No one who, like me, conjures up the most evil of those half-tamed demons that inhabit the human breast and seeks to wrestle with them, can expect to come through the struggle unscathed.
(Freud, 1905a, p. 109)
In this chapter, we follow the development of the concept of countertransference from initially being seen as a hindrance to psychoanalytic progress to its current use as an important tool in clinical practice. I cover a wide swath of theories on this subject from American, British, South American and Italian authors with an eye on how each has been a step in the evolution toward an appreciation of transformational processes in contemporary psychoanalysis. Although there is no clinical illustration in this chapter, I discuss a 1909 letter from Karl Abraham to Freud in which he reveals an interesting "symptomatic reaction" in his practice, which I "analyze" from the various perspectives on countertransference.
There has been an awareness from the earliest days of psychoanalysis that the analyst is deeply, sometimes disturbingly, affected by engagement with the patient’s unconscious experience. Freud (1910) coined the term counter-transference to refer to the therapist’s unconscious reaction to the analysand’s transference and noted that handling one’s emotions toward the patient presented the analyst with a significant challenge. It was recommended that the clinician use the countertransference as a stimulus to his self-analysis so that one’s capacity to listen to the patient’s concerns could proceed without interference from the analyst’s private reactions. In this chapter, we will review the development of the concept of counter-transference from its initially being seen as a hindrance to later perspectives that view it as a means by which to better understand the patient, which thereby goes on to enhance the therapeutic process.
In a letter to Freud, dated April 7, 1909, Abraham referred to taking on two new patients and remarked that with each new treatment his understanding of analysis increased. He also observed that
I have tracked down a symptomatic reaction in myself. While I am analyzing and am waiting for the patient’s reply, I often cast a quick glance at the picture of my parents. I know that I always do this when I am following up the infantile transference in the patient. The glance is always accompanied by a particular guilt feeling: what will they think of me? This has of course to do with my separation from them, which was not too easy. Since explaining this symptomatic action to myself, I have not caught myself at it any more.
(p. 88)
Abraham’s next thoughts are of his two-year-old daughter to whom he gave enemas recently and on each following day she expressed hope there would not be another. However, he noted that the plea was offered “with a rather arch smile. So obviously she wants to get the injection. Apart from this, she does not show any analerotic tendencies” (p. 88).
There is a sense of Abraham’s prideful accomplishment in this note to his good friend in having “tracked down a symptomatic reaction in myself” and not having “caught myself at it any more.” This has been achieved through the analyst’s observation of his reaction to the patient’s infantile transference; a reaction he has had with other patients that is considered to be a distraction from his task of listening carefully to the analysand’s associations. Abraham then engages in a piece of self-analysis: he realizes his guilt is connected to his “not too easy” separation from his parents and this insight has subsequently freed him from similar diversions. In essence, he has succeeded in three ways: first, by recognizing his distracting personal reaction stirred by the patient’s “infantile transference”; second, by engaging in self-analysis to remove this “symptomatic reaction”; and, finally, to return his attention to the analysand’s narrative.
This brief vignette is a veritable goldmine that contains within it the multitude of potential meanings that will be given to the term counter transference from its inception as an inevitable, albeit distracting, factor in analysis to contemporary perspectives that consider it an essential ingredient of the psychoanalytic process. For Abraham and his cohort, emotions evoked in the analyst were expectable (e.g., the quotes from Freud and Bion) and served to foster his own self-reflections from which his personal growth as analyst and individual developed. It was, therefore, very clear from the earliest days of psychoanalysis that powerful, even deeply disturbing, emotions were a common side-effect of this work and it was unrealistic to “expect to come through the struggle unscathed.”
If we scratch the surface of Abraham’s communication with Freud there are many other layers of meaning that await our discovery and raise important questions about the analyst’s subjective reactions. Why, for example, does Abraham look at the picture of his parents and feel guilt precisely during the interim between interpreting and the patient’s response? Is there some sort of unconscious need for approval, and worry of making an error, that is being evoked in this analyst by this particular patient at this single moment in the analytic work? Abraham does not feel this guilt with every analysand: does his contriteness surface with all facets of the patient’s infantile neurosis or with certain themes? Does the analysand “sense,” unconsciously or not, the analyst’s anxious anticipation of the patient’s reply and, if so, might he/she withhold associations to the interpretation? Is there some ambient, though unarticulated, emotion permeating the session that has to do with being a “good” boy, analyst or patient that is expressed in various ways, such as Abraham’s report to Freud that he is a dutiful analyst or his glancing over to the picture of his parents? Finally, what are we to make of Abraham’s thoughts turning next to his constipated daughter and her ambivalence about the enemas? Is this an “association” that is relevant to his “symptomatic reaction” and to the analysis?
Thus, much of the “raw material” from which additional definitions of countertransference have been crafted is implicit in the letter from Abraham to Freud and it has been left to subsequent generations to expand upon. I will begin with a discussion of Freud’s views of countertransference, which were often seemingly at odds with each other, and the perspectives of the early analysts; moving from there to later contributions in order to highlight the development of our understanding of the analyst’s subjective reactions and how these are employed in the analytic encounter.
The question of the countertransference and how it should be handled was initially discussed informally as in Abraham’s (1909) letter and appears for the first time in Freud’s (1910)2 publications when he stated that such feelings arise in the analyst
as a result of the patient’s influence on his unconscious feelings. . . [and that the analyst should] recognize this counter-transference in himself and overcome it
(p. 144) [italics added]
and that
no psychoanalyst goes further than his own complexes and internal resistances permit.
(ibid, p. 145)
These brief quotes are very significant in that they state that (1) the countertransference results from the impact of the patient’s difficulties upon the analyst’s unconscious; (2) since such emotions in the analyst are unconscious, he must strive to become aware of his reaction “and overcome it”; and (3) that the progress of an analysis also depends upon the analyst being aware of his “complexes and internal resistances.” Thus, Freud is describing psychoanalysis as an intense interpersonal process in which encounters with the patient’s unconscious deeply impact the unconscious of the analyst, an effect that the clinician must overcome. Failure to do so may impede the course of the patient’s analysis and, furthermore, it is implied that the personal growth of the analyst may be hindered.
The growing realization that countertransference was an inevitable, and sometimes destructive, phenomenon led to the requirement that all analysts have a personal analysis as part of their education. This became one of the three pillars of training, in addition to seminars and seeing analysands under supervision, that was introduced by Max Eitington (the “Eitington Model” of training) when he founded the Berlin Psychoanalytic Polyclinic in 1920. Indeed, as Balint (1954) observed, Eitington may have received the first “training analysis” as described in a letter from Freud (22 October, 1909) to Ferenczi, “Eitington is here. Twice weekly, after dinner, he comes with me for a walk and has his analysis during it.” These strolls must have had a very positive effect that stayed with Eitington and contributed to his instituting the necessity of a training analysis.
However, Freud also offered other views that suggested countertransference feelings could be of benefit in an analysis. The vignette from Abraham’s letter points to how the therapist’s subjective reactions may be a stimulus to self-analytic work and personal growth in the analyst. In addition, Freud (1912) also recommended that the analyst “use his unconscious . . . as an instrument of the analysis” (p. 116), though he did not instruct us as to how this is achieved. In the same paper, he proposed that the free associations of the patient and the “evenly suspended attention” of the analyst are linked phenomena; however, Freud and his contemporaries only explored the impact of the analysand’s unconscious upon that of the clinician, leaving aside the effect of the analyst’s unconscious upon the patient. In connecting the subjective emotions of the analyst and patient, Freud may have been suggesting that the therapist can use his unconscious “as an instrument of the analysis” by paying attention to his countertransference feelings.
These early analysts also examined how successful work on the countertransference was necessary for unlocking the analysand’s life-constricting conflicts. If Abraham had not become aware of his “symptomatic reaction” that was stirred by his patient’s infantile neurosis and had instead blocked recognition, then this denial could have thwarted the analytic progress. Freud (1910) noticed this tendency when he wrote that unrealized “internal resistances” in the analyst can limit his emotional freedom, thereby tying the analysand’s emotional development to the clinician’s capacity to manage one’s countertransference. Some years later, Theodore Reik (1924) expanded on this point by introducing the notion of counterresistance that is a subtype of countertransference in response to an obdurate resistance in the patient characterized by “a decrease of interest in the case or even a change in the mode of treatment” (p. 150). Glover (1927) subsequently added that a counterresistance was an expression of the analyst’s negative countertransference, that is, his aggression towards the patient.
Freud is often faulted for having advocated that the analyst should remain opaque and manifest the surgeon’s dispassionate attitude of “emotional coldness” (Freud, 1912, p. 115). However, it is important to note that these first psychoanalysts struggled with the heat generated by the transference-countertransference matrix and I suspect that the goal of “emotional coldness” was likely a fantasied state aimed at cooling down the necessary, but searing emotions of the analytic consulting room. Freud (1913a) seemed to be saying as much in a letter to Binswanger when he stated that the problem of countertransference was “among the most intricate in psycho-analysis” (20 February, p. 112) and that the analyst must display to the patient “spontaneous affect, but measured out consciously at times” (p. 112). He implies that some patients may require more of this than others, “but never from one’s own unconscious” (p. 112). Thus, Freud appears most concerned about the heat of the analyst’s unconscious affecting the analysis negatively; hence, his advocacy of “emotional coldness” is meant to help the clinician keep his “cool” rather than to promote an air of aloofness.
Before leaving this section, there is a statement by Freud (1912)3 that deserves our attention: it is as contemporary as any offered by current writers and lays the groundwork for the contributions of many recent analysts:
he [the analyst] must turn his own unconscious like a receptive organ towards the transmitting unconscious of the patient . . . so the doctor’s unconscious is able, from the derivatives of the unconscious which are communicated to him, to reconstruct that unconscious, which has determined the patient’s free associations.
(Freud, 1912, pp. 115–116)
Though Freud does not elaborate on this observation, he is offering a model of unconscious communication as an additional perspective from which to understand countertransference. Implicit in this vertex is the notion that the patient’s unconscious actively conveys a communication for the “doctor’s unconscious” that functions like a “receptive organ” to receive and then “reconstruct that [communicating] unconscious.” Perhaps Freud had in mind Ferenczi’s (7 February, 1911) letter a year earlier in which he suggested that the countertransference was “being induced” (p. 253) by the patients, thus implying a purposeful function to this emotional induction?
Freud (1923) introduced the structural theory (id, ego, superego) that subsumed the previous topographical theory (conscious, preconscious and unconscious) and also outlined a new theory of anxiety (Freud, 1926) that placed great importance on the role of defense mechanisms in the ego’s armamentarium for managing anxiety. This important evolution in psychoanalytic theory also signaled a shift in emphasis away from the study of unconscious [id] fantasy contents toward the workings of the unconscious ego in defense. Consequently, the exploration of countertransference, which was defined as the unconscious reaction to the analysand’s unconscious expressions, faded and tended to be seen as “unscientific” (Lothane, 2006) as compared to the examination of the ego’s functioning that could be more easily observed. Ego psychology subsequently became the predominant theoretical orientation in the United States and was galvanized by the influx of orthodox Freudian analysts from the European diaspora of World War II. However, ego psychology did not achieve the prominence in Europe, and especially South America, that it was accorded in institutes under the aegis of the American Psychoanalytic Association (Brown, 2009a, 2011a). Consequently, most American analysts were trained to adhere to Freud’s (1910) admonition to “recognize this countertransference and overcome it” (p. 253) even though he (Freud, 1912) had hinted at the relevance of countertransference for understanding the patient’s unconscious communications.
There was a significant shift in the understanding of countertransference during this period: from viewing it as an encumbrance to treatment that must be overcome to seeing countertransference as an essential “instrument of the analysis.” The 1930s ended with Alice and Michael Balint’s (1939) paper that debunked the notion there could be a “sterile” manner of analyzing free from effects of the analyst’s personality; indeed, they argued that there was an interaction between the transference and countertransference “complicated by the reactions released in each by the other’s transference onto him” (p. 228). They also observed that patients adapt to the analyst’s countertransference and go on in analysis to “proceed to their own transference” (p. 228). In addition to normalizing the presence of countertransference feelings, the Balints also brought for our consideration the effect of the analyst’s subjective experiences on the analysand; however, their view was that the patient worked around the countertransference and they did not discuss in detail its effect on the analysand’s transference. Robert Fliess’ 1942 paper, “The Metapsychology of the Analyst,” examined in great detail the nature of the analyst’s work ego that depended upon a capacity for trial identification, which required the analyst “to step into his [patient’s] shoes and obtain in this way an inside knowledge that is almost first hand” (p. 212). It was through this process that the analyst could use his countertransference as an instrument of the analysis by obtaining a “taste” of the analysand’s struggles through a transient identification in which “he becomes the subject himself” (p. 215). Now armed with the “firsthand” knowledge, the clinician may make a more accurate interpretation to the analysand; however, Fleiss cautioned the analyst take care “to guarantee that no instinctual additions of our own distort the picture” (p. 219), a view that appears to partially espouse the outlook that the countertransference is something to be “cleansed.” Nevertheless, Fleiss’ perspective represents a significant departure from the first analysts who considered the countertransference as a distraction to listening to the patient, albeit a potentially helpful one to the analyst in his self-analysis.
Though Fliess does not use the term “analyzing instrument,” he is essentially offering us an insider’s look at the process occurring in the analyst’s mind. Thus, by introducing trial identification, the work ego, and other concepts into our lexicon, contributions that Schafer (2007) states “helps launch psychoanalysis towards its contemporary form” (p. 698), Fliess expanded the range of conceptual tools to apply to our understanding of how one uses the countertransference. As discussed, beginning in the 1930s there was a divide between the ego psychologists’ attempts to develop techniques that sought to “cleanse” a patient’s material from being alloyed with countertransference, while another group (Balints, Fliess) viewed countertransference as a pathway to the analyst’s empathic understanding. In my opinion, we can see in Fliess the tension between these two perspectives: his open advocacy of the relevance of the analyst’s subjective experience on the one hand and, on the other, his wish to be “able to guarantee that no instinctual additions of our own distort the picture.” Jacobs (2007) comments:
One suspects that issues of loyalty to Freud, as well as fears of Ferenczi’s influence and of wild, undisciplined behavior on the part of colleagues, influenced Fliess and others who held this idealized and sanitized view of the analyst’s functioning.
(p. 717)
Melanie Klein (1946) introduced the term projective identification to describe how the attribution (by projection) of aspects of the self to the internal image of an object (in the projecting subject’s inner world) changes the inner experience of that object. The internal object thereby becomes identified with what has been projected into it and the patient’s behavior toward the actual external object is governed by his inner experience of that object. In more disturbed patients, such as psychotic and severe borderline individuals, the distinction between inner and outer reality may be erased; while the neurotic patient is capable of understanding his distortions that create the feeling, for example, of “it’s as if you are my father.” Klein’s followers saw in projective identification a way of explaining countertransference: that the analyst’s subjective reactions, in addition to his transference to the analysand’s transference (the classical explanation), may have been created by projective identification. In this regard, countertransference could be partly explained by the patient’s unconscious placement of painful emotions into4 the therapist; thus, not only does the patient’s subjective experience of the clinician change, but the analyst is emotionally affected by what is projected.
However, though Klein acknowledged it was sometimes difficult for the analyst to be the recipient of such projective identifications (Spillius, 2007) because of his associated inner objects stirred by the projection, like Freud she stressed that the countertransference was to be dealt with by the analyst in one’s self-analysis. Despite the fact that many of her devotees regarded countertransference, induced by the patient’s projective identification, as a useful tool of analytic work, she remained skeptical of its relevance as a guide to emotionally understanding he analysand. She held this position firmly to the end of her career: witness her comments to a group of young analysts in 1958 (quoted in Spillius, 2007):
I have never found that the countertransference has helped me to understand my patient better. If I may put it like this, I have found that it helped me to understand myself better.
(p. 78)
Paula Heimann (1950) was the first of Klein’s followers to apply the concept of projective identification to the study of countertransference and asserted that it “is an instrument of research into the patient’s unconscious” (p. 81) and also that it is “the patient’s creation, it is part of the patient’s personality” (p. 83). Thus, she linked Freud’s (1912) recommendation that the analyst use his unconscious “as an instrument of the analysis” to Klein’s projective identification, seeing the latter as the means by which the patient’s unconscious communicates with that of the therapist. By asserting that the countertransference is a creation of the patient, Heimann effectively explained the mechanism by which the countertransference is induced (see Ferenczi’s and the Balints’ earlier comments) as well as how the analyst becomes a part of the patient (Fleiss). Perhaps Brenman Pick (1985) said it best when she noted that
The child’s or patient’s projective identifications are actions in part intended to produce [emotional] reactions.
(p. 157)
Roger Money-Kyrle (1956) advanced Heimann’s ideas and elaborated them further. Like others before him, he observed that there are inevitable periods when the analyst fails to understand the analysand, which occur when an aspect of the patient disturbingly coincides with an unanalyzed portion of the analyst’s psyche. Money-Kyrle added an original element to this situation by stating that one task of the analyst is to interpret the effect of the countertransference on the patient; however, it is important to note that he did not favor disclosing one’s feelings directly to the patient. Instead, he suggests that the analyst deal with the patient’s comments about his mood, whether accurately perceived or not, by interpreting it as psychic reality that has personal meaning to the analysand. Money-Kyrle’s perspective, therefore, squarely places the emphasis on the unconscious meanings both the analyst and patient attribute to their interaction. He argues that while acknowledging the analyst’s conscious feelings toward the patient may “confirm” the accuracy of the patient’s perceptions, it does little to address the unconscious meaning the patient has attached to the perception (accurate or not) of the analyst. Betty Joseph (1975/1989) summed up this stance when she stated that
It is important to show, primarily, the use the patient has made of what he believes to be going on in the analyst’s mind.
(p. 80)
Simultaneous with these applications of projective identification by Heimann and Money-Kyrle in London, analysts in Argentina and Uruguay were exploring similar territory. The cultural ambience of the Argentine Psychoanalytic Association (APA), which was formed in 1942, was one that combined psychoanalysis (with a primary Kleinian orientation) with input from Kurt Lewin’s “field theory,” studies of dream-like states, and probes into the nature of psychosomatic states (de Leon de Bernardi, 2008). Heinrich Racker was one of the leading figures in the early days of the Argentine Society and, like Heimann, believed that the capacity to identify with the patient is the “basis of comprehension” (Racker, 1953/1968, p. 134) of the analysand. His investigation of the role of identifications in countertransference was considerably more detailed than contribution on the subject from any previous authors.
Racker (1968) delineated what he termed concordant and complementary identifications that comprise important elements of the countertransference. Concordant identifications denote the analyst’s introjection of an aspect of the patient’s self (“sent” by projective identification), in which case the analyst unconsciously feels “this part of me is you” (pp. 134–135). In contrast, a complementary identification signals that the analyst has identified with an internal object of the patient. Racker, more stridently than Money-Kyrle and Joseph, asserts that the analysand is attuned to the countertransference and that the patient’s awareness of the fantasied and real countertransference is a determinant of the transference. Thus,
Analysis of the patient’s fantasies about countertransference, which in the widest sense constitute the causes and consequences of the transferences, is an essential part of the analysis of the transferences.
(p. 131)
However, the clinician must be attuned to the possible development of a countertransference neurosis in which the patient, in the analyst’s unconscious, is equated with a disavowed part of the analyst. In such a situation, for example, the analysand may become identified with the therapist’s projected aggression and, now experiencing the patient as embodying hostility, there may be a misrecognition by the analyst that guides his interventions.
We can see how Racker has deepened our understanding of variations in the countertransference that assists the therapist in using one’s feelings toward the patient as “an instrument of the analysis.” It is an important differentiation for the analyst to be able to discern countertransference feelings resulting from an identification with a disowned segment of the patient’s self (concordant) or whether from an identification with a figure from the analysand’s inner world (complementary). Leon Grinberg, a colleague of Racker, coined the term projective counteridentification to describe the impact of the analysand’s violent projective identifications upon the analyst’s subjectivity. As we have seen, it is essential that the analyst become through a temporary identification what the patient is projecting; however, there are certain situations when the analyst “ceases to be himself and turns unavoidably into what the patient unconsciously wants him to be” (1990, p. 84). He contrasts the concept of projective counteridentification with Racker’s idea of the complementary countertransference. When the analyst is under the impact of a complementary countertransference his identification with the projected internal object of the patient stirs a personal reaction, based upon the analyst’s idiosyncratic conflicts similar to that which is projected. By contrast, with projective counteridentification
the same patient, using his projective identification in a particularly intense and specific way, could evoke the same countertransferential response (projective counteridentification) in different analysts.
[author’s italics] (Grinberg, 1990, p. 90)
Wilfred Bion, a strikingly independent thinker, was trained in the London Kleinian (second analysis with Melanie Klein) tradition and creatively expanded on some basic Kleinian concepts. Grinberg’s (1990) notion of projective counteridentification was based on the idea of violent projective identification, which denotes the effect on the analyst of a patient’s relentless barrage of accusations, for example, that the analyst hates the analysand. As such an attack continues, sooner or later the therapist will come to hate his patient independent of the analyst’s attempts to remain composed or “neutral.” Winnicott (1949) wrote convincingly about the necessity of the clinician coming to hate certain kinds of patients, which was an essential part of the treatment. Thus, violent projective identification creates an experience in the analyst of being passively taken over by a patient whose sole interest is to evacuate his own frightening emotions into the analyst.
Bion, who worked analytically with many psychotic and borderline patients, wrote a series of papers in the 1950s (1957, 1958, 1959) in which he described the communicative aspects of projective identification. In essence he was asserting that while projective identification may serve the function of emptying out the psyche of unwanted elements, it was also a means of emotional communication from one psyche to another. In this connection, even the most violent expression of projective identification that leaves the therapist feeling battered is also a communication of the nature of the patient’s anguish. Bion deeply believed in this, a conviction that led him to claim the patient as our best ally because even in his most disturbing interactions the patient was attempting, however feebly or ferociously, to communicate something of his own inner suffering. Thus, he (Bion, 1973) came to observe (cited in the quote at the beginning of this chapter) that “we, patient and analyst alike, are certain to be disturbed” (p. 4).
In proposing the communicative component of projective identification, Bion, although he did not say it directly, was in effect telling the analyst how to use one’s unconscious as “an instrument of the analysis.” Communicative projective identification, therefore, was the means by which “the transmitting unconscious of the patient” (Freud, 1912, p. 115) communicated with the “receptive organ” of the analyst’s unconscious. However, we may also wonder about the fate of that which is projected into the therapist: what becomes of it once it has been successfully communicated and taken in, or introjected, by the receiving unconscious of the analyst? Bion (1958) commented that in addition to its communicative aspects, projective identification also aimed to “put bad feelings in me and leave them there long enough to be modified by their sojourn in my psyche ” (p. 146) [italics added]. The conception that feelings are “modified by their sojourn” in the analyst’s mind became the cornerstone of Bion’s later theories and furthered our understanding of countertransference: thus, another facet of countertransference was its role in modifying what has been transmitted to the clinician’s unconscious.
Bion’s researches into how the psyche modifies the projection led to his discovery of reverie, but first a detour back to Abraham’s (1909) letter to Freud will be a useful illustration. As a thought experiment, I suggest we place ourselves as Abraham’s supervisor as he tells us about his treatment of the patient with whom he experiences the need to look over to the picture of his parents while awaiting the analysand’s reply to an interpretation. Abraham tells us that, in the classical mode, he has successfully stopped this “symptom” of gazing at the picture. Applying the notion of communicative projective identification, we may wonder whether this analyst’s (Abraham) unconscious has received some communication from the patient’s unconscious and that looking at the picture of his parents was this analyst’s unique way of unconsciously registering in his own metaphor the patient’s communication. Furthermore, we might also consider Abraham’s next thoughts about his daughter’s constipation and her “rather arch smile” about the enemas as further data, encoded in the analyst’s personal experience, about what the analysand is unconsciously communicating. Employing the analyst’s seemingly “unimportant” side remarks as his unconscious representation of the patient’s subliminal communication furthers the analyst’s ability to use his unconscious “as an instrument of the analysis.”
Bion’s (1962a, b; 1997b; Ogden, 2003a, b, 2004a) concept of reverie refers to a wide range of experiences (visual images, seemingly irrelevant thoughts, random tunes) that spontaneously come to the analyst’s mind while listening to a patient and signal that his unconscious is quietly working to transform the analysand’s unconscious communication and “re-register” it in the therapist’s personal idioms. If the clinician applies this stance, then what we consider clinical “material” that is relevant to the patient’s difficulties is greatly broadened. Thus, within this frame of reference, Abraham’s thoughts (associations?) about his daughter’s constipation are viewed as a “legitimate” potential source of information about what the patient is communicating in this session. We may therefore formulate a hypothesis that Abraham’s gaze over at his parents’ photograph for approval that is followed by thoughts about his daughter’s bowel difficulties are a reverie that indicates his unconscious reception of a communication from the analysand that is transformed into these particular thoughts. Furthermore, his unconscious may be a lightning rod for the patient’s emotions about being good (Abraham’s looking toward his parents), being withholding (his daughter’s constipation) and perhaps an enticement to draw Abraham into some sado-masochistic struggle (“the arch smile”).
I can imagine at this point that the reader may be wondering whether these extrapolations from the analyst’s countertransference are at best extremely fanciful and, at their worst, a gross misuse and misapplication of countertransference. Indeed, this was the objection in most American psychoanalytic circles in the beginning of the 1960s regarding the use of countertransference “as an instrument of research into the patient’s unconscious” (Heimann, 1950, p. 81). For example, Ross and Kapp (1962) wrote a very interesting paper in which they recommended that the analyst pay attention to his visual images stirred by listening to a patient’s dream because these images could offer clues to countertransference feelings of which the therapist was unaware. While for Bion or Heimann such images might be considered vital data about the patient, Ross and Kapp considered these images as confirmations of “when a countertransference problem has already been suspected” (p. 645), that is, information about the analyst and not the patient.
There were, however, a number of American analysts who earlier advocated using the countertransference as a means of better understanding the patient in addition to oneself, but their ideas did not gain much traction. Indeed, Theodore Reik’s (1948) book, Listening with the Third Ear: The Inner Experiences of a Psychoanalyst, which argued for the value of the analyst’s subjectivity (his “third ear”) in understanding the patient, was widely read among the general population but seemed to have much less impact on the mainstream of American psychoanalysis.
Otto Isakower (1957/1992, 1963/1992) of the New York Psychoanalytic Institute gave a series of lectures in the late 1950s and early ’60s that dealt with supervision in which he emphasized the importance of teaching candidates to use their countertransference as a component of the “analyzing instrument.” He reported his supervision of an analytic trainee who shared with an analysand a spontaneous visual image he experienced while listening to him, which Isakower discussed as having had a positive treatment effect. This presentation was met with many negative responses from the audience (Wyman and Rittenberg, 1992), including the comment by Martin Stein that questioned whether the candidate’s sharing of the visual image
has to do with some unanalyzed personal problem? To use an analogy from medieval times – when a person had a vision to tell, was the vision sent by God or the Devil?
(p. 221)
Kernberg (1965) published a groundbreaking (for American psychoanalysis) paper in which he detailed two currents in thinking about countertransference: one was the “classical” definition that regarded countertransference as the analyst’s unconscious reaction to the patient’s transference and the second use was the “totalistic” one, characterized by a broader view of countertransference as something that “should be certainly resolved . . . [and also] useful in gaining more understanding of the patient” (p. 39). He described various countertransference difficulties that may await those who undertake the treatment of seriously disturbed patients and warned that the analyst should take care to recognize the possible development of “chronic countertransference fixation” that arises from the “reappearance of abandoned neurotic character traits” (p. 54) in the analyst triggered by primitive aspects of the patient. It is important to note that this article was written during the time when he was investigating the intensive analytic treatment of patients with “borderline personality organization” (Kernberg, 1967) and narcissistic disorders and this publication argued that the analyst adopt the “totalistic” approach to countertransference as a necessary tool for treating such individuals. Although this paper did not offer new innovations in understanding the phenomenon of countertransference, its linkage of particular emotional reactions in the analyst to specific severe diagnostic states and the fact that it was published in the Journal of the American Psychoanalytic Association introduced most American psychoanalysts of that era, largely under the sway of then-prevalent ego psychological models, to a broadened (“totalistic”) view of countertransference.
Kernberg’s advocacy of the “totalistic” approach to countertransference helped to foster an evolution from a “one person” to a “two person” psychology in American psychoanalysis that began in the mid-1970s. Though Modell (1984) is generally credited with coining this distinction, the term “two person psychology” is first mentioned by John Rickman (1951), who defined it as “the psychological region of reciprocal relationships” (p. 219) that takes into account the interaction between the psychologies of the analyst and patient. In this regard, Joseph Sandler (1976) 5 introduced the idea that the transference has an intended purpose of actualizing an internal object relationship of the analysand in the analytic relationship. The patient assumes a certain role in accord with an internal fantasy and also deliberately, though unconsciously, acts to evoke in the analyst a complementary role of that fantasy. Sandler emphasizes that this role responsiveness is not just a fantasy existing in the patient’s psyche, but an actual state of emotional affairs that permeates the subjective experiences of the analyst and analysand. He treads familiar ground to what Racker had earlier described, but emphasizes the pressure brought to bear on the therapist to behaviorally step into a role that is scripted by the patient’s internal fantasy. Sandler advised the clinician to maintain a free-floating behavioral responsiveness: a receptive capacity to being placed in a variety of roles that pull him in the direction of specific actions delimited by the nature of the role he has been pushed to assume. The analyst may find himself placed into a role that causes some distress and Sandler cautions him not to simply view this upset as a mere “blind spot,” but to consider his reaction as a “compromise-formation” between his own proclivities and his reaction to the nature of the role forced upon him.
Sandler moved the classical analytic understanding of countertransference forward to include the patient’s pressure on us to take on a role in his inner world and the effect upon the analyst in acquiescing. It is through Sandler’s technical suggestion that the analyst become one of the patient’s inner objects or a disowned aspect of the analysand, what he terms “role responsiveness,” that we are able to gain knowledge of the patient’s inner workings. Thus, Sandler expanded upon the analyst’s use of his unconscious as an instrument of the analysis by giving privilege to the pull on the analyst to act in a particular role that may offer insight into the nature of the analysand’s inner drama that is played out in the therapeutic situation.
The emphasis in Sandler’s paper on the patient’s pressure for us to assume a role and act it out provides a central theoretical grounding for the focus on enactments beginning in the analytic literature in the 1980s. In Sandler’s concept of role responsiveness it was the patient’s inner world, and its externalization into the analytic situation, that spurred the analyst’s involvement; i.e., that the analyst’s psyche was viewed as reactive rather than an active participant in initiating the interaction. Beginning in the late 1970s, Theodore Jacobs (1991) has written extensively about the actualizing component of enactments, adding a two-person dimension that was essentially absent in Sandler’s discussion, bringing us closer to the “region of reciprocal relationships.” The patient and analyst may engage in an unconscious mutual enactment that serves resistance:
the enactments carried out by both patient and analyst . . . Their investigation opened the way, not only to uncovering an essential piece of history that had not yet surfaced, but to bringing to the fore certain crucial aspects of the interaction between patient and analyst that, arousing anxiety in each and strongly defended by both, had until then been insufficiently explored.
(p. 40)
For Jacobs, the analyst is typically drawn into an enactment because of his unconscious resonance with an aspect of the conflict that the patient is manifesting. Not uncommonly, the analyst identifies with an internal object of the patient who may represent a figure in the analyst’s inner world or a split-off piece of himself (Jacobs, 1983). In this situation, personages from the analysand’s representational world (Sandler and Rosenblatt, 1962) may become unknowingly linked with presences in the analyst’s mind. Invariably, however, for Jacobs an enactment and its successful analysis allows for the emergence and clarification of unconscious conflicts in the patient; thus, an enactment is considered within the framework of the classically established goal of making the unconscious conscious.
Like Jacobs, most American analysts have tended to view enactments as an avenue toward the goal of making unconscious conflicts in the patient conscious. Boesky (1990) suggests that, in addition to helping to foster the conscious awareness of previously unconscious elements, another benefit to the analyst’s being drawn into an enactment is that the analysand senses the analyst’s engagement with him:
If the analyst does not get emotionally involved sooner or later in a manner that he had not intended, the analysis will not proceed to a successful conclusion.
(p. 573)
Here Boesky is making an important point about the patient’s awareness of the analyst’s countertransference: where Money-Kyrle (1956) addressed the unconscious meaning the analysand gives to the perception of the countertransference, Boesky is additionally underscoring that the patient may find conscious reassurance in the clinician’s emotional engagement. By the early 1990s, the role of the analyst’s subjectivity in the analytic encounter was becoming an increasingly prominent area of study and we now turn to this development.
One of the criticisms of classical analytic technique (Mitchell, 1998; Renik, 1995) has been that it relied upon the analyst as an “authority” figure who sifts through the analysand’s associations to discover the hidden meaning and then offers his interpretive pronouncements. Renik (1993) introduced the notion of the analyst’s “irreducible subjectivity” to highlight the inevitable involvement of the analyst’s personality in his interpretations and that, therefore, insight is not a commodity given by the analyst to the patient but rather
that analytic truths are co-created by analyst and patient, rather than unveiled by means of the analyst’s objective observations of the patient’s projections.
(Renik, 2004, p. 1056)
These comments, distilled from the study of the analyst’s involvement in enactments, further shifted the concept of countertransference away from an artifact to be “sanitized” to an “irreducible subjectivity” and thereby promoted a diminished emphasis on the analyst’s authority.
The theme of analyst and patient co-creating insight is closely allied to the exploration of the intersubjective analytic field by other authors whose works are influenced by the writings of Melanie Klein and Bion (Brown, 2011a). The analytic field concept has an ancestry of its own (Brown, 2011c) that stretches back to Gestalt psychology in the early twentieth century and, somewhat later, Kurt Lewin (1935) coined the term field theory to denote the idea that the whole (as in Gestalt psychology), created from the sum of its parts, is greater than the sum of those parts. Bion and Rickman (1946) applied this model to the study of group processes in the 1940s and somewhat later Bion (1952) introduced Klein’s ideas of primitive mental functioning to his understanding of group phenomena. He proposed the idea of the basic assumption, which is a shared unconscious phantasy, assembled from aspects of each group member, that permeated the group and affected each member individually in accordance with his or her psychological make-up. This was an important step forward in psychoanalytic field theory because it represented the idea of an unconscious psychic entity constructed from the group members, yet having an independent existence of its own, which suffused the group with an emotional experience. Other authors further developed the idea of a third psychic presence through their unique contributions, most notably Willy and Madeleine Baranger (1961/2008) who wrote about the shared unconscious phantasy of the couple, and stated that
This structure [shared unconscious phantasy] cannot in any way be considered to be determined by the patient’s (or the analyst’s) instinctual impulses, although the impulses of both are involved in its structuring . . . Neither can it be considered to be the sum of the two internal situations. It is something created between the two, within the unit that they form in the moment of the session, something radically different from what each of them is separately.
[italics added] (p. 806).
Other notable contributions to the idea of a third subjectivity forming from the deep unconscious interaction of the patient and analyst are Ogden’s (1994) intersubjective analytic third, and Ferro’s and Civitarese’s (1992) important work on the concept of characters in the field.
This model of the analytic relationship adds a new dimension to our comprehension of countertransference: the analyst’s emotional experience in the session is a conduit to a shared unconscious experience that is built from aspects of the patient and himself. It is “something radically different from what each of them is separately” or, put another way, it represents “something fascinating about the analytic intercourse; between the two of them, they do seem to give birth to an idea” (Bion, 2005, p. 22). From this perspective, therefore, it is less important to sort out “whose ideas was it” (Ogden, 2003a), than for the analyst to regard his countertransference as tuned into a shared emotional experience that he and the patient, each in their own way, are attempting to come to terms with. Returning once again to Abraham’s (1909) letter to Freud, I began the last section (1960–1990) by speculating that Abraham’s looking at the picture of his parents for approval and his associations to his daughter’s constipation may indicate that he was unconsciously resonating with some emotion stirred by his patient. If we add the perspective of the “shared unconscious phantasy,” we may also consider the possibility that both Abraham and his patient were under the sway of an unconscious phantasy (i.e., a wish to receive parental approval and defiance against that authority) that permeated the communal analytic mood.
The literature on the analyst’s and patient’s mutual contribution to enactments, Renik’s (and others) thoughts about the co-creation of meaning (insight) in the analytic pair and the idea of a shared unconscious fantasy all fall under the umbrella of intersubjectivity. This topic is discussed in another chapter in this textbook, but it seems important to note that the study of countertransference appears to have been subsumed in recent years by investigations into the nature of intersubjectivity (Brown, 2011a). It is my impression that countertransference still carries a somewhat pejorative association; for example, countertransference dreams are not generally spoken about and candidates are loath to discuss these in supervision (Brown, 2007). On the other hand, the term “intersubjectivity” does not have the history of stigmatizing the analyst’s feelings that countertransference has carried and instead normalizes the therapist’s experience, however troubling it may be.
Before closing, there is one last perspective on countertransference that deserves attention: that the analyst’s experience of the analytic hour is a dream. Bion (1992) expanded Freud’s theory of dreaming (the reader is referred to Grotstein’s (2009c) paper dealing with Freud’s and Bion’s dream theories) when he asserted that we are always dreaming, while awake and asleep. He viewed dreaming as the mind’s way of processing raw emotional experience and giving it meaning with one’s personal stamp. Ogden (2003b, 2004a, 2007) has written extensively about Bion’s views on dreaming and describes how the analyst’s waking dream thoughts (or reveries) are the means by which our psyches unconsciously transform experiences of the patient (conveyed to us through projective identification) that are too unbearable for the analysand to “dream” on his own. Furthermore, the clinician is not only transforming an unmanageable emotional experience for the patient but his waking dream thoughts are also “unconscious work” he is doing to represent the shared unconscious phantasy active in the analytic hour.
The Italian analysts Antonino Ferro and Giuseppe Civitarese also place great importance on the concept of “waking dream thoughts” (Ferro, 2002b, 2005, 2009b) in both the analyst and patient as indicators of the analytic couple’s fertility, which is an important component of the analytic field and related to the question of analyzability: can this analyst/patient dyad engage in a mutual unconscious process that transforms unrepresented emotional experience? One offspring of the analysand and analyst unconscious interaction is the appearance of new characters in the patient’s narrative that is a barometer of aliveness in the analytic field. Abraham’s (1909) letter to Freud is a fascinating collection of characters: the picture of his parents, the infantile transferences from his patients, and the constipated daughter. Each of these for Ferro and Civitarese (1992) are representatives that carry important meaning in the context of the here-and-now of the session. Ferro views the development of a jointly constructed narrative as the vehicle for transformation of the unconscious elements of analytic field (Ferro, 2009a). He stresses that a chief task of the analyst is to adopt a stance of transformational receptiveness, which means that we must be open to experience what the patient needs us to feel and only then can we use our reverie function to give possible significance to the analysand’s communications. Ultimately, analytic progress depends on
the deep emotional level of the couple, on which the projective identifications are used to establish the emotional foundation which needs to be narrated through the characters and transformed by working through, and which must be shared by way of a story.
(Ferro, 2002, p. 25)
This overview of the ways in which our understanding of countertransference has transformed over the first hundred years of psychoanalytic history brings us to Bion’s theory of transformations. It is a complex theory that moves contemporary analytic thinking away from its prior emphasis on making the unconscious conscious to considering what is unknown and ephemeral; from the importance of understanding the meanings of an analysand’s utterances to a focus on how meaning is created jointly by analyst and patient; a rediscovery of Freud’s (1912) advice that the analyst not have an agenda for the session, now couched as beginning each session “without memory and desire”; from a more panoramic view of following the development of the transference in the course of an analysis to a focus on the individual session as a means of tracking micro-transformations in the evolution of a session; and from an emphasis on drive theory and its derivatives to a near exclusive focus on emotional experience that is alive in the here-and-now of the session. But before exploring the theory of transformations (Chapter 4), we must first discuss Bion’s discovery of alpha function (Chapter 3), which is necessary to fully understand Transformations (1965).
1 Previously published as Brown (2011b) Countertransference. In G. Gabbard, B. Litowitz and H. Smith (Eds.) Textbook of Psychoanalysis, Second Edition. NY: American Psychiatric Publishing. Pp 79–92.
2 In a letter to Jung, Freud (31 December, 1911) wrote “I believe an article on counter-transference is sorely needed; of course we could not publish it, we would have to circulate copies among ourselves” (p. 476), thus expressing an attitude that the analyst’s emotional reactions to the patient were best kept from the public view.
3 I (Brown, 2011, p. 20) have called this comment “the big bang statement from which the universe of intersubjectivity has emanated.”
4 Painful affects cannot literally be placed into an object because they “are not palpable entities with weight and mass to be transferred over a physical distance . . . [and] the notion that something is projected into an object rests upon an understanding of [Klein’s view of] the concrete nature of unconscious phantasy” (Brown, 2011, p. 51).
5 I have earlier cited contributions from London Kleinian analysts (such as Joseph and Brenman Pick) whose techniques in the 1970s were also increasingly aimed at helping the patient see the pressure being placed on the analyst to participate in an interaction that is an externalization of an unconscious internal phantasy template.