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A Counter-Theory of Transference
John M. Shlien Harvard University
"Transference" is a fiction, invented and maintained by the therapist to
protect himself from the consequences of his own behavior.
To many, this assertion will seem an exaggeration, an outrage, an indictment. It is
presented here as a serious hypothesis, charging a highly invested profession with the
task of re-examining a fundamental concept in practice.
It is not entirely new to consider transference as a defense. Even its proponents cast
it among the defense mechanisms when they term it a "projection". But they mean
that the defense is on the part of the patient. My assertion suggests a different type of
defense; denial or distortion, and on the part of the therapist.
Mine is not an official position in client-centered therapy. There is none. Carl Rogers
has dealt with the subject succinctly, in about twenty pages (1951, pp. 198-217), a
relatively brief treatment of a matter that has taken up volumes of the literature in the
fleld.[1] "In client-centered therapy, this involved and persistent
dependency relationship does not tend to develop" (p. 201), though such transference
attitudes are evident in a considerable proportion of cases handled by client-centered
therapists. Transference is not fostered or cultivated by this present-time oriented
framework where intensive exploration of early childhood is not required, and where the
therapist is visible and available for reality resting. While Rogers knows of the position
taken here and has, I believe, been influenced by it since its first presentation in 1959,
he has never treated the transference topic as an issue of dispute. This is partly so
because of his lack of inclination for combat on controversial issues, where he prefers to
do his own constructive work and let evidence accumulate with new experience.
Why then should client-centered therapy take a position on an issue of so little moment
in its own development? For one reason, the concept of transference is ubiquitous. It has
a powerful grip on the minds of professionals and the public. And, while client-centered
practice has the popular image of a relatively self-effacing therapist, it holds to a
standard of self-discipline and responsibility for the conditions and processes it
fosters, and it could not fall to encounter those emotional and relational strains so
often classed as transference.
There are many separate questions raised by the assertion at the start of this chapter.
What behavior of the therapist? Leading to which consequences? Why
invent[2] such a concept? How does it protect? In re-examining
the concept of "transference" how do we, to use Freud's words, "Inquire
into its source"?
Throughout we will consider only the male therapist/female patient data. Such was the
critical situation when the term was invented. The first five case histories in the 1895
landmark Studies on Hysteria (Breuer & Freud, 1957) are Anna O., Emmy von N., Lucy R.,
Katharina, and Elisabeth. It set up the image of the most-sensitive relationship (older
man, younger woman) most suspect in the minds of the public (whether skeptic or
enthusiast) and the combination most common for many decades.[3] Indeed
it is possible that without the sexually charged atmosphere thus engendered, the concept
of transference might not have developed as it has, if at all! For it is not insignificant
that Breuer, and Freud, were particularly vulnerable. As Jewish physicians, admitted to
the fringes of anti-Semitic Viennese society by virtue of their professional status, they
could ill afford any Jeopardy.
For psychoanalysis, transference seems to be the essential concept: "sine qua
non," "an inevitable necessity," "the object of treatment,"
"the most important thing we (Freud end Breuer) have to make known to the
world," without which "the physician and his arguments would never be listened
to." In addition, it contains end subsumes all the elaborate support structures: the
primary significance of sexual instincts, psychic determinism, the unconscious,
psychogenetic theory, the power of past experience. Crucial in theory! In practice, it
comforts, protects, and explains.
Transference is also supposed to distinguish psychoanalysis from other forms of
therapy. Perhaps it is meant to do so, but this becomes moot through contradictions in the
literature, which variously asserts that transference is peculiar to psychoanalysis, while
also common in everyday life. Whether unique or universal, it is in widespread use
throughout most psychodynamic systems. One distinction it surely serves: that between
professional end paraprofessional, or sophisticate and literalist, and in general between
those in and out of power. If transference is no longer the singular hallmark of
psychoanalysis, it at least marks those "in the know," whether novices or not.
It was in Freud's mind "a new fact which we are thus unwilling compelled to
recognize" (1935, p. 385). "Unwilling" does not truly describe Freud's
attitude. That word is an artful form of argument to make a welcome conjecture seem an
unavoidable fact. Currently, "unwilling" more aptly describes the attitude of
psychotherapists toward reexamination of the idea. But reexamination is necessary if we
are to reevaluate the usefulness of the concept.
It seems most appropriate to begin this reevaluation with the early history of the
concept. The case of Anna O. provides the cornerstone on which the theory of transference
is generally thought to be based. More than a dramatic and moving affair, it is of
momentous importance to the field, and its effects still influence the majority of theory
and practice. Though psychoanalysis and/or other firms of psychotherapy would somehow have
developed, all present forms owe much to these few pioneers and their struggles. To
properly honor them, it is necessary to study these human points of origin.
The accounts begin in the Studies of Hysteria (Breuer & Freud, 1957) first
published in 1895, thirteen years after treatment ended. Details of treatment were
reported cautiously, out of respect for the still living patient, and for other reasons
having to do with questions about the outcome, and growing tensions between Freud and
Breuer. Anna O. was, by all accounts, remarkable, and, for that time, so was her
treatment. In her twenty-first year, she was described by Breuer and others as a person of
great beauty, charm, and powerful intellect, with a quick grasp and surplus energy. Living
in a comfortable but monotonous environment at home, she was hungry for intellectual
stimulation.
She was poetic and imaginative, fluent in German, English, Italian, and French. Much of
her waking time was spent in daydreaming, her "private theatre." She was also
sharp and critical, and therefore, Breuer notes, "completely unsuggestable"
(though he routinely used hypnosis), needing to be convinced by argument on every point.
She was tenacious and obstinate, but also knows for immensely sympathetic kindness, a
quality that marked most of her life's work. She had never been in love. In short, she was
young, attractive, intelligent, lonely; it was she who named psychotherapy "the
talking-cure," and she was a near-perfect companion for the also remarkable
physician-pioneer in this form of treatment. (He was 38 at the time, admired, loved,
respected, and of high professional and social status). Both deserved all the tributes
given, end Breuer perhaps even more. While Freud was the conceptual and literary genius
without doubt, and Anna O. the central figure of the famous case, Breuer was probably the
therapeutic genius of the time. And that in a new, dangerous exploration where there were
few precedents, guidelines, or previous personal experiences.
Through the experience of Anna O. with Breuer, the material used as the basis for the
theory of transference-love (as it was then called) was gathered, but it was Freud
alone who later invented that theory to interpret that material to Breuer and the world.
In the meantime, Freud's invention had been fostered by experience of his own with at
least one other female patient.
The case of Anna O. is described in 1895 by Breuer, (Breuer & Freud, 1957, pp.
21-47) who wrote that he had "suppressed a large number of quite interesting
details" (true), and that she had left Vienna to travel for a while, free of her
previous disturbances (not quite so true, for she was taken to a sanatorium where she
"inflamed the heart of the psychiatrist in charge", (Jones, 1953, p. 225) and
was temporarily addicted to morphine). By the time Breuer reported the Studies a decade
later, he could write that "It was a considerable time before she regained her mental
balance entirely" (p. 41). Even so, he had confided sorrowfully to Freud in an
earlier discussion that he sometimes thought she were better off dead, to end-her
suffering. The "suppressed details" may in part be related to his sudden
termination of the treatment and the patient's shocking emergency regarding her
"pregnancy" and his "responsibility." James Strachey, editor of the
1957 translation of Studies on Hysteria, says Freud told him of the end of Anna O.'s
treatment: "the patient suddenly made manifest to Breuer the presence of a strong
unanalysed positive transference of an unmistakably sexual nature" (Breuer &
Freud, 1957, p. 41, fn.). This is a retroactive interpretation, of course, since at the
time of its occurrence neither Breuer nor perhaps even Freud yet had any idea of
"transference." That idea builds, and more complete information is released, as
Freud describes the case in both oblique and direct references in lectures and other
writings from 1905 to his autobiography in 1925. Still more explicit communications are
released in Ernest Jones' biography of Freud (1953). In 1972, Freeman, a well-known
popular writer, published a "novelized" biography and report of Anna O. end her
treatment. (None of these is exact, verbatim, or anything like "verifiable
data.")
Even so, the somewhat guarded report by Breuer gives us a privileged view of his work.
The editor of Studies tell us that Breuer had little need of hypnosis because Anna O. so
readily "produced streams of material from her unconscious, and all Breuer had to
do was to sit by and listen to them without interrupting her" (Breuer &
Freud, 1957, p. xvii, emphasis added). That is all? As you will see later, I argue
that this is no small thing. It may not seem much to that editor, himself a lay analyst in
training, but to the lonely, grieving, and desperate young woman, it must have seemed a
treasure. At that period, young lades were given placebos, referred from one doctor to
another, generally treated with patronizing attention or benign neglect. Breuer and Freud
were precious rarities in that they listened, took seriously. Would that Breuer had done
more of that, and had done it steadfastly through the end. Listening is behavior of
great consequence. The pity is that he felt forced to cut it short at the critical last
moment.
Meanwhile, there were many other behaviors. We can only estimate their consequences. He
fed her. She was emaciated, and he alone was able to feed her. He could give her water
when she otherwise would not drink. No doubt there were other nourishing figures in her
life, but he was clearly one himself. He paid dally visits. She held his hands in order to
identify him at times when she could not see. When she was exhausted, he put her to sleep,
with narcotics or suggestion. He restored mobility to paralyzed limbs. He hypnotized her,
sometimes twice a day, taught her self-hypnosis, and then "would relieve her of the
whole stock of imaginative products she had accumulated since (his) last visit"
(1957, p. 36). He took her for rides in his carriage with his daughter (named Berthe,
which was also Anna O.'s real name). He read her diary - a notably tricky business either
with or without her permission. He forced her to remember unpleasant experiences.
From this much alone, would you think that Anna O. had reason (real, not imaginary) for
feelings such as gratitude? hope? affection? trust? annoyance? intimacy? resentment? fear
of separation?
Finally, there was the ending. Breuer had been preoccupied with his patient, and his
wife had become jealous and morose. There had been improvement, indeed. But also,
according to Jones's account, Breuer confided to Freud that he decided to terminate
because he divined the meaning of his wife's state of mind. "It provoked a violent
reaction in him, perhaps compounded of love and guilt, and he decided to bring the
treatment to an end" Jones, 1953, p. 225).
Exactly how he announced this decision to her we do not know. That evening he was
called back by the mother and found his patient "in a greatly excited state,
apparently as ill as ever." She was "in the throes of an hysterical
childbirth" (Jones, 1953, p. 224).
Certainly that is an interpretation of her "cramps" and utterances that might
commonly occur. We have no first-hand information as to what the patient thought or meant.
Every report is second- or third-hand, through Freud about Breuer, and that
usually through Jones, who wrote, "Freud has related to me a fuller account than he
described in his writings," and some of that account is quoted as follows:
The patient, who according to him (Breuer) had appeared as an asexual being and had
never made any allusion to such a forbidden topic throughout the treatment, was now in the
throes of an hysterical childbirth (pseudocysis), the logical termination of a phantom
pregnancy that had been invisibly developing in response to Breuer's ministrations. Though
profoundly shocked, he managed to calm her down by hypnotizing her, and then fled the
house in a cold sweat. The next day he and his wife left for Venice to spend a second
honeymoon . . . (1953, p. 224)
Some ten years later, at a time when Breuer and Freud were studying cases together,
Breuer called him into consultation over an hysterical patient. Before seeing her, he
described her symptoms, whereupon Freud pointed out that they were typical products of a
phantom pregnancy. The recurrence of the old situation was too much for Breuer. Without
saying a word, he took up his hat and stick and hurriedly left the house (1953, pp.
224-226)
A somewhat more explicit (but still far from direct or verbatim) report is cited in
freeman (1972, p. 200). Freud writes to Stefan Zweig, (a relative of Anna O. by marriage):
"What really happened with Breuer I was able to guess later on, long
after the break in our relations, when I suddenly remembered something Breuer had
told me in another context before we had begun to collaborate and which he never repeated
(emphasis added). On the evening of the day when all her symptoms had been disposed of, he
was summoned to the patient again, found her confused and writhing in abdominal cramps.
Asked what was wrong with her, she replied: 'Now Dr. B's child is coming!'" [4]
Freud, speaking of Breuer, added, "At this moment he held in his hand the
key," but "seized by conventional horror he took flight and abandoned his
patient to a colleague (Freeman, 1972, p. 200)."[5]
Here is one final quotation from Breuer himself in his own report. "The element of
sexuality was astonishingly undeveloped in her. The patient, whose life became known to me
to an extent to which one person's life is seldom known to another, had never been
in love" (Breuer & Freud, 1957, p. 21-22). (emphasis added)
What then, "really happened"? We will never know. Two exceptional (in my
opinion, magnificent) people of great intelligence and noble spirit came close to
understanding. He knew her well. Probably she knew him better than he thought. The knowing
appears to have been precious to both. Understanding failed at a critical point. They
dropped the key. It is tragic; so much was lost. Thankfully, we know that both carried on
vital and constructive lives for many years.
If you are a woman, reading this will probably bring different reactions than those of
the typical man. Perhaps you feel more sympathetic to the patient. If you put yourself in
the therapist's place, supposing this could be your case, you know at least that you could
think to yourself, and possibly say to Anna O., "Unlikely that it is my child in the
physical sense, since I am a woman like yourself, but perhaps you mean that I am somehow
present to your pain, your growth, your condition whatever." (If you think that
logically a woman therapist would never face such a situation, because of the reality,
consider the implications of that for transference theory!)
More difficult if you are a men, putting yourself in this imaginary situation. You
might say, "I submitted to voluntary sterilization in order to make my life less
anxious, as it were, so it is unlikely, etc." as above. Not only a condition with
which few readers would identify, but in this case useless, since Anna knows Breuer has
recently fathered a child.
(There is another possible source of security, transference theory, but it has not yet
been invented).
Meanwhile, return to the fact that it is Dr. Breuer who is directly and immediately
involved, and to Anna O. What might they be thinking, meaning, saying to each other
in this perilous moment, at best and at worst? God knows what words she uttered in which
four languages (for she was known to speak a "gibberish" of mixed tongues when
ill). Nor what he heard, nor what he said, or what he told Freud was said. Nor what Freud
told Jones; nor how accurate Jones's translation (not always, we know). But let us take it
that Freud's letter to Zweig is the most authentic; in it, Anna, on one page, says,
"Now Dr. B's child is coming" (Freeman, 1972, p. 200) or, in a slightly
different quotation from the same scene, same book, "Now Dr. Breuer's baby is coming.
It is coming!" (p. 56).
Anna might have thought, felt, or said, for example:
- Dr. B - a baby. I feel like a baby!
- Would you abort my child? Then don't abort my treatment.
- You know me so well, but you thought I was sexually underdeveloped, had never been in
love, had no romantic feelings -although you knew, for instance, that I loved to dance.
Well, I've grown. Thanks to you in good part. Now Dr. Breuer's child has become a woman.
I'm ready at last for that sexual release. It is coming!
- When you were late for our appointment one morning, you apologized end told me (as he
had) that it had to be so because your wife was having a new baby and you had to stay up
all night. If that is what is more important to you, look, I'm having one too.
- Why did you tell me so suddenly that you could not continue to see me? Your reasons
sounded false. I know so well your voice, your eyes. What is the real reason? If you must
lie to me to leave me, I must lie to you to keep you.
- Only hear me out. I mean you no harm as you leave. We have touched. You massaged me, fed
me, gave me life, comfort, discipline; made me tell things I would not tell anyone else. I
felt loved, and I must tell you in the ultimate way, I love you too. You are handsome,
kind, distinguished. If all of this does not Justify my excitement and love, what does?
Life together is impossible, I know that. Sex is really not that important to me either.
But love is. A child would be. I want someone to love. I am in great pain over it.
None of these possibilities begins to describe conversations to which they might have
led. But meanwhile Dr. Breuer, on his part, might have thought, felt, or said something
like:
- What did I do to deserve this?
- My God, you are really out of your mind (again).
- You cannot think that I . . . (or can you?)
- We've never even discussed such a thing (which they hadn't).
- It never entered my mind (If indeed it hadn't).
- Is this more of your "private theatre"? Not amusing.
- You are punishing me.
- Damned embarrassing. I already have problems at home.
- This is a trap! How to get out of it.
- Here is the ruination of my reputation/family/livelihood/method/hope/everything.[6]
or in a more benign mood - -
- You don't want me to leave you.
- Perhaps I have been both too caring and careless, left you unfairly.
- What are you growing, laboring to deliver?
- What part did I play?
- I am touched and honored that you choose me.
- Have I led you to expect more than I can give?
- (or best of all): You are in pain. Let's try to understand. I will postpone my trip and
work with you.
Freud, as we already know, discussed this case with Breuer more than once. There is
some evidence that Breuer felt not only uncertainty about it, but guilt and shame as well.
In the late 1880s, years after Studies on Hysteria was written, Freud tried to persuade
Breuer to write more about it. Breuer had declared the treatment of hysterics an ordeal he
could not face again. Freud then described to Breuer one experience so well known now
through his autobiography (1948, p. 48) in which he too had faced "untoward
events." As Jones described it:
So Freud told him of his own experience with a female patient suddenly flinging her
arms around his neck in a transport of affection, and he explained his reasons for
regarding such "untoward occurrences" as part of the transference phenomena
characteristic of certain types of hysterla.[7] This seems to have had a
calming effect on Breuer, who evidently had taken his own experience of the kind more
personally and perhaps even reproached himself for indiscretion in the handling of his
patient (Jones, 1953, p. 250).
Momentarily this comforted, explained to, and protected Breuer, but only momentarily.
At first, Breuer agreed to join in the publication and promotion of the idea of
transference. As Freud writes many times, "I believe," he told me, "that
this is the most important thing we two have to give the world" (Breuer & Freud,
1957, p. xxviii). But then, Breuer withdrew his support for the theory and the complete
primacy of sexual etiology of neuroses - support Freud needed and urgently sought.
"He (Breuer) might have crushed me . . . by pointing to his own patient (Ann O.) in
whose case sexual factors had ostensibly played no part whatever" (Freud, 1948, p.
6).[8] That Breuer was ambivalent, that he neither crushed nor
supported, Freud put down to Breuer's suppressed secret of the case. Breuer may have had
serious and sincere doubts on other scores. They agreed to disagree, citing "the
natural and justifiable differences between the opinions of two observers who are agreed
upon the facts and their basic reading of them, but who are not invariably at one in their
interpretations and conjectures." Signed "J Breuer/S. Freud, April 1895";
(Breuer & Freud, 1957, p. xxx). Breuer, quite possibly intimidated by the nature of
his suppressed material and his loyalty to both colleague Freud and patient Anna O. did
not press his arguments, whatever they might have been. Freud did, and swept the field.
Now we have transference.
Definitions and Definers
A few definitions are in order. There are dozens. They change over time and between
authors. The main theme is constant enough that the proponent of any form of "depth
psychology" can sagely nod assent, though Orr writes, 'From about 1930 onward, there
are too many variations of the concept of transference for systematic summary" (1954,
p. 625).
Circa 1905
What are transferences? They are new editions or facsimiles of the tendencies and
phantasies which are aroused and made conscious during the progress of the analysis; but
they have this peculiarity, which is characteristic for their species, that they replace
some earlier person by the person of the physician. To put it another way: a whole series
of psychological experiences are revived, not as belonging to the past, but as applying to
the person of the physician at the present moment. Some of these transferences have a
content which differs from that of their model in no respect whatever except for the
substitution. These, then -- to keep the same metaphor -are merely new impressions or
reprints. Others are more ingeniously constructed; their content has been subjected to a
moderating influence -- to sublimation as I call it -- and they may even become
conscious, by cleverly taking advantage of some real peculiarity in the physician's person
or circumstances and attaching them to that. [9] These, then, will no
longer be new impressions, but revised editions (Freud, 1959, p. 139).
The new fact which we are thus unwillingly compelled to recognize we call
"transference." By this we mean a transference of feelings on to the person of
the physician, because we do not believe that the situation in the treatment can account
for the origin of such feelings (Freud, 1935, p. 384).
By transference is meant a striking peculiarity of neurotics. They develop toward their
physician emotional reactions both of an affectionate and hostile character, which are not
based upon the actual situation but are derived from their relations to their parents
(Freud, 1935, p. 391 ).
There can be no doubt that the hostile feelings against the analyst deserve the name of
"transference" for the situation in the treatment gives no adequate occasion for
them (Freud, 1935, p. 385).
Why should anyone feel hostility toward him? "Actually I have never done a mean
thing," wrote Freud to Putnam (Jones, 1957, p. 247). Not many can make this
disclaimer, and not all believe it borne out by Freud's record (cf. Roustang, Dire
Mastery. 1982). Still, if he only thinks this of himself it is more likely that
hostile feelings toward him would be seen as unjustified by his behavior. What matters
here is the analyst's proclamation of innocence -- a stance that permeates transference
theory throughout. While an ad hominem argument is of limited use, there is a
principle to which readers in this field must surely subscribe. It is that every honest
theory of Personality and psychotherapy must reflect the personality and experience of its
author. How could it be otherwise?
Freud continues this definition:
The necessity for regarding the negative transference in this light is a confirmation
of our previous similar views of the positive of affectionate variety (Freud, 1935, p.
385).
This "necessity" is part of that strange logic in which the second assertion
confirms the first!
Is transference useful? Yes, it overcomes resistance, enables interpretation; it is
your chief tactical ally.
The father-transference is only the battlefield where we conquer and take the libido
prisoner (Freud, 1935, p. 396).
In sum, the patient's feelings "do not originate in the present situation,
and they are not deserved by the personality of the physician, but they repeat what
has happened to him once before in his life" (Freud, 1927, p. 129) (emphasis added).
The "once before" is experience "in childhood, and usually in connection
with one of his parents." As put most simply in The Problem of Lay Analysis (Freud,
1927), "The attitude is, to put it bluntly, a kind of falling in love" (p. 129).
We must not forget, "This affection is not accounted for by the physician's behavior
nor the relationship nor situation" (1935, p. 383).
So, the analyst is not responsible, the situation is not responsible, even though there
may be some "real peculiarities" visible in the physician or circumstances.
Transference is a neurotic peculiarity. Whether it is a normal (common) trait also is
unclear, but the transference neurosis is a feature of analysis -- that is certain.
There are some updatings. They will not make a basic difference, but it is worth noting
that Fenichel tried to alter the absolute exemption when he wrote in 1941:
Not everything is transference that is experienced by a patient in the form of affects
and impulses during the course of the analytic treatment. If the analysis appears to make
no progress, the patient has, in my opinion, the right to be angry, and his anger need not
be a transference from childhood -- or rather, we will not succeed in demonstrating the
transference component in it (Fenichel, 1941, p. 95).
Later positions (Macalpine, 1950; Menninger, 1958) suggest that the analytic situation
itself is regressive, and thus somewhat influential if not responsible. Waelder (1956)
says, "Hence transference is a regressive process. Transference develops in
consequence of the conditions of the analytic situation and the analytic
technique" (p. 367, emphasis added). Waelder's statement directly contradicts some of
Freud's basic definitions, but to what effect?
The qualifications make concessions and corrections, but no one anywhere questions the
basic concept, per se. Oddly, they only serve to strengthen, never to cast doubt. The
situation is regressive because it turns all the patient's attention inward and
backward toward earliest experience, and the therapist is made to seem bland, neutral,
indistinct, even invisible. It is like a form of sensory deprivation. Other forms are
elevated into unusual prominence. So it is with the presence and with the pronouncements
of the therapist in this regressive situation.
Or, if transference is considered as a matter of "projection," the question
arises, "What is the screen?" The answer was implied, though it seemed
not to be recognized, in the first deep crack in transference theory ---
"countertransference." The instant that concept was developed, it should have
become clear that the analyst's presence was more than a blank. Presumably
countertransference was to be kept at a minimum. Until recently, definitions of and
attention to it have been relatively minimal (except for one sector where it seems most
nearly innocent, appropriate, and "natural": that is, work with children).
As Freud began to give attention to countertransference, he viewed it as responsive or
reflexive rather than as an originating characteristic of the analyst. "We have
become aware of the 'countertransference' which arises in (the physician) as a result of the
patient's influence [1O] on his unconscious feeling" (Freud,
1910, p. 122, emphasis added). This is a far cry from the notion of one of my students,
who thinks that transference lies in wait with the therapist and his wishes or
expectations, while the countertransference is on the part of the patlent! Not so
far-fetched as it first seems, for it may be only a reversal of Freud's statement Just
preceding. Which comes first?
The psychoanalytic positions on countertransference range from treating it as a
hindrance to be overcome[11] to welcoming it as a sensory asset
("third ear") (Epstein & Feiner, 1974, p. 1). In any event, one can hardly
claim "no responsibility" on a "nobody home" basis if it is admitted
that somebody, with some palpable characteristics, is there. The question now
becomes, "What is the nature of these characteristics?"
The therapist is in truth a person of some distinctiveness, some identity, no matter
how discreetly hidden. He has some self-concept -- an image of what he is and wants to be.
Perhaps the more truly modest and humble, the more he will be surprised by intense
idealizations of himself by others. If plain (he thinks), how much more inappropriate for
the patient to think him handsome.
But perhaps he is not really modest or humble. That may be only a professional
attitude. When Freud wrote to his wife Martha, telling her of Anna O.'s strenuous
affection for Dr. Breuer and of the consternation on the part of Breuer's wife, Martha
replied that she hoped that would not happen to her (a common concern of the therapist's
spouse). Freud "reproved her for her vanity in supposing that other women would fall
in love with her husband: 'for that to happen one has to be a Breuer.'"
(Jones, 1953, p. 225). Yet it was not really her vanity at issue, it would seem,
but her concern over his exposure. Having first miscast the problem, he then did
not quite give the assurance that she wanted, [12] and in the third
place, it did happen to her husband. As the theory predicted that it would. Perhaps
it already had. At some point, reported in his autobiography, Freud had discontinued
hypnosis after an "untoward event" of his own. The patient, being aroused from a
trance, threw her arms about him "in a transport of affection." At any rate,
Freud dropped the method of hypnosis (was "freed of it") shortly after, and took
a position behind the couch. Some aspect of self-image certainly was a factor: hypnosis ho
compared to the work of a "hod carrier" or "cosmetician," while
analysis was "science," "surgery." Perhaps it was more dignity at
stake than modesty.
Though modesty was a thread often pulled. He wrote to Martha, "to talk with Breuer
was like sitting in the sun; he radiates light and warmth. He is such a sunny person, and
I don't know what he sees in me to be so kind."
To Martha herself, "Can there by anything crazier, I said to myself. You have won
the dearest girl in the world quite without any merit of your own."[13]
(Jones, 1953, p. 110). Granted that this is the romantic hyperbole of courtship. Granted
too that there ere fluctuations in mood and tone as situations change, so that we hear
this humility from the same powerful genius who called his real nature that of the conquistador.
Still, the literary license we give to "without merit" is like that we give to
the supposedly indistinguishable therapist who receives what he says he does not deserve
in the service of carrying out the conditions for transference.
"Can there be anything crazier, I said to myself." Yes, a few
things. One is institutionalizing false modesty such as that, by denying the
characteristics in the situation and the personality of the analyst -- denying so
completely that a neurosis is cultivated by and for both parties while it is the very
object of treatment. And all in the name of sanity, clarity, and honest scrutiny.
Interim Thoughts
On the way to proposing a countertheory, permit me to describe some experiences which,
over the years, led me to depart from the common beliefs in psychoanalytic theory that I
once held.
- For 15 years at the University of Chicago counseling Center I worked through ranks from
student-intern to Senior faculty and Chairman of the Interdepartmental Clinical Program,
and occupied the office of my former mentor Carl Rogers after he left for Wisconsin. In
such a position, one develops the reputation of a "therapist's therapist". It is
a privileged learning opportunity. My clientele consisted largely of Junior professionals.
Three were interns on a psychiatric rotation from the university hospital. They were
taught by their medical faculty a good deal about transference. They discussed their
experiences as psychiatrists-in training. One, a shy, diffident young man, was especially
articulate about the onset of transference as he perceived it in a slightly older woman
patient. He felt a rising excitement. "This is it." He also felt that he was
being handed a power about which he was both pleased and embarrassed, end of course
embarrassed by his pleasure and embarrassment. Not only was transference theory an
"armor in his ordeal," but a source of downright satisfaction. He felt
"as if I were wearing a mask. I smiled behind it. I could have taken it off. I
thought of that, but I was too confused about what I'd have to uncover. Behind it, I could
be detached, amused, be more thoughtful and responsive." It was a revealing bit of
information on the inner experience of transference in a young adherent of the theory. I
wondered how many therapists acknowledge their pleasure so honestly. Weeks later, I took a
neighbor and his four-year-old son to the emergency room. My client was on duty. I helped
hold and soothe the little boy while Dr. G. sewed stitches in his head wound. We worked in
a kind of harmonic unison over this child of French-lranian extraction, who knew little
English and was pained and frightened. We did it well. In our next session, Dr. G. told me
that he had felt as if it were "our child". Did he mean his feminine qualities
end my masculine ones (or the reverse)? No. If it must be put in familial terms, we were
brothers, he thought. So did I (though neither of us actually had brothers). One might
easily see in this an expression of transference and/or countertransference. I found
neither. We had an experience that made us feel like brothers.
- I attended a discussion of religion between Bruno Bettleheim and Paul Tillich.
Bettleheim took the general position outlined in Freud's Future of an Illusion to the
effect that the urge toward religious belief was a projection of the longing for a father.
That seemed most plausible to me. Tillich answered, "But what is the screen?"
Not a weighty reply, to my way of thinking at the time, but increasingly I realized that
"it" cannot be nothing.
- One evening I overheard a client in the next office. She wept end shouted, "No one
has ever treated me this way before. I love it, I can't believe it, but I'm afraid every
time I come." I thought she was banging on the desk to emphasize her points. At the
end of the evening I went to that counselor's office. "For God's sake, Russ, what
were you doing?" He explained, and I heard fragments of a primitive audio-disc
recording. The banging was the steam pipes. The client was saying, "No one has ever
understood me this way before. No one. I can't believe it. I love the feeling of 'at last,
someone knows, someone cares.' But when I come back next week, with the rest of my
garbage, will you still understand? I couldn't bear it if you didn't."
I do not
know the content of what was understood, but was most struck by what understanding meant
to her, and thought about it for a long time.
- I once taught a course with the prominent Adlerian Dr. Rudolph Dreikurs -- a hearty,
gruff bear of a man. In one class he seemed especially heavy-handed. Students were angry
and critical. During the intermission, he said "Do you notice the hostility? There is
a lot of negative transference here." I told him my observations, and he was
perplexed, crestfallen. He had taught hundreds, even thousands, and no one had complained.
They usually loved him.
- In 1971, during the period of the "revolution in mental health" (community
organization, demystification, "radical therapy" and politics to fit, etc.), a
consulting psychiatrist and practicing analyst told me, "It is amazing. Some of these
paraprofessionals I'm supervising can do anything we can do - except the handling of the
transference." I wondered - what would he say if there is no
"transference"?
- Over many years, I have been perceived in many different ways. Humble and proud, kind
and cruel, loyal and unreliable, ugly and handsome, cowardly and brave, to name a few
wide-ranging contradictions. Someone must be mistaken? No, they are all true. This sense
of myself, sometimes selfish, sometimes generous, makes me hesitate before characterizing
someone's perception as a distortion. One client dreamed of me as a little boy, one she
held on her lap -- and I a white-haired father of three grown children, as she knew. But
she too was correct (and she had her own reasons for that caretaking dream). There is that
side of me. I could cast it off, but keep it for my enjoyment. I have been seen as a lion,
rabbit. True, I can be hard and soft. Is that unusual? Though happy to have been married
for 40 years, I could, when young, have fallen in love frequently - with ease, passion,
tenderness. Seriously? Sometimes seriously enough to last another lifetime, probably, but
not so seriously that I think I am the only man for this only woman for me.
[14] While I do not respect the philanderer because of the damage he is likely to do,
reading Jones's Judgment that "Freud was not only monogamous in a very unusual degree
but for a time seemed to be well on the way to becoming uxorious" (1953, p. 139)
struck me as curious and doubtful. It is, however, a condition that would more readily
incline one toward transference theory - at least as a supporting illusion. But if that is
not my condition or my personality, should his theory be my theory?
Then, about my granddaughter. I dearly love-this child. From what previous experience
do I transfer this affection? Yes, I dearly loved my two daughters and my son when they
were three-year-olds, too. But whence came that? Sooner or later, it has to be de
novo, original. We know from work in comparative psychology that most women and many
men show autonomic signs (such as papillary change) of great attraction to the typical
"configuration of infant" large head and small body. In short, it is an
instinct, and it produces its natural consequences each time for the same instinctive
reasons, as if each time were the first. This child knows me, trusts, loves me too. Is
her experience transference? Transfer of what? >From where? Is mine transference
and hers counter-transference? Neither one. The trust is earned. The love is natural. That
is the answer.
The real question is, "What conditions bring about the original
experience, the first of its kind without precedents?" Then, "What if those
conditions again prevail?" Put another way, "if every perception depends on the
past, what if there is no past?"
The Next Step
History of its origins aside, transference is a shorthand term for
qualities and characteristics of human interaction. Any shorthand will fall to represent
the particulars of a unique relationship. Rather, the shorthand will obscure (in a
sometimes comforting way) the realities of the relationship. The concept of
"father-figure," for instance, needs to be unraveled; what characteristics is it
supposed to represent? What do such concepts as "parent" or
"infantalizing" mean? In the remaining pages, an alternative view is presented,
hopefully to clarify the realties that the shorthand forms fall to represent.
A Countertheory
If transference is a fiction to protect the therapist from the consequences of his own
behavior, it is time to examine some behaviors - and their normal consequences. This does
not start with any implication of villainy. It is simply that since
"transference-love" is the consequence most fraught with concern, and since that
was the original instance in development of transference theory (from which all its
extensions come) we should examine the behaviors responsible for the development of
affectionate and erotic feelings. What is the truth, what are the facts?
First, there is the situation, its true conditions. Dependency is a built-in feature
for the petitioner at the beginning, and the treatment itself often promotes further
dependency. The patient (or client) is typically anxious, distressed, in need of help,
often lonely. The therapist, presumably, is not. Instead, he holds a professional role
(especially if a physician) that ranks at or near the top in sociological surveys of
romantic attractiveness to women seeking husbands (ahead of astronauts and other
celebrities).[15] The situation is set for intimacy, privacy, trust,
frequent contact, revelation of precious secrets.
Second, it is also the case that there is an ongoing search, on the part of most
adolescents and adults, for sexual companionship. It requires only the opportunity for
intimacy. One does not need to look into therapy for arcane and mysterious sources of
erotic feelings. They are commonplace, everywhere, carried about from place to place.
Psychotherapy will encounter sexual attraction as surely as it encounters nature. The
simple combination of urge and situation is a formula for instant, if casual, romantic
fantasy.
Third, there is a supremely important special factor in a behavior to which all
therapists subscribe and try to produce. It is understanding. Freud bluntly put it,
(of transference) "it is a kind of falling in love." Let me put this bluntly
too: understanding is a form of love-making. It may not be so intended, but that is
one of its effects. The professional Don Juan knows and uses it to deliberate advantage.
That alone may make it an embarrassment to the therapist who does not wish to take
advantage and is hard pressed to deal in an accepting but nonpossessive way with natural
feelings that conventionally call either for some response in kind -- or rejection. Such
difficulty does not relieve him of the responsibility. Intentionally he has been
understanding, and this alone will, over time, activate in the patient some object-seeking
components of trust, gratitude, and quite possibly affection or sexual desire.
In this same context, misunderstanding is a form of hate-making. It works
equally well since being misunderstood in a generally understanding relation is a shock,
betrayal, frustration. [16]
Understanding and misunderstanding and their ambivalent interplay ore the primary
factors in this thesis about "positive and negative transference," but there are
numerous supplementary behaviors. To supplement misunderstanding, for example: waiting,
asking for the key to the bathroom, paying (possibly for missed appointments), cigar
smoke, various subordinating and infantalizing conditions.
The most convincing evidence for this simple but profoundly effective thesis probably
lies in one's own experience. It was however, called to my attention by a combination of
events, such as that overheard client in the next office, end another fortuitous
circumstance. A Catholic priest took a year of sabbatical study at the University of
Chicago, and I was able to see some of the basic data on which he based his study of how
it feels to be "really understood" (Van Kaam, 1959). A simple seeming question,
but of great significance. By chance, the first questionnaire respondent was that of an
adolescent girl, a 17-year-old student in a parochial school. This Midwestern bobby-sox
type is hardly a match for the sophisticated European Anna O., but they are equally real,
and I suspect, would have understood each other. As to how she feels, in substance and
spirit, when she experiences understanding, she wrote:
I felt as if he, my boyfriend, had reached into my heart and had really seen my fears
and understood how much my religion meant to me. My whole being wanted to cry out how much
I loved him for that understanding. My body felt so alive and I wanted to tell everyone
how happy and exuberant I was. I wanted everyone to be happy with me. I wanted to hang on
to that understanding and pray it would never be lost to me.
Whenever I am understood by anyone, I feel a fresh onset of love for anyone or
anything. I can't sleep right away because I don't want that understanding to fade, and
somehow it seems to me that it will probably be lost in the morning.
My body seems to have a terrific pounding sensation and I want to cry out something
which I don't know how to express in words. I feel more sure of myself. I want to give. I
want to give everything I have to make this person who understands happier. I want to live
the full minute of every day. Life seems so much richer when you know someone understands,
because to me, one who understands is the one who cares and loves me and I feel love and
security and peace (Van Kaam, A., Personal Communication, 1961).
I submit that this is not an atypical reaction, but simply one heightened by the
enthusiastic vigor of an adolescent girl. She tells us how being understood effects a
human being psychologically or physiologically. Why should such effects be labeled
"transference"? They do in fact originate in the situation and through
the performance of psychotherapy (when that is indeed benevolent). The reaction might
better be called "originalance." It is not transferred, not inappropriate. It is
the normal and appropriate reaction. It might come about in someone who had never been so
understood before. Thus it might come from no past experience, but from a wish that the
past had been different, or from the hopes and dreams of the future!
For example, there is the filmed interview between Carl Rogers and Gloria (Rogers,
1965), of which a portion is reproduced below. Near the final section, she feels deeply
understood in a way that brings tears and a feeling she calls "precious." She
wishes her father had been so understanding - but that had not been the case. The typical
professional audience witnessing this becomes tense and alert. There is uneasy laughter.
They have been taught what to think of this, and the moods range from scornful to
sympathetic, for there is a general feeling that transference has reared its head (and the
anticipation that Rogers might be caught in a dangerous "Freudian" situation).
It can be read that way. It can equally be read as her response to understanding such
as she never had from her father. her wish that she could have a father like that, not
like her own. Is that transference?
Rogers, on display and well aware of this issue, makes certain that he does not deny or
reject, and while his response may not be the perfect model, it acknowledges the admiring
wistfulness, his appreciation in kind of her, and continues in an understanding mode.
Rogers: I sense that, in those utopian moments, you really feel kind of whole.
You really feel all in one piece.
Gloria: Yes. (Rogers: M-hm). Yeah. It gives me a choked up feeling when
you say that, because I don't get that feeling as often as I like. (Rogers: M-hm) I
like that whole Feeling. It's really precious to me.
Rogers: I suspect none of us gets it as often as we'd like, but I really do
understand. (pause) M-hm, that (referring to her tears) really does touch you, doesn't it?
Gloria: Yeah, and you know what else, though, I was just thinking ... I feel
it's a dumb thing that, uhm, all of a sudden when I'm talking, gee, how nice I can talk to
you, m d I want you to approve of me, and I respect you, but I miss that my father
couldn't talk to me like you are. I mean I'd like to say, gee, I'd like you for my father.
(Rogers: M-hm). (pause) (Rogers: You ...) I don't even know why that came to
me.[17]
Rogers: You look to me like a pretty nice daughter. (a long, long pause). But
you really do miss the fact that you couldn't be open with your own dad.
Gloria: Yeah, I couldn't be open, but I ... I want to blame it on him. I think
I'm more open than he'd allow me. I mean he would never listen to me talk like you ere.
And, ah, not disapprove, and not lower me down.
"Originalance" versus a Form of
"Repetition-Compulsion" In Psychological Thought
Originalance is a not-very-good word for another way of thinking about the problem. It
refers, if you can believe in such a possibility, to new experience. That could mean
"fresh perceptions", or "first-loves" and could also refer to an
experience previously known or an act previously performed but new in spite of its
appearance of being old. It is an orientation towards present or even future influences on
behavior. "Originalance" is merely a word-counterpart to
"transference" and is not designed to "catch-on" as a theory. The
purpose here is to balance and then dispense with these particular theories so that the
facts can once more be observed with what the phenomonologists call "sophisticated
naivete".
One of the errors in transference theory is the illogical assumption that any response
duplicating a prior similar response is necessarily replicating it.
Similar responses are not always repetitions. They appear to us to be repetitions
because, in our effort to comprehend quickly, we look for patterns, try to generalize.
There is breathing as a general respiratory pattern, but my most recent breath is not
taken because of the previous one: rather, for the same reason the previous breath was
taken, and the first breath was taken. It is not habit. It is normal function, repeated
but not repetition.
In the first instance, the original love of the child for the parent is not transferred
from the past. There was no earlier instance. What then? This original love developed for
the same sorts of reasons or conditions that will again produce it in later life. Provide
those conditions again and they will produce (not reproduce) it again and again, each time
on its own merits. The produced experience is mingled with memories and associations, but
those are not the conditions. Memories may seem to reproduce. If so, they reproduce
the conditions (for fear or passion, for example), and it is again the conditions,
not the memory, that account for the response.
How did any particular affect come into being in the first place? If love developed
through the parents' understanding (of what the child needs in the way of care, in the
development of its whole mental life from language to thought) further understanding
should elicit love too; but consider, every second instance might as well have been the
first. Warmth feels good to the body, not only because it felt good when one was an
infant, but because it always feels good. The need is "wired in" as an
innate physiological requirement. When one tastes a lemon at age 30, does it taste sour
because it tasted that way at age three? It always tastes sour, the first time at
any age, whether or not ever tasted before, and all following times for the same but
original reason each time.
This logic is functional; the logic of transference is historical. The difference is
very great. Historical logic in psychoanalysis goes even beyond looking into the past of
an individual's life. A. Freud writes, "Long ago the analytical study of the neuroses
suggested that there is in human nature a disposition to repudiate certain instincts, in
particular the sexual instincts, indiscriminately and independently of individual
experience. This disposition appears to be a phylogenetic inheritance, a kind of
deposit accumulated from acts of repression practised by many generations and merely
continued, not initiated, by individuals." (emphasis added) In contrast, the
logic of a present (or future) orientation does not deny the past, but looks at immediate
experience, or even imagination.
From experiential evidence, this newer logic explicitly asserts that any therapist has
an active and response-arousing set of roles and behaviors. He is loved for what makes him
lovable, hated for whet makes him hateful, and all shades in between. This should he
the first hypothesis. Whatever it does not account for may then be described as proof
of another phenomenon, such as transference, but understanding and misunderstanding will,
I believe, account for the major affects of love and hate.
This does not begin to analyze the complex interactions beyond understanding and
misunderstanding. Whatever they are in any given case, there too therapists play their
part. The first principle remains; for the therapist to eschew the pretense of innocent
invisibility and to reflect upon what, in the situation and his (or her) behaviors, does
in fact account for those "untoward events" that brought transference theory
into being. Adoption of this principle may engender a sense of vulnerability and remove
not only the shield but some of the most ornamental of therapeutic trappings as well. This
is not the most inviting prospect for the contemporary psychotherapist. It is easier to
have an exotic treatment for an intriguing disease. For the patient there may be some
allure and pleasure in disguise as well.
Is there no transference, whatever, at any time? Of course there is, if you wish it.
The material is there at the outset. It can be cultivated, and it can be forced. Emotional
attitudes will be expressed, through indirect channels if open expression is
discouraged. Like seeds, emotions and perceptions will grow straight and true in
nourishing soil or crookedly through cracks in the sidewalk. One can encourage
distortions, end then analyze them. It is a matter of choice. As with any fiction,
"transference" can be turned into a scenario to be acted out, creating a desired
reality.
At the beginning, there is always incipient prejudice. Upon first meeting, stereotyped
judgments and appraisals based on prior experience will be applied to the perception of
the new unknown. Some call it "stimulus generalization". In a state of
ignorance, what else can one do to make meaning? - unless it is the rare instance of those
who are able and willing to approach new experience with suspended judgment, and a fresh,
open view. Except in such cases, prejudgment applies. Then if the reality of the new
experience is concealed, attention turns inward to make meaning. If, however, the new
reality is available to be known as needed, prejudice fades; Judgments and appraisals
appropriate to that reality will develop. For example, if red suspenders (and it could be
blue eyes, swastikas, peace symbols, skin color, combinations of signals) are worn by a
person you meet, and if you have been mistreated by someone wearing red suspenders, you
will be wary of this new person. If you are permitted to know more, and wish to do so, the
effect of red suspenders will be canceled or supported or become trivial, depending upon
your whole knowledge of the new reality. But if the new reality is concealed, attention
searches for focus and meaning end, from a relationship standpoint, projections reign.
Transference, or what passes for transference, can then be cultivated. Yet it is neither
inevitable nor necessary. It is an obstruction.[18] That some derive
benefit from its analysis may come from the concentrated self-examination and the presence
of attentive intelligence on the part of the therapist -- both of which are possible in at
least equally pure form without the transference neurosis.
Will there be any change in basic transference theory? Is it possible to bring balance
through corrective criticism? Not likely. Such "balance" is only a temporary
concession. The theory itself does not allow for balance. It is too heavily weighted
(nearly all-or-none) because its logic cannot bear disturbance. As for the basic position,
it is as entrenched as ever. For the public it is high fashion and popular culture;
diverting, entertaining. For the professional it is a tradition, a convenience, a shield,
stock-in-trade, a revealed truth and a habit of thought.
How strong a habit of thought is illustrated by an instance described in the study by a
sophisticated and sympathetic journalist, J. Malcolm, under the title "Trouble in the
Archives" (1983). It reports as "striking example of Eissler's[19]
remarkable freedom from self-justification" (p. 132) a case history. "He treated
a wealthy older woman during the years before her death, and was so helpful that, in
gratitude, she changed her will and left him a huge amount of money." He could not
accept it for himself and ordered it returned to beneficiaries or donated to charities.
However, "the husband of a relative of the deceased whose legacy had been diminished
because of the change in the will, formally objected to the probation of the will. He
happened to be an analyst, and his argument was that Eissler had exercised 'undue
influence' on the patient through 'the unconscious utilization of the transference'"
(p. 132). Malcolm writes, "The case history ends with a wonderful twist." Since
the matter had caused painful embarrassment, and whet had first been seen as a 'loving
gesture' was re-interpreted by Eissler as "an expression of her hatred of him - an
expression of the negative transference that had never been allowed to emerge during
treatment." (p. 137)
It can be interpreted in other ways as well. The ex-patient may indeed
have wished him well, may even have expected that if he could not use the money for
himself he could choose to support charitable interests of importance to him. On the other
hand, she may have enjoyed the amusement afforded by anticipation of cleverly hurting both
her analyst and her relatives with one stroke. Two other observations remain. First, she
was treated, even after her death, like a psychiatric patient and therefore a minor or
incompetent. She could not exercise her choice about what was, after all, her money,
because (a) her judgment was forever suspect, (b) it dispensed something of considerable
value to others, and (c) it did not suit those who survived her and who could either call
upon, or were called upon by, transference theory. Second, everything suffers (not
entirely without compensation) except the concept of transference. One might think
that since it was born of embarrassment, it might now die of embarrassment. But no, that
is its charm. It merely changes color, never seriously questioned, only reconfirmed.
Conclusion
I have offered a brief for a countertheory, not in the sense of a complement or
counterpart, as in "transference and countertransference" but in the sense that counter
means opposite, alternative. If transference is a theory, this is the counter: personality
and situation aside for the moment, the therapist is responsible for two fundamental
behaviors -- understanding and misunderstanding -- which account for love, or for hate,
and their associated affects. These, as well as other behaviors and the situation and
personality of the therapist, may account -- should first be held accountable -- for the
whole of what passes for transference.
The power of understanding has been featured to account for the phenomenon called
"transference." That use should not hide the point that it is this very power of
understanding (not the transference, transference-love, or love itself) that heals.
Understanding makes for healing and growth; misunderstanding makes for injury and
destruction.
The proposition that "understanding heals" does not make understanding the
exclusive property of client-centered therapy. Far from it. Client-centered therapy has a
constant theme in its focus on understanding: early, in its method of seeking confirmation
from the client; later, in its stress on empathy (as a form of understanding and even a
"way of being") and how such understanding is best achieved. That is its
emphasis, not its proprietary claim.
The emphasis on understanding is stressed at this final point to indicate that, while
love is a blessing, love is not enough. Ultimately, we are trying to account not only for
transference love, or for love in general, but for healing. Even romantic love
("falling in," or choosing to be in) gives promise of, and is given in the hopes
of receiving, understanding (which may or may not be delivered). Being "in love"
often assumes understanding to exist even where it does not. When love is present,
it is an environment for or the consequence of understanding. Though the two are
strongly associated, love does not heal. Understanding heals. It also makes one feel
loved, or sustains love already felt, but the healing power is in the understanding.
Knowing that does not make the conduct of therapy easier in the slightest. It may
however help us to separate therapy from the rest of life. It seems that we can quite well
love, and take love from, those to whom we do not devote the considerable or sometimes
near-consuming effort to fully understand. That is the difference between real life
in ordinary relations and equally real life in therapy. If and to such extent as they
could be brought together, so much the better; if not, so much the good in either case.
To conclude that it is not love that heals may be a disappointment to many. The role of
the healer is appealing. So is that of the benefactor who dispenses love. Therapists and
others find these roles all too gratifying. But no, the "healer" takes credit
for a process inherent in the organism, if released, and love is only therapeutic or
enduringly beneficial if expressed through understanding. The act of understanding may be
the most difficult of any task we set ourselves -- a seemingly mundane "service
role" yet requiring kinds of intelligence and sensitivity so demanding that some
people are truly seen as gifted. Even that is not the final cause. It still remains for
the client to feel understood. Of course in doing so, he understands himself that is the
source of his confirming the understanding.
To realize that it is the understanding that promotes the healing will direct us
to the remaining problem for psychotherapy and psychology: we do not know the mechanisms
by which understanding promotes healing or even the mechanisms of understanding itself.
That knowledge cannot come from a theory such as transference, which has been a roadblock
and a pointer in the wrong direction for almost a century. That knowledge may not come
from any present version of psychotherapy, but rather from more neutral realms of
cognitive, social, and developmental psychology, or neuro-science, to the ultimate benefit
of a new theory and practice.
Footnotes
1. Transference does not appear in the index of his earlier
volume, Counseling and psychotherapy (1942b).
2. Inventions are man-made: thus invent is
used to offset Freud's use of the word discovered, which inaccurately implies a
fact found or truth revealed.
3. Social and economic conditions that create anxiety neuroses
in women end enable men to become physicians have changed enough to bring about some
evening of opportunity. Fortunately, women can now more easily find female therapists.
There are also more cross-sex, same-sex, bi-sex, and other permutations. We know
relatively little of these many parallels of the transference model, but may be sure that
the concept is now so well established that it will appear as a "demand
characteristic" in its own right. It has become part of the pseudosophisticated
belief system of informed clients.
4. One point must be stressed. There is only, but only Freud's
reconstruction in this momentous history. No other source whatever. How much Freud wanted
this data, how much and how often he pressed Breuer for it, we have a few hints. In his
autobiography (1948, first published in 1925): "When I was back in Vienna I turned
once more to Breuer's observation and made him tell me more about it" (p. 34). In
1925 he still speaks of "a veil of obscurity which Breuer never raised for me (p.
36)." This prodding, though, eventually cost them their friendship. How much Breuer's
support meant to Freud we do know. How highly motivated to get this information, which he
sometimes says Breuer would never repeat for him, we also know. Yet it is all Freud's
reconstruction; and in 1932, when he wrote the cited letter to Stefan Zweig, he still
seems wanting of confirmation. "I was so convinced of this reconstruction of mine
that I published it somewhere. Breuer's youngest daughter read my account and asked her
father about it shortly before his death. He confirmed my version, and she informed me
about it later." (Freeman, 1972, p. 200). To what "reconstruction" does
this refer, that he published "somewhere" (and where?) because he was so
convinced yet unconfirmed? Hot pursuit, without a doubt, but the facts are still reported
with slight discrepancies, and never by anyone but Freud.
5. To what? Not necessarily the arcane lock Freud had in mind.
Perhaps the door to a more literal and still more courageous exploration, and Breuer might
have founded an enlightened form of psychotherapy to advance the field by decades. But he
was frightened off by the event, his circumstances, and perhaps his colleague as well.
6. I have personally known
psychologists and psychiatrists who far exceeded Breuer's relatively innocent
transgressions, i.e., theirs were "sins" by the informal definition,
"included exchange of bodily fluids." Results included divorce, marriage to the
patient, suicide, murderous thoughts and a probable attempt, career changes, and the
development of new theories. The late O.H. Mowrer's therapy based on real guilt and
compensation (1967) is an example of the latter, as he often announced to professional
colleagues.
7. This is either the instance that is sometimes described as
the patient being just aroused from a hypnotic trance, and with a maid-servant
unexpectedly knocking or entering, or it is a separate but prototypic scene.
8. Breuer knew better. Had he walked into this trap, it is he
who would have been crushed.
9. Women are especially good at this, he writes. They
"have a genius for it" (Freud, 1935, p. 384).
10. This too is the patient's doing? Does this material not
reside in the being of the physician? Or, if an interactive quality, does the
transference, in reverse, arise in the patient as a result of the physician's influence?
11. In a letter dated 1909 about a case now become infamous,
Freud wrote to Jung, "After receiving your wire I wrote Fraulein Sp. a letter in
which I affected ignorance . . ." (McGuire, 1974, p. 230) and says of Jung's mishap,
"I myself have never been taken in quite so badly, but I have come very close to it a
number of times and had a 'narrow escape' (in English). I believe that only grim
necessities weighing on my work and the fact that I was ten years older when I came to
psychoanalysis saved me from similar experiences. But no lasting harm is done. They helped
us to develop the thick skin we need and to dominate 'counter-transference' which is after
all a permanent problem for us" (McGuire, 1974, p. 231).
12. "Later he assured her that the anatomy of the brain
was the only rival she had or was likely to have" (Jones, 1953, p. 211).
13. "But a week later he asks why he should not for once
get more than he deserved. Never has he imagined such happiness" (Jones, 1953, p.
110).
14. My wife, with good taste and Judgment, advises
("after all, this is not your biography") omitting this entire section. I would
like to but a main point of the chapter is that theory is in part biographical stemming
from thought, observation, self-concept.
15. A current social psychology suggests that love, especially
sexual love, is the result of status and power factors - "a love relationship is one
in which at least one actor gives (or is prepared to give) extremely high status to the
other" (Kemper, 1978, p. 285).
16. This should not be overlooked: the therapist wants, and
sometimes demands, to be understood by the patient, or client. Whether dealing in
reflections, interpretations, or hypnotic suggestion, he wants these understood. Feels
good about it if they are, inadequate and "resisted" if they are not. Indeed.
the therapist may have the same response to understanding as does the patient! Tempered of
course by wisdom, maturity, self-awareness, and other not-always-present virtues.
17. The typical audience thinks it knows why. "Looking
for a father". Popular wisdom ways that young women seek "father figures."
A less popular and somewhat hidden knowledge is that men also may seek "daughter
figures". Freud might have known this from his dream about "overaffectionate
feelings" for his 10 year old daughter Mathilde (Letter to W. Fliess, May 31, 1897),
but such reciprocity, or seeking from both directions does not so readily fit to
transference theory.
Whatever motives for either party -- whether benign caring, dependency, exploitation,
fulfilling of various hopes and desires -the seeking moves in both directions. So neither
party may be Justly accused of entirely uninvited or unrewarded responsibility. This is
not necessarily to explain the particular case of Gloria, but to add a statement of
general interest in the re-analysis of transference theory.
18. Without doubt, the transference-neurosis is an illness,
deliberately contrived to benefit the treatment. Perhaps this is part of what is meant in
the statement, "psychoanalysis is the disease it is trying to cure".
19. Kurt Eissler, a towering figure in the psychoanalytic
movement, of whom one of his colleagues says, "Eissler is not loveable, and he knows
it" (Malcolm, The New Yorker. December 5, 1983, p. 152). Yet his patient may have
found him so, and rightly, for the very reasons of his understanding behavior - when, if,
and inasmuch.
References
Breuer, J., & Freud, S. (1957). Studies on hysteria. New York: Basic Books.
Epstein, L., & Feiner, A. (1974). Countertransference. New York: Aronson.
Fenichel, O. (1941). Problems of psychoanalytic technique. Albany, NY:
Psychoanalytic Quarterly, Inc.
Freeman, L. (1972). The story of Anna O. New York: Walker.
Freud, A. (1946). The Ego and the Mechanisms of Defense. International
University Press, Inc., New York.
Freud, S. (1910). The future prospects of psychoanalytic theory. In J. Strachey
(Ed. and trans.), The standard edition of the complete psychological works of Sigmund
Freud (Vol. 7, pp. 3-1Z2). London: Hogarth.
Freud, S. (1923). The ego and the id. London: Hogarth.
Freud, S. (1927). The problem of lay analysis. New York: Brentano.
Freud, S. (1935). A general introduction to psychoanalysis (Vol. 1). New York:
Liveright.
Freud, S. (1948). An autobiographical study. London: Hogarth.
Freud, S. (1959). Collected papers (Vo. 3). New York: Basic Books.
Jones, E. (1953). The life and work of Sigmund Freud (Vol. 1). New York: Basic
Books.
Jones, E. (1953). The life and work of Sigmund Freud (Vol. 3). New York: Basic
Books.
Kemper, T. (1978). A social interactional theory of emotions. New York: Wiley.
Macalpine, I. (1950). The development of the transference. Psychoanalytic
Quarterly, 19, 501-539.
Masson, J. (Ed.) (1985). The complete letters of S. Freud to W. Fliess
1887-1904. Cambridge: Belknap-Harvard.
McGuire, W. (Ed.) (1974). The Freud-Jung Letters. Princeton, NJ: Princeton
University Press.
Malcolm, J. (December S, 1983). Annals of scholarship. Trouble in the
Archives-l. The New Yorker. pp. 59-152.
Menninger, K. (1958). The theory of psychoanalytic technique. New York: Basic
Books.
Mowrer, O.H. (Ed.) (1967). Morality and mental health. Chicago, Rand McNally.
Orr, D. (1954). Transference and countertransference: An historical survey.
Journal of the American Psychoanalytic Association. 621-670.
Rogers, C.R. (1942). Counseling and psychotherapy. Boston: Houghton Mifflin.
Rogers, C.R. (1951). Client-centered therapy. Boston: Houghton Mifflin.
Rogers, C.R. (1954). The case of Mrs. Oak. in C.R. Rogers & R.F. Dymond
(Eds.), Psychotherapy and personality change. Chicago. University of Chicago Press.
Rogers, C.R. (1965). Three approaches to psychotherapy 1. (film) Psychological
Films.
Roustang, F. (1982). Dire mastery. Baltimore: Johns Hopkins Press.
Shlien, J.M. (1963). Erotic feelings in psychotherapy relationships: Origins,
influences, and resolutions. Paper presented at Annual Meeting of the American
Psychological Association, Philadelphia.
Van Kaam, A. (1959). Phenomenal analysis: exemplified by a study of the
experience of "really feeling understood." Journal of Individual Psychology. 15,
66-72.
Waelder, R. (1956). Introduction to the discussion on problems of transference.
International Journal of Psychoanalysis. 37, 369-384.
Copyright 1984 John M. Shlien.
Permission is granted to distribute freely with copyright intact.
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