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