IN
TRANSFERENCE-COUNTERTRANSFERENCE
Introduced by: RICHARD J.KOSCIEJEW
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 this way rectify pathogical decisions and destines. 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 the patient should meet with greater understanding and objectivity than he found in the reality or fantasy of his childhood.
Although the concept of transference, from the point of view of definition, offers some semblance of evolutionary progression to something commanding wide agreement among psychoanalysts; the same cannot be said of countertransference. Definitions of countertransference have varied almost from the first discussions of it and there remains today widespread disagreement as to what the term comprises.
As Freud (1910) introduced the term in ‘The Future Prospects of Psychoanalytic Therapy’:
. . . We have begun to consider the ‘countertransference’ which arises in th e physician as a result of the patient’s influence on his unconscious feelings, and have nearly come to the point of requiring the physician to recognize and overcome this countertransference in himself . . . Anyone who cannot succeed in this self-analysis may without more ado regard himself as unable to treat neurotics by analysis.
On ‘Observations in Transference-Love’ Freud (1915) says of a patient’s tendency to fall in love with successive physicians.
To the physician it represents an invaluable explanation and a useful warning against any tendency to countertransference which may be lurking in his own mind. He must recognize that the patient’s falling in love is induced by the analytic situation and is not to be ascribed to the charms of his person . . . And it is always well to be reminded of this.
Freud continues, to warn against and attempt to influence the transference by partial gratification and then goes on to develop his well-known dictum that the treatment must be carried through in a ‘state of abstinence’.
On Jun e 3, 1923, at a meeting of the American Psychoanalytic Association, Adolph Stern read one of the first papers - if not the first - dealing extensively with the subject of countertransference which he defines as ’the transference that the analyst makes to the patient’ He continues:
Theoretically, the countertransference on the part of the analyst has the same origin as the transference in the part of the patient; namely, in the repressed, infantile material of the analyst. By the same law, it may manifest itself in any form that the transference does. Practically, however, owing to the previous training that the analyst has undergone, his theoretical knowledge and his actual clinical experience reduce considerably the field of activity of the countertransference in comparison with protean forms which the transference takes in patients.
Stern also differentiates libidinous from ego components in the countertransference and illustrates various unanalyzed problems in analysis that may give rise to countertransference difficulties.
Ferenczi and Rank, from whom Stern may well have drawn some of his ideas, add to the definition of countertransference:
The narcissism of the analyst seem suited to create a particularly fruitful source of mistakes, among others the development of a kind of narcissistic countertransference which provokes the person being analyzed into pushing into the foreground certain things which flatters the analyst and, on the other hand, into suppressing remarks and associations of an unpleasant nature in relation to him.
As noted, there is an explicit or implied difference in the concept of countertransference as simply a relation of the patient’s transference as distinguished from the analyst’s own transference to the patient for whatever reasons and arising from his own unresolved neurotic difficulties.
E. Glover (1927) devotes considerable space to the subject of countertransference in his published ‘Lectures on Technique in Psychoanalysis’. He distinguishes positive and negative countertransference well as countertransference and counterresistance. Both are refined for the most part in terms of relations to patient’s transference reactions, particularly in the transference neurosis, but other determinants in the psychology of the analyst and referred to. Glover adds little to the definition of countertransference, but presents a wealth of technical information.
Healy, Bronner, and Bowers (1930) seem to tread warily:
What is spoken of as ‘countertransference’ must also be reckoned with in connection with the analytic situation. By this is meant impulses on the part of the analyst to respond to the patient’s affectional trends. Schilder thinks that there is operative of an important psychological law regulating human relations and that the patient‘s feelings will of necessity call for complementary ones on the part of the analyst . . .
Reich (1933) does not define countertransference, but he does discuss countertransference problems, and assumes that they arise from the personal difficulties of the analyst.
Fenichel (1936) notes that little has been written about the important and practical subject of countertransference, nor does he undertake to define the term. An implied definition is found, however, in the following:
The analyst like the patient can strive for direct satisfactions from the analytic relationship as well as make use of the patient for some piece of ‘acting out’ determined by the analyst’s past. Experience shows that the libidinal strivings of the analyst are much less dangerous that his narcissistic needs and defences against anxieties. Little is said about this subject probably because nothing can act as a protection against such misuse of analysis except the effectiveness of the analyst’s own analysis and his honesty with himself.
What have present-day writers to say about the problem of countertransference?
Lorand writes mainly about the dangers of countertransference for analytic work. He also points out the importance of taking countertransference reactions into account fo r 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 analyst may afford the analyst from his own problems, and narcissism and the interference of personal motives in clinical purposes. He also emphasizes the fact that these problems of countertransference concern not only the candidate bu t also the experienced analyst.
Winnicott is specifically concerned with ‘objective and justified hatred’ in countertransference, particularly in the treatment of psychotics, he considers how the analyst should manage this emotion; should he, for example, bear his hatred in silence or combinative skills to the analyst. Thus Winnicott is concerned with a particular countertransference reaction insofar as it affects the behaviour if the analyst, who is the analysand’s object in his re-experience of childhood.
From a subsequent flow of papers concerning countertransference in the analysis of neurotic patient, three recent articles are greatest relevance, that in 1951, Little noted that ‘unconsciously we may exploit a patient’s illness for our purposes, both libidinal and aggressive, and will quickly respond to this’.
In 1957, Schroff gave an account of the analysis of a man with a character disorder of which sexual acting some of the therapist’s unconscious impulses; and Schroff found, in his own work with the patient, that his countertransference problems influenced unfavorably the man’s acting out, until late in eventually successful analysis. This kind of mechanism incidentally, had been described in a paper in 1952 by Johnson and Szirek, in which these authors reported their finding of children’s acting out the patient’s unconscious antisocial impulses. Barchilion, in a paper of 1957 concerning ‘countertransference cures’, reported a number of examples of analytic ‘cures’ that he showed to be based precariously upon not only transference but also countertransference, and he commented that ‘in more extreme cases, the therapist forces the patient to act out his own unconscious solutions with little relevance to the patient’s needs.
Excessive acting out in the analytic situation would point to a blindspot in the analyst. What seems to happen in this situation is that the analyst happens to be similar in a personality difficulty to an authority figure of the patient’s, so both into a familiar pattern of reacting to each other without either one’s being aware of what is going on. Thus, for example, excessive acting out should always lead to th e analyst’ exploring his own contribution to the situation. Although, of course, we know that some patients tend to act out more than others - in their own right.
None the less 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 patent Dora formed the basis for his first formularies of this concept. He said, ‘What are transferences? They are the new editions or facsimiles of the tendencies and phantasies which are aroused and make conscious during the progress of the analysis; but they have this peculiarity, which is characteristic for their species, that they replace some early person by the person of the physician. To put it another way; a whole series of psychological experiences are revived, not as belonging to the past, but applying to the person of the physician at the present moment.
According to the Freudian view, the process of 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 conclusion arrived at are correct. However, ‘the unconscious feelings strive to avoid the recognition which the cure demands’. They seek instead, emotional discharge, regardless of the reality of the situation.
Freud believed that these unconscious feelings, which 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 desirous gratification. Because the attraction of reality has weakened, the libidinal energy is still maintained in a state of regression attached to the original infantile sexual objects, although the reasons for the recoil from reality have disappeared.
Freud stated that in the analytic treatment, the analyst pursued this part of the libido to its hiding place, ‘aiming always at unearthing it, making it accessible to consciousness and 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 over and again, rather than to become conscious of their origin. 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 is 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 said, ‘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 actual and manifest.’
Freud regarded the transference-manifestations as having two general aspects - positive and negative. The negative, he at first regarded as having no value in psychoanalytic cure 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 considered to be ultimately sexual in origin, since Freud said, ‘To begin with, we knew none but sexual objects’. However, he divided the positive transference into two components - one, the repressed erotic component, which was used in the service of resistance; the other, the friendly and affectionate component, which, although originally sexual, was the ‘unobjectionable’ aspect of the positive transference, and was that which ‘brings about the successful result in psychoanalysis, as in all other remedial methods’ - Freud referred to the element of suggestion in psychoanalytic therapy.
At the moment, I should like to state that it would be a mistake to deny the value and importance of his formulations regarding transference phenomena. Nonetheless, I differ on certain points with Freud, but I do not differ with the formulation that early impressions acquired during childhood are revived in the analytical situation, and are felt as immediate and real - that they form potentially the greatest obstacles to analysis if unnoticed, and, as Freud put it, the greatest ally of the analysis when understood. Wherefore, I agree that the main work of the analysis consists in analyzing the transference phenomena, although I differ somewhat as to how this result is cure. Even so, it is my conviction that the transference is a strictly interpersonal experience. Freud gave the impression that under the stress of the repetition-compulsion the patient was bound to repeat the identical pattern, regardless of the other person, that I believe that the personality of the analyst tends to determine the character of the transference illusions, and especially to determine whether the attempt at analysis will result in cure. Horney has shown that there is no valid reason for assuming that the tendency to repeat past experiences time and again, having that he integrate with any given situation according to the necessities of his character structure.
Yet, among other things, I do want to mention a simple phenomenon, as 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 pinpoint of light, which is kept stationary, this light will soon appear to be moving about. I am sure a good many of you have noticed this phenomenon when gazing upon 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. It just wanders around. If, however, one can at the same time see some other fixed object in the room, the light immediately becomes stationary. Are a reference point having been established, and there is no longer any uncertainty, and vague wandering of the spot of light. It is fixed. The pinpoint of light wandering in the dark room is symbolic of the original attitude of the person to himself, undetermined, unstructured, with no reference point or points.
The newborn infant probably perceives everything in a vague and uncertain way, including himself. Gradually, reference points are established, a connection begins to occur between hunger and breast, between a relief if bladder tension and a wet diaper between playing 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 own body, that he can hold his breath and everyone will get excited that he can smile and coo and people will be enchanted, or just the opposite. The nature of the emotional reference points that he determines depends on or upon the environment. By that still unknown quality called ‘empathy’ he discovers the reference points that help to determine his emotional attitude toward himself. If his mother does not want him, is disgusted with him, treats him with utter disregard, he comes to look upon himself as anything-to-be-disregarded. With the profound human drive to make this rational, 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 original reference frame. Another child discovers that the state of being regarded is dependent upon specific factors- all is well as long as one does not act spontaneously, as long as one can be just not of a separate person, as long as one is good, as the state of being good is continuously defined by the parent. 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 hidden nature of the child’s experience. If this has been of a traumatic character so that spontaneity has been blocked and further emotional developments has been inhibited, the original orientations will tend to persist. Discrepancies may be rationalize 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 nice because she does not know me. If she really knew me, she would act differently. Or, the original impressions are out of line with the present actuality, that they remain unconscious, but make themselves apparent in inappropriate behavior or attitudes, which remain outside the awareness of the person concerned.
The little child who grows more and more negativistic, because of injuries and frustrations, evokes more and more hostility in his environment. However, and this is important, the basic reactions of hostility on the part of the patents, which originally induced his negativism, are still there. Thus, the pattern does not change much in character - it just gets worse in the same direction. Those persons whose life experience perpetuate the original frames of reference, are more severely injured. Among the children, who has a hostile mother, may then have a hostile teacher. If, by good luck, he got a kind teacher and if his own attitude were 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, and his personality might not suffer too greatly, especially, if a kindly aunt or uncle happened to be around.
The profoundly sick people have been so early injured, in such a rigid and limited frame of reference, that they are not able to make use of kindliness, decency, or regard when it does come their way. 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 from the ones they early learned to distrust and hate. By reason of bitter early experience, they learn never to let their guard down, never to permit intimacy, least of mention, 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 which give a pseud-satisfaction. The secondary gains at first glance might seem to be what the person was really striving for - revenge, power and exclusive possession. Actually, these are but the expressions of the deep injuring 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. Step by step, each phase to the long period of emotional development is exposed, by no means chronologically; the interconnecting, overlapping reference frames are 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 and the patient. This personal relationship with the analyst is the situation in which the transference distortion can be analyzed.
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