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.     

Neutrality,tenderness and the analyst's subjectivity

Addressing the rôle of the analyst in the psychoanalytic relationship, the author takes issue with the emphasis on acknowledging the analyst's subjectivity and the critique of concepts like neutrality and abstinence as these issues are presented in the relational tradition. He advocates a better articulation and emphasis of these concepts in the service of understanding the impact of the analyst's subjectivity, and demonstrates how the mere loosening up of analytic neutrality and abstinence and an acceptance of the analyst's self-disclosure make transference analysis more difficult to handle. Such an attitude also increases the risk for ethically dubious conduct, since there is a close link between clinical methods and ethical standards in psychoanalysis. In conclusion, the author points to the importance of the analyst's continuous self-reflection and countertransference analysis.     

Private Terrors Sexualized Aggression and a Psychoanalyst's Fear of Her Patient

This clinical paper explores the meanings and evolution of an analyst's reaction of fear in relation to her patient's sexualized aggression. From both an intrapsychic and an intersubjective perspective, the author analyzes the coconstruction of this transference—countertransference phenomenon. Case vignettes illustrate the author's attempts to address her patient's sexualized aggression while struggling to free herself from the feelings of intimidation and fearfulness stirred by his sadomasochistic fantasies and patterns of interaction. The analyst's unconscious identification with the patient's disowned femininity and narcissistic vulnerability is seen as central to this countertransference “stranglehold.” Release from the analyst's masochistic position comes through a shift in her own affective participation. The importance of the analyst's recognizing her own unconscious contributions to this sadomasochistic dynamic is emphasized and elaborated. Discussion also focuses on the relevance of gender to the issue of countertransference fear, as illustrated in this particular male patient—female analyst dyad.     

ON MISREADING AND MISLEADING PATIENTS: SOME REFLECTIONS ON COMMUNICATIONS,MISCOMMUNICATIONS AND COUNTERTRANSFERENCE ENACTMENTS1

This author focuses on an aspect of transference countertransference interaction that enacted covertly is often overlooked. He argues that conflicts, needs and biases that may go undetected for lengthy periods of time are not infrequently contained within the analyst's accurate and technically correct interventions and that for defensive reasons, patients often suppress, deny or rationalise their accurate perceptions of these countertransference elements and fail to confront their analysts with them. The mistakes, miscommunications and misperceptions that arise as a consequence of the unconscious collusions that develop between patient and analyst can have a profound effect on the analytic work. Several clinical examples are presented to illustrate the operation of such covert communications in analysis and their impact on the treatment process.     

THE ANALYST'S WAY OF BEING: RECOGNIZING SEPARABLE SUBJECTIVITIES AND THE PENDULUM'S SWING

Whether the analyst finds the patient's emerging transference affectively tolerable or intolerable plays an important role in the analytic couple's negotiation of the configuration that the transference‐countertransference relationship ultimately assumes. If the analyst is deeply repelled by transference‐related roles to which he is assigned, patient‐ascribed attributions, or projection‐drenched interactions, he may react in violent protest, engaging in enactments that say more about his separable subjectivity than about the intersubjective situation. While there has been a recent trend to view enactments as a crucial aspect of psychoanalytic technique, this trend risks overlooking the way in which the analyst's way of being comes into play in the treatment.     

Countertransference and changes in the conception of the psychoanalytic relationship

Abstract

The concept of countertransference has a long history in psychoanalysis. This paper sketches the phenomenon referred to by countertransference and the development of the concept, from being signs of disturbance in the analyst to an important road to knowledge about the patient's inner life. The complexity of the questions discussed today – how to understand the concepts of neutrality, abstinence, and empathy; the relative subjective mutuality and symmetry of the analytic situation; the analyst's enactments and self-disclosure of feelings – reflects the complexity of the contemporary view of the patient–analyst relationship. In conclusion, the author presents a model illustrating the disturbing and informative aspects of countertransference together with the conceptual relationship between countertransference on the one hand and empathy and projective identification on the other. Finally, by differentiating between intuitive and irrational levels of functioning, an integrated model for countertransference is presented, synthesising the essence of the concept as it is used today.     

On shame,countertransference, and analytic style

Some analysands experience a restricted space in the analytic situation with special counter-transferential consequences. The author discusses how shame is involved in these situations, and projected on to the analyst. This leads to an important choice of direction for the analyst regarding counter-transference acting out or conditions for a real analytic situation. Shame plays a special rôle in these choices of direction. The author illustrates the problem with a clinical vignette and shows how integration of shame is accomplished clinically, and continues with a discussion of the connections between the analyst's analytic style, his own communicative style as a defense against shame and the analytic styles of different analytic “schools”. A discussion of Liberman's concept, of “asymmetrical dialogue” and its connection with countertransference acting out and analytic styles, forms a conclusion to the paper.     

Symposium on Psychoanalytic Training and Education: Editors' Introduction

This paper offers an intimate account of a long-term analytic process and a detailed presentation of one pivotal session to illustrate and explore the issues of love, dissociation, and discipline in a therapeutic relationship. Organized around the concept of impasse, this paper presents a relational perspective on the potential in transference and countertransference love to facilitate or curtail the forward progress of therapeutic work. Love may bring life or impasse to a person in analysis. One key to the dynamics of therapeutic love and impasse is the problem of weak dissociation (Stern, 1997) and the impact of the analyst's noticing, or not noticing, a moment in the onrush of familiar clinical process that is ripe for questioning. A new concept is introduced and elaborated in this paper that relates to the resolution of preoedipal and oedipal transference love: The paradoxical analytic triangle.     

SOME VIEWPOINTS ON WOMAN'S INNER SPACE

In this paper, illusion is examined as a prerequisite and necessary medium for the analysand's finding the genuine subjective reality of his own in the psycho-analytic interaction. Two kinds of illusion are discussed The first of them, transference illusion, is well-known, as is its understanding as a simultaneous existence of experiences stemming from different levels of reality. At its side, the author introduces the concept of developmental illusion, as an essential constituent of the analytic process. As contrasted to transference illusion, the wishes inherent in a developmental illusion have never become meaningfully represented in the analysand's mind. These interrupted developmental needs attaining shape and meaning, and thus the possibility to develop further in the analytic relationship, is dependent on the analyst's ability and ways to receive and meet the analysand's activated developmental illusion. The rôle of the analyst's ways to reach and convey his understanding is considered decisive in this process.     

Marco Conci interviews Stefano Bolognini

Abstract

This paper suggests that the understanding of intersubjectivity, which refers to “the dynamic interplay between the analyst's and the patient's subjective experiences in the clinical situation”, is crucial for psychoanalytic work. The analyst's inner experiences, from the first moment that he or she thinks about or meets the patient, belong to an intersubjective situation. Not only are these experiences a valuable channel through which the inner experiences of the patient can be understood, but—as Theodore Jacobs puts it—they are often complementary to that which comes from the patient. The author tries to illustrate the above through the study of the analytic process in the psychoanalytic therapy of a severely disturbed patient. This therapy from its very early phase led to the reawakening of some of the analyst's old conflicts. The patient's difficulties in tolerating the limits of the analytic setting and using free association are discussed, as are his enactments. The analyst's close observation of the interaction between her and the patient, the permanent engagement with her countertransference, and the use of her inner experiences with the patient helped her to contain the enactments, defined the nature of her interventions, and contributed to the analytic process.     

Lies and Body Cruelties in the Analytic Hour

Discussing an intensive case study of female sexual dysfunction, this paper studies mutual deregulation and disintegration as it unfolds in the transference–countertransference dyad. I propose that ethical transgressions are potentiated in analytic dyads in which the analyst's hope for either solitude or mutuality is foreclosed. This hope can be foreclosed by the particulars of the therapeutic interaction as well as by the theoretical and clinical aspects of analytic training. The deregulation that both precipitates and follows such transgression can be healed (in the analyst, in the analysis) only by the restitution of the therapist's agency, the reduction of paranoid-schizoid guilt and shame, and the location (in the analyst) of depressive, “I-Thou” remorse.     

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.     

Early trauma and affect: the importance of the body for the development of the capacity to symbolize

In this paper I aim to outline the importance of working clinically with affect when treating severely traumatized patients who have a limited capacity to symbolize. These patients, who suffer the loss of maternal care early in life, require the analyst to be closely attuned to the patient's distress through use of the countertransference and with significantly less attention paid to the transference. It is questionable whether we can speak of transference when there is limited capacity to form internal representations. The analyst's relationship with the patient is not necessarily used to make interpretations but, instead, the analyst's reverie functions therapeutically to develop awareness and containment of affect, first in the analyst's mind and, later, in the patient's, so that, in time, a relationship between the patient's mind and the body, as the first object, is made. In contrast to general object‐relations theories, in which the first object is considered to be the breast or the mother, Ferrari (2004) proposes that the body is the first object in the emerging mind. Once a relationship between mind and body is established, symbolization becomes possible following the formation of internal representations of affective states in the mind, where previously there were few. Using Ferrari's body‐mind model, two clinical case vignettes underline the need to use the countertransference with patients who suffered chronic developmental trauma in early childhood.     

The act of interpretation1

The author understands the interpreting act as an attempt to perceive what happens in the transference/countertransference fi eld and not just what happens in the patient's mind. Interpretation transcends mere intellectual communication. It is also an experience in which analysts’ emotions work as an important instrument in understanding their patients. Interpretation is seen to possess manifest as well as latent content; the latter would contain the analysts’ feelings, emotions and personality. The unconscious content of an interpretation does not inconvenience or preclude the development of the analytic process, but, on the contrary, it allows new associative material to emerge, and it transforms the analytic session into a human relationship. Analysts’ awareness of this content derived from patients’ apperceptions is a signifi cant instrument for understanding what is happening in the analytic relationship, and what transpires in these sessions provides fundamental elements for analysts’ self‐analysis. Some clinical examples demonstrate these occurrences in analytic sessions, and how they can be apprehended and used for a better understanding of the patient. The author also mentions the occurrence of diffi culties during the analytic process. These diffi culties are often the result of lapses in an analyst's perception related to unconscious elements of the relationship.     

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.     

THE ANALYST'S RELOCATION: ANALYSIS TERMINABLE,INTERMINABLE, AND DISLOCATED

The analyst's relocation is relatively neglected in the literature. Yet relocation is profoundly unsettling, striking at the psychoanalytic contract in a way that illness or even severe countertransference disturbances do not, and this unsettling aspect of resettling can disturb analytic functioning. The few previous papers about relocation focus on how to best understand and manage “reality” intrusions in terms of the nature and status of the transference relationship. In this paper, an engagement with object relational ideas is the prism through which to examine the dislocations of relocation and the potential disruptions of thinking caused by the vicissitudes of moving.     

Metapsychology or metapsychologies? Some comments on Paul Denis's paper ‘The drive revisited: mastery and satisfaction’

In this commentary on Paul Denis's paper ‘The drive revisited: mastery and satisfaction’, the author defends the idea of a plurality of metapsychologies that must be contrasted with and distinguished from each other while avoiding incompatible translations between models. In this connection he presents various theoretical approaches to aggression and the death drive, and demonstrates the differences between the drive model and the model underlying the theory of internalized object relations. The author holds that the concept of the internal object differs from Freud's notion of the representation (Vorstellung). He also considers that the imago as defined by Paul Denis in fact corresponds to the concept of the internal object. Lastly, he addresses the complex issue of listening to archaic forms of psychic functioning and their non‐discursive presentation within the analytic process, which affects the transference‐countertransference link.     

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.     

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.     

The intersubjective links in perversion1

The author studies the intersubjective links which the pervert maintains with analyst or partner, attempting to indicate the differences between the investments in each case. Rather than accepting that empathy towards these patients is impossible to achieve and disturbs the countertransference profoundly, it attempts to show that these difficulties may be overcome if they are reinterpreted in the light of the theory of the intersubjective link. The author examines the theories and the practice of intersubjectivity and gives a definition of his approach to the link between two subjects. He applies these ideas to the case of a sexually masochistic female patient. The countertransference is marked successively by indifference, rejection and smothering. The analysis of the analyst's dream allows the situation to evolve. Failures in primary identification can result in domination over others and utilitarianism. The author examines the place of the challenge to the ‘Law’ and the father (in the attempt by the patient to put a theory to the test) in order to identify the figure of the witness in the pervert's intersubjective links. The desire of the transference would be marked by the figure of the witness rather than by that of the analyst as accomplice.