Discussion of “Freud, Transference and Therapeutic Action” by Sander Abend,

On Transference complulsion as the sole key to therapeutic efficacy of analysis *

Marilia Aisenstein
February 2009

It is a pleasure and honor to discuss Sander Abend’s text. The central question posed by
the author is if the analysis of the transference may be considered today as “the sole key
to the therapeutic efficacy of analysis.”
He immediately qualifies this Freudian assertion so as to say that he shares the
viewpoint of those who, while emphasizing the analysis of the transference, do not make
it “the only agent involved in the therapeutic action of psychoanalytic treatment.” He
asks himself why Freud, who never hesitated putting his ideas into question, did not
change this position up through the end of his life and this despite his articles of 1937 and
1938 “Analysis Terminable and Interminable” and “Constructions in Analysis.”
Sander Abend then leads us in a impassioned and skillful reading of Freud, a
reading that takes into account the twists and turns of the thoughts of the writer and his
construction.
I am in full agreement with Abend here, and I share his passion for this reading.
For me, studying Freud makes me think of a kaleidoscope, a toy that fascinated me as a
child. A great number of elements, forms and colors, a slight movement makes the
structure topple, but just as quickly reconstructs it differently. A new clinical discovery
makes Freud rethink it all, he puts everything into the pipeline, plays with concepts and
revises without abandoning any of them. Thus in 1914, the difficulties of his clinical
work led him to define the notion of narcissism and then introduce it into his drive
theory. From 1915 to 1920 some small touches like the appearance of the words

*
Translated from the French by Steven Jaron.

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“repetition compulsion,” “drive reversal” and others show that the “turning point” of
Beyond the Pleasure Principle is ineluctable. The conception of the death drive as
equivalent to an unbinding force brings him to a new version of the psychic topography:
to the unconscious described in 1915 is superposed the more complex notion of the id,
and so on.
In my view, it is beginning in 1914, with “Remembering, Repeating and
Working-Through,” through 1937 that Freud will go into and affirm his idea of
transference as the “sole” therapeutic tool. I would even go so far as to say that he never
abandoned this idea and that it belongs to the reasons why he modified his drive theory
and his understanding of psychic topography. I shall return to this point.
Sander Abend rightly takes up all the comments on transference from 1895 on in
the Studies on Hysteria, The Interpretation of Dreams, and Dora. It is true that at the
time Freud considered transference as at once an obstacle to but also an ally in the
healing process. He thought that it should be identified by the analyst and then
“destroyed” with the help of the patient becoming conscious. Sander Abend brilliantly
analyzes the famous articles of 1912, “On the Dynamics of Transference” and 1913,
“Further Recommendations on the Technique of Psychoanalysis.” I would like to add to
his analysis the idea that the difficulties Freud met and, consequently, his reading, in his
understanding of transferential phenomena, are simply the consequence of the as-then
non-recognition of the repetition compulsion, a concept that first appeared in 1914 in
“Remembering, Repeating and Working-Through.”
This short text is critical for his conception of transference, and indeed Sander
Abend does not overlook this when he notes the importance of the distinction made there
between unconscious fantasy and the repressed, the former capable of remaining forever
unknown. I think that this makes explicit certain transferential movements whose
recognition is only possible through the work of the counter-transference, and even
then . . . .
But above all a reading between the lines of the article leads me to think that
Freud poses an implicit postulate in it: there exists in the human psyche two dialectically
related compulsions, the repetition compulsion and the transference compulsion. They
are dialectically related in that they are of the same essence and their common aim is

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repetition, but they may be differentiated and opposed in the frame of the cure, one
becoming a therapeutic tool (transference and its interpretation) and the other, the opacity
of pure repetition (among which numbers the negative therapeutic reaction).
While only briefly mentioned in “Remembering, Repeating and Working-
Through,” Freud returns to this phenomenon in “The Ego and the Id” in 1923 and then in
“Analysis Terminable and Interminable.” This is where he gives the most convincing
explanation when he ties it to the death drive. I am perhaps giving the impression of
digressing, but on the contrary my intention is to show to what point reading Freud
cannot simply be chronological but that is drives us to move from one text to a much later
text, the second shedding light on the enigmas contained in the first.
I should like to return to the article of 1914 in which Freud explains that the
stronger the resistances are, the more repetition occurs in place of memory. Now
transference is a series of repetitions, displaced onto the analyst, and which fall into place
as an analyzable “transference neurosis.” But we are still in the first topography
(unconscious, preconscious, conscious) and we are missing the knowledge of an ego that
is equally a repressing agency; the resistances thus also become unconscious. This
explains how the working-through described by Freud in this essay and then in 1917
(“Transference” and “Analytic Therapy”) as patient work leading to the creation of an
interpretable transference neurosis would soon turn out to be insufficient in difficult
cures. In 1920, this would lead him to modify his drive theory in order to take into
account an intrapsychic destructiveness about which, until then, he was unaware.
While disputed by certain colleagues in the United States and France, the second
drive theory (libido and death drive) is for me a matchless conceptual tool. First, it
makes possible getting past the sterile debate as to whether sexuality is on the side of life
or death. It also makes possible a conception of thinking itself. Freud describes it one
final time in 1938 in the Outline as the opposition between a binding force, libido or
Eros, and a movement of unbinding which is likewise indispensable for life. Thinking
consists in bringing together, but also separating. Rooted in the drive, thinking is only
conceivable for me through the second drive theory. In my view, the opening up and
enrichment of the thought processes, with the help of the method of free association,
which permits the integration of unconscious movements into the secondary processes, is

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the greatest therapeutic effect of the psychoanalytic cure (Aisenstein, 2003 and 2007).
The aim of my remarks is to affirm that this last point can only take place with the help of
transference. In this sense I continue to believe, like Freud, that transference, but to
which I would give a broadened meaning, is indeed “the only agent involved in the
therapeutic action of psychoanalytic treatment.”
I shall give but a brief clinical example about what I wish to say.
The patient was a young woman forty years of age. She had serious asthma, an
illness that prevented her from working. She was single and had no children. She was
eight months into a twice weekly, face to face treatment in a hospital setting. Her psychic
organization was typically borderline but with long, very mechanical periods (Aisenstein
2006).
For months she tightly fixed my gaze and threw herself into either factual
descriptions of her life or furious diatribes against the weather or government, social
security or doctors, and so on. She was one of those distressing patients with whom I
have learned to be silent and wait. She was in the present, she did not recount her history
and recalled nothing of the past. One cannot speak of classic transference but of a
massive, undifferentiated cathexis.
One day, after she had complained about her allergist, the secretary and my
silence, she began to describe at length a new, violent intercostal pain occurring since the
weekend. She told me that they had diagnosed a rib fracture due to her coughing fits and
the high dosages of corticosteriods.
I then thought about a very dear friend who had died of an embolism. She had not
seen a doctor for the pain that she, herself a doctor, had thought was an intercostal
fracture. I was seized by a powerful affect of sadness. A few seconds later, the patient
moved and breathed loudly—an asthmatic fit was beginning. She got up as if she was
going to leave. She cried and screamed at me, “There, it’s your fault! You let go of me!”
I asked her to sit back down and then I spoke to her at length.
I told her that she was correct, in my mind I had let go of her. I had thought about
somebody else whom she made me think of. Still, we had to consider together her
intolerance of not controlling the thinking of an entirely different person. . . .

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 At that moment, the patient, who was still standing, sat down. She breathed more
easily and I suggested a construction by telling her that it was probable that she had made
me experience an invasion and thought control from which she had probably suffered in
the distant past. She cried for the first time.
This was a powerful moment. Based on the introduction of a third party and
history, analytic work could begin.
But how did this moment come about?
The patient alternated mechanical descriptions and rather discharge-type emotions
which did not organize themselves into affects. She was very short of a transference
which could arrange itself into a transference neurosis. Nevertheless she was massively
cathected thanks to what I would call “transference compulsion.”
I assert that with difficult, non-neurotic limit cases, we cannot restrict ourselves to
the Freudian definition of transference. Young children fall in love with a toy, a doll or a
truck: this is already transference. We must conceive of several levels of transference
before it becomes interpretable, just as we do in classic analysis. This is a question that I
have developed elsewhere but which I cannot go into here.
To return to my patient, thanks to the transferential cathexis she perceived
unconsciously an affect that was preconscious in me, but which would very likely have
gone unnoticed in a patient with better neurotic defenses. Some would speak of
“psychotic insight,” but if this is clinically true it is hardly satisfactory on the theoretical
level. How might we better understand it?
I mentioned an “unconscious perception,” though Freud himself never proposed a
specific theory of unconscious perception. Nevertheless it exists implicitly in his work;
in fact, it supports the entire theory of dream construction. Latent thoughts are
reactivated by condensed diurnal residues, and so on. Without the notion of unconscious
perception the entire theory of chapter 7 of The Interpretation of Dreams becomes
unintelligible (Bollas 2007).
An attentive rereading of “The Unconscious” of 1915 helped me grasp in finer
detail the fate of the affect between the unconscious and the preconscious. Freud reminds
us in this article that the specific goal of repression is the suppression of the development
of the affect: “We know, too, that to suppress the development of affect is the true aim of

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repression and that its work is incomplete if this aim is not achieved” (Freud 1915, p.
178). However, if the repressed representation remains in the unconscious as a real
formation, the affect itself is but “a potential beginning which is prevented from
developing” (ibid.).
There is no unconscious affect but there exists formations charged with energy
that seek to pierce through the barrier of the preconscious and will take on the character
of anxiety. Freud next compares affect to motility. Both are processes of discharge,
though with a difference: “Affectivity manifests itself essentially in motor (secretory and
vasomotor) discharge resulting in an (internal) alteration of the subject’s own body
without reference to the external world; motility, in actions designed to effect changes in
the external world” (ibid., p. 179 note 1).
These lines help seem enlightening when we reconsider the sequence discussed
above.
Within and thanks to the transferential-countertransferential process, the patient
perceived an affect in me which meet up with a preform of unconscious affect, which
transformed into anxiety and into the beginning of the asthmatic fit followed by a motor
discharge. I suggested a construction and interpretation which would then modify what
she was experiencing into a true affect.
My discussion is at once personal, brief and incomplete. It cannot give justice to
the richness of Sander Abend’s text. I should nevertheless like to single out a few points
here.
I consider myself still more Freudian than him. This is due to my French training
insofar as I think that transference is the sole key to therapeutic action and that it is
further the only one that enables access to the unconscious in the cures of difficult cases.
It thus does not seem to me at all astonishing that Freud did not, on this point at
least, modify his opinion. It is even perfectly logical.
Before being theoretical, Freud’s oeuvre is clinical. His theory is rooted in his
clinical work. Gradually he seeks to account for clinical experience that is more and
more complex. The second topography, for instance, superposes itself onto the first,
which, moreover, he does not abandon, in order to take into account unconscious
resistances, the repression by the ego, the sexualization of the superego (about which he

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shows how its roots are in the id and how it can weaken the ego), and so on. All his
theorizations after 1920 are the result of his clinical failures and they seek to forge useful
concepts with an increasingly difficult clinical reality which, moreover, is our
contemporary clinical reality.
I would further say that for me, there is the interpretation of the transference but
that all interpretation takes place within the transference. This is a standard distinction in
France. For me, there is thus no “extra-transferential interpretation.” Sometimes I
happen to make an interpretation or commentary on mental functioning and not on the
contents, but this remains within the transferential process and only becomes meaningful
for the patient thanks to the transference.
A final point concerns the question raised by Sander Abend on the “destruction”
of transference. On one level this a matter of translation between German and English
and French,(1) but in each case I do not believe that the transference may be “destroyed”
by its interpretation. It is made legible thanks to the setting and it is “clarified” by
interpretation, but it endures since it belongs to the life of the human psyche. In the
supplementary number of the Psychoanalytic Quarterly on therapeutic action I argued
that psychoanalysis is the only therapeutic method for helping our patients, whatever
their pathologies, “to become, or become again, the principal agent in their own history
and thought.” This may only take place through the transference. To be a thinking
subject, one must cathect an object.
At the end of an analysis on the transference on the psychoanalyst is not destroyed
but displaced, opening the way to different sublimations, and sometimes merely to the
capacity to love.

(1) In german “erschlagen” means to knock out, in French we would rather say
“elucider”: vanish…………In fact we do not know if Freud meant that
transference is ever “destroyed”.

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References

Aisenstein M (2003). “Does the Cure Come as a Byproduct of Psychoanalytic

Treatment?” Psychoanalytic Quarterly (72: 1), p. 263-274.

Aisenstein M (2006). “The Indissociable Unity of Psyche and Soma: A View from the
Paris Psychosomatic School.” S. Jaron (trans.). International Journal of Psychoanalysis
(87: 3), p. 667-680.

Aisenstein M (2007). “On Therapeutic Action.” S. Jaron (trans.). Psychoanalytic

Quarterly (76: supplement), p.

Bollas C (2007). The Freudian Moment. London: Karnac.

Freud S (1914). “The Unconscious.” SE 14, p. 166-204.