June 1, 2011

PAGE 2

The most consistent thing would have been to do away entirely with this new useless rudiment of an earlier time, and to give up the terminology, which had become dear to most analysts, in favour of a better understanding. Instead of doing this, the whole of mental life was often regarded as a mosaic of such plexuities, and the analysis then carried out with the object of ‘analyzing out’ one complex after the other, or the attempt was make of treating the whole personality as a sum total of father-mother, brother and sister complexes. It was naturally easy to collect material for these, since every one has, of course, all the plexuities, that is, every one must, in the course of his development, somehow get on with the persons and object that surround him. The connected recounting of plexuity, or the attributes of these, may have its place in descriptive psychology, but not in the practical analysis of the neurosis, nor does it even belong in the psychoanalytic study of literary or ethno-psychological products, where it must undoubtedly lead to monotony in no way justified by the many-sidelines of the material, and scarcely tempered by giving preference, first to one and then to the other complex.

Although such a flattening out may have to be put up with at times, as unavoidable in a scientific presentation, one should not therefore transfer such a cramped interest into the technique. The analysis of plexuities easily misleads the patient into being pleasing to his analyst, by bringing him ‘complex material’ as long as he likes, without giving up any of his really unconscious secrets. Thus there came to be histories of illnesses In which the patient recounted memories, evidently fabricating them, in a way that never happens in unprejudiced analyses, and can only be looked upon as the product of such a ‘breeding of plexuity’. Such results should naturally not be used subjectively either to show the correctness of one’s own method of interpreting, or as theoretic conclusions, not yet as leading to any sort of evidence.

It happens particularly frequently that the associations of the patient were directed to the sexual factor at the wrong time, or that they remained stuck at this point, if as so often happens - he came to the analysis with the expectation that he must constantly talk exclusively of his actual or infantile sexual life. Aside from the fact that this is not so exclusively the case as our opponents think, permitting such an indulgence in the sexual often gives the patient the opportunity to paralyze the therapeutic effect of the privation he must undergo.

An understanding of the many-sided and important mental contents that underlie the collective name ‘castration complex’ was also not exactly furthered by bringing the theory of the complexes into the dynamics of the analysis. On the contrary, we are of the opinion that the premature theoretic condensation of the fact under the conception of the complex interfered with the insight into deeper layers of mental life. We believe that the full appreciation of that which the analytic practitioner has accustomed himself to finish off with the label castration complex, is still lacking, so that this attempt at an explanation should not lightly be regarded as the ultimate explanation of such varied mental phenomena and processes of the patient. We can, from the dynamic standpoint which is the only justifiable one in practice, often recognized in the forms of expression of the castration complex, so they manifest themselves in the course of the analysis, only one of the kinds of resistance that the patient erects against his deeper libidinal wishes. In the early stages of some analyses the castration anxiety can often be uncovered as an expression of the dread, transferred onto the analyst, as a protection against further analysis.

Technical difficulties arose also from the analyst’s having too much knowledge. thus the importance of the theory of sexual development constructed by Freud, misled some analysts to apply in a mistaken and over-dogmatic fashion in the therapy of the neuroses, certain systems of organization and autoeroticism, which first gave us an understanding of normal sexual development . In this searching for the constructive elements of the theory of sex, in some cases, the actual analytic task was neglected. These analyses might be compared to psychochemical ‘elements analyses’. Here, again, one could see that the theoretical importance did not always correspond to the value in the practical analysis. The technique need not methodically lay bare all the, . . .as it were, prescribed historic phases of the development of the libido, still less should the uncovering of all theoretically established details and gradations be used as a principle of healing in the neuroses. It is also practically superfluous to demonstrate all the original elements of a highly complicated ‘connection’, while missing the intellectual thread, which combines the few fundamental elements into new and varying phenomena. The same thing holds for the erotogenic zones as for the plexuity, for example the urethral or the anal erotic, and for the stages of organization the oral eroticism anal-sadistic and other pregenital phases, there can be no human development without all of these, but one must not in the analysis attribute to the importance, for the history of the illness, of which the resistance under the pressure of the analytic situation gives the illusion.

On closer observation a certain inner connection between ‘element analyses’ and ‘complex analyses’ could be recognize , insofar as the latter, in their attempts to plumb the psychic depths, struck upon the granite of the complexes and thus the work was spread out over the surface instead of going to the bottom. Such analyses then usually tried to make up for the lack of depth in the dynamics of the libido by an excursion into the theory of sex, and united rigid attributes of complexes with equally schematically treated principles of the theory of sex, whereas they missed just the play of forces that takes place between the two.

Such an attitude naturally led to a theoretical over-estimation of the factor of quantity, to ascribe everything to a stronger organ - eroticism, a point of view that resembled that of the pre-analytical school of neurologists - who blinded themselves to any insight into actual play of forces of the pathological cayuses by the catch words inheritance, degeneration, and disposition.

Since the theory of the instincts and also the sciences of biology and physiology have been called upon partly as a help in understanding mental phenomena, in particular since the so-called ‘pathoneurosen’, that is the neurosis on the organic level, the organ-neuroses, and even organic illnesses are treated psychoantically, disputes about border-line cases have taken place between psychoanalysis and physiology. The stereotyped translation of physiological processes into the language of psychoanalysis is incorrect. Insofar as one attempts to approach organic processes analytically the rules of psychoanalysis must be strictly adhered to, as one must try to forget, so to speak, one’s organic, medical and physiological knowledge and bear in mind only the mental personality and its reactions.

It was also confusing when simple clinical facts were at once combined with speculations about becoming, being, and duration and such deliberations treated like established rules in practical analysis, whereas Freud himself constantly emphasized the hypothetical character of his last synthetic works. Often enough such a wandering into speculation seems to have been a dodging of uncomfortable technical difficulty. We know how a desire to condense everything prematurely under a speculative principle can wreak vengeance from the point of view of technique (The Jungian theory).

It is also a mistake, while neglecting the individual, in the explanation of the symptoms, to make cultural and phylogenetic analogies at once, no matter how fruitful the latter might be in themselves. The overestimate of the actual factors led to an anagogic prospective interpretation, which was useless so far as the pathologic fixation were concerned. The adherents of the ‘anagogic’, as well as some of those of the ‘genetic’ school, in their interest in the future and in the past, neglected the present condition of the patient. and yet almost all of the past, and everything that the unconscious attempts, insofar as it is not directly conscious or remembered (and this occurs extremely seldom), expresses itself in actual reactions in relation to the analyst or to the analysis, in other words, the transference to the analytic situation.

The requirements of the Breuer-Freud catharsis that the affects, displace upon symptoms, should be led back directly to the pathologic memory traces, and at the same time brought to a discharge and bound again proved to be unrealizable, that is, it succeeds only in the case of incompletely repressed, mostly preconscious memory material as in the case of certain derivatives of the actual unconscious. This itself, the uncovering of which is the chief task of the analysis, since it was never ‘experienced’ can never be ‘remembered’, one must let it be produced on the ground of certain indications. The mere communication, something like ‘reconstruction’, is itself not suited to call forth affect reactions: Such information glides off from the patients without any effect. They can only convince themselves of the reality of the unconscious when they have experienced - mostly after they have frequently experienced - something analogous to it in the actual analytic situation, that is, in the present. The new insight into the topography of mental life and the functions of the separate depth levels gives us the explanation for this state of affairs. The unconscious repressed material has no approach to motility, nor to those motor innervations in the sum total of which the affect discharge consists, the past and the repressed must find their representative factors in the present and the conscious (preconscious) in order that they may be affectively experienced and develop further. In contrast to the stormy abreaction one could designate the unwinding bit by bit of the affects in analysis as a reactional catharsis.

In general, that affects in order to work convincingly must first be revived, that is actually present and that what has not affected us directly and actually must remain mentally ineffective.

The analyst must always take into account that almost every expression of his patients springs from several periods, but he must give his chief attention to the present reaction. Only from this point of view can he succeed in uncovering the roots of the actual reaction in the past, which means changing the attempts of the patient to repeat into remembering. In this process be need pay little attention to the future. One may quietly leave this care to the person himself who has been sufficiently enlightened about his past and present mental strivings. The historic, cultural and phylogenetic analogies also need, for the most part, not be discussed in the analysis. The patient need hardly ever, and the analyst extremely seldom, occupy himself with this early period.

At this place we must consider certain misunderstandings about the enlightenment of people who are being analyzed. There was a phase, in the development of psychoanalysis, in which the goal of the analytic treatment consisted in filling the gaps in the memory of the patient with knowledge. Later recognizes that the neurotic ignorance proceeded from the resistance, that is from not wishing to know, and that it was this resistance that had to be constantly uncovered and made harmless. If one proceeds thus the amnesic gaps in the chain of memories fill themselves in, for the most part automatically, for the other part with the help of sparse interpretations and explanations. The patient therefore learns nothing more and nothing other than what he needs, and in the quantity requisite to allay the predominating disturbances. It was a fatal mistake to believe that no one was completely analyzed who had not been theoretically familiarized with all the separate details of his own abnormality. Naturally it is not easy to set a boundary line up to which the instruction of the patient should be carried. Interruption of the correct analysis by formal courses of instruction may satisfy both the analyst and the patient, but cannot effect any change in the libido-attitude of the sick person. A further result of such instruction was that without noticing it, one pushed the patient into withdrawing himself from the analytical work by means of identifying himself with the analyst. The fact that the desire to learn and to teach creates an unfavourable mental attitude for the analysis is well known but should receive much serious attention.

At times one heard from analysts the complaint that this or that analysis failed on account of ‘too great resistances’ or a too ‘violent transference’. The possibility in principle of such extreme cases is admitted; we do find ourselves at times confronted with quantitative factors, which we , must in no way practically underestimate, since they play an important part in the final; outcome of the analysis, as well as in its causes. But the factor of quantity, so important in itself, can be used as a screen for incomplete insight into the play of forces that finally decide the kind of application and the distribution of those very quantities. Because Freud once uttered the sentence, ‘Everything which impedes the analysis work is resistance.’ one should not, every time the analysis comes to a standstill, simply say, ‘this is a resistance’. This resulted, particularly in patients with an easily aroused sense of guilt, in creating an analytic atmosphere in which th y, so to speak, were fearful of making the ‘faux pas’ as having a resistance, and the analyst found himself in a helpless situation. One evidently forgot another utterance of Freud’s, namely, that the analysis we must be prepared as to meet the same forces, which formerly caused the repression as ’resistance’, as soon as one sets to work to release these repressions.

Another analytical situation that one was also in the habit of labeling incorrectly as ‘resistance’ is the negative transference, which, from its very nature, cannot express itself otherwise than as ’resistance’ and the analysis of which is the most important task of the therapeutic activity. One need, of course, not be afraid of the negative reactions of the patient for they constitute, with iron necessity, a part of every analysis. Also the strong positive transference, particularly when it expresses itself in the beginning of the cure, is only a symptom of resistance that requires to be unmasked. In other cases, and particularly in the later stages of an analysis, it is an actual vehicle for bringing to light desires that have remained unconscious.

In this connection an important rule of psychoanalytic technique must be mentioned in regard to the personal relation between the analyst and the patient. The theoretic requirements of avoiding all personal contact outside if the analysis mostly led to an unnatural elimination of all human factors in the analysis, and thus again, to a theorizing of the analytic experience.

From this point of view, some practitioners all too readily failed to attribute that importance to a change in the person of the analyst, which results from the interpretation of the analysis as a mental process, the unity of which is determined by the person of the analyst. A change of analysts may be unavoidable for outer reasons in rare, exceptional cases, but we believe that technical difficulties - in homosexuals, for example - are not simple to be avoided by the choice of an analyst of the opposite sex. For in every correct analysis the analyst plays all possible roles for the unconscious of the patient; it only depends upon him always to recognize this at the proper time and under certain circumstances to make use of it consciously. Particularly important is the role of two parental images - father and mother - in which the analyst actually constantly alternatives (transference and resistance).

It is not an accident that technical mistakes occurred of frequently just in the expression of transference and resistance. One was easily inclined to let oneself be surprised at these elementary experiences in the analysis and strangely enough forgot just here the theory that had been incorrectly pushed into the foreground in the wrong place. This may also be due to subjective factors in the analysis. The narcissism of the analyst seem suited to create a particularly fruitful source of mistakes: Among others the development of a kind of narcissistic counter-transference that provokes the person being analyzed into pushing into the foreground certain things that flatter the analyst and, on the other hand, into suppressing remarks and associations of an unpleasant nature in relation to him. Both are technically incorrect, he first, because it can lead to an apparent improvement of the patient in only intended to bribe the analyst and in this way to win a libidinal counter-interest from him. The second because it keeps the analyst from the necessity of noticing the delicate indications of criticism, which mostly only venture forth hesitantly, and help the patient to express plainly or to abreact them. The anxiety and the sense of guilt of the patient can never be overcome without this self-criticism, requiring a certain overcoming of himself on the part of the analyst; and yet these two emotional factors are the essentials for bringing about and maintaining the repression.

Another form under which technical inaccessibility hid itself was an incidental remark of Freud’s to the effect that the narcissism of the patient could set limits to the degrees to which he could be influenced by the analysis. If the analysis did not progress well, one consoled oneself with the thought that the patient was ‘too narcissistic’. And since narcissism forms a connecting link between ego and libidinal strivings in all normal, as well as abnormal, mental processes, it is not difficult to find proofs in his behaviour and thoughts of the narcissism of the patient. Particularly one should not handle the narcissistically determined ’castration’ or ‘masculinity’ complexes as they set the limits for analytic solution.

When the analysis struck upon a resistance of the patient one often over-looked to what extent a pseudo-narcissistic tendency was brought into the question. The analyses of people who bring a certain theoretic knowledge a great deal of what one was theoretically inclined to scribe to narcissism, is actually secondary, pseudo-narcissistic and can continue analysis be completely solved in the parental relationship. Naturally it is necessary in doing this to take up analytically the ego-development of the patient, as it is in general, necessary in the analysis of the resistance to consider the up-to-now much-too-neglected analysis of the ego, for which Freud has recently given valuable hints.

The newness of a technical point of view introduced by Ferenczi under the name of ‘activity’ resulted in some analysts, in order to avoid technical difficulties, overwhelming the patient with commands and prohibitions, which one might characterize as a kind of ‘wild activity’. This, however, must be looked upon as a reaction to the other extreme, to holding too fast to an over-looked upon as a reaction to the other extreme, to holding too fast to an over-rigid ‘passivity’ in the matter of technique. The latter is certainly sufficiently justified by the theoretic attitude of the analyst who must at the same time be an investigator. In practice, however, this easily leads to sparing the patient the pain of necessary intervention, and to allowing him too much initiative in his associations as well as in the interpretation of his ideas.

The moderate, but, when necessary, energetic activity in the analysis consists in the analyst’s taking on, and, to a certain extent, really carrying out those rules that the unconscious of the patient and his tendency to flight prescribe. By doing this the tendency to the repetition of earlier traumatic experiences is given an impetus, naturally with the goal of finally overcoming this tendency by revealing its content. When this repetition takes place spontaneously it is superfluous to provoke it and the analyst can simply call forth the transformation of the resistance into remembering (or plausible reconstruction).

These last purely technical remarks lead back to the often-mentioned subject of the reciprocal effect of theory and practice.

I do not mean by this to deny the correctness of Freud’s view of transference also acting as a resistance. As a matter of fact, 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, on the basis of the original distortions of his personality and his subsequent vicissitudes. His capacity for spontaneous feeling and acting has gone into hiding. Now it has to be sought. If some such phase as the ‘capacity for self-realization’ is substituted in placing Freud’s concept of the repressed libidinal impulse, much the same conclusion can be reached about the way in which the transference-manifestations appear in the analysis as resistance. It is just in the satisfactory situation, where the spontaneous feeling might come out of hiding, that the patient develops intense feelings. Sometimes of a hallucinatory character, that relates to most directed experiences of the past. It is at this point that the hidden natures and the use by the patient of the transference distortion have to be understood and correctly interpreted , by the analyst. It is also, that the personality of the analyst modifies the transference reaction. A patient cannot feel close to the character hostile analyst and will therefore never display the full intensity of his transference illusions. The complexity of this process, whereby the transference can because as the therapeutic instrument and, at the same time, as a resistance may be illustrated by the following example, in his everyday life. the transference feelings towards this were of great value and elucidating his origin problems with his real father. As the patient became more and more aware of his own personal+ validity, he found this narcissistic 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 proof to this, he had succeeded 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 particular point in the analysis in order to retain and to justify his attachment to his father figure, the weakening of which attachment and threatened him so profoundly. The entire pattern was elucidated as when that which he had driven to a submissive attachment to a dominating father, due to the utter untrustworthiness of his real mother. If the transference character of this sudden feeling of untrustworthiness of the analyst had not been clarified, he would have further postponed his development of independence. Nevertheless, the development of this transference to the analyst brought to light a new insight .

Freud’s view of the so-called narcissistic neuroses, was felt that personality disorders called schizophrenia or paranoia could not be analyzed because the patient was unable to develop a transference to the analyst. However, in that the real difficulty in treating such disorders is that the relationship is essentially nothing but transference illusions. Such persons hallucinate the original frame of reference to the exclusion of reality. Nowhere in the realm of psychoanalysis can one find more complete proof of the effect of early experience of the person than in attempting to treat these patients. Frieda Fromm Reichmann has shown in her work with schizophrenics the necessity to realize the intensity of the transferee reactions, which have become almost completely real to the patient. And yet, if one knows the correct interpretation, by actually feeling the patient‘s needs, one can over years of time do the identical thing that is accomplished more quickly and less dramatically with patients suffering a less severe disturbance of their interpersonal relationship.

Another point of interest is that Freud had taken the position that all subsequent experience in normal life is merely a repetition of the original one. Thus, love is experienced for someone today in terms of the love felt for someone in the past. Perhaps, in believing that this is not exactly true, the child who has not had to repress certain aspects of his personality enters into a new situation dynamically, not just as a repetition of what he felt, say, with his mother, but as an active continuation of it, in that of believing that there are constitutional differences with respect to the total capacity for emotional experience, just as there are with respect on the total capacity for intellectual experiences. Given this constitutional substratum, the child engages in personal relationships not passively as a lump of clay waiting to be molded, but most dynamically, bringing into play all his emotional potentialities. He may possibly find someone later whose capacity for response is deeper than his mother’s. If he is capable of a greater depth, he experience s an expansion of himself. Many later in life have met a ‘great’ person and have felt a sense of newness in the relationship which is described simply as otherwise ‘wonderful’ and 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.

In considering the process of psychoanalytic cure, Freud very seriously discussed the relationship of analysis to suggestion therapy an hypnosis. He believed, that part of the positive transference could be made use of in the analysis to bring about successful result. He said, ‘In so far we readily admit that the results of psychoanalysis rest upon a basis of suggestion, only by suggestion we must be understood to mean that which we, with Ferenczi, find that it consists of influence on a person through and by means of the transference-manifestations of which he is capable. The eventual independence of the patient is our ultimate object when we use suggestion to bring him to carry out a mental operation that will necessarily result in a lasting improvement in his mental; condition’. Freud elsewhere indicated very clearly that in hypnosis, the relationship of the patient to the hypnotist was not worked through, whereas in analysis the transference to the analyst was resolved by bringing it entirely into consciousness. He also said that the patient was protected from unwitting suggestive influence of the analyst by the awakening of his own conscious resistance.

Even so, Freud describes transference as both the greatest danger and the best tool for analytic work. He refers to the work of making the repressed past conscious. Besides these two implied meanings of transference, Freud gives it a third meaning: It is in the transference that the analysand may relive the past under better conditions and in the way rectify pathological decisions and destinies. Likewise three meanings of countertransference may be differentiated. It too, may be the greatest danger and at the same time an important tool for understanding, an assistance to the analyst in his function as interpreter. Moreover, it affects the analyst’s behaviour. It interferes with his action as object of the patient’s re-experience in that new fragment of life that is the analytic situation, in which he found in the reality or fantasy of his childhood.

Lorand writes mainly about the dangers of countertransference for analytic work. He also points out the importance of taking countertransference reactions into account, for they may indicate some important subject to be worked through with the patient. he emphasizes the necessity of the analyst’s being always aware of his countertransference, and discusses specific problems such as the conscious desire to heal, the relief analysis may afford the analyst from his own problems, and narcissism and the interference of personal motives in clinical purposes. He also emphasizes the fac t that these problems of countertransference concern not only the candidate but also the experienced analyst.

Heimann deals with countertransference as a tool for understanding the analysand. The basic assumption is that the analyst’s unconscious understands that of his patient. This rapport on the deep level comes to the surface in the form of feelings that the analyst notices in response to his patient, in his countertransference. The emotional response of the analyst is frequently closer to the psychological state of the patient than is the analyst’s conscious judgment thereof.

Little discusses countertransference as a disturbance to understanding and interpretation and as in influence the analyst’s behaviour with decisive effect upon the patient’s re-experience of his childhood. She stresses the analyst ‘s tendency to repeat the behaviour of the patient’s parents and to satisfy certain needs of his own, not those of the analysand. Little emphasizes that one must admit one’s countertransference to the analysand and interpret it, and must do so not only in regard to ‘objective’ countertransference reactions (Winnicott) but also to ‘subjective ‘ ones.

Annie Reich is chiefly interested in countertransference as a source of disturbance in analysis. She clarifies the concept of countertransference and differentiates two types; ‘Countertransference in the proper sense’ and the ‘analyst’s using the analysis for acting-out purposes’. She investigate s the cause of these phenomena, and seeks to understand the conditions that lead to good, excellent or poor results in analytic activity.

Gitelson distinguishes between the analyst’s ‘reactions to the patient as a whole’ (the analyst’s ‘transference’) and the analyst’s ‘reactions to partial aspects of the patient (the analyst’s ‘countertransference’). He is concerned also with the problem of intrusion of countertransference e into the analytic situation, and states that, in general, when such intrusion occurs the countertransference should be dealt with by analyst and patient working together, thus agreeing with Little.

Weigert favours analysis of countertransference insofar as it intrudes into the analytic situation, and she advises, in advance stages of treatment, less reserve in the analyst’s behaviour and more spontaneous display of countertransference.

Briefly, is to consider countertransference in the history of psychoanalysis are that we meet with a strange fact and striking contrast. The discovery by Freud of countertransference and its great importance in therapeutic work gave to the institution of didactic analysis which became the basis and centre of psychoanalytic training. Yet countertransference received little consideration over the next forty years. Only during the last few years has the situation changed, rather suddenly, and countertransference became a subject examined frequently and with thoroughness. How is one to explain this in initial recognition. This neglect, and the recent change? Is there no reason to question the success of didactic analysis in fulfilling its function, if this very problem, the discovery of which led to the creation of didactic analysis, has had so little scientific elaboration?

These questions are clearly important, and those have personally attested of a great part of the development of psychoanalysis in the last forty years have the best right to answer them. Nonetheless, I will suggest or exemplify on or upon of only one explanation.

The lack of scientific investigation of countertransference must be due to rejection by analyst of their own countertransference - a rejection that represents unresolved struggles with their own primitive anxiety and guilt. These struggles are closely connected with those infantile ideals that survive because of deficiencies the didactic analysis of just those transference problems that latter affect the analyst’s countertransference. These deficiencies in the didactic analysis are in turn due to countertransference problems insufficiently solved in the didactic analyst. Thus, we are in a vicious circle, but we can see where a breach must be made. That is to say, that we must begin by revision of our feelings about our own countertransference and try to overcome our infantile ideals more thoroughly, accepting more fully the fact that we are still children and neurotics even when we are adults and analysts. Only in this way - by better overcoming our rejection of countertransference - can we achieve the same result in candidates.

The insufficient dissolution of these idealizations and underlying anxieties and guilt feelings leads to special difficulties when the child becomes an adult and the analysand an analyst , for the analyst unconsciously requires of himself that he be fully identified with these ideals, that it is at last, partly for this reason that oedipus complex of the child toward its parents, and of the patient toward his analysand, has been so much more fully considered than that of the parents toward their children and of the analyst toward the analysand. For the same basic reason transference has been dealt with much more than countertransference.

The fact that countertransference conflicts determine the deficiencies in the analysis of transference becomes clear if we recall that transference is the expression of the internal object relations; for understanding of transference will depend on the analyst’s capacity to identify himself both with the analysand’s impulses and defences, and with his internal object s, and to be conscious of these identification. This ability in the analyst will in turn depend upon the degree to which he accepts his countertransference, fo r his countertransference is likewise based on identification with the patient’s id and ego and his internal objects. One might also say that transference is the expression of the patient’s relations with the fantasies and real countertransference of the analyst. For just as countertransference is the psychological response to the analysand’s real imaginary transference, so also is transference the response to the analyst’s imaginary and real countertransference. Analysis of the patient’s fantasies out countertransference, which in the widest sense constitute the causes and consequence of the transference, is an essential part of the analysis of the transference. Perception of the patient‘s fantasies regarding countertransference will depend in turn upon the degree to which the analyst himself perceives his countertransference processes - on the continuity and depth of his conscious constant with himself.

Finally, the repression of countertransference (and other pathological fates that it may meet) necessarily leads to deficiencies in the analysis of transference, which in turn lead to the repression and other mishandling of countertransference soon as the candidate becomes an analyst. It is a heritage from generation to generation, similar to the heritage of idealizations and denials concerning the imagoes of the parents, which continue working even when the child becomes a father or mother. The child’s mythology is prolonge in the mythology of the analytic situation, the analyst himself being partially subject to it and collaborating unconsciously in its maintenance in the candidate.

Let us briefly consider one of these ideals in it specifically psychoanalytic expression: The ideal of the analyst’s objectivity. No one, of course, denies the existence of subjective factors in th analyst and of countertransference in itself, but there seems to exist an important difference between what is generally acknowledged in practice and the real state of affairs. The first distortion of truth in ‘the myth of thee analytic situation’ is that analysis is an interaction between two personalities in both of which the ego is under pressure from the id, the superego, and the external world, each personality has its internal and external dependencies, parents, and that of the analyst - responds to every event of the analytic situation. Besides these similarities between the personalities of analyst and analysand, there also exist differences, and one of these is in ‘objectivity’. The analyst’s objectivity consists mainly in a certain attitude toward his own subjectivity and countertransference. The neurotic (obsessive) ideal of objectivity lead to repression and blocking of subjectivity and so to the apparent fulfilment of the myth of the ‘analyst without anxiety or anger’. The other neurotic extreme is that of ‘drowning’ in the countertransference. True objectivity is based upon a form of internal division that enables the analyst to make himself (his own countertransference and subjectivity) the object of his continuous observations and analysis. This position also enables him to be relatively ‘objective’ toward the analysand.

The term countertransference has been given various meanings. They may be summarized by the state that for some authors countertransference includes everything that arises in the analysis as psychological response to the analysand, whereas for others not all this should be called countertransference. Some, for example, prefer to reserve the term for what is infantile in the relationship of the analyst with his analysand, while others make different limitation (Annie Reich and Gitelson). Hence efforts to differentiate from each other certain of the complex phenomena of countertransference lead to confusion or to unproductive discussion of terminology . Freud invented the term countertransference in evident analogy to transference, which he defined as ‘reimpressions’ or ‘re-editions’ of childhood experiences, including greater or less modifications of the original experience. hence one frequently uses the term transference for the totality of the psychological attitude of the analysand toward the analyst. We know, to be sure, that real external qualities of the analytic situation in general and of the analyst in particular, have important influences on the relationship of the analysand with the analyst, but we also know that all these present factors are experienced according to the past and the fantasy, - according. That is to say, too a transference predisposition. As determinants of the transference neurosis and, in general, if the psychological situation of the analysand toward the analyst, we have both the transference predisposition and the present real and especially analytic experiences, the transference in its diverse expressions being the resultant of these two factors.

Analogously. In the analyst there are the countertransference predisposition and the present and immediacy or the real, and especially analytic, experience; and the countertransference is the result. It is precisely this fusion of present immediacy and the past, the continuous and intimate connection of reality and fantasy, of external and internal, conscious and unconscious, that demands a concept embracing the totality of the analyst’s psychological response, and renders it advisable, at the same time, to keep for this totality of response the accustomed term ‘countertransference’. Where it is necessary for greater clarity one might say of ‘total countertransference’ and then differentiated and separate within it one aspect or another. One of its aspects consists precisely in what is transferred in countertransference; this is the part that originates in an earlier time and that is especially the infantile and primitive part within total countertransference. Another of these aspects - closely connected with the previous one - is what is neurotic in countertransference it main characteristics the unreal anxiety and the pathological defences. Under certain circumstances one might in saying of a countertransference neurosis.

To clarity better the concept of countertransference, on might start from the question of what happens, in general, in the analyst in his relationship with the patient, as one might think that everything happens that can happen in one personality faced with another. But this says so much that it says hardly anything - bearing in mind that in the analyst there is a tendency that normally predominates in his relationship with the patient: Is the tendency pertaining to his function of being an analyst, that of understanding what is happening in the patient. Together with the tendency there exist toward the patient virtually all the other possible tendencies, fears, and other feelings that one person may have toward another. The intention to understand creates a certain predisposition , a predisposition to identify oneself with the analysand, which is the basis of comprehension. The analyst may achieve this aim by identifying his ego with the patient’s ego, or put it more clearly although a certain terminological inexactitude, by identifying each part of his personality with the corresponding psychological part in the patient - his id with the patient id, his ego with the ego, his superego with the superego, accepting these identifications in his consciousness. But this does not always happen, nor is it all that happens. Apart from these identifications, which might be called concordant (or homologous) identifications, there exist also highly important identifications of the analyst’s ego with the patient’s internal objects, for example, with the superego. Adapting an expression from Helene Deutsch, they might be called complementary identifications. Such are that follows:

1. The concordant identifications are based on introjection and also projection, or, in other words, on the resonance of the exterior in the interior as justly as the outer is of the inner, on the recognition of what belongs to another as one ‘s own (‘this part of you is I’) and on the equation of what is one’s own with what belongs to another (‘this part of me is you’). The processes inherently in the complementary identifications are the same, but they refer to the patient’s objects. The greater the conflicts between the parts of the analyst’s personality, the greater are his difficulties in carrying out the concordant identifications in their entirety.

2. The complementary identifications are produced by the fact that the patient treats the analyst as an internal (projected) object, and in consequence the analyst feels treated as such: That is, he identifies himself with the object. The complementary identifications are closely connected with the destiny in the concordant identifications: It seems that to the degree to which the analyst fails in the concordant identifications and rejects them, certain complementary identifications become intensified. It is clear that rejection of a part of tendency in the analyst himself, - his aggressiveness, for instance, - may lead to a rejection of the patient’s aggressiveness (whereby this concordant identification fails) and that such a situation leads to a greater complementary identification with the patient‘s rejecting objects, toward which this aggressive impulse is directed.

3. Current usage applies the term ‘countertransference’ to the complementary identifications only: This is to say, to those psychological processes in the analysis by which, because he feels treated as and partially identifies himself with an internal object of the patient, the patient becomes an internal (projected) object of the analyst. Usually excluded from the concept countertransference are the concordant identifications, - those psychological content s that arise in the analyst by reason of the empathy achieved with the patient and that really reflect and reproduce the latter’s psychological contents. Perhaps it would be best to follow this usage, bu t there are some circumstances that make it unwise to do so. In the first place, some authors include the concordant identifications in the concept of countertransference. One is thus faced with the choice of entering upon a terminological discussion of accepting the term in this wider sense. Where for various reasons the wider sense is to be preferred. If one considers that the analyst’s concordant identifications (his ‘understanding’) are a sort of reproduction of his own past processes, especially of his own infancy, and that this reproduction or-re-experience is carried out as response to stimuli from the patient, one will b e more read y to include the concordant identifications in the concept of countertransference. Moreover, the concordant identifications are closely connected with the complementary ones (and thus with ‘countertransference‘ in the popular sense), and this fact renders advisable a differentiation but not a total separation of the term. Finally, it should be borne in mind that the disposition to empathy, - this is, to concordant identification, springs largely from the sublimated positive countertransference in the wider sense. All this suggests, then, the acceptance of countertransference as the totality of the analyst’s psychological response to the patient. if we accept this broad definition of countertransference, the difference between its two aspects as listed above, must still be defined. On the one hand we have the analyst as subject and the patient as the object of knowledge, which in a certain sense annuls the ‘object relationship’, such that is said arises in its stead the approximate union of identity between the subject’s and the object’s parts (experiences, impulses, defences). The aggregate of the processes pertaining to that union might be designed, where necessary, ‘concordant countertransference’. However, on the other hand, we have an object relationship like many others, a real ‘transference’ in which the analyst ‘repeats’ previous experiences, the patient representing internal objects of the analyst. The aggregate of these experiences, which also exist always and continually, might be termed ‘complementary countertransference’.

A brief example can be made if we are to consider in that of patient who threatens the analyst with suicide. In such situations there sometimes occur s rejection of the concordant identifications by the analyst and an identification with the threatened object. The anxiety that such a threat can cause the analyst to lead of various reactions or decence mechanisms within him, for instance, annoyance with the patient. This - his anxiety and annoyance - would be contents of the ‘complementary countertransference’. The perception of his annoyance may, in turn, originate guilt feelings in the analyst and these lead to desires for reparation and to intensification of the ‘concordant’ identification and ’concordant’ countertransference.

Moreover, these two aspects of ‘total countertransference’ have their analogy in transference. sublimated positive transference is the main and indispensable motive force for the patient’s work: It does not in itself constitute a technical problem. Transference becomes a ‘subject’, according to Freud’s words, mainly when ‘It becomes resistance, when because of resistance, it has become sexual or negative. Analogously, sublimated positive countertransference is the primary and indispensable motive force in the analyst’s work (disposing him to the continued concordant identification), and also, countertransference become a technical problem or ‘subject’ mainly when it becomes sexual or negative, and this occurs (to an intense degree) principally as a resistance - in this case the analyst’s - that is to say, as countertransference, in as much as of leading into the problematic function of the dynamics of countertransference.

Every transference situation provokes a countertransference situation, which arises out of the analyst’s identification of himself with the analysand’s (internal) objects (this is the ‘complementary countertransference’). These countertransference situations may be repressed or emotionally blocked, but probably they cannot be avoided; certainly they should not be avoided if full understanding is to be achieved These countertransference reactions are governed by the laws of the general and individual unconscious. Among these the law of talion is especially important. Thus, for example, every positive transference situation is answered by a positive countertransference: To every negative transference there responds, in one part of the analyst, a negative countertransference. It is of great importance that the analyst be conscious of this law, for awareness of it is fundamental to avoid ‘drowning’ in the countertransference. If he is not aware of it he will not be able to avoid entering into the vicious circle of the analysand’s neurosis, which will hinder or even prevent the work of therapy.

A simplified example: If the patient’s neurosis centre round a conflict with his introjected father, he will project the latter upon the analyst and treat him as his father. The analyst will feel treated as such - he will feel treated badly - and he will react internally. In part of his personality. In accordance with the treatment he receives. If he fails to be aware of this reaction, his behaviour will inevitably be affected by it, and he will renew the situation that, to a greater or lesser degree, helped to establish the analysand’s neurosis. Hence it is of the greatest importance that the analyst develop within himself an ego observer of his countertransference reactions, which are, naturally, continuous. Perception of these countertransference reactions will help him to become conscious of the continuous transference situations of the patient and interpret them rather than unconsciously ruled by these reactions, as not seldom happens. A well-known example is the ‘revengeful silence’ of the analyst. if the analyst is unaware of these interactions there is danger that the patient will have to repeat, in his transference experience, the vicious circle brought about by the projected introjection of ‘bad objects’ (in reality neurotic ones) and the consequent pathological anxieties and defences, but his transference interpretations made possible by the analyst’s of his countertransference expedience making it possible to open important breached in this vicious circle.

To return to the previous example: If the analyst is conscious of his own countertransference, he can more easily make the patient conscious of his projection and the consequent mechanisms. Interpretation of these mechanisms will show the patient that the present reality is not identical with his inner perceptions (for, if it were, the analyst would not interpret and otherwise act as an analyst), the patient then introjects a reality better than his inner world. This sort of rectification does not take place when the analyst is under the sway of his unconscious countertransference.

For some considering applications of these principles one mus t return to the question of what the analyst does during the session and what happens within him, one might say, at first thought , that the analyst liste ns. But this is not completely true, he listens most of the time, or wishes to listen, but is not invariably doing so. Ferenczi refers to this fact and expresses the opinion that the analyst’s distractability is of little importance, for the patient as such moments must certainly be in resistance. Ferenczi’s remark (which dates form the year 1918) sounds like an echo from the era when the analyst was mainly interested in the repulses, because now that we attempt to analyze resistance, the patient’s manifestations of resistance are a significant as any other of his productions. At any rate, but as Ferenczi refers is the countertransference response and deduces from it the analysand’s psychological situation. He says ’ . . . we have unconsciously reacted to the emptiness and futility if the associations given a this moment with the withdrawal of the real conscious charge’. The situation might be described as one of mutual withdrawal - which, however. Is are responses to an imagined or real psychological position of th analyst. If we have withdrawn - if we are not listening but are thinking of something else - we may utilize this event in the service if the analysis, in like any other information we acquire. And the guilt we may feel over such a withdrawal is just as analytically utilizable as any other countertransference reaction. Ferenczi’s next words, ‘the danger of the doctor’s falling asleep . . . need not be regarded as grave because we awake at the first occurrence of any importance for the treatment, are clearly intended to placate this guilt. but better than to allay the analyst’s guilt would b e to use it to promote the analysis - and so use the guilt would be the best way of alleviating it. In fact, we encounter a cardinal problem of the relation between transference and countertransference, and of the therapeutic process in general. For the analyst’s withdrawal is only an example of how the unconscious of one person responds to the unconscious of another. This response seems in part to be governed, insofar as we identify ourselves with the unconscious objects of the analysand, by the law of talion; and, insofar as this law unconsciously influences the analyst, there is danger of a vicious circle of reactions between them, for the analysand also responds ‘talionically’ in his turn, and so on without end.

Looking more closely, we see that the ‘talionic response’ or ‘identification with the aggressor’ (the frustrating patient) is a complex process. Such a psychological process in the analyst usually starts with a feeling of displeasure or of some anxiety as a response to this aggression (frustration) and, because of this feeling, the analyst identifies himself with the ‘aggressor’. By the term ‘aggressor’ we mus t designate not only the patient but also some internal object of the analyst (especially his own superego or an internal persecutor) now projected upon the patient, this identification with the aggressor, or persecutor, causes a feeling of guilt; probably it always does so, although awareness of the guilt may be repressed. For what happens is, on a small scale, a process of melancholia, just as Freud described it : The object has to some degree abandoned us, we identify ourselves with the lost object, and then we accuse the introjected ‘bad’ object- in other words, we have guilt feelings. This may be sensed in Ferenczi’s remarks, such of which mechanisms are at work designed to protect the analyst against these guilt feelings; denial or guilt (‘the danger is not grave’) and a certain accusation against the analysand for the ‘emptiness’ and ‘futility’ of his association. In this way a vicious circle - a kind of paranoid ping-pong - has entered into the analytic situation.

Two situations of frequent occurrence illustrate both the complementary and the concordant identifications and the vicious circle these situations may cause.

1. One transference situation of regular occurrence consist s in the patient’s seeing in the analyst hi s own superego. The analyst identifies himself with the id and ego of the patient and with the patient’s dependence upon his superego, and he also identifies himself with this same superego - a situation in which the patient places him - and experience domination of the superego over the patient’s ego. The relation of the ego to the superego of the superego over the patient‘s ego. The relation of the ego to the superego is, at bottom, a depressive and paranoid situation; the relation of the superego to the ego is, on the same plane, a manioc one insofar as this term may be used to designate the dominating, controlling, and accusing attitude of the superego toward the ego. In this sense we may say, broadly speaking, that to a ‘depressive-paranoid’ transference in the analysand there corresponds - as regards the complementary identification - a ‘manic’ countertransference in he analyst. This, in turn, may entail various fears and guilt feelings.

2. When the patient, in defences against this situation, identifies himself with the superego, he may place the analyst in the situation of the dependent and incriminated ego. The analyst will not only identify himself with this position of the patient; he will also experience the situation with the content the patient give it : He will also feel subjugate and accused, and may react to some degree with anxiety and guilt. To a ‘manic’ transference situation (of the type called mania for reproaching) there corresponds, then - as regards the complementary identification -a ’depressive-paranoid’ countertransference situation.

The analyst will normally experience these situations with only a part of his being, leaving another part free to take note of them in a way suitable for the treatment. Perception of such a countertransference situation by the analyst and his understanding of it as a psychological response to certain transference situations will enable him the better to grasp the transference at the precise moment when it is active. It is precisely these situations and the analyst’s behaviour regarding them, and in particular his interpretations of them, that are of decisive importance for the process of therapy, fo r they are the moment when the vicious circle within which the neurotic habitually moves - by projecting his inner world outside and reintrojecting his same world is or is not interpreted. Moreover, these decisive points the world - is projecting his inner world outside these decisive points the vicious circle may be-enforced by the analyst, if he is unaware of having entered it .

A brief example: An analysand repeats with the analyst his ’neurosis of failure’, closing himself up to every interpretation or representing it at once, reproaching the analyst for the uselessness of the analysis, foreseeing nothing better in the future, continually declaring his complex indifference to everything. The analyst interprets the patient’s position toward him, and its origins, in its various aspects. He shows the patient his defences against the danger of becoming too dependent, of being abandoned, or being tricked, or of suffering counter aggression by the analyst, if he abandons his amour and indifference of bad internal objects and his subsequent sado-masochistic behaviour in the transference, his need of punishment, his triumph and ‘masochistic-revenge’ against the transference patients; his defences against the ‘depressive position’ by means of schizoid paranoid and manic defences (Melaine Klein) and he interprets the patient‘s rejection of a bond which is the unconscious has a homosexual significance. But it may happen that all these interpretations, in spite of being directed to the central resistance and connected with the transference situation, suffer the same fate for the same reasons: They fall into the ‘whirl in avoid’ of the ‘neurosis of failure’. Now the decisive moments arrive, the analyst, subdued by the patient ‘resistance, may begin to feel anxious over the possibility of failure and feel angry with the patient. What this occurs in the analyst, the patient feels it coming, for his own ‘aggressiveness’ and other reactions have provoked it; consequently he fears the analyst’s anger. If the analyst, threatened by failure, to put more precisely threatened by his own superego or by his own archaic objects which have found an agent provocateur in the patient, acts under the influence of these internal objects and of his paranoid and depressive anxieties, the patient again finds himself confronting a reality like that of his real or fantasized childhood experiences and like that of his inner world, and so the vicious circle continues and may even be re-enforced. But if the analyst grasps the importance of this situation, if, through his own anxiety or anger, he comprehends what is happening in the analysand, and if he overcomes, thanks to the new insight, his negative feelings and interprets what has happened in the analysand, being now in his new positive countertransference situation, then he may have made a breach - be it large or small - in the vicious circle.

All this we infer from the reaction of the patient, who submits to the analyst’s suggestion, telling to previous criticism of his aspect of his internal reality, ‘overcomes’ the resistance, while in reality everything is going on unchanged. It cannot be otherwise, for the analysand is aware of the analyst’s neurotic wish and his transference is determined by that awareness. To a certain degree, the analysand finds himself, once, again, in the actual analytic situation, confronting his internal or external infantile reality and to this same degree will repeat his old defences and will have no valid reason for really overcoming to such as the his own resistance, however much the analyst may try to convince her or his tolerance and understanding. This he will achieve only by offering better interpretations in which the neurosis does not so greatly interfere.

The following more detailed examples demonstrate: (I) The talion law in the relationship of analyst and analysand: (ii) How awareness of the countertransference reaction indicates what is happening in the transference and what at the moment is of the greatest significance what interpretation is mos t suitable to make a breach in the vicious circle; and (iv) how the later associations show that this has been achieved, even if only in part - for the same defences return and once again countertransference points out the interpretation the analysand needs.

We will consider the most important occurrence in one session. An analysand who suffers from an intense emotional inhibition and from a ‘disconnection’ in all his object relationships begin the session by saying, that he feels completely disconnected from the analyst H e speaks with the difficulty as if he were overcoming a great resistance, and always in an unchanging tone of voice that seems in no way to reflect his instincts and feelings. Yet the countertransference response to the content of his associations (or, rather, of his narrative, for the exercise a rigid control over his ideas) does change from time to time. At a certain point the analyst feels a slight irritation. This is when the patient, a physician, tells how in slight irritation. This is when the patient, a physician, tells him how in conversation with another physician, he sharply criticized analysis for their passivity (they give little and cure little), for their tendency to dominate their patients, the patient’s statement and his behaviors mean several things. It is clear, in the first place, that these accusations, though couched in general terms and with reference to other analysts, are directed against his own analyst; the patient has become the analyst’s superego. This situation in the patient represents a defence against his own accusing superego, projected on the analyst. It is a form of identification with the internal persecutors that leads to inversion of the feared situation. It is, in other words, a ‘transitory mania for reproaching’ as defence against a ‘paraoid-depressive’ situation in which the superego persecutes the patient with reproaches and threatens him with abandonment together with this identification with the superego, there occurs projection of a part of the ‘bad ego’, and of the id, upon the analyst. The passivity (the mere receptiveness, the inability to make reparation), the selfish exploitation, and the domination he ascribes to the analyst are ‘bad tendencies’ of his own for which he fears reproachment and abandonment by the analyst. At a lower stratum, this ‘bad ego’ consists of ‘bad objects’ with which the patient has identified himself as a defence against their persecution.

No comments:

Post a Comment