a way the counterpart of acting out. The patient regresses rapidly to childhood, and forms an unconscious fantasy of a mutual child-parent relationship. He mistook such reality and object relations as exists as a basis in the analytic relationship wholly for an infantile one and unconsciously obeyed (spites or obliges) the parent imago. What happens in these cases is in fact that the analysand has in fantasy formed a mutual hypnotic transference relation with the analyst: Analytic interpretation was not either quick enough to prevent it, or the analysand’s transference readiness was too strong. He could not be made to adapt gradually to the infantile setting. In other words, the analysand faced with the stimulus of infantile situation issuing by way of autosuggestion (or indirect suggestion) to rid himself of a symptom.
Transference has resistance value in as far as it impedes the recovery of memories and so stops the regressive orientation. Per se, it is the only possible vehicle for unconscious content to come to consciousness. Transference should therefore not be indiscriminately equated with resistance as Fernichel did.
The analyst himself is also subjected to the infantile setting of which he is a part. In fact, the infantile setting to which he is exposed contains another important infantile factor, the regressing analysand. The analyst’s ego is also split into an observing and experiencing one. The analyst has had his own thorough analysis and knows what to expect, and furthermore, unlike the analysand, is in an authoritative position. Whereas, it is the analysand’s task to adapt actively to the infantile setting by regression, remaining resistant to such adaptation is necessary for the analyst? While the analysand has to experience the past and observe the present, the analyst has to experience the present and observe the past, he must resist any regressive trend within himself. If he fall victim to his own techniques, and experience the past instead of observing it, he is subject to counter resistance. The phenomenon of counter transference may be best described by paraphrasing Fernichel’s simile: The analyst misunderstands the past about the present.
To respond to the classical analytic technique, analysands must have some object relations intact, and must have at their disposal enough adaptability to meet the infantile analytic setting by further regression. For both hypnosis and psychoanalysis there is a sliding scale from the hysteric to the schizophrenic. Abraham said: “The negativism of dementia praecox is the most thorough antithesis of transference. In contrast to hysteria these patients are only to a very slight degree accessible to hypnosis. In attempting to psychoanalyse them we notice the absence of transference again.” The high degree of suggestibility, i.e., the capacity to form transferences, is extensively known as a leading feature of hysteria. Hysteria, and the whole group belonging to the transference neurosis are distinguished by an impaired and immature adjustment to reality, these reactions are mingled with infantile attitudes and mechanisms. Therefore under pressure from the infantile analytic milieu they respond freely and quickly with increased infantile behaviour to the loss of object world and object relations. The neurotic character responds not much easily and to a lesser extent in a free manner, because its object relations are firmly established (for instance, well-functioning sublimations), and therefore are harder to resolve analytically. The denial of object relations and libidinal gratification in analysis is frequently parried by reinforced sublimations, but before analysis can continue this ‘sublimated object relationship’ must be reversed.
Psychotics are refractory to the classical technique, accordingly, because their object relations are deficient and slender, and nothing therefore remains of which the analytic pressure of the classical technique could deprive these patients, or their object relations are too slight for their denial to make any difference. Freud said, that
” . . . from our clinical observations of these patients we stated that they must have abandoned the investment of objects with the libido, and transformed the object libido into an ego libido.” As the core of the classical technique is the denial of object relations of the patient through his exposure to an infantile milieu, the narcissistic regressive must consequently prove inaccessible to the classical approach. This does not, of course, exclude them from analytic methods that deviate from the classical form. The main change of approach for them must be an adjustment of the technique in the early stages of analytic treatment, this aspect has a bearing also on the problems of transference and particularly on the transference neurosis that are in dispute among child analysts.
If a person with a certain degree of inherent suggestibility is subject to a suggestive stimulus and reacts to it, he can be said to be under the influence of suggestion. To arrive at a definition of analytic transference, introducing an analogous term for suggestibility in hypnosis is necessary first and speaks of a person’s inherent capacity or readiness to form transference. This readiness is precisely the same factor and may be defined in the same way as suggestibility, namely, a capacity to adapt by regression. Whereas, in hypnosis the precipitating factor is the suggestive stimulus, followed by suggestion, in the psychoanalysis the person’s adaptability by regression is met by the outside stimulus (or precipitating factors) of the infantile analytic setting. In psychoanalyses it is not followed by suggestion from the analyst, but by continued pressure to further regression through the exposure to the infantile analytic setting. If the person reacts to it, he will form a transference relationship, i.e., he will regress and form relations to early imagos. Analytic transference may thus be defined as a person’s gradual adaptation by regression to the infantile analytic setting.
Transference cannot be regarded as a spontaneous neurotic reaction. It can be said to be the resultant of two sets of forces: The analysand’s inherent readiness for transference, and the external stimulus of the infantile setting. There are, then, to be distinguished in the mechanism of analytic transference intrinsic and extrinsic factors: The response to the analytic situation will vary in intensity with different types of analysands. The capacity to form a transference neurosis was found inherent-varying only in quality-in all analysands who could be analysed at all, whether they were neurotic if not. To account for this, the term ‘neurotic’ was extended until it lost most of its meaning because the precipitating factor, the infantile setting, was not perceived.
It is historically interesting to observe that in the heyday of hypnosis, hypnotically was considered a characteristic trait of hysteria: Hypnosis in fact was to be inside an enclosed space as considered the “artificial hysteria” (Charcot). Clearly the same situation has risen in the psychoanalysis with respect to the transference neurosis. When, to his amazement, Freud first encountered transference in his new technique, which he applied to neurotic patients only, he attributed “this strange phenomenon of transference’ to the patient’s neurosis, and he saw ‘a characteristic peculiar to neurosis.” When he coined for the acute manifestations of transference the designation “transference neurosis,” it was explicitly affirmed that these manifestations were some “new editions” of an old neurosis revealing itself within the framework of psychoanalytic treatment. Once the concept of transference necrosis had become a tenet in psychoanalytic teaching, the acute manifestations were without further questioning accepted as inseparably linked with the neurotic.
Thus, historically the linkage of transference with neurosis is a replica of the early linkage of hypnosis with the hysteric. Freud, in his pre-analytic period, hailed with enthusiasm Bernheim’s demonstration that most people were hypnotizable and that hypnosis was no longer to be regarded as inseparable from hysteria. In the introduction to Bernheim’s book, Freud said: “The accomplishments of Bernheim . . . changes in precisely the inside enclosed space as ingested by a pass over to the manifestations of hypnotism of their strangeness by linking them with familiar phenomena of normal psychological life and of sleep.” In the face of this statement, it is extraordinary that a psychoanalysis has never officially divorced transference from clinical neurosis.
The resolution of transference has been considered the safeguard against and proof of the fact that suggestion plays no part in the psychoanalysis. The validity of this argument was questioned earlier since the meaning and definition of “suggestion” are in themselves vague and shifting and used with varying connotations. Additional weight is given to this caution when it is realized that the resolution itself of psychoanalysis transference is not understood in all its aspects. True enough, but its manifestations are continually analysed in psychoanalysis. An attempt is made to reduce them, but its ultimate resolution or even its ultimate fate is not clearly understood. Whenever it is finally resolved, it is during an ill-defined period after the cancellation of analysis. By this feature alone it escapes strict scientific observation. It might even be argued that analytic transference in some of its aspects must in the last resort resole itself. In hypnosis, of course, no attempt is ever made to resolve the transference, but this should not be thought of as if it were bound to persist. More correctly it is left to look after itself. This trend of thought is followed here not in any way to distract from the essential difference in the resolution of hypnotic and analytic transference respectively, but to emphasize that as for theory the conception is not exact enough and therefore likely to create confusion of fundamental issues instead of clarifying them. Stressing this pint as seems important, by sheer weight of habit and repetition, ambiguous conceptions have a tendency to assume the character and dignity of clear scientific concepts.
There is, however, another difference between hypnotic and analytic transference that is free from all ambiguity, which may be considered of more cardinal significance in demarcating the psychoanalysis from all other psychotherapies. The hypothesis has been presented here that both hypnosis and psychoanalysis exploits infantile situations that both create. Nevertheless, in hypnosis the transference is truly a mutual relationship existing between the hypnotist and the hypnotized. The hypnotic subject transfers, but is it also transferred? One is tempted to say that countertransference is obligatory in an essential part of hypnosis (and for that matter of all psycho therapies in which the patient is helped, encouraged, advice or criticized). This interaction between hypnotist and hypnotized-made Freud described hypnosis as a “group formation of two.” The patient is subjected to direct suggestion against the symptom. In psychoanalytic therapy alone the analysand is not transferred too together. The analyst has to resist all temptation to regress, he remains neutral, aloof, a spectator, and he is never a coacher. The analysand is induced to regression and to ‘transfer’ alone in response to the infantile analytic setting. The analytic transference relationship ought, strictly speaking, not to be called a relationship between analysand and analyst, but more precisely as the analysand’s relation to his analyst. Analysis keeps the analysand in isolation. By its essential nature analysis, in the contradistinction to hypnosis, is not a group formation of two. It is not through which the denial that the analysis of which a ‘team put to work’, in as far as it is, an “objective” relation exists between the analyst and the analysand. Because the analyst remains outside the regressive movement, because it is his duty to prove resistant to countertransference by virtue of his own analysis, suggestion can inherently play no part in the classical procedure of psychoanalytic technique.
It is of historical interest to look back upon the development of psychoanalysis and find that, although the theoretical basis as shown in the essay has never been advanced, the subject of countertransference was unconsciously felt to be the most vulnerable point and the most significant issue in the psychoanalysis. The literature regarding the ‘handling of transference’ easily verifies this statement. Though this postulated immunity to arrested developments in the concept of the analyst’s passivity rightly arose, but was wrongly allowed to be extended to an idea of passivity governing the whole of psychoanalytic technique.
To make transference and its developments the essential difference between a psychoanalysis and all other psycho therapies, making differences as it may define psychoanalytic technique as the only psychotherapeutic method in which compound-to-one-sided, infantile regression-analytic transference-is induced in a patient (analysand), analysed, worked through, and finally solved.
It is the analysis of the transference that is generally acknowledged to be the central feature of analytic technique. Freud regarded transference and resistance as facts of observations, not as conceptual representations. He wrote “ . . . the theory of the psychoanalysis is an attempt to account for two striking and unexcepted facts of observation that emerge whenever we have made an attempt to trace the symptoms of a neurotic back to their sources in his past life: The facts of transference and of resistance . . . anyone who takes up other sides of the problem while avoiding these two hypotheses will hardly escape a charge of misappropriations of property by attempted impersonation, if he persists in calling himself a psychoanalyst.” Rapaport (1967) argued, in his posthumously published paper on the methodology of psychoanalyses, that transference and resistance inevitably follow from the fact that the analyst situation is interpersonal.
Despite this general agreement on the centrality of transference and resistance in techniques, it is that we have not pursued the analyst of the transference as systematically and comprehensively as it could be and should be, in that the relative privacy in which psychoanalysis work makes it impossible to state this view anything more than one or one’s impression. On the assumption that evens if wrong, reviewing issues in the analysis of the transference will be useful and to state several reasons that an important aspect of the transference, namely, resistance to the awareness of the transference, is especially often slighted in analytic practice.
Distinguishing it clearly between two types of interpretation of the transference is first. The one is an interpretation of resistance to the awareness of transference. The other is an interpretation of resistance to the resolution of transference. Greenson had shown the distinction in outline literature (1967) and Stone (1967). We may call the first kind of resistance defence transference. Although that subjectively we have mainly employed a term to refer to a phase of analysis characterized by a general resistance to the transference of wishes, it can also be ill-used for more isolated instances of transference of defence. For its imbounding place of value the containing quality of some construing measures under which has usually been called the second kind of resistance transference resistance. With some oversimplification, one might say that in resistance to the awareness of transference, the transference is what is resisted, whereas in resistance to the resolution of transference, the transference is what does the resisting.
Another descriptive way of stating this distinction between resistance and the awareness of transference and resistance ti the resolution of transference is between implicit and indirect references to the transference and explicit or direct references to the transference. They have intended the interpretation of resistance to awareness of the transference to make the implicit transference explicit, while we have intended the interpretation of resistance to the resolution of transference to make the patient realize that the already explicit transference does include a determinant from the past.
It is also important to distinguish between the general concept of an interpretation of resistance to the resolution of transference and a particular variety of such an interpretation, namely, a genetic transference interpretation-that is, an interpretation of how an attitude in the present is an inappropriate carry-over from the past. While there is a tendency among analysts to deal with explicit references to the transference primarily by a genetic transference interpretation, and there are other ways of working toward a resolution of transference? However, it can be to argue that not only is not enough emphasis being given to interpretation of the transference in the here-and-now, that is, to the interpretation of implicit manifestations of the transference, but also that interpretations intended to resolve the transference as manifested in explicit references to the transference should be primarily in the here-and-now, than genetic transference interpretations.
A patient’s statement that he feels the analyst is harsh, for example, is, at least to begin with, likely best dealt with not by interpreting that this is a displacement from the patient’s feeling that his father was harsh but by an elucidation of another aspect of this here-and-now attitude, such as what has gone on in the analytic situation that seems to the patient to justify his feeling or what was the anxiety that made it so difficult for him to express his feelings. How the patient experiences the actual situation is an example of the role of the actual situation in a manifestation of transference, which will be one of the implicitly major points.
Transference interpretations are here-and-now a genetic transference interpretation, in which is of course exemplified in Freud’s writings and are in the repertoire of every analyst. Nevertheless, they have not distinguished them sharply enough.
Because Freud’s case histories focus much more on the yield of analysis than on the details of the process, they are readily but perhaps incorrectly construed as emphasizing work outside the transference much more than work with the transference, and, even within the transference, emphasizing genetic transference interpretations much more than work with the transference in the here-and-now. The example of Freud’s case reports may have played a role in what is readily considered as a common maldistribution of emphasis in these two respects-not enough on the transference and, within the transference, not enough on the here-and-now.
Before turning within the issues in the analysis of the transference, least of mention, what is a primary reason for a failure to deal adequately with the transference, it is that work with the transference is that aspect of analysis that involves both analyst and patient in the most affect-laden and potentially disturbing interactions. Both participants in the analytic situation are motivated to avoid these interactions. Flight away from the transference and to the past can be a relief to both patient and analyst.
A divisional split in which a discussion will draw into five parts, as: (1) The principle that the transference should be encouraged to expand as much as possible within the analytic situation because the analytic work is best done within the transference: (2) The interpretation of disguised allusions to the transference as a main technique for encouraging the expansion of the transference within the analytic situation: (3) The principle that all transference has a connection with something in the present actual analytic situation: (4) How the connection between transference and the analytic situation is used in interpreting resistance to the awareness of transference, and (5) the resolution of transference within a here-and-now as, the role of genetic transference interpretation.
The importance of transference interpretation will surely be agreeing to by all analysts, the greater effectiveness of transference interpretations than interpretations outside the transference will be agreeing to by many, but what of the relative roles of interpretation of the transference and interpretation outside the transference?
Freud can be read either as saying that the analysis of the transference is auxiliary to the analysis of the neurosis or that the analysis of the transference is equivalent ti the analysis of the neurosis. The first position is stated in his saying that the disturbance of the transference has to be overcome by the analysis of transference resistance to get on with the work of analysing the neurosis. It is also implied in his restatement that the ultimate task of analysis is to remember the past, to fill the gaps in memory. The second position is stated in his saying that the victory must be won on the field of the transference and that the mastery of the transference neurosis “coincides with getting rid of the illness that was originally brought to the treatment.” In this second view, he says that after the resistance is overcome, memories appear without difficulty.
These two different positions also find expression in the two very different ways in which Freud speaks of the transference. In Dynamics of Transference, he refers to the transference, on the one hand, as “the most powerful resistance to the treatment,” but, as doing us, the inestimable service of making the patient’s, . . . immediate impulses and manifest. For when all is said and done, destroying anyone in an absentia is impossible or in effigies. Freud wrote once, in summary: “This is the possible work of the therapeutic process that falls into two phases. In the first, all in the libido is forced from the symptoms into the transference and concentrated there: In the second, the struggle is waged around this new object and the libido is liberated from it.”
The detailed demonstration that he advocated that the transference should be encouraged to expand as much as possible within the analytic situation lies in clarifying that resistance is primarily expressed by repetition, which repetition takes place both within and outside the analytic situation, but that the analyst seeks to deal with it primarily within the analytic situation, that repetition can be not only in the motor sphere (acting) but also in the physical sphere, and that the physical sphere is not confined to remembering but includes the present, too.
Freud’s emphasis that the purpose of resistance is to prevent remembering can obscure his point that resistance shows itself primarily by repetition, whether inside or outside the analytic situation: “The greater the resistance the more extensively willing acting out ( repetition ) replaces remembering.” Similarly in The Dynamics of Transference Freud said, that the main reason that the transference is so well suited to serve the resistance is that the unconscious impulses “do not want to be remembered . . . but endeavour to reproduce themselves . . .” The transference is a resistance primarily as far as it is a repetition.
The point can be restated as for the relation between transference and resistance. The resistance empresses itself in repetition, that is, in transference both inside and outside the analytic situation. To deal with the transference, therefore, is equivalent to dealing with the resistance. Freud emphasized transference within the analytic situation so strongly that it has come to mean only repetition with the analytic situation. Even though, conceptually speaking, repetition outside the analytic situation is transference too, and Freud once used the term that way: “We soon perceive that the transference is itself only a piece of repetition, and that the repetition is a transference of the forgotten past not only onto the doctor but also onto all the other aspects of the current situation. We . . . find . . . the compulsion to repeat, which now replaces the impulsion to remember, not only in his personal attitude to his doctor but also in every other activity and relationship that may occupy his life at the time. . . .”
Realizing that the expansion of the repetition inside the analytic satiation is important, whether or not in a reciprocal relationship to repetition outside the analytic situation, is the avenue to control the repetition: “The main instrument . . . for curbing the patient’s compulsion to repeat and for turning it into a motive for remembering lies in the handling of the transference. We render the compulsion harmless, and indeed useful, by giving it the right to assert itself in a definite field.”
Kanzer has discussed this issue well in his paper on The Motor Sphere of the Transference (1966). He writes of a “double-pronged stick-and-carrot” technique by which the transference is fostered within the analytic situation and discouraged outside the analytic situation. The “stick,” is the principle of abstinence as exemplified in the admonition against making important decisions during treatment, and the ‘carrot’ is the opportunity afforded the transference to expand within the treatment ‘in almost complete freedom” as in a playground?” Every bit as Freud put it: “Provided only that the patient shows compliance enough to respect the necessary conditions of the analysis, we regularly succeed in giving all the symptoms of the illness a new transference meaning and in replacing his ordinary neurosis by a “transference psychoneuroses” of which he can be cured by the therapeutic work.”
The reason that being expressed within the treatment is desirable for the transference is that there, it “is at every point accessible to our intervention.” In a later statement he made the same point this way: We have followed this new edition [the transference-neurosis] of the old disorder from its start, we have observed its origin and growth, and we are especially well able to find our way about in it since, as its object, we are situated at it's very centre’. It is not that the transference is forced into the treatment, but that it is spontaneously but implicitly present and is encouraged to expand there and become explicit.
Freud emphasized acting in the transference so strongly that one can look out over that which repetition in the transference, which of those, is that does not necessarily mean it an id enacted. Repetition need not go as far as motor behaviour. It can also be expressed in attitudes, feedings, and intentions, and, indeed, the repetition often does take such form than motor action. Such repetition is in the psychical rather than the motor sphere. The importance of masking this clear is that Freud can be mistakenly read to mean that repetition in the psychical sphere can only mean remembering the past, as when he writes that the analyst “is prepared for a perpetual struggle with his patient to keep in the psychical sphere all the impulses that the patient would like to direct inti the motor sphere, and he celebrates it as a triumph for the treatment if he can bring it about that something the patient wishes to discharge in action are disposed of through the work of remembering.”
It is true that the analyst’s efforts are to convert acting in the motor sphere into awareness in the psychical sphere, but transference may be in the psychical sphere to begin with, although disguised. The psychical sphere includes awareness in the transference plus remembering.
An objection one hears, from both analyst and patient, to a heavy emphasis on interpretation of associations about the patient’s real life primarily about the transference is that it means the analyst is disregarding the importance of what goes on in the patient’s real life. The criticism is not justified. To emphasize the transference meaning is not to deny or belittle other meanings, but to focus on the one of several meanings of the content that is the most important for the analytic process, for the reasons that were earliest of commenting.
Another way in which interpretations of resistance to the transference can be, or at least appear to the patient to find faults with so important of the patient’s outside life is to make the interpretation as though the outside behaviour is primarily “an-acting out” of the transference. The patient may undertake some actions in the outside world as an expression of and resistance to the transference, that is, acting out. Still the interpretation of associations about actions in the outside world as having implications for the transference embraces to an awakening spark of meaning that can only be that the choice of an outside action figure in associations with the co-determined need to express the transference indirectly. It is because of the resistance to awareness of the transference that the transference has to be disguised. When the disguise is unmasked by interpretation, despite the inevitable differences between the outside situations and the transference situation, the content is clearly the same for the analytic work. Therefore, the analysis of the transference and the analysis of the neurosis coincide. In particular, the advocacy of its analysis is that of the transference for its own sake rather than to overcome the neurosis, Freud wrote that the mastering of the transference neurosis ‘coincides with getting rid of the illness that was originally brought to the treatment’.
The analytic situation itself fosters the development of attitudes with primary determinants in the past, i.e., transferences. The analyst’s keep backs in providence of whose patients are with few and equivocal cues. The purpose of the analytic situation fosters the development of strong emotional responses, and the very fact that the patient has a neurosis means, as Freud said, that“ . . . it is a perfectly normal and intelligible thing that the libidinal cathexis [we would now add negative feelings] of someone who is partly unsatisfied, a cathexis held readies in anticipation, should be directed as well to the figure of the doctor."
While the analytic setup itself fosters the expansion of the transference within the analytic situation, the interpretation of resistance to the awareness of transference will further this expansion.
There are important resistances of both patient and analyst to awareness of the transference. On the patient’s part, this is because of the difficulty in recognizing erotic and hostile impulses toward the very person to whom they have to be mentioned. On the analyst’s part, this is because the patient is likely to attribute the very attitudes that he is most likely to cause him discomfort. The attitudes the patient believes that the analyst has toward him, are often the ones the patient is least likely to voice, in a general sense because of a feeling that it is impertinent for him to concern himself with the analyst’s feelings, and in a more specific sense because the attitude the patient ascribes to the analyst is often the attitude the patient feels the analyst will not like and be uncomfortable about having ascribed to him? The id, consequently that the analyst must be especially alert to the attitudes the patient believes he has, not only to the attitudes the patient does have toward him. If the analyst can see himself as a participant in an interaction, as he will become much more attuned to this important area of transference, which might otherwise escape him.
The investigation of the attitudinal values ascribed to the analyst, who investigation the intrinsic factors in the patient that played a role in such ascriptions. For example, the exposure of the fact that the patient ascribes sexual interest in him to the analyst, and genetically to the parent, makes undemanding the subsequent exploration of the patient’s sexual wish toward the analyst, and genetically the parent.
The resistances to the awareness of these attitudes are responsible for their appearing in various disguises in the patient’s manifest associations and for the analyst’s reluctance to unmask the disguise. The most commonly recognized disguise is by displacement, but identification is an equally important one. In displacement, the patient’s attitudes are narrated as toward a third party. In identification, the patient attributes to himself attitudes are believed the analyst has toward him.
To encourage the expansion of the transference within the analytic situation, the disguises in which the transference appears have to be interpreted. With displacement the interpretation will be of allusions to the transference in associations not manifestly about the transference. This is a kind of interpretation every analyst makes. For identification, the analyst interprets the attitude the patient ascribes to himself as an identification with an attitude he attributes to the analyst. Lipton has recently described this form of disguised allusion to the transference with illuminating illustrations.
Many analysts believe that transference manifestations are infrequent and sporadic at the beginning of an analysis and the patient’s associations are not dominated by the transference unless a transference neurosis has developed. Other analysts believe that the patient’s associations have transference meanings from the beginning and throughout. That is, that those who believe otherwise are failing to recognize the persuasiveness of direct allusions to the transference-that is, what is called a resistance to the awareness of the transference.
In his autobiography, Freud wrote: “The patient remains under the influence of the analytic situation although he is not directing his mental activities onto a particular subject. We will be justified in assuming that nothing will occur to him that has not some reference to that situation.” Since associations are obviously often not directly about the analytic situation, the interpretation of Freud’s remark rests on what he meant by the “analytic situation.”
Freud’s meaning can be clarified by reference to a statement he made in The Interpretation of Dreams. He said that when the patient is told to say whatever comes into his mind, his associations become directed by the “purposive ideas inherent in the treatment” and that there are two such inherent purposive themes, one relating to the illness and the other-concerning which, Freud said, “The patient has “no suspicion”
- relating to the analyst. If the patient has 'no suspicion' of the theme relating to the analyst, the clear implication is that the theme appears only in disguise in the patient’s associations.” Perhaps, Freud’s remark not only specifies the themes inherent in the patient’s associations, but also means that the associations are simultaneously directed by these two purposive ideas, not sometimes by one and sometimes by the other.
One important reason that the early and continuing presence of the transference is not always recognized is that it is considered absent in the patient who is talking freely and apparently without resistances. As Muslin pointed out in a paper on the early interpretation of transference (Gill and Muslin, 1976), resistance to the transference is probably present from the beginning, even if the patient is talking apparently freely. The patient might be talking mostly of some issues not manifestly about the transference that are nevertheless, also allusions to the transference. Nevertheless, the analyst has to be alert to the persuasiveness of such allusions to discern them.
The analyst should continue the working assumption, then, that the patient’s associations have transference implications pervasively. This assumption is not to be confused with denial or neglect of the current aspects of the analytic situation. Giving precedence to a transference interpretation is theoretically always possible if one can discern it through its disguise by resistance. This is not to dispute the desirability of learning as much as one can about the patient, if only to be able to make correct interpretations of the transference. One therefore does not interfere with an apparently free flow of associations, especially early, unless the transference threatens the analytic situation to the point where its interpretation is mandatory rather than optional.
With the recognitions that even the apparently freely associating patient may also be showing resistance to awareness of the transference, the unformidable formulations that one should not interfere if useful information is being gathered should replace Freud’s dictum that the transference should not be interpreted until it becomes a resistance.
Most certain, all analysts would doubtless agree that there are both current and transferential determinants of the analytic situation, and probably no analyst would argue that a transference idea can be expressed without contamination, as it was without any connection to anything current in the patient-analyst relationship. Nevertheless, it would be to believe the implications of this fact for technique are often neglected in practice? Several authors (e.g., Kohut, 1959, Loewald, 1960) have pointed out that Freud’s early use of the term transference in The Interpretation of Dreams, in a connection not immediately recognizable as related to the present-day use of the term, reveals the fallacy of considering that transference can be expressed free of any connection to the present. The early use was to refer to the fact that an unconscious idea cannot be expressed as such, but only as it becomes connected to a preconscious or conscious content. In the phenomenon with which Freud was concerned, the dream, transference took place from an unconscious wish to a day residue. In the Interpretation of Dreams, Freud used the term transference both for the general rule that an unconscious content is expressible only as it becomes transferred to a preconscious or conscious content and for the specific application of this rule to a transference to the analyst. Just as the day residue is the point of attachment of the dream wish, so must there be an analytic-situation residue, though Freud did not use that term, as the point of attachment of the transference.
Analysts have always limited their behaviour, both in variety and intensity, to increase the extent to which the patient’s behaviours are determined by his idiosyncratic interpretation of the analyst’s behaviour. In fact, analysts unfortunately sometimes limit their behaviour so much, as compared within Freud’s mindful intentions, were those in apprehension that are even to any understanding of the entire relationship with the patient is a matter of technique, with no nontechnical personal relations, as Lipton (1977) has pointed out.
However, no matter how far the analyst attempts to carry this limitation of his behaviour, the very existence of the analytic situation gives the patient innumerable cues that inevitably become his rationale for his transference responses. In other words, the current situation cannot be made to disappear-that is, the analytic situation is real. Forgetting this truism in one’s zeal to diminish the role of the current situation in determining the patient’s responses is easy. One can try to keep past and present determinants of been perceptible from one-another, but one cannot obtain either in 'pure culture'. Just as Freud wrote: “I insist on this procedure [the couch], however, for its purpose and result are to prevent the transference from mingling with the patient’s association imperceptibly, to isolate the transference and to allow it to come forwards indue courses sharply defined as a resistance.” Even 'isolate' is too strong a word in the light of the inevitable intertwining of the transference with the current situation.
If the analyst remains under the illusion that the current cues he provides to the patient can be reduced to the vanishing point, he may be led into a silent withdrawal, which is not too distant from the caricature of an analyst as someone who does indeed refuse to have any personal relationship with the patient. What happens then it is the silence that has become a technique rather than merely an indication that the aneled are listening. The patient’s responses under such conditions can be mistaken for uncontaminated transference when they are in fact transference adaptations to the actuality of the silence.
The recognition that all transference must have some relation to the actual analytic situation, from which it takes its point of departure, as it was within a crucial implication for the technique of interpreting resistance to the awareness of transference.
If the analyst becomes persuaded of the centrality of transference and the importance of encouraging the transference to expand within the analytic situation, he has to find the presenting and plausible interpretations of resistance to the awareness of transference he should make? Here, his most reliable distribution of the cues offered by what is going on in the analytic situation: On the one hand, the events of the situation, such as change in time of session, or an interpretation made by the analyst, and, on the other hand, the patient via experiencing the situation as reflected in explicit remarks about it, however fleeting these may be. This is a primary yield for technique of the recognition that any transference must have a link to the actuality of the analytic situation. The cue points to the nature of the transference, just as the day residue for a dream may be a quick pointer to the latent dream thoughts. Attention to the current stimulus for a transference elaboration will keep the analyst from making mechanical transference interpretations, in which he interprets that there are allusions to the transference in associations not manifestly about the transference, but without offering any plausible basis for the interpretation. Attention to the current stimulus also offers some degree of protection against the analyst’s inevitable tendency to project his own views onto the patient, either because of countertransference or because of a preconceived theoretical bias about the content and hierarchical relationship in psychodynamics.
The analyst may be very surprised at what in his behaviour the patient finds important or unimportant, for the patient’s responses will be idiosyncratically determined by the transference. The patient’s response may be something the patient and the analyst considers trivially, because, as in displacement to a trivial aspect of the day residue of a dream, displacement can better serve resistance when it is to something trivial. Because it is connected to conflict-laden materials, the stimulus to the transference may be difficult to find. It may be quickly disavowed. The patient may also gain insight into how it repeats a disavowal earlier in his life. In his search for the present stimulus that the patient is responding to transferential, the analyst must therefore remain alert to both fleeting and apparently trivial manifest reverences to himself and to the events of the analytic situation.
If the analyst interprets the patient’s attitudes in a spirit of seeing their possible plausibility in the light of what information the patient does have, than in the spirit of either affirming or denying the patient’s view, the way is open for their further expression and elucidation. The analyst will be respecting the patient’s effort to be plausible and realistic, than insuring him as manufacturing his transference attitudes out of whole cloth.
To allow of its belief, making a transference interpretation plausible to the patient as for a current state of affairs that is so important, if the analyst is persuaded that the manifest content has an important implication for the transference but he is unable to see a current stimulus for the attitude, he should explicitly say so if he decides to make the transference interpretation anyway. The patient himself may then be able to say what the current stimulus is.
It is sometimes argued that the analyst’s attention to his own behaviour as a precedent for the transference will increase the patient’s resistance to recognizing the transference. On the contrary, the inevitable interrelationship of the current and transferential determinants, it is only through interpretation that they can be disentangled.
It is also argued that one must wait until the transference has reached optimal intensity before it can be advantageously interpreted. It is true that too hasty and interpretation of the transference can serve a defensive function for the analyst and deny him the information he needs to make a more appropriate transference interpretation. Nevertheless, it is also true that delay in interpreting runs the risk of allowing an unmanageable transference to develop. It is, again, trued that deliberate delay can be a manipulation in the service of the abreaction rather than the analyst and, like silence, can lead to a response to the actual situation mistaken for uncontaminated transference. Obviously important issues of timing are involved. Justly, as an important clue to when a transference interpretation is aptly which one to make lies in whether intolerable and patient virtues can make the interpretation plausibly about the determinants current analytic situations.
A critic of an earlier version of these issues was in saying, that all the analysts need do is to interpret the allusion to the transference. Nevertheless, that, least of mention, leaves one in not because interpretation of why the transference had to be expressed by allusion than directly is also necessary, of course, that is to say, when the analyst approaches the transference in the spirit of seeing how it appears plausibly realistic to the patient, it paves the way toward its furthering elucidation and expression.
Freud’s emphasis on remembering as the goal of the analytic work implies that remembering is the principle avenue to the resolution of the transference. Yet his delineation of the successive steps in the development of analytic technique makes clear that he saw this development as a change from an effort to reach memories directly to the use of the transference as the necessary intermediary to reaching the memories.
In contrast to remembering as the way negativity ad positivity has resolved the transference, Freud also described Resistances as primarily overcome in the transference, with remembering following easily after that: ‘From the repetition reactions exhibited in the transference regainfully to employ of what has led us along the familiar paths to the awakening of the memories, which appear without difficulty, and as it was, after the resistance has been overcome’, and ‘This revision of the process of repression can be accomplished only in part concerning the memory traces of the process that led to repression. The decisive part of the work is achieved by creating in the patient’s relation to the doctor-in the ‘transference’-new editions of the old conflicts . . . Thus the transference becomes the battlefield on which all the mutually struggling forces should meet another. This is primary insight Styrachey (1934) cast off light on out in his seminal paper on the therapeutic action of the psychoanalysis.
There are two main ways in which resolution of the transference can take place through work with the transference before us and now. The first lies in the clarification of what are the cues in the current situation that are the patient’s point of departure for a transference elaboration. The exposure of the current point of departure at once raises the question of whether it is adequate to the conclusion drawn from it. The relating of the transference to a current stimulus is, after all, parts of the patient’s effort to make the transference attitude plausibly determined by the present. The reserve and ambiguity of the analyst’s behaviour are what increases the ranges of apparently plausible conclusions the patient may draw. If an examination of the basis for the conclusion makes clear that the actual situation to which the patient responds is subject to other meanings than the one the patient has reached, he will more readily consider his pre-existing bias, that is, his transference.
Another critic of an earlier version suggestively sights that in speaking of the current relationship and the relation between the patient’s conclusions and the information on which they seem plausibly based is to imply of some absolute conception of what is real in the analytic situation, of which the analyst is the final arbiter. This is not so. In what the patient must come to see is that the information he has is subject to other possible interpretations implies the contrariety to an absolute conception of reality. In fact, analyst and patient engage in a dialogue in the spirit of attempting to arrive at a consensus about reality, not about some fictitious absolute reality.
The second way in which resolution of the transference can take place within the work with the transference in the here-and-now is that in the very interpretation of the transference the patient has a new experience. He is being treated differently from how he expected to be. Analysts seem reluctant to emphasize this new experience, as though it endangers the role of insight and argues for interpersonal influence as the significant factor in change. Strachey’s emphasis on the new experience in the mutative transference interpretation has unfortunately been overshadowed by his views on introjection, which have been mistakes to advocate manipulating the transference, Styrachey meant introjection of the more benign superego of the analyst only as a temporary step on the road toward insight. Not only is the new experience not to be confused with the interpersonal influence of a transference gratification, but the new experience occurs with insight into both the patient’s biassed expectation and the new experience. As Styrachey points out, what is unique about the transference interpretation is that insight and the new experience take place in relation to the very person who was expected to behave differently, and it is this that gives the work in the transference its immediacy and effectiveness. While Freud did stress the affective immediacy of the transference, he did not make the new experience explicit.
Recognizing that transference is not a matter of experience is important, in contrast to insight, but a joining of the two together. Both are needed to cause and maintain the desired changes in the patient. It is also important to recognize that no new techniques of intervention are required to provide the new experience. It is an inevitable accompaniment of interpretation of the transference in the here-and-now. It is often overlooked that, although Styrachey said that only transference interpretation was mutative, he also said with approval, that most of all interpretations are outside the transference.
In a further explication of Strachey’s paper and entirely consistent with his position, Rosenfeld (1972) has pointed out that clarification of material outside the transference is often necessary to know what is the appropriate transference interpretation, and that both genetic transference interpretations and extra-transference interpretations play an important role in working through. Styrachey said little about working through, but surely nothing against the need for it, and him explicitly recognized a role for recovery of the past in the resolution of the transference.
Following, a needed explanation is to emphasis, and the role of the analysis of the transiency in the here-and-now, both in interpreting resistance to the awareness of transference and in working toward its resolution by relating to the actuality of the situation, one must pay heed to that of an extra-transference and genetic transference interpretations and, of course, working through is important too. The matter is one of emphasis in the interpretation of resistance to awareness of the transference and should figure in most of sessions, and that if this is done by relating the transference to the actual analytic situation, the very same interpretation is a beginning of work to the resolution of the transference. To justify this view more persuasively would require detailed case material.
It may be considered that siding with the Kleinians who, many analysts feel, are in error of giving the analysis of the transference too great if not even an exclusive role in the analytic process. It is true that Kleinians emphasize the analysis of the transference more, in his writings at least, than does the general run of analysts. Indeed, Anna Freud’s (1968) complaint that the concept of transference has become overexpanded may be directed against the Kleinians. One of the reasons the Kleinians consider themselves the true followers of Freud in techniques are precisely because of the emphasis they put on the analysis of the transference. Hanna Segal (1967), for example, writes as follows: ‘To say that all communications are seen as communications about the patient’s phantasy and current external life is equivalent to saying that all communications contain something used for the transference situation. In Kleinian technique, the interpretations of the transference are often more central than in the classical technique’.
Despite their disclaimer to the contrary, many Kleinian case materials directively lead one to agree with what is believed is the general view that Kleinian transference interpretations often deal with so-called deep and genetic material without adequate connection to the current features of the present analytic situation and thus differ sharply from the kinds of transference interpretations advocated in present case.
The insistence on exclusive attention to any particular aspect of the analytic process, like the analysis of the transference in the here-and-now, can become a fetish. However, in that other kinds of interpretations should not be made, but in feeling to an emphasis on the transference interpretations within the analytic situation needs to be increased, or at the least reaffirmed, and that we need more clarification and specification on just when other kinds of interpretations are in order.
Of course, making a transference interpretation is sometimes tactless. Surely two reasons that would be included in a specification of the reasons for not making a particular transference interpretation, even if one seems to the analyst, would be preoccupation with an important extra-transference event and an inadequate degree of rapport, to user Freud’s term, to sustain the sense of criticism, humiliation, or other painful feeling the particular interpretation might engender, though the analyst had no intention of evoking such a response. The issue may be, however, not of whether or not an interpretation of resistance to the transference should be made, but whether the therapist can find that transference interpretation that in the light of the total situation, both transferential and current, the patient can hear and benefit from primarily as the analyst intends it.
Transference interpretations, like extra-transference interpretations, are, indeed, like any behaviour on the analyst’s part, can affect the transference, which in turn needs to be examined if the result of an analysis is to depend as little as possible on unanalyzed transference. The result of any analysis depends on the analysis of the transference, persisting effects of unanalysed transference, and the new experience as the unique merit of transference interpretation in the here-and-now. Remembering this is especially important lest one’s zeal to search out the transference itself becomes an unrecognized and objectionable actual behaviour on the analyst’s part, with its own repercussions on the transference.
The emphasis placed on the analysis of resistance to the transference could easily be misunderstood as implying that recognizing the transference is always easy as disguised by resistance or that analysis would go on without a hitch if only such interpretations are made. However, to imply of neither, but rather than the analytic process will have the best chance of success if correct interpretation of resistance to the transference and work with the transference in the here-and-now are the core of the analytic practicality is of less than is a meaningful term as an academic term.
These points mentioned are not new, however, they are present in varying degrees of clarity and emphasis throughout our literature, but like so many other aspects of psychoanalytic theory and practice, they fade in and out of prominence and are rediscovered repeatedly, possibly occasionally in the accompaniment with some modest conceptual advance, but often with a newness attribution only to ignorance of past contributive dynamic functions. Yet, our investigations are to occupy a certain position of continency.
Although, few current problems are concerning the problem of transference that Freud did not recognize either implicitly or explicitly in the development of this theoretical and clinical framework. For all essential purposes, moreover, his formulations, in spite of certain shifts in emphasis, remain integral to contemporary psychoanalysis theory and practice. Recent developments mainly concern the impact of an ego-psychological approach: The significance of object relations, both current and infantile, external and internal, the role of aggression in mental life, and the part played by regression and the repetition compulsion in the transference. Nevertheless, analysis of the infantile Oedipal situation in the setting of a genuine transference neurosis is still considered a primary goal of psychoanalysis procedure.
Originally, transference was ascribed to displacement onto the analyst of repressed wishes and fantasies derived from early childhood. The transference neurosis was viewed as a compromise formation similar to dreams and other neurotic symptoms. Resistance, defined as the clinical manifestation of resistance, could be diminished or abolished by interpretation mainly directed toward the content of the repressed. Transference resistance, both positive and negative, was ascribed to the threatened emergence of repressed unconscious material in the analytic situation. Soon, with the development of a structural approach, the superego-described as the heir to the genital Oedipal situation was also recognized as playing a leading part in the transference situation. The analyst was subsequently viewed not only as the object by displacement of infantile incestuous fantasies, but also as the substitute by projection for the prohibiting parental figures internalized as the definitive superego. The effect of transference interpretation in mitigating undue severity of the superego has, therefore, been emphasized in many discussions of the concept of transference.
Certain expansions in the structural approach directly to increased recognition of the role of early object relations in the development of both ego and superego has affected current concepts of transference. As for this, the significance of the analytic situation as a repetition of the early mother-child relationship has been stressed from different points of view. An equally important development relates to Freud’s revised concept of anxiety which not only led to theoretical developments in the field of ego psychology, but also caused related clinical changes in the work of many analysts. As a result, attention was no longer mainly focussed on the content of the unconscious. In addition, increasing importance was attributed to the defensive processes by means of which the anxiety that would be engendered if repression and other related mechanisms were broken down, was avoided in the analytic situation. Differences in the interpretation of the role of the analyst and the nature of transference developed from emphasis, on the one hand, on the importance of early object relations, and on the other, from primary attention to the role of the ego and its defences. These defences first emerged clearly in discussion of the technique of child analysis, in which Melanie Klein and Anna Freud, the pioneers in this field, played leading roles.
From a theoretical point of view, discussion foreshadowing the problems that faced up today was presented in 1934 in well-known papers by Richard Sterba and James Styrachey, and further elaborated at the Marienbad Symposium at which Edward Bibring made an important contribution. The importance of identification with, or introjection of, the analyst in the transference situation was clearly imitated. Therapeutic results were attributed to the effect of this process in mitigating the need for pathological defences. Styrachey, however, considerably influenced by the work of Melanie Klein, regarded transference as essentially a projection onto the analyst of the patient’s own superego. The therapeutic process was attributed to subsequent introjection of a modified superego because of ‘mutative’ transference interpretation. Sterba and Bibring, on the other hand, intimately involved with development of the ego-psychological approach, emphasized the central role of the ego, postulating a therapeutic split and identification with the analyst as an essential feature of transference. To some extent, this difference of opinion may be regarded as semantic. If the superego is explicitly defined as the heir of the genital Oedipus conflict, then earlier systemic conflicts within the ego, although they may be related retrospectively to the definitive superego, must, nevertheless, is defined as contained within the ego, although they may be related retrospectively to the definitive superego, must, nevertheless, be defined as contained within the ego. Later divisions within the ego of the type suggested by Sterba and very much expanded by Edward Bibring in his concept of therapeutic alliance between the analyst and the healthy part of the patient’s ego, must also be excluded from superego significance. In contrast, those who attribute pregenital intra-system conflicts within the ego primarily to the introjection of objects, consider that the resultant state of internal conflict appears similar in all dynamic respect the situation seen in later conflicts between ego and superego. They, therefore, believe that these structures develop simultaneously and suggest that no sharp distinction should be made between pre-oedipal, oedipal, and a post-oedipal superego.
The differences, however, are not entirely verbal, since those who attribute superego formation to the early months of life tend to attribute some significance too early object relations that differ from the conception of those who stress control and neutralization of instinctual energy as primary functions of the ego. This theoretical difference necessarily implies some disagreement as to the dynamic situation both in childhood and in adult life, inevitably reflected in the concept of transference and in hypotheses as to the nature of the therapeutic process. From one point of view, the role of the ego is central and crucial at every phase of analysis. A differentiation is made between transference as therapeutic alliance and the transference neurosis, which, is considered as the manifestation of resistance. Effective analysis depends on a sound therapeutic alliance, a prerequisite for which is the existence, before analysis, of a degree of mature ego functions, the absence of which in them certain severely disturbed patiently and in young children may preclude traditional psychoanalytic procedure. Whenever indicated, interpretation must deal with transference manifestation, which mans, in effect, that the transference must be analysed. The process of analysis, however, is not exclusively ascribed to transference interpretations. Other interpretations of unconscious material, whether related to defence or too early fantasy, will be equally effective provided they are accurately timed and provided a satisfactory therapeutic alliance has been made. Those, in contrast, who stress the importance of early object relations emphasize the crucial role of transference as an object relationship, distorted though this may be by a variety of defences against primitive unresolved conflicts. The central role of the ego, both in the early stages of development and in the analytic process, are definitely accepted, the nature of the ego is, however, considered determined by its external and internal objects. Therapeutic progress indicated by changes in ego function results, therefore, primarily from a change in object relations through interpretation of the transference situation. Less differentiation is made between transference as therapeutic alliance and the transference neurosis as a manifestation of resistance. Therapeutic progress depends almost exclusively on transference interpretation. Other interpretations, although indicated at times, are not, in general, considered an essential feature of the analytic process. From this point of view, the pre-analytic maturity of the patient’s ego is not stressed as a prerequisite for analysis: Children and relatively disturbed patients are considered potentially suitable for traditional psychoanalytic procedure.
These differences in theoretical orientation are not only reflected in the approach to children and disturbed patients. They may also be recognized in significant variations of technique in respect to all clinical groups, which inevitably affect the opening phases, understanding of the inevitable regressive features of the transference neurosis, and handling of the terminal phases of analysis. The unavoidedly derailed discussions of controversial theory, its natures of early ego development are arbitrary in the differentiations between those who related ego analysis and the analysis of defences and those who stress the primary significance of object relations are referred in the transference, and in the developments inferred as the definitive structure of the ego. Of course, this involves some oversimplifications, least of mention, which will importantly to an analysis of patient suitability toward the classical analytic procedure.
- the transference neurosis. Those who emphasis the role of the ego and the analysis of defence, not only maintain Freud’s conviction that analysis should continue from a surface to depth, but also consider that early materials in the analytic situation drives, usually, from defensive processes than from displacements onto the analyst of early instinctual fantasies. Deep transference interpretation in the early phases of analysis will, therefore, be meaningless to thee patient since its unconscious significance is so inaccessible either, or, if the defence’s ae precarious, will lead to premature and possibly intolerable anxiety. Premature interpretation of the equally unconscious automatic defensive processes by means of which instinctual fantasy has been kept unconsciously is also ineffective and undesirable. There are, however, differences of opinion within this group, about how far analysis of defence can be separated from analysis of contents. Waelder, for example, stresses the impossibility of such separation. Fernichel, however, considered that at least theocratical separation should be made and shown that, as far as possible, analysis of defence should precede analysis of unconscious fantasy. It is, nevertheless, generally agreed that the transference neurosis develops, as a rule, after ego defences have been sufficiently undermined to mobilize previously handled instinctual conflict. During both the early stages, and at frequent points after the development of the transference neurosis, defence against the transference will become a main feature of the analytic situation.
This approach, is based on certain definite premises regarding the nature and dynamic function of the ego in respect to the control and neutralization of instinctual energy and unconscious fantasy. While the importance of early object relations is not neglected, the conviction that early transference interpretation is ineffective and potentially dangerous is related to the hypothesis that the instinctual energy available to the mature ego has been neutralized and is, for all effective purposes, relatively or absolutely divorced from its unconscious fantasy meaning at the beginning of analysis. In contrast, there are many analysts of differing theoretical orientation who do not view the development of the mature ego as a relative separation of ego functions from unconscious sources, but consider that unconscious fantasy continues to operate in all conscious mental activity. This analyst also tends to emphasize the crucial significance of primitive fantasy in respect to the development of the transference situation. The individual entering analysis will inevitably have unconscious fantasies concerning the analyst derived from primitive sources. This material, although deep in one sense, is, nonetheless, strongly current and accessible to interpretation. Mrs. Klein, in addition, relates the development and definitive structure of both ego and superego to unconscious fantasy determined by the easiest phases of object relationships. She emphasis the role of early introjective and projective processes in relation to primitive anxiety ascribed to the death instinct and related aggressive fantasies. The unresolved difficulties and conflict of the earliest period continue to colour object relations throughout life. Failure to achieve an essentially satisfactory object relationship in this early period, and failure to master relative loss of that object without retaining its good internal representative, will not only affect all object relations and definitive ego function, but more specifically determine the nature of anxiety-provoking fantasies on entering the analytic situation. According to this point of view, therefore, early transference interpretation, though it may relate to fantasies derived from an early period of life, should result not in an increased, but a decrease of anxiety.
In considering next problems of transference in relation to analysis of the transference neurosis, two main points must be kept in mind. First: Those who emphasize the analysis of defence tend to make a definite differentiation between transference as therapeutic alliance and the transference neurosis as a compromise formation that serves the purposes of resistance. In contrast, those who emphasize the importance of early object relations view the transference primarily as a revival or repetition, sometimes attributed to symbolic processes of early struggles in respect to objects. Yet, no sharp differentiations are made between the early manifestations of transference and the transference neurosis. In view, moreover, of the weight given to the role of unconscious fantasy and internal objects in every phase of mental life, healthy and pathological functions, though differing in essential respects, do not differ as for their direct dependence on unconscious sources.
In the second place, the role of regression in the transference situation is subject to wide differences of opinion. It was, of course, one of Freud’s earliest discoveries that regression to earlier points of fixation is a cardinal feature, not only in the development of neurosis and psychosis, but also in the revival of earlier conflicts in the transference situation. With the development of the psychoanalysis and its application of experience, an ever increasing range of disturbed personalities, the role of regression in the analytic situation had received increased attention. The significance of the analytic situation for fostering regression as a prerequisite for the therapeutic work has been emphasized by Ida Macalpine in a recent paper of differing opinions as to the significance, value, and technical handling of regressive manifestations from the basis of important modifications of analytic technique, in respect, however, to the transference neurosis, the view recently expressed by Phyllis Greenacre, in that regression, an indispensable feature of the transference situation, is to be resolved by traditional technique would be generally accepted. It is also a matter of general agreement that a prerequisite for successful analysis is revival and repetition in the analytic situation of the struggles of primitive stages in the developmental distributives of contributory dynamic functionalities. Those who bring out defence analysis, however, tend to view regression as a manifestation of resistance: As a primitive mechanism of defence employed by the ego in the setting of the transference neurosis. Analysis of these regressive manifestations with their dangers depends on the existing and continued functioning of adequate ego strength to maintain therapeutic alliance at an adult level, those, by contrast, who stress the significance of transference as a revival of the early mother-child relationship does not place emphasis on regression as an indication of resistance or defence. The revival of these primitive experiences in the transference situation is, in fact, regarded as an essential prerequisite for satisfactory psychological maturation and true genitality. The Kleinian schools, as already showed, stress the continued activity of primitive conflicts in determining essential features of the transference at every stage of analysis. Their increasingly overt revival in the analytic situation, therefore, signifies a deepening of the analysis, and in general, is regarded as an indication of diminution than an increase of resistance. The dangers involved according to this point of view are determined more by failure to mitigate primitive anxiety by suitable transference interpretation, than by failure to achieve, in the early phases of analysis, a sound therapeutic alliance based on the maturity of the patient’s essential ego characteristics.
Briefly considering the terminal phases of analysis. Many unresolved problems concerning the goal of therapy and definition of a completed psychoanalysis must be kept in mind. Distinction must also be made between the technical problems of the terminal phase and evaluation of transference resolution after the analysis has been ended. There is widespread agreement as to the frequent revival in the terminal phases of primitive transference manifestations apparently resolved during the earthly phase of analysis? Balint, and those accept Ferenczi’s concept of primary passive love, suggest that some gratifications of primitive passivity need be the essentially successive in succeeding by its end. To Mrs. Klein the terminal phases of analysis also represent a repetition of important features of the early mother-child relationship. According to her point of view, this point represents, in essence, a revival of the early weaning situation. Completion depends on a mastery of early depressive struggles culminating in successful introjection of the analyst as a good object. Although, as for this, emphasis differs considerably, it should be noted that those in whom stress the importance of identification with the analyst as a basis for therapeutic alliance, also accept the inevitability of some permanent modifications of a similar nature. Those, however, who make a definite differentiation between transference and the transference neurosis stress the importance of analysis and resolution of the transference neurosis as a main prerequisite for a successful end. The identification based on therapeutic alliance must be interpreted and understood, particularly about the reality aspects of the analyst’s personality. In spite, therefore, of significant important differences, there are, as already showed about the earlier papers of Sterba and Styrachey, important points of agreement in respect to the goal of the psychoanalysis.
Differences already considered, as far as discussions have permitted of a limited variation within the framework of a traditional technique, nonetheless, we are drawn to consider problems related to overt modifications in due consideration as a preliminary to classical psychoanalyses, and modification based on changes in basic approach, lead to significant alterations regarding both the method and to the aim of therapy.
It is generally agreed, that some variations of technique are shown in the treatment of certain character neurosis, borderline patients, and the psychoses. The nature and meaning of such changes are, however, viewed differently according to the relative emphasis placed on the ego and its defences, on underling unconscious conflicts, and on the significance and handling of regression in the therapeutic situation. In Analysis Terminable and Interminable, Freud suggested, that certain ego attributes may be inborn or constitutional and, therefore, probably inaccessible to psychoanalytic procedure. Hartmann has suggested that beyond these primary attributes, other ego characteristics, originally developed for defensive purposes, and the related neutralized instinctual energy at the disposal of the ego, may be relatively or absolutely divorced from unconscious fantasy. This not only explains the relative inefficacy of early transference interpretation, but also hints on the possible limitations in the potentialities of analysis attributable to secondary autonomy of the ego considered being irreversible. In certain cases, moreover, it is suggested that analysis of precarious or seriously pathological defences-particularly those concerned with the control of aggressive impulses-may not only be ineffective, but dangerous. The relative failures of ego development in such cases not only preclude the serious regressive, often predominantly hostile transference situations. In certain cases, therefore, a preliminary period of psychotherapy is recommended to explore the capacities of the patient to tolerate a traditional psychoanalysis. In others, as Robert Knight, in his paper on borderline states, and as many analysts working with psychotic patient has suggested. Psychoanalytic procedure is not considered applicable. Instead, a therapeutic approach based on analytic understanding that, in essence, uses an essentially implicit positive transference for reinforcing, than analysing the precarious defences of the individual, is advocated.
In contrast, Herbert Rosenfeld has approached even severely disturbed psychotic patients with small modifications of psychoanalytic technique. Only changes that the severity in therapy is not emphasized since primitive fantasy is considered active under all circumstances. The most primitive period is viewed as early object relations with special stress on prosecutory anxiety related to the death instinct. Interpretations of this primitive fantasy in the transference situation, is considered to diminish rather than to increase psychotic anxiety and offer the best opportunity of strengthening the severely threatened psychotic ego. Other analysts, Dr. Winnicott, for example, an attribute psychosis mainly to severe traumatic experiences, particularly of deprivation in early infancy. According to this view, profound regression offers an opportunity to fulfil, in the transference situation, primitive needs that had not been met at the appropriate level of development. Similar suggestions have been proposed by Margolin and others, in the concept of anaclitic treatment of serious psychosomatic disease. This approach is also based on the premise that the inevitable regression shown by certain patients should be used in therapy, for gratifying, in an extremely permissive transference situation, demands that had not been met in infancy. It must, for this, be of note, that the gratifications recommended in the treatment of severely disturbed patients are determined by the conviction that these patients are incapable of developing transference as we understand it in connection with neurosis and must therefore be handled by a modified technique?
The opinions so far considered, is, nonetheless a great deal more than they may differ in certain respects, are nonetheless all based on the fundamental premise that an essential difference between analysis and other methods of therapy depends on whether interpretation of transference is an integral feature of technical procedure. Results based on the effects of suggestion are to be avoided, as far as possible, whenever traditional technique is employed. This goal has, nonetheless, proved more difficult to achieve. Freud expected when he first discerned the significance of symptomatic recovery based on positive transference. The importance of suggestion, even in the most strict analytic methods, has been repeatedly stressed by Edward Glover and others. Widespread and increasing emphasis as to the part played by the analyst’s personality in determining the nature of the individual transference also implies recognition of unavoidable suggestive tendencies in the therapeutic process. Many analysts today believe that the classical conception of analytic objectivity and anonymity cannot be maintained. Instead, thorough analysis of reality aspects of the therapists personality and point of view are able prerequisite for the dynamic changes already discussed in relation to the end of analysis. It thus remains the ultimate of the psychoanalysis, whatever their theoretical orientation, to avoid, as far as is humanly possible, results based on the unrecognized or unanalysed action of suggestion, and to maintain, as a primary goal, the resolution of such results through consistent and careful interpretation.
There are, however, many therapists, both within and outside the field of the psychoanalysis, who consider that the transference situation should not be handled only or mainly as a setting for interpretation even in the treatment or analysis of neurotic patients. Instead, they advocate use of the transference relationship for the manipulation of corrective emotional experience. The theoretical orientation of those using this concept of transference may be closer to, or more distant form, a Freudian point of view according to the degree to which current relationships are seen as determined by past events. At one extreme, current aspects and cultural factors are considered very important: At the other, mental development is viewed to inherent limitations of the analytic method rather than to essentially changed conceptions of the early phases of mental development. Of this group, Alexander is perhaps the best example. It is thirty years since, in his Salzburg paper, he suggested the tendency for patients to regress, even after apparently successful transference analysis of the oedipal situation to narcissistic dependent pregenital levels that prove stubborn nd refractory to transference interpretation, in his more recent work, the role of regression in the transference situation has been increasingly stressed. The emergence and persistence of dependent, pregenital demands’ in a very wide range of clinical conditions, it is arguably suggested that the encouragement of a regressive transference situation is undesirable and therapeutically ineffective. The analyst, therefore, should when threatens adopt a definite role explicitly differing from the behaviour of the parents in early childhood on order to cause therapeutic results through a corrective emotional experience in the transference situation. This, it is suggested, will prevent the tendency to regression, thus curtailing the length of treatment and improving therapeutic results. Limitation of regressive manifestations by active steps modifying traditional analytic procedure in a variety of ways is also frequently suggested, according to this point of view.
To those who clearly maintain the conviction that interpretation of all transference manifestation remain an essential feature of the psychoanalysis, the type of modification presently described, though based on a Freudian reconstruction of the early phases of mental development, represents as major modification. It is determined by a conviction that psychoanalysis, as a therapeutic method, has limitations related to the tendency to regression, which cannot be resolved by traditional technique. Moreover, the fundamental premise on which the conception of corrective emotional experience is based minimizes the significance of insight and recall. It is, essentially, suggested that corrective emotional experience alone may cause qualitative dynamic alternations in mental structure, which can lead to a satisfactory therapeutic goal. This implies a definite modification of the analytic hypothesis those current problems are determined by the defences against instinctual impulses and internalized objects that had been set up during the decisive periods of early development. An analytic result therefore is depending on the revival, repetition and mastery of early conflicts if the current experience on the transference situation with insight an indispensable feature of an analytic goal.
Since certain important modifications are applicable concepts latent upon the regression of the transference situation, it should be to believe that to consider this concept in relation to the repetition compulsion, that transference is essentially a revival of earlier emotional experiences, much of which can be related as a manifestation of the repetition compulsion that is generally accepted. Distinguishing it between repetition on compulsion as an attempt to master traumatic experience and repetition compulsion as an attempt to return to a real or fantasied earlier state of rest or gratification is, however, necessary. Lagache, in a recent paper, announced that the repetition compulsions to an inherent need to regress back to any problem that had previously been left unsolved, in that, from this point of view, the regressive aspects of the transference situation are to be regarded as a necessary preliminary to the mastery of unresolved conflict. From the second point of view, however, the regressive aspects of transference are mainly attributed to a wish to return to an earlier state of rest or narcissistic gratification, to the maintenance of the status quo instead of any progressive action, and finally, to Freud’s original conception of the death instinct. There is a good deal to suggest that both aspects of the repetition compulsion may be seen in the regressive aspects of every analysis. To those who feel that regressive self-destructive forces tend to be stronger than progressive libidinal impulses, the potentialities of the analytic approach will be limited. Those, by contrast, who regard the reappearance in the transference situation of earlier conflicts as an indication of tendencies to master and progress will continue to feel that the classical analytic method remains the optimal approach to psychological illness wherever it is applicable.
In the attemptive efforts in trying to show an outline in some current problems of transference both in relation to the history of psychoanalytic thought and in relation to the theoretical premises on which they are based. In that, regarding contemporary views that advocate serious modifications of analytic technique, it cannot be to improve in the remarks made by Ernest Jones, in his Introduction to the Salzburg Symposium thirty years ago. Depreciation of the Freudian (infantile) factors at the expense of the pre-Freudian, 'pre-infantile' and 'post-infantile', is a highly characteristic manifestation of the general human resistance against the former, being usually a flight from the Oedipus conflict that is the centre of infantile factors. We also can note that in the practice to showing a psychoanalysis it really does not always insure immunity from this reaction. With regard, to the important problems that arise from genuine scientific differences within the framework of traditional technique, the focussing of issues for discussion by emphasizing as objectively as possible divergence rather than agreement. All of which, by which the primary importance of transference analysis may have accepted as significant modifications of traditional technique as either shortening analysis or accepting a modified analytic goal, as to the basic importance of understanding the significance and dangers of countertransference manifestations. Unfortunately, however, this vitally important unconscious reaction is not limited to the individual analytic situation. It may also be aroused in respect to scientific theories both within and outside our special fields of knowledge. Therefore, resolutions of the individual transference situation depend on the analyst’s understanding of his own countertransference, so too, similar insight and objectivity on a wider scale may determine of the problems outlined above.
In a balanced way, we, once, again, point out Freud’s statement, as he writes regarding transference resistance: Thus, the solution of the puzzle is that transference to the doctor is suitable for resistance to the treatment only in as far as it is a negative transference or a positive transference of repressed erotic impulses. If we ‘remove’ the transference by making it conscious, we are detaching only those two components of the emotional set from the person of the doctor, the other component, which is admissible consciousness and unobjectionably, persists and is the vehicle of success in the psychoanalysis exactly as it is in other methods of Treatment (1912).
The “negative transference” and “positive transference of repressed impulses” have generally been accepted as sources of resistance, although we have come to recognize that “removing” they by making them conscious are much more difficult than it sounds. However, most of us have no doubts about the necessity of resolving them to a considerable extent, even if we are not so optimistic about being able to ‘remove’ them. How often we do all we can in this respect is open to question.
Strictly speaking, our attentions will personify to what Freud called ‘the other component', which is admissible to consciousness and unobjectionable, persists and is the vehicle of success in analysis. . . . “On the face of it, assuming that there is some is reasonable enough factors that allow the patient to begin work and to continue to cooperate during analysis, and that this factor bears some relation to the positive transference, without, however, being clearly based on ‘repressed erotic impulses.”
Inevitably, this brings us to question how we are first to cultivate this component, which is essential for the success of the analysis, what is to be done with it as the analysis ends, and how we may recognize and understand the origins, development, and meaning of this useful, even essential component. The answer to the latter question, is basically by no clear means. This positive component has hardly been neglected in the literature and in clinical work, but we may question whether it has been subjected to the same degree of analytic scrutinies as have other elements of the transference. It has been exploited most obviously by those who developed the concept of the 'alliance' between patient and analyst, for example, Greenson (1967) and Zetzel (1970). Greenson emphasized that the working alliance is indeed part of the transference, just when contrasting it with the full-blown transference neurosis, also he sees them as parallel antithetical forces in the analysis. Elsewhere, he refers to ‘transference reactions, a working alliance and [the] real relationship’.
Greenson and Zetzel are not alone or even in a minority in considering some concept such as the working alliance integral to our understanding of the therapeutic process in analysis. There are many variants: Erikson’s (1959) ‘basic trust’, many references to ‘rapport’, and the like. One way or another they all are related to Freud’s “unobjectionable” component, although we may conclude that their true sources are far more ancient.
For appropriate reasons, the terms working alliance and therapeutic alliance have entered the common idiomatic expression of analysis and perhaps make more even the variants of analysis classed as psychotherapy. A positional claim to which it can seem as generally stated that an adequate alliance is a prerequisite for successful therapy, which on them face of it might seem unquestionable. Of course, the patient must be willing to manage to do his best to conform to the behavioural demands of the treatment, to come to the analyst’s office with some regularity, to talk as transparently honest as he can, to make a payment of his bills and generally to show that he and the analyst have some goals in common. If, on the other hand, he behaves in a way that made the analysis impossible, we could lay claim to an adequate alliance that was never established or, if it were, not maintained. Nevertheless, if all goes smoothly, we might congratulate ourselves onto the support of a good working alliance.
A finer calibrated accompaniment with Brenner (1979) and Curtis (1979), and others a serious concern about the usefulness of the concept and the adherent direction and, even more, about its capacity to be misleading by encouraging the blurring of important transference elements and impeding our search for the nature of the ‘unobjectionable’ component, to which, Freud referred.
In particular, when patients express, as they go on expressing their transference to feelings, predominantly positive, respectful, and sometimes affectionate, employ the very effective devices of selfly limited and only rarely deeply disturbing episodic events to experiences, often dispose of their necrotic symptoms within a few months of beginning analysis, and they go on annualizing just as eagerly as before. Resistance is expressed with silences, usually not at all, to a very prolonged, on one side of a complaint, not factually insufferable, or by acting out, not particularly disruptive. One condition, however, does not change. These attractive people may be married or single, living with a lover or alone. Nevertheless, they are not in love and doubt the capacity for passionate sexuality. There may be affectionate, but sexual intensities seem strangely distant and lacking in these otherwise sensitive and often loving individuals.
In them, at any rate, the transference neurosis is very highly developed, taking on distinctly oedipal forms: It is powerfully defended by these patients, who show in their characteristics of brilliant, charming, and precocious children, who of a superficial level appear very mature. The main current of their sexuality becomes directed into the analysis, turning the process into a kind of exciting, yet innocent, liaison. When this transference neurosis is brought to these patients’ attention, that is, interpreted for what it is, the reaction is likely to be dramatic: Most often they become anxious and depressed, experience great difficulty in associating, stop remembering dreams, and may be inclined to engage in acting out. This may be the one area of interpretation that produces a distinct reaction of anger and some distress. The analysis is no longer such an unalloyed pleasure, and one almost regrets having introduced the subject. After all, the machine had been running so smoothly.
The commonality is that of a highly intelligible combination of developed ego and super-ego organization, the use of sophisticated and effective defences and a history of having established a well-developed oedipal organization, and difficulty in achieving resolution of the conflicts arising out of the phase type of transference neurosis. Assiduously, to evoke complications and complexities in the reactions in the analyst, stimulating his own transference neurosis or, as it is more a comfortable situation dominated by mutual reciprocity, appreciative and intellectual competition. It is likely, therefore, that such patients will evoke of the analyst what corresponds to the “unobjectionable” component of the transference. He finds himself regarding the patient as if he or she were a favourite child, going out of his way to be kindly and protectively considerate, in that of the appreciating patient’s accomplishments, and so on.
Although such attitudes are kept strictly within the bounds of analytic propriety, these patient types are too sensitive to allow otherwise, their subtle effects may, nonetheless, be hostile to the analytic process, perpetuating infantile patterns by the analysand, and making it very difficult for both parties to cause a proper cancellation. In this respect the analysis of the ‘good’ patient offers difficulties that, while they are less upsetting than determinants responsible laded upon the status quo and it's fractional determinates. As, presented by others, more challenging as, if, by conquest, are the patients who are justly as important to a resolution by which any inexhaustible force of attentions weave themselves into the transference resistance concealed by the overpowering attributions by making some presents on one side.
The emphasis placed upon the role in the resistance of such as rationality, intelligence, and the capacity for cooperative efforts should not be construed as a denigration of their vital part in making analysis at all possible, components of any mature, not to say civilized, behaviour. All the same, however, reminding ourselves from time to time that even the essential may be necessary and finely construct instruments are double-edged, and these aspects of character are no exception. We are simply less likely to perceive the same as their function and not only in resolving, but in maintaining neurosis, and they may operate by seducing the analyst into the self-satisfying belief that he has accomplished far more than is in fact the case. Sadly, therefore, we must confront and analyse unsparingly those traits we are most likely to admire, least of mention, that the same principles and problems would apply if the structure of the neurosis had been more firmly rooted in pre-oedipal than in oedipal conflict. The difficulties would simply have been more severe for both analyst and patient.
During the intervening time, as to solving the problem of analysing the transference neurosis, necessary for more than purely abstract reasons, would have a justifiable impossible. Following Freud’s (1913) principle, which of his earlier statement he had not only described this unobjectionable part of the transference, but went further: ‘while the patient’s communications and ideas run in without any obstruction, the theme of transference should be left untouched’ working alliance and, while not quoted by Kohut (1971), may have contributed to his specific advice to delay interpreting positively, idealizing statements made by the narcissistic analysand.
If we examine Freud’s statement more closely, we are struck by many difficulties. First, what is meant by ‘admissible to consciousness’? In 1912, it implied that this transference component was part of the system PcsCs. Since during this period interpretation consisted in essence of making conscious that which had been unconscious, it would in any case have been irrelevant, if not conceptually impossible, to do more than is depicted by the patient’s attention (hyper-cathexis) to it, but there could be no question of unconscious elements playing an important role.
With patients to whom of many derivatives of oedipal fantasies, may be largely within awareness. Nonerotic or de-erotised admiration and affection may be conscious from the first, and their role in the analytic process may be quite clear. What is generally obscure is the role of this positive, overtly Nonerotic transference in maintaining a powerful resistance, not only to the resolution of inhibitions, but also to the analytic exploration of hidden springs of defiance and revenge. What looks accessible to consciousness may be so only in part: What seems free of suppressed erotic impulses may be not so in fact, and what seemed altogether unobjectionable may after a time constitutes the most difficult aspect of the transference neurosis. What appears on the surface to be so very positive may also be the screen for stubborn aggressive elements, in that respect a persistent obstacle to analytic resolution.
To return to Freud’s 1912 formulation, we need to be reminded that he never regarded consciousness as a simple matter, but always conceived of it as fluid and uncertain of definition. This is evident in The Interpretation of Dreams and is elaborated in his brilliant little paper, A Note upon the Mystic Writing-Pad (1925) in which he presents a view of consciousness as not simply a passive receptor, but bring dependent on an active function: This agrees with a notion that has long since been at work the method by which the perceptual apparatus of our mind functions, which I have as yet kept to myself.
Its theory is that cathectic innervations are sent out, withdrawn in rapid peridotic impulses from within into the completely pervious system Pcpty.-Cs. If that system is cathected in this manner, it receives perceptions (which are accompanied by consciousness) and passes the excitation onto the unconscious anemic system, but as soon. As the cathexis is withdrawn, consciousness is extinguished. The functioning. Of the system comes to a standstill. It is as though the unconscious stretches. Out feelers, through the medium of the system Pcpty.-Cs. Toward the external world and hastily withdraws them when they have sampled the excitations coming from it.
Freud might have been describing a kind of psychic radar, an ingenious device by which the mind tests external reality. In any casse, a careful reading of his work from the Project (1895) to the New Introductory Lectures (1933) gives no comfort to those who would see a simple definition of what was meant by ‘admissible to consciousness’. How accessible, how fleeting, under what conditions, are all open questions, the answer to which are not determined in any simple way.
By 1937, when Freud published, Analysis Terminable and Interminable, it was evident of how much of his views had developed. He no longer insisted on the existence of a relatively simple Nonerotic or de-erotised conscious positive transference that required no analysis. Now, with some regret, he emphasized the presence of conflictual elements that were inaccessible to analysis not because they were conscious and ‘unobjectionable’, but because they were latent or inactive during the treatment. They could, in fact, be very objectionable indeed. Not the least of these conflicts were those centred on the transference that, unanalyzed, could so often predispose to future difficulties.
These latent conflicts, he decided, could not be brought into the analysis by the analyst, either by verbal intrusions or by active manipulation, manoeuvres he regarded as both ineffective and potentially damaging. Yet in the same paper he stated what is a contradiction, in his disavowal of the principle of ‘letting sleeping dogs lie’. He went further: ‘Analytic experience has taught us that the better is always the enemy of good and that in every phase of the patient’s recovery we fight against his inertia, which is ready to be content with an incomplete solution’ (Freud, 1937).
Defining it precisely what would justify that we are to regarding a conflict as an inactive or latent and therefore inaccessible to analysis is difficult. Undoubtedly, some conflicts are so heavily defended from analysis that as good as we suspect their presence, but we are baffled to uncover them, much less to analyse them. We may become aware of them only when the patient returns to us for further help or when he enters analysis with a colleague and lets us know of his decision. Achieving some comfort by convincing ourselves that condition had not been propitious is possible, for example, that the patient was a candidate in training, was caught in a difficult marriage or in another situation that favoured stubborn resistances. No doubt this is often the case-still, was that the only reason? Could we and should we have done more?
The analyst, by his very presence and his willingness to listen, sets up a relationship described by Bird (1972) as ‘false’ transference', to become in effect ‘the worst enemy of the transference’. To some analysts are agreeable with this assessment of the complications inherent in this necessary, early development of the analytic situation, however, the inclining inclination of being ‘false’ is regarded as controversial, it is often manifested before the first visit, sometimes even in transparent dreams, and as such it reflects the wishes and fantasies of the patient rather than that his recognition of the reality of the situation.
Questioning ourselves would be wise, therefore, as to the nature of this response, to ask which conflicts are being expressed and concealed by it, and to what extent it is dependent on the reality of the analytic situation, the patient’s conviction that the person he consults is benign, wise, and helpful is, we hope, justified by the reality. Yet we know well enough that a patient may experience extreme distrust of an analyst who is in fact perfectly trustworthy, and conversely he may place his implicit confidence in one who deserves it not at all. The personal success of so many charlatans in the mental health field is evidence enough.
This positive response to the analyst corresponds in part at least to Freud’s unobjectionable component, and in its more developed phases it may be called the working alliance. Yet though it is necessary and useful for initiating and maintaining the analysis, we are hardly justified in concluding that it is altogether accessible to consciousness, nor that it is by its unobjectable nature. In fact, it carried a particular heavy load of unconscious conflict, much of which has to be repressed in order for the treatment to begin, and its long-term effects often highly objectionable. Eventually, therefore, we need to understand this phenomenon as thoroughly as any other we encounter in analysis. If we accept that eventually it must be interpreted, we accept also that we must study it in detail. But, nonetheless how?
Listening carefully to a patient’s first impressions of us is instructive. They may consist of apparently diverse observations about the furniture of the office, of personal idiosyncrasies, and the like. Just when there is a neglect of such matters as whether or not we are relaxed and confident, youthful or aged in appearance and manner, and other factors we regard as far more significant.
This is not to say that these latter details are not perceived and stored in memory, quite the contrary. However, they are often repressed and subject to distortion, to appear later in the analysis in various forms. Often the patient will question, for example, whether I wear glasses, although he has seen me a hundred times or more, never without them, or he will be wildly wrong in estimating my age, or astonishing becoming aware of a picture that has been facing the couch for years. Such familiar phenomena may, with some effort, be understood and analysed: It is to be believed that they contain the clues that can help us solve the mystery of the unobjectionable element.
The patient’s reaction to and impressions of the analyst are built up of many determinants. They are first and most profoundly the needs and desires he brings to the analysis, the unconscious wishes that seek to be gratified. Superimpose on these are his early impressions of the analyst, derived from a host of perceptions, for example, the mode of referral, the initial telephone call, early impressions of appearance and manner, discussions of indications and conditions for the analysis, including hours and fees. An entry in a new world, it often takes on aan overwhelming quality-far too much to be dealt within a few sessions. Inevitably its effects are manifested throughout even a very long analysis, often in forms that make their sources difficult to detect. Yet before us, is the material of much of the transference, especially of the unobjectionable component.
This aspect is not so willingly scrutinized with the same intensity with which we approach other phenomena. The reasons are, upon examination, not so obscure. For one thing, the trusting, positive attitude of the analysand does allow the analysis to continue, and it is comfortable for the two parties-unless the analyst forces himself to put aside that comfort. Secondly, it seems free of conflict. Third, it seems to make sense, to be entirely rational, that one person should admire and trust another who is so worthy of it. Finally, we are influenced by the dictum that we analyse the transference only when it serves the resistance, advice that would be easy to follow if we could always be sure when that took place. Suspicions are that without much difficulty prescience is a very rare gift. If we resist the temptation to take the positive transference for granted, therefore, we must find some way of analysing a component that on the surface looks unanalyzable.
In 1955 Lewin wrote Dream Psychology and the Analytic Situation, a work that has been insufficiently recognized for its theoretical and technical importance. It described the analyst as fulfilling a double role, first as one who encourages the patient to allow himself to regress, to suspend criticism, to associate freely, to put himself into his past, to allow himself to feel helpless and to restrain his impulses toward physical change of position, although not to oral communication. Lewis pointed out the analogy with hypnosis, with the analyst as inducer of quasi-sleep and dreaming states, in which the wish to analyse is substituted for the wish to sleep.
The encouragement of regression is fundamental to the analytic process, but it is hardly the analyst only function, a fact that may be ignored in many therapeutic innovations. The analyst must also become the one who rouses the ‘dreaming patient’, who interprets, who encourages and guides the process of self-observation. By this token, he is the one who awakens, who insists on the substitution of secondary for primary process. Of higher ego functions for more archaic ones. Inevitably he becomes the transference representative of that agency most often responsibly for insomnia, the conscience.
Perhaps, its venture that the loving, conscious, unobjectionable part of the transference is directed toward the analyst as the one who soothes, who induces sleep and allows the patient to feel less frightened, for he is ‘safe’, but not for a long time can this love be directed toward the one who accomplishers the awakening. Conducting a long treatment is possible, of course, while maintaining one’s role as the inducer of sleep and dreams, to accomplish a good deal in the way of symptom relief, and thus be rewarded by expressions of gratitude. Whether, without fulfilling one’s role as awakener, one may be rewarded by having accomplished effective analysis is another matter.
To employ Lewin’s striking metaphor, it might be taken care of, in that we mindfully experiment in treating the patient’s demands on the analyst as if these were derivative of unconscious wishes expressed in a dream, and that we consider the various perceptions stored and used from time to time as if they were the memories and day residues employed by the dream work. By this device we may treat the patient’s overtly expressed altitudes as if they corresponded to a manifest dream. We make the assumptions that there are unconscious wishes that seek gratification, that such wishes are subject to conflict and must attain expression in disguised forms. To achieve expression, memory traces of percept, including a day residue, are used both to afford a vehicle for the wish fulfilment and to disguise, as far as necessary, their true purpose. Thus, these wishes are allowed to reach consciousness in some form in spite of disapproval by other agencies, e.g., by evading the (preconscious) censorship according to the model described in The Interpretation of Dreams (Freud, 1900), or the (larger unconscious) repressive functions of the ego and superego according to the later structure model.
The patient’s wishes and fantasies may be worked over further, brought into more rational, logical, organized form by a process analogous to secondary revisions: In the topographic model this depends on the preconscious system, in the structural model it would be considered a manifestation of the synthetic function of the ego. The description of secondary revision, described by Freud in 1900, may be regarded as one of the earliest precursors of the structural model of the ego.
To pursue further the analogies between this aspect of transference and secondary revision of dreams let us look upon the Freudian say-so, atop which Freud wrote, ‘because of its efforts, the dream loses its appearance of absurdity and disconnectedness and approximates to the model of an intelligible experience. The connection of secondary revision with daydreams may also be extended to transferences, how much of the patient’s attitudes is based on fantasies of what the ideal patient-analyst relationship should be? A respectful, finial attitude, an eager pupil-teacher re-enactment, an innocent liaison with no threat os consummation? These are so appropriate, so sensible, so truly helpful to the analysis that we tend to forget how much of the wild aspects of this analysis are thus ‘moulded’ into a kind of daydream.
In what is admittedly a highly simplified fashion, we might consider the case of these patients who treat their analysts as if they were kindly, intelligent, benign, and in a good manner, trained and disciplined, rightly interested and even fond of them, but not a danger in any erotic sense. It seems of reasonable enough description of the actual situation if one does not examine its unconscious components.
Rather than taking this at face value as an intelligent patient’s evaluation of the reality of the analytic situation, accepting gratefully a fine working alliance or an unobjectionable component, if instead we insist upon the arduous and possibly disagreeable task of analysing beliefs and attitudes, we find something very different, far more conflicted, complex, and not altogether benign. The patient has been a model analysand, working hard, associating well, bringing gifts of associations and dreams. For example, she may be charming without being erotically seductive, and faithful to the point of causing concern for both of us. It may be entirely rational, justified by the reality of the situation. It is, of course, much too good to be true, for it is not accompanied by progress in the most urgent therapeutic goals, for example, that of achieving a gratifying sexual life and an ultimately satisfying career. There are also likely to be curious distortions and self-deceptions displayed, for example, when a patient talks of herself as obnoxious and without friends, statements that are manifestly false whatever their unconscious truth. Young women’s patients particularly complain of the usual distortions of a body image so common in them, to being fat and ugly, all of which being quite aware of the contrary. They may be fishing for compliments, but that is not all. These analyses, smooth as they are most of the time, do not altogether result in untroubled ‘sleep’. Sometimes without understanding why, patients become frightened, agitated, and depressed, as if repressed impulses had broken through, like a bad dream.
We might now try the experiment of treating this material as if it were a manifest dream, consisting of a childlike, innocent, and highly educational liaison under the name of analysis. The underlying wishes that have emerged contain erotic fantasies about the parents, combined usually with violent impulses to destroy them both. Behind the befittingly-behaved and rational person may be the image of a lustful, destroying angel, who would kill without mercy in a kind of oedipal rage. To allow these wishes to achieve any kind of expression, they must be made more acceptable for the patient by allowing her to assume such desires without a penalty whose weakness is such that she need not fear of destroying the beloved parents. Or they may be expressed more openly by an ironic stance, which allows them to be proclaimed, and to be disowned.
These memory traces may again be compared to how they are dealt within the dream work. The patient may recall; being a great favourite of many older people and always having a teacher’s pet at school, always loved: These generally seem accurate. They often recall at least one and perhaps more screen memories that include some early sexual experience’s h a parent, fantasies that may have been related to horseplay with siblings and even to a greater extent to medical procedures later in childhood. Most of the childhood memories reported in the analysis are generally quite plausible and subject to relatively little obvious distortion, except the inevitable effects of the passage of time. There is little of the bizarre and strange about them, reflecting both the powerful reality sense of these patients and the highly organized structure of their intelligent and well-disciplined families.
Whatever is observed in the analytic environment, the patient uses as a day residue, as material to carry fantasies. Yet the whole is likely to be so sensible, so rationalized, so free of manifest erotic or violent elements, that we must assume that a powerful synthesized ego function is at work, like a very effective secondary revision of an otherwise bizarre and disturbing dream, with few breakthroughs of incongruous ideation and affect.
This process, again by analogy, “protects sleep.” That is, it helps the ego to maintain a comfortable regressive state of affairs in analysis, in which the patient is apparently a sensible, conscious, and sophisticated adult and an erotically excited, vengeful child. To ‘awaken’ her, that is, to interpret, would be to lead her to recognize her unconscious wishes for what they are, to help her deal with her repressive and ironic defences that have allowed the neurosis to continue and the analysis to go on without much real impact on the most important problem. To continue in a sleep-like state, on the other hand, permits her to act both roles and to continue to play out the surprising contradictions in her personality.
If we suppose that interpretation ‘removes’ the transference, as Freud suggested in 1912, we should be hesitant to bring it to consciousness before it has produced a resistance-assuming we are so prescient as to be able to detect the moment at which that latter event occurs. Still, we are not sure any more that transference is so easily ‘removed’ by interpretation. It seems certain that Freud no longer believed this when he wrote Analysis Terminable and Interminable.
How and when to interpret phenomena such as these make up a really reasonable dilemma. Kohut (1971), for example, approaching his patients with a theory that emphasizes a developmental view and puts’ aside conflictual considerations, would ‘accept’, possibly for a long period, even the most highly idealized expressions of admiration for himself. He warns against ‘premature interpretation’ of such positive expressions, especially in the cases he classifies as narcissistic character disorders.
Many years earlier, Phyllis Greenacre (1954), employing a different point of view, cautioned against early transference interpretations with narcissistic patients who are prone to acting out, since such interventions might result in at least temporary impairments of certain defensive controls and result in episodes of destructive behaviour. She made it clear that she was discussing a limited group of patients and her remarks were not confined to the ‘unobjectionable’ component. She was very much concerned with the development of a fix in a firm manner of over-idealizing attitudes toward the analyst and the problems engendered by these.
Without question interpreting the patient’s good-nature appears rarely advisable, cooperative attitude during the early part of analysis. Being inadvisable is not merely likely: It is worse than that, because during the first few weeks or months we could not possibly understand the unconscious components of this phenomenon. Early interpretations may remarkably be possible in a quickening notation that may prove sufficiently used for a vivid notable in characterizing its mark of notoriety, out of luck or intuition, but during the phase when we hardly know the patient venturing definite statements of meaning would be foolhardier.
We need not interpret early, therefore, and could not if we would. Nevertheless, there is a vast difference in accepting a phenomenon as reality-based, conflict-free, representing only itself, and, on the other hand, treating it more properly as a surface manifestation of a complex set of opposing forces, most of which operate outside conscious awareness, which require explanation eventually in analysis.
The questions we encounter are like those addressed to a particularly good manner of defending its dream, in that, taken on a superficially reasonable form. A good example would be Freud’s Dream of the Botanical Monograph. Repeating is brief enough: “I had written a monograph ion a certain plant. The book lay before me and I was just over a folded coloured plate. Bound up in each copy there was a dried specimen of the plant, as though it had been taken from a herbarium” (1900). Jumping to the conclusion would have been easy, by no incorrect means, that the dream expressed the wish that the yet incomplete monograph intended to make his reputation was already published and on display. How reasonable and easy to understand. Freud was, fortunately, not so easily satisfied. He discovered, in his analysis of the dream. References to matters ranging from his experiments with cocaine back to infantile sexual investigations, to which he understandably only eluded.
Similarly, if the patient imagines that his analyst is a fine and helpful person, he is expressing a wish, which on the face of it is perfectly reasonable. He is, we hope, correct in his expectations. We are certainly not obliged to contradict him, any more than we contradict the statements of a manifest dream. However, we are obliged to ask ourselves questions, not only about the origins of this wish, which may make an impression on us both obvious and universal, but also about a complex of different wishes and defensive operations that may lie concealed beneath this understandable and benign phenomenon. To what extent is it seductive? To what degree masochistic and tricky? Is it possible that the patient harbours a deeply passive wish that says in effect, “You are so great, my fate lies in your hand, do, your best and I shall yet defeat you?”
These probe need not be spoken aloud, but neither need they are entirely some secrets from the patient. The latter, when deeply engaged in the analytic process, are likely to be especially sensitive to nuances in the analyst’s state of mind, especially with respect to emotionally charged attitudes, a phenomenon commonly observed in children and present to a disconcerting degree in certain paranoid individuals. In the analysis of neurotic patients it varies with the state of regression encouraged by use of the couch and of free association.
Complex as it is, there is nothing necessarily mysterious about it. While the patient does not during the session itself see, the analyst’s facial expression, he is generally keenly aware of his minimal responses, his tone of voice, movements, and the like. Furthermore, he has the opportunity to pick up clues from the latter’s expression at the beginning and end of the session. That he may draw some quite inaccurate conclusions is to be expected, and these misinterpretations themselves become material for the analysis. Some patient sense quite quickly and often accurately, for example, whether the analyst responds to expressions of appreciation by a warm glow of satisfaction or by a questioning attitude, the latter signifying a willingness to wait until the phenomenon can be understood in depth.
Whether the analyst reacts by ‘acceptance’ or by questioning makes considerable difference in the future course of the treatment. What has often been taken for granted as an ‘empathic’ approach tends to reduce emphasis on the importance of questioning, treating the patient’s appreciation, for example, as if it were simply genuine, taking it at face value, justifying this by the need to establish the kind of transference situation that is believed essential for the progress of the treatment.
Such an approach has its own appeal: It seems humane, understanding, and protective, it is often regarded as a manifestation of a loving attitude by the analyst, which is perfectly appropriate-a counterpart, it would seem, of the unobjectionable component of the patient. Nevertheless, that we must raise questions whether its usefulness may not ultimately be outweighed by its cost.
The failure to maintain a questioning attitude, an active curiosity about the unconscious dynamics and meaning of this type of response, is likely to favour the persistence of troublesome misunderstanding as to the true nature of the transference. This may in turn lead to serious errors in attempts to place too great an emphasis on an introspective-empathic response at the expense of thoughtful questioning and evacuations of all types of detained by observation of the analytic situation. One of the risks of the former approach is that patient and analyst may find them existing in a state of mutual narcissistic regression, a kind of near-erotic mutual sleep. This can be a very gratifying experience for both: Its prototype was the sleep therapy employed by the Greeks at Epidaurus and Pergamum, which provided symptomatic relief. We need not decry it, if it is recognized.
Analysis, however, requires regular ‘arousal’ in Bertram Lewin’s sense, accomplished by the analyst’s activity, by questioning and interpretation, which may be explicit and verbalized or silent, expressed by a less intrusive means, e.g., by gesture, look and tone. Only in this way are we likely to achieve some understanding of the function and the origins of the ‘unobjectionable’ component and the other factors in the transference with which being joined is likely.
Establishing some hypotheses to account for the origins of this phenomenon of transference would seem important that at this point. This is not so easily accomplished, and must wait for further exploration. Up too now, our efforts have been partial at best, and for the most part has failed to take into account such factors as genetic endowment, at the one extreme, and late childhood, adolescent, and adult experiences at the other. Its genetic sources have been sought for largely in the experiences of early childhood, the neonatal and preverbial phases by choice, concentrating especially on mother-child exchanges. Denying the importance of early mothering in this regard would be rash, but being persuaded by those who would make it the one crucial determinant is difficult, as if good mothering were not only the earliest, but also the only essential genetic factor in the capacity to develop this aspect of transference.
It is too-simple if appealing explanation, and too dependent upon treating the manifest phenomenon as the whole article, as if the patient’s trust and cooperation were a direct reflection of the trust and cooperation he learned at his mother’s breast, and on the other hand, as if it reflected the need to replace a disappointing “unemphatic” mother by a new and more reliable object-or, “self-object,” to employ Kohut’s (1971) term.
Primordial explanations are understandably popular. Those historical events that are most deeply buried in the distant past are the most difficult to evaluate and thus the more apt for myth-making. Even the most meticulous hypotheses about the psychic developments of preverbial children require influences based on giant steps that become even larger when we attempt to extend them into explanations of behaviour and symptoms in adults. It is undeniable that very early experiences contribute significantly to the nature and severity of adult psychopathology, and the more we know about them the better. Still, to know them is not nearly enough. It is essential that we undertake the arduous task of tracing the effects of such experiences through later childhood, adolescence, and adult life, thus establishing the coherent chain of historical events that is indispensable for a soundly based sense of conviction. It is only by accomplishing this that we may be able to precent psychological explanations from deteriorating into a series of appealing fantasies, a kind of pseudo history based on presumed prehistoric events, which tends to operate as a defence against the discovery of something close to the genuine article.
Gill (1979) has described some of the difficulties in the tendency to interpret transference by a too-ready resorted to early genetic factors rather than by recognizing the immediate context of the analytic situation. We need to go all the way with him in his emphasis on the ‘here-and-now’ in the analysis of the transference, to recognize the relevance of its argument.
Here-and-now work with transference materials is an emotionally potent experience for both patient and therapist. Anxieties and misunderstandings in both patient and therapist may lead them to resist this focus. Transference can be a powerful therapeutic tool: being aware of impediments to effective intervention is important, Freud (1905) once commented that ‘transference, which seemed ordained to be the greatest obstacle to the psychoanalysis, becomes its most powerful ally, if its presence can be detected each time and explained to the patient’. Leading to conclude that ‘In psychoanalysis therapy, the phenomenon of projection of feelings, thoughts, and wishes onto the analyst, who has come to represent an object from the patient’s past’ also, that ‘the patient sees in the analyst the return-the reincarnation-of some important figure out of his childhood or past, and consequently transfers onto him feelings and reactions that undoubtedly applied to this model’. Analysis of transference in the here-and-now opens the way to new object relations through a step-by-step removal of implements to such relations as represented by the transference. As the patient can understand and work through distortions resulting from transference attitudes, he begins to see others starting with the therapist, in a new way. The goal of here-and-now is to establish more realistic object relations. First with the therapist, then with others: The therapist strives to help the patient develop more successful interaction within the therapy relationship than was experienced in the past. A focus on transference is intended to remove obstacles that interfere with the patient’s ability to deal with the therapist in a relatively mature, rational, and a non-conflictual manner. If transference is a preexisting perceptual and emotional bias, resolution of the transference helps the patient add flexibility and decrease constriction to the manner in which the therapeutic situation is viewed. Both the therapist and patient attempt to work out a relationship that is a realistic reflection of the present and without excess baggage from the past: The message to be conveyed is that relationships are not conflict-free, and that the therapist is willing to continue, with openness and purpose, toward resolution of conflict with others.
Yet, the analysis of the transference is generally acknowledged to be the central feature of analytic technique. Freud regarded transference and resistance as facts of observation, not as conceptual inventions. He wrote: “ . . . the theory of psychoanalysis is an attempt to account for two striking and unexpected facts of observation that emerge whenever an attempt is made to trace the symptoms of neurotic backs their sources in the past life, the facts of transference and of resistance . . . anyone who takes up other sides of the problem while avoiding these hypotheses will hardly escape a charge of misappropriation of property by attempted impersonation, if he persists in calling himself a psychotherapist.” Rapaport (1967) argued, in his posthumously published paper on the methodology of psychoanalysis, that transference and resistance inevitably follow from the fact that the analytic situation is interpersonal.
Despite this general agreement on the centrality of transference and resistance in technique, its impressions drawn from ones experience as to observe of the transference that is not to pursue as systematically and comprehensively compensable state of one how would imaginatively think of what really should be. The relative primacy in which psychoanalysts work makes it possible for one or one’s state to view as anything more than its own impression. On the assumptions that even if we were wrong, reviewing issues in the analysis of the transference will be useful and to state many reasons to posit of itself as an important aspect of the e analysis of the transference, namely, resistence to the awareness of the transference, is especially often slightly in analytic practice that one or one’s reasons to acknowledge these issues and of what really should be.
Seemingly, the first gaiting steps of which did not originate with a big-bang but forwarded forthright through a whimpering between two types of interpretations of the transference. The one is an interpretation of resistance to the awareness of transference. The other is an interpretation of resistances to the resolution of transference. The distinction, however, had been best explained in the literature by Greenson (1967) and Stone (1967). The first kind of resistance may be called defence transference. Although that terminology is mainly employed to refer to a phase of analysis characterized by a general resistance to the transference of wishes. The second whimpering overture of resistance is usually called transference resistance. With some oversimplification, one might say that in resistance to the awareness of transference, the transference is what is resisted, whereas in resistance to the resolution of transference, the transference is but the withstanding resistance.
Yet, another descriptive way of stating this distinction between resistance and the awareness of transference and resistance to the resolution of transference is between implicit and indirect reference to the transference and explicit or direct references to the transference, the interpretation of resistance to awareness of the transference in intended to make the implicit transference explicit, while the interpretation of resistance to the resolution of transference is intended to make the patient realize that the already explicit transference does include a determinant from the past.
It is also important to distinction between the general concept of an interpretation of resistance to the resolution of transference and a particular variety of such an interpretation, namely, a genetic transference interpretation-that is, in the interpretation of how an attitude in the present is an inappropriate carry-over from the past. While there is a tendency among analysts to deal with explicit references to the transference primarily by a generic transference interpretation, there are other ways of working toward a revolution of the transference. It will be argued that not only is it not enough of an emphasis being given to interpretation of the transference in the here-and-now, that is, to the interpretation of implicit manifestations of the transference, but also that interpretations intended to resolve the transference as manifested in explicit references to the transference should be primarily in the here-and-now, rather than genetics transference interpretation.
A patient’s statement that he feels the analyst is harsh, for example, is, at least to begin with, likely best dealt with not by interpreting that this is a displacement from the patient’s feeling that his father was harsh but by an elucidation of another aspect of his here-and-now attitude, such as what has gone on in the analytic situation that is the patient to justify his feedings or what as the anxiety that made it so difficult for him to express his feelings. How the patient experiences the actual situation is an example of the role of the actual situation in a manifestation of transference, which will be one point contributive to both the transference in the here-and-now and genetic transference interpretations valid and constitute a sequence. We presume that a resistance that transference ultimately rests on the displacement onto the analyst of altitudes from the past.
Transference interpretations in the here-and-now and genetic transference interpretations are of course, exemplified in Freud’s writings and are in the repertoire of every analyst, but they are not distinguished sharply enough.
Because Freud’s case histories focus much more on the yield of analysis than on the details of the process, they are readily but perhaps incorrectly construed as emphasizing work outside the transference much more than work with the transference, and, even within the transference, emphasizing genetic transference interpretations much more than work with the transference in the here-and-now (Muslin and Gill 1978). The example of Freud’s case reports may have played a role in what is to be considered as a common maldistribution of emphasis in these two respects-not enough on the transference and, within the transference, not enough on the here-and-now, least of mention, is a primary reason for a failure to deal adequately with the transference. It is that work with the transference is that aspect of analysis that involves both analyst and patient in the apprised affect-laden and potentially disturbing interactions that by participants in the analytic situation are motivated to avoid these interactions. Flight away from the transference and to the past can be a relief to both patient and analyst.
The importance of transference interpretations will surely be agreeing to by all analysts, the greater effectiveness of transference interpretations than interpretations outside the transference will be agreeing to by many, and that of the relative roles of interpretation of the transference and interpretation outside the transference?
Freud can be read either as saying that the analyst of the transference is auxiliary to the analysis of the neurosis or that the analyst of the transference is equivalent to the analysis of the neurosis. The first position is stated in his saying (1913) that the disturbance of the transference has to be overcome by the analysis of transference resistance to get on with the work of analysing the necrosis. It is also implied in his reiteration that the ultimate task of analyses is to remember the past, to fill the gaps in memory. The second position is stated in his saying that the victory must be won on the field of the transference (1912) and that the mastery of the transference neurosis ‘coincides with getting rid of the illness that was originally brought to the treatment’(1917). In this second view, he says that after the resistances are overcome, memories appear without difficulty (1914).
These two different positions also find expression in the two very different ways in which Freud speaks of the transference. In Dynamics of Transference, he refers to the transference, on the one hand, as ‘the most powerful resistances to the treatment’ (1912) but, on the other hand, as doing us ‘the inestimable service of masking the patient’s . . . impulses immediate and manifest. For when all is said and done, destroying anyone in an absentia or in effigies’ is impossible (1912).
One or one’s mindful purposes of incitation can draw from its demonstration that his principal emphasis falls on the second position. He wrote once, in summary: “Thus our therapeutic work falls into two phases. In the first, all libidos are forced from the symptoms into the transference and concentrated there, in the second, the struggle is waged around this new object and the libido is liberated from it” (1917).
Yet, the detailed demonstration that he advocated that the transference should be encouraged to expand as much as possible within the analytic situation lies in clarifying that resistance is primarily expressed by repetition, that repetition takes place both within and outside the analytic situation, but that the analyst seeks to deal with it primarily within the analytic situation, that repetition cannot be only in the motor sphere (acting) but also in the physical sphere, and that the physical sphere is not confined to remembering but includes the present, too.
Freud’s emphasis that the purpose of resistance is to precent remembering can obscure his point that resistance shows itself primarily by repetition, whether inside or outside the analytic situation: “The greater the resistance, the more extensive will acting out (repetition) replaces remembering” (1914). Similarly, in The Dynamics of Transference, Freud said, that the main reason that the transference is so well suited to serve the resistance is that the unconscious impulses “do not want to be remembered . . . but, endeavour to reproduce themselves . . ." (1912). The transference is a resistance primarily insofar as it is a repetition.
The point can be restated as to the relations between transference and resistances. The resistance expresses itself in repetition, that is, in transference both inside and outside the analytic situation. To deal with the transference, therefore, is equivalent to dealing with the resistances. Freud emphasized transference within the analytic situation so strongly that it has come to mean only repetition within the analytic situation, even though, conceptually speaking, a repetition outsider the analytic situation is transference too, and Freud once used the term that way: “We soon perceive that the transference is itself only a piece of repetition, and that the repetition is a transference of the forgotten past not only on the doctor but also on all other aspects of the current situation. We . . . find . . . the compulsion to repeat, which now replaces the impulsion to remember, not only in his personal attitude to his doctor but also in every other activity and relationships that may occupy his life at the time . . . " (1914).
Realizing that the expansion of the repetition inside the analytic situation is important, whether or not in a reciprocal relationship to repetition outside the analytic situation, is the avenue to control the repetition: “The main instrument . . . for curbing the patient’s compulsion to repeat and for turning it into a motive for remembering lies in the handling of the transference. We render the compulsion harmless, and really useful, by giving it the right to assert itself in a definite field” (1914).
Kanzer has discussed this issue well in his paper on The Motor Sphere of the Transference, (1966). He writes on a ‘double-pronged stick-and-carrot’ technique by which the transference is fostered within the analytic situation and discouraged outside the analytic situation. The ‘stick’ is the principle of abstinence as exemplified in the admonition against masking important decisions during treatment, and the ‘carrot’ is the opportunity afforded the transference to expand within the treatment “in almost complete freedom” as in a ‘playground’ (Freud, 1914). Freud writes: “Provided only that the patient shows compliance enough to respect the necessary conditions of the analysis, we regularly succeed in giving all the symptoms of the illness a new transference meaning and in replacing his ordinary neurosis by a ‘transference neurosis’ of which he can be cured by the therapeutic work” (1914).
The reason that being expressed within the treatment is desirable for the transference is that there, it “is at every point accessible to our intervention” (1914). In a later statement he made the same point this way: “We have followed this new edition [the transference-neurosis] of the old disorder from its start, we have observed its origin and growth, and we are especially well able to find our way about in it since, as its object, we are situated at it’s very centre” (1917). It is not that the transference is forced onto the treatment, but that it is spontaneously but implicitly present and is encouraged to expand there and become explicit.
Freud emphasized ‘acting’ in the transference so strongly that one can overlook the repetition in the transference providing it does not necessarily mean it is enacted. Repetition need not go as far as motor behaviours. It can also be expressed in attitudes, feelings, and intentions, and, the repetition often takes such form rather than motor action. Such repetition is in the physical rather than the motor sphere. The importance of making this clear is that Freud can be mistakenly read to mean that repetition in the physical sphere can only mean remembering the past, as when he writes that the analyst “is prepared for a perpetual struggle with his patient to keep in the physical sphere all the impulses that the patient would like to direct into the motor sphere, and he celebrates it as a triumph for the treatment if he can bring it about that something the patient wishes to discharge in action are disposed of through the work of remembering” (1914),
Still, it is true that the analyst’s efforts are to convert acting in the motor sphere into an intuitive awareness upon the certainty of which the physical sphere of transference, however, transference may be in the physical sphere to begin with, even if disguised. The physical sphere includes those of an awakened spheres of awareness through which the transference is just as well as to remembering.
An objection one hears, from both analyst and patient, to a heavy emphasis on interpretation of associations about the patient’s real life primarily about the transference is that it means the analyst is disregarding the importance of what goes on in the patient’s real life. The criticism is not justified. To emphasize the transference meaning is not to deny or belittle other meanings, but to focus on the one of several meanings of the contentual representations set forth, that is most important for the analytic process.
Another way in which interpretations of resistance to the transference can be, or at least appear to the patient as to be belittling of the importance of the patient’s outside life is to make the interpretation as though the outside behaviour is primarily an acting out of the transference. The patient may undertake some actions in the outside world as an expression of and resistance to the transference, that is, acting out. Til now, the interpretation of associations about actions in the outside world as having implications for the transference needs mean only that the choice of outside action to figure in the associations in co-determined needs to express of the transference indirectly. It is because of the resistance to awareness of the transference that the transference has to be disguised. When the disguise is unmasked by interpretations, despite the inevitable differences between the outside situations and the transference situation, the content is clearly the same for the analytic work. Therefore, the analysis of the transference and the analysis of the neurosis coincide. Particularly because some critics of earlier versions of our agreement that in its advocating the analysis of the transference for its own sake rather than in overcoming the neurosis. Freud wrote, “that the mastering of the transference neurosis ‘coincides with getting rid of the illness that was originally brought to the treatment” (1917).
The transference is encouraged to develop within the analytic situation, toward fostering this development of attitudes with primary determinants in the past, i.e., transferences. The analyst’s reserve gives the patient few and equivocal cues. The purpose of the analytic situation fosters the development of strong emotional responses, and the very fact that the patient has a neurosis means, as Freud said, that
“ . . . It is a perfectly normal and intelligible thing that the libidinal cathexis [we would now add negative feelings] of someone who is partly unsatisfied, a cathexis held readily in anticipation, should be directed as well to the figure of the doctor” (1912).
There is important resistance for both patient and analyst to awareness of the transference. On the patient’s part, this is because of the difficulty in recognizing erotic and hostile impulses toward the very person to whom they have to be revealed. On the analyst’s part, this is because the patient is likely to attribute the very attitudes to himself, in that causing him discomfort is most likely. The attitudes the patient believes that the analyst has toward him are often the ones the patient is least likely to voice, in a general sense because of a feeling that it is impertinent for him to concern himself with the analyst’s feelings. In a more specific sense because the attitudes that the patient ascribes of the analyst are often attitudes the patient feels the analyst will not like and be uncomfortable about having ascribed to him. It is so that the analyst must be especially alert to the attitudes the patient believes he has, not only to the attitudes the patient does have toward him. If the analyst can see himself as a participant in an interaction, as he will become much more attuned to this important area of transference, which might otherwise escape him.
The investigation of the attitudes ascribed with the analyst makes easier the subsequent investigation of the intrinsic factors in the patient that played a role in such ascriptions. For example, the exposure of the fact that the patient ascribes sexually, an interest in him to the analyst, and genetically to the patient, easily makes the subsequent exploration of the patient’s sexual wish toward the analyst, and genetically the parent.
The resistance to the awareness of these attitudes is responsible for their appearing in various disguises in the patient’s manifest associations and for the analyst’s reluctance to unmask the disguise. The most commonly recognized disguise is by displacement, but identification is an equally important one. On displacement, the patient’s attitudes are narrated for being a third party. In identification, the patient attributes to himself attitudes he believes the analyst has toward him.
To encourage the expansion of the transference within the analytic situation, the disguises in which the transference appears have to be interpreted. In displacement the interpretation will be of allusions to the transference in association not manifestly about the transference. This is a kind of interpretation every analyst often makes. With identification, the analyst interprets the attitude the patient ascribes himself as an identification with which attitudes he attributes toward the analyst. Lipton (1977) has recently described this form of disguised allusion to the transference with illuminating illustrations.
Many analysts believe that transference manifestations are infrequent and sporadic at the beginning of an analysis and the patient’s associations are not dominated by the transference unless a transference neurosis has developed. Other analysts believe that the patient’s associations have transference meanings from the beginning and throughout. That is to say, if one is to think of those who believe otherwise are failing to recognize the persuasiveness of indirect allusions to the transference-that is, what is called the resistance to the awareness of the transference.
In his autobiography, Freud wrote: “The patient remains under the influence of the analytic situation abounding in even if he is not directly his mental activity onto a particular subject. We will be justified in assuming that nothing will occur to him that has not some reference to that situation” (1925). Since associations are obviously often not directly about the analytic situation, the interpretation of Freud’s remark rests on what he meant by the 'analytic situation'.
Trusting of what, Freud’s meaning can be clarified by reference to a statement he made in The Interpretation of Dreams. He said that when the patient is told to say whatever comes into his mind, his associations become directed by the ‘purposive ideas inherent in the treatment’ and that there are two such inherent purposive themes, one relating to the illness and the other-concerning which, Freud said, the patient had ‘no suspicion’-relating to the analyst (1900). If the patient has ‘no suspicion’ of the theme relating to the analyst, the clear implication is that the theme appears only in disguise in the patient’s association. Its following interpretation is that Freud’s remark not only specifies the themes inherent in the patient’s associations, but also means that the associations are simultaneously directed by these two purposive ideas, not sometimes by one and sometimes by the other.
One important reason that the early and continuing presence of the transference is not always recognized is that it is considering being absent in the patient who is talking freely and apparently without resistance. As Muslin and others have pointed out on the early interpretation of transference (Gill and Muslin, 1976), resistance to the transference is probably present from the onset, even if the patient is talking apparently freely. The patient might be talking about issues not manifestly about the transference that are nevertheless also allusions to the transference. Nevertheless, the analyst has to be alert to the percussiveness of such allusions to discern them.
The analyst should continue the working assumption, to assert that the patient’s associations have transference implications pervasively. This assumption is of course, not to be confused with denial or neglect of the current aspects of the analytic situation. Giving precedence to a transference interpretation is theoretically always possible if one can only discern it through its disguise by resistance. This is not to dispute the desirability of learning as much as one can about the patient, if only to be a position to make correct interpretations of the transference. It therefore does not interfere with an apparently free flow of associations, especially early, unless the transference threatens the analytic situation to the point where its interpretation is mandatory rather than optional.
With the recognitions that even the apparently freely associating patient may also be showing reluctance to awareness of the transference, in that, the formularisation of one should not interfere if useful information is being gathered should replace Freud’s dictum that the transference should not be interpreted until it becomes a resistance (1913).
It may be argued of all transference manifestations with something in the actual analytic situation has some connection to some aspect of the current analytic situation, in that, all the determinants of the transference are current in the sense that past can exert an influence only because it exists in the present. What, however, the distinguishing is, of its current reality of the analytic situation, that is, what goes on between patient and analyst in the present, from how the patient is currently formed as of his past.
All analysts would doubtless agree that there are both current and transferential determinants of the analytic situation, and probably no analyst would argue that a transference idea can be expressed without contamination, as it was, that is, without any connection to anything current in the patient-analyst relationship. Nevertheless, the applicable implication of this fact for techniques is often neglected in practice and is believed that it will be dealt among them as past-present point references.
After-all, several authors (e.g., Kohut 1959, Loewald 1060) have pointed out that Freud’s early use of the term transference in The Interpretation of Dreams, in a connection not immediately recognized as related to the present-day user of the term, reveals the fallacy of considering that transference can be expressed free of any connection to the present. That early use was to refer to the fact that an unconscious ideas cannot be expressed as such, but only as it becomes connected to a preconscious or conscious representation of content. Thus holding to contentual representations in the phenomenon with which Freud was then concerned, the dram, transference took place from an unconscious wish to a day residue. In the Interpretation of Dreams Freud used the term transference both for the general rule that an unconscious content is expressible only as it becomes transferred to a preconscious or conscious content and for the specific application of this rule to a transference to the analyst. Just as the day residue is the point of attachment of the dream wish, so must there be an analytic-situation residue, though Freud did not use that term, as the point of attachment of the transference.
Analysts have always limited their behaviour, both in variety and intensity, to increase the extent to which the patient’s behaviour is determined by his idiosyncratic interpretation of the analyst’s behaviour. In fact, analysts unfortunately sometimes limit their behaviour so much, as compared with Freud’s practice, that they even conceptualize the entire relationship with the patient a matter of technique, with no nontechnical personal relation, as Lipton (1977) has pointed out.
Nonetheless, no matter how far the analyst attempts to carry this limitation of his behaviour, the very existence of the analytic situation gives the patient innumerable cues that inevitably become his rationale for his transference response. In other words, the current situation cannot be made to appear-that is, the analytic situation is real. It is say to forget this truism in one’s zeal to diminish the role of the current situation in determining the patient’s responses. One can try to keep past and present determinants as a step-by-step perceptible form of one and another, but one cannot obtain either in ‘pure culture’. Freud wrote: “Insist on this procedure [the couch], however, for its purpose and result are to prevent the transference from mingling with the patient’s associations imperceptibly, to isolate the transference and to allow it to come forwards in due courses sharply defined as a resistance.” Even ‘isolate’ is too strong a word in the light of the inevitable intertwining of the transference with the current situation.
If the analyst remains under the illusion that the current cues he provides to the patient can be reduced to the vanishing point, he may be led into a silent withdrawal, which is not too distant from the caricature of an analyst as someone who does indeed refuse to have any personal relationship with the patient. What happens then is that silence has become a technique rather than merely an indication that the analyst is listening. The patient’s responses under such conditions can be mistaken for uncontaminated transference when they are in fact transference adaption to the actuality of the silence.
The recognition that all transferences must have some relation to the actual analytic situation, from which it takes its point of departure, as it was, has a crucial implication for the technique of interpreting resistance to the awareness of transference, to which the analyst becomes persuaded of the certainty of transference and the importance of encouraging the transference to expand within the analytic situation, he has to find the presenting and plausible interpretations of resistance to the awareness of transference he should make. At this point, his most reliable asset is the cues offered by what will go on in the analytic situation: On the one hand, the events of the situation, such as change in time of session, or an interpretation made by the analyst, and, on the other, however, the patient is experiencing the situation as reflected in explicit remarks about it, however fleeting these may be. This is the primary yield for technique of the recognition that any transference must have a link to the actuality of the analytic situation. The cue points to the nature of the transference, just as the day residue for a dream may be a quick pointer to the latent dream thoughts. Attention to the current stimulus for a transference elaboration will keep the analyst from making mechanical transference interpretation, in which he interprets that there are allusions to the transference in associations not manifestly about the transference, but without offering any plausible basis for the interpretation. Attention to the current stimulus also offers some degree of protection against the analyst’s inevitable tendency to project his own views onto the patient, either because of countertransference or because of a preconceived theoretical bias about the content and hierarchical relationship in psychodynamics.
The analyst may be very surprised at what in his behaviour the patient finds important or unimportant, for the patient’s responses will be idiosyncratically determined by the transference. The patient’s response may be something the patient and the analyst considers trivially, because, as in displacement to a trivial aspect of the day residue of a dream, displacement can better serve resistance when it is to something trivial. Because it is connected to conflict-laden material, the stimulus to the transference may be difficult to find. It may be quickly disavowed, so that its presence in awareness s only transitory. With the discovery of the disavowed, the patient may also gain insight into how it repeats a disavowal earlier in his life. In his search for the present stimulus that the patient is responding to transferentially, the analyst must therefore remain alert to both fleeting and apparently trivial manifest calls himself well as the events of the analytic situation.
It is sometimes argued that the analyst’s attention to his own behaviour as a precipitant for the transference will increase the patient’s resistance to recognizing the transference. On the contrary, is that because of the inevitable interrelationship of the current and transferential determinants, it is only through interpretation that they can be disentangled-in that it is also argued that one must wait until the transference has reached optimal intensity before it can be advantageously interpreted. It is true that too hasty the interpretation of the transference can serve a defensive function for the analysts and deny him the information he needs to make a more appropriate transference interpretation. However, it is also true that delay in interpreting runs the risk of allowing an unmanageable transference to develop. It is also true that deliberate delay can be a manipulation in the service of an abreaction rather than analysis and, like silence, can lead to a response to the actual situation mistaken for uncontaminated transference. Obviously important issues of timing are involved as an important clue to when a transference interpretation is given that one to make lies in whether the interpretation can be made plausible concerning the determinant stresses, namely, something in the current analytic situation. Of course, with other aspects of the transference attitude in saying that when the analyst approaches the transference in the spirit of seeing how it appears plausibly realistic to the patient, it paves the way toward its further elucidation and expression.
Freud’s emphasis on remembering as the goal of the analytic work implied that remembering is the principal avenue to the resolution of the transference. Yet his delineation of the successive steps in the development of analytic technique makes clear that he saw this development as a change from an effort to reach memories directly to the use of the transference as the necessary intermediary to reaching the memories.
By contrast alone, a remembering as the way the transference is resolved, Freud also described resistance for being primarily overcomes in the transference, with remembering following easily thereafter: “From the repetitive reactions exhibited in the transference we are led along the familiar paths to the awakening of the memories, which appear without difficulty, as it was, after the resistance has been overcome” (1914). “This revision of the process of repression can be accomplished only in part concerning the memory traces of the process that led to repression. The decisive part of the work is achieved by creating in the patient’s relations to the doctor-in the 'transference'-new editions of the old conflicts . . . Thus, the transference becomes the battlefield on which all the mutually struggling forces should meet one-another” (1917). This is the primary insight Strachey (1934) clarified in his seminal paper on the therapeutic action of the psychoanalysis.
Accedingly, there are two main ways in which resolution of the transference can take place through work with the transference in the here-and-now. The first lies in the clarification of what are the cues in the current situation that are the patient’s point of departure for a transference elaboration. The exposure of the current point of departure at once raises the question of whether it is adequate to the conclusion drawn from it. The relating of the transference to a current stimulus is, after all, parts of the patient’s effort to make the transference attitude plausibly determined by the present. The reserve and ambiguity of the analyst’s behaviour are what increases the ranges of apparently plausible conclusions the patient may draw. If an examination of the basis for the conclusion makes clear that the actual situation to which the patient responds is subject to other meanings than the one the patient had reached, he will more readily consider his pre-existing bias-that is, his transference.
A decisive summation would include that, in speaking of the current relationship and the relation between the patient’s conclusions and the information on which they seem plausibly based, may as to imply of some absolute conception of what is real in the analytic situation, of which the analyst is the final arbiter. That is not the case. Seemingly, what the patient must come to see is that the information he has is subject to other possible interpretations implies the very contrary to an absolute conception of reality. In fact, analyst and patient engage in a dialogue in a spirit of attempting to arrive at a consensus about reality, not about some staged out-and-out reality.
The second way in which resolution of the transference can take place within the work with the transference in the here-and-now is that in the very interpretation of the transference the patient had a new experience. He is being treated differently from how he expected to be. Analysts seem reluctant to emphasis this new experience, ads though it endangers the role of insight and argues for interpersonal influence as the significant factor in change. Strachey’s emphasis on the new experience in the mutative transference interpretation has unfortunately been overshadowed by his views on introjection, which have been mistaken to advocate manipulating the transference. Strachey meant introjection of the more benign superego of the analyst only as a temporary step on the road toward insight. Not only is the new experience nit to be confused with the interpersonal influence of a transference gratification, but the new experience occurs with insight into both the patient's-based expectation and the new experience. As Strachey points out, what is unique about the transference interpretation is that insight and the new experience take place in relation to the very person who was expected to behave differently, and it is this that gives the work in the transference its immediacy and effectiveness. While Freud did stress the affective immediacy of the transference, he did not make the new experience explicit.
Recognizing that transference interpretation is not a matter of experience is important, in contrast to insight, but a joining of the two together. Both are needed to cause and maintain the desired changes in the patient. It is also important to recognize that no new techniques of intervention are required to provide the new experience. It is an inevitable accomplishment of interpretation of the transference in the here-and-now. It is often overlooked that, although Strachey said that only transference interpretations were mutative, he also said with approval that most interpretations were outside the transference.
In a further explication of Strachey’s paper and entirely consistent with Strachey’s position, Rosenfeld (1972) has pointed out that clarification of material outside the transference is often necessary to know what is the appropriate transference interpretation, and that both genetic transference interpretation and extratransference interpretations play an important role in working through. Strachey said relatively little about working through, but surely nothing against the need for it, yet made so explicitly to a recognized role for recovery of the past in the resolution of the transference.
The holding position is to emphasis the role of the analysis of the transference in the here-and-now, both in interpreting resistance to the awareness of transference and in working toward its resolution by relating it to the actuality of the situation. Believing that the interpretation of resistance to awareness of the transference should figure in most of sessions, and that if this is done by relating the transference to the actual analytic situation, the very same interpretation is a beginning of work to the resolution of the transference. To justify this view more persuasively would require detailed case material.
One might be taken in some specified state as siding with the Kleinians whom, many analysts feel, are in error in giving the analysis of the transference too great if not even an exclusive role in the analytic process. It is true that Kleinians emphasize the analysis of the transference more, in their writings at least, than do the overall run of analysts. Anna Freud’s (1968) complaint that the concept of transference has become overexpanded is directed against the Kleinians. One reason the Kleinians consider themselves the true followers of Freud in technique is precisely because of the emphasis they put on the analysis of the transference. Hanna Segal (1967), for example writes as follows: “To say that all communications are seen as communications about the patient’s phantasy plus current external life is equivalent to saying that all communications contain something used for the transference situation. In Kleinian technique, the interpretation of the transference is often more central than in the classical technique.”
Yet, it is nonetheless, the insistence on exclusive attention to any particular aspect of the analytic process. Like the analysis of the transference in the here-and-now, can become a fetish. In that other kinds of interpretation should not be made, but the emphasis on transference interpretation within the analytic situation needs to be increased or at the least reaffirmed, and that we need more clarification and specification of just when other kinds of interpretations are in order.
Of course making a transference interpretation is sometimes tactless. Surely two reasons that would be included in a specification of the reasons for not making a particular transference interpretation, even if one seems apparent to the analyst, would be preoccupation with an important extratransference event and an inadequate degree of rapport, to use Freud’s term, to sustain the sense of criticism, humiliation, or other painful feelings the particular interpretation might engender, though the analyst had no intention of evoking such a response. The issue might be, however, not of whether or not an interpretation of resistance to the transference should be made, but whether the therapist can find that transference interpretation that in the light of the total situation, both transferential and current, the patient can hear and benefit from primarily as the analyst intends it.
Transference interpretations, like extratransference interpretations, indeed like any behaviour on the analyst’s part, can affect the transference, which in turn needs to be examined if the result of an analysis is to depend as little as possible on the unanalyzed transference. The result of any analysis depends on the analysis of the transference, persisting effects of unanalyzed transference, and the new experience that particularly have in emphasizing as the unique merit of a transference interpretation in the here-and-now. Remembering this less one’s zeal to ferret out the transference itself becomes is especially important an unrecognized and objectionable actual behaviour on the analyst’s part, with its own repercussions on the transference.
The emphasis that is of placing on the analysis of resistance to the transference could easily be misunderstood as implying that recognizing the transference is always easy as disguised by resistance or that analysis would go without a hitch if only such interpretations were made. If not only to imply of neither, but rather than the analytic process will have the best chance of success if correct interpretation of resistance to the transference and work with the transference in the here-and-now are the core of analytic work.
However it remains, that the significance of the transference phenomenon impressed Freud so profoundly that he continued through the years to develop his ideas about it. His classical observations on the patient Dora formed the basis for his first formulation of this concept. He says, “What is the transference? They are the new edition or facsimiles of the tendencies and phantasies aroused and made consciously during the progress of the analysis. However, they have this peculiarity, which is characteristic for their species, that they replace some earlier person by the person of the physician. To put it another way: A whole series of psychological experiences is revived, not as belonging to the past, but as applying to the person of the physician currently.”
According to Freud’s view, the process of a psychoanalytic cure depends mainly upon the patient’s ability to remember that which is forgotten and repressed, and thus to gain conviction that the analytical conclusions arrived at being correct. However, “the unconscious feelings derive to avoid the recognition that the cure demands,” they seek instead, emotional discharge, despite the reality of the situation.
Freud believed that these unconscious feelings that the patient strives to hide are made up of that part of the libidinal impulse that has turned away from consciousness and reality, due to the frustration of a desired gratification. Because the attraction of reality has wakened, the libidinal energy is still maintained in a state of regression attached to the original infantile sexual object, although the reasons for the recoil from reality have disappeared.
Freud states that in the analytic treatment, the analyst pursues this part of the libido to its hiding place, “aiming always at unearthing it, making it accessible to consciousness at last serviceable to reality.” The patient tries to achieve an emotional discharge of this libidinal energy under the pressure of the compulsion to repeat experiences repeatedly again rather than to become conscious of their origin, but he uses the method of transferring to the person of the physician past psychological experiences and reacting to this, at times, with all the power of hallucination. The patient vehemently insists that his impression of the analyst be true for the immediate present, in this way avoiding the recognition of his own unconscious impulses.
Thus, Freud regarded the transference-manifestations as a major problem of the resistance. However, Freud says, “It must not be forgotten that they (the transference-manifestations) and they only, render the invaluable service of making the patient’s buried and forgotten love-emotions and manifestations.”
Freud regards the transference-manifestations as having two general aspects
- positive and negative. The negative, was at first regarded as having no value in psychoanalytic cures and only something to be 'raised' into consciousness to avoid interference with the progress of the analysis. He later accorded it a place of importance in the therapeutic experience. The positive transference he concluded to be ultimately sexual in origin, since Freud says, “To begin with, we knew none but sexual objects.” However, he divides the positive transference into two components-one, the repressed erotic component, which is used in the service of resistance, the other, the friendly and affectionate component, which, although originally sexual, is the 'unobjectionable' aspect of the positive transference, and is involved with that “causation of a successful result on the psychoanalysis, as in all other remedial methods.” Freud refers here to the element of suggestion in psychoanalytic therapy.
Although not agreeing with the view of Freud that human behaviour depends ultimately on the biological sexual drives, and that it would be a mistake to deny the importance of his formulations regarding transference phenomena, I differ on certain points with Freud. However, I do not differ with the formulation that early impressions acquired during childhood is revived in the analytical situation, and are felt as immediate and real-that they form paternally the greatest obstacles to analysis, if unnoticed and, as Freud puts it, the greatest ally of the analysis when understood. Agreeing that the main work of the analysis consists in analysing the transference phenomena, although differing about how this results in a cure -that the transference is a strictly interpersonal experience. Freud gives the impression that under the stress of the repetition-compulsion the patient is bound to repeat the identical pattern, despite the other person. Thus and so, I believe that the personality of the analyst tends to decide the character of the transference illusion, and especially to figure out whether the attempt at analysis will result in a cure. Horney has shown that there is no valid reason for assuming that the tendency to repeat experiences repeatedly has an instinctual basis. The particular character of the person requires that he integrate with any given situation according to the necessities of his character structure-and the implications of in the psychoanalytic therapy.
Transference, and its use in therapy, has now become necessary to begin at the beginning, and to point out in a very schematic way how a person finds his particular orientation to himself and the world-which one might call his character structure.
The infant is born without a frame of reference, as far as interpersonal experience goes. He is already acquainted with the feelings of bodily movement-with sucking and swallowing-but, among other things, he has had no knowledge of the existence of another person in relationship of himself. Although I do not wish to draw any particular conclusions from this analogy, however, to mention a simple phenomenon, described by Sherif, connected with the problem of the frame of reference. If you have a completely dark room, with no possibility of any light being seen, and you then turn on a small-pin-point of light, which is kept stationary, this light will be moving about. It is certainty with which many of you have noticed that this phenomenon when gazing at a single star. The light seems to move, and it does so, apparently, because there is no reference point in relation to which one can establish it at a fixed place in space and time. It just wanders around. If, however, one can at the same time see some light as a fixed object in the room, the light immediately becomes stationary-its reference point becomes the centre of a fixed frame reference from which its orientation from a pin-of-light, soon becomes the reference point in which has been established, and there is no longer any uncertainty of wandering of the spot of light. It is fixed. The pinned-point of light wandering in the dark room is symbolic of the original attitude of the person to himself, undetermined, unstructured, with no reference points.
The new-born infant probably perceives everything in a vague and uncertain way, including himself. Gradually, reference points are established that a connection begins to occur between hunger and breast, between a relief of bladder tension and a wet diaper, between plating with his genitals and a smack on the hand. The physical boundaries and potentialities of the self are explored. One can observe the baby investigating the extent, shape and potentialities of his body. He finds that the realm of him and his other will come, or will not come, in that he will in spite hold his breath. Everything will get excited that he can smile and speak lovingly? People will be enchanted, or just the opposite? The nature of the emotional reference points that the determiner depends upon the environment. By that still unknown quality called “empathy,” he discovers the reference points that help to figure out his emotional attitude toward himself. If his mother did not want him, is disgusted with him, treats him with utter disregard, he comes to look upon himself as a thing-to-be-disregarded. With the profound human drive to make this rationally, he gradually builds up a system of “reasons why.” Underneath all these “reasons” is a basic sense of worthlessness, undetermined and undefined, related directly to the origin reference frame. Another child discovers that the state of being regarded is dependent upon specific factors-all is well if one does not act spontaneously, since one is not a separate person, since one is good, as the state of being good is continuously defined by the parents. Under these conditions, and these only, this child can feel a sense of self-regard.
Other people are encountered with the original reference frame in mind. The child tends to carry over into later situations the patterns he first learned to know. The rigidity with which these original patterns are retained depends upon the nature of the child’s experience. If this had been a traumatic character so that spontaneity has been blocked and further emotional development has been inhibited, the original orientation will tend to persist. Discrepancies may be rationalized or repressed. Thus, the original impression of the hostile mother may be retained, while the contact with the new person is rationalized to fit the original reference frame. The new person encountered acts differently, but probably that is just a pose. She is just being pleasant because she does not know me. If she really knew me, she would act differently. Or, the original impressions are so out of line with the present actuality, that they remain unconscious, but make themselves apparently inappropriate in behaviour or attitudes, which remain outside the awakening awareness of the person concerned.
The incongruity of the behaviour, or of the attitude, may be a souse of astonishment to the other person involved. Sullivan provides insight into the process by the elucidation of what he calls the “parataxic distortions.” He points out that in the development of the personality, certain integrative patterns are organized in response to the important persons in the child’s past. There is a “self-in-relation-to-A” pattern, or “self-in-relation-to -B” pattern. These patterns of response become familiar and useful. The person learns to get along as a “self-in-relation-to A” or B, C, D and E, depending on the number of important people to whom he had to adjust during his early development. For example, a young woman, who had a severely dominating mother and a weak, kindly father, learned a pattern of adjustment to her mother that could be briefly described as submissive, mildly rebellious in a secret way, but mostly lacking in spontaneity. Toward the father she developed loving, but contemptuous attitude. When she encountered other people, whatever sex, she oriented herself to them partly as the real people they were, and partly as she had learned to respond to her mother and father in the past. She thus was feeling toward the real person involved as if she were dealing with two people at once. However, since it is very necessary for people to behave as rational persons, she suppressed the knowledge that some of her reactions were inappropriate to the immediate situation, and wove an intricate mesh of rationalizations, which permitted her to believe that the person with whom she was dealing really was someone either to be feared and submitted to, as her mother, or to be contemptuous of, as her father. To a greater extent, the real person fitted the original picture of the mother and father, the easier it was for her to maintain that the original “self-in-reflation-to-A-or-B” was the real and valid expression of herself.
It happened, however, that this woman had, had a kindly nurse who was not a weak person, although occupying an inferior position in the household. During the many hours when she was with this nurse, she can experience a great deal of undeserved warmth, and of freedom for self-realization, no demands for emotional conformity were made on her or his relationship. Her own capacities for love and spontaneous activity could flourish. Unfortunately, the contact with this nurse was all too brief. Still, they’re remained, despite the necessity for the rigid development of the patterns toward the mother and father, a deeply repressed, but still vital experience of self, which most closely approximated the fullest realization of her potentialities. This, which one might call her “real self,” although “snowed under” and impeded by all the distortions incurred by her relationship to the parents, was finally able to emerge and become again active in analysis. In this treatment, she learned how much her reactions to people were “transference” reactions, or as Sullivan would say, “parataxic distortions.”
Of course, a deliberate schematization was made to illustrate the earliest frames of reference and then, least of mention, the parents are not overlooked as to other possible reference frames. Also, one has to realize that one pattern connects with another-the whole making a tangled mass that only years of analysis may buoyantly unscramble. Also, an attemptive glimpse into what has not taken of its time to outline the compensative drives that the neurotic person has to develop to handle his life situation. Each compensatory manoeuver causes some change in his frame of reference, since the development of a defensive trait in his personality sets off a new set of relationships to those around him. The little child who grows ever more negativistic, because of injuries and frustrations, evokes more hostility in his environment. However, and this is important, the basic reactions of hostility by the parents, which originally induced his negativism, are still there. Thus, the pattern does not change much in character, and it just gets worse in the same direction. Those persons whose later life experiences perpetuate the original; frames of reference are more severely injured. A young child, who has a hostile mother, may then have a hostile teacher. If, by good luck, she got a kind teacher and if his own attitude was not already badly warped, so that he did not induce hostility in this kind teacher, he would be introduced into a startlingly new and pleasant frame of reference. His personality might not suffer too greatly, especially if a kindly aunt or uncle happened to be around. Surely, that if the details of the life histories of healthy people were studied, it would be found that they had some very satisfactory experiences early enough to establish in them a feeling of validity as persons. The profoundly sick people have been so early injured, in such a rigid and limited frame of reference, that they are not able to use kindliness, decency or regard when it does come their ways. They meet the world as if it were potentially menacing. They have already developed defensive traits entirely appropriate to their original experience, and then carry them out in completely inappropriate situations, rationalizing the discrepancies, but never daring to believe that people are different to the ones they early learned to distrust and hate. Because of bitter early experience, they learn to let their guards down, never to permit intimacy, lest at that moment the death blow would be dealt to their already partly destroyed sense of self-regard. Despairing of real joy in living, they develop secondary neurotic goals that a pseudo-satisfaction. The secondary gains at first glance might be what the person was really striving for-revenge, powerfulness and exclusive possession. Actually, these are but the expressions of the deep injuries sustained by the person. They cannot be fundamentally cured until those interpersonal relationships that caused the original injury are brought back to consciousness in the analytic situation. In stages, each phase of the long period of emotional development is exposed, by no means chronologically, the interconnectivity in overlapping reference frames is made conscious, those points at which a distortion of reality, or a repression of part of the self had to occur, are uncovered. The reality gradually becomes 'undistorted', the self, refound, in the personal relationship between the analyst ant the patient. This personal relationship with the analyst is the situation in which the transference distortions can be analysed.
In Freud’s view, the transference was either positive or negative, and was related in an isolated way to a particular person in the past. Perhaps, the transference is the experiencing in the analytic situation the entire pattern of the original reference frames, which include at every moment the relationship of the patient to himself, to the important persons, and to others, as he experienced them at the time, in the light of his interrelationships with the important people.
The therapeutic aim in this process is not to uncover childhood memories that will then lend themselves to analytic interpretation-the important difference to Freud’s view. Fromm has pointed this out in a recent lecture. Psychoanalytic cure is not the amassing of data, either from childhood, or from the study of the present situation. Nor does cure resolve itself from a repetition of the original injuries’ experience in the analytic relationship. What is curative in the process is that in tending to reconstruct with the analyst the atmosphere that obtained in childhood, the patient achieves something new. He discovers that part of himself that had to be repressed at the time of the original experience. He can only do this is an interpersonal relationship with the analyst, which is suitable to such a rediscovery. To illustrate this point, If a patient had a hostile parent toward whom he was required to show deference, he would have to repress certain of his own spontaneous feelings. In the analytical situation, he tends to carry over his original frame of reference and again tends to feel himself to be in a similar situation. If the analyst’s personality in addition contains elements of a need for deference that need will be the unconscious implication as imparted to the patient, who will, therefore ease the repressive magnitude of his spontaneity as previously he was the same benevolence. True enough, he may act or try to act as if analysed, since by definition, that is what the analyst is attempting to accomplish. Nevertheless, he will never have found his repressed self, because the analytical relationship contains for him elements actually identical with his original situation. Only if the analyst provides a genuinely new frame of reference-that is, if he is truly non-hostile, and truly not in need of deference-can this patient discover, and it is a real discovery, the repressed elements of his own personality. Thus, the transference phenomenon is used so that the patient will completely re-experience the original frames of reference, and himself within those frames, in a truly different relationship with the analyst, to the end that can discover the invalidity of his conclusions about himself and others.
That is not to mean that this is to deny the correctness of Freud’s view of the transference, yet acting as a resistance is a matter of fact, in that the tendency of the patient to reestablish the original reference frame is precisely because he is afraid to experience the other person in a direct and unreserved way. He has organized his whole system of getting along in the world. Bad as that system might be, based on the original distortions of his personality and his subsequent vicissitudes. His capacity for spontaneous feeling and a ting has gone into hiding. Now it has to be sought. If some such phrases as the 'capacity for self-realizations' are substituted in place of Freud’s concept of the repressed libidinal impulse, much the same conclusions can be reached about the way in which the transference-manifestations appear in the analysis as resistance. It is just in the safest situation, where the spontaneous feeling might come out of hiding, that the patient develops intense feelings, sometimes of a hallucination character, that relate to the most dreaded experiences of the past. It is at this point that the nature and the use by the patient of the transference distortions have to be understood and correctly interpreted by the analyst. It is also here that the personality of the analyst modifies the transference reaction. A patient cannot feel close to a detached or hostile analyst and will therefore never display the full intensity of his transference illusions. The complexity of this process, by which the transference can be used as the therapeutic instrument and, while, as a resistance may be illustrated by an example through which a patient having had developed intense feelings of attachment to a father surrogate in his everyday life. The transference feelings toward this man were of great value in explaining his original problem with his real father. As the patient became more aware of his personal validity, he found his masochistic attachment to be weakening. This occasional acute feeling of anxiety, since his sense of independence was not yet fully established. At that point, he developed very disturbing feelings regarding the analyst, believing that she was untrustworthy and hostile, although before this, he has successes in establishing a realistically positive relationship to her. The feelings of untrustworthiness precisely reproduced an ancient pattern with his mother. He experienced them at this point in the analysis to retain and to justify his attachment to the father figure, the weakening of which attachment had threatened him so profoundly. The entire pattern was explained when it was seen that he was re-experiencing an ancient triangle, in which he was continuously driven to a submissive attachment to a dominating father, due to the utter untrustworthiness of his weak mother. If the transference character of his sudden feeling of untrustworthiness of the analyst had not been clarified, he would have turned again submissively to his father surrogate, which would have further postponed his development of independence? Nonetheless, the development of his transference to the analyst brought to light a new insight.
To the fundamental direction upon which Freud’s view of the so-called narcissistic neurosis, was that Freud felt that personality disorders called schizophrenia or paranoia cannot ne analysed because the patient is unable to develop a transference to the analyst. Yet nonetheless, it is viewed as that of a real difficulty in treating such disorders that the relationship is essentially nothing but transference illusions of reality. Nowhere in the realm of psychoanalysis can one find complete proof of the effect of early mention experience on the person that in attempting to treat these patients. Frieda Fromm-Reichmann has shown in her work with schizophrenics the necessity to realize the intensity of the transference reaction, which have become almost completely real to the patient. Yet, if one knows the correct interpretations, by actually feeling the patient’s needs, one can over years of time do the identical thing accomplished more quickly than is less dramatical with patients suffering some less severe disturbances within their own interpersonal relationships.
Just for this, yet a peculiar moment is to say of what reasons was that Freud took of his position that all subsequent experiences in normal life are merely a repetition of the original one. This love is experienced for someone today about the love felt for someone in the past that it is, nonetheless, to believe this to be exactly true. The child who had to repress certain aspects of his personality enters a new situation dynamically, not just as a repetition of it. Therefore there are constitutional differences with respect to the total capacity for emotional experience, just as they are with respect to the total capacity for intellectual experiences. Given this constitutional substrate, the child engages in personal relationships, not passively as a lump of clay waiting to be moulded, but most dynamically, bringing into play all his emotional potentialities. He might find someone later whose capacity for response is deeper than his mother’s. If he is capable of that greater depth, he experiences an expansion of himself. Many later in life met a “great” person and have felt a sense of newness in the relationship with certain described to others as “wonderful” which is regarded with a certain amount of awe. This is not a “transference” experience but represents a dynamic extension of the self to a new horizon.
Ours is to discuss hypnosis a little further in detail and to make by some attributive affordance as drawn upon a few remarks about its correlation with the transference phenomenon in psychoanalytic therapy.
According to White, the subject under hypnosis is a person striving to act like a hypnotized person as that state is continuously defined by the hypnotist. He also says that the state of being hypnotized is an “altered state of consciousness.” However, as Maslow points out, it is not an abnormal state. In everyday life transient manifestations of all the phenomena that occur in hypnosis can be seen. Such examples are cited as the trance-like state a person experiences when completely occupied with an absorbing book. Among the phenomena of the hypnotic state is the amnesia for the enchantment of a trance. The development of certain anaesthetics, such as insensitivity to pain, deafness to sounds other than the hypnotist’s voice, greater ability to recall forgotten events, loss of capacity to initiate activities spontaneously, and has the greater suggestibility. This heightened suggestibility in the trance state is the most important phenomenon of hypnosis. Changes in behaviour and feeling can be induced, such as painful or pleasant experiences, headaches, nausea, or feelings of well-being. Post-hypnotic behaviour can be influenced by suggestion, this being one of the most important aspects of experimental hypnosis for the clarifying of psychopathological problems.
The hypnotic state is induced by a combination of methods that may include relaxation, visual concentration and verbal suggestion. The methods vary with the personality of the experimenter and the subject.
Maslow has pointed the interpersonal character of hypnosis, which accounts for some different conclusions by different experimenters. Roughly, the types of experimenters may be divided into three groups-the dominant type, the friendly or brotherly type, and the cold, detached, scientific type. According to the inner needs of the subject, he can probably be hypnotized more readily by one type or the other. The brotherly hypnotizer cannot, for instance, hypnotize a subject whose inner need is to be dominated.
Freud believed that the relationship of the psychological subject to the hypnotist was that of an emotional, erotic attachment. He comments on the “uncanny” character of hypnosis and says that, “the hypnotist awakens in the subject part of his archaic inheritance that had also made him compliant to his parents.” What is thus awakened is the concept of “the dreaded primal father,” “toward whom, only a passive-masochistic attitude is possible. Toward whom one’s will has to be surrendered.”
Ferenczi considered the hypnotic state to be one in which the patient transferred onto the hypnotist his early infantile erotic attachment to the parents with the same tendency to blind belief and to uncritical obedience as obtained then. He calls attention to the paternal or frightening type of hypnosis and the maternal or gentle, stroking type. In both instances the situation tends to favour the “conscious and unconscious imaginary return to childhood.”
The only point of disagreement with these views is that one does not need to postulate an erotic attachment to the hypnotist or 'transference' of infantile sexual wishes. The sole necessity is a willingness to surrender oneself. The child whose parent wished to control it, by one way or another, is forced to do this. To be loved, or to at least be taken consideration of it. The patient transfers this willingness to surrender to the hypnotist. He will also transfer it to the analyst or the leader of a group. In any one of these situations the authoritative person, is the hypnotist, analyst or leader, promises because of great power or knowledge the assurance of safety, a cure or happiness, as the case may be. The patient, or the isolated person, regresses emotionally to a state of helplessness and lack of initiative similar to the child who has been dominated.
If it is asked how in the first place, the child is brought into a state of submissiveness, it may be discovered that the original situation of the child had certain aspects that already resemble a hypnotic situation. This depends upon the parents. If they are destructive or authoritarian they can achieve long-lasting results. The child is continuously subjected to being told how and what he is. Day in and day out, in the limited frame of reference of his home, he is subjected to the repetition, often again: “You are a naughty boy.” “You are a bad girl.” “You are just a nuisance and are always giving me trouble. “You are dumb,” “you are stupid,” “you are a little fool.” “You always make mistakes.” “You can never do anything right,” or “that’s right, I love you when you are a good boy.” “That’s the kind of boy I like.” “Mother lovers a good boy who does what she tells him.” “Mother knows best. Mother always knows best.” “If you would listen to mother, you would get along all right. Just listen to her.” “Don’t pay attention to those naughty children. Just listen to your mother.”
Over and again, with exhortations to say attention, to listen, to be good, the child is brought under the spell. “When you get older, never forget what I told you. Always remember what mother says, then you will never get into trouble.” These are like Post-hypnotic suggestions. “You will never come to a good end. You will always be in trouble.” “If you are not good, you will always be unhappy.” “If you don’t do what I say, you will regret it.” “If you do not live up to the right things-again, “right” as continuously defined by the mother-you will be sorry.”
Hypnotic experiments, according to Hull, for many reasons, including that of learning the uses and misuses of language, there is a marked rise of verbal suggestibility up to five years, with a sharp dropping off at around the eighth year. Ferenczi refers to the subsequent effects of threats or orders given in childhood as “having much in common with the Post-hypnotic command-automatisms.” Pointing out how the neurotic patient follows out, without being able to explain the motive, a command repressed long ago, just as in hypnosis a Post-hypnotic suggestion is carried out for which amnesia has been produced.
Unfortunately, having had no personal experience with hypnosis, I refer only to hypnosis in discussing the transference is to further a better understanding of the analytic relationship. The child may be regarded for being in a state of “chronic hypnosis,” as described, but with all sorts of Post-hypnotic suggestions thrown in during this period. This entire pattern-this entire early frame of reference-may be “transferred” to the analyst. When this has happened, the patient is in a highly suggestible stye. Due to many intrinsic and extrinsic factors, the analyst is now in the position of a sort of “chronic hypnotist.” First, due to his position of a doctor he has a certain prestige. Second, the patient comes to him, even if expressedly unwillingly, still if there were not something in the patient that was co-operative he would not come at all, or at least he would not stay. The office is relatively quietly, external stimuli relatively reduced. The frame of reference is limited. Many analysts maintain an anonymity about themselves. The attention is focussed on the interpersonal relationship. In this relatively undefined and unstructured field the patient can discover his “transference” feelings, since he has few reference points in the analytical situation by which to go. This is greatly enhanced by having the patient assume a physical position in the room under which he does not see the analyst. Thus, the ordinary reference points of facial expression and gestures are lacking. True enough, he can look around or get up and walk about. Nevertheless, for considerable periods he lies down-itself a symbolically submissive position. He does what is called “free association.” This is again, giving up-willingly, to be sure-the conscious control of his thoughts, that is, the willingness and cooperativeness of all these acts. That is precisely the necessary condition for hypnosis. The lack of immediate reference points permits the eruption into consciousness of the old patterns of feeling. The original frame of reference becomes more clearly outlined and felt. The power that the parent originally has to cast the spell is transferred to the analytical situation. Now it is the analyst who can do the same thing-placed there partly by the nature of the external situation, partly by the patient who comes to be freed from his suffering.
There is no such thing as an important analyst, nor is the idea of the analyst’s acting as a mirror anything more than the “neatest trick of the week.” Whether intentionally or not, whether conscious of it or not, the analyst does express, day in and day out, subtle or overt evidences of his own personality in relationship to the patient.
The analyst may express explicitly his wish not to be coercive, but if he has an unconscious wish to control the patient, analysing and to resolve the transference distortions is impossible for him correctly. The patient is thus not able to become free from his original difficulties and for lack of something better adopts the analyst as a new and less dangerous authority. Then the situation occurs in which it is not “my mother says” or “my father says,” but now “my analyst says.” The so-called chronic patients who need lifelong support and may benefit by such a relationship, however, that frequently the long-continued unconscious attachment-by which is not meant of any genuine affection or regard-is maintained because of a failure on the analyst’s part to recognize and resolve the sense of being uttered of a sort of hypnotic spell that originated in childhood.
To develop an adequate therapeutic interpersonal relationship, the analyst must be without those personal traits that tend to perpetuate the originally destructive or authoritative situation unconsciously. Besides this, he must be able, because of his training, to be aware of every evidence of the transference phenomena, and lastly, he must understand the significance of the hypnotic-like situation that analysis helps to reproduce. If, with the best of intentions, he unwittingly uses the enormous power with which he is endowed by the patient, he may certainly achieve something that looks like change. His suggestions, exhortations and pronouncements based on the patient’s revelation of himself, may be certainly makers an impression. The analyst may say, “You must not do this just because I say so.” That is a sort of Post-hypnotic command. The patient then strives to be “an analysed person acting on his own account”-because he was told to do so. He is still not really acting on his own.
It is to my firm conviction that the analysis is terminable. A person can continue to grow and expand all his life. The process of analysis, however, as an interpersonal experience, has a definite end. That an end is achieved when the patient has rediscovered his own self as an activity and independently functioning entity.
Transference problems concerning to most psychoanalytic authors maintain that schizophrenic patient cannot be treated psychoanalytically because they are too narcissistic to develop with the psychotherapist an interpersonal relationship that is sufficiently reliable and consistent for psychoanalytic work. Freud, Fenichel and other authors have recognized that a new technique of approaching patients psychoanalytically must be found if analysts are to work with psychotics. Among those who have worked successfully in recent years with schizophrenics, Sullivan, Hill, and Karl Menninger and his staff has made various modifications of their analytic approach.
We think of a schizophrenic as a person who has had serious traumatic experience in early infancy at a time when his ego and its ability to examine reality were not yet developed. These early traumatic experiences seem to furnish the psychological basis for the pathogenic influence of the frustrations of later years. Earlier the infant lives grandiosely in a narcissistic world of his own. His needs and desires may be taken care of by something vague and indefinite which he does not yet differentiate. As Ferenczi noted they are expressed by gestures and movements since speech is yet undeveloped. Frequently the child’s desires are fulfilled without any expression of them, a result that seems to him a product of his magical thinking.
Traumatic experiences in this early period of life will damage a personality more seriously than those occurring in later childhood such as are found in the history of psychoneurotic. The infant’s mind is more vulnerable the younger and less used it ha been, furthered, the trauma is a blow to the infant’s egocentricity. In addition early traumatic experience shortens the only period in life in which an individual ordinarily enjoys the moist security, thus endangering the ability to store up as it was a reasonable supply of assurance and self-reliance for the individual’s late struggle through life. Thus is such a child sensitized considerably more toward the frustrations of later life than by later traumatic experience. So many experiences in later life that would mean little to a ‘healthy’ person and not much to a psychoneurotic, mean a great deal of pain and suffering to the schizophrenic. His resistance against frustration is easily exhausted.
Once he reaches his limit of endurance, he escapes the unbearable reality of present life by attempting to reestablish the autistic, delusional world of the infant, but this is impossible because the content of his delusions and hallucinations are naturally coloured by the experiences of his whole lifetime.
How do these developments influence the patient’s attitude toward the analyst? The analyst’s approach to him?
Due to the very early damage and the succeeding chain of frustrations that the schizophrenic undergoes before finally giving in to illness, he feels extremely suspicious and distrustful of everyone, particularly of the psychotherapist who approaches him with the intention of intruding into his isolated world and personal life. To him the physician’s approach means the threat of being compelled to return to the frustrations of real life and to reveal his inadequacy to meet them, or-still worse-a repetition of the aggressive interference with his initial symptoms and peculiarities that he has encountered in his previous environment.
In spite of his narcissistic retreat, every schizophrenic has some dim notion of the unreality and loneliness of his substitute delusionary world. He longs for human contact and understanding, yet is afraid to admit it to himself or to his therapist for fear of further frustration.
That is why the patient may take weeks and months to test the therapist before being willing to accept him.
However, once he has accepted him, his dependence on the therapist is greater and he is more sensitive about it than is the psychoneurotic because of the schizophrenic’s deeply rooted insecurity; the narcissistic seemingly self-righteous attitude is but a defence.
Whenever the analyst fails the patient from reasons to be of mention-one severe disappointment and a repetition of the chain of frustrations the schizophrenic has previously endured.
To the primitive part of the schizophrenic’s mind that does not discriminate between himself and the environment, it may mean the withdrawal of the impersonal supporting forces of his infancy. Severe anxiety will follow this vital deprivation.
In the light of his personal relationship with the analyst it means that the therapist seduced the patient to use him as a bridge over which he might be led from the utter loneliness of his own world to reality and human warmth, only to have him discover that this bridge is not reliable. If so, he will respond helplessly with an outburst of hostility or with renewed withdrawal as may be seen most impressively in a catatonic stupor.
Through reasons of change, this withdrawal during treatment is a way the schizophrenic has of showing resistance and is dynamically comparable to the various devices the psychoneurotic uses to show resistance. The schizophrenic responds to alterations in the analyst’s defections and understanding by corresponding stormy and dramatic changes from love to hatred, from willingness to leave his delusional world to resistance and renewed withdrawal.
As understandable as these changes are, they nevertheless may come quite as a surprise to the analyst who frequently has not observed their source. This is quite in contrast to his experience with psychoneurotic whose emotional reactions during an interview he usually predicts. These unpredictable changes seem to be the reason for the conception of the unreliability of the schizophrenic’s transference reactions, yet they follow the same dynamic rules as the psychoneurotic’s oscillations between positive and negative transference and resistance. If the schizophrenic’s reactions are more stormy and seemingly more unpredictable than those of the psychoneurotic, perhaps this may be due to the inevitable errors in the analyst’s approach to the schizophrenic, of which he himself may be aware, than to him unreliability of the patient’s emotional response.
Why is it inevitable that the psychoanalyst disappoints his schizophrenic patients time and again?
The schizophrenic withdraws from painful reality and retires to what resembles the early speechless phase of development where consciousness is yet crystallized. As the expression of his feelings is not hindered by the conventions, he has eliminated, so his thinking, feeling, behaviour and speech-when present-obey the working rules of the archaic unconscious. His thinking is magical and does not follow logical rules. It does not admit any, and likewise no yes: There is no recognition of space and time, as ‘I’, ‘you’ and ‘they’ are interchangeable. Expression is by symbols, often by movements and gestures rather than by words.
As the schizophrenic is suspicious, he will distrust the words of his analyst. He will interpret them and incidental gestures and attitudes of the analyst according to his own delusional experience? The analyst may not even be aware of these involuntary manifestations of his attitudes, yet they proficiently mean much of the hypersensitive schizophrenic who uses them to orient himself to the therapist’s personality and intentions toward him.
In other words, the schizophrenic patient and the therapists are people living in different worlds and on different levels of personal development with different means of expressing and of orienting themselves. We know little about the language of the unconscious of the schizophrenic, and our access to it is blocked by the very process of our own adjustment to a world the schizophrenic has relinquished. So we should not be surprised that errors and misunderstandings occur when we undertake to communicate and strive for a rapport with him.
Another source of the schizophrenic’s disappointment arises from the following: Since the analyst accepts and does not interfere with the behaviour of the schizophrenics, his attitude may lead the patient to expect that the analyst will assist in carrying out all the patients’ wishes, though they might not be his interest, or to the analyst’s and the hospital’s in their relationship to society. This attitude of acceptance so different from the patient’s experiences readily fosters the anticipation that the analyst will try to carry out the patient’s suggestions and take his part, even against conventional society should give occasion to arise. Frequently, agreeing with the patient's wish to remain unbathed and untidy will be wise for the analyst until he is ready to talk about the reasons for his behaviour or to change spontaneously. At other times, he will unfortunately be unable to take the patient’s part without being able to make the patient understands and accept the reasons for the analyst’s position.
If, however, the analyst is not able to accept the possibility of misunderstanding the reactions of his schizophrenic patient and in turn of being misunderstood by him, it may shake his security with his patient. The schizophrenic, once accepted the analyst and wants to rely upon him, will sense the analyst’s insecurity. Being helpless and insecure himself-in spite of his pretended grandiose isolation-he will feel utterly defeated by the insecurity of his would-be helper. Such disappointment may furnish reasons for outbursts of hatred and rage that are comparable to the negative transference reactions of psychoneurotic, yet more intense than these since they are not limited by the restrictions of the actual world.
These outbursts are accompanied by anxiety, feelings of guilt, and fear of retaliation that in turn lead to increased hostility. Thus, is established a vicious circle: We disappoint the patient: He hates us, is afraid we hate him for his hatred and therefore continues to hate us. If in addition he senses that the analyst is afraid of his aggressiveness, it confirms his fear that he is actually considered dangerous and unacceptable, and this augments his hatred.
This establishes that the schizophrenic can develop strong relationships of love and hatred toward his analyst. After all, one could not be so hostile if it were not for the background of a very close relationship, once to emerge from an acutely disturbed and combative episode. In addition, the schizophrenic develops transference reaction in the narrower sense that he can differentiate from the actual interpersonal relationship.
What is the analyst’s further function in therapeutic interviews with the schizophrenic? As Sullivan has stated, he should observe and evaluate all of the patient’s words, gestures, changes of attitude and countenance, ad he does the associations of psychoneurotics. Every production-whether understood by the analyst or not-is important and makes sense to the patient. Therefore the analyst should try to understand, and let the patient feel that he tries. He should as a rule not attempt to prove his understanding by giving interpretations because the schizophrenic himself understands the unconscious meaning of his productions better than anyone else. Nor should the analyst ask questions when he does not understand, for he cannot know what trend of thought, far off dream or hallucination he may be interpreting. He gives evidence of understanding, whenever he does, by responding cautiously with gestures or actions appropriate to the patient’s communication, for example, by lighting his cigarette from the patient’s cigarette instead of using a match when the patient seems to show a wish for closeness and friendship.
What has been said against intruding into the schizophrenic’s inner world with superfluous interpretations also holds true for untimely suggestions? Most of them do not mean the same thing to the schizophrenic that they do to the analyst. The schizophrenic who feels comfortable with his analyst will ask for suggestions when he is ready to receive them. While he does not, the analyst does better to listen. Least of, the schizophrenic’s emotional reactions toward the analyst have to be met with extreme care and caution. The love that the sensitive schizophrenic feels as he first emerged, and his cautious acceptances of the analyst’s warmth of interest are really most delicate and tender things. If the analyst deals unadroitly with the transference reactions of a psychoneurotic, it is bad enough, though as a rule reparable, but if he fails with a schizophrenic in meeting positive feelings by pointing it out for instance before the patient suggests that he be ready to discuss it, he may easily freeze to death what had just begun to grow and so destroy any further possibility of therapy.
Sometimes the therapist’s frank statement that he wants to be the patient’s friend but that he is going to protect himself should he be assaulted may help in coping with the patient’s combativeness and relieve the patient’s fear of his own aggression. As, too, some analysts may feel that the atmosphere of complete acceptance and strict avoidance of any arbitrary denials that we recommend as a basic rule for the treatment of schizophrenics may not accord with our wish to guide them toward reacceptance of reality. This may not be as apparently so. Certain groups of psychoneurotics have to learn by the immediate experience of analytic treatment how to accept the denials life has in store for each of us. The schizophrenic has above all to be cured of the wounds and frustrations of his life before we can expect him to recover.
Other analysts may feel that treatment as we have outlined it is not psychoanalysis. The patient is not instructed to lie on a couch, he is not asked to give free associations (although frequently he does), and his productions are seldom interpreted other than by understanding acceptance. Freud says that every science and therapy that accept his teachings about the unconscious, about transference and resistance and about infantile sexuality, may be called psychoanalysis. According to this definition we believe we are practising psychoanalysis with our schizophrenic patients.’
Whether we call it analysis or not, successful treatment clearly does not depend on technical rules of any special psychiatric school but on the basic attitude of the individual therapist toward psychotic persons. If he meets them as strange creatures of another world whose productions are non-understandable to ‘normal’ beings, he cannot treat them. If he realizes, however, that the difference between himself and the psychotic is only one of degree and not to kind, he will know better how to meet him. He can probably identify himself sufficiently with the patient to understand and accept his emotional reactions without becoming involved in them.
Countertransference was once considered a hindrance to analytic work. Now, though controversies still exist about, what constitutes its optimal use, and though there are real dangers of misuse, countertransference is recognized by most of analysts not only as integral to the analytic relationship, whether or not it is in awareness, but as a potentially powerful and often crucial analytic tool. In some instances’ sensitivity to Countertransference nay be the only basis for tuning into the patient to be able to achieve an analytic possibility.
It seems, but not fully understood to why the belief that the problem of countertransference resistance itself not only precludes using countertransference data in facilitating ways in the analysis, but also increases the likelihood that countertransference will affect the work in less than optimal ways. It can constitute one of the gravest threats to analytic work.
Countertransference resistance often arises when awareness of countertransference requires us to face aspects of ourselves and our feelings that may be threatening. In this regard it is interesting that positive emotions can be as threatening as negative ones. Every bit as justly evident as in as early as of 1895 in Breuer’s treatment of patient Anna O.
Countertransference resistance includes, of course, resistance to awareness of collusive involvements. It can involve identification and reaction formation, or defences such as a detachment, resistance to awareness of one’s own affective reactions, or resistance to awareness of particular nuances of the transference-countertransference interaction. Occasionally, however, countertransference resistance may involve resistance not simply to awareness of one’s own reactions, but also to allowing any kind of emotional engagement with the patient. It might be that in such instances thinking of this kind of analyst is more accurate “detachments” as a form of countertransference itself.
Alternatively, Countertransference resistance may reflect the analyst’s basic assumptions about the analytic task-the principle of neutrality is understood as requiring no, or minimal, emotional responsiveness by the analyst, for others neutrality is defined in term s of how the analyst uses his or her reactions, the assumption being that these are inevitable. From the former perspective an analyst’s emotional response can be viewed as evidence of a failure to maintain the proper analytic stance. As for the latter, the taboo on affective experience is seen as preventing the analyst from using himself as a sensitive analytic instrument, and as precluding the kind of affective engagement that may be essential. The latter view draws upon Heimann’s (1950) observation that: The emotions roused in [the analyst] are much nearer to the central issue than his reasoning, or to put it in other words, his unconscious perception of the patient’s unconscious is more acute and before his conscious conception of the situation . . . the analyst’s emotional response to his patient within the analytic situation represents one of the most important tools for his work.
It seems that the analyst’s ability to respect and use his or her awareness of whatever is begun internally while the work becomes a source of power and strength. From this perspective, even when we know our own issues are involved, we still can gain important information if we consider why with this patient and not others, and why now with this patient and not this patient at other times.
A common example of this kind of countertransference resistance involves those moments when the analyst may be overcome with sleepiness and him or she never relates it to being with the patient. Sometimes we become alert to this the session following when we find to our great surprise that we are suddenly wide awake. Only then does the sleepy response in the prior session was apparently very specific to the earlier interaction. This, of course, allows us to see this awareness as a basis for structuring an analytic exploration.
We learn from these experiences that even when it may seem to us that our reactions are independent of the immediate context, which we are tired or distracted because of our own preoccupations, or that we are at the mercy of our own pathology, it is usually prudent to consider how our experience may be responsible to the interactive subtleties of the immediate moment.
Failure to consider that our feeling tired or distracted might be to some subtle development in the interaction may actually reflect a wish to avoid dealing with the anxieties of the moment or possible anxiety about being vulnerable to the patient’s impact. If this is the case then the real issue in such instances may actually be the countertransference resistance. In such instances tracking the interactive subtitles as they evolve between analyst and patient requires a collaborative engagement as it touches on aspects of the interaction that neither patient nor analyst could illuminate on his or her own-because patients tune into the analyst and the analyst into them, how the analyst deals with his own Countertransference obviously reveals a great deal about the analyst’s relation to his own experience and about his trustworthiness and authenticity, which also has impact. As early as 1915, Freud wrote: “ . . . Since we demand strict trustfulness from our patients, we jeopardize our whole authority if we let ourselves be caught out by them in a departure from the truth.” (1915)
In this regard, Ferenczi (1933) emphasized that patients: “show a remarkable, almost clairvoyant knowledge about the thoughts and emotions that go on in their analyst’s mind. To deceive a patient it seems hardly possible and if one tries to do so, it leads only to bad consequences.”
Lacan’s (1958) view is that “the inability to sustain a praxis in an authentic manner result as often happens with humans, in the exercise of power”:
Little (1951) approached the same issue from yet another angle, she wrote”: It is [the] question of a paranoid or phobic attitude toward the analyst’s own feelings that lay the groundwork for the greater danger and difficulty in countertransference. The very real; fear of being flooded with feelings of any kind, rage, anxiety, love, etc., in relation to the patient and of being passive to it and at its mercy leads to an unconscious avoidance or denial, honest recognition of such feeling is. Essential to the analytic process, and the analysand is naturally sensitive to any insincerity in his analyst and will inevitably respond to it with hostility. He will, identify with the analyst in it (by introjection ) for denying his own feelings and will exploit it generally in every way possible, to the detriment of his analyst.
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