CLINICAL ASPECTS Chaired 6y

CHARACTER ~ I A R T IH.
01; N STEIN,MD.
Reported by
MARTINS. ~ V I L L I C KMD.
,

M ARTIN STEININTRODUCED THE PANEL BY RECOUNTING recent

changes in psychiatry with regard to character disorders. He
directed our attention to the Diagnostic and Statistical hlanual of Mental
Disorders (third edition), also known as DShl-111, published by the
American Psychiatric Association. He pointed out that the authors of
DSM-I11 state that the approach taken in the manual is atheoretical
with regard to etiology o r pathophysiological processes except for
those disorders for which this is well established. Stein noted that the
employment of such an “atheoretical” syqem must be based on the
assumption that a purely descriptive methodology which employs no
theoretical system is possible and conceptually defensible, as well as
useful. He stated that it is doubtful that one can classify any body of
data without a theory upon which that classification is based.
DSM-I11 includes a dozen diagnostic categories under the head-
ing of “specific personality disorders.” For many of these disorders
the subheading “predisposing factors” is followed by ‘(no informa-
tion.” Stein indicated that, on the contrary, we have an enormous
amount of information about predisposing factors. The fact that there
are conflicting opinions and theories about them does not warrant
the conclusion that we have “no information” concerning them. He
also stated that DSM-I11 treated character disorders without sufficient
reference to considerations of development and fluctuation, i.e., that
there was a tendency to put aside the history of the illness o r disorder.
Stein reminded us that we have not only a theory but a great deal
of information about the determinants of character derived from

Held at the Fall hIeeting of the American Psychoanalytic Association. New

York City, December, 1980.
Panelists: Stephen A. hlorgenstern, hlardi J. Horowitz; Discussants: hlilton
H. Horowitz, Samuel Ritvo.

775

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226 SCIENTIFIC PROCEEDINGS

clinical analyses and child observation as well as the data of history,

and the wisdom of poets, novelists, and untold numbers of ordinary
people. T h e formation of character has been understood largely in
terms of genetic endowment, biological factors, and life experience
in the broadest sense, including physical and psychic trauma.
Psychoanalytic theory furnishes us with a valuable tool for ob-
serving, organizing, and interpreting clinical data. For the under-
standipg of character, psychoanalysis, properly used, furnishes a
unique body of data and applicable theory not readily found else-
where. Stein then introduced the two papers of the panel, noting that
both present aspects of the study of character, of transference, and
of technique which ate quite far apart in their emphasis on particular
ways of looking at the psychic apparatus.
Stephen A. hforgenstern’s paper, “A Child Isn’t Being Beaten,”
presented a detailed discussion of a patient whose anal-ysis revealed
that behind a seemingly normal facade, socially acceptable behavior
and a prolonged unobjectionable transference, lay conflicts from early
life which had profound effects on the development of character. He
noted that our literature about normality often mentions aspects of
adaptation as signs of this normality. Adaptation, with its advantages
and disadvantages, has been playing an increasingly significant role
in our society. At times, an individual is so successful at working in
pace with his environment that his days and nights are easy. Both at
work and at love, he manages to be unobjectionable, even unexcep-
tional, in the pursuit of his goals. As a patient he can readily adjust
to the initial expectations of the analytic situation. He frequently forms
a rapid positive transference in which, without stormy erotizations
(including destructiveness) he expresses his affects and associates
freely enough to uncover connections in his work with his analyst.
hlorgenstern’s patient, a successful surgeon, came to analysis after
his romantic marriage had startlingly led to divorce, throwing the
patient into a state of anxious confusion. It was not long, however,
before he reestablished his solid character defenses and style of being
a thoughtful and considerate gentleman who remembers birthdays
and provides for his family, friends, and office personnel. He is a
devoted father, absorbed in his work and is highly organized. He is
stoic about physical and emotional pain. He eats, houses, and dresses
himself with concern only for the basic necessities. He divides every-
thing in his life into good and evil. People are also defined in terms
of what one may or may not expect from them. They offer few, if
any, surprising disappointments.
During the initial phases of his analysis he becomes an engaging

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 CLINICAL ASPECTS OF CHARACTER 227

analysand. While the transference manifestations are much lcss calm

and he has begun to question his stoicism and take serious note of his
intense control in expressing his fears and desires, and while he has
been able to rail bitterly about transference frustrations-his anger
and questioning only contribute to the unobjectionableness of the
analytic situation. He is admired by his friends, leads a busy life, but
has no clear awareness of his drives.
At the beginning of treatment the patient mentions an affectless
memory from early childhood in ivhich he visualizes himself standing
in a crib and watching an older brother receive a “savage” beating
from his “crazed and vicious” parents. As the analysis proceeds, the
memory of the childhood beating barely appears in his associations.
Nor does he note anything incomplete o r unconvincing in his well-
rationalized explanation for not having spoken with his brother for
years.
Gradually, it becomes plain how painful is his struggle to be a
cultured gentleman; how he must resist inquiry into the unobjection-
able quality of his life and his analytic relationship. He has seriously
devoted himself to the proposition that life can and should be beau-
tiful. Women should be attractive and good. They should be good
mothers. Fathers should be devoted to their children’s emotional and
physical welfare. Doctors should see patients in pain promptly. Chil-
dren should respect their parents. Analysands should understand the
procedure and cooperate with it. In this kind of world, children cer-
tainly would not be beaten.
Morgenstern stressed the gradual emergence of conflicts over
sexual and aggressive drives which had been warded off by his patient
for many years. T h e patient’s ego ideal incorporated values that dic-
tated the pursuit of socially acceptable behavior and life styles. Some
of these made him strive to be an ideal analysand. But incorporated
within them were defenses against being disappointed and reaction
formations against sexual temptations as well as angry feelings. T h e
patient became aware of his shallowness and the control and inhibition
of libido. His relationships did not deepen because of these constric-
tions.
hlorgenstern warned that analysts might not be able to look be-
hind the unobjectionable, adaptive behavior and transference mani-
festations which serve as character defenses against and sublimations
of threatening drive expression. \Ve emphasize conflicts over aggres-
sion as being more crucial in the development of neurotic symptoms
and character traits than conflicts over the sexual drives. There are
libidinal conflicts without significant hostile components. Libido is

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228 SCIENTIFIC PROCEEDINGS

bound in many acceptable ways. T h e ego ideal serves as a repository

for drives and objects relegated to a position of prestige where they
can d o no harm. In this way, character structure preserves life and
drive while rendering them innocuous. T h e ego-syntonic, acceptable
traits can easily escape scrutiny. T ~ L I Scharacter
, structures have an
economic function in relation to drive.
T h e patient gradually became aware of his childhood fears re-
l a e d to his relationship with his brother, primal-scene memories and
fantasies, and the arousal of sexual feelings and fears of smallness
and helplessness. He uses protective isolation to shield himself from
feeling alone, deprived, o r frightened. His separation of good and
bad consigns sexual impulses to a warded-off compartment. His lack
of desire for better food, clothing, and shelter makes it unnecessary
to depend on women who might evoke sexual and competitive im-
pulses. His “good” traits would show no signs of destructiveness o r
selfishness. Since they are ego-syntonic, they also have a narcissistic
potential in enhancing his self-image. T h e stormy phallic strivings of
a young boy can be maintained and anxiety thereby reduced by de-
veloping a certain kind of character style which regulates and controls
drives while living u p to “good” ego ideals and superego attitudes.
Anal phase derivatives were defended against by needs for order
and control, by reaction formation and denial: the well-regulated
analytic contract helped him in these defensive maneuvers. However,
when he mistakenly prepared a vacation that coincided with the an-
alyst’s last week in the office, he opened up a new and decisive area
of analytic exploration. Later, when billed for the time he had missed,
he politely ignored that portion of the bill and presented a check for
the balance. He tried to maintain an attitude of indifference. T h e
analysis revealed that behind his politeness and indifference was a
storm of anger. His fear was connected to love and needy feelings.
By working in the analysis he was dutifully working as he had in his
parents’ store.
But his careful lack of awareness of any desire to love o r be loved
by his analyst warded off frustration of his drives and subsequent
anger with sadistic and masochisticconsequences. His envy of a patient
who came earlier than he and his wish to see the analyst attack that
patient became conscious. T h e beating fantasy finally emerged, and
with it memories of masturbation. He realized the meaning of his
beating fantasy. His parents’ sexuality could be acknowledged as well
as his envy and wishes for vengeance. His fear of and attachment to
the father he had loved and admired emerged. He gradually became
less critical and demanding of others and of himself. All of these traits

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 CLINICAL ASPECTS OF CHARACTER 229

were connected with his beating fantasy. Its denial was a sexual re-
nunciation.
hforgenstern concluded his presentation by reviewing his un-
derstanding of his patient who, while adequately protected by his
character traits of adaptability, had repressed troublesome areas of
his sexuality. T h e analysis of his “healthy narcissism” revealed that
these traits led back to libidinal conflicts, with masturbation fantasies
and castration anxiety at their core. T h e understanding of his patient’s
conflicts reasserted the central role of drive theory. T h e patient’s
narcissistic solutions served to avoid fear and humiliation associated
with libidinal wishes. T h e patient’s aggression, which was directed
toward others, served as an attempt to relieve the pressure of his own
superego. His libidinal interests were at the source of his conflicts.
T h e more frustration they met, the more complex and elegant became
his solutions. He placed increasing weight on adaptability so that once
passionate strivings came to be subsumed under the politeness and
social alliances of everyday life. He created to the best of his ability
an unobjectionable world and tried to be an unobjectionable person.
But in the service of achieving this satisfaction, and relieving his pain,
he had given up the ability to feel love.
Mardi J. Horoivitz then presented “Nuances of Interpretation in
Relation to Neurotic Character Styles.” Early in treatment an analyst
may recognize that his patient fits loosely into a typological cluster in
terms of habitual patterns of expression and ways of processing inter-
pretations. Certain nuances of technique are used with greater fre-
quency with persons of particular neurotic defensive styles. Two
aspects of change are important to consider when discussing these
nuances of technique-the mutative situation and the modification
of defenses.
A transference reaction is just one more instance of organizing
experience according to an unrealistic model of relationship. T h e
compulsive repetition of these forms is altered only when the trans-
ference reaction leads into a new experience within the regressive
transference neurosis, one that alters beliefs and builds a new view
of self and other. This altered form of experience has been called the
mutative situation. It consists of active confrontation between two
incompatible views of the same immediate and emotionally vivid sit-
uation. .One view is organized by the transference projections; the
other is organized by the therapeutic alliance. T h e interpretations of
the analyst assist the patient in establishing a kind of parallel proc-
essing. This parallel processing has also been referred to as the split
between the observing and experiencing ego. Differentiation of reality

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230 SCIENTIFIC PROCEEDINGS

and fantasy allows a more realistic view of the present situation, which
strengthens the therapeutic alliance and increases the safety of the
context, allowing further regression with repetitive cycles of trans-
ference.
Patients begin analysis with their habitual cognitive and inter-
personal styles (defenses and character) which may impede the de-
velopment of the mutative situation in two ways. They attempt at the
beginning of treatment to present role relationship models to defend
against deepening of both transference and therapeutic alliance. They
avoid o r distort meanings so that they impede the kind of parallel
processing that would otherwise allow a comparison of immature self-
concepts and views of others with more mature and realistic versions
of the present relationship and its future possibilities.
Early in analysis the patient’s defenses are regulatory processes
operating outside of conscious awareness. Certain avoidances and
distortions become automatic-a habit of character as ivell as a reaction
to specific and immediate dangers. Interpretation of dynimic config-
urations (defenses against warded-off contents and the anticipated
threat if impulses are expressed) fosters’self-awareness in the patient
and hence the possibility of consciously acting to counter the uncon-
sciously operating avoidances and distortions. T h e paradox of finding
safety in the midst of a threatening state of mind encourages the
patient to probe deeper strata of memory and fantasy, with reduced
defensive resistances. T h e patient’s new coping or consciously con-
trolling activities may follow the same lines as his habitual unconscious
defenses, such as using selective suppression of anxiety-laden thoughts
and feelings instead of repression.
Mardi Horowitz discussed in detail the nuances of interpretation
that might be used to further the mutative situation and to decrease
habitual modes of defense in the hysterical and obsessional patient.
His focus was on the associative process, and he concentrated on the
hysterical patient who uses repression, inhibition, and premature clo-
sure of associational processes as resistance.
Miss Smith’s style was reflected in her speech. Either she declared
that she did not know, o r she prematurely closed a topic by announc-
ing she knew the meanings. “I don’t know,” the virtual hallmark of
communications of the hysterical character, was not only a statement
of fact, but an injunction against further associative thoughts, an in-
junction now internalized, but once a family style. Because of fears
of being bad, dirty, and out of control, she inhibited associational
lines. If ideas that designated her as active were evoking negative
affects, she shifted associational lines to those that designated her as

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 CLINICAL ASPECTS OF CHARACTER 23 1

passive. This defensive control maneuver activated a childlike and

defensive self-schema.
She also went into an altered state-a dissociative process, when
anxiety and guilt mounted. She would lose her reflective self-aware-
ness and could not remember what she had been thinking o r per-
ceiving. She could not remember linkages of associations and would
change the directional path of thought. IVhen sexually tinged wishes
and fears threatened her, she fantasied a kind of oceanic nurturing
as a defense. T h e distinction between reality and fantasy was blurred,
making reality less disappointing and fantasy more enjoyable.
I n the face of these habitual cognitive maneuvers, the analyst
must use interpretations to illuminate and link what was warded off,
why it was warded off, how the basic unconscious fantasy arose in
past developmental conflicts, and how it did not accord with present
realities and future possibilities.
Horowitz emphasized the nuances of the delivery of these inter-
pretations, which are important in treating the hysterical patient. T h e
analyst’s repetition of what the patient said served the function of
increasing time on a topic she would otherwise close because of her
mounting anxiety. It also provided a message to her about the con-
tinued calm attention of the analyst, at just the time when she felt in
danger of changing her state of mind from one that was haltingly
anxious but in control, to one she anticipated would be a crescendo
of overwhelming excitement, fear, and guilt. The analyst timed the
delivery of a word o r phrase so that it came at a point when it could
stabilize the patient in her anxiously working state. A single word
from the analyst could provide the patient with a much-needed label
for the emotions welling up into her awareness. This process helped
her recognize she could use ideation to feel in control while being
emotional, even when the ideas felt like bad, dirty, o r dangerous
actions. Repetition of even the exact words used by the patient carried
new meanings for her. When she spoke, what she said seemed almost
unreal to her. When the analyst spoke, she contemplated her own
ideas by listening to them.
T h e habitual defensive styles of a person are evolved by automatic
repetition of postures developed initially in situations of interpersonal
conflict. They are precipitates of form. Operating against habitual
cognitive control leads into fundamental dilemmas of relationship.
There is a risk of a transference repetition that seems too real to the
patient because the therapist has acted in a manner reminiscent of
the time when the avoidant postures were developed in the first place.
If the patient avoids associating to reduce her dread of excitement,

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232 SCIENTIFIC PROCEEDINGS

efforts to increase her associational capacity may be taken as a rep-

etition of a provocative, seductive father. On the other hand, not
helping her to expand her associational abilities impedes the analytic
process, ignores resistances, and leaves her at an immature level of
cognitive ability.
After some experience with a patient, an analyst develops a prc-
conscious model that guides intuitive selection of interventions. While
$cldom acutely conscious of having this knowledge, the analyst knows
when the patient is about to shift in state of mind, and which stateof
mind is likely to occur next. These observations about how the analyst
works became clear when a group of colleagues went over notes of
sessions in detail to determine how and when interventions were
made. I n the situation where abandonment themes tend toward an
out-of-control state of mind, more frequent interventions that allow
expansion of associative meanings may be made, for they signal the
realistic closeness of the therapeutic alliance. When incestuous anxiety
and guilt are pending as a fearfully out-of-control mental state, less
frequent interventions to expand associations may be made to help
stabilize an anxiously working state in which the appropriate trans-
ference interpretations can be heard and assimilated by the patient.
Ultimately the patient was able to permit herself to enter into the
regressive transference neurosis while allowing herself reflective
awareness of what she experienced. This also facilitated comparisons
between transference and alliance, utilizing parallel processing.
Milton H. Horowitz began his discussion by reminding us that
Freud’s 1908 paper, “Character and Anal Erotism,” linked a constel-
lation of personality traits in adult patients to specific origins in be-
havior (and fantasy) in the childhood of these patients. Early bodily
experiences (and the responses of adults) served as a forerunner of
later psychological experience. Freud had discerned that these pa-
tients had developed patterned, structured, repetitive, and relatively
fixed psychological attitudes whose origins could be discovered ana-
lytically; this emerged as a wide-ranging by-product of what had been
the narrower exploration of symptom formation. This discovery was
a prefiguration of the structural hypotheses of the mental apparatus.
All human beings demonstrate character traits, i.e., patterned
behavior. I n some, where the patterns are fixed, rigid, automatic,
repetitive responses, regardless of specificity of current stimulus, we
are accustomed to think of “character disorder.” “Character defenses”
are those defense phenomena and derivatives that appear always and
unspecifically. “Character resistances” are derivatives of fixed defen-
ses that appear in the course of analytic work. They are not specific
to the analytic situation, but serve the function of resistance.

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 CLINICAL ASPECTS OF CHARACTER 233

Horowitz quoted from Fenichel’s comments on technique: “The

uncovering of systems of character attitudes that fight anxiety is the
first step in analysis. . . . If done correctly, it results in the patient’s
experiencing anxiety o r various anxiety equivalents. This has to be
followed by the analysis of the nature and history of the anxiety and
the undoing of the dynamic constellation that created and still creates
the anxiety to be warded off.” Horowitz added that the therapeutic
action of the psychoanalysis of character traits and disorders is not
different from that in other neuroses. IVhat is deemed necessary is
the acquisition of integrative dynamic insight in a manner unique to
each personality, hinging upon what may be a “given” for each per-
son-the integrative functions of the ego itself. No special educative
task is necessary. hforgenstern’s paper illustrates this technical point
of view, while hlardi Horowitz’s paper challenges it.
hlorgenstern approaches the understanding of his “pseudo nor-
mal” patient by analyzing both the wider transference phenomena
and the unobjectionable aspects of positive transference. T h e patient,
in his “pseudo normality,” shows a “reaction-formation’’ character
with inhibitions, spartan “cowboy” s.elf-denials, and externalization of
conflict in which his focus on the external world shuts off the internal
world of wishes and fantasies. Furthermore, he demands of the world
that it “live by the rules.” Some of these characteristics undergo change
in the analytic situation. T h e ideals shift slightly and one glimpses the
repressed anger and sadism, and the frustrated libidinal wishes as
well. With the analysis of masturbation conflicts and the emergence
of fantasies of the parental sexual life, the beating-fantasy memory
could take on new meaning and affective investment. T h e therapeutic
alliance, i.e., the unobjectionable aspects of the positive transference,
was seen to be in the service of resistance. Renunciations of the original
sexual impulses seem to have led to secondary libidinal wishes, i.e.,
the wish to be loved as a good analysand. IVe see secondary syste-
matization of character formations in which the return of the re-
pressed is clearly visible, but in a socially acceptable, aim-inhibited
form. This patient developed a special character structure rather than
a symptom neurosis precisely because the character served to simul-
taneously defend against the infantile aggression and to provide chan-
nels for the gratification of infantile libidinal derivatives. Its object-
sparing function, i.e., saving the object from hurt, gratified superego
needs and gave the entire structure social and cultural sanction.
Horowitz then turned to a discussion of hlardi Horowitz’s paper.
T h e crux of the paper’s argument is in the concept that “habitual
defensive styles” are evolved by automatic repetition of postures de-

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234 SCIENTIFIC PROCEEDINGS

veloped-in situations of intrapsychic and interpersonal conflict, allow-

ing repetition in the transference. Cognitive issues are then studied
from the point of view of form. T h e emphasis on form in the clinical
example, i.e., form and style of associations, is viewed in relative iso-
lation from the remainder of the clinical analytic situation. Because
we are confronted by data detached from the historical base (a delib-
erate artifact of the mode of study) and are given no history for the
patisnt, we have what Freud described as a drawback in examining
single traits removed from the developmental historical and dynamic
contexts.
Horoivitz then turned to hlardi Horowitz’s distinction between
the transference neurosis and the therapeutic alliance. He felt it was
not clear whether the “therapeutic alliance” and other unobjectionable
transference phenomena were also examined for the warded-off fan-
tasies embedded within them, serving resistance, as had been dem-
onstrated in hlorgenstern’s paper. He also questioned hlardi Horowiu’s
idea that the patient is not able to compare “immature” self and object
concepts and more “mature” versions. T!iis implies that the patient
experiences, o r can experience, two separate and comparable versions
of transference phenomena. Neurotic conflict and patterns are con-
stantly repeated because the conditions for their repetition are re-
newable by the fresh upsurge of fantasy and wishful demand. For the
neurotic, especially in the regressive grip of the analytic situation, the
present is the past, not an illusion of the past, all supported by a
defensive flight from awareness of current impulses.
T h e analysis of character requires special attention to the analysis
of the capacity for self-observation. hlardi Horoivitz implies that his
technical procedure is to enhance self-observation, but he does not
describe a process of analysis of vicissitudes of that function, nor does
he explore intrasystemic conflicts of the ego between the need to
observe oneself as contrasted to the need for defense against anxiety.
T h e technique of interpreting forms of associations seems to be “re-
learning” devices determined by the analyst’s firmness in following
a specific pattern of intervention. This suggests that the relearning
takes place by identification with the analyst’s style. However, form
follows substance in internal psychological matters as well as in art.
\Ve would need to know more about Miss Smith to assess the reasons
for these formal structures. T h e focus on the ego and its cognitive
functions, to the partial neglect of the other psychic agencies, may
give an inaccurate view of intrapsychic events.
Samuel Ritvo noted that one of the central ideas in the psychoan-
alytic concept of character is that it refers to psychic and behavioral

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 CLINICAL ASPECTS OF CHARACTER 235

phenomena which, like the definition of the word character, are

deeply graven, almost ineradicably carved or, in psychological terms,
highly organized and structured accommodations or amalgams of
drive and defense, gratification, frustration, and sublimation. Turn-
ing to hiorgenstern’s case, Ritvo stated that it shows us indirectly hoiv
the concepts of sexual and aggressive drives serve as a guide in the
analysis of this highly stable, well-adapted character. We can infer
from the description of these character features hoiv each facet of
resistance was rooted in the character structure. T h e attaining of the
critical transference-neurotic reaction around the issue of the fee
would not have been possible without the laborious analysis of drive-
defense-adaptation features. Morgenstern shows us hoiv the concept
of drive, and especially its features of transformation, is indispensable
to the psychoanalysis of character problems.
Morgenstern seems to indicate that of the dual drives, libido has
recently been overshadowed by interest in aggression. T h e implication.
in hlorgenstern’s paper is that the concept of libido might offer a
better explanation for the formation of symptom and neurosis, and
that we have a better theoretical understanding of it. Ritvo feels that
our patients prefer libido to aggression as well. Up to a point, being
loving presents many fewer points of conflict than being angry o r
hateful. Narcissism is much easier to live with than self-destructive-
ness. I n analysis, libidinal transferences evoke less intense resistance
than aggressive ones which threaten the availability o r even the ex-
istence of the object. T h e same is true of countertransfercnce.
T h e most instructive feature of hlorgenstern’s case is that the
vicissitudes of libido were more visible in the defensive, character-
forming features of the personality. T h e crucial mutative situation
could only be achieved with analysis when the patient felt safe enough
in the situation to countenance the aggression in the transference.
I n his discussion of hlardi Horowitz’s paper, Ritvo pointed out
that Horowitz offers a contribution to the psychoanalytic technique
of bringing about a mutative situation and influencing the preferred
defenses which become the cornerstone of the resistances and the
styles of associating in the analytic situation. For example, the inhib-
iting regressive moods preferred by the hysteric and the isolation and
undoing which are the hallmark of the obsessional. Horowitz’s view
on change processes related to modification of cognitive controls
draws heavily on the idea of learning. T h e idea of the patient gradually
becoming more aware of the split between the experiencing and self-
observing ego is well known, but what Horowitz proposes further is
the use of modes of interpretation that take into account the char-

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236 SCIENTIFIC PROCEEDINGS

acteristic styles of association in the analytic hour which are as much

in the service of resistance and defense as they are of communication.
This idea addresses itself to a most significant and difficult sector of
analytic technique which Ritvo feels is central to the analysis of char-
acter. It involves exploiting the split between the experiencing and
observing ego to understand and learn about the other splits in the
ego which have been established and maintained as defense against
cyflict and anxiety.
Ritvo stated that what Horowitz describes in the “nuances of
interpretation” addresses issues dealt with by Paul Gray about the
learning aspects of analysis and by Hartmann concerning a hoped-
for advance in analytic technique through the analysis of intrasystemic
conflicts within the ego. Though they are not presented as such, some
of these nuances would meet the criteria of an interpretation that
addresses itself to the drive and the defense. Others might be viewed
as calling conscious attention to an inhibiting function of the ego and
depriving the patient of the full and effective use of an essential
function of “judging” o r “knowing.”
T h e fact that Horowitz couches some of his ideas in the language
of cognitive psychology should not put us off from seeing where and
how they may be related to more familiar psychoanalytic ideas.
Rlorgenstern responded by raising the question of the balance
between ihe libidinal and aggressive drive conflicts in each patient.
Perhaps conflicts over aggressive drives lead more to the development
of character traits as part of‘the compromise formation, while those
over libidinal drives are more likely to lead to symptom formation.
hlardi Horowitz replied to the discussions by pointing out that in his
paper he had placed special emphasis on form and cognitive style,
but, of course, one could not isolate these from the patient’s unique
individual history and his dynamic conflicts. He agreed with both
Stein and Milton Horowitz, who had raised questions about the con-
cept of the therapeutic alliance. T h e therapeutic alliance is also an
aspect of the transference and has to be analyzed. Stein stressed that
hlorgenstern’s case was a good example of the so-called “good patient”
where the working alliance is part of the transference neurosis. Francis
Baudry, speaking from the floor, remarked that it was not unusual
in the course of the analysis of character disorders and character traits
to see the emergence of transient symptoms. Morgenstern concurred
and reported that after the intensification of the transference neurosis
raised by the issue of the fee, two symptoms recurred in his patient
which led to the understanding of specific childhood wishes and fears.

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