WAYNE MASON17 March 2010

HISTORY OF TRANSFERENCE 1 Freud commenced practice in Vienna as a

neurologist in 1886 and was exposed to many “nerve patients”

Treatments available were of a physical nature such as electrotherapy (Erb) and rest cures (Weir Mitchell)

Freud also used hypnotic suggestion (Mesmer, Charcot, Bernheim, Liebeault) under Breuer’s influence

Breuer referred to it as the “cathartic’ method

HISTORY OF TRANSFERENCE 2• This was then adapted to an

exploration of the origin of symptoms.• This was further adapted to the application of

pressure to the patient’s head to overcome resistance.

• This was later replaced by “insistence and encouragement” but it became “too much of a strain on both sides”

• So finally the technique of free association evolved

HISTORY OF TRANSFERENCE 3At this point in time Freud regarded

hysteria as due to a disruption in associations

The affect associated with one memory had been “transferred” to something else

Hence the origin of the term transferenceNote that at this point transference is an

intra-psychic event

HISTORY OF TRANSFERENCE 4Because of this the task of therapy is to

connect up the memory and the affectIt was also regarded as an obstacleThis probably accounts for the archaeological

and detective metaphorsNote: Freud first uses the term “splitting of

consciousness” in this context

HISTORY OF TRANSFERENCE 5Breuer’s case of Anna O (1880 – 1882)

intrigues Freud(chimney sweeping)Breuer fled from her amorous advances to

him at the end of the hypnotherapy, believing them to be real

Freud argued this was an artefact of the treatment – transference – rather than a genuine love relationship

HISTORY OF TRANSFERENCE 6Dora 1901This is an illustration of a case that went

badly wrong, in part because Freud failed to recognise and interpret the transference

There were however other serious problems with the case that went unrecognised

By now transference is becoming an interpersonal event

HISTORY OF TRANSFERENCE 7In 1912 Freud spells it out in “The Dynamics

of Transference”:“each individual...has acquired a specific

method of his own in his conduct of his erotic life. .....this produces what might be described as a stereotyped plate (or several such), which is constantly repeated...” (P99)

Note the emphasis on “erotic life”

What Is Transference? 1“What are transferences? They are new

editions or facsimiles of the impulses and phantasies which are aroused 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.” Freud 1905

What Is Transference? 2“For psycho-analysis, a process of

actualisation of unconscious wishes. Transference uses specific objects and operates in the framework of a specific relationship established with these objects. Its context par excellence is the analytic situation.

In the transference, infantile prototypes re-emerge and are experienced with a strong sensation of immediacy.” LaPlanche & Pontalis

What Is Transference? 3“It became clear that erotic feelings were

only one example of the kinds of intense feeling that a patient could develop for the therapist, which could in fact include the whole range of feelings that one human being can have for another; and moreover that these feelings could be accepted, ‘worked through’ and resolved, provided they were confined to

What Is Transference? 3 (cont)...verbal expression and were traced to their

origins in the past, usually of course in the relation with parents.” Malan 1979, P74

What Is Transference? 4Essentially it is an emotional relationship

with the therapist that has its origins in the patient’s past rather than in their relationship in the present.

At times this will be very obvious, and at other times it will be subtle and may take a long period of time to manifest

Why Make Transference Interpretations? 1This is often the only way the patient will

have an opportunity to become aware of the displacement of his feelings onto the therapist

By doing so the patient has an option to re-work an old traumatic relationship from the past and arrive at a different resolution

Note that transference interpretations are not always immediately curative, and may require “working through”

Why Make Transference Interpretations? 2Transference interpretations are of necessity

almost always very painful for a patientOccasionally immediate relief may be an

outcomeUsually it means very painful feelings from

childhood are experienced with immediacy in the therapy, and often towards the therapist

Formulation 1

Not “You are reacting towards me as if I am your father”

This may well be true but is rather intellectual and is not ‘experience-near’

Formulation 2Rather “You hate the feeling that I am in

control of you”This brings the interpretation into the

therapist-patient relationship and allows the patient to experience and explore current feelings towards the therapist

The connection with the past may be made immediately, or much later in time, by either patient or therapist

COUNTERTRANSFERENCE 1“It is a very remarkable thing that the

(system) unconscious of one human being can react upon that of another, without passing through the (system) conscious.” (Freud 1915 The Unconscious P194)

 

COUNTERTRANSFERENCE 2Freud made only 4 mentions of

countertransference1910 Letter to Jung 2 February 19101910 The Future Prospects of Psychoanalytic

Therapy 30-31 March 1910 Nuremburg

1911 Letter to Jung 31 December 19111915 Observations on Transference Love

COUNTERTRANSFERENCE 3 Therapist’s TransferenceAs for the patientTo the patientTo the patient’s transference

COUNTERTRANSFERENCE 4Heimann 1950 “On Countertransference”Re-defines countertransference“All the feelings which the analyst

experiences towards his patient”“The analyst’s counter-transference is an

instrument of research into the patient’s unconscious”

Note that ‘feelings’ are not unconscious

Using CountertransferencePatient free associatesTherapist meets this with evenly suspended

attentionTherapist notes own internal reactionsTherapist decides if reactions are from own

pathology or stimulated by patientTherapist decides if reactions can be used to

inform an interpretation

Concordant IdentificationsRacker

Therapist identifies with corresponding aspect of patient

Therapist’s id with patient’s id, etc.Can be thought of as similar to empathy, but

more is involved than feeling what the patient feels

Processes of introjection and projection are involved

Complementary IdentificationsRacker

Patient treats the therapist as an internal objectIt is “as if” the patient projects an aspect of self

“onto” or “into” the therapist in a desperate attempt to have the therapist experience and understand what is unbearable for the patient

Occurs when concordant identification failsUnderlines what Heimann describesBasis of modern view of countertransferenceSimilar processes of introjection and projection