Looking back,looking forward: A reexamination of Benjamin Wolstein’s interlock and the emergence of intersubjectivity

In this paper the author takes a close look at Benjamin Wolstein’s chapter, ‘Therapy’, from his book, Countertransference, published in 1959. This chapter contains a discussion of what he refers to as the interlock between analyst and patient, or today what we might describe as transference/countertransference enactment. The author shows how Wolstein’s concept of the interlock and its relation to the analyst’s countertransference was radical and innovative for its time. Wolstein’s notion of a transference/countertransference interlock, along with the seminal contributions of Ferenczi and some of the early interpersonal theorists, anticipates the complexities of a two‐person psychology and the entanglement which can occur from the intermingling of unconscious processes of analyst and patient in the experiential field. The author highlights three main ideas. First, the author provides a brief review of enactment with an emphasis on the role of the analyst’s participation as conceptualized by the various theoretical perspectives. An historical context is given for Wolstein’s clinical theorizing. Second, the author explicates Wolstein’s concept of the interlock, with particular attention to the processes involved which account for the complexities it presents. Third, the author examines the ‘working through’ process, including the emergence of intersubjectivity in the resolution of the interlock. The author shows throughout Wolstein’s emphasis on the influence of the analyst’s personal psychology, mutuality, and intersubjectivity, all of which anticipated the gradual interpersonalization of psychoanalysis across the various schools of thought.     

Projective identification,containment and sojourn in the psyche: Clinical notes on a specific type of transference-countertransference interaction

Abstract

This paper suggests that the interplay between transference and countertransference is considered to be a valuable channel of communication. The author puts an emphasis on the containing function of the analyst. The patient strives for an experience of an object (analyst) that tolerates and copes with the patient's projections. There are some moments when analysts feel themselves to be invaded, controlled or abused by their patient's products. As Bion has postulated, this situation takes the form of a sojourn in the analyst's psyche. Clinical vignettes are given to provide support for the ways in which the analyst contains and elaborates the projections of the patients in his or her own mind and the therapeutic role that these processes have.     

Tactics and empathy: Defences against projective identification

In this paper the author argues that interpretations made when the analyst has not done the emotional work of recognising and bearing what kind of object she has become in the patient's psychic reality will be experienced as empty tactics – even lies – rather than interpretations of integrity. However, interpreting from a position of bearing the truth of the patient's perception will be technically difficult and indicate turmoil as the analyst struggles to take in the patient's view of her. If the analyst avoids integrating her own picture of herself with the patient's picture (despite giving voice to the patient's picture) the split inside the analyst will be felt and intensify the patient's need to split. Vignettes demonstrate how the analyst, believing she is trying to understand, may become a projective‐identification‐refusing object and the issue of the analyst's disclosure of her countertransference is examined. Ultimately, the author argues, a capacity to receive and bear projective identification requires empathy with both patient and analyst‐as‐patient's object, engaged in a process about which both are ambivalent.     

Countertransference evolution in theory and practice

A framework is suggested for conceptualizing countertransference, based on expansion of the concept emerging subsequent to Freud's original view of the phenomenon: from Ucs to Cs, from reactions to transference to all reactions, from the analyst's neurosis to the analyst's functioning, from self-analysis to self-scrutiny, from obstacle to contribution. Particular attention is called to the advantages of maintaining the distinction between the patient's transference and the analyst's countertransference; the importance for successful psychoanalytic work of being aware of the subtleties of countertransference in work with neurotic patients, especially in contrast to the blatant countertransference experiences more disturbed patients thrust upon the analyst; the need for further investigation of the relations between the analyst's empathy, regression, and countertransference; the lack of understanding of and information about the homosexual countertransference, based on insufficient knowledge of the mechanisms of resistance to self-analysis, among other reasons; and the need for more reliable information about the limits of and indications for using countertransference responses in particular kinds of clinical situations, whether for informing the patient as to the analyst's responses to him, for informing the analyst in the interpretive process, or in formulating reconstructions. A clinical example provides an illustration of the complexity of countertransference-transference interaction and of the impact of countertransference on the transference.     

The Mastery of Countertransference or Mynothaur's Labyrinth

This paper considers the fundamental change introduced by Ferenczi in 1919 by proposing the use of countertransference as an instrument. Basically it reconsiders the concept of analytic neutrality; mastery of countertransference is reached through tolerating it, overcoming resistances against it, demanding a very intense involvement of the analyst, as opposed to the image of the surgeon or the mirror. The paper analyzes the implications of this position for psychoanalysis. It places these concepts in the scientific and personal context in which it was written, then follows the later developments of these ideas in Ferenczi's own work, as well as in that of some other authors, and comments on the effects of these ideas on the psychoanalytic movement. Finally it poses some questions regarding our present use of countertransference in clinical work, with two brief vignettes highlighting these points.     

Transcendental empathy in the therapeutic encounter

Abstract

The experience of many therapists suggest that most contemporary conceptions of empathy underestimate empathic potential. This paper describes deep or transcendental empathy as a more direct knowing of the client's world. The author examines the epistemic process or the activity of knowing of transcendental empathy by considering two broad forms: transcendental countertransference and psychological resonance. Difficulties and distortions are explored as well as characteristics of an individual that correspond with deep empathy.     

Psychoanalyst's Values and Countertransference

On the subject of countertransference we attempt to establish a line of continuity between Freud's own expression "blind spot" and Fromm's idea of "counterattitude". It is pointed out that both expressed the idea of the analyst's unconscious as an "instrument" for understanding the patient's unconscious. It follows that the decision to openly use or not to use countertransference in analysis also depends on the concept we have of it and on its extent. The psychoanalyst's real and illusory values and his convictions with regard to human nature influence the countertransference and the analytic relationship. Analytic listening itself may be distorted by it. We must be highly aware of this to avoid enclosing what the patient says in a theoretic scheme. What is needed, therefore, is an open theoretic scheme, more oriented towards understanding than interpretation. Aspects of analytic communication and of the relationship between language, thought and insight are examined. A humanistic point of view is assumed in distinguishing between the transferral and the real plane, and the reasons behind the legitimacy of such a distinction are expounded.     

Psychoanalysis is a two‐way street

The paper discusses psychoanalysis as a mutual exchange between the analyst and analysand. A number of questions are raised: What was Ferenczi's and the early psychoanalysts' contribution to the interpersonal relational dynamics of psychoanalytic treatment? Why did countertransference become an indispensable tool in relationship‐based psychoanalysis? Why is the transference‐countertransference dynamic seen as a special dialogue between the analyst and analysand? What was Ferenczi's paradigm shift in the trauma theory? How did he combine the object relation approach with Freud's original trauma theory? The paper illustrates through some case study vignettes the intersubjective and intrapsychic dynamic in the process of traumatization. We can look at countertransference as an indicator of the patient's basic interpersonal experiences and traumas. Finally the paper discusses countertransference in the light of attachment theory, connecting the early initiatives of inter‐relational approaches in psychoanalysis with recent research.     

Residues in the analyst of the patient's symbiotic connection at a somatic level: unrepresented states in the patient and analyst

This paper discusses the residues of a somatic countertransference that revealed its meaning several years after apparently successful analytic work had ended. Psychoanalytic and Jungian analytic ideas on primitive communication, dissociation and enactment are explored in the working through of a shared respiratory symptom between patient and analyst. Growth in the analyst was necessary so that the patient's communication at a somatic level could be understood. Bleger's concept that both the patient's and analyst's body are part of the setting was central in the working through.     

DESIRE AND RESPONSIBILITY: THE ETHICS OF COUNTERTRANSFERENCE EXPERIENCE

The analyst's desire expressed in impactful wishes and intentions is foundational to countertransference experience, yet undertheorized in the literature. The “wider” countertransference view, associated with neo‐Kleinian theory, obscures the nature of countertransference and the analyst's contribution to it. A systematic analysis of the logic of desire as an intentional mental state is presented. Racker's (1957) talion law and Lacan's (1992) theory of the dual relation illustrate the problems that obtain with a wholesale embrace of the wider countertransference perspective. The ethical burden placed on the analyst in light of the role played by desire in countertransference is substantial. Lacan's ethics of desire and Benjamin's (2004) concept of the moral third are discussed.     

A Picture Book of Internal Events: The Colours of Rage and Love

The views on countertransference in psychoanalytic theory and practice have undergone a change within the last fifty years. From being considered an impediment to analysis, countertransference is today looked upon as an important potential for a tentative understanding of what is unconsciously communicated from the analysand to the analyst. This implies that the analyst is susceptible to the unconscious interaction in the transference and the countertransference, and that he/she becomes conscious as quickly as possible of what is taking place. This applies especially to erotic feelings which are often intensified in analyses with patients with a serious psychopathology, as well as in analyses with patients in regressive phases where projective identification is the dominant factor used as a defence and a communication. Opinions differ as regards the question of how to deal with such a situation, especially whether it is right to be candid about the analyst's countertransference feelings towards the analysand, something most would caution against. In an example from an analysis, the analyst describes how he was influenced by an unconscious erotic countertransference. After three years of therapy with a patient with a serious psychopathology, he developed ?motherly” feelings, which he interpreted as reflecting a child's longing for closeness and physical contact. The result was that a few times, he ?forgot” to indicate the end of the session, which was then prolonged, and also that he embraced her on several occasions before she left the session. One year later, he had intense sexual fantasies and dreams about the analysand, which he experienced as both enticing and alarming, and as an impediment to the analysis. He soon became aware of the element of projective identification in the interaction, and by interpreting the analysand's unconscious communication, he regained his ability to maintain an analytic attitude and clear boundaries.     

The analyst's countertransference to the psychoanalytic process1

There is countertransference, not just to individual patients, but to the process of psychoanalysis itself. The analytic process is a contentious topic. Disagreements about its nature can arise from taking it as a unitary concept that should have a single defi nition whereas, in fact, there are several strands to its meaning. The need for the analyst's free associative listening, as a counterpart to the patient's free associations, implies resistance to the analytic process in the analyst as well as the patient. The author gives examples of the self‐analysis that this necessitates. The most important happenings in both the analyst's and the patient's internal worlds lie at the boundary between conscious and unconscious, and the nature of an analyst's interventions depends on how fully what happens at that boundary is articulated in the analyst's consciousness. The therapeutic quality of an analyst's engagement with a patient depends on the freeing and enlivening quality, for the analyst, of the analyst's engagement with his or her countertransference to the analytic process.     

Judicious Self-Disclosure by the Psychoanalyst

One of Sándor Ferenczi's greatest contributions to clinical theory and method is his pioneering concept of analyst self-disclosure. First introduced in his famous paper ?The elasticity of psycho-analytic technique? (1928), analyst self-disclosure changed the nature of clinical interaction between analyst and analysand, from the Freudian model of a surgeon to the responsiveness of an empathic mother. Ferenczi's clinical work with the so-called ?difficult cases? (narcissistic, borderline and psychotic disorders) moved him to discover the ethos of activity within an empathic method. Analyst self-disclosure is one of those responsive measures he developed to address the deficits in communication and interpersonal functioning in trauma survivors. An outline is presented of the ?Confusion of Tongues? which is the model from which self-disclosure is derived. A contemporary extension of this idea is offered in the clinical and theoretical distinction between judicious vs. conspicuous self-disclosure.     

Being, thinking, creating: when war attacks the setting and the transference counter-attacks

When trauma enters into the reality of the analyst and of the analysand, when it attacks the setting, what becomes of the analyst’s role? How can transformations be brought about? With reference to three clinical situations, the author attempts to explore how the articulation between transference and countertransference – the inter‐relation – structures the situation; the analyst must remain in his or her role as analyst through managing to create and to reflect upon the clinical aspects of that situation when faced with the unpredictability of what war brings in its wake. It then becomes possible to see how the work of the negative can be confined to the outer limits of the setting.     

Some thoughts on empathy and countertransference

Two aspects of countertransference-namely, the countertransference reaction and empathic understanding-must be distinguished. The term countertransference should be reserved exclusively for the conscious reactions of the analyst emerging from the preconscious by virtue of the patient's current transferences; the term empathy should be used to denote a perspective whereby the analyst employs current countertransference reactions for an understanding of the patient's inner life.     

The Imp in the iPhone

ABSTRACT

A case vignette involving contemporary communications technology—an iPhone, a computer, digital photos, and Skype—suggests that unconscious communications are not only repetitions of the patient’s ongoing experience and dynamics, but may also be prospective, expressing emerging emotional and psychological potentials that were previously unavailable to the patient. These communications may also provide direction for the treatment via the analyst’s countertransference fantasies and responses. It is also suggested that these bidirectional communications are shared between patient and analyst through an unconscious field akin to what Jung posited as a collective unconscious.     

Countertransference, empathy, and the analytic ideal: the impact of life stresses on analytic capability

Analysts' emotional attitudes toward countertransference issues are influenced by unduly perfectionistic ideals that are partly derived from the early period of psychoanalytic theory. Analysts' unconscious receptivity, whether of the beneficially empathic kind or the disadvantageous countertransference variety, is a reflection of a dynamic internal state. This fundamental relationship between empathy and countertransference is illustrated with examples. Important events that occur in the life of the analyst, by virtue of their impact on his own central compromise formations, cannot but affect his analytic functioning. Minor disturbances in analytic capability are commonplace and do not significantly handicap effective work.     

Countertransference as a complex tool for understanding the patient in psychotherapy

This paper shows some of the complexities of the analytic relationship and processes in psychotherapy by focusing on the concept of countertransference. The development of the related concept of transference is briefly outlined and the history of the concept of countertransference and its place in the practice of psychoanalysis is presented. A clinical example is provided to illustrate some of the complexity of the issues that arise when the countertransference is used as a tool to understand the patient. Attention is drawn to the importance of sustaining the countertransference response until the transference aspects and the patient's unconscious communications have been recognised and understood. It is only at this point that an interpretation meaningful to the patient can be made.     

Commentary on ‘The arms of the chimeras’ by Béatrice Ithier

In this Commentary I will first of all summarise my understanding of the proposal set out by Béatrice Ithier concerning her concept of the ‘chimera’. The main part of my essay will focus on Ithier's claim that her concept of the chimera could be described as a ‘mental squiggle’ because it corresponds to Winnicott's work illustrated in his book ‘Therapeutic Consultations’ (1971). At the core of Ithier's chimera is the notion of a traumatic link between analyst and patient, which is the reason she enlists the work of Winnicott. I will argue, however, that Ithier's claim is based on a misperception of the theory that underpins Winnicott's therapeutic consultations because, different from Ithier's clinical examples of work with traumatised patients, Winnicott is careful to select cases who are from an ‘average expectable environment’ i.e. a good enough family. Moreover, Winnicott does not refer to any traumatic affinity with his patients, or to experiencing a quasi‐hallucinatory state of mind during the course of the consultations. These aspects are not incorporated into his theory. In contrast (to the concept Ithier attempts to advance), Winnicott's squiggle game constitutes an application of psychoanalysis intended as a diagnostic consultation. In that sense Winnicott's therapeutic consultations are comparable with the ordinary everyday work between analyst and analysand in a psychoanalytic treatment. My Commentary concludes with a question concerning the distinction between the ordinary countertransference in working with patients who are thinking symbolically in contrast to an extraordinary countertransference that I suggest is more likely to arise with patients who are traumatised and thus functioning at a borderline or psychotic level.     

A Farewell to Countertransference

The "discovery" of countertransference provided a much-needed corrective to the one-sided view of transference and a patient's pathology. Even if its usefulness in the development of psychoanalysis was indisputable, its days are numbered. When I present my clinical work at conferences, I am often asked questions about my countertransference. These questions contain numerous assumptions that are challenged in this paper. Treatment is discussed from a self psychological perspective to highlight the therapeutic value of enabling the patient to engage a selfobject transference. The concept of "projective identification" is also challenged. Systems theory, in which the therapeutic relationship is understood as a co-construction between therapist and patient, is proposed as a more effective model to deal with the issues formerly included under transference-countertransference.