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Countertransference

Condensed of Issues
L.
BRYCE

History

and Personal Patients

View

With Regressed
BOYER,

M.D.

Freuds

amfrivalently
countertransference

negative

attitude

to-

M
and issues ered avoided. chewing cissistic

y training,

which

began

in

the

1940s,

ward

discouraged psychoanalysts,

system-

atic study
predominantly tients conscious therapeutic Balint,

until

some

Kleinians, narcissistic
contribution process,

began neuroses.

to treat paRecognizing and to the

occurred in an ultraconservative institute where the psychoanalytic treatment of regressed disorders was strongly disapproved
any

with

discussion of involved in their Countertransference embarrassing I doubted psychoanalytic disorders,

countertransference therapy was deemed was topic, one considto be

the need

to understand

the unconscious of the analyst


Heimann, pioneered Rosenfeld,

irrelevant. an

and

Racker

in serious

Freuds grounds for estreatment of the narnoting his ambivalence and I tolerated with dissometimes despair the contempt of my mentors in determining of the studying psychomore patients.2

study

of countertransference. Racker and Boyerfound that unresolved countertransference problems contributed signaficantly to unfavorable
seriously Giovacchini, wise furthered Following

responses
disturbed Ogden, a historical

to psychoanalysis
patients. Searles, Vothan have

in
like-

and contradictions, couragement and open ridicule and while the Doing analysis thoroughly I pursued effectiveness, of seriously so inevitably

my research in my hands, disturbed required

and

countertransference review,

research. the author to understandof

de-

the transference-countertransferin working I suggested that or psychoses in the treated grata treatment as an with such countertranswere enfant and a major terrible, society. of regressed

lineates

his personal

approach

ing patients, especially seriously disturbed ones, in terms of the ongoing introjection
patient tions. initial and

ence interactions patients. When ference cause patients, persona neuroses of failure I was non

and
This

analyst
approach

of each others
stems from

projecRosenfelds Practice

prop ositions. (The Journal Research 1994;

in my institute nonexistent, from be gleaned. could

of Psychotherapy 3:122-137)

The
subject there were

ego

psychological
some studies28

literature
which

on the
although use-

was practically

ful understanding

Received

April

1, 1993;

revisedJune

20,

1993;

accepted

June 24, 1993. of the Psychoses, print requests Berkeley, Copyright

From the Center San Francisco, to Dr. Boyer, 1994 American

for the Advanced Study California. Address re3021 Telegraph Avenue, Psychiatric Press, Inc.

CA 94705.

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It was and contacts

not with

until Latin literature,

I was exposed thinking, Americans initially and

to Kleinian through their psysubject of became This new

less well most conveyed analysts sulted inantly

recognized

that

many

of the

analysts are

neo-Kleinian

critical

transference

interpretations

choanalytic transference-coun more understanding work with disorders. The mendous about with

that the tertransference to me.

to the analysand by means of the interpretative actions that have refrom his processing, probably his introjections predomof the changed to hold now unconsciously,

understandable

facilitated my psychoanalytic patients who had narcissistic past quarter-century has changes in clinicians of patients who can In general, that seen treattitudes be treated altered

patients projective identifications.24 Similarly, psychoanalysts have their view of their own many of being dynamics, made analyst about method. analysts OShaughnessy,25 that instead intrapsychic should tient 281; be and see also Heightened

According

the types psychoanalysis. has

about the patients interpretations the interaction of palevel(p.

attitude knowledge pathology

been ascribed to our expanded of character structure and psychoand our increased understanding

at an

intrapsychic

Volkan26). interest

in countertransferthe rapidly therapy for expanding severely re-

of early developmental processes and primitive internalized object relations. The crucial importance of how the therapist uses responses his own conscious and to the patient, whether unconscious psychical or

ence has paralleled use of psychoanalytic gressed because disorders ing of that In the individuals, treatment demands interaction. Americas, introduced

no doubt of patients heightened Racker the

in large part with primitive understandand notion impediment Boyer2 that problems to treatment of seTheir contribuwith the work of in Kern berg been central that inun-

somatic, verbal or nonverbal, recognized; this recognition to the increased therapy sistic, and disturbances, alexithymic Today (aside from for severe

has been clearly is probably due psychonarcisand psychotic and that action

use of psychoanalytic characterological, disorders as psychosomatic accepted

dependently resolved often present

countertransference the principal

borderline as well disorders. it is generally verbal

the effective psychoanalytic verely regressed patients. tions,4932 Giovacchini,33 Searles,ss and establishing standing in conjunction Gro ts te in others, have
,

symbolization)

constitutes

an important medium through which the analysand indicates specific unconscious meanings to the analyst, as through the actions role mediating projective responsiveness,2 and enactments.23 identifications,92#{176} evocation by However, it is

the conception of countertransference

the underin work with comparable from, the

deeply regressed importance to, analysis of the

patients is of and inseparable transference.

proxy,22

The first five volumes of The Index of Psychoanalytic Writings27 list 29 references to studies whose titles include the word countertrancference. Those volumes list writings from the origins of psychoanalysis through 1952. Volumes 6 through 9, covering 1953 through 1960, list 61 publications that have the word countertransference in the title.28 Apart from those citations, such references are almost nonexistent in psychological literature up to 1960. By stark contrast, a brief review of the titles of the psychological and social work literature of Europe and the Americas for the years 1988 through 1991 reveals references in the thousands to publications that include the word counteriransference in the title. The
until

Latin
the

American, 1960s, has

particularly the South American, been rich in studies of transference

psychoanalytic literature, and countertransference

unknown involving

to me split-

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COUNTERTRANSFERENCE

HISTORY MID-TWENTIETH

To

THE CENTURY

negative joking

transference. when in 1937 complaint he

Freud spoke that

may the

have mentor

been had

of his answer transference; been interpreFreuds on his counterdis-

to a patients

There

is a large

literature
reactions neurotic history

tertransference patients with

pertaining in the disturbances,

to counanalyses of
includ-

not interpreted Freud replied ted, covery it had not Heimann52

the negative that if it had not appeared.5 suggested was based that

ing a number
section, including a brief

of reviews.3403
of more toward attitudes

The

following
ideas

modern countertransfer-

of resistance

with regressed patients, is to to other studies such as those of Boyer,57 Epstein and Feiner, Etchegoyen,45 and Scharff.4#{176} It must be stressed that before the mid-twentieth century, very few contributors disagreed with the view that countertransference was an interference in the analytic procedure. Those such as Ferenczi who communicated their emotional reactions to their patients in word or action were reprimanded severely; see M. Balint (pp.
its uses 149-156) and in St#{227}rcke.47 the term

ence and be added

transference, a resistant

his feeling force in the

that he was meeting patient. I agree with profitable in theraso-called not only past, espepsychosoI agree Ogden,24 regressed who pa-

Grotstein53

that

it is more

peutic situations resistances as about cially matic also hold the present in the cases problems with that

to think of many communications, but about the of, for example, and alexithymia.5

D. RosenfeldM and in treating severely

tients it is the through the sumed picture

task of the analyst to contain, countertransference, a preof the patients infantile past during treatment and patient at appropriate commulater

Freud
ference

introduced

though
concern study

the context the phenomenon


him, he was never

of

countertransdisapproval. Alcontinued to
a specific of countertrans-

to be revised
nicated times. failures to the

devoted

to it, nor

a theory

It is well known that Freuds clinical sometimes were the products of interferences.67 the word technical untrained countertrans-

ference elaborated until much later. Freud seldom if ever totally renounced any theoretical position he had introduced. For example, he continued in his last works to combine the topographical and the structural theories as explanatory models.49 We
shall canted see that this holds that true with regard to

countertransference Freud introduced ference alyzed when and writing largely

advice to unanphysicians who

were practicing psychoanalysis; doubtless he hoped that the danger of the clinicians emotional involvement and acting out with the
patient could be reduced. as a function of and He defined of the counanalytertransference sand, the product patients verbal cations on the

countertransference
his position

as well.

He

never

re-

countertransference

was an undesirable impediment. In 1912, in a letter written to Ferenczi, Freud5#{176} implied that his failure to overcome his positive, paternal possible countertransference the interpretation had made to Ferenczi imof a

the influence of the nonverbal communiof the analyst. recomtraining

unconscious

Two years later he5#{176} specifically mended that therapists undergo

ting and projective and introjective identification since the early 1950s. In 1966, in their article The Psychoanalytic Situation, Arlow and Brenner37 made no direct reference to countertransference, although it constituted the main topic of their Argentinean discussants.ss Waldinger and Gunderson scarcely mention countertransference in their recent Effective Psychotherapy with the Borderline Patient.

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analysis:

and

that

the

therapist

turn organ of unconscious

his own towards the pais unconis an of amdisthe the quent

Things

are

unconscious like the transmitting tient. able.. scious example


.

a receptive unconscious the doctors the This ambivalence

the objective
the study in the nomena

different, danger.
that real..
..

however,

as regards

It is probable
will of 58) these some

that
result phe-

of occult

phenomena

.so .to

that (pp.

admission are

reconstruct 115-116). of Freuds

patients position

(p.

or a reflec-

His Freuds telepathy,

attitudes articles. contributions summarized

did

not

change in his

in

subseof and

tion of his dialectical which he was largely bivalence agreement totalistic At the analyst spots, should sand. Probably Janet much having continues between approaches same time be he be purified says that in contact that

mode of thinking, unconscious. This to characterize the classic the and

Eisenbud,77 Freuds

survey

to psychoanalysis position:

to countertransference. Freud insists that

so that he the analysts with been that

has no blind unconscious of the influenced analyby

What Freud says, in effect, is: Distortion of perception is one of the characteristics of mental functioning dominated by unconscious needs. But this distortion is purposeful and occurs along dynamic, deterministic lines. There is no reason to
suppose that telepathic perceptions

should
(p.9)

be free from

this universal

effect.

while studying with Charcot, Freud was interested in the subject of telepathy,
671

publishing and 1921 Stekels72 specifically

on related Soon about

subjects after the

in 1899, appearance

1904, of

The TelepathicDream
dreams dreams pected ference footnote while working

was based with neurotic

on Stekels patients, susa

The Telepathic

Dream,

telepathy;

Freud73 wrote other publicaIn his wrote,

that today would of being associated phenomena.32596178 to Freuds 1922

be strongly with countertrans-

tions appeared earliest article

in 1925 and 1933. on telepathy, Freud7

However, article acknowlbook question

Psychoanalysts. only

. .

study

occult

material

edging his awareness of Stekels no allusion to countertransference. Freuds validity open. not dealing wonders consciously, aspect of interactions. have implied communications of extrasensory Oddly, appear the word the perception

makes In all of of the

because they hope that this would enable them to eliminate once and for all the creations of the human wish from the realm of material reality. If, in the course of his work, [the psychoanalyst] is on the lookout for occult phenomena, he runs the risk of overlooking everything which is closer at hand. The
.. . .. .

remained

countertransferencedoes communications occult. perhaps One unsome analysts that and the thought,

in any of Freuds with telepathy whether Freud that telepathy

constituted

analysts against interest

self-discipline the subjective

can risk by occult of

protect having

him his

transference-countertransference Surely many other their similar belief,

absorbed

phenomena.

namely

There seems ample evidence that Freud, cause of unresolved countertransference tions, technique, and style demonstrated of unanalyzed transference-countertransference
Excerpts It was long and of his first two for

at least at times, had disappointing clinical results beproblems.67 May has suggested that Freuds formulain the case history of the Wolf Man were largely products phenomena. contributions
particularly identification

articles
many

and
Kleinian

his last three


psychoanalysts,

appear

in Devereux.76
America, the patients such as actual

common

in Latin as constituting

Garma79

Goldberg,8#{176}

to speak

of projective

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unconscious sensory

communication perception. In his

involves summary

extra-

suggests

that

the

introjective

process

has

of the theories of Istv#{225}n Holl#{243}s, Devereux76 writes, Telepathic incidents became especially numerous during a difficult period in the
surely linking them although the word Devereux in this with attri-

been underinvestigated because of interference from the effects of the patients selective introjection of the analysts narcissism. Scharff4#{176}would add that the analysts narcissism may affect what the patient finds available for introjection, suggesting that the analyst censors the introjective fore and after it occurs, because inside The ceeded sis, has the self (p. 52). study of introjection, from the beginnings determined that the process beit is gratifying which has proof psychoanalymeans by which

analysts life (p. 200), with countertransference, was not used context. the butes Many, about Analysts means

by Holl#{243}sor

have long been concerned by which the psychological

of one person are assumed following Freuds82 lead, the influence of patients attributes Fenichel83 on the was the first

by another. have written introjection rethat to note

of analysts lationship. analysts termined

transference

the analyst the others


pathology

and
qualities

the

analysand
are L[e, legion.

may
In

introject
The Psychoforms Vicissimode intro-

of Everyday

Freud9#{176} commented

countertransferences by the influences

are largely deon their uncon-

scious conflicts attributes-a tion.8486 Meltzer87 most important

of introjections of patients frequently affirmed observa(p. 14) and called introjection mysterious concept the in

on sensory preference in referring to of memory, and in Instincts and Their tudd2 he noted that every perceptive is related to introjection. In 1917, he duced the concept step in identification, anal incorporation, of van written infantile tion found spond of Ophuijsen93 independently prototype persecutor epidermal to feces-smearing;

of oral incorporation as a as did Abraham92 with affirming the inferences and of St#{227}rcke,47 who of the enema the paranoids had as the equa-

psycho-analysis and said we have not yet described the process by which the childs experience of MenziesLythss troject have the external added, in no way object is introjection found in the taken and psycho-

in.
in-

and feces. incorporation later

Abraham92 to correLewin94 viewed

analytical literature a place projection and project (p. with Meissner and countless ing that Projection turns exciting, ing, to pathological perhaps, been ence, tuition so more innovative, our understanding development at a reason that reluctant to study instead enactment, to

comparable to 1). She agrees others in notout to be more more illuminatof normal and

it to be an equivalent Leonard95 wrote of Fenichel83 made special study tract has an common and stated autonomous

of oral incorporation. visual incorporation. incorporation a that the respiratory erotogenicity. It is

respiratory

(p. 3). Hinting, many analysts have countertransferinvestigate Menzies-Lyth in-

mode
jection; for the internal

can

knowledge that every perceptive also be used in the service of prowrote unification of the use of vision of fragmented

Malcolm attempted objects.

preferring and

rather

than

fantasied

projection

into

the analyst,

a phenomenon

that

surely

resembles

telepathy.

This material has been reviewed at great length in Devereux,76 where relevant articles by Helene Deutsch, Hitschmann, R#{243}heim,Schilder, Zulliger, and others are republished and the EisenbudPederson-Krag-Fodor-Ellis controversy is reviewed, and in Volume 10 of Confrontation: Telepathie,8 where several of those articles and more recent contributions by Bergson, Costa de Beauregard, Derrida, Dumas, Farrell, Mignotte, and others are reprinted.

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It has

long

been

assumed

that

counter-

Reik#{176}6 mentions

countertransference,

he

transferences are analysts introjection tient therapists Federn,84 chinis,ss experience effective the most frequently that come unresolved Fenichel, Ogdens,24 and relevant based

determined largely by the of qualities of the painto and Searless, my and contact infantile Fliessss). and the with conflicts the (see

views it as a resistance and that the analysts response conflict refers intuitions. tertransferential wrote, to and the analysts of to

does not indicate is nourished by a W. Reich#{176}7 reactions as them counEtchegoyen45 in listening

his own. Similarly, his own affective Racker3#{176}would reactions, his sought call and

In GiovacVolkans26 the recovery most of

own,7#{176} both

mitierconsists

interpretations

scrutinizing have

countertransfer-

repressed memories are on information gathered the few reactions, countertransferinterpreting appears practice it may to of have But by that

ence-that
Analysts constitutes

is his intuition
Reiks#{176}4 listening that analyzing analyst

(p. 163).
to understand with the what third

through countertransference is, interpreting through ence. Until the past

years, the

ear, or Isakowers Spiegel#{176}8 noted operate in similar ing attention and tively) unique and that

instrument. and analysand (free-floatrespecis et al.#{176}9 speak as operating of the analyst, connections which are

through the countertransference have been very unusual in North American analysts. been limited to the it was not uncommon as illustrated Spillius.98 There were countertransference years following To my knowledge, analysts reactions almost the by the analysts among case

states free

of mind association, Balter

In fact,

the

resultant instrument of the ego to perceive and

conversation

cited above. neo-Kleinians, selected

to psychoanalysis.

histories

of the analyzing within a subsystem who is more words, likely between

no direct studies of for approximately forty

ideas

images

introduction of the term. the first to suggest that the to the patients data by producwas HannStrachey#{176} by not was as helpful followed

the products because his the ing, They system nature of the

of the patients primary process, subsystem is in part freed from process think(pp. 490-491). (ego) of the subsame

constraints of secondary reality testing, and so on note the regression which obtains (p. 486).
KLEINS

tions could be used Kende, who was with his concept tion, which Kohut.#{176}2 Although investigated,

in the in the

of the as that analysand


MELANIE

analyst

is essentially

of the mutative interpretawas later rediscovered countertransference curiosity about was intuition

subsystem

N T R I B U T I 0

active, as it is today. Throughout his Reik#{176}#{176}5 indicated that if the analyst receptive attitude and trusts intuition than mere reasoning, he will be

works, has a more

The vast majority of todays authors about transference-countertransference

who

write in-

surprised

with a sudden understanding of a message from the analysands unconscious, an intuitive grasp from unconscious to unconscious, as Freud5082 indicated previously. When

teractions use one or another version of Kleins0 concepts of splitting and projective and introjective identification in their attempts to understand the phenomena. This is true whether their dominant orientation

As does Ogden, I use the term projective identification to refer to a wide range of psycholocalinterpersonal events, including the earliest forms of mother-infant communication (Bion ), fantasied coercive incursions into and occupation of the personality of another person, schizophrenic confusional states (Rosenfeld3), and healthy empathic sharing (Pick4).

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stems
deriving theories Although

from

the

ideas

about

object

relations
or from School. firmly held

Through tertransference psychoanalytic

the

inclusion

of views

of counthe pa-

from the structural theory of the British Independent Melanie Klein herself

to be discussed treatment of the revolutionized seemingly oppose treatment.

below, regressed

view that countertransference constituted solely an obstacle to treatment (Grosskurth,5 pp. 378-379), according to OShaughnessy,25 her work has been the most powerful single influence for the shift of perspective (p. 281) that has led to interpretations now being directed toward the interaction of patient and analyst at an
intrapsychic modern level. understanding with its emphasis This shift of has potentiated countertransfer-

the traditional

tients is becoming America, despite position psychologists primitive states of many who

in North adamant opego regression to

Hartmann-influenced also during

COUNTERTRANSFERENCE AND INTROJECTION SINCE C E N T U H Y

I 0

ence, peutic
patients

uses

of
the

verbal

Obviously,

sion of Kleins well: he found

on the positive therathe analysts reactions to the and nonverbal productions. importance of Bions2 extenwork must be recognized as projective identification to be
but also with an its

I turn now to the definition of countertransference as it is used here and a history of the
development of that view. My concept of transference-countertransference concept terplay involves others between their projective analyst mutual follows constant inof that the

of the

and analysand introjection

not only a defense mechanism, infants first way of communicating objects, and (see and he posited the role the analyst as metabolizing also Wmnicott67). As early as 1961, Stone8 Rackers32 of the instrument that work countertransference facilitates

identifications.

Regarding

of the mother containers ascribed a growing percepincipient to a richer to the apas an

countertransference, tion functions

projective identificaas a means of communication,

of learning
think words to form

from

the patient
The analyst between and the the space

what

he cannot
to find

consciously. analyst that

seeks

a bridge

the subjective patient while that separates

neo-Kleinian preciation affirmative

states of the understanding

them

is the

most

potentially

powerful

link

tion.
enhances reactions

In

Rackers

view,

countertransference

awareness of the analysts to the patient and leads

between the patients dissociated Faimberg39 argues that what

states. the analyheard dreams, only of the

sand
silences, from

cannot
and

say

and
patients Kleinian

more

subtle
transference contributors

understanding
striving. More

of

the

through symptoms

parapraxes, can be

recent

the countertransference

position

thought
Meltzer,225 nessy,

include
and Segal.

to this area of analytic Grinberg,2 Joseph,


OShaugh-

analyst. As Bromberg4#{176} suggests, are found and negotiated, they part of the patients ize and enunciate creative in words effort what

when words can become to symbolhe had no

Money-Kyrle,26

A similar revolution is gaining impetus among the thinking and field techniques of investigators of personality development. Over 30 years passed between the writing and the publication of Devereuxs28 landmark From Anxiety to Method in the Behavioral Sciences because he introduced the unpopular theme of countertransference distortions into anthropological fieldwork, as had Racker and Boyer into psychoanalytic treatment. Since then, the understanding and even the technique of fieldwork have been heavily influenced by psychoanalytically knowledgeable anthropologists who are taking into account the effects of countertransference (see Crapanzano, Good et al. Kracke, R. Levine,32 S. Levine,33 Parsons,TM Stein,35 and Tobin15.

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way of expressing. not in need reality, but, another found As he for

He finds

that

the

patient faulty with

is

of insight that will correct rather, needs a relationship

person that

through which words can be which has no verbal language. that represent his experiadds expetoo. She himself. E. Balint4 knows about mutual about the analyst,

finds

words

ence, he knows that as the patient rience, he knows

holds that in the transference-countertransference relationship, another person to enable the patient to put himself provided responses without Ogden24 the use the to analyst can the patients

so on. Neither the intersubjectivity of the mother-infant nor that of the analystanalysand (as separate psychological entities) exists in pure form. The intersubjective and the individually subjective each create, negate and preserve the other. In both the relationship of mother and infant and the relationship of analyst and analysand, the task is not to tease apart the elements constituting the relationship in an effort to determine dividual which qualities belong in to each in-

is there together,

use his emotional communications with actions distortion; some patients are of more of

countertransference would add that

analysts interpretive than his words. A major thread in

from the point of view of the dialectical interdependence of subject and object, the analytic task involves an effort to describe as fully as one can the specific nature of the interplay of individual subjectivity and intersubjectivity.45
participating it; rather,

the

development

analytic understanding ence of transference ence emerged from concerning jectivities creation

of the interdependand countertransferWinnicotts ideas of the and subthe in

The

Gaddinis49

and words

Boyer50 with case from

have

dis-

cussed and demonstrated the emergence of chesoma during

examples the psyregression the analyst conthe

the interdependence of mother and infant7 of a third area space that exists the baby and the authors understanding have

complementary whatever analytic

of experiencing

of patient and therapist. It is held here that experiences stitutes patients tions, and the reactions during the

the potential exist) between 107). expanded Subsequent the

(but cannot object42 (p. significantly of the analytic

session

his idiosyncratic introjection of verbal and nonverbal communicacontaining the patients projections unconscious In addition, analysts predominantly to those introjections.

process as taking areas of playing, of the therapist Ogden43). such thing ternal lieves analysand the analyst from his Ogden2445 analytic third.

place in the overlap of two that of the patient and that (Winnicott,42 p. 38; held there to be no (apart from the ma-

Winnicott as an infant

the analyst exists as a part of the analytic third, experiencing and simultaneously observing himself, the analysand, and the analytic third as they interact with one another. We should not be misled ently unrelated into thinking our stray, apparthoughts, fantasies, and phys-

provision) there to apart

(p. 39 fn), and Ogden bebe no such thing as an from the relationship with to be an analyst apart with the analysand. the concept of the

or there relationship has developed He

ical or emotional reactions can be dismissed as idle preoccupations, taking us away from the business at hand, interfering hovering with attention. our free-floating has or evenly

writes,

the
the cal sand own

intersubjective
analyst-analysand tension as with separate the

entity
coexists analyst

described
in dialectiand with analytheir

as

Drowsiness is a reaction been dismissed often for rational

of the analyst that as irrelevant or ex-

plainable

reasons.

McLaughlin5

individuals

thoughts,
reality,

feelings,
psychological

sensations,
identity

corand

poral

and others have emphasized its countertransference implications, and Boyer#{176} illustrated how sleepiness provided highly important clues to patients unconscious conflicts.

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It is obvious emotional state repressed degree tions. The mental or of openness

that the analysts and individual will to the analysands set of the analyst

prevailing conflicts, his projecis firmly

in the consultation interpretation that tension psychotic and lifted regression

room, both him

led me relieved from pp.

to make an my inner sudden 121-137).

otherwise,

determine

a deep,

(Boyer,7

Automatically when patients insects,TM leads standing The transference especially or

thinking of sibling rivalry begin to talk of tiny animals or Christmas or introjection Easter, and often under-

embedded in his life history, which will influence strongly his receptivity. To cite a few examples will suffice. My lifelong experiences with psychotic people have conditioned me to be automatically aware of very early stages of regression as possibly premonitory of psychotic outbreak. Here I note only subtle manifestations, as slips speech tasies person leaving aside such obvious events of the tongue and the insertion into or action of false memories or of fanmomentarily who regularly held uses to be facts. good
grammar

to a quickened

of a projection. analysts involvement

in his counter-

may prove distracting at times, when his patients succeed each

other with only a few minutes break between. It may be difficult for the analyst to make the internal perception a states patients of the consultation contemporary countertransference similar. For similarly childhoods, quent example, severely and changes of the second room. characterological nature requisite conflicts patient This for and who is more structures undistorted emotional enters true and the if the the are

When be-

gins to use pronouns incorrectly, such as saying to him and I, I become alerted and keep track of possible in which calling repetitions and the circummy to stances eventually they occur. Frequently, the analysands attention

of the transferencerelationships women had infancies undergone involving

two

suffered and freintense

the erroneous than me leads rect use regression, of

use of (for instance) to his awareness that

I rather his incorin

traumatic each had episodes,

I signals a speaking

a potential profound from a position

catatonoid

which he had not yet become differentiated into an land a me (see E. Balint52). Similarly, when an analysand begins language, I am especially bodily ings. We some basis analyst cant sensations all know and their to use aware scatological of relevant meanthat the the re-

withdrawal until they quently,

and obviously psychotic thinking, left home to attend school. Subseeach withdrew from stressful situa-

potential holding

tions, having similar episodes that might last for days or weeks. Neither had been hospitalized, but both had undergone repeated psychotherapy and highly respected America. Neither have them been useful voluntarily psychoanalysis in the care of training analysts in North considered her analyses to clinically; when the each analysts had stopped would not of was

of Freuds53

dreams cannot of the patients is certain elements. that My

be interpreted on associations, yet that he understands many years of and study use of the me, in that meaning, field

signifiof folklore Rorschach with has in-

search in anthropology and the cross-cultural Test50 have led


firmly

allow regression in the service An extreme example follows. these being cover ceded patients asked her analyst

of treatment. When one why she to

agreement each symbol apparently

Freud, to believe at least one basic born, in meanings automatic mother, cupied

discouraged from attempting fantasies that had immediately a frightening dissociated state

repreduring

addition to whatever additional have been added by learning. My subliminal when a patient thought, began of furniture femaleto be preocnear him

with

the

wood

therapy, the analyst told her that the recovery of the fantasies might lead to her suicide. It was more usual for the analyst to discourage covertly the patients attempt to regress, usually by asking questions that changed the

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subject; that the own

it

has long therapist

been often

common seeks

knowledge to relieve his have to allow need for the the a excreativ-

love

and

hate

are

directed

to the same,

whole

anxiety in this way.58 Winnicott42 and Ogden56 the occur, to enter need and for the space Bion62 into I find analyst the that of potential in which

object. The theme of concern for the object is central to the idea (Spillius,98 p. 4). There is also recognition of the objects separateness the and both and the intrinsic position, and a part analyst of their relationship symbolic between thought, depressive creativity analysand that

stressed existence ity can analyst similar

a reverie

allowing my most

At such times retain sufficient minds can ob-

development.

objectivity

hilarating and productive with regressed patients unusual occasions when, of reverie, with I play the game patient.

periods in working occur during those while in a slight state squiggle use pencils verbally associaof and to We do not

serve the interplay among primitive mental functions. During such a period, one of the female patients mentioned above laughed aloud and said listened in on would For sessions their of the if any other analyst our conversation, two she knew he or she patients week; times period,

Winnicotts4963 our drawings to each others

but instead create through associating tions. both

surely deem us mad. a few months, these were consecutive four During hours that were few one

It is at these times that the thinking analysand and analyst most easily switches use without conflict

day each at separate months

other day.

understandably the simultaneous ous, schizo-paranoid,

of the autistic-contiguand depressive modes It is take the

of generating experience (Ogden6). doubtful that such an interchange could place in a therapeutic endeavor in which analytic maintained; apist cause was of frame nor anxiety

each had bravely regressed to a primitive state during her interviews; this regression both frightened and greatly encouraged each because she deemed it a necessary reliving in the service of her analysis. For several days, each of them had been playing a verbal squiggle game with me. Our interactions created a state tial wrote, mother that space we found of which to be similar Winnicott to the and occur attuned. potenOgden when It is

had not been consistently would it be likely if the therpresumably concerning his beown the

uncomfortable,

aggressive or libidinal urges, during patients sometimes psychotic regressions. Especially important in this interchange are the position form nition distinctive as the features integration and of the depressive of part objects

within which creations and infant are properly

to

my impression that many analysts become uneasy with the onset of reverie and seek to terminate the state. One had night, after such one of the women and I experienced an episode, I dreamed

the whole object by the individual

the painful recogthat his feelings of

I am analysand Although ing terms

unable and this fails

to cite cannot

an

example keep

because dependable between and the secondary implied

at such notes. analyst

times

I am

quite

lost

in

my

interaction

with

the

interchange of primary the

and process

the

analysand three modes

can viewing

be

thought the

of

as freely in

involvthese

combinations to convey

thinking,67

interchange

richness

in Ogdens

of experience.6

Except for the periods of reverie during which to retain my observing ego while simultaneously state, and I am able to record detailed process
rarely conscious disturbs fantasies my analysands, and my even emotional those who

the analysand interacting notes during


are otherwise reactions.

and I play squiggle, I am easily able with the patient during my altered ego the interview51-a procedure that very quite paranoid. My notes include my

and

physical

JOURNAL

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COUNTERTRANSFERENCE

that she and I were Siamese twins, connected solely by our occipital cortices. One of my waking seeing visual become head. The associations eye cortices. Siamese following to to eye For me, twins, day was and these that did we had been share had by patient my my
any

of such to deal instead nal

early with

molestation. her and demand on

Finally at face my experiencing litany and that I could

I chose value cramping

not but inter-

depended anxiety

indeed two women

gastrointestinal

connected I told the

while listening to her her tension. I told her on the basis of her ical and psychiatric was had while and her which accurate, been very physical complaints. was but severely young

observing not know

stated history or my medknowledge that her belief that I felt certain that she psychically traumatized

dream, something analysand, only

I had never remember

done with subsequently

and secretly that I had in fact had the dream about the other patient. In this instance, no harm was done. However, on other occasions I have indeed felt when I state transferinto foolish and delayed analytic progress have unwittingly carried my emotional and preoccupation with hour. led me the former interactions ence-countertransference the successive among others,

on the basis

of my emotional of she

reactions to her presentation Relieved and intrigued, psychoanalytic successful. of countertransferof perception, she articulates treatment,

promptly

entered remarkably

Khan507#{176}conceives ence as an McDougall6 introjections presymbolic comes bances aware instrument holds that

and her

Such experiences, to seek to view each

of the patients experiences. At of countertransference

preverbal and times she bedistur-

analytic session as if it were a dream, in which the major unresolved transference-countertransference issue of the last or last few sessions composes the day residue. Accordingly, I assume that every communication of

through dreams of her own, as do I. At midcentury, analysts began suddenly to present and publish studies devoted specifically to countertransference, perhaps beginning with Winnicotts7 Countertransference tributions such as tle,7374 Nacht,Th and Many psychoanalysis and those Hate followed of Lacan,72 the toward in the by conLitearlidewas who withThe

the day

interview residue

in

is in some way related the context of the interested opening my

to that ensuing in the verbal Often, notes in

dream symbolic

and am particularly meanings of the

and/or nonverbal communications. to refresh my memory, I review advance my own and of the interview, notes fantasies, emotional

A. Reich.43 agree that

that include experiences, can

est systematic and valuable work veloping a theory of countertransference

physical sensations. Countertransference a reactively begin treatment. that her and multiple predominantly of her having

interpretations

done by Heimann5276 and Racker,32 apparently worked independently, each out knowledge of the others thinking.

even enable patient to convinced turbance toms, products

hostile, frightened A woman was dissympwere moalthough event. She any of a

characterological psychosomatic gastrointestinal, been sexually

contributions of Rosenfeld77 have been overlooked by many. This may be attributable to his not having used the word cauntertransferonce in any title until very late in his career37 (chap. 12). Although he depicts himself as an orthodox Kleinian, in his earliest publication dealing with psychotic states (1947) Rosenfeld78 notes his use of countertransference reactions as guides to interpretation. He first 1952 uses the word while discussing

lested during she had no refused series drug none lieved

her early childhood, memory of such an psychotherapy

to enter

with

of analysts whom she consulted after therapy had proved ineffective, because of them would vouchsafe that he bethat her symptomatology was the result

countertransference
the with difficulties schizophrenia: is frequently

in in inthe

terpreting to patients Our countertransference

VOLUME

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BOYER

133

only wanted Klein Paula

guide

(p.

126).

No

doubt with

Rosenfeld Melanie

identifications.

An

important attitudes should increased

element regarding be included

in the the as

to protect

his relations

(his analyst), who was so incensed with Heimann that their previously cordial was terminated paper when at the Similarly, after said, she Heimann Zurich Klein conwas in be 6). the her 1950 (DePaola79).

change in therapists types of patients who analytic ing therapist regressions understanding ted. Freud solely always believed ference sensory Although originally as an ambivalent subjects nature and is the of the

understandbetween

relationship delivered ference

of the

interaction

patient during the inevitable in the service of treatment-an that can be usefully interprethat he may was have transextracredthe

hostile toward Little7374 the use of countertransference treatment, as, it has been eventually toward In the early 1950s analysts conscious tional reactions has also been

advocated reactions would

she

Hanna Segal (chap. Balint82 advocated use in therapy position

it is generally believed viewed countertransference impediment on this to analysis, issue. He between and usually roles

of his emo-

to patients. Balints overlooked generally. S


U M M A H V

there is a relationship and countertransference perception. Racker are the major

ited During ference the past half century, countertransas a valuable tool has come to be seen

Heimann and with having

in

development

of a systematic

theory

of counwork of Balint, has

in our therapeutic armamentarium, rather than solely as an impediment to psychoanalytic treatment. This change of attitude resulted their both level, dynamics, tions tween mutual from psychoanalysis coming to view of task as interpreting patient and therapist rather and analysand introjection in terms than the understanding of the and constant the interactions on an intrapsychic patients intrapsychic those interplay interacbe-

tertransference, and the important others, such as Rosenfeld and probably been underemphasized. L.Doty version assisted in manuscript of this article was presented

preparation. A at the Centerfor


San FranMe-

the Advanced Study of the Psychoses, cisco, June 1992, and at the Graduate Department of Psychiatry, Alta morial Hospital, is a companion unpublished.

Seminar,

Bates-Herrick

analyst, involving their of the others projective

Berkeley, CA, December 1992. It to a clinically focused article as yet

1. Boyer

LB: Roles

played

by music

as revealed

through regresin Psycho-

larged. 5. Boyer

New LB:

York,Jason Countertransference

Aronson,

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regressed 22:25itwere 24:275-

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Psychoanalysis of the interview Psychoanalysis

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Science House, of Schizophrenic, Disorders, 2nd

9. Boyer LB: Thinking a dream. Contemporary

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281 10. Boyer working IntJ 11. Boyer on Jason ships. 13. Glover don:

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