The transference neurosis in Freud's writings

This paper reviews the evolution of the concept of transference neurosis in Freud's writings. It suggests that the language in which the concept of the transference neurosis is originally expressed by Freud includes an idea of the analyst as aggressively pursuing the analytic cure by waging a solitary battle against the patient's disease. With the representation of the death drive and the larger role accorded to sadism as its external manifestation in Freud's revised drive theory of 1920, the patient becomes the ally; resistance, in the sense of the conservative forces, not disease, in the sense of libidinal conflict, becomes the enemy. It is thus difficult to speak of a transference neurosis in the circumscribed way Freud originally meant it, and he ceased to use the term after 1926 rather than redefine it to fit his broader perspective. In this broader perspective, relative resolution of conflict replaced radical liberation of the patient from disease. That Freud did not redefine the term does not imply that he discarded it, or that we necessarily should. This paper suggests that Freud implied a functional distinction between transference as transforming agent and transference neurosis as result of that transformation. That distinction defines psychoanalytic cure in terms of the understanding of a symbolic transformation which is, through the transference neurosis, reexperienced as part of the psychoanalytic process.     

Erotized transference reconsidered: expanding the countertransference dimension

A reconsideration of the erotized transference from a contemporary perspective has been presented utilizing detailed case material provided by Stoller. The main thesis is that this type of transference, traditionally conceived as a product of a particular kind of patient often felt to be borderline, is better understood as arising in a specific intersubjective context involving both participants in the psychoanalytic situation. The focus is on the intricate interaction of analyst and patient, recognizing that either may serve as a selfobject for the other. This view assumes a more expanded countertransference role than recognized in the earlier literature. The psychoanalytic situation can be erotized by either or both participants. A corollary thesis is that the details of a patient's fantasy should also be viewed as codetermined and that imbedded within it might be the patient's subjective experience of the psychoanalytic interaction. Alluded to peripherally is that the erotized transference in the interaction between male analyst and female patient is, in part, a manifestation of traditional roles assumed in situations involving a male authority figure in close engagement with a female who perceives herself as relatively powerless. This issue has recently received considerable attention from writers who have addressed themselves to the important gender issues in psychoanalysis.     

Countertransference—Transference seen from the Point of View of Child Psychoanalysis

This paper explores the ‘point of interaction’, that interface where the psyches of the patient and analyst meet. The author examines what is activated in the analytic pair at the point of interaction, with a particular focus on the mental activity of the patient and analyst. This exploration of the mental activity of the patient and analyst is from a theoretical position that combines contemporary Freudian and Kleinian perspectives on the therapeutic process. The author concludes that the capacity for mutuality in both the patient and analyst rests upon a part of the mind that is connected to a certain aspect of the Oedipus complex. Finally, the point of interaction is also discussed as a place where there is a potential meeting of minds around divergent methods and applications of psychoanalytic treatment. Clinical material is presented to illustrate these points.     

An Analyst Has a Birthday - Can Forgiveness Heal?

Forgiveness is a challenging endeavor in human experience and in clinical work. Is it an important and/or legitimate analytic concept? Long the province of theologians and philosophers, forgiveness has had little theoretical place in the psychoanalytic lexicon. This paper considers the analytic place of forgiveness through a treatment that was shadowed by two lost mothers – the patient’s and analyst’s - in the consulting room. The patient’s question, “must we forgive to heal?” will be examined in this story of healing for both him and his analyst.     

A Century of Psychoanalysis: Critical Retrospect and Prospect

Abstract

The distinction between having mode and being mode would seem to be the basis of the Frommian clinical approach, which finds its main application in the “center-to-center” relatedness between analyst and patient. The analyst can understand the patient because he/she experiences what the patient experiences. The dialogue is based on emotional and conceptual responses and reactions which are reciprocally communicated; both identities come into play. Psychoanalytic treatment which is not inspired by biophilia can only compile an inventory of data upon data, imposing interpretations and reconstructions. Biophilia makes psychoanalysis an art because it is applied to living things. The psychoanalytic session can save itself from the having mode by addressing the patient's living memory, which represents the past relived in the present, according to the being mode. The author comments on a psychoanalytic session.     

Transference-countertransference

This paper concerns the dynamics of transference-countertransference as they reveal themselves in object relations and specifically in the psychoanalytic process. It is postulated that transference and countertransference cannot be viewed separately, that both analyst and patient exhibit transference-countertransference reactions, and that they are normal ingredients of the psychoanalytic process. Brief clinical illustrations are provided. Attention is called to special problems when the patient's defenses are primitive, and to the therapeutic value of the analyst's countertransference.     

Child versus adult psychoanalysis: Two processes or one?

Child analysis continues to be seen as a different technique from adult analysis because children are still involved in a developmental process and because the primary objects continue to play active roles in their lives. This paper argues that this is a false dichotomy. An extended vignette of the analysis of a latency‐aged girl is used to demonstrate that the psychoanalytic process that develops in child analysis is structurally the same as that in adult analysis. Both revolve around the analysis of resistance and transference and use both to promote knowledge of the patient’s mind at work. And both techniques formulate interventions based on the analyst’s appraisal of the patient’s mental organization. It is hoped that stressing the essential commonality of both techniques will promote the development of an overarching theory of psychoanalytic technique.     

Forgiveness – It Depends: A Discussion of “An Analyst Has a Birthday - Can Forgiveness Heal?”

Diane Barclay’s article (this issue) is a clear example of rich and productive clinical work and how in some contexts, both patient and analyst can benefit personally from the inherently intersubjective nature of psychoanalytic practice. Both analyst and patient spent years struggling to forgive mothers who were very deficient and who bore considerable resemblance to one another. Ultimately forgiving their respective mothers proved very helpful to both analytic partners, though I argue in my discussion that we cannot conclude that forgiveness per se, ought to be a universal value or aim.     

Mixed Race and the Negotiation of Racialized Selves: Developing the Capacity for Internal Conflict

The author uses contemporary psychoanalytic theory in further understanding the negotiation of conflict and dissociation in biracial patients who are both African-American and White. Drawing on the work of contemporary theorists who have made efforts to navigate the relationship between inner and outer worlds in our understanding of race from a psychoanalytic perspective, the author examines the relationship between race, culture, and internalized self-other relations—how they interact with each other and impact splitting and dissociative processes among self-states. The author argues for a notion of the unconscious as one that contains historical trauma related to race relations that influences the developing capacity to sustain internal conflict between opposing self-states borne out of this trauma. The author shows how society works against the integration of racialized self-states and interferes with the capacity to contain conflict. Through an extended clinical vignette from an analysis of a mixed-race patient, the author looks at the interplay of self-states between a White analyst (author) and a mixed-race patient (African-American and White) as manifested through a series of enactments and the unconscious “mating” between dissociated self-states in both patient and analyst. The author argues that the analyst's engagement of his or her own dissociated self-states and containment of internal conflict is critical to aiding the patient in moving toward greater integration.     

In Progress … I Hope: From Pediatrics to Psychoanalysis to …

Psychoanalysis must be an idiosyncratic matter. That means that the encounter between the patient and the analyst is carried out through the personal character of both participants. But there is something more. Historical and cultural patterns are also most influential. The present and the past social context where the psychoanalytic bipersonal meeting occurs is a significant factor in the evanescent constitution and the constant movement between the ego of the analyst and the ego of the patient. Therefore, in this radical view only Freud would fulfill a Freudian encounter. We, as probable post-Freudians, must be permanently searching for personal, idiosyncratic ways in the clinical work. Brazilian psychoanalysts face the challenge to treat their patients in a Brazilian way. To understand Brazilian people and the way psychoanalysis may develop in this land, we must know that Brazilians' lived experience is frequently blended by irony, paradox, and the fleeting character of the human life. Words—a pragmatic perspective of Brazilian words in action—are essential for the task. Interrogative psychoanalytic dialogues are my main topic of research.     

Psychoanalytic Interpretation as Pharmakon: Applying Derrida’s “Plato’s Pharmacy” to Psychoanalysis

This paper presents a metaphorical heuristic to expand psychoanalysts’ views on the nature and method of interpretation from an intersubjective perspective. It uses one of Jacques Derrida’s findings in his essay “Plato’s Pharmacy,” a critique of Plato’s Phaedrus, as a model of psychoanalytic interaction. A parallel is drawn between psychoanalytic interpretation and the pharmakon—an ancient Greek term for ‘drug’ that means both remedy and poison. From this comparison, the inescapable dependence of personal meaning on contextual factors, specifically the context of the clinical intersubjective field, is shown. As a result, when an interpretation is offered, the analyst cannot truly know if the patient will receive it as remedy or poison. By keeping the context-dependent nature of personal meaning in awareness through the use of the pharmakon metaphor, analysts increase their abilities of interpretive understanding. In further discussion, the classical psychoanalytic concept of ‘negative therapeutic reaction’ is presented as an example of a decontextualized and reified psychoanalytic construct that becomes superfluous when interpretations are viewed through an intersubjective lens as pharmakon. Without the burden of expectation for being the authoritative imparter of reality and truth, the analyst may now attend to the patient in a way that is more fluid and reciprocal, where the relational field becomes what is primarily interpreted. Further, practical clinical implications of the concept of pharmakon suggest that since the analytic interpretation is subjective in every respect, effective clinical practice cannot be reduced to rigid protocols of technique.     

PATIENT‐ANALYST “WITHNESS”: ON ANALYTIC “PRESENCING,” PASSION,AND COMPASSION IN STATES OF BREAKDOWN,DESPAIR, AND DEADNESS

This paper focuses on the analyst's “presencing” (being there) within the patient's experiential world and within the grip of the psychoanalytic process, and the ensuing deep patient–analyst interconnectedness, as a fundamental dimension of analytic work. It engenders new possibilities for extending the reach of psychoanalytic treatment to more disturbed patients. Here patient and analyst forge an emergent new entity of interconnectedness or “withness” that goes beyond the confines of their separate subjectivities and the simple summation of the two. Using a detailed clinical illustration of a difficult analysis with a severely fetishistic‐masochistic patient, the author describes the kind of knowledge, experience, and powerful effects that come into being when the analyst interconnects psychically with the patient in living through the process, and that relate specifically to the analyst's compassion.     

“It Ain't Over ‘til It's Over”: Infinite Conversations,Imperfect Endings,and the Elusive Nature of Termination

Despite general agreement as to the importance and subtlety of managing the final (“termination”) phase of psychoanalysis, the way that analytic work is brought to a close has been both undertheorized and problematic in practice. How and under what conditions a psychoanalytic process might best be brought to an end is a problem that has plagued psychoanalytic theorists, clinicians, and their patients from the earliest days of psychoanalysis. Patient and analyst do not discover a “royal road” to the end of analysis. Rather, patient and analyst together forge a trail through the thickets of their work to a juncture at which they find that their paths can once again diverge. This paper attempts to explore the ways in which patients and analysts negotiate these most complex and elusive transitions. Analyst and analysand, having come to recognize the limits of their conscious awareness and the ultimate uncertainty at the heart of the psychoanalytic process, must live with the tension generated in the encounter between the inherent limits that eventually will herald the end of analysis and the recognition of new possibilities that beckon the pair into new byways of analytic exploration. Since we can never be certain when ending analysis forecloses promising avenues of new growth, or when continuing analysis constitutes a collusion between patient and analyst in eluding the difficult but ultimately generative ending of analysis, the author suggests that it is preferable to hold the notion of termination lightly, trying as best he can throughout an analysis to facilitate the exploration of its very boundaries, limits, and possibilities.     

Psychic Truth and the In-Session Work of the Analyst

I seek to address one of the issues most affected by the postmodern culture, such as the crisis of rationality and truth, and try to reformulate its place within the psychoanalytic clinic using the contributions of Freud and Ferenczi, who drew the matrix of a passionate dialogue about the truth and the analyst work that has nurtured many contemporary theoretical developments. Essentially, the major influences of postmodern thought in psychoanalysis are to emphasize the importance of the patient–analyst interaction, the role played by the analyst in the patient’s transference and the rejection of the model of the analyst as a distant observer who interprets without having anything to do with whatever happens within the mind of the patient. Consequently, because both postmodernism and psychoanalysis are concerned with human subjectivity and love for truth, although indeed understanding them from different perspectives, both schools of thought become easily interrelated. I conclude that psychoanalysis, committed as it is with the search for truth, cannot ignore the influence of postmodern thought, as well as the postmodernist movement should not disregard all theoretical consistency provided by psychoanalytic theory and metapsychology.     

Self‐disclosure,trauma and the pressures on the analyst

This paper argues that self‐disclosure is intimately related to traumatic experience and the pressures on the analyst not to re‐traumatize the patient or repeat traumatic dynamics. The paper gives a number of examples of such pressures and outlines the difficulties the analyst may experience in adopting an analytic attitude – attempting to stay as closely as possible with what the patient brings. It suggests that self‐disclosure may be used to try to disconfirm the patient's negative sense of themselves or the analyst, or to try to induce a positive sense of self or of the analyst which, whilst well‐meaning, may be missing the point and may be prolonging the patient's distress. Examples are given of staying with the co‐construction of the traumatic early relational dynamics and thus working through the traumatic complex; this attitude is compared and contrasted with some relational psychoanalytic attitudes.     

A Comparative Assessment of an Analysis of Envy: Commentary on Paper by Julie Gerhardt

This discussion is introduced with emphasis on the need for comparative psychoanalytic studies in our pluralistic psychoanalytic world and describes an approach to such an endeavor. A very brief comment on the extensive literature review is followed by a more detailed focus on the “analysis of envy,” which gradually changed into the analysis of the patient, as a person. The discussant's “empathic entry” into the analyst's mode of listening and responding was simultaneously also applied to the patient's experience, to see how well patient and analyst communicated with each other and whether or not the patient indicated that she felt understood or not. When she did not feel understood, the patient signaled this with an intensification of her envy into furious “envy attacks.” The analyst's “decoding interpretations” implied that the patient was causing her own problems and should not feel the way she did. The analyst discovered this later herself. Her discoveries in the fourth year of the analysis yielded notable changes both in her approach and in the patient's progress. Ultimately, the analyst allowed her subjectivity to enter the analysis and became better amalgamated with her chosen theory, leading to the changes in a progressively more fruitful analysis.     

The infant and the infinite: On psychoanalytic faith – Bion,Meltzer and Kierkegaard

This paper discusses the meaning of psychoanalytic faith as a useful developmental concept, which applies to the therapeutic process in the consulting room as to other intimate educational experiences. Faith is a concept which has been little considered in relation to psychoanalysis, partly owing to semantic confusion with ‘the Faith’ as in religious or psychoanalytic dogma, and partly owing to the difficulty of defining or describing what it is, outside accepted jargon. Yet, faith is traditionally the gateway to experiencing the unknown – a psychoanalytic goal-demanding negative capability. It is suggested that philosophy and poetry, where the concept is more familiar, can provide psychoanalytic parallels for this particular type of learning from experience. The viewpoints of Bion, Meltzer and Kierkegaard are taken as contributing to a picture of how, in the psychoanalytic session, there may be a developmental encounter between the infant (patient) and the infinite (the transference process, rather than the analyst as a person).     

Die institutionelle und die innere Familie des Analytikers

The author postulates the existence of an intense interaction between the analyst’s two families, the historical one of his infancy and the institutional one of his psychoanalytic education. In his opinion they both step into the analyst’s work with his patient on the level of his inner fantasy and to different degrees according to the various moments in the work. He points out that the common element between the infantile experience and the analytic one is the enormous opportunity for profound introjection. There are important moments that favor introjection in the young analyst’s training course which establish and constitute the cultural, theoretical and clinical foundations of his working ego and of his working self. The importance of a thoroughly analyzed separation process from the personal analyst and from the supervisors during the analysis is strongly emphasized.