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The analyst should progress on the working assumption, that the patient’s associations have transference implications pervasively, that with which this assumption is not to be confused with denial or neglect of the current aspects of the analytic situation. It is theoretically always possible to give precedence to a transference interpretation if one can only discern it through its disguise by resistance. This is not to dispute the desirability of learning as much as one can about the patient, if only to be a position to make more correct interpretations of the transference. One therefore, does not interfere with an apparently free flow of associations, especially early, unless the transference threatens the analytic situation to the point where its interpretation is mandatory rather than optional.
With the recognition that evens apparently freely associating patient may also be showing resistance to awareness of the transference, this formulation should not interfere as long a useful information being gathered should relace Freud’s dictum that the transference should not be interpreted until it becomes a resistance (1913).
It can be argued that every transference has some connection to some aspect of the current analytic situation, in the sense that the past can exert an influence only insofar as it exists in the present. Of course, all the determinants of a transference are current in the sense that what I am distinguishing is the current reality of the analytic situation, that is, what actually goes on between patient and analyst in the situation from how the patient is currently constituted as a result of his past.
All analysts would dubiously agree that there are both current and transferential determinants of the analytic situation, and probably no analyst would argue that a transference of the analytic situation, and probably no analyst would argue that a transference idea can be expressed without contamination, as it was, that is, without any connection to anything current in the patient-analyst relationship. Nevertheless, the implications of this fact for technique are often neglected in practice, as my next point is only to argue for the connection.
Several authors, e.g., Kohut 1959 and Loewald 1960, have pointed out that Freud`s early application by the act or practice of using something or the state of being used, this, however, employ of the quality of being appropriate or valuable to some end as to accommodate the accountable or warrant the use of the term transference. In `The Interpretation of Dreams, in a connection not immediately recognizable as related to the present day use of the term, reveals the fallacy of considering that transference can be expressed free of any connection to the present. That early use was to refer to the fact that an unconscious idea cannot be expressed as such, but only as it becomes connected to a preconscious o r conscious content. In the phenomenon with which Freud was then concerned, the dream transference took place from an unconscious wish to a day residue. In `The Interpretation of Dreams, `Freud used the term transference both for the general rule that an unconscious content is expressible only as it becomes transferred to a preconscious or conscious content and for the specific application of this rule to a transference to the analyst. Just as the day residue is the point of attachment of the dream wish, so must there be an analytic-situation residue, though Freud did not use that term, as the point of attachment of the transference.
Analysts have always limited their behaviour, both in variety and intensity, to increase the extent to which the patient‘s behaviour is determined by his idiosyncratic interpretation of the analyst’s behaviour. In fact, analysts unfortunately sometimes limit the behaviour so much as to compare with such an expression or unpiled standard or absolute approximation, that the entire relationship with the patient matter of technique, with no nontechnical personal relation, as Liptop (1977) has pointed out.
But no matter how far the analyst attempts to carry this limitation of his behaviour, the very existence of the analytic situation provides the patient with innumerable cues which can enviably become his rationale for his transference responses. In other words, the current situation cannot be made to disappear - that is, the analytic situation is real. It is easy to forget this truism in one’s zeal to diminish the role of the current situation in determining the patient ‘s responses. One can try to keep past and present determinants relatively perceptible from one another, but one cannot obtain either ‘pure culture‘. Freud wrote: ‘I insist on this procedure [the couch], however, for its purpose and result are to prevent the transference from mingling with the patient’s associations imperceptibly, to isolate the transference and to allow it to come forward in due course sharply defined as a resistance’ (1913). Even ‘isolate’ is too strong a word in the light of the inevitable intertwining of the transference with the current situation.
If the analyst remains under the illusion that the current cues he provides to the patient can be reduced to the vanishing point, he may be led into a silent withdrawal, which is not too distant from the caricature of an analyst as someone who does refuse to have any personal relationship with the patient. What happens then is that silence has become a technique rather than merely an indication that the analyst is listening. The patient’s responses under such conditions can be mistaken fo uncontaminated transference when they are in fact transference adaptions to the actuality of the silence.
The recognition, from which it takes its point of departure, as it was, has a crucial implications for the technique of interpreting resistance to the awareness of transference, in that, if, the analyst becomes persuaded of the centrality of transference and the importance of encouraging the transference to expand within the analytic situation, he has to find the presenting and plausible interpretation of resistance to the awareness of transference he should make. Is that, his most reliable guide is the cues offered by what is actually going on in the analytic situation? : On the one hand, the events of the situation, such as change in time of session, or an interpretation made by the analyst, and, on the other hand, how the patient is experiencing the situation as reflected in explicit remarks about it, however, fleeting these may be. This is the primary yield for technique of the recognition that any transference must have a link to the actuality of the analytic situation. The cue points to the nature of the transference, just as the day residue for a dream may be a quick pointer of the latent dream thoughts. Attention to the current situation for a transference elaboration will keep the analyst from making mechanical transference interpretation, in which he interprets that there are allusions to the transference in association not manifestly about the transference, but without offering any plausible bias for the interpretation. Attention to the current stimulation offers some degree of protection against the analyst’s inevitability whose tendency to project his own views onto the patient, either because of countertransference or because of a preconceived theoretical bias about the content and hierarchical relationships in psychodynamics.
The analyst may be very surprised at what in his behaviour the patient finds important or unimportant, for the patient’s responses will be idiosyncratically determined by the transference, the patient’s responses may seem to be something the patient as well as the analysts consider trivial, because, as in displacement to a trivial aspect of the day residue of a dream, displacement can better serve resistance when it is to something trivial. Because it is connected to conflict-laden material, the stimulus to the transference may be difficult to find. It may be quickly disavowed, so that its presence in awareness is only transitory. With the discovery of the disavowed, the patient may also gain insight into how it repeats as disavowed earlier in his life. In his search for the present stimuli which the patient is responding transferentially, as the analyst must therefore remain alert to both fleeting and apparently trivial manifested reference to himself as well as in the events of the analytic situation.
If the analyst interprets the patient’s attitudes in a spirit of seeing their possible plausibility in the light of what information the patient does have, rather than in the spirit of either affirming or denying the patient’s views, the way is open for their further expression and elucidation. The analyst will be respecting the effort to be plausible and realistic, rather than manufacturing his transference attitudes out of whole bodied material.
Importantly, is to make a transference interpretation plausible to the patient in terms of as current stimulus that, if the analyst is persuaded that the manifest content has important implications for the transference but he is unable to see a current stimulus for the attitude, he should explicitly say so if he decides to make the transference interpretation anyway. The patient himself may then be able to say what the current stimulus is.
It is sometimes argued that the analyst’s attention to his own behaviour is a precipitant for the transference, will increase the patient’s resistance to recognizing the transference. That, on the contrary, that because of the inevitable interrelationship of the current and transferential determinants, it is only through interpretation that they can be disentangled.
It is also argued that one must wait until the transference has reached optimal intensity before it can be advantageously interpreted. It is true that too hasty and interpretation of the transference can serve as a defensive function for the analyst and deny him the information he needs to make a more appropriate transference interpretation. But it is true that delay in interpreting transference interpretation, but it is also true that delay in interpreting runs the risk of allowing an unmanageable transference to develop. It is also true that deliberate delay can be a manipulation in the service of abreaction rather than analysis, and, like silence, can lead to a response to the actual situation which is mistaken for uncontaminated transference. Obviously important, is assumed in the issues of timing are involved, whereas an important clue to when a transference interpretation is apt and which one to makes lies in whether the interpretation can be made plausibly in terms of the determinant, namely, as something in the current analytic situation. Such as, in the approaching transference in the spirit of seeing how it appears plausibly realistic to the patient, it paves the way toward its further elucidation and expression.
Freud’s emphasis on remembering as the goal of the analytic work implies that remembering is the principal avenue to the resolution of the transference. But the delineation of the successive steps in the development of the analytic technique (1920) makes clear that he saw this development as a change from an effort to reach memories directly to the utilization of the transference as the necessary intermediacy to reaching the memories.
In contrast to remembering as the way the transference is resolved, Freud also described resistance for beings primarily overcome in the transference, with remembering following relatively easily afterwards, ‘From the repetitive reactions which are exhibited in the transference we are led along the familiar paths to the awakening of the memories, which appear without difficulty, as it was, after the resistance has been overcome’ (1914), and ‘This revision of the process of repetition can be accomplished only in part in connection with the memory traces of the process which led to repression. The decisive part of the work’s achieved by creating in the patient’s relation to the analyst - in the ‘transference‘ new editions of the old conflicts . . . Thus, the transference becomes the battlefield on which all the mutually struggling forces should meet one another’ (1917). This is the primary indication for which Strachey (1934) classified in his seminal paper on the therapeutic action of psychoanalysis.
There are two main ways in which resolution of the transference can take place through work with the transference in the here and now. The first lies in the clarification of what are the clues in the current situation which are the patient‘s point of departure force a transference elaboration. The exposure of the current point of departure at once raises the question of whether it is adequate to the conclusion drawn from it. The relating of the transference to a current stimulus is, after all, parts of the patient‘s effort to make, the transference attitude plausibly determined by the present. The reverse and ambiguity of the analyst’s behaviour are what increases the ranges of apparently plausible conclusions the patient may draw. If an examination of the basis for the conclusion makes clear that the actual situation to which the patient responds is subject to other meanings than the one the patient has reached, he will more reality consider his pre-existing bias, that is to say, in that of transference.
Critically, it is suggested that, in speaking of the current relationship and the relation between the patient’s conclusion and the information on which they seem plausibly based, such in some absolute conception of what is real in the analytic situation, of which the analyst is the final arbiter. That is not the case, that what the patient must come to see is that the information he has is subject to other possible interpretations implies the very contrary to an absolute conception of reality. In fact, analyst and patient engage in a dialogue in a spirit of attempting to arrive at a consensus about reality, not about some factious absolute reality.
The second way in which resolution of the transference can take place within the work with the transference in the here and now is that in the very interpretation of the transference the patient had a new experience. He is being treated differently from how he expected to be. Analysts seem reluctant to emphasize his new experience, as though it endangers the role of insight and argue for interpersonal influence as the significant factor in change. Strachey’s emphasis on the new experience in the mutative transference interpretation has unfortunately been overshadowed by his views on introjection, which have been mistaken to advocate manipulating the transference. Strachey meant introjection of the more benign superego of the analyst only as a temporary strep on the road toward insight. Not only is the new experience not to be confused with the interpersonal influence of a transference gratification, but the new experience occurs together with insight into both the patient’s biassed expectation and the new experience. As Strachey points out, what is unique about the transference interpretation is that insight and the new experience take place in relation to the very person who was expected to behave differently, and it is this which gives the work in the transference, its immediacy and effectiveness. While Freud did stress the effective immediacy of the transference, he did not make the new experience explicit.
It is important to recognize that transference interpretation is not a matter of experience, in contrast to insight, but a joining of the two together, both are needed to bring about and maintain the desired changes in the patient. It is also important to recognize that no new techniques of intervention are required to provide the new experience. It is an inevitable accompaniment of interpretation of the transference in the here and now. It is often overlooked that, although Strachey said that only transference interpretations are outside the transference.
Rosenfeld (1972) has pointed out that clarification of material outside the transference is often necessary to know what is the appropriate transference interpretation, and that both genetic transference interpretations and extratransference interpretation taking to consider an inclination as marked by or indication of notable worth or simply the consequence based upon the role in working through. Strachey said relatively little about working through, but surely nothing against the necessary provision with which every thing needfully is explicitly recognized as the role for the recovery of the past in the resolving dissection of the purposiveness determined by the transference.
In taking positions, as to emphasis the role of the analysis of the transference in the here and now, both in interpreting resistance to the awareness of transference and in working toward its resolution by relating to the actuality of the situation. In that of opinion or purpose with the evidence that extratransference and genetic transference interpretation and, of course, working through is important too, that the matter is one of emphasis. Also, interpretation of resistance to awareness of the transference should figure in the majority of sessions, and that if this is done by relating the transference to the actual analytic situation, the very same interpretation is a beginning of work to the resolution of the transference. To justify this view more persuasively would require detailed case material.
The concern and considerations that the Kleinian annalists whom, many analysts feel, are in error in giving the analysis of the transference too great if not even as exclusive role in the analytic process. It is true that Kleinians emphasize the analysis of the transference more, in their writing at least, than does the general run of analysts. As, Anna Freud (1968) complained that the concept of transference has become overexpanded seems to be directed against the Kleinians. One of the reasons the Kleinians consider themselves the true followers of Freud in technique are precisely because of the emphasis they put on the analysis of the transference. Hanna Segal (1967), for example, writes, `Too say that all communications are seen as communications about the patents phantasy as well as current external life is equivalent to saying that all communications contain something relevant to the transference situation. In Kleinian technique, the interpretation of the transference is often more central than in the classical technique.
Affirmly held point of view or way of regarding that Freud and transference had accedingly connected by simulating observations that we can only offer, that Freud wrote briefly about transference, and did so, to sustain the way in which, is, as a whole, that his actions were justly taken in and around 1917. Another observation which can rarely be made about Freud’s works, and which everyone may not agree with, is that, with one or two exceptions, what he did write on transference did not reach the high level of analytical thought which has come to be regarded as standard for him. Some indication of what his contribution consists of is given by the editors of the Standard Edition, who list them in several places. One of the longer lists, in a footnote on page 431 of Volume 16, includes six references: ‘Studies of Hysteria’ with Breuer (1895), the Dora paper (1905), ‘The Dynamics of Transference’ (1912), ‘Observations on Transference-Love’ (1915), the chapter on transference in the Introductory Lectures (1917), and ‘Analysis Terminable and Interminable’ (1937). Although the editors, in no sense suggest that these six papers include everything Freud wrote on the subject. It does seem evident that, considering the essential importance of transference to analysis, he wrote, ‘The Dynamics of Transference’, ‘Transference-Love’, and the transference chapter in the Introductory Lectures, came across, as, perhaps, his least significant contribution.
Freud’s first direct mention of transference comes upon the pages ascribed within the ’Studies of Hysteria’ (1895), his first significant reference to it, however did not appear until five years later, when, in a letter to Fliess on April 16, 1900, he said (Freud, 1887-1902) he was ‘beginning to see that the apparent endlessness of the treatment is something of an inherent feature and is connected with the transference’. In a footnote to this letter the editors said that, ‘This is the first insight into the role of transference in psychotherapy.’
Despite these early references, it seems correct to say that yet another five years were to go by before the phenomenon of transference was actually introduced. Even so, the introduction was far from prominent, for it was tacked on like an afterthought as a four-page portion of a postscript to what was perhaps Freud’s most fascinating case history to date, the case of Dora (1905).
Using data from Dora’s three-month-long, unexpectedly terminated analysis, and especially from her dramatic transference reaction which had taken him quite unawares, Freud now gave to transference its first distinct psychological entity and for the first time indicated its essential role in the analytic process. His account, although in general more than adequate - in the elegant fact and unmistakably ‘finished’ - was brief, and almost to the point, and perhaps not an entirely worthy introduction so much more a truly great discovery. What was uniquely great was his recognizing the usefulness of transference. In his analysis of Dora he had noted not only that transference feelings existed and were powerful, but, much to his dismay, he had realized what a serious, perhaps, even insurmountable obstacles that objectively would be. Then, in what seems like a creative leap, Freud made the almost unbelievable discoveries that transference was in fact, the key to analysis, that by properly taking the patient’s transference and therapeutic force was added to the analytic method.
The impact on analysis of this startling discovery was actually much greater and much more significant than most people seem to appreciate. Although the role of transference as the sine quo non of analysis and is widely accepted, and was stated by Freud from the first, it has almost never been acclaimed for having brought about an entire change in the nature of analysis. The introduction of free association to analysis, a much lesser change, receives and still receives much more recognition.
One of the reasons for the relatively unheralded entry of transference into analysis may have been for circumstances of its discovery. Although Freud’s new ideas were recorded as if they arose as sudden inspiration during the Dora analysis, they may in fact have developed somewhat later. In the paper‘s precatory remarks, for instance, Freud said he had not discussed transference with Dora at all, and in the postscript, he said he had been unaware of her transference feelings. Also, pointing to a later discovery date is the extraordinary delay in the paper’s publication. According to the editor’s note, the paper had been completed and accepted for publication by late January 1901, but this date was then actually set back more than four and a half years until October 1905. The editors said, ‘We have no information as to how it happened that Freud, . . . deferred publication.’ It readily seems that for reasons to have been that only during those four and a half years, as a consequence to his own self-analysis, that he came to a better understanding of the relevantly significant as the applicable reason to posit of the transference. Only then may it have been possible for him to turn again to the Dora case, to apply to it of what he had learned in himself, to write this essay as part of the postscript, and at last to release the paper for publication.
Freud’s self-analysis has been considered from many angles, but not significantly, as can be of valuing measure, in at least from the standpoint of transference. Opponents of the idea that there is such a thing as definite self-analysis, some of whom say it is impossible, generally an object on grounds that without any analyst there can be no transference neurosis. Freud clearly demonstrated, as, perhaps, that the situation that may be necessary to fill this need: Self-analysis may require that, at least a halfway satisfactory transference object. In Freud`s case, the main transference object at this time seems to have been Fliess, who filled the role rather well. As with any analysis, the authenticity as known in the unfeigned design as if existing or having no illusions and facing reality squarely, by which the ‘real’ impact on Freud was slight, he was essentially a neutral figure, relatively anonymous and physically separates. All of this, and Fliess`s own reciprocal transference reactions, made it possible for Freud to endow Fliess with whatever qualities and whatever feelings were essential to the development of Freud`s transference, and, it should be added, his transference neurosis. In the end, of course, the transference was in part resolved. Freud`s eventual awakening of its self realization in its presence within him of such strange and powerful psychological forces must have come to the conclusion as a stupefied disilluionary dejection toward Fliess, however, his subsequent working out of some of these transference attachments must have been both an intellectual triumph and an immensely healing and releasing of actions, operations or motions involved in the accomplishment of an ending that makes from its process.
In the years following this revolutionary discovery, the central role of transference in analysis increased in remarkable acceptance, and it has easily held this central position ever since. What the substance of this central position distinctfully compose in having or be capable of having within the constructs to which is something of a mystery, for, it seems as nothing about analysis and is, of least to be, the well known than how individual analysis actually uses transference in their day-to-day work with patients. As a guess, as, perhaps of each analysts concept of transference derives variably but significantly from his own inner experience, transference probably means many and varying differentiations to things as to different analysts.
In the same differentiated individuals, as that Freud’s own pupils must have differed on this issue, not only from him but from each other. Although some of their differences may have been slight, others, my have contributed significantly to later analytic developments. A question could be raised, for instance, whether differences in handling the transference which at first were the property of one analyst gradually develop into formal clinical methods used by many, and whether these clinical methods, after having been conceptualized, serve as the beginning of variously divergent schools of analysis. Such occurrences, consistent with certain beliefs that analytic ideas do arise in this way, primarily out of transference experiences in the analytic situation, would lead to the question whether the history of the ideological differences in what was actually said and done in response to transference reactions that to any other factor. Whatever the case, many differences and divergencies did occur among the early analysts, and all of that is supposed to have had to do in some major way with differences in the handling of the transference.
Strangely, Freud himself seems to have taken little part in influencing this rapid and divergent period of growth. Usually accused of being too dominating in such matters, Freud seems to have done just the opposite during the development of this most critical aspect of analysis, the process itself, and, for reasons unknown, detached himself from it.
What was needed, one might be inclined to say, was not leadership in the form of domination, but leadership in trying to provide what was lacking, and still lacking, namely an analytical rationale for transference phenomena. The question must be asked, of course, whether in fact this would have been a good thing at that particular time in psychoanalytic history. Perhaps not. The exercise of closure, which Freud’s structuring might have amounted to. But although adding to understanding and stability at ceratin theoretical levels, could at another level, so such closures have often done, have placed many obstacles in the way of further analytical developments. Thus, his leaving the matter of transference wide open, even though it led to confusion and uncertainty, may have been just as well.
In many ways the closest Freud ever came to establishing a formal analytical rationale for transference was his first attempt, in the postscript to the case of hysteria (1905). These few pages are and among the most important of all Freud’s writings, outweighing by far the paper to which they are appended. Yet, in the case of Dora has always been taught as an entity rather than the ancillary to the essay on transference. In that essay Freud was clear: His ideas revealed tremendous insights and promised more to come, and that, the powers of the neurosis are occupied in creating a new edition of the same disease. Just think of the analytic implications of his saying that this new edition consists of a special class of mental structures, for the most part unconscious, having the peculiar characteristic of being able to replace earlier persons with that of the person of the analyst, and in the fashion applying all components of the original neurosis to the person of the analytical at the present time. Surely as profound a statement as any he ever made.
He then goes on to say that there is no way to avoid transference, that this ‘latest creation of the desire must be combatted like all the earlier ones’, and that, although this is by far the hardest part of analysis, only after the transference has been resolved can a patient arrive at a sense of conviction of the validity of the connection which have been constructed during analysis.
He concludes by saying, ‘In psychoanalysis . . . all the patients’ tendencies, including hostile ones, are aroused, they are then turned to account for reasons to explain or the internalization of justification, and by the same measure was to purposively give a sensible reason for the proposed change in the analysis by which of being made conscious. That, in this way, the transference is constantly being put-down, however, transference, which seems ordained to be the greatest obstacle to psychoanalysis, becomes its most powerfully . . .
These remarkable observations, in conveying a sense of deep conviction that could arise, one feels, only from Freud’s own hard-won inner experience, that nowhere is there a suggestion that transference is a mere technical matter. Far from it, as Freud announces that he has come upon as new and exciting kind of mental function, or, as it is to believe, that a new and exciting kind of ego function.
Very quickly, however, Freud’s conviction sees to have failed him. Nothing he wrote afterwards about transference was at this level, and most of his later references were a retreat from it, for instance, he never did develop the promising idea that the mind constantly creates new editions of the original neurosis and meaningfully incline the minded inclusion in them, an ever-changing series of persons. Instead, he tended to become less specific, even referring to transference at times in a broad terms as if it were no more than rapport between patient and analysts, or as if it was an interpersonal or psychosocial relationship, concepts which, of course, a great many analysts have since adopted, but which were not part of Freud’s original ideas.
Perhaps his most persistent deviation was an on-and-off tendency to regard transference merely as a technical matter, often writing of it as an asset to analysis when positive and a liability when negative.
Significantly, because it indicated that an active struggle was still going on within him, Freud occasionally expressed once again, even though briefly his earlier insights, particularly his ideas that transference is an essential although unexplored part of mental life. An example of this appears in his alternative obtainments such that is gainfully to appear of as quality of being pleasant or agreeable to a feature that makes for pleasantness or ease, among the amenities of the central geniality, otherwise, the prevailing indifference account for the transference in ‘An Autobiographical Study’ (1925). Transference, he says, ‘is a universal phenomenon of the human mind. And in fact dominated the whole of each person’s relations to his human environment. In these few words’ Freud again made the point, and in declarative fashion, that transference is a mental structure of the greatest magnitude, but he never really followed it up.
Rather extensive evidence of his departure from the original concept and his continuing struggle with that concept is seen most clearly, wherein, the ‘Analysis Terminable and Interminable’ is much more than a courageous, brilliant, and pessimistic, appraisal of the difficulties and limitations of analysis, although transference is briefly mentioned in its content, yet a great deal about it comes through, some quite directly, some by easy inference. When looked at in this way, two themes stand out: Freud’s personal frustration with the enigmas of transference and his tacit placing of transference in the centre of success and failure in analysis, both as a therapy and as a developing science. What also comes through, is the perplexing realization of how far Freud had, by now, seemingly moved away from his original concepts. Or had he?
All the same, even if it is insufficient for exclusive reliance in relations to the complicated neurosis, for which it would be fallacious to assign to the recall and reconstruction of the past an exclusively explanatory value (in the intellectual sense), important though that functions be, and difficult as its full-blown emotional correlate may be to come by. There is no doubt that, even in complicated neurosis, equivalently complicated transference neurosis, the genuine complex and complicated transference neurosis, the genuinely experienced linking of the past and present can have, at times, a certain uniquely specific dynamic effect of its own, a type of telescoping or merging of common elements in experience, which must be connected with the meaninglessness of time in unconscious life, compared with its stern authority in the life of consciousness and adaptation to everyday reality. Contributing decisively to such experiences as to whatever degree it occurs, is of course, the vivid currency of the transference neurosis, and central in this, the reincarnations of old objects in an actual person, the analyst.
Thus, an allied problem in the general sphere of transference is the fascination and often enigmatic interplay of past and present. If one wishes to view this interplay in terms of a stereotyped formulation, the matter can remain relatively uncomplicated - as a formulation. Unfortunately. , This is too often the case. The phenomenon, however, retains some important obscurities, which cannot thoroughly dispel, but to which I would like to call attention. To concentrate on the dimension of time, it seems in reference to the complication and immediate aspects of technique, nonetheless, essential. For example, we can assume that the transference neurosis re-enacts the essential conflicts of the infantile neurosis in a current setting. If a reasonable degree of awareness of transference is established, the next problem is the genetic reduction of the neurosis to its elements in the past, through analysis of the transference resistance and allied intrapsychic resistances, ultimately genetic interpretations, recollections and reconstructions and working through. Such that the transference is related to its genetic origins, the analyst thereby emerges in his true, i.e., real, identity to the patient, the transference is putatively ‘resolved’. To the extent that one follows the traditional view that all resistances, including the transference itself, is ultimately directed against the restoration of early memories as, this is a convincing formulation. Is that, only to say, that in his own right as such as having to a certain tightly logical quality? However, we know that it this is not so readily accomplished, apart from the special intrapsychic considerations described afterward by Freud in ‘Analysis Terminable and Interminable’. Although in a favourable case, much of the cognitive interpretative work can be accomplished, there remains the fact that cognition responsibility, in its bare sense, does not necessarily lead to the subsidence of powerful dynamism, to the withdrawal of ‘cathexes’ from importantly real objects. For, as mentioned, a short while ago, the analyst is a real and living object, apart from the representations with which the transference invests him, and which are interpretable as such, for which there is no, at any time a seldom, a confusing interrelations and commonly of the emergent responses, due to the same old seeking, and this is directed toward a new individual in his own right, both are important, furthermore, there are large and important ones of overlapping. Apart from such considerations, even the explicitly incestuous transference is currently experienced (as, at least in good part) by a full-grown adult (like the original oedipus), instead of a totally and actually helpless child. To be sure, the latter state is reflected in the emergent transference elements of instinctual striving, but it is subject to analysis, and the residual is something significant, if not totally different. It is these residual sexual wish, presumably directed toward the person of the analyst, as such, which must be displaced to others, if, as generally agreed, the revival of infantile fantasies and strivings in the biologically mature adolescent presents a new and special problem, one must assume distinctiveness of experience for the adult, although it is true that in the majority of instances, adequate solution is favoured by the adult state. There is, in any case, a residual relationship between persons who have worked together in a prolonged, arduous and intimate relationship, which, strictly speaking, are reversibly disconnected or divorced of services, in that the transference merely ushers out the retirement for which its rendering retreat of that state of mind or feeling by an inner avoidance of something usually felt as unpleasant or pronounced for it’s adverse but mutual colouration. Blending to some confusion between the two spheres of feeling. The general tendency is that both components are fully gratified to some degree. But, there is the ubiquitous power of the residual primordial transference, yet, argue to cling to an omnipotent partisan to resist the displacement of its ‘sublimated’ anaclitic aspects, even if the various representation of the wishes for bodily intimacy has been thoroughly analysed and successfully displaced. The outcome is largely the transference of the transference, as mentioned earlier, in a different context. For everyday reality can provide no actual answer to such cravings. In this connection, note, Freud’s genial envy of Pfister. If the man of faith finds this gratification in revealing religion, others in a wide range of secular beliefs and ‘leaders’ the modern rational and sceptical intellectual is less fortunate in this respect. Presumably free, he is prone to invest even intellectual disciplines or the proponents with inappropriate expectations and partisan passions, but, least of mention, that within these fields of analytical and theoretical thought, is not to provide exceptions to this tendency.
Though if one is to maintain and beneficially confine its bothering of reservations about the clarity of conceptualization, the explanatory discussion of Kohut and Seitz, is a very useful contribution to the direct complication or which by some understanding the awkwardness of oneself. Both Loewald and Kohut have deliberately associated a special but the different use of one of Freud’s three conceptions of transference, i.e., the transference from the unconscious to the preconscious.
Yet, to furthering comments on primordial transference, at least potentially, are largely psychological (mental) component, the concept of ‘transference of the transference’ would be applicable to this component. For it does appear that certain aspect of the search for the omnipotent and omniscient caretaking parents are implicitly practical as virtually capable for being turned to use or account for its functional practicability for something of a process or the procedure for being all but the essential purpose to come to or tend toward a common point, for which are the knowledgeable information or ideas, is nothing but causative effectuality. As suggested earlier, there are important qualitative and quantitative distinctions in the mode of persistence and such strivings, however, even to the extent that they are detached from the analyst and carried into some reasonably appropriate expression in everyday life, they retain at least a subtle quality which contravenes reality, one which derives from earliest infancy, and remains - to this extent - a transference. ‘Santa Claus’ lives on, where one might least expect to meet him, whether as a donor of miracle drug or of far more complex panaceas.
If one prescribes to this parasymbiotic transference drive, a true primordial origin, it is necessary to take cognizance of certain important concepts dealing with the earliest period of life. If we assume a powerful original organismic drive toward an original ‘object’, a striving to nullify separation from the beginning, how does this make something legally valid or operative usually by formal approval or sanctioned with concepts such as ‘primary narcissism’ or the ‘objectless phase’ or ‘the primary psycho physiological self’ (We note in passing that there are those who do not accept these as usually construed in the technique of Balint), for example, or Fairbairn or - conspicuously - Melanie Klein. These are states, variously defined or conceived, which apply to the earliest neonatal period, in which life, to state more simply, exists only as the potential in physiological processes. Since there is (we postulate) no clear awareness of self-withdrawal from the mother, there can be no ‘mentally’ represented or experienced drive to obliterate the separation (concerning oneself and object, conceiver of as separate, in a continuing sense). There are, of course, discharge phenomena, the precursors of purposive activity, and there are urgent physiological needs, directed toward fulfilment or relief, rather than toward an object as such. However, in relation to these physiological needs as archaistic precursors of object relationships, it must be noted that in all, except respiration and spontaneous sphincter relief (even in these instances, not without exception or reservation), the need fulfilment must be mediated by the primordial object (or her surrogate). There is also, of course, the uniquely important requirement for ‘holding’, in a literal expression, from the outset. The material partner in human symbiosis which supplies what the neonate cannot seek by ‘clinging’, as for Bowlty and Murphy, in the sense that must be experienced to the physiological ebb and flow of tension, even if restricted to the kinaesthetic, connected with a peripheral sensory registration, which is the protophase of the recognition of separation from the object or nonpresence of the object, as a painful instance of, her presence in apposition the converse? That the general context may be only in which the sense of unity is preponderant, or, more accurately, that there is no general awareness of ‘separation’ as such, means that the drive for union does not exist in a general psychological sense. It is, so to speak, satisfied. That object constancy, with its cognate ‘longing’, is quite a different experience from the urgencies of primitive need fulfilment is true, however, regardless of what may be added by maturational and developmental considerations, instinctual and perceptual, there is no reason to assume other than a core of developmental continuity from the earliest needs and their fulfilment to the later state, and some continuing degree of contingency based on them.
There is a very rough parallel in the way certain analytic patients, before a firm relationship with the analyst is established, signal certain primitive experiences and tendencies in special reactions to the end of the hour, to the nonvisibility of the analyst, to interruption of their association, to failure of the analyst to talk, and similar matters. We must note that in the basic formation of the ego is evident amongst the primitive reactions and beyond to separations, in the form of very early identifications as based on care taking functions. Certainly in the very development of autonomous ego of the mother’s investment in the, have a decisive role in the character of the their development. And in the case of object constancy, in its connotation of libidinal cathexis, where is no need whatsoever (emotional or otherwise) is needed for prolonged periods. The importance of the object is, to put it mildly, liable to deteriorate, or to differ complicating aggressive change. Probably the characteristic feature of later developing relations to the object (love and the wish for love), as separate if not always separated from demonstrable primitivity, in the need fulfilment, have a special relationship to those ‘ancillary’ aspects of neonatal nurture, whose lack has been shown to be an actual threat to life in some instances, not to speak of sound emotional development. So that from the first, regardless of the assumed state of libidinal (and aggressive) economy, or the assumed state of psychological nondifferentiation between self and potential object, there are critical percussive phenomena, objectively observed, and probably prototypic subjective experiences of separation, which are the forerunners of all subsequent experiences of the kind. One may generalize to the effect that, with maturation and development, secondary identifications, and the various other processes of ‘internalization’ in its broadest sense, the problem of separation and its mastery becomes correspondingly more complex, and changes with the successive phase of life, but never entirely disappears.
In the view of the psychoanalytic situation described earlier, the latent mobilization of experiences of separation stimulated by the situational structure awakens the driving primordial urge to undo or to master the painful separations which it represents, usually embodied in the various forms of clinical transference that which we are familiar. One legitimate gratification which tends to mitigate superfluous transference regression is the transmission of understanding that at times, are thought that by the ‘mature transference’, in effect, the ‘therapeutic alliance’ or a group of mature ego functions which enter into such an alliance. Now, there is one blurring and overlapping at the conceptual edges in both instances, but the concept as such is largely distinct from either one, as it is from the primitive transference, which we have been discussing. Whether the concept is thought by others to comprehend a demonstrable actuality, which is a further question. This question, of course, can only follow on conceptual clarity. This in saying, of a nonrational urge, not directly dependent on the perception of immediate clinical purposes, a true transference in the sense that it is displaced (in currently relevant form) from the parent of early childhood to the analyst. Its content is not anti-sensational, but largely non-sensual of sometimes transitional, as the child’s pleasure in the assemblages of ‘dirty words’ and encompasses a special and not minuscule sphere of the object relationship: The wish to understand, and to be understood, the wish to be given understanding, i.e., teaching, specifically by the parent (or later surrogate); the wish to be taught to use ingenuity in making or doing o r achieving an end through the actions in a nonpunitive way, corresponding to the growing perception of hazard and conflict and very likely the implicit wish to be provided with and taught channels of substitutional drive discharge. With this, there may well be a wish, corresponding to that element in Loewald’s description of therapeutic process, to be seen in terms of one’s developmental potentialities by the analyst. No doubt, the list could be extended into many subtleties, details, and variations. However, one should not omit to specify that, in its peak development, it would include the wish for increasingly accurate interpretations and the wish to facilitate such interpretations by providing adequate material ultimately, of course, by identification, to participate in, or even be the author of the interpretations. The childhood system of wishes which underlies the transference is a correlate of biological maturation, and the latent (i.e., teachable) autonomous ego function, appearing with it, however, there is a drive-like quality in the participation phenomena, which disqualifies any conception of the urge’s identical with the functions. No one who has ever watched a child importune a parent with questions, or experiment with new words, or solicit her interests in a new game, or demand a storytelling or reading, can doubt this. That this powerful support and integration in the ego identification with a loved parent is undoubtedly true, just as it is true of the identification with an analyst toward whom a positive relationship has been established. That ‘functional pleasure ‘ inscribes the part, where certain specific ego energies, perhaps very likely the ego’s own urge to extend its hegemony in the personality. However, it can be stressed in the derive element, even the special phase configurations and colourations, and with its importance of object relations, libidinal and aggressive, for a specific reason. For just as the primordial transference seeks to undo separation, in a sense to obviate object relationships as we know them, the ‘mature transference’, tends toward separation and individuation, and increasing contact with the environment, optimally with a large affirmative (increasing neutralized) relationship toward the original object toward whom (or her surrogates) a different dynamic of demands is now increasingly directed. The further considerations which has led to the emphasis that the drive-like element in these attitudes are integrated phenomena, as examples of ‘multiple functional’ rather than the discrete exorcise of function or functions, is the conviction that there is a continuing dynamic relation of relative interchangeability between the two series, at least based on the response to gratifications in a significant zone of complicated energetic overlap, possibly including the phenomenon of neutralization. That the empirical ‘interchangeability’ is limited, and that goes without saying, that in no way diminishes its decisive importance. The linguistic communications as in mention, that the excessive transference neurosis regression, which can seriously vitiate the affirmative psychoanalytic process, finds a prototype in the regressive behaviour and demands of certain children, who do not receive their share of teaching, ‘attention’, play, nonseductive, affectionate demonstration, as to use the quality of being appropriate or valuable to some end, even the act or practice of using something or the state of being used to which of responsible interests in development, and similar matters, from their parents. In the psychnalytic situation, both the gratifications offered by the analyst and the freedom of expression by the patient, are diversely limited and concentrated, practically entirely (in the every day demonstrable sense) in the sphere of linguistic expression, on the analyst’s side, further, in the transmission of understanding.
Whereas, the primordial transference exploits the primitive aspects of linguistic communication, by expressing the mature transference as to advocate the seeking mastery of the outer and inner environments, a mastery to which the mature elements in speech contribute importantly, for which these are stressed upon the clear-cut genetic prototype for the free associating its interpretative dialogue is the original learning and teaching of speech, the dialogue between child and mother. It is interesting to note that just as the profundities of interests between people who often include - in the service of the ego - transitory introjection and identifications, of the very word ‘communication’, representing the central ego function of speech, from which is a closely intimate relation to the etymologically certain, in actual usages, to the word chosen for that major of religious sacrament for that which is the physical ingestion of the body and blood of the Deity. Perhaps, this is just another suggestion that the oldest of individual problems does, after all, continue to seek its solution, in its own terms if only in a minimal sense, and in channels so remote as to be unrecognizable.
The mature transference is a dynamic and integral part of the therapeutic alliance, alone with the tender aspect of the erotic transference, even more attenuated (and more dependable) friendly feeling of adult type, and the ego identification with the analyst. Indispensable, of course, are the genuine adult need for help, the crystallizing rational and intuitive appraisal of the analyst, the adult sense of confidence in him, and innumerable other nuances of adult thought and feeling. With these, giving a driving momentum and power to the analytic process, but always, by its very nature, a potential source of resistance, and always requiring analysis, is the primordial transference and its various appearances in the specific therapeutic transference. That it is, if well managed, not only a reflection of the repetition compulsion in its menacing sense, but a living presentation from the id, seeking new solutions, and trying again, so to speak, to find a place in the patient’s conscious and effective life, has important affirmative potentialities. This has been specifically emphasized by Nunberg, Lagache and Loewald among others. Loewald has recently elaborated very effectively the idea of ‘ghosts’ seeking to become ‘ancestors’ based on an early figure of speech of Freud. The mature transference, in its own infantile right, provides some of the unique qualities of propulsive force, which comes from the world of feeling, rather than the world of thought. If one views it in a purely figurative sense, that fraction of the mature transference which derives from ‘conversion’ is somewhat like propulsive fraction as the wind in a boats sailing to windward currents into motion, the strong headwind, the ultimate source of both resistance and propulsion, is the primordial transference. This view, however, should not displace the original and independent, if cognate, a favourable tide or current would also be required. It is not that the mature transference is itself entirely exempt from analytic clarification and interpretation. For one thing, in common with other childhood spheres of experience, there may have been traumas in this sphere, punishments, serious defects or lacks of parental communication, Listening, attention or interest. In general, this is probably far more important than has hitherto appeared in our prevalent paradigmatic approach to adult analysis, even taking into account the considerable changes due to the growing interest in ego psychology. ‘Learning’ in the analysis can, of course, be a troublesome intellectualizing resistance. Furthermore, both the patient’s communications and his receptions and utilization of interpretations may exhibit only too clearly, as sometimes in the case of other ego mechanisms, their origin in and tenacious relation to instinctual or anaclitic dynamism; the longing implement out of silence for which the analyst is to override the uncritical acceptance (or rejection) of interpretations, in that the patient revealingly is to mention the unmindful assimilation, fluently, rich, endlessly detailed associations without spontaneous reflection or integration. In the direct demands for solution of moral and practical probability for an entirely intellectual scope, and a variety of others. It may and always be easy to discriminate between the utilization of speech by an essentially instinctual demand, and an intellectual or linguistic trait or having to be determined by specific factors in their own developmental sphere, however, the underlying and essentially genuine dynamism which have to continue to be placed for a notable time interval or remain to an arbitrary or conventional character most favoured to the purposes of processes of analysis, as it was to the original processes of maturational development, communication, and benign separation. Lagache, on the desirability of separating the current unqualified usage, ‘positive’ and ’negative’ transference, as based on the patient‘s immediate state of feeling, from a classification based on the essential effect on analytic processes. Yet, the later of mature transference is, in general, a ‘positive transference’.
Concerning considerations in the transference neurosis, and the problem of transference interpretation, may be offered at this point. The whole situational structure of analysis (in contrast with other personal relationships), its dialogue of free association and interpretation, and its deprivations as to most ordinary cognitive and emotional interpersonal drives that tend toward the separation of discrete transferences from their synthesis with one another and with defences in character or symptoms, and with deepening regression, toward a contuative enactment of the essential of the infantile neurosis, in the transference neurosis. In other relationships, the ‘give and take’ aspects - gratifying aggressive, punitive or otherwise actively responsive, and the open mobility of searching for alternative or greater satisfaction - exert a profound dynamic and economic influence, so that only extraordinary situations, or transference of pathological character, or both, occasion to comparable regression.
It is a curious fact, whereas the dynamic meaning to the importance of the transference neurosis have been well established since Freud gave this the phenomenon a central position in his clinical thinking, the clinical reference, when the term is used, remains variable and somewhat ambiguous. For example, Greenson, in his excellent recent paper, speaks of it as appearing, ‘when the analyst and the analysis become the central concern in the patient’s life’. However, previous remarks in this connection, for which it is worthwhile to specify certain aspects of Greenson’s definition, for the term ‘central’ is somewhat ambiguous, as to its specific reference. Certainly, the term could apply to the symbolic position of the analyst in relation to the patient’s experiencing ego and the symbolically decisive position which he correspondingly assumes in the relation to the other important figures in the patient’s current life. However, while the analysis is in any case, and for multiple reasons, exceedingly important the seriously involved patient, there is a free observing portion of is ego, also involved, not in the same sense as that involved in the transference regression and revived in infantile conflicts. And here is here being, of course, always the integrated adult personalty, however diluted in may seem at times, of its rarity, although certainly does occur, that the analysis actually exceeds the quality or state of being of notable worth or influence that the other major concerns, attachments, and responsibilities of the patient’s life, nor is it desirable that his should occur, on the other hand, if construed with proper attention to the economic considerations as mentioned, the concept is important, both theoretically and clinically. In the theoretical direction to the assumption that there is a continuing system of object relationships and conflict situations, most important in the unconscious representations, but participating to some degree in all others, deriving in a successive series of transference from the experiences of separation from the original object, the mother. In this sense, the analyst’s applicability to a uniquely important portion of the patient‘s personality, the portion that ‘never grew up’, to maintain a central figure. In the clinical sense, to call or direct attention especially to a supposed cause, source, or to refer to the importance of the transference neurosis as outlining for the essential and central analytic task, providing by its very currency and demonstrability a relatively secure cognitive base for procedural duties. By its inclusion of the patient’s essential psychopathological processes and tendencies, in their original functional connection, it offers, in its resolution or marked reduction, the most formidable lever for analytic cure. Nonetheless, transference neurosis must be seen in its interweaving with the patient’s extra-analytic system of personal contacts. The relationship to the analyst may influence the course of relationships to others, in the same sense that the clinical neurosis did, except that the former is alloplastic, relatively exposed, and subject to constant interpretation. It is also an important fact that, except in those rare instances where the original dyadic relationship appears to turn, the analyst, even in the strict transference sphere, cannot be assigned all the transference role simultaneously. Other actors are required. He may at times oscillate with confusing rapidity between the status of mother and father, but he is usually predominantly in one of the roles for long periods, someone else representing the other. Furthermore, apart from ‘acting out’, complicated and mutually inconsistent attitudes of the anterior apprehensions for realizing often about something not generally realized in the verbalization, may require the seeking of other transference objects, i.e., The husband or wife, friend, another analyst and so forth. Children, even the patient’s own children, may be invested with strivings of the patient, displaced from the analysis, even experience the impulses which they would wish to call forth in the analyst. The range is extensive, varied, and complicated, requiring constant alertness. Transference interpretation therefore often has a necessarily paradoxical inclusiveness, which is an important reality of technique. There is another aspect, and that is the dynamic and economic impact of the intimate and actual dramatist personate of the transference neurosis in the progress of the analysis as such, and on the patient ‘s motivation, as well as his real lifer avenues for recovery. For the persons in his milieu may fulfill their ‘positive’ or ‘negative ‘ roles in transference drama, which may facilitate or impede interpretative effectiveness, they provide the substantial and dependable real life gratification which ultimately facilitate the analysis of the residual analytic transference, or their capacities or attitudes may occasion overload of the anaclitic and instinctual needs in the transference which renders the same process far more difficultly. In the most unhappy instances, there can be a serious undercounting of the motivation for basic change.
There is also the fundamental question of the role of the transference interpretation. At the Marienbad Symposium most of Strachey’s colleagues appeared to accept the essential import of his contribution and thus unique significance of the transference interpretations, despite the various reservations as to detail and emphasis on other important aspects of the therapeutic process. Nevertheless, there are still many who, if not in doubt regarding the great value of transference interpretations are inclined to doubt their uniqueness, and to stress the importance of economic considerations in determining the choice as to whether transference or extratransference interpretations may be indicated. Now, apart from the realistic considerations mentioned in the preceding passage (in a sense the necessarily ‘distributed’ character of a variable fraction of transference interpretation). There is in fact that the extra-analytic life of the patent often provides indispensable data fo the understanding of detailed complexities of his psychic functioning, because of the sheer variety of its references, some of which cannot be reproduced in the relationship to the analyst. For example, there is no repartee (in the ordinary sense ) in the analysis. The way the patient handles the dialogue with an angry employee may be importantly revealing. The same may be true of the quality of his reaction to a real danger of dismissal. There is not only the realities, but the ‘formal’ aspects of this responses. These expressions of personality remain important, even though his ‘acting out‘ of the transference (assuming this was this was the case) may have been more important, and, of course, requiring transference interpretation. Furthermore, they remain useful, if discriminatingly and conservatively treated, even if they are inevitably always subject that epistemological reservations, which haunts so much of analytic data. Of course, the ‘positive’ transference has a role in the utilization of such interpretations that what enables the patent to listen to them and them seriously.
In an operational sense, it would seem that extratransference interpretations cannot set aside, or underestimated in importance, but the unique effectiveness of transference interpretations is not thereby disestablished. No other interpretation is free, within reason, of the doubt introduced by not really knowing the ‘other person’s’ participation in love, or quarrel or criticism or whatever the issue. And no other situation provides the patient the combined sense of cognitive acquisition, with the experience of complete personal tolerance and acceptance, that is implicit in an interpretation by an individual who is an object of the emotion, drive, or even defences, which are active at the time. There is no doubt that such interpretations must not only (in common with all others) include personal tact, but must be offered with special care as to their intellectual reasonability, in relation to the immediate context, lest they defeat their essential purpose. It is not too often likely that a patient who has just been jilted in a long-standing love affair, and suffering exceedingly, will find an immediate interpretation that his suffering is due to the fact that the analyst does not reciprocate his love, even though a dynamism in this general sphere may be ultimately demonstrable, and acceptable to the patient. On the other hand, once the transference neurosis is established, with accompanying subtle (sometime gross) colouration of the patient’s life, th n more far-reaching anticipatory, transference interpretations are indicated, for, if all of the patient’s libidinal and aggression is not, in fact, invested in the analyst, he has at least an unconscious role in all important emotional transactions, and, if the assumption is correct that the regressive drive, mobilized by the analytic situation, is in the direction of restoration of a single all-encompassing relationship, specified pragmatically in the individual case by the actually attained level of development, then there is a dynamic factor at work, importantly meriting interpretation as such, to the extent that available material supports it. This would be the immediate clinical application on the material regarding the ‘cognitive lag’ or ‘cognitive fall-back’.
Post-Traumatic Stress Disorder, resides in a mental illness that some people develop after experiencing traumatic or life-threatening events. Such events include warfare, rape and other sexual assaults, violent physical attacks, torture, child abuse, natural disasters such as earthquakes and floods, and automobile or aeroplane crashes. People who attest of the traumatic events may also develop the disorder.
Post-traumatic stress disorder in war veterans is sometimes called shell shock or combat fatigue. In victims of sexual or physical abuse, the disorder has been called rape trauma or battered woman syndrome. The American Psychiatric Association (APA) adopted the current name of the disorder in 1980.
In the late 1960's and early 1970's, mass demonstrations erupted throughout the United States protesting US involvement in the Vietnam War (1959-1975). Thousands of veterans joined together in a national organization, Vietnam Veterans Against the War, that supported and influenced the antiwar movement. In this transcript from an April 22, 1971, hearing before the Senate Committee on Foreign Relations, committee chairman Senator J. William Fulbright indicated his sympathy for the antiwar movement. Fulbright’s comments were followed by the testimony of Vietnam veteran John Kerry, who called for an end to the war. Kerry also detailed what he believed to be the war’s negative effect in both Vietnam and the United States. Kerry became a Democratic senator from Massachusetts in 1985.
People with this disorder relive the traumatic event again and again through nightmares and disturbing memories during the day. They sometimes have flashbacks, in which they suddenly lose touch with reality and relive images, sounds, and other sensations from the trauma. Because of their extreme anxiety and disruptive opposition to events, they try to avoid anything that reminds them of it. They may seem emotionally numb, detached, irritable, and easily startled. They may feel guilty about surviving a traumatic event that killed other people. Other symptoms include trouble concentrating, depression, and sleep difficulties. Symptoms of the disorder usually begin shortly after the traumatic event, although some people may not show symptoms for several years. If left untreated, the disorder can last for years.
Post-traumatic stress disorder can severely disrupt one’s life. Besides the emotional pain of reliving the trauma, the symptoms of the disorder may cause a person to think that he or she is "going crazy." In addition, people with this disorder may have unpredictable, angry outbursts at family members. At other times, they may seem to have no affection for their loved ones. Some people try to mask their symptoms by abusing alcohol or drugs. Others work very long hours to prevent any "down" periods when they might relive the trauma. Such actions may delay the onset of the disorder until these individuals retire or become sober.
Studies have set or to bring into a new found control from 1 to 14 percent of people that suffer from post-traumatic stress disorder at some point during their lives. The findings vary widely due to differences in the populations studied and the research methods used. Among people who have survived traumatic events, the prevalence appears to be much higher. The disorder may be particularly prevalent among people who have served in combat. For example, one study of veterans of the Vietnam War (1959-1975) found that veterans exposed to a high level of combat were nine times more likely to have post-traumatic stress disorder than military personnel who did not serve in the war zone of Southeast Asia.
Post-traumatic stress disorder is an extreme reaction to extreme stress. In moments of crisis, people respond in ways that allow them to endure and survive the trauma. Afterward those responses, such as emotional numbing, may persist even though they are no longer necessary.
Not everyone who experiences a traumatic event develops post-traumatic stress disorder. Several factors influence whether people develop the disorder. Those who experience severe and prolonged trauma are more likely to develop the disorder than people who experience less severe trauma. Additionally, those who directly witness or experience death, injury, or attack are more likely to develop symptoms.
People may also have been existing biological and psychological vulnerabilities that make them more likely to develop the disorder. Those with histories of anxiety disorders in their families may have inherited a genetic predisposition to react more severely to stress and trauma than other people. In addition, people’s life experiences, especially in childhood, can affect their psychological vulnerability to the disorder. For example, people whose early childhood experiences made them feel that events are unpredictable and uncontrollable have a greater likelihood than others of developing the disorder. Individuals with a strong, supportive social network of friends and family members seem somewhat protected from developing post-traumatic stress disorder.
Treatment of post-traumatic stress disorder may involve psychotherapy, psychoactive drugs, or both. Psychotherapists help individuals confront the traumatic experience, work through their strong negative emotions, and overcome their symptoms. Many people with post-traumatic stress disorder benefit from group therapy with other individuals suffering from the disorder. Physicians may prescribe antidepressants or anxiety-reducing drugs to treat the mood disturbances that sometimes accompany the disorder.
At the arriving considerations that are marked and noted, through which the essence of functional dynamics as based of the transference in the psychoanalytic process or the basic underlying the most basic of beliefs that in politics there is neither good nor evil, however, in that something that forms part of the minimal body, character or structure of that thing predetermines the properties to the good life. Nonetheless, most psychoanalysts maintain that schizophrenic patients cannot be treated psychoanalytically because they are too narcissistic to develop with the psychotherapist as interpersonal relationship that is sufficiently reliable and consistent for psychoanalytic work. Freud, Fenichel and others have recognized that a new technique of approaching patients psychoanalytically must be found if analysts are to work with psychotics. Among those who have worked successfully in recent years with schizophrenics, Sullivan, Hill, and Karl Menninger and his staff have made various modifications of their analytic approach. The techniques that are in use with psychotics is different from our approach to psychoneurotics. This is not a result of the schizophrenic’s inability to build up a consistent personal relationship with the therapist but due to his extremely intense and sensitive transference reactions.
Let us see first what the essence of the schizophrenic’s transference reactions are and how we try to meet these reactions.
We think of a schizophrenic as a person who has had serious traumatic experiences in early infancy at a time when his ego and its ability to examine reality were not yet developed. These early traumatic experiences seem to furnish the psychological basis for the pathogenic influence of the flustrations of later years. At this early time the infant lives grandiosely in a narcissistic world of his own. His needs and desires seem to be taken care of by something vague and indefinite which he does not yet differentiate. As Ferenczi noted, they are expressed by gestures and movements since speech is as yet undeveloped. Frequently the child’s desires are fulfilled without any expression of them, a result that seems to him a product of his magical thinking.
Are a person’s characteristics primarily shaped by early influences, remaining relatively stable thereafter throughout life? Or does change spontaneously occur continuously throughout life? Many people believe that early experiences are formative, providing a strong or weak foundation for later psychological growth. This view is expressed in the popular saying "As the twig is bent, so grows the tree." From this perspective, it is crucial to ensure that young children have a good start in life. But many developmental scientists believe that later experiences can modify or even reverse early influences; studies show that even when early experiences are traumatic or abusive, considerable recovery can occur. From this vantage point, early experiences influence, but rarely determine, later characteristics.
Traumatic experiences in this early period of life will damage a personality more seriously than those occurring in later childhood such as are found in the history of psychoneurotics. The infant’s mind is more vulnerable the younger and less used it has been, further, the trauma has quickened the infant ‘s egocentricity. In addition early traumatic experiences shortens the only period in life in which an individual ordinarily enjoys the most security, thus endangering the ability to store up as it were a reasonable supplies of assurance and self-reliance for the individual’s later struggles through life. Thus, as such, a child sensitized considerably more toward the frustrations of later like than by later traumatic experiences. hence many experiences in later life which would mean little to a ‘healthy’ person and not much to a psychoneurotic, mean a great deal of pain and suffering to the schizophrenic. His resistance against frustration is easily exhausted.
Once he reaches his limit of endurance, he escapes the unbearable reality of his present life by attempting to reestablish the autistic, delusional world of the infant, but this is impossible because the content of his delusions and hallucinations are naturally coloured by the experiences of his whole lifetime.
How do these developments influence the patient’s attitude toward the analyst and the analyst’s approach to him?
Due to the very damage and the succeeding chain of frustrations which the schizophrenic undergoes before finally giving in to illness, he feels extremely suspicious and distrustful of everyone, particularly of the psychotherapist ho approaches him with the intent of intruding into his isolated world and personal life. To him the physician’s approach means the threat of being compelled to return to the frustrations of real life and to reveal his inadequacy to meet them or, - still worse – a repetition of the aggressive interference with his initial symptoms and peculiarities which he has encountered in his previous environment.
The difficulty that the patient’s dilemma through his frustrations is the product through which is called ‘delusion’: Delusion itself is a false belief which is firmly held by a person even though other people recognize the belief as obviously untrue. For example, a person who truly believes he is Napoleon Bonaparte is delusional. Religious beliefs or popular conceptions, such as the belief that people have been abducted by aliens, are not delusions because they are widely held beliefs. Delusions are a type of psychotic symptom that indicate a person has lost contact with reality.
There are many different types of delusions. A person with a paranoid delusion believes that others - such as the FBI, or the CIA, even the Mafia as trying to harm or plot against him. A person with a delusion of reference believes that events or people refer specifically to him or her when they do not. For example, a woman with schizophrenia may believe that a television news broadcaster is talking personally to her rather than to the entire viewing audience. A grandiose delusion is a belief that one is extremely famous or that one has special powers, such as the ability to magically heal people.
A delusion of control is a belief that others are able to control one’s thoughts, feelings, or actions. For example, a man with this type of delusion may believe that someone has implanted a microchip in his brain that enables other people to control his thoughts. A somatic delusion is a belief that something is wrong with one’s body - for example, that one’s brain is rotting away - even though no medical evidence supports this belief. A person with an erotic delusion believes that someone is in love with him or her despite a lack of evidence for this belief. In a delusion of jealousy, a person believes that his or her spouse or lover is unfaithful despite evidence to the contrary.
Delusions commonly occur in certain severe mental illnesses, such as schizophrenia, bipolar disorder (also called manic-depressive illness), some cases of major depression, Dissociative disorders, post-traumatic stress disorder, and paranoid personality disorder. In addition, delusions may result from abuse of certain drugs, including alcohol, cocaine, amphetamines, and hallucinogens such as lysergic acid diethylamide (LSD), phencyclidine (PCP), and mescaline. Medical conditions affecting the brain, such as syphilis and brain tumours, may also cause delusions.
Delusional disorder is a relatively uncommon mental illness characterized by delusions. People with this disorder have one or more delusions that persist for at least one month. In addition, they do not suffer from other symptoms of schizophrenia, such as disorganized speech and bizarre behaviour. Usually their delusions are less bizarre than those that occur in schizophrenia and seem merely odd or unsupported by facts. Examples of nonbizarre delusions include beliefs that one is being followed, loved by someone famous, or deceived by one’s spouse. Because delusional disorder is relatively rare, little research has systematically examined its treatment. However, doctors most often use Antipsychotic drugs (also called neuroleptics) to treat this disorder. These drugs help reduce or eliminate delusions, hallucinations, and other psychotic symptoms.
In spite of his narcissistic retreat, every schizophrenic has some underlying notion of the unreality and loneliness of his substitute delusionary world. He longs for human contact and understanding, yet is afraid to admit of himself, or his therapist for fear of further frustration.
That is why the patient may take weeks and months to test the analyst before being willing to accept him, however, once he has accepted him. His dependence on the analyst is greater and he is more sensitive about it than is the psychoneurotic because of the schizophrenic’s deeply rooted insecurity, the narcissistic seemingly self-righteous attitude is but a defence.
Whenever the analyst fails the patient from reasons to be discussed later - one cannot at times avoid failing one’s schizophrenic patients - it will be severe disappointment and a repetition of the chain of frustrations the schizophrenic has previously endured.
The instinctually primitive part of the schizophrenic’s mind that does not discriminate between himself and the environment, it may mean the withdrawal of the impersonal supporting forces of his infancy. Severe anxiety will follow this vital deprivation.
In the light of his personal relationship with the analyst it means that the therapist seduced the patient to use him as a bridge over which he might possibly be led from the utter loneliness of his own world to reality and human warmth, only to have him discover that this bridge is not reliable. if so, he will respond helplessly with an outburst of hostility or with renewed withdrawal as may be seen most impressively in catatonic stupor.
The symptoms of mental illness can be very distressing. People who develop schizophrenia may hear voices inside their head that say nasty things about them or command them to act in strange or unpredictable ways. Or they may be paralysed by paranoia—the deep conviction that everyone, including their closest family members, wants to injure or destroy them. People with major depression may feel that nothing brings pleasure and that life is so dreary and unhappy that it is better to be dead. People with panic disorder may experience heart palpitations, rapid breathing, and anxiety so extreme that they may not be able to leave home. People whom experience episodes of mania may engage in reckless sexual behaviour or may spend money indiscriminately, acts that later cause them to feel guilt, shame, and desperation.
Research suggests that the genes one inherits strongly influence one’s risk of developing schizophrenia. Studies of families have shown that the more close one is related to someone with schizophrenia, the greater the risk one has of developing the illness. For example, the children of one parent with schizophrenia have about a 13 percent chance of developing the illness, and children of two parents with schizophrenia have about a 46 percent chance of eventually developing schizophrenia. This increased risk occurs even when such children are adopted and raised by mentally healthy parents. In comparison, children in the general population have only about a 1 percent chance of developing schizophrenia.
Some evidence suggests that schizophrenia may result from an imbalance of chemicals in the brain called neurotransmitters. These chemicals enable neurons (brain cells) to communicate with each other. Some scientists suggest that schizophrenia results from excess activity of the neurotransmitter dopamine in certain parts of the brain or from an abnormal sensitivity to dopamine. Support for this hypothesis comes from Antipsychotic drugs, which reduce psychotic symptoms in schizophrenia by blocking brain receptors for dopamine. In addition, amphetamines, which increase dopamine activity, intensify psychotic symptoms in people with schizophrenia. Despite these findings, many experts believe that excess dopamine activity alone cannot account for schizophrenia. Other neurotransmitters, such as serotonin and norepinephrine, may play important roles as well.
Although scientists favour a biological cause of schizophrenia, stress in the environment may affect the onset and course of the illness. Stressful life circumstances - such as maturing in age and character as for living in poverty, the death of a loved one, an important change in jobs or relationships, or chronic tension and hostility at home—can increase the chances of schizophrenia in a person biologically predisposed to the disease. In addition, stressful events can trigger a relapse of symptoms in a person who already has the illness. Individuals who have effective skills for managing stress may be less susceptible to its negative effects. Psychological and social rehabilitation can help patients develop more effective skills for dealing with stress.
Although there is no cure for schizophrenia, effective treatment exists that can improve the long-term course of the illness. With many years of treatment and rehabilitation, significant numbers of people with schizophrenia experience partial or full remission of their symptoms.
Treatment of schizophrenia usually involves a combination of medication, rehabilitation, and treatment of other problems the person may have. Antipsychotic drugs (also called neuroleptics) are the most frequently used medications for treatment of schizophrenia. Psychological and social rehabilitation programs may help people with schizophrenia function in the community and reduce stress related to their symptoms. Treatment of secondary problems, such as substance abuse and infectious diseases, is also an important part of an overall treatment program.
Whether we call it analysis or not, it is clear that successful treatment does not depend on technical rules of any special psychiatric school but rather on the basic attitude of individual therapist toward psychologic persons. If he meets them as strangle creatures of another world whose productions are not comprehensible to ‘normal’ beings, he cannot treat them, if he realizes, however, that the difference between himself and the psychologic is only of degree, and not of kind, he will know better how to meet him. He will not be able to identify himself sufficiently with the patient to understand and accept his emotional reactions without becoming involved in them.
The process of constant and perpetual change is examined and closely matched within the study of philosophical speculations and pointed of a world view which asserts that basic reality is constantly in a process of flux and change. Indeed, reality is identified with pure process. Concepts such as creativity, freedom, novelty, emergence, and growth are fundamental explanatory categories for process philosophy. This metaphysical perspective is to be contrasted with a philosophy of substance, the view that a fixed and permanent reality underlies the changing or fluctuating world of ordinary experience. Whereas substance philosophy emphasizes static being, process philosophy emphasizes dynamically becoming.
Although process philosophy is as old as the 6th-century Bc Greek philosopher, Heraclitus, renewed interest in it was stimulated in the 19th century by the theory of evolution. Key figures in the development of modern process philosophy were the British philosophers Herbert Spencer, Samuel Alexander, and Alfred North Whitehead, the American philosophers Charles S. Peirce and William James, and the French philosophers Henri Bergson and Pierre Teilhard de Chardin. Whitehead's Process and Reality: An Essay in Cosmology (1929) is generally considered the most important systematic expression of process philosophy.
Contemporary theology has been strongly influenced by process philosophy. The American theologian Charles Hartshorne, for instance, rather than interpreting God as an unchanging absolute, emphasizes God's sensitive and caring relationship with the world. A personal God enters into relationships in such a way that he is affected by the relationships, and to be affected by relationships is to change. So too is in the process of growth and development. Important contributions to process theology have also been made by such theologians as William Temple, Daniel Day Williams, Schubert Ogden, and John Cobb, Jr.
‘Reality’ is a difficult word to use to every one’s satisfaction or even to one’s own satisfaction. In this instance the word reality is used arbitrarily to designate the direct, here-and-now impact of the analyst upon the patient. Reality. In this sense, contrasts with the impact the analyst has through his representation in the patient’s fantasy life, neurosis, and transference, since both kinds of impact seem always to coexist and since the former - the analyst’s real impact - may be the worst enemy of the transference, the matter of their differentiation is possibly the most challenging aspect of analysis.
The analytic situation, which is set up to shut out ordinary reality intrusions, that cannot nor should not exclude all, but to say, that in the beginning months, for instance, reality inevitably has the upper hand. The analyst, the office, the procedure, are all overwhelmingly real. Everything is strange, frightening and exciting, gratifying and frustrating. Unlike the patient can test it and orient himself to it, the impact of this reality is usually so great that even an ordinary useful transference relationship cannot be expected to develop.
Perhaps the most confusing aspect of this beginning period is the frequent appearance in it of what can be regarded as a false transference relationship. With great intensity and clarity, the patient may reveal, through transference-like references about the analyst, some of the deepest secrets only of his neurosis but of its genesis. The pseudotransference, too good to be true, is almost sure to be nothing more than the patient’s attempt to deal with the person of the analyst, the entire spectrum of his various patterns of behaviour. If, it is easy to do, the analyst overlooks the likelihood that the patient’s relationship with at this time is really about that almost everything said about it is related, analysis may get off to a very bad start. And if, as is even earlier to do, the analyst’s interests the genetic meaning of the openly exposed material, a good transference relationship may be seriously delayed and a workable transference neurosis may never appear. even after initial reality has had time to fade, reality may continue to intrude in ways that are very hard to detect and that are very troublesome.
One of the most serious problems of analysis is the very substantial help which the patient receives directly from the analyst and the analytic situation. For many a patient, the analyst in the analytic situation is in fact the most stable, reasonable, wise and understanding person he has ever met, and the setting in which they meet may actually be the most honest, open, direct and regular relationship he has ever experienced. Added to this is the considerable helpfulness to him of being able to clarify his life storey. confess his guilt, express his ambitions, and explore his confusions. Further real help comes from the learning-about-life accruing from the analyst’s skilled questions, observations and interpretations. Taken together, the total real value to the patient of the analytic situation can easily be immense. The trouble with this kind of help is that it goes on and on, it may have such a real, direct and continuing impact upon the patient that he can never get deeply enough involved in transference situation to allow him to resolve or even to become acquainted with his most crippling internal difficulties. The trouble is far too good, the trouble also is that we as analysts apparently cannot resist the seductiveness of being directly helpful, and this, when combined with the compelling assumption that helpfulness is bound to be good, permits us top credit patient improvements to ‘analysis’ when more properly it should often be recognized for being the amounting result for the patient’s using the analytic situation, as the model, for being the preceptors and supporter in the dealing practically within the immediate distractions as holding to some problem.
Perhaps, we can now refer to something in a clear unmistakable manner, and it would be to mention, for being, that one more difficult-to-handle intrusion of reality into the analysis, that by saying, that this is the definitive and final interruption of the transference neurosis by the reality of termination; in the sense, the situation is reversed and the intrusion is analytically desirable, since ideally the impact of reality of impending and certain termination is used to facilitate the resolution of the transference. As with the resolution of earlier episodes of transference neurosis, this final one is brought about principally by the analyst’s interpretations and reconstructions. As these take effect, the transference neurosis and, hopefully, along with it the original neurosis is resolved. This final resolution, however, which is much more comprehensive, is usually very different and may not come about at all without the help of the reality of termination. Accordingly, any attenuation of the ending, such as tapering off or causal or tentative stopping, should be expected to stand in the way of an effective resolution of the transference. Yet, it seems that this is what most commonly happens to an ending, and because of this a great many patients may lose the potentially great benefit of a thorough resolution and are forever after left suspended in the net of unresolved transference.
Yet, utter indistinctly rigorous termination seems understandable, as difficult as transference neurosis may be in the analyst at other times, this ending period, if rigorously carried out, simply has to be the period of his greatest emotional strain. There can surely be no more likely time for an analyst to surrender his analytic position and, responding to his own transference, become personally involved with his patient than during the process of separating from a long and self-restrained relationship. Accordingly, it may be better to slur over the ending lightly than to mishandle it in an attempt to be rigorous.
In considering more broadly the function of the transference in the psychoanalytic process, one is confronted by the apparent naïve, but, nonetheless important questions of the role of the actual (current) object as compared with that of the object representation of the original personage in the past. We recall Freud’s paradoxical, somewhat gloomy, but portentous concluding passage in "The Dynamics of Transference." This struggle between the doctor and the patient, between intellect and instinctual life, between understanding and seeking to act, is played out almost exclusively in the phenomena of transference. It is on that field that the victory must be won - the victory whose expression is on that field that the victory must be won - the victory whose expression is the permanent cure of the neuroses. It cannot be disputed that controlling the phenomena of transference presents the psychoanalysis with the greatest difficultly, but it should not be forgotten that they do us the inestimable service of making the patient ‘s hidden and forgotten erotic impulses of showing their immediate and manifested impossibilities, for when all is said and done, it is impossible to destroy anyone in absentia or in effigies.
Both object and representation are made necessary by the basic phenomenon of original separation. The existence of an image of the object, which persist in the absence of the object, is one of the important beginnings of psychic life in general, certainly an indispensable prerequisite for object relationship. As generally construed. Whether this is viewed as (or a times demonstrably is) something unstable for allotting introjection, s always subject to alternative projection, or an intrapsychic object representation clearly distinguished from the self-representation, or firm identification in the superego, or in the ego itself, these phenomena are in various ways components of the system of mastery of the fact of separation, or separateness, from the original absolutely necessarily anaclitic (in the earliest period) symbiotic ‘object’. In the light of clinical observation, it would appear to be that the relative stability (parental) object representation. At which time of varying degree, are to a greater extent for the archaic phenomena. Even in nonpsychotic patients, overwhelmed by them, sometimes resembles the restoration from oedipal identification, which provides the preponderant basis for most demonstrable analytic transferences. That within the necrotic patients, the transference is effectively established when this representation invests the analyst to a degree - depending on intensity of drive and most of ego participation - which ranges in all the, wishing and strivings to remake and analyst to biasses judgements and misinterpretation of data, finally are the actual perceptual distortions.
However, the old object representations may be invested, however rigidly established the libidinal or aggressive cathexis of the image may be, this as such can become the actual and exclusive focus of instinctual discharge, or of complicated and intense instinct-defence solutions, only and general energy-sparing quality of strictly intrapsychic processes. For the vast majority of persons, visible to any degree, including those with severe neurosis, character distortions, addictions and certain psychoses, the striving is toward the living and actual object, even at the cost of intense suffering. In a sense, this returns us to the state in which the psychological ‘object-to-be’. Has a critical importance never again to be duplicated, except in certain acute life emergencies, even if the object is not firmly perceived as such, in the sense of later object relations? And it does seem that trance impressions from the earliest contacts in the service of life preservation, and the associated instinctual gratifications, and innumerable secondarily associated sensory impressions. Are activated by the specific inborn urges of sexual maturation? These propel the individual to renew many of the earliest modes of actual bodily contact, in connection with seeking for specific instinctual gratification. Or, to look away from clear-cut instinctual matters to the more remote elaborations of human contact: Few regard loneliness as other than a source of suffering, even self-imposed, as an apparent matter of choice, and the forcible imposition of ‘solitary confinement ‘ is surely one of the most cruel of punishments.
In taking to question, we are entering an area of life in which things are other then themselves, where meaning is multifaceted, and where the line between the old and the new is blurred. It should, by, its immediate measure, help develop our recognition or meaning of the pertinent applicability as to the relevance of interrelated aspects of the psychology of ‘metaphor’. In the psychology of metaphor we will find a useful analogy to the psychology of transference interpretation. Our’;s will be newly encountered as good metaphors, those it response to which we say, ‘That’s it exactly’ or ‘That really captures it‘ or ‘That says it all’.
Some literary and linguistic analysis, (e.g., Lewis, 1936 and Snell, 1953) and also people in everyday life, believe that there are experiences that can only be expressed metaphorically. And it is for this achievement that these metaphors, which may be entire poem or as lines or even words highly valued. But how can this be so? Just what in th e ‘it’ that the metaphor ‘is’ or ‘captures’ or ‘says’? If this ‘is’ or this ‘experience’ can only be rendered metaphorically, when we can know it only as such, that is, as the metaphor itself. Of the position out of which are put forward by, T.S, Eliot (1933) and E.W. Harding (1963) in their discussion of poetry, for in these instances we are granted that there is no known and logically independent version of the experience that can serve to validate the metaphor. Whatever the metaphor makes available to us depends on it and it and so cannot be used to prove its correctness.
It seems justifiable conclude that the metaphor is a new experience rather than a mere paraphrase of an already fully constituted expedience. The metaphor creates an experience that one has never had before. It is an experience one has not realized by oneself. The metaphor does, of course, suggest certain constituent experiences of which one may have been more or less dimly aware. One may say, therefore, that the metaphor speaks for those constituents, on the existence of which much of its appeal depends. But in its organizing and implicit ly rendering these constituents in its new way, it is a creation rather than a mere paraphrase or anew edition. Paraphrasing and new editions never speak as forcefully as good new metaphors, nor could they facilitate further new experience. One analytically familiar feature of these creations is that they make it safe and pleasing to experience something that otherwise would be considered too threatening and so would be kept in fragmented obscurity through defensive measures.
Thus, when one says, ‘That’s it exactly’ one is implicitly recognizing and announcing that one has found and accepted a new mode of experiencing one’s self and one’s world, which is to say, asserting a transformation of one’s own subjectivity. Something is now said to be true, and in a sense it is true, but it is true for the first time. Nothing just like it can ever happen again, for the second time cannot be the same as the first. One can’ t step into the same watering point and then step once again into the same spot of that river. A revelatory metaphor re-encountered or repeated later may lose some of its force, alternatively, it may gain some significance, butt it cannot remain exactly the same metaphor or mobilize an experience identical with the first. The point applies as well as to new metaphors that are similar to familiar ones: They have to be judged or experienced through their conventionalized predecessors, as through methods of knowing or already proved instrumentally of perceiving. The audience and the performer, who may be one person, as such that may not have, as yet.
What is to be said about the psychology of metaphor is analogous to the transformational aspects of developed transference and the steadfast interpretation that both facilitate and organize them as transference. Allowing that these transferences and ‘remembered’ experiences come into existence over a period of time, nothing that is identical with them has ever before been enacted, and nothing will ever be enacted again. They are creations that may be fully achieved only under specific analytic conditions. Such that living was not reliving that moment, words like re-living, re-experiencing and reliving simply do not do justice to the phenomena, that in making this claim. A seeming contradiction over-writes some of our well-establish ideas. - in offering, - I am not contradicting some of our well-established ideas about interpretation and insight, I am , however, disputing the point that insight refers to much than the recovery of lost memories, and takes in as well, a new grasp of the significance and interpretations of events one has always remembered. In point, as, Freud pointed out, ‘As a matter of fact I’ve always known it, only that I’ve never thought of it; (1914), In fact, it is to develop that point in furthering to say that it takes an adult to do that, especially with the help of an analyst. It was, after all, Freud’s analysis of adults that make it possible to define infantile psychosexuality. In this respect, but without disregard, child analysis retains a quality of applied psychoanalysis’ in the same way that the interpreted transference neurosis is: Both are always of describing as true something that was not true in quite that way at the time of its greatest developmental significance. This apparent paradox about ‘remembering’ as a form of creating goes a long way, probably that what it is, is distinctive about psychoanalytic interpretation.
This time, however, to further the discussion on the interpretive technique that surrounds the phase of a mutative interpretation - that in which a portion of the patient’s id-relation to the analyst is made conscious in virtue of the latter’s position as auxiliary super-ego - is in itself complex. In the classical model of an interpretation, the patient will first be made aware of a state of tension of an interpretation, will next be made aware that there is repressive factor at work (that his super-ego is threatening him with punishment), and will only then be made aware of the id-impulse which has stirred up the protects of his super-ego and so given to the anxiety in his ego. This is the classical scheme. In actual practice, the analyst finds himself working from all three sides at once, or in irregular successions. At one moment a small portion of the patient‘s super-ego may be revealed to him in all its savagery, at another the shrinking defencelessness of his ego, at yet another his attention may be directed to the attempts which he is making at restitution - at compensating for his hostility, on some occasions a fraction of id-energy may even be directly encouraged to break its way through the last remains of an already weakened resistance. There is, however, one characteristic which all of these various operations have in common, they are essentially upon a small scale. For the mutative interpretation is inevitably governed by the principle of minimal doses. It is a commonly agreed clinical fact that alternations in a patient under analysis appear almost always to be extremely gradual: We are inclined to suspect sudden and large changes as an indication that suggestive rather than psycho-analyst processes are at work. The gradual nature of the change brought about in psychoanalysis will be explained, as, only to suggest, those changes are the result of the summation of an immense number of minuet steps, each of which correspond to a mutative interpretation. And the smallness of each step is in turn imposed by the very nature of the analytic situation. For each interpretation involves the release of a certain quantity of id-energy, and, if the quantity released is too large, the higher unstable state of equilibrium which enables the analyst to function as the patient’s auxiliary super-ego is bound to be upset. The whole analytic situation will thus be imperilled, since it is only in virtue of the analyst’s acting as auxiliary super-ego that these released id-energy can occur at all.
The effectuality from which follow the analytic attempt to bring unequalled amounts in the confronting collections of some improper use too a resultant quantity of id-energy into the patient’s consciousness all at once. On the one hand, nothing whatever may happen, or on the other hand there may be an unmanageable result, but in neither event will a mutative interpretation have been effected. The analyst’s power as auxiliary super-ego may be for two very different reasons. It may be that the id-impulses was trying to bring out were not in fact sufficiently urgent at the moment: For, after all, the emergence of an id-impulse depends on two factors - not only on the permission of the super-ego, but also on the urgency (the degree of cathaxis) of the id-impulse itself. This, then, may be one cause of an apparently negative response to an interpretation, and evidently a fairly harmless one. but the same apparent result may also be due to something else, in spite of the id-impulse being really urgent, the strength of the patient’s own repressive forces (the degree of repression) may have been too great to allow his ego to listen to the persuasive voice of the auxiliary super-ego. Now we have a situation dynamically identical with the next one we have to consider, though economically different. this next situation is one in which the patient accepts the interpretation, that is, allows the id-impulse into his consciousness, but is immediately overwhelmed with anxiety. This may show itself in a number of ways, for instance, the patient may produce a manifest anxiety-attack. Or the may exhibit signs of ‘real’ anger with the analyst with a complete lack of insight, or he may break off the analysis. In any of these cases the analytic situation will, for the moment, at least, have broken down. The patient will be behaving just as the hypnotic subject behaves when, having been ordered by the hypnotist to perform an action too much at variance with his own consciousness, he breaks off the hypnotic relation and wakes up from his trance. This state of things, which is manifest where the patient responds to an interpretation with an actual outbreak of anxiety or one of its equivalents, may be latent were the patient shows no response, and this latter case may be the more awkward of the two, since it is masked, and it may sometimes be the effect of a greater overdose of interpretation than where manifest anxiety arises (though obviously other factors will be of determining importance, and in particularly the nature of the patient’s neurosis). Yet this threatened collapse of the analytic situation to an overdose of interpretation: But it might be more accurate in some ways to ascribe it to an insufficient dose. For what has happened is that the second phase of the interpretation process has not occurred: The phase in which the patient becomes aware that his impulse is directed towards an archaic phantasy object and not toward a real one.
In the second phase of a complete interpretation, therefore, a crucial part is played by the patient’s sense of reality: For the successful outcome of that phase depends upon his ability, at the critical moment of the emergence into consciousness of the released quantity of id-energy, to distinguish between his phantasy object and the real analyst. The problem is closely related to one that has been discussed elsewhere, namely that of the extreme liability of the analyst’s position as auxiliary super-ego. The analytic situation is all the time threatening to degenerate into a ‘real’ situation. But this actually means the opposite of what it appears to. It means that the patient is all the time on the brink of turning the real external object (the analyst) into the archaic one; that is to say, he is on the brink of projecting his primitive introjected images onto himself. In so far as the patient actually does this, the analyst becomes like anyone else that he meets in real life - a phantasy object. The analyst then ceases to possess the peculiar advantages derived from the analytic situation, he will be introjected like all other phantasy objects into the analytic situation, he will be introjected like all other phantasy objects into the patient’s super-ego, and will no longer be able to function in the peculiar ways which are essential to the effecting of a mutative interpretation. In this difficulty the patient’s sense of reality is an essential but a very feeble-ally: An improvement in it is one of the things that we hope the analysis will bring about. It is important, therefore, not to submit it to any unnecessary strain, and that is the fundamental reason why the analyst must avoid any real behaviour, that is likely to confirm the patient’s view of him as a ‘bad’ or a ‘good’ phantasy object . This is perhaps more obvious as regards the ‘bad’ object. If, for instance, the analyst were to show that he was really shocked or frightened by one of the patient’s id-impulses, as the patient would immediately treat him in that respect as a dangerous object and introject him into his archaic severe super-ego. Therefore, on the one hand, there would be a diminuation in the analyst’s power to function as an auxiliary super-ego and to allow the patient’s to become conscious of his id-impulses - that is to say, in his power to bring about the first phase of a mutative interpretation, and on the other hand, he would, as a real object, become sensibly less distinguishable from the patient’s ‘bad’ phantasy object and to that extent the carrying through of the second phase of a mutative interpretation would also be made more difficult. Or, agin, there is another case. Supposing the analyst behaves in an opposite way and actively urges the patient to give free rein to his id-impulse. There is then a possibility of the patient confusing the analyst with the image of a treacherous parent who first encourages him to seek gratification, and then suddenly turns and punishes him. In such a case the patient’s ego may look for defence by itself suddenly turning upon the analyst as though he were his own id-, and treating him with all the severity of which his super-ego is capable. again, the analyst is running a risk of losing his privileged position. But it may be equally unwise for the analyst to act really in such a way as to encourage the patient to project his ‘good’ introjected object on to him. For the patient will then tend to regard him as a good objective and archaic sense and will incorporate him with his archaic ‘good’ images and will use him as a protection against his ‘bad’ ones. In that way, his infantile positive impulses as well as his negative ones may escape analysis, for there may no longer be a possibility for his ego to make a comparison between the phantasy external object and the real one. it will, perhaps, be argued that, with the best of wills in the world, the analyst, however careful he may be, will be unable to prevent the patient from projecting these various images on to him. This is, of course, indisputable, and, the whole effectiveness of analysis depends upon its being so. The lesson of these difficulties is merely to remind us that the patient’s sense of reality has the narrowest limits. It is a paradoxical fact that the best way of enuring that his ego shall be able to distinguish between phantasy and reality is to withhold reality from him as much as possible. but it is true, his ego is so weak - so much at the mercy of his id and super-ego - that he can only cope with reality if it is administered in minimal doses. And these doses are in fact what the analyst gives him, in the form of interpretations.
A mutative interpretation can only be applied to an id-impulse which is actually on a state of cathexis. This seems self-evident; for the dynamic changes in the patient’s mind implied by a mutative interpretation can only be brought about by the operation of a charge of energy originating in the patient himself: The function of the analyst is merely to ensure that the energy should or can flow along one channel rather than along another. It follows that the purely informative ‘dictionary’ type of interpretation will be non-mutative, however useful it may be a prelude to mutative interpretations. And this leads to a number of practical inferences. Every mutative interpretation must be emotionally ‘immediate’, the patient must experience it as something actual. This requirement, that the interpretation must be ‘immediate’, may be expressed in another way by saying that interpretation must always be directed to the ‘point of urgency’. At any given moment some particular id-impulse will be generated in activity, this is the impulse that is susceptible of mutative interpretation at the time, and no other one. It is, no doubt, neither possible nor desirable to be giving mutative interpretations all the time. as Melanie Klein has pointed out, it is a most precious quality in an analyst to be able at any moment to pick out the point of urgency.
But the fact that every mutative interpretation must deal with an ‘urgent’ impulse takes us back one more to the commonly felt fear of the explosive possibilities of interpretation, and particularly of what is vaguely referred to as ‘deep’ interpretation. The terminological description is, no doubt, as the interpretation of material which is neither genetically early and historically distant from the patient’s actual experience or which is under an especially heavy weight of repression – material, in any case, which is in the normal course of things exceedingly inaccessible to his ego and remote from it. There seems reason to believe, moreover, that the anxiety which is liable to be aroused by the approach of such material to consciousness and may be of peculiar severity. The question whether it is ‘safe’ to interpret such material will, as usual, mainly depend upon whether an interpretation can be carried through, in the ordinary run of the case, as this material which is urgent during the earlier stages of the analysis is not deep. We have to deal at first only with more or less far-going displacements of the deep impulse. And the deep material itself is only reached later and by degrees, so that no sudden appearance of unmanageable quantities of anxiety is to be hesitorially anticipated. In exceptional cases, however, owing to some peculiarities in the structure of the neurosis, deep impulses may be urgent at a very early stage of the analysis. We are then faced by a dilemma. If we give an interpretation of this deep material, the resultant amounts of anxiety produced in the patient may be so great that his sense of reality may not be sufficient to permit of its accomplishment, and the whole analysis may be jeopardised, but, it must not be thought that, in such critical cases as we are now considering, the difficulty can necessarily be avoided simply by not giving any interpretation or by giving more superficial interpretations of non-urgent material or by attempting reassurances. It seems probable, in fact, that these alternative procedures may do little or nothing to obviate the trouble, on the contrary, they may even exacerbate the tension created by the urgency of the deep impulses which are the actual cause of the threatening anxiety. Thus the anxiety may break out in spite of these palliative efforts and, if so, it will be doing so under the most unfavourable conditions, that is to say , outside the mitigating influences afforded by the mechanism of interpretation. It is possible, therefore, that, of these alternative procedures which are open to the analyst faced by such a difficulty. The interpretation of the urgent id-impulses, deep though they may b e, will actually be the safer.
It is, of course, a matter of common experience, that it possible with certain patients to continue indefinitely giving interpretations without producing any apparent effect whatever. There is an amusing criticism of this kind of ‘interpretation-fanaticism’ in the excellent historical chapter of Rank and Ferenczi. But it is clear from their words that what they have in mind are essentially extra-transference interpretations, for the burden of their criticism is that such a procedure implies neglect of the analytic situation. This is the simplest case. Where a waste of time and energy is the main result. But there are other occasions, on which a policy of giving strings of extra-transference interpretations is apt to lead the analyst into more positive difficulties. Attention was drawn by Reich a few years back, in the course of some technical discussions in Vienna too a tendency among inexperienced analysts to get into trouble by eliciting from the patient great quantities of material in a disordered and unrelated fashion: This may, be maintained, be carried to such lengths that the analysis is brought to an irremediable state of chaos. He pointe out truly that the material we have to deal with is stratified and that it is highly important in digging it out not to interference, more that we can help with th e arrangement of that state. He had in mind, of course, the analogy of an incompetent archaeolist, whose clumsiness may obliterate for all time the possibility of reconstructing the history of an important site. However, the results in the case of a clumsy analysis do not hold of any pessimistic cause to happen, as it were, re-stratification itself of its own accord if it is given the opportunity; That is to say, in the analytic situation. At the same time, is that of the presence of the risk, and it seems to be particularly likely to occur where extra-transference interpretation is excessively or exclusively restored to. The means of preventing it, and the remedy if it has occurred, lie in returning to transference interpretation at the point of urgency. For if we can discover which of the material is ‘immediate’ in the sense that the problematic occurrence enabling stratification is automatically solved, and it is a characteristic if most extra-transference material that it has no immediacy and consequently stratification is far more difficult to decipher. The measures suggested by Reich himself for preventing the occurrence of this state of chaos are not inconsistent with those that he stresses the importance of interpreting resistance as opposed to the primary id-impulses themselves - and this, was a policy that was laid down at an early stage in the history of analysis. But it is, of course, one of the characteristics of a resistance that it arises in relation to the analyst; and thus interpretation of a resistance will almost inevitably be a transference interpretation.
But the most serious risks that arise from the making of extra-transference interpretation are due to the inherent difficulty in completing their interpretation, for a successful outcome as such, depends upon his ability, at which time of the emergence into consciousness and the released quantity of id-energy. They are from their nature unpredictable in their effects. There seems to be a special risk of the patient not carrying through to a competed interpretation, hitherto, namely that the extreme liability of the analyst’s position as auxiliary super-ego, is that, the analytic situation is all the time threatening to degenerate into a ‘real’ situation. It means that the patient is all the time perched upon the circumference edge-horizon of turning the external object (the analyst) into the archaic one, but of projecting the id-impulse that has been made conscious on to the analyst. This risk, no doubt, applies to some extent to transference interpretations. However, the situation is less likely to arise when the object of the id-impulses is actually present and is moreover the same person as the maker of interpretation. We may, once, more, recall the problem of ‘deep’ interpretation, and point out that its dangers, even in the most unfavourable circumstances, seem to be greatly diminished if the interpretation in question is a transference interpretation. Even so, there appears to be more of a chance that in this whole process occurring silently and so being overlooked in the case of an extra-transference interpretation, particularly in the earlier stages of an analysis. For this reason, it would seem to be important after giving an extra-transference interpretation to be specially in the ‘qui-vive’ for transferences complications. This last peculiarity of the extra-transference interpretation is actually one of their most important from a practical stand-point. For on account of it they can be made to act as ‘feeders’ for the transference situation, and so to pave the way for mutative interpretations. In other words, by giving an extra-transference interpretation, the analyst can often provide a situation in the transference of which he can then give a mutative interpretation.
Therefore, it is probable that a large majority of our interpretations are outside the transference - though it should be added that it often happens that one is ostensibly giving an extra-transference interpretation one is implicitly giving a transference one. A cake cannot be made of nothing but currants, and, though it is true that extra-transference interpretations are not for the most part mutative, and do not themselves bring about the crucial results that involve a permanent change in the patient’s mind. They are, nonetheless essential, if taken to an analogy of trench warfare, the acceptance of a transference interpretation corresponds to the capture of a key position, while the extra-transference interpretations correspond to the general advance and to the consolidation of a fresh line of defence, which are made possible by the capture of the key position. But when this general advance goes beyond a certain point, there will be another check, and the capture of a further key position will be necessary before progress can be resumed. An oscillation of this kind between transference and extra-transference interpretations will represent the normative course of events in an analysis.
As a prefatory remark about Freud and transference, the observations can be offered that Freud wrote briefly about transference and did so, in the main, before 1917. Another observation which can rarely be made about Freud’s work, what he did write on transference and did not reach the high level of analytical thought which has come to be regarded as standard for him. Some indication of what his contribution consist of is given by the editors of the Standard Edition, who list them in several places. One of the longer lists, in a footnote includes six reference ‘Studies on Hysteria’, with Breuer (1895),the Dora paper (1905), The Dynamics of Transference’ (1912), Observations on Transference-Love’ (1915), the chapter on transference in the Introductory Lectures (1917), and Analysis Terminable and Interminable (1937). Although the editors in no sense suggest that these six papers include everything Freud wrote on the subject that these six papers include everything Freud wrote on the subject, it does seem evident that, considering the essential importance of transference to analysis, he wrote little. moreover, the three papers in which transference is the specific theme. `The Dynamics of Transference,`Transference-Love ; and the transference chapter in the Introductory Lectures, come across as perhaps his least significant contributions.
Freud’s first direct mention of transference occurs in "Studies on Hysteria" (1895), His first significant reference to it, however, did not appear until five years later when, in a lecture to Fliess on April 16, 1900, he said (Freud 1887-1902) he was ‘beginning to see that the apparent endlessness of the treatment is something of an inherent feature and is connected with transference. In a footnote to his letter the editors state that, ‘this is the first insight into the role of transference in psychoanalytic therapy’.
Despite these early references, it seems correct to say that yet another five yea s was to go by before the phenomenon of transference was actually introduced. Even then the introduction was far from prominent, for it was tacked like an afterthought as a four-page portion of a postscript to what was perhaps Freud’s most fascinating case history to date, the case of Dora (1905).
Using data from Dora’s three-month-long, unexpected terminated analysis, and especially from her dramatic transference reactions which had taken him quite unaware. Freud now gave to transference its first distinct psychological entity for th first time indicated its essential role in the analytic process. His account, although in general more than adequate - in fact elegant and remarkable ‘finished’ - was brief, almost Iaconic, and perhaps not an entirely worthy introduction to such a truly great discovery. What was uniquely great was his recognizing the usefulness of transference. In his analysis of Dora h e had noted not only that transference feelings existed and were powerful, but much to his dismay, he had realized that as serious, perhaps, even insurmountable, obstacle they could be,. Then, in what seems like a creative leap, Freud made the almost und unbelievable discovery that transference was in fact the key to analysis, that by properly taking the patient’s transference into account, an entirely new, essential and immensely effective heuristic and therapeutic force was added to the analytic method.
The impact on analysis of this startling discovery was actually much greater and much more significant than most people seem to appreciate. Although the role of transference as the ‘sine quo non’ of analysis was and is widely accepted, and was so stated by Freud from the first, It has almost never been acclaimed for having brought about an entire change in the nature of analysis. The introduction of free association to analysis, a much lesser change, received and still receives much more recognition.
One of the reasons for the relatively unheralded entry of transference into analysis my have been the circumstances of its discovery. Although Freud’s new ideas were recorded as if they arose as a sudden inspiration during the Dora analysis, they may in fact have developed somewhat later. In the paper’s prefatory remarks, for instance, Freud said he had no t discussed transference with Dora at all, and in the postscript, he said he had been unaware of her transference feelings. Also pointing to a later discovery date is the extraordinary delay in the paper’s publication. According to the editors’ note, the paper had been completed and accepted for publication by late January 1901, but this date was actually set back more than four and half years until October 1905. The editors’ said: ‘We have no information as to how it happened that Freud . . .deferred publication’. As, perhaps, that this reason may have been that only during those four and half years, as a consequence to his own self-analysis, did he come to an understanding of the significance of the transference. Only then may it have been possible for him to turn again to the Dora case, to apply to it what he had learned in himself, to write his essay as part of the postscript, and, at last, to release the paper for publication.
Freud’s self-analysis has been considered from many angles, but not significantly, is that from the standpoint of transference. Opponents of the idea that there is such a thing ass definite self-analysis, some of whom say it is impossible, generally object on grounds that without an analyst there can be no transference neurosis. Freud clearly demonstrated, such as the situation that may be necessary to fill this need, self-analysis may require at least a half-way satisfactory transference object. In Freud’s case, the transference at this times seem to have been Fliess, who filled the role rather well. As with any analyst., his, ‘real’ impact on Freud was slight . He was essentially a neutral figure, relatively anonymous and physically separate. All of this, plus Fliess’s own reciprocal transference reactions, make it possible for Freud to endow Fliess with whatever qualities and whatever feelings were essential to the development of Freud’s transference, and it should be added. His transference neurosis, in the end, of course, the transference was in part resolved. Freud’s eventual awakening to the realization on of the presence within him such strange and powerful psychological forces must have come as a stupendous disillusionment, directed not only toward Fliess but toward himself, and yet his subsequent working out of some of these transference attachments must have been both an intellectual triumph and an immensely healing and releasing process.
It was this event, the development, the discovery, and then the resolution within himself of the complexities of the transference neurosis, that constitute the actual centre of his self-analysis, and it was this event that was the beginning of analysis as we know it.
In the years following this revolutionary discovery, the central role of transference in analysis gained remarkably wide acceptance, and it has, long since for becoming to change from a closed to an open condition, however is something of a mystery, there is nothing about analysis that is less known than how individual analysts actually use transference in their day-to-day handling in the work with patients. Ast first glance, because each analyst’s conception of transference derives various, but significantly from the analysts own inner experience, Transference probably means many different things to many different analysts.
As understandable as these changes are, nevertheless may come as a surprise to the analyst who frequently has not observed their source, this is quite in contrast to his experience with psychoneurosis whose emotional reactions during an interview he can usually predict. These unpredictable changes seem to be the reason for the conception of the unreliability of the schizophrenic’s transference reaction, yet they follow the same dynamic rules as the psychoneurotic’s oscillations between positive and negative transference and resistance, however, if the schizophrenic’s reactions are stormy and seemingly more unpredictable than those of the psychoneurotic, that instances suggested to be due to the inevitable errors in the analyst’s approach to the schizophrenic, of which he himself may be unaware, rather than to the unreliability of the patient‘s emotional response?
Why is it inevitable that the psychoanalysts disappoint his schizophrenic patient time and again?
The schizophrenic withdraws from painful reality and retires to what resembles the early speechless phase of development where consciousness is not yet crystalized. As the expression of his feelings is not hindered by the convention that he has eliminated, as his thinking, feelings, behaviour and speech - when present - obey the working rules of the archaic unconscious. His thinking is magical and does not follow logical rules. It does not admit to every last ‘no’ and likewise the no to ‘yes’: There is no recognition of space and time, I, you, and they, am interchangeable expression through which of symbols and often by movement and gestures rather than by words.
As the schizophrenic is suspicious, he will distrust the words of his analyst. He will interpret them and incidental gestures and attitudes of the analyst according to his own delusional experience. The analyst may not even be aware of these involuntary manifestations of his attitudes, yet they mean much to the hypersensitive schizophrenic who uses them as a means of orienting himself to the therapist‘s personality and intentions toward him.
In other words, the schizophrenic patient and the therapist are people living in different worlds and no different levels of personal development with different means of expressing and of orienting themselves. We know little about the language of the unconscious that belongs to the schizophrenic, and our access to it is blocked by the very process of our own adjustment to a world the schizophrenic has relinquished, so, we should not be surprised that errors and misunderstandings occur when we under take to communicate and strive for a rapport with him.
Another source of the schizophrenic’s disappointment arises form which the analyser accepts and does not interfere with the behaviour of the schizophrenic, his attitude may lead the patient to expect that the analyst will assist in carrying out all the patient’s wishes, even though they may not seem to be in his interest to the analyser‘s and the hospital’s in their relationship to society. This attitude of acceptance so different from the patient’s previous experiences readily fosters the anticipation that the analyst will try to carry out the patient’s suggestion and take his part, even against conventional society with which it should occasionally arise. Frequently it will be wise for the analyst to agree with the patient‘s wish to remain unbattled and untidy until he is ready to talk about the reasons for his behaviour or to change spontaneously. At other times, he will unfortunately be unable to take the patient’s part without being able to make the patient understand and accept the reasons for the analyst’s position.
If the analyst is not able to accept the possibility of misunderstanding the reaction of the schizophrenic patient and in turn of being misunderstood by him, it may shake his security with his patient.
That is to say, that, among other things, the schizophrenic, once he accepts the analyst’s insecurity. being helpless and open to himself - in spite of his pretended grandiose isolation - he will feel utterly defeated by the insecurity of his would-be helper. Such disappointment may furnish reasons for outbursts of hatred and are comparable to the negative transference reactions of psychoneurosis, yet more intense than these, since they are not limited by the restrictions of the actual world - that is, it exists in or based on fact, its only problem is a sure-enough externalization for which things are existing in the act of being external in something that has existence, ss if it were an actualization as received in the obtainable enactment for being externalized, such that its problem of in some actual life that proves obtainable achieved, in that of doing something that has an existence for having absolute actuality.
These outbursts are accompanied by anxiety, feelings of guilt, and fear of retaliations which in turn lead to increased hostility. Yet this established a vicious circle: We disappoint the patient, he is afraid that we hate him for his hatred and therefore continues to hate us. If in addition he senses that the analyst is afraid of his aggressiveness, it confirms his fear that he is actually considered as some dangerous and unacceptable, and this augments his hatred.
This establishes that the schizophrenics capable of developing strong relationships of love and hatred toward the analyst. After all, one could not be so hostile if it were not for the background of a very close relationship. In addition, the schizophrenic develops transference reactions on the narrower sense which he can differentiate from the actual interpersonal relationship. For which the schizophrenic’s emotional reactions toward the analyst have to be met with extreme care and caution. The love which the sensitive schizophrenic feels as he first emerges, and his cautions acceptances of the analyst’s warmth of interest are really most delicate and tender things. If the analyst deals with the transference reactions of a psychoneurotic is bad enough, though as a reparable rule, but if he fails with a schizophrenic in meeting positive feelings by pointing it out for instance before the patient indicates that he is ready to discuss it, he may easily freeze to death what has just begun to grow and so destroy any further possibility of therapy.
Some analysts may feel that the atmosphere of complete acceptance and of strict avoidance of any arbitrary denials which we recommend as a basic rule for the treatment of schizophrenics may not avoid our wish to guide of reacceptance of reality, nevertheless, Freud says that every science and therapy which accept his teachings about unconscious, about transference and resistance and about infantile sexuality, may be called psychoanalysis. According in this definition we believe we are practising psychoanalysis with our schizophrenic patients.
Whether we call it analysis or not, it is clear that successful treatment does not depend on technical rules of any special psychiatric school but rather on the basic attitude of individual therapist toward psychologic persons. If he meets them as strangle creatures of another world whose productions are not comprehensible to ‘normal’ beings, he cannot treat them, if he realizes, however, that the difference between himself and the psychologic is only of degree, and not of kind, he will know better how to meet him. He will not be able to identify himself sufficiently with the patient to understand and accept his emotional reactions without becoming involved in them.
The process of constant and perpetual change is examined and closely matched within the study of philosophical speculations and pointed of a world view which asserts that basic reality is constantly in a process of flux and change. Indeed, reality is identified with pure process. Concepts such as creativity, freedom, novelty, emergence, and growth are fundamental explanatory categories for process philosophy. This metaphysical perspective is to be contrasted with a philosophy of substance, the view that a fixed and permanent reality underlies the changing or fluctuating world of ordinary experience. Whereas substance philosophy emphasizes static being, process philosophy emphasizes dynamically becoming.
Although process philosophy is as old as the 6th-century Bc Greek philosopher, Heraclitus, renewed interest in it was stimulated in the 19th century by the theory of evolution. Key figures in the development of modern process philosophy were the British philosophers Herbert Spencer, Samuel Alexander, and Alfred North Whitehead, the American philosophers Charles S. Peirce and William James, and the French philosophers Henri Bergson and Pierre Teilhard de Chardin. Whitehead's Process and Reality: An Essay in Cosmology (1929) is generally considered the most important systematic expression of process philosophy.
Contemporary theology has been strongly influenced by process philosophy. The American theologian Charles Hartshorne, for instance, rather than interpreting God as an unchanging absolute, emphasizes God's sensitive and caring relationship with the world. A personal God enters into relationships in such a way that he is affected by the relationships, and to be affected by relationships is to change. So too is in the process of growth and development. Important contributions to process theology have also been made by such theologians as William Temple, Daniel Day Williams, Schubert Ogden, and John Cobb, Jr.
‘Reality’ is a difficult word to use to every one’s satisfaction or even to one’s own satisfaction. In this instance the word reality is used arbitrarily to designate the direct, here-and-now impact of the analyst upon the patient. Reality. In this sense, contrasts with the impact the analyst has through his representation in the patient’s fantasy life, neurosis, and transference, since both kinds of impact seem always to coexist and since the former - the analyst’s real impact - may be the worst enemy of the transference, the matter of their differentiation is possibly the most challenging aspect of analysis.
The analytic situation, which is set up to shut out ordinary reality intrusions, that cannot, . . . neither should not exclude all, but to say, that in the beginning months, for instance, reality inevitably has the upper hand. The analyst, the office, the procedure, are all overwhelmingly real. Everything is strange, frightening and exciting, gratifying and frustrating. Unlike the patient can test it and orient himself to it, the impact of this reality is usually so great that even an ordinary useful transference relationship cannot be expected to develop.
Perhaps the most confusing aspect of this beginning period is the frequent appearance in it of what can be regarded as a false transference relationship. With great intensity and clarity, the patient may reveal, through transference-like references about the analyst, some of the deepest secrets only of his neurosis but of its genesis. The pseudotransference, too good to be true, is almost sure to be nothing more than the patient’s attempt to deal with the person of the analyst, the entire spectrum of his various patterns of behaviour. If, it is easy to do, the analyst overlooks the likelihood that the patient’s relationship with at this time is really about that almost everything said about it is related, analysis may get off to a very bad start. And if, as is even earlier to do, the analyst’s interests the genetic meaning of the openly exposed material, a good transference relationship may be seriously delayed and a workable transference neurosis may never appear. even after initial reality has had time to fade, reality may continue to intrude in ways that are very hard to detect and that is very troublesome.
One of the most serious problems of analysis is the very substantial help which the patient receives directly from the analyst and the analytic situation. For many a patient, the analyst in the analytic situation is in fact the most stable, reasonable, wise and understanding person he has ever met, and the setting in which they meet may actually be the most honest, open, direct and regular relationship he has ever experienced. Added to this is the considerable helpfulness to him of being able to clarify his life storey. confess his guilt, express his ambitions, and explore his confusions. Further real help comes from the learning-about-life accruing from the analyst’s skilled questions, observations and interpretations. Taken together, the total real value to the patient of the analytic situation can easily be immense. The trouble with this kind of help is that it goes on and on, it may have such a real, direct and continuing impact upon the patient that he can never get deeply enough involved in transference situation to allow him to resolve or even to become acquainted with his most crippling internal difficulties. The trouble is far too good, the trouble also is that we as analysts apparently cannot resist the seductiveness of being directly helpful, and this, when combined with the compelling assumption that helpfulness is bound to be good, permits us top credit patient improvements to ‘analysis’ when more properly it should often be recognized for being the amounting result for the patient’s using the analytic situation, as the model, for being the preceptors and supporter in the dealing practically within the immediate distractions as holding to some problem.
Perhaps, we can now refer to something in a clear unmistakable manner, and it would be to mention, for being, that one more difficult-to-handle intrusion of reality into the analysis, that by saying, that this is the definitive and final interruption of the transference neurosis by the reality of termination; in the sense, the situation is reversed and the intrusion is analytically desirable, since ideally the impact of reality of impending and certain termination is used to facilitate the resolution of the transference. As with the resolution of earlier episodes of transference neurosis, this final one is brought about principally by the analyst’s interpretations and reconstructions. As these take effect, the transference neurosis and, hopefully, along with it the original neurosis is resolved. This final resolution, however, which is much more comprehensive, is usually very different and may not come about at all without the help of the reality of termination. Accordingly, any attenuation of the ending, such as tapering off or causal or tentative stopping, should be expected to stand in the way of an effective resolution of the transference. Yet, it seems that this is what most commonly happens to an ending, and because of this a great many patients may lose the potentially great benefit of a thorough resolution and are forever after left suspended in the net of unresolved transference.
Yet, utter indistinctly rigorous termination seems understandable, as difficult as transference neurosis may be in the analyst at other times, this ending period, if rigorously carried out, simply has to be the period of his greatest emotional strain. There can surely be no more likely time for an analyst to surrender his analytic position and, responding to his own transference, become personally involved with his patient than during the process of separating from a long and self-restrained relationship. Accordingly, it may be better to slur over the ending lightly than to mishandle it in an attempt to be rigorous.
In considering more broadly the function of the transference in the psychoanalytic process, one is confronted by the apparent naïve, but, nonetheless important questions of the role of the actual (current) object as compared with that of the object representation of the original personage in the past. We recall Freud’s paradoxical, somewhat gloomy, but portentous concluding passage in ‘The Dynamics of Transference.’ This struggle between the doctor and the patient, between intellect and instinctual life, between understanding and seeking to act, is played out almost exclusively in the phenomena of transference. It is on that field that the victory must be won - the victory whose expression is on that field that the victory must be won - the victory whose expression is the permanent cure of the neuroses. It cannot be disputed that controlling the phenomena of transference presents the psychoanalysis with the greatest difficultly, but it should not be forgotten that they do us the inestimable service of making the patient ‘s hidden and forgotten erotic impulses of showing their immediate and manifested impossibilities, for when all is said and done, it is impossible to destroy anyone in absentia or in effigies.
Both object and representations are made necessary by the basic phenomenon of original separation. The existence of an image of the object, which persist in the absence of the object, is one of the important beginnings of psychic life in general, certainly an indispensable prerequisite for object relationship. As generally construed. Whether this is viewed as (or a times demonstrably is) something unstable for allotting introjection, s always subject to alternative projection, or an intrapsychic object representation clearly distinguished from the self-representation, or firm identification in the superego, or in the ego itself, these phenomena are in various ways components of the system of mastery of the fact of separation, or separateness, from the original absolutely necessarily anaclitic (in the earliest period) symbiotic ‘object’. In the light of clinical observation, it would appear to be that the relative stabilities (parental) object representation. At which time of varying degree, are to a greater extent for the archaic phenomena. Even in nonpsychotic patients, overwhelmed by them, sometimes resembles the restoration from oedipal identification, which provides the preponderant basis for most demonstrable analytic transferences. That within the necrotic patients, the transference is effectively established when this representation invests the analyst to a degree - depending on intensity of drive and most of ego participation - which ranges in all the, wishing and strivings to remake and analyst to biasses judgements and misinterpretation of data, finally are the actual perceptual distortions.
However, the old object representations may be invested, however rigidly established the libidinal or aggressive cathexis of the image may be, this as such can become the actual and exclusive focus of instinctual discharge, or of complicated and intense instinct-defence solutions, only and general energy-sparing quality of strictly intrapsychic processes. For the vast majority of persons, visible to any degree, including those with severe neurosis, character distortions, addictions and certain psychoses, the striving is toward the living and actual object, even at the cost of intense suffering. In a sense, this returns us to the state in which the psychological ‘object-to-be’. Has a cr11itical importance never again to be duplicated, except in certain acute life emergencies, even if the object is not firmly perceived as such, in the sense of later object relations? And it does seem that trance impressions from the earliest contacts in the service of life preservation, and the associated instinctual gratifications, and innumerable secondarily associated sensory impressions. Are activated by the specific inborn urges of sexual maturation? These propel the individual to renew many of the earliest modes of actual bodily contact, in connection with seeking for specific instinctual gratification. Or, to look away from clear-cut instinctual matters to the more remote elaborations of human contact: Few regard loneliness as other than a source of suffering, even self-imposed, as an apparent matter of choice, and the forcible imposition of ‘solitary confinement ‘ is surely one of the most cruel of punishments.
In taking to question, we are entering an area of life in which things are other then themselves, where meaning is multifaceted, and where the line between the old and the new is blurred. It should, by, its immediate measure, help develop our recognition or meaning of the pertinent applicability as to the relevance of interrelated aspects of the psychology of ‘metaphor’. In the psychology of metaphor we will find a useful analogy to the psychology of transference interpretation. Our’s will be newly encountered as good metaphors, those it response to which we say, ‘That’s it exactly’ or ‘That really captures it‘ or ‘That says it all’.
Some literary and linguistic analysis, (e.g., Lewis, 1936 and Snell, 1953) and also people in everyday life, believe that there are experiences that can only be expressed metaphorically. And for this achievement that these metaphors, which may be entire poem or as lines or even words highly valued. But how can this be so? Just what in th e ‘it’ that the metaphor ‘is’ or ‘captures’ or ‘says’? If this ‘is’ or this ‘experience’ can only be rendered metaphorically, when we can know it only as such, that is, as the metaphor itself. Of the position out of which are put forward by, T.S, Eliot (1933) and E.W. Harding (1963) in their discussion of poetry, for in these instances we are granted that there are no known and logically independent version of the experience that can serve to validate the metaphor. Whatever the metaphor makes available to us depends on it and it and so cannot be used to prove its correctness.
It seems justifiably warrantable to consider that the metaphor is a new experience rather than a mere paraphrase of an already fully constituted expedience. The metaphor creates an experience that one has never had before. It is an experience one has not realized by oneself. The metaphor does, of course, suggest certain constituent experiences of which one may have been more or less dimly aware. One may say, therefore, that the metaphor speaks for those constituents, on the existence of which much of its appeal depends. But in its organizing and implicit ly rendering these constituents in its new way, it is a creation rather than a mere paraphrase or anew edition. Paraphrasing and new editions never speak as forcefully as good new metaphors, nor could they facilitate further new experience. One analytically familiar feature of these creations is that they make it safe and pleasing to experience something that otherwise would be considered too threatening and so would be kept in fragmented obscurity through defensive measures.
Thus, when one says, ‘That’s it exactly’ one is implicitly recognizing and announcing that one has found and accepted a new mode of experiencing oneself and one’s world, which is to say, asserting a transformation of one’s own subjectivity. Something is now said to be true, and in a sense it is true, but it is true for the first time. Nothing of one and the same can ever happen again, for the second time cannot be the same as the first. One can’ t step into the same watering point and then step once again into the same spot of that river. A revelatory metaphor re-encountered or repeated later may lose some of its force, alternatively, it may gain some significance, butt it cannot remain exactly the same metaphor or mobilize an experience identical with the first. The point applies as well as to new metaphors that are similar to familiar ones: They have to be judged or experienced through their conventionalized predecessors, as through methods of knowing or already proved instrumentally of perceiving. The audience and the performer, who may be one person, as such that may not have, as yet.
What is to be said about the psychology of metaphor is analogous to the transformational aspects of developed transference and the steadfast interpretation that both facilitate and organize them as transference. Allowing that these transferences and ‘remembered’ experiences come into existence over a period of time, nothing that is identical with them has ever before been enacted, and nothing will ever be enacted again. They are creations that may be fully achieved only under specific analytic conditions. Such that living was not reliving that moment, words like re-living, re-experiencing and reliving simply do not do justice to the phenomena, that in making this claim. A seeming contradiction over-writes some of our well-establish ideas. - in offering, - I am not contradicting some of our well-established ideas about interpretation and insight, I am, however, disputing the point that insight refers to a greater proportion or in its range of comprehension, which its distance between possible extremes extent and regain former or normal state, such that, for the recovery of lost memories, and takes in as well, a new grasp of the significance and interpretations of events one has always remembered. In point, as, Freud pointed out, ‘As a matter of fact I’ve always known it, only that I’ve never thought of it; (1914), In fact, it is to develop that point in furthering to say that it takes an adult to do that, especially with the help of an analyst. It was, after all, Freud’s analysis of adults that make it possible to define infantile psychosexuality. In this respect, but without disregard, child analysis retains a quality of applied psychoanalysis’ in the same way that the interpreted transference neurosis is: Both are always of describing as true something that was not true in quite that way at the time of its greatest developmental significance. This apparent paradox about ‘remembering’ as a form of creating goes a long way, probably that what it is, is distinctive about psychoanalytic interpretation.
This time, however, to further the discussion on the interpretive technique that surrounds the phase of a mutative interpretation - that in which a portion of the patient’s id-relation to the analyst is made conscious in virtue of the latter’s positions as auxiliary super-ego - is in itself complex. In the classical model of an interpretation, the patient will first be made aware of a state of tension of an interpretation, will next be made aware that there is repressive factor at work (that his super-ego is threatening him with punishment), and will only then be made aware of the id-impulse which has stirred up the protects of his super-ego and so given to the anxiety in his ego. This is the classical scheme. In actual practice, the analyst finds himself working from all three sides at once, or in irregular successions. At one moment a small portion of the patient‘s super-ego may be revealed to him in all its savagery, at another the shrinking defencelessness of his ego, at yet another his attention may be directed to the attempts which he is making at restitution - at compensating for his hostility, on some occasions a fraction of id-energy may even be directly encouraged to break its way through the last remains of an already weakened resistance. There is, however, one characteristic which all of these various operations has in common, they are essentially upon a small scale. For the mutative interpretation is inevitably governed by the principle of minimal doses. It is a commonly agreed clinical fact that alternations in a patient under analysis appear almost always to be extremely gradual: We are inclined to suspect sudden and large changes as an indication that suggestive rather than psycho-analyst processes are at work. The gradual nature of the change brought about in psychoanalysis will be explained, as, only to suggest, those changes are the result of the summation of an immense number of minuet steps, each of which correspond to a mutative interpretation. And the smallness of each step is in turn imposed by the very nature of the analytic situation. For each interpretation involves the release of a certain quantity of id-energy, and, if the quantity released is too large, the higher unstable state of equilibrium which enables the analyst to function as the patient’s auxiliary super-ego is bound to be upset. The whole analytic situation will thus be imperilled, since it is only in virtue of the analyst’s acting as auxiliary super-ego that these released id-energy can occur at all.
The effectuality from which follow the analytic attempt to bring unequalled amounts in the confronting collections of some improper use to a resultant quantity of id-energy into the patient’s consciousness all at once. On the one hand, nothing whatever may happen, or on the other hand there may be an unmanageable result, but in neither event will be a mutative interpretation has been effected. The analyst’s power as auxiliary super-ego may be for two very different reasons. It may be that the id-impulses were trying to bring out being not in fact sufficiently urgent at the moment: For, after all, the emergence of an id-impulse depends on two factors - not only on the permission of the super-ego, but also on the urgency (the degree of cathaxis) of the id-impulse itself. This, then, may be one cause of an apparently negative response to an interpretation, and evidently a fairly harmless one. but the same apparent result may also be due to something else, in spite of the id-impulse being really urgent, the strength of the patient’s own repressive forces (the degree of repression) may have been too great to allow his ego to listen to the persuasive voice of the auxiliary super-ego. Now we have a situation dynamically identical with the next one we have to consider, though economically different. this next situation is one in which the patient accepts the interpretation, that is, allows the id-impulse into his consciousness, but is immediately overwhelmed with anxiety. This may show itself in a number of ways, for instance, the patient may produce a manifest anxiety-attack. Or the may exhibit signs of ‘real’ anger with the analyst with a complete lack of insight, or he may break off the analysis. In any of these cases the analytic situation will, for the moment, at least, have broken down. The patient will be behaving just as the hypnotic subject behaves when, having been ordered by the hypnotist to perform an action too much at variance with his own consciousness, he breaks off the hypnotic relation and wakes up from his trance. This state of things, which is manifest where the patient responds to an interpretation with an actual outbreak of anxiety or one of its equivalents, may be latent were the patient shows no response, and this latter case may be the more awkward of the two, since it is masked, and it may sometimes be the effect of a greater overdose of interpretation than where manifest anxiety arises (though obviously other factors will be of determining importance, and in particularly the nature of the patient’s neurosis). Yet this threatened collapse of the analytic situation to an overdose of interpretation: But it might be more accurate in some ways to ascribe it to an insufficient dose. For what has happened is that the second phase of the interpretation process has not occurred: The phase in which the patient becomes aware that his impulse is directed toward an archaic phantasy object and not toward a real one.
In the second phase of a complete interpretation, therefore, a crucial part is played by the patient’s sense of reality: For the successful outcome of that phase depends upon his ability, at the critical moment of the emergence into consciousness of the released quantity of id-energy, to distinguish between his phantasy object and the real analyst. The problem is closely related to one that has been discussed elsewhere, namely that of the extreme liability of the analyst’s position as auxiliary super-ego. The analytic situation is all the time threatening to degenerate into a ‘real’ situation. But this actually means the opposite of what it appears to. It means that the patient is all the time on the brink of turning the really external object (the analyst) into the archaic one; that is to say, he is on the brink of projecting his primitive introjected images onto himself. In so far as the patient actually does this, the analyst becomes like anyone else that he meets in real life - a phantasy object. The analyst then ceases to possess the peculiar advantages derived from the analytic situation, he will be introjected like all other phantasy objects into the analytic situation, he will be introjected like all other phantasy objects into the patient’s super-ego, and will no longer be able to function in the peculiar ways which are essential to the effecting of a mutative interpretation. In this difficulty the patient’s sense of reality is an essential but a very feeble [-ally]: An improvement in it is one of the things that we hope the analysis will bring about. It is important, therefore, not to submit it to any unnecessary strain, and that is the fundamental reason why the analyst must avoid any real behaviour, that is likely to confirm the patient’s view of him as a ‘bad’ or a ‘good’ phantasy object. This is perhaps more obvious as regards the ‘bad’ object. If, for instance, the analyst were to show that he was really shocked or frightened by one of the patient’s id-impulses, as the patient would immediately treat him in that respect as a dangerous object and introject him into his archaic severe super-ego. Therefore, on the one hand, there would be a diminuation in the analyst’s power to function as an auxiliary super-ego and to allow the patient’s to become conscious of his id-impulses - that is to say, in his power to bring about the first phase of a mutative interpretation, and on the other hand, he would, as a real object, become sensibly less distinguishable from the patient’s ‘bad’ phantasy object and to that extent the carrying through of the second phase of a mutative interpretation would also be made more difficult. Or, agin, there is another case. Supposing the analyst behaves in an opposite way and actively urges the patient to give free rein to his id-impulse. There is then a possibility of the patient confusing the analyst with the image of a treacherous parent who, at the beginning, encourages him to seek gratification, and then suddenly turns and punishes him. In such a case the patient’s ego may look for defence by itself suddenly turning upon the analyst as though he were his own id-, and treating him with all the severity of which his super-ego is capable. again, the analyst is running a risk of losing his privileged position. But it may be equally unwise for the analyst to act really in such a way as to encourage the patient to project his ‘good’ introjected object onto him. For the patient will then tend to regard him as a good objective and archaic sense and will incorporate him with his archaic ‘good’ images and will use him as a protection against his ‘bad’ ones. In that way, his infantile positive impulses as well as his negative ones may escape analysis, for there may no longer be a possibility for his ego to make a comparison between the phantasy external object and the real one. it will, perhaps, be argued that, with the best of wills in the world, the analyst, however careful he may be, will be unable to prevent the patient from projecting these various images onto him. This is, of course, indisputable, and, the whole effectiveness of analysis depends upon its being so. The lesson of these difficulties is merely to remind us that the patient’s sense of reality has the narrowest limits. It is a paradoxical fact that the best way of enuring that his ego will be able to distinguish between phantasy and reality is to withhold reality from him as much as possible. but it is true, his ego is so weak - so much at the mercy of his id and super-ego - that he can only cope with reality if it is administered in minimal doses. And these doses are in fact what the analyst gives him, in the form of interpretations.
A mutative interpretation can only be applied to an id-impulse which is actually on a state of cathexis. This seems self-evident; for the dynamic changes in the patient’s mind implied by a mutative interpretation can only be brought about by the operation of a charge of energy originating in the patient himself: The function of the analyst is merely to ensure that the energy should or can flow along one channel rather than along another. It follows that the purely informative ‘dictionary’ type of interpretation will be non-mutative, but useful it may be a prelude to mutative interpretations. And this leads to a number of practical inferences. Every mutative interpretation must be emotionally ‘immediate, but the patient must live through it as something actual or genuine. This requirement, that the interpretation must be ‘immediate’, may be expressed in another way by saying that interpretation must always be directed to the ‘point of urgency’. At any given moment some particular id-impulse will be generated in activity, this is the impulse that is susceptible of mutative interpretation at the time, and no other one. It is, no doubt, neither possible nor desirable to be giving mutative interpretations all the time. as Melanie Klein has pointed out, it is a most precious quality in an analyst to be able at any moment to pick out the point of urgency.
But the fact that every mutative interpretation must deal with an ‘urgent’ impulse take us back one more to the commonly felt fear of the explosive possibilities of interpretation, and particularly of what is vaguely referred to as ‘deep’ interpretation. The terminological description is, no doubt, as the interpretation of material which is neither genetically early and historically distant from the patient’s actual experience nor under an especially heavy weight of repression – material, in any case, which is in the normal course of things exceedingly inaccessible to his ego and remote from it. There seems reason to believe, moreover, that the anxiety which is liable to be aroused by the approach of such material to consciousness and may be of peculiar severity. The question whether it is ‘safe’ to interpret such material will, as usual, mainly depend upon whether an interpretation can be carried through, in the ordinary run of the case, as this material which is urgent during the earlier stages of the analysis is not deep. We have to deal at first only with more or less far-going displacements of the deep impulse. And the deep material itself is only reached later and by degrees, so that no sudden appearance of unmanageable quantities of anxiety is to be hesitorially anticipated. In exceptional cases, however, owing to some peculiarities in the structure of the neurosis, deep impulses may be urgent at a very early stage of the analysis. We are then faced by a dilemma. If we give an interpretation of this deep material, the resultant amounts of anxiety produced in the patient may be so great that his sense of reality may not be sufficient to permit of its accomplishment, and the whole analysis may be jeopardised, but, it must not be thought that, in such critical cases as we are now considering, the difficulty can necessarily be avoided simply by not giving any interpretation or by giving more superficial interpretations of non-urgent material or by attempting reassurances. It seems probable, in fact, that these alternative procedures may do little or nothing to obviate the trouble, on the contrary, they may even exacerbate the tension created by the urgency of the deep impulses which are the actual cause of the threatening anxiety. Thus the anxiety may break out in spite of these palliative efforts and, if so, it will be doing so under the most unfavourable conditions, that is to say, outside the mitigating influences afforded by the mechanism of interpretation. It is possible, therefore, that, of these alternative procedures which are open to the analyst faced by such a difficulty. The interpretation of the urgent id-impulses, deep though they may b e, will actually be the safer.
It is, of course, a matter of common experience, that it possible with certain patients to continue indefinitely giving interpretations without producing any apparent effect whatever. There is an amusing criticism of this kind of ‘interpretation-fanaticism’ in the excellent historical chapter of Rank and Ferenczi. But it is clear from their words that what they have in mind are essentially extra-transference interpretations, for the burden of their criticism is that such a procedure implies neglect of the analytic situation. This is the simplest case. Where a waste of time and energy is the main result. But there are other occasions, on which a policy of giving strings of extra-transference interpretations is apt to lead the analyst into more positive difficulties. Attention was drawn by Reich a few years back, in the course of some technical discussions in Vienna to a tendency among inexperienced analysts to get into trouble by eliciting from the patient great quantities of material in a disordered and unrelated fashion: This may, be maintained, be carried to such lengths that the analysis is brought to an irremediable state of chaos. He pointe out truly that the material we have to deal with is stratified and that it is highly important in digging it out not to interference, more that we can help with th e arrangement of that state. He had in mind, of course, the analogy of an incompetent archaeolist, whose clumsiness may obliterate for all time the possibility of reconstructing the history of an important site. However, the results in the case of a clumsy analysis do not hold of any pessimistic cause to happen, as it was, re-stratification itself of its own accord if it is given the opportunity; That is to say, in the analytic situation. At the same time, is that of the presence of the risk, and it seems to be particularly likely to occur where extra-transference interpretation is excessively or exclusively restored to. The means of preventing it, and the remedy if it has occurred, lie in returning to transference interpretation at the point of urgency. For if we can discover which of the material is ‘immediate’ in the sense that the problematic occurrence enabling stratification is automatically solved, and it is a characteristic if most extra-transference material that it has no immediacy and consequently stratification is far more difficult to decipher. The measures suggested by Reich himself for preventing the occurrence of this state of chaos are consistent with those that he stresses the importance of interpreting resistance as opposed to the primary id-impulses themselves - and this, was a policy that was laid down at an early stage in the history of analysis. But it is, of course, one of the characteristics of a resistance that it arises in relation to the analyst. Thus, interpretation of a resistance will almost inevitably be a transference interpretation.
But the most serious risks that arise from the making of extra-transference interpretation are due to the inherent difficulty in completing their interpretation, for a successful outcome as such, depends upon his ability, at which time of the emergence into consciousness and the released quantity of id-energy. They are from their nature unpredictable in their effects. There seems to be a special risk of the patient not carrying through to a competed interpretation, hitherto, namely that the extreme liability of the analyst’s position as auxiliary super-ego, is that, the analytic situation is all the time threatening to degenerate into a ‘real’ situation. It means that the patient is all the time perched upon the circumference edge-horizon of turning the external object (the analyst) into the archaic one, but of projecting the id-impulse that has been made conscious onto the analyst. This risk, no doubt, applies to some extent to transference interpretations. However, the situation is less likely to arise when the object of the id-impulses is actually present and is moreover the same person as the maker of interpretation. We may, once, more, recall the problem of ‘deep’ interpretation, and point out that its dangers, even in the most unfavourable circumstances, seem to be greatly diminished if the interpretation in question is a transference interpretation. Even so, there appears to be more of a chance that in this whole process occurring silently and so being overlooked in the case of an extra-transference interpretation, particularly in the earlier stages of an analysis. For this reason, it would seem to be important after giving an extra-transference interpretation to be specially in the ‘qui-vive’ for transferences complications. This last peculiarity of the extra-transference interpretation is actually one of the most important forms to a practical stand-point of things. For on account of it they can be made to act as ‘feeders’ for the transference situation, and so to pave the way for mutative interpretations. In other words, by giving an extra-transference interpretation, the analyst can often provide a situation in the transference of which he can then give a mutative interpretation.
Therefore, it is probable that a large majority of our interpretations are outside the transference - though it should be added that it often happens that one is ostensibly giving an extra-transference interpretation one is implicitly giving a transference one. A cake cannot be made of nothing but currants, and, though it is true that extra-transference interpretations, are not for the most part, mutative and do not they bring about the crucial results that involve a permanent change in the patient’s mind. They are, nonetheless essential, if taken to an analogy of trench warfare, the acceptance of a transference interpretation corresponds to the capture of a key position, while the extra-transference interpretations correspond to the general advance and to the consolidation of a fresh line of defence, which are made possible by the capture of the key position. But when this general advance goes beyond a certain point, there will be another check, and the capture of a further key position will be necessary before progress can be resumed. An oscillation of this kind between transference and extra-transference interpretations will represent the normative course of events in an analysis.
Although the giving of mutative interpretations may thus only occupy a small portion of psycho-analytic treatment, it will, upon being, that the most important part from the point of view of deeply exerting affective percussions. Do so, because of the influencing characteristic confirmations as drawn upon the spoken-exchange of the patient’s mindful knowing, in that the individuals that feel, perceive, think, wills, and especially reasons are all taken into heedful compliance. It may be of interest to consider how a moment through which of such an importance to the patient affects the analyst himself. Mrs. Klein has suggested that there must be some quite special internal difficulty as to involve the analyst in interpretations. This is shown in their avoidance by psycho-therapists of non-analytic schools, but many psycho-analysts will be aware of traces of the same tendency in themselves. It may be rationalized into mutative interpretations. This is shown in the avoidance by psycho-therapists of non-analytic schools, if not many consisting of a psycho-analyst as flown over to passing their flow of emptying space, nonetheless, this dialectic awareness traces of the same tendency as in them. But behind this there is somewhat of a lurking difficulty in the actual giving of the interpretation, for there seems to be a constant temptation for the analyst to do something else instead. Questions may be asked of whether o r not. As given to the reassurances or advice or discourses upon theory, or may give interpretations -but interpretations that are not mutative, extra-transference interpretations, interpretations that are non-immediate, or ambiguous, or in exacting of two or more alternative interpretations simultaneously, or he may, perhaps, give interpretations and at the same time, show his own scepticism about them. All of this strongly suggests that the giving of a mutative interpretation is a crucial act for the analyst as well as for the patient. And this inturn will become intelligible when we reflect that at the moment of interpretation the analyst is in fact deliberately Evoking a quantity of the patients id-energy while it is a live and actual and unambiguous and aimed directly himself. Such a moment must be above all others put to the test his relations with his unconscious impulses.
Interpretation of the transference is central to all psychoanalytic models. Definitions of transference and transference interpretation have changed greatly during the past half-century, influenced by major movements in philosophy, but advances in psycho-analytic research and theory, and changes in our of understanding Freud. Suggestively. The advances in psychnalytic research and theory, and changes in our understanding of Freud. Is that, the historical, relatively simple, concepts of the transference as the reproductions in the presence of significant relationships from therapists do not adequately meet current clinical theoretical demands? Modernist views of the transference emphasize as in additional sources of transference responses, the role of the analytic background of safety, the constant modifications of unconscious fantasy and internal representations, and the interactive nature of transference response, with important interpersonal and intersubjective components. It is suggested that the evolving modernists view of transference and transference interpretation permit a fuller accounting for transference and transference components. Such in a fuller accountability, for which of these issues of psychological ‘truth’ has open the way for better informed interventions. The issue of psychological ‘truth’ and ‘distortion’ as applied to transference phenomena will be presented with clinical vignettes.
Psychoanalysis, since the earliest days of the, Studies on Hysteria (Breuer and Freud, 1993-1905), have always given special attention to the transference and to the interpretation of transference, believing it to be central in our theory and technique. While there, has never been a lack of interest in transference interpreting. It is not clear why this is so, and the reasons may vary in different parts of the international psychoanalytic community. In America, at least, Gill’s (1982) recent, and somewhat radical presentation of transference interpretation has surely helped to the grasping upon our developing attentions. Nevertheless, of another reason for our intensified interests in transference interpretation is the opportunity it provides for the rhetorically dialectic awareness, in that discussions, have lead us to the diverse analytic theories and techniques that today complete the diverseness as observed, for which of our attentions and allegiance to which transference interpretation seems to have replaced self-psychology. Thus, the encompassing topic that allows analysts of varied persuasions among many structural and fundamental elements that forge out the shape for taking upon the imparting of instinctual information. As to know, and knowing that you know, is, applied, however, of its depthful concerning contemplations with which is distinguished by the evolving characterizations that are of knowing that you know is really nothing whatsoever.
Despite the diversity of the transference and its interpreting in analytic process and cure, differing only in whether transference is everything or almost everything to give a clear-cut definition of what transference is.
Laplanche and Pontalis (1973) had written that, ‘The reason it is so difficult to produce a definition of transference is that for many authors the notion has taken on a very broad extension, even coming to connote all the phenomena which constitute the patient’s relationship with the psychoanalyst, as a result the concept is burdened down more than any other with each analyst’s particular view on the treatment - on its objective, dynamics, tactics, scope, and so forth. The question of the transference is thus beset by a whole series of difficulties which have been the subject of debate in classical psychoanalysis.’
Sandler (1983) has discussed how the terms transference and transference resistance, as well as other terms have undergone profound changes in meaning as new discoveries and new trends of psycho-analytic technique assume ascendency. He said, . . . major changes in technical emphasis brought about the extension of the transference concept, which now has dimensions of meaning which differ from the official definition of the term. I am not sure there has ever been a simplified definition of the term. While a certain flexibility of definition makes conversation possible in a field of diverse views, which we may never be clear on what any two people mean when they use the term is a significant hindrance to our discourse.
However: with this in mind we might review one of Freud’s last comments on transference. In ‘An Outline of Psycho-Analysis’ (1940), published posthumously, he wrote on the analytic situation:
The most remarkable thing is this. The patient is not satisfied with regarding the analyst in the light of reality as a helper and advisor who, moreover, is remunerated for the trouble he takes and who would himself be content with some role that of a guide on a different mountain to climb, on the contrary, the patient sees in him. the return, and the reincarnation, of some important figure out of his childhood or past, and consequently transfer onto him, feelings and reactions which undoubtedly apply this prototype. This fact of transference soon proves to be a factor of an undreamt-of importance, on the other hand bud an instrument of irreplaceable value and on the other, that he set out on a different undertaking without any suspicion of extraordinary power that would be at his command. . . .
Another advantage of transference, too, in that in it the patient produces before us with plastic clarity an important part of his life-story, of which he would, otherwise have probably given us only an insufficient account. He acts it before us, as it was, instead of reporting it to us.
Freud saw the transference interpretation as a method of strengthening the ego against past unconscious wishes and conflicts.
It is the analyst’s task constantly to speak abruptly, and in doing so, the patient may relinquish of his menacing illusions and to show him again and again, of what it takes to be or begin of a new life, are the reflections of the past. And least, he should fall into a state in which he is inaccessible to all evidences, the analyst takes that neither the love nor the hostility reaching an extreme height. This is affected by preparing him in good time for these possibilities and by not overlooking the first signs of them. Careful handling of the transference on these lines is as a role richly rewarded. If we succeed, as we usually can, in enlightenment the patient on the true nature of the phenomena of the transference, we thus have struck a powerful weapon out of the hand of his resistance and will have converted dangers into gains. For a patient never forgets again what he has experienced in the form of transference, it carries a greater force of conviction than anything he can acquire in other ways.
We have used the term ‘transference’ several times, in that we attributed the therapeutic results to the transference without further definition of the word. We will now consider more closely the emotional relationship which is thus designed. During a psychoanalytic treatment, the patient allows the analyst to play a predominating role in his emotional life. This is of great importance in the analytic process. After his treatment is over, this situation is changed. The patient builds up feelings of affection for and resistance to his analyst which, in their ebb and flow, so exceed the normal degree of feeling that the phenomenon has long attracted the theoretical interest of the analyst. Freud studied this phenomenon thoroughly, explained it, and gave it the name ‘transference’, we most probably will understand the significance of the transference phenomenon impressed Freud so profoundly that he continued through the years to develop his ideas about it.
In all afforded efforts, to refuse to consider the demise of forebears as too merely disdain, that we cannot reproduce of all Freud’s research about transference but for an instance of obligation, would be used to indicate the requirement by the immediate need or purpose upon such condition that might point beyond a normal or acceptable limit, as to an excessive amount of which something does not or cannot to their essentials. When we speak of the transference in connexion with social reeducation, we mean the emotional responses of the education or counsellor or therapist, as the case maybe, without meaning that it takes place in exactly the same way as in an analysis. The ‘countertransference‘ is emotional aptitude of the teacher toward the pupil, the counsellor toward his charge, the therapist toward the patient. The feeling which the child develops for the mentor is conditioned by a much earlier relationship to someone else. We must take cognisance of this fact in order to understand these relationships. The tender relationships which go to up the child’s love life are no longer strange to us. Many of these have already been touched upon in the foregoing literature. We have learned how the small boy takes the father and mother as love objects. We have followed the strivings which arise out of this relationship, the Oedipus situation, we have seen how this runs its course and terminates in an identification with the parents. We have also had opportunity to consider the relationship between brothers and sisters, how their original rivalry is transformed into affection through the pressure of their feeling for the parents. We know that the boy at puberty must give up his first love object within the family and transfers his libido to individuals outside the family.
Our present purpose is to consider the effects of these first experiences from a certain angle. The child’s attachment to the family, the continuance and the subsequent dissolution of these love relationships within the family, not only leave a deep effect on the child through the resulting identifications, they determine at the same the actual forms of this love relationships in the future. Freud compares these forms, without implying too great a rigidity, to copper plates for engraving. He has shown that in the emotional relationships of our later life we can do nothing but make an imprint from one or another of these patterns which we have established in early childhood.
Why Freud chose the term ‘transference’ for the emotional relationship between patient and analyst is easy to understand. The feelings which arose long ago in another situation are transferred upon the analyst. To the counsellor of the child, the knowledge of the transference mechanism is indispensable. In order to influence the dissocial behaviour, he must bring his charge into the transference situation. The study of the transference in the dissocial child shows regularly a love life that has been disturbed in early childhood by a lack of affection or an undue amount of affection. A satisfactory social adjustment depends on certain conditions, among them an adequate constitutional endowment and early love relationships which have been confined within certain limits. Society determines these limitations, just as definitely as the later love life of an individual is determined by early form his libidinal development. The child develops normally and assumes his proper place in society, if he can cultivate within the privacy to such relationships as can favourably be carried over into the schools and from there into the ever-broadening world around him. His attitude toward his parents must be such that it can be carried over onto the teacher, and that toward his brothers and sisters must be transferred to his schoolmates. Every new contact, according to the degree of authority or maturity which the person represents, repeats a previous relationship with very little deviation. People whose early adjustment to succeed or supervene from such a normative course have no difficulties in their emotional relations with others, and they are able to form new ties, to deepen them, or to break them off without conflict when the situation demands it.
We can easily see why an attempt to change the present order of society always meets with resistance and where the radical reformer will have to use the greatest leverage. Our attitude to society and its members has a certain standard form. It gets its imprint from the structure of the family and the emotional relationships set up within the family, therefore, the parents, especially the father, assume overwhelming responsibility for the social orientation of the child. The persistent, ineradicable libidinal relationships carried over from childhood are facts with which social reformers must reckon. If the family represents the best preparation for the present social order, which seems to be the case, then the introduction of a new order means that the family must be uprooted and replaced by a different personal world for the child. It is beyond our scope to attempt a solution of this question, which concerns those who strive to build up a new order of society. We are remedial educators and must recognize these sociological relationships. We can ally ourselves with whatever social system will, but we have the path of our present activity well marked out for us, to bring dissocial youth into the line with present-day society.
If the child is harmed through too great disappointment or too great indulgence in his early life, he builds up reaction patterns which are damaged, incomplete, or too delicate to support the wear and tear of life. He is incapable of forming libidinal object relationships which are considered normal by society. His unpreparedness for life, his inability to regulate his conscious and unconscious libidinal striving and to confine his libidinal expectations within normal bounds, creates an insecurity in relation to his fellow men and constitute one of the first and most important condition’s fo r their development of delinquency. Following this point of view, we look for the primary causes of dissocial behaviour in early childhood, where the abnormal libidinal ties are established. The word ‘delinquency’ is an expression used to describe a relationship to people and things which are at variance with what society approve in the individual.
It is not immediately clear, from which are pointed from the particular form of the delinquency, just what libidinal disturbances in childhood have given rise to the dissocial expression. Until we have a psychoanalytically construed scheme for the diagnosis of delinquency, we may content ourselves by separating these forms into two groups: (1) Borderline neurosis cases with dissocial symptoms, and (2) dissocial cases for which are in part, the ego giving to develop of the dissocial behaviour, and showing no trace of neurosis. In the first type, the individual finds himself in an inner conflict because of the nature of his love relationships, a part of his own personality forbids the indulgence of libidinal desires and strivings. The dissocial behaviour results from this conflict. In the second type, the individual finds himself in open conflict with his environment, because the outer world has frustrated his childish libidinal desires.
The differences in the forms of dissocial behaviour are important for many reasons. At present, they are significant to us because of the various ways in which the transference is established in these two types, we know that with a normal child the transference takes place of itself through the kindly efforts of the responsible adult. The teacher in his attitude repeats the situations long familiarly to the child, and thereby evokes a parental relationship. He does not maintain this relationship at the same level, but continually deepens it as long as he is the parental substitute.
When a neurotic child with symptoms of delinquency comes into the institution, the tendencies to transfer his attitude toward his parents to the persons in authority are immediately noticeable. The worker will adopt the same attitude toward the dissocial child as to the normal child, and bring him into positive transference, if he acts toward him in such a way as to prevent a repetition with the worker of the situation with the parents which led to the conflict. In psychoanalysis, on the other hand, it is of greatest importance to let this situation repeat itself. In a sense the worker becomes the father or the mother, but still not wholly so, he represents their claims, but in the right moment he must let the dissocial child know that he has insight into his difficulties and that he will not interpret the behaviour in the same way as do the parents. He will respond to the child’s feeling of a need for punishment, but he will not completely satisfy it.
He will conduct in himself be entirely differently in the case of the child who in open conflict with society. In this instance he must take the child’s part, be in agreement with his behaviour, and in the severest cases even give the child to understand that in his place he would behave just the same way. The guilt feelings found so clearly in the neurotic cases with dissocial behaviour are present in these cases also. These feelings do not arise, however, from the dissocial ego, but have another source.
Why does the educator conduct himself differently in dealing with this second type? These children, too, he must draw into a positive transference to him, but what is applicable and appropriate for a normal or a neurotic child would achieve opposite results. Otherwise the worker would bring upon himself all the hate and aggression which the child bears toward society, thus leading the child into a negative instead of positive transference, and creating a situation in which the child is not amenable to training.
Nevertheless, what was said about psychoanalysis theory is only a bare outline, that much deeper study of the transference is necessary to anyone interested in re-educational work from the psychoanalytic point of view. The practical application of this theory is not easy, since we deal mostly with mixed types, such that the attitude of the counsellor cannot be as uniform as having enough verbal descriptions for evincing of individual forms of dissociated behaviour to enable us to offer detailed instructions about how to deal with them. At present our psychoanalytic knowledge is such that a correct procedure cannot be stated specifically for each and every dissocial individual.
The necessity for bringing the child into a good relationship to his mentor is of prime importance. The worker cannot leave this to chance, he must deliberately achieve it and he must face the fact thus no effective work is possible without it. It is important for him to grasp the psychic situation of the dissocial child in the very first contact he makes with him, because only this can be known in what attitude to adopt. There is a further difficulty in that the dissocial child takes pains to hide his real nature: He misrepresents himself and lies. This is to be taken for granted, it should not surprise or upset us. Dissocial children do not come to us of their own volition but are brought to us, very often with the threat, ‘You’ll soon find out what’s going to happen to you.’ Generally parents resort our help only after every other means, including corporal punishment, have failed. To the child, we are only another form of punishment, an enemy against whom he must be on his guard, not a source of help to him. There is a great difference between this and the psychoanalytic situation, where the patient comes voluntarily for helping. To the dissocial child, we are a menace because we represent society, with which he is in conflict. He must protect himself against this terrible danger and be careful what he says in order not to give himself away. It is hard to make some of these delinquent children talk, remain unresponsive and stubborn. One thing they all have in common: They do not tell the truth. Some lie stupidly, pitiably, others, especially the older ones, show great skill and sophistication. The extremely submissive child, the ‘dandily’, the very jovial, or the exaggeratedly sincere, some especially hard to reach. This behaviour is so much to be expected that we are not surprised or disarmed by it, the inexperienced teacher or adviser is easily irritated, especially when the lies are transparent, but he must not let the child be aware of this. He must deal with the situation immediately without telling the child that he can see that coming through were attributive values about his attitudinal behaviours.
There is nothing remarkable in the behaviour of the dissocial, but it differs only quantitatively from normal behaviour. We all hide our real selves and use a great deal of psychic energy to mislead our neighbours. We masquerade more or less, according to necessity. Most of us learn in the nursery the necessity of presenting ourselves in accordance with the environmental demands, and thus we consciously or unconsciously build up a shell around ourselves. Anyone who has had experience with young children must have noticed how they immediately begin to dissimulate when a grown-up comes into the room. Most children succeed in behaving in the manner which they think is expected of them. Thus they lessen the danger to themselves and at the same time they are casting the permanent moulds of their mannerisms and their behaviour. How many parents really bother themselves about the inner life of their children? Is this mask necessarily for life? I do not know, but it often seems that the person on whom childhood experiences have forced the dissocial individual masquerades to a greater extent, and more consciously, then the normal. He is only drawing logical deductions from his unfortunate disagreeable authority? Why should he be sincere with those people who represent disagreeable authority? This is an unfair demand.
We must look further into the differences between the situation of social retraining and the analytic situation. The analyst expects to meet in his patient unconscious remittances which prevent him from being honest or make him silent: But the treatment is in vain when the patient lies persistently. Those who work with dissocial children expect to be lied to. To send this child away because he lies are only giving in to him. We must wait and hope to penetrate this mask which covers the really psychic situation. In the institution it does not matter if this is not achieved immediately, it means merely that the establishment of the transference is postponed. In the clinic, however, we must work more quickly. Taking with the patient does not always suffice, and we must introduce other remedial measures. Generally, we see the delinquent child, only, in at least as infrequent to a smattering of times, but we are forced to take some steps after the first few interviews, to formulate some tentative conception of the difficulty and to establish a positive transference as quickly as possible. This means we must get at least a peep behind the mask. If the child is not put in an institution, he remains in the old situation under the same influences which caused the trouble. In such cases we wish to establish the transference as quickly as possible, to intensify the child`s positive feelings for us that are aroused while the child is with us, and to bring them rapidly to such a pitch that they can no longer be easily disturbed by the old influences. To carry on such work successfully presupposes a long experience.
Let us now go against our theoretical concerns and considerations and see how the analyst and the patient seek to grasp upon a try to solve situational thoughts for which the transference, and, moreover, its mask on which can be understood that feelings and a better understanding the differentiation that intentionality that allies with others and exclusively its need to achieve to some end.
Even so, there are few current problems concerning the problem of transference that Freud did not recognize either implicitly or explicitly in the development of the theoretical and clinical framework. For all essential purposes, moreover, his formulations, in spite of certain shifts in emphasis, remain integral to contemporary psychoanalytic theory and practice. Recent developments mainly concern the impact of an ego-psychological approach, the significance of object relations, both current and infantile, external and internal, the role of aggression in mental life, and the part played by regression and the repetition compulsion in the transference. Nevertheless, analysis of the infantile Oedipal situation in the setting of a genuine transference neurosis is still considered as a primary goal of psychoanalytic procedure.
Originally, transference was ascribed to displacement on the analyst of repressed wishes and fantasies derived from early childhood. The transference neurosis was viewed as a compromise formulation similar to dreams and other neurotic symptoms. Resistance, defined as the clinical manifestation of repression, could be diminished or abolished by interpretation mainly directed toward the content of the repressed. Transference resistance, both positive and negative, was inscribed to the threatened emergence of repressed unconscious material in the analytic situation. Presently, as with the development of a structural approach, the superego had been portrayed as the heir to the genital Oedipal situation, also was the recognition as playing a leading role in the transference situation. The analysis was subsequently viewed not only as the object by displacement of infantile incestuous fantasies, but also as the substitute by projection for the prohibiting parental figures which had been internalized as the definitive superego. The effect of transference interpretation in mitigating undue severity of the superego has, therefore, been emphasized in many discussions of the concept of transference.
Certain expansions in the structural approach related increasingly to the recognition of the role that had earlier objective relations, in the development of the superego. This had affected the current concepts of transference, in that this connection, the significance of the analytic situation as a repetition of the early mother-child relationship has been stressed from different points for viewing to such equally important developments related to Freud’s revised concept of anxiety which can only lead to theoretical developments in the field of ego psychology. However, this brought about their related clinical changes in the work of many analysts. As a result, attention was no longer the main attraction that had focussed on the content of the unconscious. In addition, increasing importance was attributed to the defence processes by means of which the anxiety which would be engendered if repression and other related mechanisms were broken down, was avoided in the analytic situation. Differences in the interpretation of the role of the analyst and the nature of transference developed from emphasis, on the one hand, on the importance of early object relations, and on the other, from primary attention to the role of the ego and its defences. These defences first emerged clearly in discussion of the technique of child analysis, in which Melanie Klein and Anna Freud, the pioneers in the fields of thought as playing the leading roles.
From a theoretical point of view, discussion foreshadowing the problems which face us today was presented in 1934 in a well-known paper by Richard Sterba and James Strachey, and further elaborated at the Marienbad Symposium at which Edward Bibring made an important contribution. The importance of identification with, or introjection of, the analyst in the transference situation of identification with, or introjection of, the analysts in the transference situation were clearly indicated. The therapeutic results were attributed to the effect of this process In mitigating the need for pathological defences. Strachey, however, considerably influenced by the work of Melanie Klein, regarded transference as essentially a projection onto the analyst of the patient’s own superego. The therapeutic process was attributed to subsequent introjection of a modified superego as a result of ‘mutative’ transference. Sterba and Bibring, on the other hand, intimately involved with development of the ego-psychological approach, reemphasised the central role of the ego, postulating a therapeutic split and identification with the analyst as an essential feature of transference. To some extent, this difference of opinion may be regarded as semantic. If the superego is explicitly defined as the heir of the genital Oedipus conflict, then earlier intra-systematic conflicts within the ego, although they may be related retrospectively to the definite superego, much, nevertheless, are defined as contained within the ego. Later divisions within the ego of the type indicated by Sterba and very much expanded by Edward Bibring in his concept of therapeutic alliance between the analyst and the healthy part of the patient’s ego, must also be excluded from superego significance. In contrast, those whom attribute pregenital intra-systemic conflicts within the ego primarily to the introjection of objects, consider that the resultant state of internal conflict appears like the dynamic idea that something conveys to the mind as having an endless meaning attached to the coherence of the therapeutic situation and seen in the later conflicts between ego and superego. They, therefore, believe that these structures developed simultaneously and suggest that no sharp distinction should be made between pre-oedipal, oedipal, and post-oedipal superego.
The differences, however, are not entirely verbal, since those whom attribute superego formations to the early months of life tend to attribute significantly too early object relation which differs from the conception of those who stress control and, neutralization of instinctual energy as primary functions of the ego. This theoretical difference necessarily implies some disagreement as how the dynamic situation both in childhood and in adult life, inevitably reflected in the concept of transference and in hypotheses as to the hidden nature of the therapeutic process. From one point of view, the role of the ego is central and crucial at every phase of analysis. A differentiation is made between transference as therapeutic alliance and the transference neurosis, which, on the whole, is considered a manifestation of resistance. Effective analysis depends on a sound and stable therapeutic alliance, a prerequisite for which is the existence, before analysis, of a degree of mature superego functions, the absence of which in certain severely disturbed patients and in young children may preclude traditional psychoanalytic procedure. Whenever indicated, interpretation’s manifestations, which means, in effect, that the transference must be analysed. The process of analysis, however, is not exclusively ascribed to transference interpretation. Other interpretations of unconscious material, whether related to defence or to early fantasies, will be equally effective provided they are accurately timed and provide a satisfactory therapeutic alliance has been made. Those, in contrast, whom stress the importance of early object relations emphasizes the crucial role of transference as an object relationship, distorted though this may be of a variety of defences against primitively unresolved conflicts. The central role of the ego, both in the early stages of development and in the analytic process, are definitely accepted. The hidden nature of the ego is, however, considered at all times to be determined by its external and internal objects. Therapeutic process indicated changes in ego function results, therefore, primarily from a change in object relations though interpretation of the transference situation, finds of less differentiation as made between transference as for being the therapeutic alliance and transference neurosis as a manifestation of resistance. Therapeutic progress depends almost exclusively on transference interpretation. Other interpretations, although at times, are not, in general, considered an essential feature of the analytic process. From this point of view, the preanalytic maturity of the patient’s ego is not stressed as considered potentially suitable for traditional psychoanalytic procedure.
These differences in theoretical orientation are not only reflected in the approach to children and disturbed patients. They may also be recognized in significant variations of technique in respect to all clinical groups, which inevitably affect the opening phases, understanding of the inevitable regressive features of the transference neurosis, and handling of the germinal phases of analysis. By its emphasis as drawn on or upon the main problems, and, by contrast, rather than similarity, our efforts will be to avoid to detailed discussions of controversial theory regarding the hidden nature of early ego development by a somewhat arbitrary differentiation between those who relate ego analysis to the analysis of defences and those who stress the primary significance of object relations both in the transference, and in the development and definitive structure of the ego. Needless to say, this involves some oversimplification, where I hope that it may, at the same time, clarify certain important issues. To take, on or upon the analysis of patients we are generally agreeing to be suitable for classical analytic procedure, the transference neurosis. Those which emphasis the role of the ego and the analysis of defences, not only maintain Freud’s conviction that analysis should proceed from surface to depth, but also consider that early material in the analytic situation derives, that, in general, from defensive processes rather than from displacement onto the analyst of early instinctual fantasies. Deep transference interpretation in the early instinctual fantasies. Deep transference interpretation in the early phases of analysis will, therefore, rather be meaningless to the patient since its unconscious significance is so inaccessible, or, if the defences are precarious, will lead to premature and possibly intolerable anxiety. Premature interpretation of the equally unconscious automatic defensive processes by means of which instinctual fantasy kept unconscious is also ineffective and undesirable. There are, nonetheless, differences of opinion within this group, as to how far analysis of defence can be separated from analysis of content. Waelder, for example, has stressed the impossibility of such separation. Fenichel, however, considered that at least theoretical separation should be made and indicated that, as far as possible, analysis of defence should precede analysis of unconscious fantasy. It is, nevertheless, generally agreed that the transference neurosis develops, as a rule after ego defences have been sufficiently undermined to mobilize previously hidden instinctual conflict. During both the early stages of analysis, and at frequent points after development of the transference neurosis, defences against the transference will become a main feature of the analytic situation.
This approach, has already been indicated, is based on certain definite premises regarding the hidden natures and function of the ego in respect to the control and neutralization of instinctual energy and unconscious fantasies, while the importance of early object relations is not neglected, the conviction that early transference interpretation is ineffective and potentially relations are not neglected, the conviction and unconscious fantasy. The conviction that early transference interpretation is ineffective and potentially dangerous is related to the hypothesis that the instinctual energy available to the mature ego has been neutralized from unconscious fantasies, meaning at the beginning of analysis, for all effective purposes, relatively or absolutely divorced from its unconscious fantasy, as yet, there are a number of analysts of differing theoretical orientation of ego function from unconscious sources, but consider that unconscious fantasy continues to operate in all conscious mental activity. The analysts also construct upon the whole of their existing in the emphasis to the crucial significance of primitive fantasies, in respect to the development of the transference situation. The individual entering analysis will inevitably have unconscious fantasies concerning the analyst derived from primitive sources. This material, although deep in a sense, is, nevertheless, strongly current and accessible to interpretation. Klein, in addition, creates the development and definitive structure of the superego to unconscious fantasy determined by the earliest phases of object relationships. She emphasizes the role of early introjective and projective processes in relation to primitive anxiety ascribed to the death instinct and related aggression drive fantasies. The unresolved difficulties and conflict of the earliest period continue to colour object relations throughout life. Failure to achieve an essentially satisfactory object relationship in this early period, and failure to master relative loss of that object without retaining its good internal representative, will not only affect all object relations and definitive ego function, but more specifically determine the nature of anxiety-provoking fantasies on entering the analytic situation. According to this point of view, therefore, early transference uninterpreted, even thought it may relate to fantasies derived from an early period of life, should result not in an increase, but a decrease of anxiety
In considering next problems of transference in relation to analysis of the transference neurosis, two main points must be kept in mind. First, as already indicated, those who emphasize the analysis of defence tend to make a definite differentiation between transference as therapeutic alliance and the transference neurosis as a compromise formation which serves the purposes of resistance. In contrast, those who emphasize the importance of early object relations view the transference primarily as a revival or repetition, sometimes attributed to symbolic processes of early struggles in respect to objects. Still, there is no sharp differentiation made between the early manifestations of transference and the transference neurosis. In view, moreover, of the weight given to the role of unconscious fantasy and internal objects in every phase of mental life, healthy and pathological functions, though differing in essential respect, do not differ with regard to their direct dependence on unconscious sources.
In the second place, the role of regression in the transference situation is subject to wide differences of opinion. It was, of course, one of Freud’s earliest discoveries that regression had of its earliest points of fixation, and is a cardinal feature, not only in the development of neurosis and psychosis, but also in the revival of earlier conflicts in the transference situation. With the development of psychoanalysis and its application to an ever increasing range of received increased attention. The significance of the analytic situation as a means of fostering regression as a prerequisite for the therapeutic work has been emphasized by Ida Macapline in a recent paper. Differing opinions as to the significance, value, and technical handling of regressive manifestoes from the basis of important modifications of analytic technique, which will be considered, however, in respect to the transference neurosis, the view recently expressed by Phyllis Greenacre, that regression, and indispensable features would be generally accepted. It is also a matter of generally based agreement that a prerequisite for successful analysis is revival and repetition in the analytic situation of the struggle of primitive stages of development. Those who emphasize defence analysis, however, tend to view regression as a manifestation of resistance, as a primitive mechanism of defence employed by the growth sets of the transference neurosis. Analysis of these regressive manifestations with their potential dangers depends on the existing and continued functioning of adequate ego strength to maintain therapeutic alliance at an adult level. Those, in contrast, who stress the significance of transference as a revival of the early mother-child relationship does not emphasize regression as an indication of resistance or defence, the revival of these primitive experiences in the transference situation is, in fact, regarded as can essential prerequisite for satisfactory psychological maturation and true geniality. The Kleinian school, as already indicated features the continued activity of primitive conflicts in determining essential features of the transference at every stage of analysis. Their increasing overt revival in the analytic situation, therefore, signifies a reopening of the analysis, and in general, is regarded as an indication of diminuation rather than increase of resistance. The dangers involved according to this point of view and are determined more but to the failure to mitigate anxiety by suitable transference interpretation. By this failure to obtainably achieve, in the early phases of analysis, a sound and stabling therapeutic alliance is based on the maturity of the patient’s essential ego characteristics.
In considering, briefly, the terminal phases of analysis, many unresolved problems concerning the goal of the therapy and definition of a completed psychoanalysis must be kept in mind. Distinction must also be made between the technical problems of the terminal phase and evaluation of transference after the analysis has been terminated, there is widespread agreement as to the frequent revival in the terminal phases of primitive transference manifestations apparently resolved during the early phases of primitive transference manifestation, apparently resolved during the early phase of analysis has been terminated. Balint, and those who accept Ferenczi’s concept of primary passive love, suggest that some gratification of primitive passive needs may be essential for successful termination. To Klein, the terminal phases of analysis also represent a repetition of important features of the early mother-child relationship. According to her point of view, this period represents, in essence, a revival of the early weaning situation. Completion depends on a mastery of early depressive struggles culminating in successful introjection of the analysis as a good object. Although, in this connection, emphasis differs considerably, it should be noted that those who stress the importance of identification with the analyst as a basis for therapeutic alliance, also accept the inevitability of some permanent modifications of a similar nature. Those, however, who make a definite differentiation between transference of the transference neurosis as a main prerequisite for successful termination. The identification based on therapeutic alliance must be interpreted and understood, particularly with reference to the reality aspects of the analyst’s personality. In spite, therefore, of significant important differences there are, as already indicated in connection with the earlier papers of Sterba and Strachey, important points of agreement in respect to the goal of psychoanalysis.
The differences already considered indicate some basic current problems of transference. So far, however, discussion has been limited to variations within the framework of a traditional technique. We must consider problems related to overt modifications, so as the essential expanding context of use between variations introduced in respect to certain clinical conditions. Often as a preliminary to classical psychoanalysis, and modifications based on changes on basic approach which lead to significant alterations with regard both to the method and to the aim of therapy. It is generally agreed that some neurosis, borderline patients and the psychosis. The nature and meaning of such changes are, however, viewed differently according to the relative emphasis placed on the ego and its defences, on underlying unconscious conflicts, and on the significance and handling of regression in the therapeutic situation.
In ‘Analysis Terminable and Interminable’, Freud suggested that certainly inaccessible to psychoanalytic procedure. Hartmann has suggested that in addition to these primary attributes, other ego characteristics, originally develop for defensive purposes, and the related neutralized instinctual energy at the disposal of the ego, may be relatively or absolutely divorced from unconscious fantasy. This not only explains the relative inefficacy of early transference interpretation, but also hints of possible limitations in the potentialities of analysis attributable to secondary autonomy of the ego which is considered to be relatively irreversible. In certain cases, moreover, it is suggested that analysis of precarious or seriously pathological defences - particularly those concerned of aggressive impulses - may be not only ineffective, but dangerous. The relative failure of ego development in such cases not only precludes the development of a genuine therapeutic alliance, but also raises the risk of a serious regressive, often predominantly hostile transference situation. In certain cases, therefore, preliminary period of psychotherapy is recommended in order to explore the capacities of the patient to tolerate traditional psychoanalysis. In others, as Robert Knight in his paper on borderline states, and as many analysts’ working with psychotic patients have suggested, psychoanalytic procedure is not considered applicable. Instead, a therapeutic approach based on analytic understanding which, in essence, utilizes an essentially implicit positive transference as a means of reinforcing, rather than analysing the precarious defences of the individual, is advocated. In contrast, Herbert Rosenfeld approached even severely disturbed psychotic patients with minimal modifications of psychoanalytic techniques. Only changes which the severity of the patient’s condition enforces are introduced. The dangers of regression in therapy are not emphasized since primitive fantasy is considered to be active under all circumstances. The most primitive period is viewed in terms of early object relations with special stress on prosecutory anxiety related to the death instinct. Interpretation of this primitive fantasy in the transference situation, is best offered the opportunity of strengthening the severity-threatened psychosis mainly to serve traumatic experiences, particularly of deprivation in early infancy. According to this point of view, profound regression offers an opportunity to fulfil, in the transference situation, primitive needs which had not been met at the appropriate level of development. Similar suggestions have been proposed by Margolin and others, in the concept of anaclitic treatment. Serious psychosomatic diseases, that approach the premise that the inevitable regression is shown by certain patients and should be utilized in therapy, as a means for gratifying, in their extremely permissive transference situation. Having distinctive or certain limits in the burdensome instant for demanding to that which has not been met in infancy, as this must, in the connection of being taken to understand that the gratifications recommended in the treatment of severely disturbed patients are determined by their conviction. Of these patients are incapable of developing transference as we understand it, in the connection with neurosis and must therefore be handled by a modified technique.
The opinions so far considered, however, much of them, as mine differ in certain respects, are, nonetheless, all based on the fundamental premise that an essential difference between analysis and other methods of therapy depends on whether or not interpretation of transference is an integral feature of technical procedure. Results based on the effects of suggestions are to be avoided, as far as possible, whenever traditional technique is employed. This goal has, however, tp establish a point by appropriate objective means, that corroborated evidence that proved the need for better a state of being even more difficult to achieve than Freud expected when he first discerned the significance of symptomatic recovery based on positive transference. The importance of suggestion, even in the most strict analytic methods, has been repeatedly stressed by Edward Glover and others. Widespread and increasing emphasis as to the part played by the analyst’s personality in determining the nature of the individual transference also implies recognition of unavoidable suggestive tendencies in the therapeutic process. Many analysts today believe that the classical conception of analytic objectivity and anonymity cannot be maintained. Instead, thorough analysis of reality aspects of the therapist’s personality and point of view is advocated as an essential feature of transference analysis and an indispensable prerequisite for the dynamic changes already discussed in relation to the termination of analysis. It thus remains the ultimate goal of psychoanalyst’s whenever their theoretical orientation, to avoid, as far as is humanly possible, results based on the unrecognized or unanalysed action of suggestion, and to maintain, as a primary goal, the resolution of such results through consistent and careful interpretation.
There are, however, a number of therapists, both within and outside the field of psychoanalysis, who consider that the transference situation should not be handled only or mainly as a setting for interpretation even in the treatment or analysis of neurotic patients. Instead, they advocate utilization of the transference relationship for the manipulation of corrective emotional experience. The theoretical orientation of those utilizing this concept of transference may be closer to, or more distant form, a Freudian point of view according to the degree to which current relationships are seen as determined by past events. At one extreme, current aspects and cultural factors are considered of predominant importance, at the other, mental development is viewed in essentially Freudian terms and modifications of technique are ascribed to inherent limitations of the analytic method rather than to essentially changed conceptions of the early phases of mental development. Of this group, Alexander is perhaps the best example. It is thirty years since, in his Salzburg paper, he indicated the tendency for patients to regress, even after apparently successful transference analysis of the oedipus situation to narcissistic dependent pregenital levels which prove stubborn and refractory to transference interpretation. In his more recent work, the role of regression in the transference situation has been increasingly stressed. The emergence and persistence of dependent, pregenital commands for something as or is if one’s right or due requirements are challenged in measuring moderations of a wide range of clinical conditions. It is argued, that its indications that the encouragement of a regressive transference situation is undesirable and therapeutically ineffective. The analyst, therefore, should when this threatens adopt a definite role explicitly differing from the behaviour of the parents in early childhood in order to bring about therapeutic results through a corrective emotional experience in the transference situation. This, it is suggested, will obviate the tendency to regression, thus curtailing the length of treatment and improving therapeutic results. Limitations of regressive manifestations by active steps modifying traditional analytic procedure in a variety of ways are also frequently indicated, according to this point of view.