Countertransference

Theory, Technique, Teaching

Athina Alexandris, Grigoris Vaslamatzis, Athina Alexandris, Grigoris Vaslamatzis

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367104627
• eBook ISBN: 9780429912337
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

A collection of papers on the Oedipus complex, divided into three parts: theory, practice and supervision. The contributors, who include Joyce McDougall, Hanna Segal, Otto Kernberg and Leon Grinberg, invite the reader to explore with them the processes affecting the therapist's mind - and, occasionally his body - during psychoanalytic therapy, and the reasons why the therapist thinks, feels, and reacts in a particular way. The full significance of these processes, referred to as "counter-transference" since Freud's time, has recently been recognized, resulting in the therapist's use of additional resources so that he or she can understand and help the patient more effectively. In the 1950s and 1960s, Paula Heimann and Heinrich Racker, following on Freud's own observations, made important contributions to the study of the countertransference, considerably enlarging upon the concept and re-evaluating the nature of the psychoanalytic therapeutic relationship as a result.

PART ONE

COUNTERTRANSFERENCE: THEORETICAL AND TECHNICAL ASPECTS

CHAPTER ONE

Countertransference

Hanna Segal

As analysis developed, transference, at first considered a major obstacle in treatment, came to be seen as the fulcrum on which the psychoanalytic situation rests. Similarly, countertransference, first seen as a neurotic disturbance in the psychoanalyst, preventing him from getting a clear and objective view of the patient, is now increasingly recognized as a most important source of information about the patient as well as a major element of the interaction between patient and analyst. In her pioneering paper on the subject, Paula Heimann (1950) drew attention to the fact that, though not recognized as such, countertransference had always been a guide in psychoanalytical work. She suggested that Freud’s discovery of resistance was based on his countertransference, his feeling that he was meeting a resistant force in the patient. Once our attention is drawn to it, this view of countertransference seems almost obvious.

To take a single example. I had a patient who evoked in me a whole gamut of unpleasant feelings. It would have been very foolish of me to ignore these feelings or consider them my own neurotic reactions, since this patient’s principal complaint was her terrible unpopularity. Obviously, the way she affected me was a function of her psychopathology—a function of utmost importance to her, and one that it is crucial for us to understand.

This view of countertransference as a function of the patient’s personality is not universally accepted. It is still often contended that ideally countertransference should be eliminated, though it is recognized that in practice this might not be possible. On the other hand, the view of countertransference as an important part of the psychoanalytic process is widely recognized. The literature on the subject is far too vast to discuss in this short paper, but, to mention only a few, there are papers on the subject by Winnicott (1949), Money-Kyrle (1956), León Grinberg (1962), and a book by Heinrich Racker (1968). Many authors simply take countertransference for granted and describe the uses to which they put it, as Bion (1967) does in his account of his work with psychotics.

Our changing views on countertransference are, in part, related to changes in our views on transference. Originally, the analyst was seen as a mirror onto which the patient projects his internal figures and to whom he then reacts. As Enid Balint put it succinctly in a paper read in the British Society, “We now have a more three-dimensional view of the transference”. We do not think of the patient projecting onto but, rather into the analyst. This view assumes that transference is rooted in primitive pre-verbal infantile experience and is consistent with the Kleinian concept of projective identification. We see the patient not only as perceiving the analyst in a distorted way, reacting to this distorted view, and communicating these reactions to the analyst, but also as doing things to the analyst’s mind, projecting into the analyst in a way that affects the analyst.

We are all familiar with the concepts of acting in, which can happen in quite a gross way: I speak here, however, not of gross acting but of something constantly present—a non-verbal constant interaction in which the patient acts on the analyst’s mind. This non-verbal activity takes many forms. It may be underlying and integrated with other forms of communication, giving them depth and emotional resonance. It may be the predominant form of communication, coming from pre-verbal experiences that can only be communicated in that way. Or it may be meant as an attack on communication; though when understood, even this can be converted into communication. Of course, all communication contains an element of desire for action. We communicate in order to produce some effect on the other person’s mind; but the degree to which action occurs, whether non-verbal or apparently verbal (using words to act rather than to communicate), varies enormously from situation to situation and patient to patient. As a general rule, the nearer we are to the psychotic processes, the more this kind of acting takes precedence over symbolic or verbal communication. If we look at transference in this way, it then becomes quite clear that what Freud describes as free-floating attention refers not only to intellectual openness of mind, but also to a particular openness of feelings—allowing our feelings, our mind to be affected by the patient to a far greater degree than we allow ourselves to be affected in normal social intercourse—a point stressed by Paula Heimann (1950).

By speaking of these free-floating feelings in the analyst, am I saying that there is no difference between transference and countertransference? I hope I am not saying anything of the kind, because at the same time as the analyst is opening his mind freely to his impressions, he has to maintain distance from his own feelings and reactions to the patient. He has to observe his own reactions, to conclude from them, to use his own state of mind for the understanding of the patient but at no point be swayed by his own emotions. The analyst’s capacity to contain the feelings aroused in him by the patient can be seen as an equivalent to the function of a mother containing the infant’s projections, to use Bion’s model (1967). Where the parents react instinctively, however, the analyst subjects his state of mind to an examination—a reflection, albeit much of the time preconscious.

In the past we have thought of an ideal analyst as cold, objective, having no feelings, etc. Am I presenting here, in the analyst’s perfect containment, a similarly unattainable ideal? I think so. This would be an idealization of the analyst’s capacity. In fact, this capacity for containment can be breached in many ways. There is a whole area of the patient’s pathology (I am ignoring for the moment the analyst’s pathology), which specifically aims at disrupting this situation of containment, such as invasion of the analyst’s mind in a seductive or aggressive way, creating confusion and anxiety, and attacking links in the analyst’s mind. We have to try to turn this situation to good account and learn about the interaction between the patient and ourselves from the very fact that our containment has been disturbed. It is from such disturbances in the analyst’s capacity to function that one first gets an inkling of such psychotic processes as, for instance, attacks on links, again a subject with vast literature.

There is a particular countertransference difficulty (described also by Grinberg [1962] as projective counteridentification) produced by some patients who, as infants, have themselves been subjected to heavy parental projections. I shall give an example here from the second session with a patient—a mild example of the kind of thing I have in mind. In the first session the patient had spoken about the various ways in which she felt she had been a great disappointment to her parents and to herself. In the following session she seemed extremely depressed, spoke in a hardly audible voice, and went on at fairly great length describing how terrible she felt. She was depressed, she felt dead, terribly weak, she had an awful headache, perhaps it was due to her period which was about to start. The session went on for a time, and I felt unduly affected by it. I wondered whether I had done something wrong in the previous session. I felt helpless and very eager to understand her. In answer to a question the patient said that, no, she did not usually have headaches with her periods, but her mother had that symptom. I knew that at that point the patient was identifying with her mother, but somehow this knowledge did not help, and I felt that there would not be much point in interpreting it to her. I was more puzzled by my own overreaction and slowly came to realize that now I felt that I was a disappointment both to her and to myself. I was in the position of a helpless and rather bewildered child, weighed down by projections coming from a depressed mother, and it was an interpretation emphasizing that aspect which produced a change in the situation.

Later on the patient related that she had perfect pitch, but that although she was trained and encouraged and apparently gifted enough to become a soloist, she could never do it and so had specialized as an accompanist. When she was a child, her mother sang, and she used to accompany her on the piano. It seemed to me that this patient had developed perfect pitch for her mother’s depression and found a way of getting on with her some of the time, but only as an accompanist. I also understood that my quite unwarranted concern in the second session that I did not understand my patient perfectly arose because, somehow, she managed to make me feel, right at the start, that I must now be the child with the perfect pitch. I shall return to the problem of the perfect pitch. This situation can be compared and contrasted with a much more violent though similar one.

The patient mentioned earlier, who complained of unpopularity, was particularly able to disrupt my capacity to function. The experience of closeness with her has been an experience of almost unceasing discomfort or pain. She has evoked anxiety, confusion, guilt, anger, irritation; occasions on which I felt more relaxed were dangerous. I was immediately and unexpectedly assaulted in some way or other. Her stream of accusations was almost incessant. This patient is the child of parents who had hated one another at the time of her birth. So far as I can reconstruct, from infancy on she was flooded with extreme anxiety by her mother (an anxiety neurotic) and with the hatred derivative of her mother’s hatred for her father. The father, on the other hand, a near psychotic, flooded her with either aggressive accusations or gross sexuality. She described how once she was older and her parents divorced, her father would pour accusations and complaints about her mother at her and how, when she was with her mother, the mother on a few occasions pinned her to the armchair and made her listen to violent attacks on the father. This latter situation probably reproduced what was originally a non-verbal but violent experience of projection from both parents. In the countertransference, it may be this experience that she tried to inflict on me, often with success. I frequently felt with her that I was pinned into my armchair and forced to listen to violent outpourings of accusations against some third person. I felt attacked; I did not want to hear them, and could not defend myself against them. The experience is not that of a parent bombarded by infantile projections, but of an infant bombarded by overpowering projections, often beyond its understanding. This lends to the countertransference feelings of a particular kind of helplessness, and there is always a danger of reacting by withdrawal, omnipotence, hatred of the patient, etc.—in other words, of mobilizing our own infantile defences against helplessness. We are all familiar, of course, with patients reversing roles and putting us in the position of a helpless child. But here I think is an infrequent added dimension. This patient is a borderline case, and her method of projecting infantile experiences into the analyst may be what protects her from psychosis.

The cases of these two patients may be compared and contrasted. From the “unpopular” patient it is exceedingly difficult to obtain any kind of non-destructive communication. In defending herself against projections, she projects violence and in turn experiences her objects as projecting it back in a vicious circle of increasing distress and violence. The first patient, the one with the perfect pitch, had obviously developed some kind of satisfactory communication with her mother, albeit one based on a split and at great cost to her own personality (becoming an accompanist).

But I knew that her perfect pitch would cause other big problems. One was her expectation, projected into me, that I, too, should have perfect pitch (hence my discomfort in the second session). Another was the early indication of her perfect pitch in relation to me. In the third session she spotted some minor change in my expression—one unnoticed by other patients. If we think of the transference/countertransference situation as an interaction, we must take into account that the patient’s perceptions of us are not all projections. Patients do, indeed, react to aspects of our personalities, changes of mood, etc., whether these are a direct response to their material or come from some other source, and patients with perfect pitch present a particular problem in that way. I think this perfect pitch is a function of the patient’s dependence. It is the extremely dependent patient who develops an unusual sensitivity to the slightest change in the analyst’s attitude. Usually, the pitch is only selectively perfect. We are all familiar with the misleading perfect pitch of the paranoid patient, who most correctly perceives anything negative and is totally blind to any evidence of positive attitudes, or with that of the depressive patient, who is most sensitive to any sign of weakness or illness. Be that as it may, one must be aware of the patient’s pitch, or responsiveness to what comes from us, and not deny it in ourselves. I am not advocating here breast-beating or confessions of countertransference, just awareness of the nature of the interaction and recognition of it in the interpretation.

Of course, all this is easier said than done. I have noticed that when people speak of transference, they recognize that the major part of the transference is unconscious, while, when speaking of countertransference, they apparently speak as though countertransference referred only to the analyst’s conscious feelings. Of course, the major part of the counter-transference, like the transference, is always unconscious. What we do become aware of are conscious derivatives. The way I visualize it is that at depth, when our countertransference is, say, in a good functional state, we have a dual relation to the patient: one is receptive, containing and understanding the patient’s communication; the other is active, producing or giving understanding, knowledge, or structure to the patient in the interpretation. It might be analogous to the breast as containing and the nipple as feeding, or to the maternal/paternal functions. This does not exclude our own infantile experience, since our capacity to perceive and contain infantile parts of the patient depends on our capacity to contain the infant part of ourselves. We must not, however, equate that analytic function with the parental function. We give over part of our mind to this experience with the patient, but we also remain detached from it as professional analysts, using professional skills to assess the interaction between the patient and the parental parts of ourselves. In other words, we are deeply affected and involved but, paradoxically, uninvolved in a way unimaginable between an actual good parent and a child. When our countertransference works that way, it gives rise to a phenomenon called empathy or psychoanalytic intuition or feeling in touch. It is a guide to understanding. When breaches in this attitude occur, we become aware of disruption in our analytic functioning, and we must, in turn, try to understand the nature of the disruption and the information it gives us about our interaction with the patient. When such disruptions occur, there is always an internal pressure to identify with our countertransference, and it is very important to be aware that countertransference is the best of servants but the worst of masters, and that the pressure to identify with it and act it out in ways either obvious or very subtle and hidden is always powerful.

Countertransference has become a very abused concept, and many analytic sins have been committed in its name. In particular, rationalizations are found for acting under the pressure of countertransference, rather than using it as a guide to understanding. I often find myself telling supervisees that countertransference is no excuse; saying that the patient “projected it into me”, or “he made me angry”, or “he put me under such seductive pressure” must be clearly recognized as statements of failure to understand and use the countertransference constructively. I do not contend here that we must—or, indeed, can—be perfect, merely that we will not learn from our failures unless we clearly recognize them as such.

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Reprinted by permission from Hanna Segal, ‘Countertransference’. In: The Work of Hanna Segal (North Vale, NJ: Jason Aronson, 1981).

CHAPTER TWO

The analytic management and interpretation of projective identification

Thomas H. Ogden

Projective identification is not a metapsychological concept. The phenomena it describes exist in the realm of thoughts, feelings, and behaviour, not in the realm of abstract beliefs about the workings of the mind. Whether or not one uses the term or is cognizant of the concept of projective identification, clinically one continually bumps up against the phenomena to which it refers—unconscious projective fantasies in association with the evocation of congruent feelings in others. Resistance on the part of therapists and analysts to thinking about these phenomena is understandable: it is unsettling to imagine experiencing feelings and thinking thoughts that are in an important sense not entirely one’s own. And yet, the lack of a vocabulary with which to think about this class of phenomena seriously interferes with the therapist’s capacity to understand, manage, and interpret the transference. Projective identification is a concept that addresses the way in which feeling-states corresponding to the unconscious fantasies of one person (the projector) are engendered in and processed by another person (the recipient)—that is, the way in which one person makes use of another person to experience and contain an aspect of himself. The projector has the primarily unconscious fantasy of getting rid of an unwanted or endangered part of himself (including internal objects) and of depositing that part in another person in a powerfully controlling way (Klein, 1946, 1955). The projected part of the self is felt to be partially lost and to be inhabiting the other person. In association with this unconscious projective fantasy there is an interpersonal interaction by means of which the recipient is pressured to think, feel, and behave in a manner congruent with the ejected feelings and the self—and object—representations embodied in the projective fantasy (Bion, 1959; Ogden, 1979). In other words, the recipient is pressured to engage in an identification with a specific, disowned aspect of the projector.

The recipient may be able to live with such induced feelings and manage them within the context of his own larger personality system—for example, by mastery through understanding or integration with more reality-based self-representations. In such a case, the projector may constructively reinternalize by introjection and identification aspects of the recipient’s handling of the induced feelings. On the other hand, the recipient may be unable to live with the induced feelings and may handle such feelings by means of denial, projection, omnipotent idealization, further projective identification, or actions aimed at tension relief, such as violence, sexual activity, or distancing behaviour. In these cases the projector would be confirmed in his belief that his feelings and fantasies were indeed dangerous and unbearable. Through identification with the recipient’s pat...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgements
• Preface
• Introduction
• Part One Countertransference: Theoretical and Technical Aspects
• Part Two Clinical Illustrations of Countertransference: Theoretical and Technical Considerations
• Part Three Aspects of Countertransference–Transference Interaction in Supervision
• References
• Index