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L.
BRYCE
History
View
With Regressed
BOYER,
M.D.
Freuds
amfrivalently
countertransference
negative
attitude
to-
M
and issues ered avoided. chewing cissistic
y training,
which
began
in
the
1940s,
ward
discouraged psychoanalysts,
system-
atic study
predominantly tients conscious therapeutic Balint,
until
some
Kleinians, narcissistic
contribution process,
began neuroses.
occurred in an ultraconservative institute where the psychoanalytic treatment of regressed disorders was strongly disapproved
any
with
the need
to understand
irrelevant. an
and
Racker
in serious
Freuds grounds for estreatment of the narnoting his ambivalence and I tolerated with dissometimes despair the contempt of my mentors in determining of the studying psychomore patients.2
study
of countertransference. Racker and Boyerfound that unresolved countertransference problems contributed signaficantly to unfavorable
seriously Giovacchini, wise furthered Following
responses
disturbed Ogden, a historical
to psychoanalysis
patients. Searles, Vothan have
in
like-
and contradictions, couragement and open ridicule and while the Doing analysis thoroughly I pursued effectiveness, of seriously so inevitably
and
countertransference review,
de-
the transference-countertransferin working I suggested that or psychoses in the treated grata treatment as an with such countertranswere enfant and a major terrible, society. of regressed
lineates
his personal
approach
ing patients, especially seriously disturbed ones, in terms of the ongoing introjection
patient tions. initial and
ence interactions patients. When ference cause patients, persona neuroses of failure I was non
and
This
analyst
approach
of each others
stems from
projecRosenfelds Practice
of Psychotherapy 3:122-137)
The
subject there were
ego
psychological
some studies28
literature
which
on the
although use-
was practically
ful understanding
Received
April
1, 1993;
revisedJune
20,
1993;
accepted
for the Advanced Study California. Address re3021 Telegraph Avenue, Psychiatric Press, Inc.
CA 94705.
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not with
recognized
that
many
of the
analysts are
neo-Kleinian
critical
transference
interpretations
choanalytic transference-coun more understanding work with disorders. The mendous about with
to the analysand by means of the interpretative actions that have refrom his processing, probably his introjections predomof the changed to hold now unconsciously,
understandable
facilitated my psychoanalytic patients who had narcissistic past quarter-century has changes in clinicians of patients who can In general, that seen treattitudes be treated altered
patients projective identifications.24 Similarly, psychoanalysts have their view of their own many of being dynamics, made analyst about method. analysts OShaughnessy,25 that instead intrapsychic should tient 281; be and see also Heightened
According
been ascribed to our expanded of character structure and psychoand our increased understanding
at an
intrapsychic
Volkan26). interest
of early developmental processes and primitive internalized object relations. The crucial importance of how the therapist uses responses his own conscious and to the patient, whether unconscious psychical or
ence has paralleled use of psychoanalytic gressed because disorders ing of that In the individuals, treatment demands interaction. Americas, introduced
in large part with primitive understandand notion impediment Boyer2 that problems to treatment of seTheir contribuwith the work of in Kern berg been central that inun-
somatic, verbal or nonverbal, recognized; this recognition to the increased therapy sistic, and disturbances, alexithymic Today (aside from for severe
has been clearly is probably due psychonarcisand psychotic and that action
the effective psychoanalytic verely regressed patients. tions,4932 Giovacchini,33 Searles,ss and establishing standing in conjunction Gro ts te in others, have
,
symbolization)
constitutes
an important medium through which the analysand indicates specific unconscious meanings to the analyst, as through the actions role mediating projective responsiveness,2 and enactments.23 identifications,92#{176} evocation by However, it is
proxy,22
The first five volumes of The Index of Psychoanalytic Writings27 list 29 references to studies whose titles include the word countertrancference. Those volumes list writings from the origins of psychoanalysis through 1952. Volumes 6 through 9, covering 1953 through 1960, list 61 publications that have the word countertransference in the title.28 Apart from those citations, such references are almost nonexistent in psychological literature up to 1960. By stark contrast, a brief review of the titles of the psychological and social work literature of Europe and the Americas for the years 1988 through 1991 reveals references in the thousands to publications that include the word counteriransference in the title. The
until
Latin
the
unknown involving
to me split-
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COUNTERTRANSFERENCE
HISTORY MID-TWENTIETH
To
THE CENTURY
negative joking
may the
have mentor
been had
to a patients
There
is a large
literature
reactions neurotic history
to counanalyses of
includ-
the negative that if it had not appeared.5 suggested was based that
ing a number
section, including a brief
of reviews.3403
of more toward attitudes
The
following
ideas
modern countertransfer-
of resistance
with regressed patients, is to to other studies such as those of Boyer,57 Epstein and Feiner, Etchegoyen,45 and Scharff.4#{176} It must be stressed that before the mid-twentieth century, very few contributors disagreed with the view that countertransference was an interference in the analytic procedure. Those such as Ferenczi who communicated their emotional reactions to their patients in word or action were reprimanded severely; see M. Balint (pp.
its uses 149-156) and in St#{227}rcke.47 the term
transference, a resistant
that he was meeting patient. I agree with profitable in theraso-called not only past, espepsychosoI agree Ogden,24 regressed who pa-
Grotstein53
that
it is more
peutic situations resistances as about cially matic also hold the present in the cases problems with that
to think of many communications, but about the of, for example, and alexithymia.5
task of the analyst to contain, countertransference, a preof the patients infantile past during treatment and patient at appropriate commulater
Freud
ference
introduced
though
concern study
of
countertransdisapproval. Alcontinued to
a specific of countertrans-
to be revised
nicated times. failures to the
devoted
to it, nor
a theory
It is well known that Freuds clinical sometimes were the products of interferences.67 the word technical untrained countertrans-
ference elaborated until much later. Freud seldom if ever totally renounced any theoretical position he had introduced. For example, he continued in his last works to combine the topographical and the structural theories as explanatory models.49 We
shall canted see that this holds that true with regard to
were practicing psychoanalysis; doubtless he hoped that the danger of the clinicians emotional involvement and acting out with the
patient could be reduced. as a function of and He defined of the counanalytertransference sand, the product patients verbal cations on the
countertransference
his position
as well.
He
never
re-
countertransference
was an undesirable impediment. In 1912, in a letter written to Ferenczi, Freud5#{176} implied that his failure to overcome his positive, paternal possible countertransference the interpretation had made to Ferenczi imof a
unconscious
ting and projective and introjective identification since the early 1950s. In 1966, in their article The Psychoanalytic Situation, Arlow and Brenner37 made no direct reference to countertransference, although it constituted the main topic of their Argentinean discussants.ss Waldinger and Gunderson scarcely mention countertransference in their recent Effective Psychotherapy with the Borderline Patient.
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analysis:
and
that
the
therapist
Things
are
the objective
the study in the nomena
different, danger.
that real..
..
however,
as regards
It is probable
will of 58) these some
that
result phe-
of occult
phenomena
.so .to
that (pp.
admission are
patients position
(p.
or a reflec-
did
not
change in his
in
subseof and
tion of his dialectical which he was largely bivalence agreement totalistic At the analyst spots, should sand. Probably Janet much having continues between approaches same time be he be purified says that in contact that
Eisenbud,77 Freuds
survey
to psychoanalysis position:
What Freud says, in effect, is: Distortion of perception is one of the characteristics of mental functioning dominated by unconscious needs. But this distortion is purposeful and occurs along dynamic, deterministic lines. There is no reason to
suppose that telepathic perceptions
should
(p.9)
be free from
this universal
effect.
while studying with Charcot, Freud was interested in the subject of telepathy,
671
in 1899, appearance
1904, of
The TelepathicDream
dreams dreams pected ference footnote while working
The Telepathic
Dream,
telepathy;
Psychoanalysts. only
. .
study
occult
material
edging his awareness of Stekels no allusion to countertransference. Freuds validity open. not dealing wonders consciously, aspect of interactions. have implied communications of extrasensory Oddly, appear the word the perception
because they hope that this would enable them to eliminate once and for all the creations of the human wish from the realm of material reality. If, in the course of his work, [the psychoanalyst] is on the lookout for occult phenomena, he runs the risk of overlooking everything which is closer at hand. The
.. . .. .
remained
countertransferencedoes communications occult. perhaps One unsome analysts that and the thought,
constituted
protect having
him his
absorbed
phenomena.
namely
There seems ample evidence that Freud, cause of unresolved countertransference tions, technique, and style demonstrated of unanalyzed transference-countertransference
Excerpts It was long and of his first two for
at least at times, had disappointing clinical results beproblems.67 May has suggested that Freuds formulain the case history of the Wolf Man were largely products phenomena. contributions
particularly identification
articles
many
and
Kleinian
appear
in Devereux.76
America, the patients such as actual
common
in Latin as constituting
Garma79
Goldberg,8#{176}
to speak
of projective
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COUNTERTRANSFERENCE
unconscious sensory
involves summary
extra-
suggests
that
the
introjective
process
has
of the theories of Istv#{225}n Holl#{243}s, Devereux76 writes, Telepathic incidents became especially numerous during a difficult period in the
surely linking them although the word Devereux in this with attri-
been underinvestigated because of interference from the effects of the patients selective introjection of the analysts narcissism. Scharff4#{176}would add that the analysts narcissism may affect what the patient finds available for introjection, suggesting that the analyst censors the introjective fore and after it occurs, because inside The ceeded sis, has the self (p. 52). study of introjection, from the beginnings determined that the process beit is gratifying which has proof psychoanalymeans by which
analysts life (p. 200), with countertransference, was not used context. the butes Many, about Analysts means
by Holl#{243}sor
of one person are assumed following Freuds82 lead, the influence of patients attributes Fenichel83 on the was the first
transference
and
qualities
the
analysand
are L[e, legion.
may
In
introject
The Psychoforms Vicissimode intro-
of Everyday
Freud9#{176} commented
of introjections of patients frequently affirmed observa(p. 14) and called introjection mysterious concept the in
on sensory preference in referring to of memory, and in Instincts and Their tudd2 he noted that every perceptive is related to introjection. In 1917, he duced the concept step in identification, anal incorporation, of van written infantile tion found spond of Ophuijsen93 independently prototype persecutor epidermal to feces-smearing;
of oral incorporation as a as did Abraham92 with affirming the inferences and of St#{227}rcke,47 who of the enema the paranoids had as the equa-
psycho-analysis and said we have not yet described the process by which the childs experience of MenziesLythss troject have the external added, in no way object is introjection found in the taken and psycho-
in.
in-
analytical literature a place projection and project (p. with Meissner and countless ing that Projection turns exciting, ing, to pathological perhaps, been ence, tuition so more innovative, our understanding development at a reason that reluctant to study instead enactment, to
comparable to 1). She agrees others in notout to be more more illuminatof normal and
it to be an equivalent Leonard95 wrote of Fenichel83 made special study tract has an common and stated autonomous
respiratory
mode
jection; for the internal
can
knowledge that every perceptive also be used in the service of prowrote unification of the use of vision of fragmented
preferring and
rather
than
fantasied
projection
into
the analyst,
a phenomenon
that
surely
resembles
telepathy.
This material has been reviewed at great length in Devereux,76 where relevant articles by Helene Deutsch, Hitschmann, R#{243}heim,Schilder, Zulliger, and others are republished and the EisenbudPederson-Krag-Fodor-Ellis controversy is reviewed, and in Volume 10 of Confrontation: Telepathie,8 where several of those articles and more recent contributions by Bergson, Costa de Beauregard, Derrida, Dumas, Farrell, Mignotte, and others are reprinted.
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It has
long
been
assumed
that
counter-
Reik#{176}6 mentions
countertransference,
he
transferences are analysts introjection tient therapists Federn,84 chinis,ss experience effective the most frequently that come unresolved Fenichel, Ogdens,24 and relevant based
determined largely by the of qualities of the painto and Searless, my and contact infantile Fliessss). and the with conflicts the (see
views it as a resistance and that the analysts response conflict refers intuitions. tertransferential wrote, to and the analysts of to
his own. Similarly, his own affective Racker3#{176}would reactions, his sought call and
own,7#{176} both
mitierconsists
interpretations
scrutinizing have
countertransfer-
repressed memories are on information gathered the few reactions, countertransferinterpreting appears practice it may to of have But by that
ence-that
Analysts constitutes
is his intuition
Reiks#{176}4 listening that analyzing analyst
(p. 163).
to understand with the what third
years, the
ear, or Isakowers Spiegel#{176}8 noted operate in similar ing attention and tively) unique and that
instrument. and analysand (free-floatrespecis et al.#{176}9 speak as operating of the analyst, connections which are
through the countertransference have been very unusual in North American analysts. been limited to the it was not uncommon as illustrated Spillius.98 There were countertransference years following To my knowledge, analysts reactions almost the by the analysts among case
states free
In fact,
the
conversation
to psychoanalysis.
histories
ideas
images
introduction of the term. the first to suggest that the to the patients data by producwas HannStrachey#{176} by not was as helpful followed
the products because his the ing, They system nature of the
of the patients primary process, subsystem is in part freed from process think(pp. 490-491). (ego) of the subsame
constraints of secondary reality testing, and so on note the regression which obtains (p. 486).
KLEINS
tions could be used Kende, who was with his concept tion, which Kohut.#{176}2 Although investigated,
in the in the
analyst
is essentially
of the mutative interpretawas later rediscovered countertransference curiosity about was intuition
subsystem
N T R I B U T I 0
active, as it is today. Throughout his Reik#{176}#{176}5 indicated that if the analyst receptive attitude and trusts intuition than mere reasoning, he will be
who
write in-
surprised
with a sudden understanding of a message from the analysands unconscious, an intuitive grasp from unconscious to unconscious, as Freud5082 indicated previously. When
teractions use one or another version of Kleins0 concepts of splitting and projective and introjective identification in their attempts to understand the phenomena. This is true whether their dominant orientation
As does Ogden, I use the term projective identification to refer to a wide range of psycholocalinterpersonal events, including the earliest forms of mother-infant communication (Bion ), fantasied coercive incursions into and occupation of the personality of another person, schizophrenic confusional states (Rosenfeld3), and healthy empathic sharing (Pick4).
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stems
deriving theories Although
from
the
ideas
about
object
relations
or from School. firmly held
the
inclusion
of views
of counthe pa-
from the structural theory of the British Independent Melanie Klein herself
below, regressed
view that countertransference constituted solely an obstacle to treatment (Grosskurth,5 pp. 378-379), according to OShaughnessy,25 her work has been the most powerful single influence for the shift of perspective (p. 281) that has led to interpretations now being directed toward the interaction of patient and analyst at an
intrapsychic modern level. understanding with its emphasis This shift of has potentiated countertransfer-
the traditional
tients is becoming America, despite position psychologists primitive states of many who
I 0
ence, peutic
patients
uses
of
the
verbal
Obviously,
on the positive therathe analysts reactions to the and nonverbal productions. importance of Bions2 extenwork must be recognized as projective identification to be
but also with an its
I turn now to the definition of countertransference as it is used here and a history of the
development of that view. My concept of transference-countertransference concept terplay involves others between their projective analyst mutual follows constant inof that the
of the
not only a defense mechanism, infants first way of communicating objects, and (see and he posited the role the analyst as metabolizing also Wmnicott67). As early as 1961, Stone8 Rackers32 of the instrument that work countertransference facilitates
identifications.
Regarding
of learning
think words to form
from
the patient
The analyst between and the the space
what
he cannot
to find
seeks
a bridge
them
is the
most
potentially
powerful
link
tion.
enhances reactions
In
Rackers
view,
countertransference
sand
silences, from
cannot
and
say
and
patients Kleinian
more
subtle
transference contributors
understanding
striving. More
of
the
through symptoms
parapraxes, can be
recent
the countertransference
position
thought
Meltzer,225 nessy,
include
and Segal.
analyst. As Bromberg4#{176} suggests, are found and negotiated, they part of the patients ize and enunciate creative in words effort what
Money-Kyrle,26
A similar revolution is gaining impetus among the thinking and field techniques of investigators of personality development. Over 30 years passed between the writing and the publication of Devereuxs28 landmark From Anxiety to Method in the Behavioral Sciences because he introduced the unpopular theme of countertransference distortions into anthropological fieldwork, as had Racker and Boyer into psychoanalytic treatment. Since then, the understanding and even the technique of fieldwork have been heavily influenced by psychoanalytically knowledgeable anthropologists who are taking into account the effects of countertransference (see Crapanzano, Good et al. Kracke, R. Levine,32 S. Levine,33 Parsons,TM Stein,35 and Tobin15.
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He finds
that
the
is
person that
through which words can be which has no verbal language. that represent his experiadds expetoo. She himself. E. Balint4 knows about mutual about the analyst,
finds
words
holds that in the transference-countertransference relationship, another person to enable the patient to put himself provided responses without Ogden24 the use the to analyst can the patients
so on. Neither the intersubjectivity of the mother-infant nor that of the analystanalysand (as separate psychological entities) exists in pure form. The intersubjective and the individually subjective each create, negate and preserve the other. In both the relationship of mother and infant and the relationship of analyst and analysand, the task is not to tease apart the elements constituting the relationship in an effort to determine dividual which qualities belong in to each in-
is there together,
use his emotional communications with actions distortion; some patients are of more of
from the point of view of the dialectical interdependence of subject and object, the analytic task involves an effort to describe as fully as one can the specific nature of the interplay of individual subjectivity and intersubjectivity.45
participating it; rather,
the
development
analytic understanding ence of transference ence emerged from concerning jectivities creation
The
Gaddinis49
and words
have
dis-
the interdependence of mother and infant7 of a third area space that exists the baby and the authors understanding have
of experiencing
of patient and therapist. It is held here that experiences stitutes patients tions, and the reactions during the
session
his idiosyncratic introjection of verbal and nonverbal communicacontaining the patients projections unconscious In addition, analysts predominantly to those introjections.
process as taking areas of playing, of the therapist Ogden43). such thing ternal lieves analysand the analyst from his Ogden2445 analytic third.
place in the overlap of two that of the patient and that (Winnicott,42 p. 38; held there to be no (apart from the ma-
Winnicott as an infant
the analyst exists as a part of the analytic third, experiencing and simultaneously observing himself, the analysand, and the analytic third as they interact with one another. We should not be misled ently unrelated into thinking our stray, apparthoughts, fantasies, and phys-
(p. 39 fn), and Ogden bebe no such thing as an from the relationship with to be an analyst apart with the analysand. the concept of the
ical or emotional reactions can be dismissed as idle preoccupations, taking us away from the business at hand, interfering hovering with attention. our free-floating has or evenly
writes,
the
the cal sand own
intersubjective
analyst-analysand tension as with separate the
entity
coexists analyst
described
in dialectiand with analytheir
as
plainable
reasons.
McLaughlin5
individuals
thoughts,
reality,
feelings,
psychological
sensations,
identity
corand
poral
and others have emphasized its countertransference implications, and Boyer#{176} illustrated how sleepiness provided highly important clues to patients unconscious conflicts.
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that the analysts and individual will to the analysands set of the analyst
otherwise,
determine
a deep,
(Boyer,7
thinking of sibling rivalry begin to talk of tiny animals or Christmas or introjection Easter, and often under-
embedded in his life history, which will influence strongly his receptivity. To cite a few examples will suffice. My lifelong experiences with psychotic people have conditioned me to be automatically aware of very early stages of regression as possibly premonitory of psychotic outbreak. Here I note only subtle manifestations, as slips speech tasies person leaving aside such obvious events of the tongue and the insertion into or action of false memories or of fanmomentarily who regularly held uses to be facts. good
grammar
to a quickened
in his counter-
other with only a few minutes break between. It may be difficult for the analyst to make the internal perception a states patients of the consultation contemporary countertransference similar. For similarly childhoods, quent example, severely and changes of the second room. characterological nature requisite conflicts patient This for and who is more structures undistorted emotional enters true and the if the the are
When be-
gins to use pronouns incorrectly, such as saying to him and I, I become alerted and keep track of possible in which calling repetitions and the circummy to stances eventually they occur. Frequently, the analysands attention
two
I signals a speaking
catatonoid
which he had not yet become differentiated into an land a me (see E. Balint52). Similarly, when an analysand begins language, I am especially bodily ings. We some basis analyst cant sensations all know and their to use aware scatological of relevant meanthat the the re-
and obviously psychotic thinking, left home to attend school. Subseeach withdrew from stressful situa-
potential holding
tions, having similar episodes that might last for days or weeks. Neither had been hospitalized, but both had undergone repeated psychotherapy and highly respected America. Neither have them been useful voluntarily psychoanalysis in the care of training analysts in North considered her analyses to clinically; when the each analysts had stopped would not of was
of Freuds53
be interpreted on associations, yet that he understands many years of and study use of the me, in that meaning, field
allow regression in the service An extreme example follows. these being cover ceded patients asked her analyst
Freud, to believe at least one basic born, in meanings automatic mother, cupied
discouraged from attempting fantasies that had immediately a frightening dissociated state
repreduring
addition to whatever additional have been added by learning. My subliminal when a patient thought, began of furniture femaleto be preocnear him
with
the
wood
therapy, the analyst told her that the recovery of the fantasies might lead to her suicide. It was more usual for the analyst to discourage covertly the patients attempt to regress, usually by asking questions that changed the
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it
been often
common seeks
knowledge to relieve his have to allow need for the the a excreativ-
love
and
hate
are
directed
to the same,
whole
anxiety in this way.58 Winnicott42 and Ogden56 the occur, to enter need and for the space Bion62 into I find analyst the that of potential in which
object. The theme of concern for the object is central to the idea (Spillius,98 p. 4). There is also recognition of the objects separateness the and both and the intrinsic position, and a part analyst of their relationship symbolic between thought, depressive creativity analysand that
a reverie
allowing my most
development.
objectivity
hilarating and productive with regressed patients unusual occasions when, of reverie, with I play the game patient.
periods in working occur during those while in a slight state squiggle use pencils verbally associaof and to We do not
serve the interplay among primitive mental functions. During such a period, one of the female patients mentioned above laughed aloud and said listened in on would For sessions their of the if any other analyst our conversation, two she knew he or she patients week; times period,
surely deem us mad. a few months, these were consecutive four During hours that were few one
It is at these times that the thinking analysand and analyst most easily switches use without conflict
other day.
of generating experience (Ogden6). doubtful that such an interchange could place in a therapeutic endeavor in which analytic maintained; apist cause was of frame nor anxiety
each had bravely regressed to a primitive state during her interviews; this regression both frightened and greatly encouraged each because she deemed it a necessary reliving in the service of her analysis. For several days, each of them had been playing a verbal squiggle game with me. Our interactions created a state tial wrote, mother that space we found of which to be similar Winnicott to the and occur attuned. potenOgden when It is
had not been consistently would it be likely if the therpresumably concerning his beown the
uncomfortable,
aggressive or libidinal urges, during patients sometimes psychotic regressions. Especially important in this interchange are the position form nition distinctive as the features integration and of the depressive of part objects
to
my impression that many analysts become uneasy with the onset of reverie and seek to terminate the state. One had night, after such one of the women and I experienced an episode, I dreamed
to cite cannot
an
example keep
times
I am
quite
lost
in
my
interaction
with
the
and process
the
can viewing
be
thought the
of
as freely in
involvthese
combinations to convey
thinking,67
interchange
richness
in Ogdens
of experience.6
Except for the periods of reverie during which to retain my observing ego while simultaneously state, and I am able to record detailed process
rarely conscious disturbs fantasies my analysands, and my even emotional those who
and I play squiggle, I am easily able with the patient during my altered ego the interview51-a procedure that very quite paranoid. My notes include my
and
physical
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that she and I were Siamese twins, connected solely by our occipital cortices. One of my waking seeing visual become head. The associations eye cortices. Siamese following to to eye For me, twins, day was and these that did we had been share had by patient my my
any
early with
depended anxiety
gastrointestinal
while listening to her her tension. I told her on the basis of her ical and psychiatric was had while and her which accurate, been very physical complaints. was but severely young
stated history or my medknowledge that her belief that I felt certain that she psychically traumatized
and secretly that I had in fact had the dream about the other patient. In this instance, no harm was done. However, on other occasions I have indeed felt when I state transferinto foolish and delayed analytic progress have unwittingly carried my emotional and preoccupation with hour. led me the former interactions ence-countertransference the successive among others,
on the basis
of my emotional of she
reactions to her presentation Relieved and intrigued, psychoanalytic successful. of countertransferof perception, she articulates treatment,
promptly
entered remarkably
Khan507#{176}conceives ence as an McDougall6 introjections presymbolic comes bances aware instrument holds that
and her
analytic session as if it were a dream, in which the major unresolved transference-countertransference issue of the last or last few sessions composes the day residue. Accordingly, I assume that every communication of
through dreams of her own, as do I. At midcentury, analysts began suddenly to present and publish studies devoted specifically to countertransference, perhaps beginning with Winnicotts7 Countertransference tributions such as tle,7374 Nacht,Th and Many psychoanalysis and those Hate followed of Lacan,72 the toward in the by conLitearlidewas who withThe
the day
interview residue
in
dream symbolic
and/or nonverbal communications. to refresh my memory, I review advance my own and of the interview, notes fantasies, emotional
physical sensations. Countertransference a reactively begin treatment. that her and multiple predominantly of her having
interpretations
done by Heimann5276 and Racker,32 apparently worked independently, each out knowledge of the others thinking.
contributions of Rosenfeld77 have been overlooked by many. This may be attributable to his not having used the word cauntertransferonce in any title until very late in his career37 (chap. 12). Although he depicts himself as an orthodox Kleinian, in his earliest publication dealing with psychotic states (1947) Rosenfeld78 notes his use of countertransference reactions as guides to interpretation. He first 1952 uses the word while discussing
to enter
with
of analysts whom she consulted after therapy had proved ineffective, because of them would vouchsafe that he bethat her symptomatology was the result
countertransference
the with difficulties schizophrenia: is frequently
in in inthe
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guide
(p.
126).
No
doubt with
Rosenfeld Melanie
identifications.
An
in the the as
to protect
his relations
(his analyst), who was so incensed with Heimann that their previously cordial was terminated paper when at the Similarly, after said, she Heimann Zurich Klein conwas in be 6). the her 1950 (DePaola79).
change in therapists types of patients who analytic ing therapist regressions understanding ted. Freud solely always believed ference sensory Although originally as an ambivalent subjects nature and is the of the
understandbetween
of the
interaction
patient during the inevitable in the service of treatment-an that can be usefully interprethat he may was have transextracredthe
hostile toward Little7374 the use of countertransference treatment, as, it has been eventually toward In the early 1950s analysts conscious tional reactions has also been
she
it is generally believed viewed countertransference impediment on this to analysis, issue. He between and usually roles
of his emo-
ited During ference the past half century, countertransas a valuable tool has come to be seen
in
development
of a systematic
theory
in our therapeutic armamentarium, rather than solely as an impediment to psychoanalytic treatment. This change of attitude resulted their both level, dynamics, tions tween mutual from psychoanalysis coming to view of task as interpreting patient and therapist rather and analysand introjection in terms than the understanding of the and constant the interactions on an intrapsychic patients intrapsychic those interplay interacbe-
tertransference, and the important others, such as Rosenfeld and probably been underemphasized. L.Doty version assisted in manuscript of this article was presented
the Advanced Study of the Psychoses, cisco, June 1992, and at the Graduate Department of Psychiatry, Alta morial Hospital, is a companion unpublished.
Seminar,
Bates-Herrick
1. Boyer
LB: Roles
played
by music
as revealed
larged. 5. Boyer
New LB:
York,Jason Countertransference
Aronson,
gressed patients, in Countertransference: The Therapists Contribution to the Therapeutic Situation, edited by Epstein L, FeinerAF!. New York,Jason Aronson, 6. Giovacchini the Treatment York,Jason 7. Boyer LB: 1979, pp 347-374 LB (eds): Technical Disturbed Patient. of treating New Factors Patient. York, the in New Jason of the Severely Aronson, 1982 The Regressed aspects PL, Boyer
Scandinavian
2. Boyer LB: Provisional with few parameters nia. IntJ Psychoanal 3, Boyer fects. 4, Boyer LB: On maternal Psychoanal Study LB, Giovacchini and
evaluation of psycho-analysis in the treatment of schizophre1961; 42:389-403 overstimulation and ego deChild 1956; 11:236-256 PL: Psychoanalytic Treatment Characterological Disorders. 1967; Psychoanalytic Borderline, and Charedition, revised and en-
JOURNAL
OF PSYCHOTHERAPY
PRACTICE
AND RESEARCH
134
COUNTERTRANSFERENCE
281 10. Boyer working IntJ 11. Boyer on Jason ships. 13. Glover don:
liminar. LB: with Psychoanal LB, Treating Aronson, Psychoanal E: The the
Revista
de Psicoan#{225}lisis
1952;
9:342-354
Countertransference
the regressed 1989; PL patient (eds.): Patient. aspects 32:393-407 70:701-714
and
in
further Master
30. Racker E: A contribution to the problem of countertransference. IntJ Psychoanal 1953; 34:313-324 31. Racker ence. E: The Psychoanal meanings and 1957; uses of countertransfer-
NJ,
32. Racker E: Transference New York, International published PsicoanalItica. 33. Giovacchini Catastrophes. 34. initially Buenos Northvale, Splitting and Aronson, Object New as
12. Giovacchini
Estudios
sobre
1963; and
Aires,
Technique E: The
PL: Countertransference NJ,Jason Projective 1981 Theory Aronson, and Universities psychoanalytic edited Universities FR, Liberman in Psychoanalysis RE. New JG: York, Effective New
Balli#{232}re, Tindall of schizophrenia.J E: The International BD: The 1950 H: On and HF: the Self
14. Hoedemaker
therapeutic
process
Psychoanal
GrotsteinJS:
New York,Jason
ment
3:89-109 15.Jacobson York, 16. Lewin Norton, 17. Loewald ysis
and
the
35. Kernberg OF: Psychoanalysis. 36. Searles jects. 37. ArIowJA, HF: NewYork, Brenner
Relations York,Jason
Psychoanalysis New York, 23-43 38. AberasturyA, of Arlow icas, edited Universities 39. Waldinger apy with 1987 40. ScharffJS: and the and
(1960),
Loewald:
duction Northvale, 18. Searles Subjects. 1959, 19. Ogden apeutic in Collected
D, etal:
Schizophrenia
International PsychotherMacmillan,
Psychother1982
Patients.
York,
Aronson,
20. Rosenfeld HA: Contribution to the psychopathology of psychotic states: the importance of projective identification in the ego structure and the object relations of the psychotic patients, in Problems of Psychosis, edited 155-178 by Doucet P, Laurin C. Excerpta Medica 1971;
Use
NJ,
Jason Aronson, 41. LangsJ: The Overview 1976 42. Orr DW: historical 670 43. Reich and
Transference survey.J Am
a 2:621-
22. Wangh M:The evocation of a proxy: a psychological maneuver, its use as a defense, its purpose and genesis. Psychoanal Study Child 1962; 17:451-472 23. McLaughlinJT: enactment.J 24. Ogden choanal Psychoanal TH: Clinical and Am Psychoanal The concept (in press) E: Words 1983; 64:281-290 and countertransference: point of view of internalized and Self A Developmental S, Kaye Universities C, Zimmerman Press, 1981, theoretical aspects of an Assoc 1991; 39:595-614 action. through. PsyIntJ
A: On
Psychoanal
Countertransference: to the Therapeutic 1979 la t#{233}cnica editores; TechAspects 1979 sign in delusions of of Sit-
45. Etchegoyen psicoanalItica, also nique. 46. Balint Regression. as The London, M: The
25. OShaughnessy
26. Volkan VD: Transference an examination from the object relations, in Object Approach, M. New edited York, byTuttman International
New
persecution. IntJ Psychoanal 48. Freud 5: The future prospects therapy (1910), Psychological SE), in The Standard plete after, Works
1920; 1:231-234 for psycho-analytic Edition and edited (1933). 11 19011955 of the Freud Com(here-
pp 429-451 27. Grinstein A: The Index of Psychoanalytic vols I-V. New York, International Universities 1960 28. Grinstein A: The vols VI-IX. New Press, 29. Racker como 1966 Index York, of Psychoanalytic International
Writings, Press,
Writings, Universities
London, Hogarth Press, 49. Freud 5: New introductory 50. Freud 5: Recommendations (1912). psycho-analysis
J.
51.Jones
pre1919,
E: The Life and Work of Sigmund Freud: Years of Maturity. New York, Basic Books,
VOLUME
S#{149}NUMBER2 .SPRING
1994
BOYER
135
P: Counter-transference. 31:81-84 Splitting Aronson, RM: Modes of somatic and and Projective 1981
lntJ
Psychoanal
Baum, 73. Freud 74. Freud SE, vol dif Psy75. Freud Lectures: 76. Devereux
(1922).
SE, vol
18
(1925).
York,Jason
(1933).
SE, vol 22
Psychoanalysis
Psy-
York, International Universities Press, 1953 77. EisenbudJ: Psychiatric contributions to parapsychology: a review, by Devereux Press, 78. Bollas in Psychoanalysis G, New York, and the International Object: Occult, edited Universities Psychoanalysis Free ClInica, Association y T#{233}cnica.
56. Krystal H: Alexithymia choanalytic treatment. choanalytic Psychotherapy 57. Marty P, de MUzan psychosomatique. France, 58. McDougallJ: process. 1974; 59. McDougall communication, ity. New pp 247-298 York, 11:437-459 1963 The International
of psyof Psy-
1982/83; 9:353-378 David C: Linvestigation Presses and Universitaires the of psychoanalytic Psycho-Analysis and primitive of AbnormalPress, 1978, view1982; de
of the
Paris, psychesoma
A:
Review
Aires,
transference-counterInt
J:
transference in 1979; 60:347-356 81. Major R (ed): Aubier-Montaigne, 82. Freud vol 14 83. Fenichel Collected S: Instincts
states. Confrontation,
J
no
60. McDougall J: Alexithymia: point, Psychotherapy and 61. 38:81-90 McDougallJ: Approach ton, 62. Shipko apy and 63. Wilson ality 1989 5: Alexithymia Psychosomatics CP, Mintz Disorder. IL (eds): Treatment Northvale, D: The Psychotic Karnac, 1992 and Theaters to Psychosomatic of the
Their
Vicissitudes
Nor-
1982;
38:193-201 Underlying
Psychoanal,
D: A note on introjective of the British Psycho-Analytical 1978, privately circulated I: Some pathological
processes, in the Society, 14aspects of introBrazilian identificaIdentifiCT, 27-49 life SE, vol
of the
66. Boyer LB, Giovacchini PL: Psychoanalytic Treatment of Schizophrenic, Borderline and Characterological Disorders, York,Jason 67.Jones 1900, New 68. May and E: The The York, R: The the 2nd Life Basic idea edition, and Books, Work Years of history 1953, revised 1980, pp75-77 of Sigmund and the Great pp 221-267 in psychoanalysis: Psychology dream and and York, and Occult, fulfilled chance: the Occult, (1899). an excerpt edited Universities (1921), by Devereux in PsyG. by Freud 1990; SE, Freud: 1856Discoveries. and enlarged. New Aronson, Formative
jection. Unpublished paper read Psychoanalytic Congress, 1983 89. Meissner WW: Projection and tion, in Projection, Identification, cation, International 90. Freud (1901). 91. Freud 14 92. Abraham K A short libido, viewed in the in Selected Papers garth Press, 1948, 93. van OphuijsenJHW: persecution. IntJ BD: 94. Lewin Ueber-Ich. choanalyse 95. Leonard velopment 16:300-320
96. Malcolm study of the
at the
9th
projective Projective
edited 5: The
by Universities
Sandler Press,
J.
1987,
WoIf-Man.Psychoanalytic
7:163-183 69. Freud S: A premonitory vol 5 70. Freud (1904), Devereux Press, 71. Freud 1953, S: Premonitions G. New pp 52-55
development
light
(1924), Hoof
in Psychoanalysis
feeling weibliches
choanalysis
New York, International 56-68. Originallypublished aus dem London, 72. Stekel Nachlass, Imago. See
Universities Press, 1953, pp with no title in Schriften Gesammelte also SE, vol Traum. Werke 18 Berlin,Johannes 17:25-44.
Psychoanal una
W: Der
telepathische
RR
sexual
JOURNAL
OF PSYCHOTHERAPY
PRACTICE
AND
RESEARCH
136
COUNTERTRANSFERENCE
en
una
mujer,
vista
como
defensa
contra
un
Psicoan#{225}lisis
1957;
14:23-28
derrumbe
27:793-782
psic#{243}tico. Revista
Psychoanalytic Norton, 1945
de Psicoan#{225}lisis1970;
Theory of the Neu-
120. Grinberg
ence due Psychoanal 121.Grinberg
L: On a specific aspect of countertransferto the patients projective identification. Int L: 1962; 43:436-440 Countertransference Contemporary patient who edited New is difficult and Psychoanalysis to reach, Therapy, in II: coun-
97. Fenichel 0: The roses. New York, 98. SpilliusEB inTheoryand Routledge, 99. SpilliusEB in Theory don, 100. Hann-Kende tertransference and 101. 102. 103. 104. 105. the Occult, The International StracheyJ: (ed):
Melanie Practice,vol
Klein Today: Developments I: MainlyTheory. London, Klein Today: vol II: Mainly of transference Developments Practice. Lonand G. New pp 158-167 in psyaction counYork,
1988 (ed): Melanie and Practice, 1988 F: On the role edited Universities nature in psychoanalysis, by Devereux Press, 1953, of therapeutic in Psychoanalysis
Technique LB.
in Psychoanalytic
Routledge,
Countertransference, Flarsheim A, Boyer 1975, 123.Joseph 124. Meltzer 342 125. Meltzer 126. pp205-216 B: Addiction D: The
to near
1982; 63:449-456 relation of anal masturbation 1966; jective identification. IntJ Psychoanal D: Adhesive identification.
cho-analysis. IntJ Psychoanal Kohut H: The Analysis of the tional Universities Reik T: New ways Psychoanal Reik T: Farrar-Straus, 1933; Listening 1948
1934; 15:127-159 Self. New York, Internatechnique. Ear. New IntJ York,
Psychoanalysis Money-Kyrle
1975; 11:289-310 R: Normal counter-transference IntJ of Hanna Anxiety Mouton, Portrait Psychoanal Segal. to Method 1967 of a Moroccan.
some
366 127.
of its deviations.
Reik T: The Haunting riences in Life and and Young, 1953 Reik T: Some remarks
Melody. Psychoanalytic Music. New York, Farrar, on the study of resistances. York,
Segal H: The Work Aronson, 1981 Devereux Sciences. Crapanzano G: From The University BJ, Herrara Hague,
128. 129.
106.
Psychoanal 1924; 5:141-154 107. Reich W: Character Analysis. 108. Press, 1933 Spiegel LA: The functions of free analysis: their relation to technique national Baker instrument. 110. Klein
Review
New
Press, 1980 MJD, et al: Reflexivity Medicine dreams Chicago, about Essays Free the Press, experience and
countertransference. association in psychoand therapy. Inter1975; 2:379-388 On the analyzing mechanisms (1946), 131. 132. 133. 134. 135. atry 1982; 6:281-303 Kracke W: Kagwahiv father. Levine Ethos 1981; RA: Dreams
109.
L, Lothane M: Noteson
of Psycho-Analysis Z, SpencerJHJr:
Psychoanal some
1980; 49:474-504
schizoid
in Envy and Gratitude pp 1-24. New York, rence, 111. Ogden subjectivity, jugating 112. 113. Bion Heineman, Rosenfeld superego 114. 115. 116. 117. IntJ Pick third. WR: 1975 TH: On the IntJ Learning 1962 HA: Notes conflict
and Other Works, 1946-1963, Delacorte Press/Seymour Laudialectic Psychoanal from on the of subjectivity identification (in press) London, Experience. psycho-analysis schizophrenic the Her and and the intersub-
Ethos 1981; 9:276-293 A: Belief, Magic, and Anthropology. HF: Massive social New change
in Psy1969
II: projective
of loss: a study in the cultural in a North American Great choanalytic 136. TobinJ: Study of Society Countertransference
psychology of mourning Plains community. Psy(in and press) failure in interculLondon, BrJ Med Psyand 1992; Philip out. On
of the patient. 137. 138. Work. PaediatBooks, and 1958 the 141. 140. 139.
tural therapy. Ethos 1986; 14:120-143 Rosenfeld HA: Impasse and Interpretation. Tavistock, 1987 HA: Counter-transference. countertransference Int Reply knowing Dialogues patient Playing to 33:9-15 Rosenfeld chol 1960;
ence.
66:157-166
Faimberg H: The the countertransference. 73:541-547 Bromberg Brombergs Psychoanalytic Balint knowing Dialogues PM: On
Maturational
York, Situation.
118. 119.
Universities Press, 1965 Stone L: The Psychoanalytic International Universities Press, Grinberg L: Perturbaci#{243}nes Ia contraidentificaci#{243}n
Philip
1961
Winnicott national
Inter-
VOLUMES
#{149} NUMBER
#{149}
SPRING
1994
BOYER
137
143.
Ogden subject
TH: The dialectically constituted/decentred of psychoanalysis, II: the contributions Psychoanal 1992; 73:613-626 theory of the parent-infant Maturational New 1965, in and pp 37-55 of subjectivity of the and analytic Processes York,
Bion
WR:
Papers 1967
on Consulta-
Psy-
144.
and Winnicott. IntJ Winnicott DW: The tionship the tional (1960), Universities TH: On the Facilitating
Hogarth
Press,
Environment.
Segal H: A psycho-analytical approach to aesthetics. IntJ Psychoanal 1952; 33:196-207; also in The Work of Hanna 185-206 Segal 1957; New Segal. New York,Jason Aronson, 1981, pp
145.
Ogden subjectivity,
I: experience
IntJ Psychoanal (in press) 146. Gaddini E: Ilproblema mente-corpoen 147. Rivista Gaddini tendency Foundation 148. Gaddini Master edited Jason 149. Gaddini
on symbol formation. Also in The Work Aronson, and 1981, artistic creativity.
IntJ Psychoanal of Hanna Segal. Int Rev Psyof Hanna 207-216 The Psy-
de Psicoanalisi 1981; 27:3-29 R: Early psychosomatic symptoms toward integration.Journal 1985; 1:49-56 R: Regression and Clinicians on Treating by Boyer Aronson, LB, 1990, Giovacchini pp 227-244 and of the
pp 49-65
choanalytic
of Society
Greenacre
reconstruction. and
Am
its
uses in treatment:
thinking Genius
lytic
170. Khan
257-272 150. Boyer LB: Introduction: in treating on LB, 1990, Treating Giovacchini pp 1-32 JT: The the regressed the Regressed PL
the role of reconstruction ation, in The Privacy tional Universities 171. Winnicott DW: (1947)in Collected cho-analysis. 172. New
Press, 1964,
pp 59-68
Hate in the countertransference Papers: Through Paediatrics to PsyYork, Basic Books, 1958, pp194-203 in Ecrits. patients re-
151. McLaughlin
LacanJ: Intervention surle transfert (1951), Pans: Editions du seuil, 1966, pp 215-226 Little MI: Counter-transference and the sponse to it (1951), in Transference Transference Psychosis. New York, 1981, pp33-50 MI: R-the (1957), Psychosis. analysts total response
tions on states of consciousness in the analyst JAm Psychoanal Assoc 1975; 23:363-382 152. Balint E: Before agination, edited 153. 154. I Was I: Psychoanalysis by MitchellJ, Parsons of Dreams Folklore: New 1979 Symbolic York,
Guilford, 1993 Freud 5: The Interpretation vols 4-5 Boyer LII: Childhood Study of Apache Anthropology, GA, Boyer LB: Berkeley, LII, Boyer the Tanaina 1989; and Folklore.
Little
Neurosis and Jason Aronson, Paris, Presses Med Psychol Hogarth state with of PaPL.
1981, pp. 51-80 175. Nacht 5: La presence 176. 177. 178. 179. Universitaires Heimann
chological 155. De Vos 156. turally. Boyer between among Alaska. 157.
Analysis
1960; 33:9-15 Rosenfeld HA: Press, 1965 HA: HFB: theory Rosenfeld Dc Paola
psychological ETHOS
Boyer LB: Christmas pressive States and Volkan V. Northvale, 297-316 Gill MM, Newman view in Psychiatric Universities Press, TH: On Ogden
NJ, Jason
1985,
Clinicians 2, edited
Giovacchini
158.
R, Redlich FC: The Initial InterPractice. New York, International 1954 potential space. Int
180.
Northvale, NJ,Jason Balint E: A portrait ment of his 5:211-222 E, Balint M: On ideas Journal on International 1974;
1993, pp 143-172 Balint the developof the drug doctor. Medicine counteriransthe Illness.
159. 160.
Psychoanalytic and
1985; 66:129-142 Ogden Th: The Matrix of the Mind Aspects of Object Relations Theory. Northvale, NJ,Jason Aronson, 1986 TH: The NJ,Jason Primitive Aronson, Edge 1989 of Experience. Northvale,
transference
161. Ogden
Publications,
JOURNAL
OF PSYCHOTHERAPY
PRACTICE
AND RESEARCH