Transference and Countertransference

Heinrich Racker

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429923203
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book presents a classic examination of transference phenomena and focuses on the development of psychoanalytic technique and theory. It addresses a perceived gap between psychoanalytic knowledge and its capacity to effect psychological transformation in a patient.

1

Psycho-Analytic Technique¹

The subject of this address is the technique of psycho-analysis. I do not think it necessary to give an extensive explanation of the choice of the subject. Not only for analysts, but also for physicians in general, for educationists, and for any person who in some way must‘practise psychology’—as for instance parents must do with their children or children with their parents—it is important to know the principles on which psycho-analysis is based, and the methods which lead to the internal and external changes that this technique pursues. But even for the person who does not practise psychology actively in any sense (supposing that such a person exists), even for the one who only suffers passively the ‘practice of psychology’ by others, as the patient might at times consider himself, the subject is of interest. Anyone submitting to a surgical intervention will want to know what will be done to him and how this will be done. But in psycho-analysis such curiosity is still more legitimate and even indicated, for in reality it is not a merely passive experience; the analyst is not the only one who ‘operates’; the patient has to ‘co-operate’. And to this end it is useful lor him to know what is the method and what is the aim of this ‘operation’.

Interest in a topic implies the wish to know its past, its present, and its future. Let us consider, first, the history of psycho-analytic technique. You probably know that during the nineteenth century, mental illnesses, neuroses, and other phenomena, which nowadays we understand as being psycho-logical or psychogenic disorders, were then considered to be organic disorders, or more precisely, expressions of a ‘degeneration’ of the nervous system, the only cause of which was heredity. The depreciative tinge that the term ‘hereditary degeneration’ usually has for us, was also true for those times. Neuroses do not seem to have awakened the affection of physicians, but rather their distrust and rejection. Hysteria, for instance, was considered, more than anything, to be ‘simulation’ and ‘theatre’. Possibly such an attitude arose largely from the anxiety which the perception of his impotence regarding neuroses originated in the physician, given his lack of understanding. Vice-versa, anxiety and contempt undermined the latent disposition and capacity to understand something of psychopathological phenomena. Thus, the situation constituted a vicious circle in which Freud made the decisive breach by approaching these problems in another spirit, free of anxiety, rejection, and prejudice; desirous to discover the unknown, and endowed with the psychological and scientific capacity of a genius.

I must cite, now, some facts about the prehistory of psycho-analysis which represent something like the milestones on the road to analytic technique. In the year 1885, Freud, who was then 29 years old, travelled to Paris to study nervous illnesses with Charcot, the first to consider hysterical phenomena seriously. There Freud took note of the fact that hysterical paralyses can be produced by suggestion, in a hypnotic state, from which it is deduced that these paralyses are the result of mental representations. A little later, having already returned to Vienna, Freud received the news that two other French physicians, Liébeault and Bernheim, obtained good therapeutic results with hysterics, by means of suggestion, predominantly with hypnosis. In his work with ‘nervous patients’, Freud abandoned electrotherapy, the partial successes of which were soon understood as being successes of the physician’s suggestion, and used the hypnotic-suggestive method more and more. This method consisted in giving orders to patients put into a hypnotic state, which must counteract the manifestation of the pathological symptoms. The method is successful in a certain number of cases, but it is unstable—the symptoms reappear— and not applicable to those who cannot be hypnotized.

Moreover, Freud remained unsatisfied with this method due to the fact that it taught him nothing about the origin of the illness. That is why he continued his search for another road. Before Freud went to Paris, a friend, the physician Joseph Breuer, had told him of an experience with one of his patients, Anna O ..., who had suffered from hysterical paralyses and from serious confusional states. On one occasion Breuer casually observed that the patient was freed of her mental disturbance when she could express verbally the fantasies and affects which were dominating her. Subsequently Breuer based his therapeutic method with this patient on that observation: he placed her under hypnosis and made her tell him what was affecting her. The patient who knew nothing of the origin of her illness while awake, found the link between her symptoms and experiences under hypnosis. The symptoms mainly derived from feelings and thoughts which had emerged within her while she was taking care of her ill father, and which she had suppressed. Afterwards the symptoms had appeared in their place. When the patient, under hypnosis, remembered those experiences in a hallucinatory form and discharged the suppressed feelings, the symptoms disappeared. This method of ‘abreacting’ affects was known as the cathartic method.

Freud adopted this method and some years later, together with Breuer, published the book Studies on Hysteria, in which the two authors state their observations and conclusions. The description of the various difficulties and disadvantages of the hypnotic method is also found in it; for instance, the fact that deep hypnosis could only be reached in a limited number of patients. These difficulties were the main incentive which stimulated Freud to search for a technique which would dispense with hypnosis. In this search he was helped by the recollection of an experiment that Bernheim had made with one of his patients, and which Freud had witnessed. At first the patient remembered nothing of what had happened during his hypnotic state; but Bernheim insisted tenaciously that he should remember, and little by little, and part by part, the patient recalled what had happened. This meant that even those experiences which appear to be totally unconscious can be restored to consciousness, and this even without hypnosis, since that patient remembered them awake. Based on this experience Freud began to give up hypnosis and in its place he urged his patients to remember the forgotten or ‘repressed’ experiences. At the same time, and step by step—and this was decisive for the subsequent change in his technical procedure—Freud began to understand the dynamic processes, that is to say, the interplay of psychological forces and tendencies, which had caused the forgetting or ‘repressions’, the difficulties in remembering or rendering conscious the unconscious being due to these pro-cesses. Freud discovered, in particular, that a force or tendency exists which opposes recollection, which tends to maintain repression, and which therefore also opposes the physician’s attempts to induce the patient to remember. Freud called this forceresistance, and this discovery led him to the next decisive technical change.

He soon understood that resistance arose, above all, from the fact that what should be remembered was painful for the patient, embarrassed him, or was contrary to his moral feelings. The comprehension of the diverse forms in which the resistance expressed itself was equally important for the subsequent change of technique. The patients kept silent about certain recollections, adducing, for instance, that these—or what in their regard occurred to them during the session—lacked importance or sense. Freud understood that the patients’ objections were nothing more than a disguise of the resistance, and the occurrences which appeared in such a disguise were, precisely, the recollections sought, or at least showed the way towards them. The following technical step consisted, thus, in abandoning the ‘technique of insistence’ (with which some measures of suggestion were also linked, like placing the hand on the patient’s forehead to aid concentration, etc.); and in its place setting up a rule for the patient which should determine his conduct in the treatment, the patient engaging himself to obey the rule. This ‘fundamental rule,’ which represented the basis of the treatment consisted in the patient’s communicating all his thoughts to the physician, telling him every occurrence, without omitting anything, however painful, or apparently senseless or unimportant, or out of place. Thus the patient should watch that no internal objection, no self-criticism should keep him from communicating every thought that occurred; he was to say everything without selection, surrendering fully to free association.

What I have summarized here in a few words was the result —one of the many results — of a long and arduous investigation which led Freud to the basic understanding of the causes of neuroses. The analytic technique, above all the substitution of the hypnotic and suggestive method by the one of free association, issued from this understanding. The basic understanding was that neuroses are due to an internal conflict, an irreconcilability or intolerance between different parts of the personality, and especially between the moral and social part on the one hand, and the instinctive and egoistic part on the other. I say ‘especially’ because this conflict has not been and is not considered as the only one. Furthermore, the struggle against one’s own instincts did not at the beginning appear as the main cause (although it had already been pointed out in Freud’s first papers); for Freud at one time considered certain passively suffered experiences, as for instance seduction at an early age, ‘traumatic’ experiences, as the decisive factor in the aetiology of neuroses. The recollection and ‘abreaction’ of these experiences which constituted ‘the repressed’ above all, was what should lead to the cure. This external factor and the early ‘trauma’ also maintained their importance later on, but Freud gradually discovered the child’s autonomous instinctive life, and the conflicts with one’s own infantile instincts showed themselves to be the principal factor in the genesis of neuroses. One’s own sexual and aggressive impulses were, therefore, those which above all constituted ‘the repressed’, and their ‘recollection’ and ‘rendering conscious’ should lead to the cure.

Thus, technique was based on this understanding. The patient was supposed to associate freely, abolishing any rejection of his own thoughts, and in this manner all that had been rejected from consciousness should reappear. In general, what actually appears is no longer the repressed properly speaking, but derivatives of those infantile conflicts, more superficial and more acceptable expressions of them. The patient does not usually remember that he had sexual desires towards his mother, but he does remember—and with equally intense feelings of guilt—that, for instance, he desired the wife of an older friend, etc. The analyst’s function, thus, was to guess, through the free associations (through these ‘derivatives’), the repressed infantile impulses, and to communicate what he had guessed to the patient. Dreams constituted an especially opportune access to the repressed, since in them—due to the decrease of moral and logical censorship during sleep—the infantile conflicts were shown with greater clarity. Freud expected that communicating the repressed to the patient would put an end to the alienation between the ego and the instincts, the ultimate cause of neurosis. In this manner the interpretation of infantile impulses became the therapeutic instrument par excellence.

But Freud’s expectation was fulfilled only up to a certain degree. Patients listened to interpretations, but their content frequently continued to be experienced as alien to the ego; they then could not recognize what the analyst told them as something belonging to themselves, and the rendering conscious of what was repressed and with it the integration of the personality, was not produced. Freud soon understood that this was due to the fact that resistances continued, and rendering conscious the unconscious was made impossible. Before communicating the patient’s repressed impulses to him, therefore, the resistances had to be overcome. How could he do this? Again, by understanding and pointing out the manifestations of their resistances, their ways of acting, and their motives.

And just as the investigation of the repressed had led to the discovery of a whole world of impulses, fantasies, and feelings which from earliest infancy act upon the human psyche, so, also, the investigation of the resistances led to the discovery of a multitude of facts and processes, and especially of a series of internal action or ‘mechanisms’ which the psyche effects in its need to reject those impulses, rejection which in the treatment is expressed, precisely, as ‘resistances’ to analysis; for instance, superficially, as resistance to the communication of one’s thoughts or to the acceptance of the interpretation of the ‘repressed’. I cannot enter, here, upon a detailed description of this other part of the world which had been discovered, and must limit myself to what is necessary for the meaning of the interpretation of the resistance to be clear, which, as you already know, must precede the interpretation of the repressed impulses, or be linked with it. Thus, above all, it is a matter of showing how the ego rejects the impulses and also why it does so. We have already said something about the latter. To admit that one has certain desires or fantasies is experienced with shame, with a sensation of humiliation, or of contemptibility, with feelings of guilt, with fear of punishment, or, in more general terms, it is experienced with pain or anxiety. As a defence against these disagreeable sensations the ego rejects such desires and fantasies from consciousness. A beautiful example of such happenings is already found in a work of Nietzsche, who — like some other philosophers and poets — had intuitively anticipated some of the psycho-analytic discoveries, although in an isolated way. In Beyond Good and Evil the following aphorism is found: ‘ “I have done this,” says my memory. “I cannot have done it,” says my pride, and remains relentless. Finally memory yields.’

The different ways in which the ego achieves rejection arc called the defence mechanisms, since in the last instance the purpose is to defend against a fantasied danger to the ego or to the object. Repression—that is to say, the exclusion of a psychological content from consciousness by means of a ‘counter-cathexis’ —is only one of these mechanisms. Projection(to place outside and assign to another person what belongs to oneself), introjection(to take and assign to oneself what belongs to another person), isolation of ideas from their corresponding affects,regression to preceding stages of evolution, are others of the many defence mechanisms. In their entirety they express themselves as resistances to analysis, since the function and tendency of the latter is to integrate the personality, that is to say, to show as pertaining to the self what belongs to it, annulling the pathological defences. In the measure in which these arc overcome the patient can feel and admit the instinctual desires and fantasies as belonging to the ego, and can be cured. With the interpretation of the resistances and of the rejected impulses the analyst’s technical task would thus be fulfilled.

Nevertheless, things turned out to be more complex. New and unexpected phenomena appeared during the treatment. It occurred that while Freud was engaged in interpreting the resistances and the repressed impulses and experiences of the past, the patients, who up to a certain moment had collaborated in this task, lost interest in the past and turned towards the present, a very definite present which was none other than the person of Dr Sigmund Freud himself. One of his patients, for instance, threw her arms about his neck in the middle of analytic work, and only the entrance of a servant saved him from the difficulties inherent in this embarrassing situation. Other patients also demanded his love in various ways, in its sexual expression or in a sublimated form. Freud easily conquered the temptation to assign these amorous successes to his own irresistibility; he suspected other causes and discovered a phenomenon soon destined to have the greatest importance in analytic therapy, namely the transference. Not only female patients but men too changed their attitude towards the treatment and the therapist. For instance, after a period of collaboration they frequently started to become rebellious towards Freud, and it was more important to them to be right, to owe him nothing, and to show him his impotence, than to be cured.

What was this phenomenon and what was its cause? To begin with, the appearance of erotic or hostile desires and feelings towards him upset and interfered with the analytic work, and what disturbed this work was usually an expression of the resistance. Attentive observation of when those feelings emerged confirmed his suspicion, for it was regularly at a moment in which the investigation of the past reached a sensitive point, one of the intensely repressed infantile psychological complexes. Instead of remembering this complex, the patient reproduced some feeling contained in it, and referred it— ‘through a mistaken mental connexion’ — to the person of the physician. With this observation Freud had obtained two most important understandings of this phenomenon: firstly that it was an expression of the resistance, and secondly that these feelings were a displaced repetition of older ones, pertaining to the emotional infantile complexes, that is to say, originally directed to the first objects — usually the parent and siblings—of love and hate, desire and fear. The impulses and feelings directed towards the analyst were, thus, transferred from the original objects. Hence Freud denominated ‘transference’ the entirety of the patient’s psychological phenomena and processes referred to the analyst and derived from other, previous object relations.

The phenomenon of the transference, which at first seemed to be a disturbing factor only, soon showed itself to be a highly valuable and even indispensable element of analytic work. First of all, Freud understood that the disposition to collaborate, the faith in the physician’s work, was also an expression of the old feelings of affection for, and faith in, the parents; it was a transference of ‘positive’ feelings, it was ‘positive sublimated transference’, inasmuch as the erotic impulse appeared in its sublimated form, that is, as affection and esteem. But the sexual and the ‘negative’ transference (inasmuch as the ‘negative’ feelings of hostility, distrust, contempt, etc., predominated) also showed themselves to be very useful for analytic work, since they represented a re-edition of infantile impulses and feelings, processes and ‘complexes’. The task of overcoming repressions, of analysing and conquering the diverse defence mechanisms could be realized in these re-editions of past experiences in the same way as in the recollection of childhood itself. What is more, experience showed that a considerable quantity of these recollections could not be evoked vividly, the original experiences not being sufficiently accessible to memory; but they could be restored to consciousness by means of their repetition •or ‘revival’ in the transference. Consequently, some years after discovering it, Freud (1912) considered that the decisive battles for the recuperation of mental health are fought on the field of the transference. He counsels analysts to ‘concentrate all of the patient’s libido in the transference’, and to free him of his repressions through the analysis of his psychic relations to the analyst in which all his infantile conflicts return. If this is achieved, Freud says, the patient remains free of repressions in his other relationships too, once the analysis is terminated.

This ‘concentration of the libido in the transference’ thus represents a matter of cardinal interest. A large part of that ‘concentration’ is spontaneously produced, another part is not, but constitutes an important technical task. The spontaneous concentration of libido in the relation to the analyst is due to various factors. Freud has emphasized three: first, the ‘repetition compulsion’; second, the libidinal need (i.e. the desire to find in the analyst a father or a mother who gives to the patient the satisfactions which the original parents had not given him); and third—as we already know—the resistance which leads to the appearance of old desires and conflicts in the relation to the analyst as a defence against the anxiety which the analytic work creates. There are other factors which condition the spontaneous concentration of libido in the transference, which I discuss in Chapter 3. Regarding the ‘concentration of libido’ as a technical task, it may possibly shock you that an affective relation of ...