Contemporary transference work and the analytic attitude: aims and methods--a clinical workshop

There are various ways of working as an analyst, and there are various ways of utilizing the concept and the phenomena of transference‐countertransference. I hope to draw an adequate picture of a way of working that is called ‘working‐in‐the‐transference’ as distinct from ways of working that ‘analyse transference’. The former has long been practised by many Jungians as well as by many psychoanalysts. As a method, it has aroused controversy in both groups, and is frequently both misunderstood and imitated. It can arouse strong anxiety. It can appear narrow and restrictive. It famously precludes a gamut of activities in which many analysts engage. Is working‐in‐the‐transference old fashioned, or does it deserve to be increasingly appreciated? Can it offer support and validation whilst remaining true to its conception? It was hoped that these questions would be addressed in the clinical material brought to the workshop. The emphasis in the workshop was on active participation and it was hoped that those attending would bring their clinical concerns for discussion.     

The dynamics of empirically derived factors in the therapeutic relationship

The therapeutic relationship is the source of major concepts in psychoanalytic clinical theory. Such concepts as resistance, transference, countertransference, and the alliance are fundamental, even though there may be shifts in meaning between theoretical schools and clinical contexts. In the clinical psychoanalytic literature, disagreement exists over the nature of the alliance and its essential components. Empirical studies using reliable patient, therapist, and observer scales to assess the alliance demonstrate a correlation with psychotherapeutic gains. In the study reported here, thirteen patients were followed for 6 to 33 months of psychodynamic psychotherapy, during which time their views of the therapeutic relationship were assessed, and several experiential measures taken, all on a weekly basis. Statistical analyses reveal that the therapeutic relationship, as reflected in the patients' weekly responses to the St. Louis Therapeutic Relationship Rating Scale, has four distinct components: therapeutic alliance, resistance, transference love, and negative transference. On a week-by-week basis, the therapeutic alliance was the strongest predictor of improvement in patient-reported general adjustment, as reflected in such areas as self-esteem, positive affect, social relations, work productivity, satisfaction, and optimism. Time plots of the variables show the typical time course for the components of the therapeutic relationship, as well as for improvement on the experiential variables. Results indicate that the therapeutic alliance, transference, and resistance are central components of the psychotherapeutic relationship, which in turn predict the ongoing life experience of the patient.     

Changes in psychoanalytic ideas: transference interpretation

Interpretation of the transference is central to all psychoanalytic models. Definitions of transference and transference interpretation have changed greatly during the past half-century, influenced by major movements in philosophy, advances in psychoanalytic research and theory, and changes in our understanding of Freud. This paper suggests that historical, relatively simple, concepts of the transference as the reproduction in the present of significant relationships from the past do not adequately meet current clinical and theoretical demands. Modernist views of the transference emphasize as additional sources of transference responses, the role of the analytic background of safety, the constant modification of unconscious fantasy and internal representations, and the interactive nature of transference responses, with important interpersonal and intersubjective components. It is suggested that the evolving modernist views of transference and transference interpretation permit a fuller accounting for transference phenomena and open the way for better informed interventions. A brief discussion of the issue of psychological "truth" and "distortion" as applied to transference phenomena is presented. The themes are illustrated with clinical vignettes.     

The analyst's awkward gift: balancing recognition of sexuality with parental protectiveness

The author describes the many roles that the analyst is called upon to fulfill in the transference during the course of an analysis. The loving transference is distinguished from the erotic transference and the erotized transference. Repetition is discussed, as is narcissism, especially in the light of clinical situations in which oedipal issues take center stage. Four brief clinical examples are presented.     

Developments in cognitive neuroscience: II. Implications for theories of transference

An integration of psychoanalytic theory with contemporary developments in cognitive neuroscience offers a useful perspective on long-standing controversies about the nature of transference, and a better understanding of the precise mechanisms by which transferential processes occur. Contemporary psychoanalytic views of transference are reviewed, and the many processes that constitute transference are described. Two issues that have emerged in different guises for several decades-the role of the analyst in eliciting transference, and the nature of "real" and "transferential" components of the therapeutic relationship-are reconsidered in the light of concepts such as connectionist networks. Although a useful analytic stance is one that allows the patient's enduring dynamics to dominate the analytic field, it is suggested, anonymity is neither a cognitive possibility nor the driving force behind most transference reactions, and the distinction between "real" and "transferential" perceptions is one of therapeutic interest, not of mechanism. Certain features of the analytic situation make some dynamics more likely than others to enter the treatment relationship, notably those related to authority, intimacy and attachment, and sexuality. Transference reactions are best understood as constructed from a combination of the patient's enduring dispositions to react in particular ways under particular conditions; features of the analytic situation and of the analyst; and interactions between patient and analyst. These reactions do not unfold ineluctably from the patient's mind in the consulting room, nor are they cognitive constructions of the patient-analyst dyad or co-constructions of relatively equal partners exerting their influence on the analytic field.     

The Unseen Spouse: Pitfalls and Possibilities for the Individual Therapist

Individual therapists often hear a great deal about our patients' spouses or partners, and naturally develop ideas and beliefs about that unseen other and about the causes of any relationship difficulties the patient reports. Not uncommonly, therapists can lose touch with the fact that their impressions of an unseen spouse are constructions that have emerged from the transference/countertransference field, based on only partial or limited information—not veridical truths. They can then talk with the patient about his or her partner or relationship issues in ways that can ultimately do both patient and spouse a significant disservice and perhaps distract from the patient's own issues and analytic goals. This paper discusses several factors that seem to contribute to the development of this problematic dynamic, including various qualities of the transference/countertransference field, and offers suggestions for avoiding or reducing it. Clinical material is used to illustrate key points.     

TRANSFERENCE BEFORE TRANSFERENCE

This paper is predominantly a clinical presentation that describes the transmigration of one patient's transference to another, with the analyst functioning as a sort of transponder. It involves an apparently accidental episode in which there was an unconscious intersection between two patients. The author's aim is to show how transference from one case may affect transference in another, a phenomenon the author calls transference before transference. The author believes that this idea may serve as a tool for understanding the unconscious work that takes place in the clinical situation. In a clinical example, the analyst finds himself caught up in an enactment involving two patients in which he becomes the medium of what happens in session.     

Object relations theory in clinical practice

This paper outlines the psychoanalytic techniques derived from ego psychology-object relations theory. It stresses the centrality of affects to interpretation and describes how the focus on dominant object relations in the transference modifies the economic, dynamic, and structural criteria for interpretation. Clinical examples illustrate this technique across a broad spectrum of psychopathology. The technique for genetic constructions and reconstructions in the transference is described, and this approach is contrasted with other object relations theories. Finally, the application of this approach to countertransference and dream analysis is summarized.     

Art, dreams and active imagination: a post-Jungian approach to transference and the image

The term active imagination is sometimes applied rather uncritically to describe all forms of creative activity that take place in depth psychology. Whilst there are many forms of expression that evoke or are evoked by active imagination, they cannot automatically be classed as active imagination. In this article investigation of visualized mental imagery, dreams and art reveals three distinct forms of image-based psychological activity. Integrated and mediated within the transference and countertransference dynamic, it is proposed that the engagement in active imagination reflects and is influenced by the transference. Distinctions between sign and symbol, simple and big dreams as well as diagrammatic and embodied imagery clarify the differences. Examples from clinical practice demonstrate each mode in action within the analytic frame.     

Making Interpersonal Meaning: Significant Others in Mind in Transference

The social cognitive process of transference may serve as a means of constructing interpersonal meaning. Support for this proposition is presented through a review of evidence on the relational self in transference, reframed in terms of meaning construction, as well as new investigations of the ways precise ways in which transference can serve this function. In the underlying theory, knowledge one has about each of the various significant others in one’s life is represented in memory and linked to a distinct relational self in memory by means of the relationship with that other. Significant‐other knowledge can be activated in an interpersonal encounter and, when transference occurs, used to go beyond the information given about a new person and also influences affect, motivation, and self‐regulation ( Andersen & Glassman, 1996 ). Distinct relational selves also arise in transference depending on which significant other is triggered by the situation. These processes allow the individual to imbue the interpersonal encounter with personalized meaning. Further, recent evidence suggests that whole meaning systems shared with the significant other are constructed in that relationship and are thus evoked and pursued in the transference encounter.     

Transference in the rat man case: the transference in transition

This study has concentrated on the use of the transference concept in the Rat Man case as a method for revealing repressed memories and to gain conviction about these repressed memories. In this treatment-transference model, transference interpretations focusing on the analyst are not germane, since the transferences are merely the vehicle by which memories are uncovered. Thus, Freud's transference work in 1907 revealed a transitional phase of his clinical activity soon to be supplanted by later insights into the curative aspects of transference analysis.     

The analyst's excitement in the analysis of perversion

The author believes that unconscious sexual excitement in the transference and countertransference is an especially problematic aspect of the analysis of perverse character pathology and that perverse sexual gratifi cation deserves a more prominent position in the clinical theory of analyzing perversion than that which has been assigned tacitly through analysts' routine focus on the defensive and destructive dynamics of perversion. He presents clinical material from the analysis of a perverse patient that illustrates the role of excitement in the transference perversion established in this analysis; and he asserts that gratifying perverse enactments occurring in the transference perversion can appear not only as conscious or unconscious excitement in the transference but also, at times most clearly, as the analyst's excitement. The author suggests that using a clinical theory that supports the analyst in understanding his excited responses as perverse countertransferences-i.e. evoked excitement complementary to the sexual component of a perverse transference-will assist him in locating and thinking about gratifying, perverse excitement in the transference where it is most usefully analyzed. Finally, he discusses some of the reasons why analysts might deny, suppress or otherwise avoid perverse countertransferences and in so doing contribute to sustaining perverse resistances.     

Erotic Transference and Its Relationship to Childhood Seduction

The phenomenon of an erotic transference has long been a difficult, if not mysterious, process within clinical psychoanalysis. Traditionally, the development of an erotic transference has been viewed as a negative clinical event fueled by the analyst's countertransference reaction. A much neglected dimension, the relationship between childhood seduction and the development of an erotic transference, will be introduced and examined. In three clinical cases our data suggest that actual sexual abuse in childhood is a causal factor in the manifestation of an erotic transference in the clinical interaction of an analysis.     

Clinical reflections on self-attack

This paper reflects on the clinical phenomena of mental and physical self-attack as encountered in everyday psychotherapeutic practice in the NHS. The author considers two distinct but closely related internal dynamics which he terms ‘melancholic’ and ‘antilibidinal’. In both, there is a sadomasochistic structure which serves a number of defensive purposes for the individual. The origins and functioning of these structures are explored in the clinical material. These defensive systems are often perversely rewarding for the patient and highly resistant to change. The author discusses some of the major obstacles to working therapeutically in this area, and emphasizes the role of the transference and countertransference in helping the therapist to understand who is doing what to whom within the therapeutic relationship and within the patient. Although the paper deals with theoretical issues the emphasis throughout is on clinical understanding and effectiveness within a (mainly) once-weekly analytic setting.     

Primal seduction, matricial space and asymmetry in the psychoanalytic encounter

Wishing to highlight the asymmetric dimension that characterizes ethics as 'responsibility toward the other' in Levinas's philosophy, the author presents as an introduction three related concepts of Levinas's thinking: the caress, the face, the saying. Following some poetic narrative reflections offered as 'interlude' moments, the author seeks to bring together her concept of 'matricial space' inspired by Levinas's conception of ethics and the Laplanchian concept of 'primal seduction', both based on asymmetry. She suggests adding to Laplanche's proposition of two kinds of transference (filled-in transference and hollowed-out transference) a third kind: the matricial-space transference. She argues that together with the hollowed-out transference, which is related to the primal seduction, the matricial-space transference, which relates to the matricial position in the parent/analyst, is provoked by the analyst. If the hollowed-out transference assures the moving-on of the analysis, the matricial-space transference, in combination with the hollowed-out transference, is prerequisite for transformation to occur and may be deciphered specifically in 'impasse' situations, at what she coined 'subjectal moments'. As a conclusion, while insisting on the need for asymmetry in the analytic encounter, she suggests the existence in the human neonate of a need for ethics, and she questions the origin of the human capacity to be responsible toward the other. She illustrates her argument using clinical material from her own work alongside that of other authors.     

The manifestation of transference during early psychotherapy sessions

Despite the clinical use of therapeutic transference across various schools of psychotherapy, there have been relatively few empirical studies of this phenomenon, none of which has examined transference with a non‐pathological population. In this study, the core conflictual relationship theme (CCRT) method was used to examine the manifestation of therapeutic transference in the first three sessions of 22 counselling contracts with high‐functioning individuals. Factor analyses of the wish (W) and response of other (RO) components of the CCRT indicate a complementary pattern of relating in which the therapist is idealised and others are devalued. Within the response of self (RS) component, clients exhibited a concordant relational transfer whereby they had a negative response to both the therapist and others. Additionally, control issues emerged in the W component for significant others and in the RS component for the therapist.     

The transferential chimera: a clinical approach

The author presents four quite different clinical situations which he believes show the development of an aspect of the transference as a genuinely autonomous psychical neo-reality of the transferential inter-space, which, in the words of Michel de M'Uzan, he calls the transferential chimera. Basing himself on a reading of 'The psychology of the transference', he goes on to propose a more general application of this particular transferential dynamic whose origin lies in matriarchal incest and which develops around the alchemical quaternio of the cross-projective space of the transference-counter transference and in the analytic setting. Finally, he examines the four clinical situations in the light of this application of the transference in order to propound an understanding of his reading, and proposes a hypothesis for the constitution of the transferential chimera out of the intermingling of the de-integrated parts of the self of the analyst and those of the analysand.     

Critical refl ections on intersubjectivity in psychoanalysis1

The authors review the philosophical trend known as postmodernism and the way it has infl uenced a part of psychoanalytic thought, concluding with some comments on the qualities and shortcomings of the new developments. The authors consider the origins and the cultural and aesthetic‐philosophical meaning of postmodernism, identifying some key concepts such as deconstructionism, the disappearance of the ‘individual subject’ and individual identity, and the rejection of ‘in‐depth’ models of psychoanalysis. Then they examine various, wide‐ranging developments in psychoanalytic thought and treatment. They review the intersubjective fi eld in psychoanalysis, especially in the USA, and then explore whether the underlying lack of truth to be discovered, stressed by these ‘new view’ statements, or the fact that the ‘truth’ only exists in linguistic‐narrative constructions is consistent with basic analytic concepts such as the unconscious, phantasy, transference and countertransference, which recall the tri‐dimensional nature of inner psychic reality. The psychoanalytic process is a condition activated through a bond that is able to hold and contain the relationship of the analytic couple and the patient's unconscious world and not through hermeneutic or narrative constructions.     

A metasynthesis of published case studies through Lacan's L‐schema: Transference in perversion

Transference in perversion is characterized by specific problems such as a defiant and polemic attitude, erotic transference, projections, and aggression. Such transference poses particular problems in the treatment of perversion and might render analytical work with these patients impossible. The authors propose that Lacan's L‐schema can contribute to separating productive from counterproductive aspects of transference as it distinguishes between an Imaginary and a Symbolic dimension in transference. In this meta‐synthesis of 11 published case studies on sexual perversion, patterns of transference are analysed. On the Imaginary dimension, the authors found that patients with perversion tend to (un)consciously engage the analyst in a relationship characterized by identification, fusion and rivalry. On the Symbolic dimension, they found that perverse patients are able to question their motives, lapses, symptoms, and subjective identity. The thematic analysis revealed the importance of the position of the analyst in this work, which is described within the L‐schema as being the representative of the otherness in the Other. Implications for clinical practice and recommendations for further research are outlined.