Limit setting and the analyst's working through

The American Journal of Psychoanalysis -     

The analyst's theory: A third source of countertransference

The author asserts that the analyst's theory, personal and/or academic, is an important source of countertransference which complicates our traditional understanding of the analyst's emotional responses as being constructed from a mix of his transferences and the patient's effects on him. From this perspective, theory - because it has no intrinsic relevance to the essential phenomena of individual analytic processes - may be a confounding, as well as a necessary, factor in clinical work. Although the analyst's theory might be conceptualized as a component of his personality that shapes his emotional reactions to a patient, the author believes that there is a valuable increment of conceptual clarity and additional clinical utility to thinking about a more direct role of theory in the process of countertransference formation. He uses aspects of the clinical analysis of narcissistic resistances to illustrate how some theories might predispose an analyst to confounding unconscious enactments by generating either positive or negative countertransferences which can be used defensively by the patient and/or analyst. He also illustrates how, in some contexts, an analyst's theory might attenuate potentially informative countertransference reactions and interfere in this way with the analyst's apprehension of the patient's psychic functioning. Finally the author addresses the importance of 'fit' between an analyst's working theory and a patient's psychopathology, and considers implications of his ideas for psychoanalytic training and practice.     

The analyst's words

Evidence of the analyst's inner processing and self-analysis is built into his choice and use of words. The dyadic context in which he speaks and the internal formation of his words are examined and considered for their implications for the analytic process.     

The analyst's space

The space the analyst creates in his consulting room gives expression to the most primitive elements in his personality. It does this despite, and even by means of, the professional conventions it incorporates. This phenomenon is first apparent in Freud's office where the space of the psychoanalytic situation originated. Here the room itself--filled with the antiquities he collected so passionately--met important narcissistic/symbiotic needs. In this sense it encodes a very early, unanalyzed level of relationship with his mother. It is suggested here that these phenomena, visible in Freud's office, are continuing elements of the analytic frame. Because of the character of the analyst and the structure of the relationship, the room becomes a mise-en-scène in which the narcissistic/symbiotic layers of both participants' characters are played out. Failing to recognize this may lead the analyst to treat seemingly regressive behavior as resistance and to intervene at developmental levels the patients has not achieved. Indeed, such "regressions" can only be understood as products of the situation itself. Phenomenologically, the analyst has become the corner in which he took refuge as a child; the corner to which the patient now comes for sanctuary. Because this connection is unconscious it cannot be called an alliance. Rather, it is a fortuitous interlocking that--like mother-child symbiosis--constitutes a matrix for new growth.     

The analyst's insights

The patient's fresh perceptions of himself come through mutative work shared with the analyst in the focused intimacy of their interaction. In finding transferential expectancies realized, the patient can experience these as yet different, providing he has the analyst's optimal participation. In this concurrence of crucial differences he can discount and discard the old perceptions that had shaped his psychic reality, and build out of them fresh insights. The analyst's regressive lapses in his best work are a liability inherent in the compromise formations comprising his work ego, built as it is out of the needs and motives of his own transferential past. The stagnation and tensions his regressive transferences contribute to the analytic work produce vivid actualization of the intrapsychic conflicts of both, now intertwined and mutually reinforcing. The analyst's self-analysis at such times can lead to resolving insights about himself that redress the impasse and restore the analytic work both must do.     

The analyst's witnessing and otherness

The analyst's active though silent witnessing of the patient's self-inquiry is presented as an essential aspect of the analytic process. Witnessing, though rooted in the analyst's empathy and holding, represents a more advanced development of those functions based on relational muturation from union to self-other differentiation. Self-definition and regard for otherness are seen as intrinsically unitary. Psychoanalytic witnessing is first illustrated and defined, then located as a derivative of negation in the unfolding of the analytic process, next considered in relation to current concerns for intersubjectivity, and finally linked to current shifts in philosophical thought.     

Superego transformations through the analyst's capacity for reverie

The author discusses the application of certain Kleinian and Bionian principles to psychoanalytic work with patients who suffer from symptoms arising out of pathological superego functioning. Clinical vignettes are presented to demonstrate how the analyst's willingness to employ reverie, and to move from conviction-based interpretations to more open and tentative ones, can help such patients to change maladaptive behavioral patterns that may have stemmed from early interactions with an unavailable or nonreceptive Other.     

The analyst's trust and therapeutic action

The analyst's trust, a neglected topic in psychoanalytic discourse, participates in therapeutic action--through the analyst's emotional openness, "unobjectionable positive counter-transference" (see Fox 1998), the holding environment, and the promoting of adaptive internalizations, among other ways. When the analyst's trust--in the patient, in the analyst's self, and/or in the psychoanalytic process--fails, crucial interactions may occur, capable of destroying treatment, or alternatively, of restoring mutual regulatory functions and potentially leading to important mutative processes. Patients benefit from analysts' becoming sensitive to, having useful ways of thinking about, and working with their states of trust and distrust. The author presents clinical examples to illustrate these points.     

The quality of the analyst's attention

Compiled and edited from lectures on psychoanalytic technique given by the late Karen Horney at the American Institute for Psychoanalysis during the years 1946, 1950, 1951, and 1952. Further lectures in this series will appear in subsequent issues of the Journal.     

The analyst's attitude toward pharmacotherapy

The increased acceptance of medication in psychoanalysis has occurred with too little consideration of possible complications. The potentially adverse psychological effects and disintegrative aspects of this important technical modification require further examination. While the use of phenomenologically defined diagnostic criteria provides valuable guidance to the clinician, the decision to include pharmacotherapy in a psychoanalysis must be understood also as a transference-countertransference enactment. The analyst's attitude toward pharmacotherapy is an essential element in some defensive and gratifying enactments, resistances that can interfere with psychoanalytic processes. Clinical material is presented illustrating narcissistic and perverse resistances that might be facilitated by analysts' attitudes toward pharmacotherapy, attitudes often tacitly communicated in decisions to use combined treatment.