Influential Papers from the 1950s

Andrew C. Furman, Steven T. Levy, Andrew C. Furman, Steven T. Levy

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781855759299
• eBook ISBN: 9780429914935
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This volume presents a series of papers that appeared in the International Journal of Psycho-Analysis during the 1950s. It recognizes a turning of psychoanalytic attention from the exploration of the analysand's intra-psychic experience to mapping out equally relevant psychoanalytic concerns.

CHAPTER ONE

Hate in the counter-transference¹

D. W. Winnicott

In this paper I wish to examine one aspect of the whole subject of ambivalency, namely, hate in the counter-transference. I believe that the task of the analyst (call him a research analyst) who undertakes the analysis of a psychotic is seriously weighted by this phenomenon, and that analysis of psychotics becomes impossible unless the analyst’s own hate is extremely well sorted-out and conscious. This is tantamount to saying that an analyst needs to be himself analysed, but it also asserts that the analysis of a psychotic is irksome as compared with that of a neurotic, and inherently so.

Apart from psychoanalytic treatment, the management of a psychotic is bound to be irksome. From time to time I have made acutely critical remarks about the modern trends in psychiatry, with the too easy electric shocks and the too drastic leucotomies. Because of these criticisms that I have expressed I would like to be foremost in recognition of the extreme difficulty inherent in the task of the psychiatrist, and of the mental nurse in particular. Insane patients must always be a heavy emotional burden on those who care for them. One can forgive those who do this work if they do awful things. This does not mean, however, that we have to accept whatever is done by psychiatrists and neurosurgeons as sound according to principles of science.

Therefore although what follows is about psychoanalysis, it really has value to the psychiatrist, even to one whose work does not in any way take him into the analytic type of relationship to patients.

To help the general psychiatrist the psychoanalyst must not only study for him the primitive stages of the emotional development of the ill individual, but also must study the nature of the emotional burden which the psychiatrist bears in doing his work. What we as analysts call the counter-transference needs to be understood by the psychiatrist too. However much he loves his patients he cannot avoid hating them, and fearing them, and the better he knows this the less will hate and fear be the motive determining what he does to his patients.

Statement of theme

One could classify counter-transference phenomena thus:

1. Abnormality in counter-transference feelings, and set relationships and identifications that are under repression in the analyst. The comment on this is that the analyst needs more analysis, and we believe this is less of an issue among psychoanalysts than among psychotherapists in general.

2. The identifications and tendencies belonging to an analyst’s personal experiences and personal development which provide the positive setting for his analytic work and make his work different in quality from that of any other analyst.

3. From these two I distinguish the truly objective counter-transference, or if this is difficult, the analyst’s love and hate in reaction to the actual personality and behaviour of the patient, based on objective observation.

I suggest that if an analyst is to analyse psychotics or anti-socials he must be able to be so thoroughly aware of the counter-transference that he can sort out and study his objective reactions to the patient. These will include hate. Counter-transference phenomena will at times be the important things in the analysis.

The motive imputed to the analyst by the patient

I wish to suggest that the patient can only appreciate in the analyst what he himself is capable of feeling. In the matter of motive; the obsessional will tend to be thinking of the analyst as doing his work in a futile obsessional way. A hypo-manic patient who is incapable of being depressed, except in a severe mood swing, and in whose emotional development the depressive position has not been securely won, who cannot feel guilt in a deep way, or a sense of concern or responsibility, is unable to see the analyst’s work as an attempt on the part of the analyst to make reparation in respect of his own (the analyst’s) guilt feelings. A neurotic patient tends to see the analyst as ambivalent towards the patient, and to expect the analyst to show a splitting of love and hate; this patient, when in luck, gets the love, because someone else is getting the analyst’s hate. Would it not follow that if a psychotic is in a “coincident love–hate” state of feeling he experiences a deep conviction that the analyst is also only capable of the same crude and dangerous state of coincident love-hate relationship? Should the analyst show love he will surely at the same moment kill the patient.

This coincidence of love and hate is something that characteristically recurs in the analysis of psychotics, giving rise to problems of management which can easily take the analyst beyond his resources. This coincidence of love and hate to which I am referring is something which is distinct from the aggressive component complicating the primitive love impulse and implies that in the history of the patient there was an environmental failure at the time of the first object-finding instinctual impulses.

If the analyst is going to have crude feelings imputed to him he is best forewarned and so forearmed, for he must tolerate being placed in that position. Above all he must not deny hate that really exists in himself. Hate that is justified in the present setting has to be sorted out and kept in storage and available for eventual interpretation.

If we are to become able to be the analysts of psychotic patients we must have reached down to very primitive things in ourselves, and this is but another example of the fact that the answer to many obscure problems of psychoanalytic practice lies in further analysis of the analyst. (Psychoanalytic research is perhaps always to some extent an attempt on the part of an analyst to carry the work of his own analysis further than the point to which his own analyst could get him.)

A main task of the analyst of any patient is to maintain objectivity in regard to all that the patient brings, and a special case of this is the analyst’s need to be able to hate the patient objectively. Are there not many situations in our ordinary analytic work in which the analyst’s hate is justified? A patient of mine, a very bad obsessional, was almost loathsome to me for some years. I felt bad about this until the analysis turned a corner and the patient became lovable, and then I realized that his unlikeableness had been an active symptom, unconsciously determined. It was indeed a wonderful day for me (much later on) when I could actually tell the patient that I and his friends had felt repelled by him, but that he had been too ill for us to let him know. This was also an important day for him, a tremendous advance in his adjustment to reality.

In the ordinary analysis the analyst has no difficulty with the management of his own hate. This hate remains latent. The main thing, of course, is that through his own analysis he has become free from vast reservoirs of unconscious hate belonging to the past and to inner conflicts. There are other reasons why hate remains unexpressed and even unfelt as such:

1. Analysis is my chosen job, the way I feel I will best deal with my own guilt, the way I can express myself in a constructive way.

2. I get paid, or I am in training to gain a place in society by psychoanalytic work.

3. I am discovering things.

4. I get immediate rewards through identification with the patient, who is making progress, and I can see still greater rewards some way ahead, after the end of the treatment.

5. Moreover, as an analyst I have ways of expressing hate. Hate is expressed by the existence of the end of the “hour”.

I think this is true even when there is no difficulty whatever, and when the patient is pleased to go. In many analyses these things can be taken for granted, so that they are scarcely mentioned, and the analytic work is done through verbal interpretations of the patient’s emerging unconscious transference. The analyst takes over the role of one or other of the helpful figures of the patient’s childhood. He cashes in on the success of those who did the dirty work when the patient was an infant. These things are part of the description of ordinary psychoanalytic work, which is mostly concerned with patients whose symptoms have a neurotic quality.

In the analysis of psychotics, however, quite a different type and degree of strain is take by the analyst, and it is precisely this different strain that I am trying to describe.

Illustration of counter-transference anxiety

Recently for a period of a few days I found I was doing bad work. I made mistakes in respect of each one of my patients. The difficulty was in myself and it was partly personal but chiefly associated with a climax that I had reached in my relation to one particular psychotic (research) patient. The difficulty cleared up when I had what is sometimes called a “healing” dream. (Incidentally I would add that during my analysis and in the years since the end of my analysis I have had a long series of these healing dreams which, although in many cases unpleasant, have each one of them marked my arrival at a new stage in emotional development.)

On this particular occasion I was aware of the meaning of the dream as I woke or even before I woke. The dream had two phases. In the first I was in the gods in a theatre and looking down on the people a long way below in the stalls. I felt severe anxiety as if I might lose a limb. This was associated with the feeling I have had at the top of the Eiffel Tower that if I put my hand over the edge it would fall off on to the ground below. This would be ordinary castration anxiety.

In the next phase of the dream I was aware that the people in the stalls were watching a play and I was now related to what was going on on the stage through them. A new kind of anxiety now developed. What I knew was that I had no right side of my body at all. This was not a castration dream. It was a sense of not having that part of the body.

As I woke I was aware of having understood at a very deep level what was my difficulty at that particular time. The first part of the dream represented the ordinary anxieties that might develop in respect of unconscious fantasies of my neurotic patients. I would be in danger of losing my hand or my fingers if these patients should become interested in them. With this kind of anxiety I was familiar, and it was comparatively tolerable.

The second part of the dream, however, referred to my relation to the psychotic patient. This patient was requiring of me that I should have no relation to her body at all, not even an imaginative one; there was no body that she recognized as hers and if she existed at all she could only feel herself to be a mind. Any reference to her body produced paranoid anxieties because to claim that she had a body was to persecute her. What she needed of me was that I should have only a mind speaking to her mind. At the culmination of my difficulties on the evening before the dream I had become irritated and had said that what she was needing of me was little better than hair-splitting. This had had a disastrous effect and it took many weeks for the analysis to recover from my lapse. The essential thing, however, was that I should understand my own anxiety and this was represented in the dream by the absence of the right side of my body when I tried to get into relation to the play that the people in the stalls were watching. This right side of my body was the side related to this particular patient and was therefore affected by her need to deny absolutely even an imaginative relationship of our bodies. This denial was producing in me this psychotic type of anxiety, much less tolerable than ordinary castration anxiety. Whatever other interpretations might be made in respect of this dream the result of my having dreamed it and remembered it was that I was able to take up this analysis again and even to heal the harm done to it by my irritability which had its origin in a reactive anxiety of a quality that was appropriate to my contact with a patient with no body.

Postponement of interpretation

The analyst must be prepared to bear strain without expecting the patient to know anything about what he is doing, perhaps over a long period of time. To do this he must be easily aware of his own fear and hate. He is in the position of the mother of an infant unborn or newly born. Eventually, he ought to be able to tell his patient what he has been through on the patient’s behalf, but an analysis may never get as far as this. There may be too little good experience in the patient’s past to work on. What if there be no satisfactory relationship of early infancy for the analyst to exploit in the transference?

There is a vast difference between those patients who have had satisfactory early experiences which can be discovered in the transference, and those whose very early experiences have been so deficient or distorted that the analyst has to be the first in the patient’s life to supply certain environmental essentials. In the treatment of the patient of the latter kind all sorts of things in analytic technique become vitally important that can be taken for granted in the treatment of patients of the former type.

I asked an analyst wh...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• SERIES PREFACE
• ABOUT THE EDITORS
• Introduction
• CHAPTER ONE Hate in the counter-transference
• CHAPTER TWO On counter-transference
• CHAPTER THREE Counter-transference and the patient’s response to it
• CHAPTER FOUR A contribution to the problem of counter-transference
• CHAPTER FIVE Normal counter-transference and some of its deviations
• CHAPTER SIX On counter-transference
• CHAPTER SEVEN Current concepts of transference
• CHAPTER EIGHT Attacks on linking
• CHAPTER NINE Notes on symbol formation
• CHAPTER TEN Autism and symbiosis, two extreme disturbances of identity
• CHAPTER ELEVEN New beginning and the paranoid and the depressive syndromes
• CHAPTER TWELVE On transference
• CHAPTER THIRTEEN Transitional objects and transitional phenomena—a study of the first not-me possession
• CHAPTER FOURTEEN The nature of the child’s tie to his mother
• CHAPTER FIFTEEN Some remarks on the role of speech in psycho-analytic technique
• CHAPTER SIXTEEN Some reflections on the ego