Transference

Shibboleth or Albatross?

Joseph Schachter

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9780881633238
• eBook ISBN: 9781134903498
• Edition: 1
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

The theory of transference and the centrality of transference interpretation have been hallmarks of psychoanalysis since its inception. But the time has come to subject traditional theory and practice to careful, critical scrutiny in the light of contemporary science. So holds Joseph Schachter, whose Transference: Shibboleth or Albatross? undertakes this timely and thought-provoking task.After identifying the weaknesses and inconsistencies in Freud's original premises about transference, Schachter demonstrates how contemporary developmental research across a variety of domains effectively overturns any theory that posits a linear deterministic relationship between early childhood and adult psychic functioning, including the adult patient's treatment behavior toward the analyst. No less trenchantly, he shows how contemporary chaos theory complements developmental research by making the very endeavor of historical reconstruction - of backward prediction - suspect on logical grounds. Nor, Schacter continues, does the clinical evidence normally adduced in support of transference theory provide the firm bedrock of data that most analysts suppose to exist. What one finds, he holds, are endlessly reiterated claims of identifying determining historical antecedents sustained only by descriptions of current behaviors through a gloss of theory.Less a polemic than a call to order, Transference: Shibboleth or Albatross? is cogently argued and straightforwardly written. It is destined to be a thorn in the side of analysts who resist change and a spur to those who seek to bring analytic theory into closer alignment with contemporary science in the interest of improves treatment efficacy.

1

Transference and the Psychoanalytic Identity

Valentine: “It’s the best possible time to be alive, when almost everything you thought you knew is wrong.”

—Tom Stoppard, Arcadia

Tradition, to Tevye, the poor, worshipful, God-fearing Everyman in Fiddler on the Roof, was sacred and beautiful. So it was to Jack Streit, who provides a telling analogy for psychoanalysts’ attitudes toward the tradition of psychoanalytic theory. Jack Streit was described in his obituary (Thomas, 1998) as “a master matzoh maker devoted to keeping an ancient tradition and a family business alive on the Lower East Side” (p. C18). The obituary elaborated:

The problem is that matzoh is so basic, a simple—and not especially appetizing—mixture of plain flour and water, that the temptation to add just a little something extra to the dough can be overwhelming. That, of course, would undercut the symbolic value of matzoh as the authentic unleavened—and unsalted and un-everything else—bread that kept the Israelites alive on their flight from Egypt. And since what began as an Exodus expedient … became a powerful Passover tradition, those who prepare matzoh for Passover do not fool around with the recipe (88 pounds of flour and 25.6 pounds of water for the basic Streit batch). By rights the Streit factory on Rivington Street should have been shuttered long ago, the ovens sold for scrap. But his attention was never far from the ovens, in part because they are so old that they have needed extensive attention. “Why is Streit’s Matzoh different from all other domestic brands? Because Streit’s bakes only Streit’s Matzoh in our own ovens” [p. C18].

Jack Streit considered the tradition inviolable and his ovens sacred. Jack Streit died Wednesday, February 4, 1998; he was 89.

The traditions of psychoanalytic theory have been profoundly important for psychoanalysis, and, as Jack Streit realized, maintaining tradition is closely associated with keeping the business alive. Psychoanalytic theory, too, has been carefully nurtured even longer than Jack Streit’s ovens. It, too, has needed extensive attention, especially in recent years when formerly fundamental concepts like abstinence, anonymity, and even neutrality have begun to fall into disrepair (Schachter, 1994). But two core principles, transference and transference interpretation, continue to be staunchly supported as a way of distinguishing psychoanalysis from all other brands of therapy. As Person (1993) writes trenchantly, “The development of the transference and its analysis appear to have replaced dream analysis as the “royal road” to the unconscious” (p. 5). When there first was temptation some years ago to add a little something extra, a dash of patient-analyst interaction, many analysts refused to “fool around” with the recipe for fear of undercutting the tradition of transference theory.

Why has traditional theory, with transference at its core, been so important to psychoanalysts? It was Erikson (1956, 1959, 1968), a man who struggled with his own personal identity, who brought the importance of the sense of identity to the attention of psychoanalysis. For many psychoanalysts, identity as an analyst is central to personal identity, perhaps to a greater degree than with many other professions. Transference and the interpretation of transference has distinguished the analyst from other therapists; it has come to symbolize the specific identity of the analyst.

Shibboleth was a test word used by the Gileadites to distinguish the escaping Ephraimites, who could not pronounce the initial “sh.” Thus, shibboleth referred to a password that enabled an unknown to identify himself or herself as a member of a particular group. Freud (1914a) once referred not to the transference, but to the interpretation of dreams as “the shibboleth of psychoanalysis” (p. 57). As Person has noted, however, the focus on dream interpretation has been replaced by analysis of transference, and, therefore, especially in the last decade when psychoanalysis has been battered by both internal (theoretical) and external attacks, transference has become the shibboleth of psychoanalysis. Questioning the value of transference in our theory and practice, as this book does, potentially threatens reliance on this shibboleth.

Analysts’ Uncertainty about Their Work

I think many analysts are concerned about their professional identity at least in part as a reaction to being troubled by an underlying uncertainty, sometimes acknowledged and other times either unrecognized or denied, about their analytic work. Few analysts write about this sense of uncertainty, which has many roots. Some of the roots plainly have to do with recent theory change. Meissner (1992) writes: “As the analyst gradually becomes less the “authority” and more an egalitarian participant in the patient’s process of discovery, the analyst experiences a sense of uncertainty and of the unknown” (p. 1078). But a sense of uncertainty is also intrinsic to the endeavor and the more the field evolves the greater this uncertainty seems to become. Britton and Steiner (1994), referring to the bewildering variety of impressions from the patient, comment: “The resultant uncertainty and confusion is often difficult to bear, and pressure to reduce the uncertainty may influence both patient and analyst to search for a means of integrating or limiting the impressions in order to create a meaningful whole” (p. 1069). Goldberg (1997) also acknowledges the analyst’s uncertainty; he refers to the need “to restore balance to our ever-present condition of uncertainty and lack of closure” (p. 14). He views the uncertainty as a function of the need to oscillate between empathy and judgment. Lichtenberg (1998) summarizes simply: “The analytic clinical exchange inevitably arouses recurrent states of uncertainty for both participants” (p. 25). Green (2000b) expresses concern that “there are sufficient signs among the ranks of psychoanalysts that this [psychoanalytic] identity is presently less assured with the evolution of our discipline. Sometimes, there is a feeling that it is threatened with fading away, if not disappearing under different influences” (p. 32).

Other sources of this lack of confidence are our failure to agree on definitions of basic concepts such as analytic process, successful termination, or a specifically analytic treatment outcome, as well as the dearth of accepted objective measures of any of these. The scathing and at times devastating criticisms of analytic theory and technique, from analysts as well as from outsiders, have contributed to the uncertainty as well. Skolnikoff (2000), discussing analytic identity, observes, “a larger doubt has arisen in the minds of many analysts with recent criticisms from outside our field” (p. 607). In addition, the recent queries about how the analyst knows what he or she knows, including recognition of the inevitable influences of the analyst’s subjectivity on what he or she thinks he or she knows about the patient and about patient-analyst interaction, serve to further highlight the analyst’s sense of uncertainty. Lastly, and perhaps most important, there is the widespread diminution in analytic practice and income (Brauer, personal communication, 1997).

Several kinds of evidence suggest that analysts do lack confidence in their analytic work, either acknowledged or covert. In regard to the latter, I would note Kernberg’s astute observation (1986, 1993) that very few analysts are willing to present their own analytic work to candidates when teaching about analysis, despite the pedagogic advantages of doing so. Although numerous factors may be involved in this reluctance, including concern about maintaining confidentiality, an underlying lack of confidence in their analytic work arguably contributes to this reluctance to expose it to candidates. Concern about confidentiality does not prevent institutes from requiring that candidates present their analytic work in seminars. Tuckett (1994), too, noted “a relative absence of [published] process material and a great deal of apparent nervousness about presenting it” (p. 868). Because few candidates have the opportunity to hear the work of senior analysts, I developed the Senior Analyst Presentation Program. During the last five years, at each meeting of the American Psychoanalytic Association a senior analyst presented his or her own analytic work to a small group of candidates for a full day, in the manner of a continuing case presentation. This program has been appreciatively and enthusiastically received by the candidates.

Currently, only approximately 50% of newly appointed members of the American Psychoanalytic Association go on to apply for certification, which involves further, even more intensive scrutiny of their analytic work. Here too, lack of confidence in their psychoanalytic work may well be one of the factors operating.

A feeling of uncertainty can be inferred also from analysts’ reluctance to participate in studies of either their past or present analytic work. Ticho (1972), and later I, observed that graduate analysts were generally unwilling to participate in studies of the outcome of analytic treatment of their former patients. Although analysts expressed numerous concerns, Ticho and I both speculate that concern about having their analytic work scrutinized by another analyst was a major factor.

Another area of analyst behavior, although complex, may also reflect an underlying lack of confidence. Commonly, analysts experience discomfort when meeting a former or present patient outside the analyst’s office, whether in the corridor or in the elevator en route to the analyst’s office. One recent example that I observed was of an analyst who came to unlock the front door to the office building to admit his patient. After opening the door, the analyst turned on his heel and without a word strode rapidly down the hallway to his office, leaving his patient to follow him, mutely, several paces behind. What concerns led him to behave in such an asocial, potentially humiliating fashion? After all, Freud prescribes social tact as the basis for technique. To my mind, his behavior in the hallway reflects discomfort. In that setting, where the protective analytic rules are unclear, he may be more concerned about exposing his sense of professional uncertainty. He may be less concerned in the relative security of his familiar analytic office, where he is the arbiter of analytic rules and regulations.

Finally, we might consider the results of replicated questionnaire studies (Schachter and Luborsky, 1998) about analysts’ attitudes toward reading analytic research papers versus reading clinical psychoanalytic papers. A majority of clinical analysts reported high or very high levels of confidence in their psychoanalytic theory and technique. Strikingly, there was a strong negative association; higher levels of confidence were associated with lower levels of interest in reading research papers. Various hypotheses may explain the inverse relationship. The intense assaults on psychoanalysis, coupled with the widespread decrement in analysts’ practice and income (Brauer, personal communication, 1997), make it difficult to take at face value analysts’ reports of such high levels of confidence in their theory and technique as an indifference to research might suggest. One hypothesis is that the reported high levels of confidence represent a defensive reaction to underlying feelings of uncertainty about analytic work. The avoidance of research papers may also reflect a concern that analytic research might highlight their own covert questions and uncertainty about their analytic work.

Need for a Shibboleth

If there is a little-acknowledged lack of confidence in analytic theory and technique, the aggrandizement of a shibboleth, specifically, the theory of transference and the technique of transference interpretation, is understandable. Any criticism or threat to the symbol, such as this book, understandably may be experienced by analysts as undermining the support for analytic identity the shibboleth provides. Even though unconvincing defenses of analytic theory and techniques might actually be damaging to the psychoanalytic profession, analysts may well maintain the shibboleth regardless of cost.

Spence (1994) sounds a related note: “psychoanalytic theory may function much more as a shared fantasy that binds its followers in a common belief system and protects them from uncertainty and doubt” (p. 5, italics added). Earlier, Holt (1989) had asserted: “Psychoanalysts have been living in a fool’s paradise, believing that the clinical theory was soundly established when in fact very little of it has been, and virtually all of that thanks to the efforts of nonpsychoanalysts” (p. 331). He noted, “It is hard to admit how little proof there is for any psychoanalytic hypothesis after all these years of use, when the theory seems so clinically valuable and when such a large part of the intellectual world has adopted great hunks of the clinical theory and treats it not as a set of interesting hypotheses but as received knowledge” (p. 339). Holt concluded: “American psychoanalysis has lived for so long within a snug cocoon of myth that it seems unable to go through the predictable pains of metamorphosis into a viably progressive discipline” (p. 341). A review of the Psychoanalytic Electronic Publishing Inc. (PEP) CD-ROM disc for the five years following 1989, when Holt wrote the above, indicates that not a single paper referred to his clarion call.

The thesis of this book is twofold: (1) There are good and sufficient reasons to argue that the traditional theory of transference is neither theoretically viable nor clinically useful and should be replaced; (2) There is available a substitute for transference theory that I believe is theoretically superior and may be clinically more effective. There are three major reasons that dictate replacing the theory of transference: (1) Transference theory and its keystone, infant determinism, are not testable and therefore are not theoretically viable; (2) Traditional psychoanalytic theory has failed to provide analysts with a satisfactory professional sense of confidence in the face of numerous threats to psychoanalysis; and (3) As it has been conducted heretofore, under the guiding rubric of transference theory and historical transference interpretation, psychoanalytic treatment, while apparently helpful to many, has proved to have limited therapeutic efficacy. In later chapters, I explore the first two reasons in greater detail. Here, however, I briefly take up the third reason, because it may strike many analyst readers as too severe a judgment and thereby bear quite directly on the issue of our concern about our professional identity. Because it is not the primary focus of this book, necessarily, selected results will be presented.

Therapeutic Efficacy of Traditional Psychoanalytic Treatment

Therapeutic efficacy of traditional psychoanalytic treatment is demonstrable but it is definitely limited, and that is a major reason to consider changing and improving traditional theory of technique. The subject is exceedingly complex and has a long history. The history of studies of therapeutic efficacy contains a litany of methodological problems and manifest difficulties dealing with them. For many reasons, there has never been a controlled study of the effectiveness of traditional psychoanalytic treatment with adult neurotic patients compared to placebo and to no treatment. Such a study would require that there be a pool of comparable adult neurotic patients, that these patients be randomly assigned either to psychoanalytic treatment, other treatment, or no treatment, and that independent measures be made of treatment process, treatment outcome, and long-term follow-up. The limitations of actual studies can be assessed in comparison to this ideal study.

Wallerstein (1999a) recently reviewed the entire field of psychoanalytic therapy research in a presentation to the annual meeting of the Rapaport-Klein Study Group at Austin-Riggs Center. One typical example of what were characterized as second-generation research approaches was the New York Psychoanalytic Institute studies (Erle, 1979; Erle and Goldberg, 1979, 1984) in which 40 supervised analytic patients were studied. Twenty-four (60 percent) were judged to have benefited substantially (which is consistent with findings of earlier studies), but only 17 were judged to have been involved in a proper psychoanalytic process. Of course, in the absence of controls, it is not possible to assess the power of placebo effects or other factors. Twenty-five of the patients terminated satisfactorily, but only 11 of these were considered to have completed treatment.

Wallerstein characterized as the third-generation studies of the outcome of psychoanalysis those systematic and formal psychoanalytic therapy research projects that have attempted both to assess analytic outcomes across a significant array of cases and to examine the processes through which these outcomes have been reached via the intensive longitudinal study of each individual case. There were two such studies: the Boston Psychoanalytic Institute studies (Kantrowitz, Katz, and Greenman, 1989; Kantrowitz, Katz, and Paolitto, 1990a, b, c) and the Psychotherapy Research Project of the Menninger Foundation (Wallerstein, 1986, 1988). In the former, 22 supervised analytic cases were selected for prospective study; nine of the 22 (41 percent) were felt to have had a successful analytic outcome, five to have had a limited outcome, and eight to be unanalyzed. Wallerstein noted that therapeutic benefit was regularly in excess of what could be accounted for by the interpretive resolution (as best as possible) of the transference neurosis. The nature of the analyst-patient match did play a role in the outcome achieved in 12 of 17 patients.

Bachrach et al. (1991) have described the Menninger Foundation Psychotherapy Research Project as “by far the most comprehensive formal study of psychoanalysis yet undertaken” (p. 878). Wallerstein summarized the results of studies of 42 patients: (1) The benefits in the more supportive therapies seemed often enough to entail just as much structural change in the patients; indeed, benefit received seemed indistinguishable from change based on the interpretive resolution, within the transference-countertransference matrix, of unconscious intrapsychic conflicts; (2) Supportive therapeutic approaches often achieved far more than was expected of them, and psychoanalysis achieved less than had been anticipated or predicted.

Another element in considering the effectiveness of psychoanalytic treatment is the fact that analysts seem to regard successfully treated patients as if they were representative of most treated patients. A possibly apocryphal story about Pavlov illustrates this same tendency toward misrepresentation. Showing a group of visitors around his laboratory, Pavlov opened a drawer in search of a “representative” record, but was unable to find one. He opened another drawer and examined more records, but again he was unable to find “it.” Embarrassed, he commented, “I don’t know where that ‘representative’ record is; I can’t seem to find it anywhere.” Clearly, to label that particular record representative of many was a distortion. By publishing primarily studies of successful cases without specifying the proportion of such successful outcomes the author implies that they are representative treatments. Feelings of uncertainty and inferiority may be stirred in analysts reading these purportedly representative successes.

Individual analysts don’t evaluate treatment outcome in their total practice. We have no idea whether theoretically differentiated practitioners, be they traditional analysts, object-relations analysts, self psychologists, or Kleinians, differ in the proportion of patients who benefit. Significant factors in the therapeutic benefits are probably the important personality differences among the analysts as well as their convictions and passions in their work. Such differences may be partially related to choice of theory, but they are also independent of theory. Kantrowitz (1995) has noted i...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• Acknowledgments
• Chapter 1: Transference and the Psychoanalytic Identity
• Chapter 2: Causation in “Transference” Theory: Historical Origins
• Chapter 3: Origins of Sexual Etiology
• Chapter 4: Problems with the Theory of “Transference”
• Chapter 5: Infant Determinism: Trauma, Temperament, and Attachment
• Chapter 6: “Transference” Theory and Chaos Theory
• Chapter 7: Problems with the Clinical Application of “Transference” Theory
• Chapter 8: Nachträglichkeit
• Chapter 9: Habitual … What? An Alternative to “Transference”
• Chapter 10: A Theory of Technique
• Chapter 11: A Psychoanalytic Treatment Without “Transference”
• Chapter 12: “Transference” and the Posttermination Relationship
• Chapter 13: Conclusion
• References
• Index