Countertransference

Anxiety, Desire, and the Object a: Lacan on Lucia Tower's "Countertransference"

Lacan's seminars are a treasure trove of innovative psychoanalytic explorations. In Seminar X, Anxiety, he takes up this Freudian theme and explores a number of interrelated ideas: castration, the difference between the sexes, two different forms of acting out, and what he terms his only original theoretical contribution: the object a and its "various incidences." The object a is described here in detail, especially in relation to Lacan's argument that analysts who are women have a freer relationship to their desire and the countertransferences it spawns than do men. Lacan discussed Lucia Tower's classic paper, "Countertransference," in light of these notions. This essay is a close reading of Lacan's close reading of Tower, whose account, he says, must be approached in all its "innocence and freshness."

Il controtransfert in Lacan

Lacan al controtransfert oppone, per operare nella cura, la funzione "il desiderio dell'analista". Dopo aver affrontato la questione in Freud, Lacan si volge verso i fautori della concezione allargata del controtransfert (inteso cioè non come "transfert dell'analista" ma come l'insieme di tutte le sue reazioni al paziente) e dimostra che il controtransfert funziona mettendo in gioco il desiderio dell'analista. Non si tratta del desiderio della persona dell'analista ma di una funzione: quella che permette l'elaborazione simbolica per cogliere, al di là del rapporto duale, e quindi immaginario, il reale in gioco nel vissuto del proprio paziente. L'intento di Lacan sarà allora quello di puntualizzare quali sono gli aspetti nodali per l'emergenza di questa funzione in un analizzante affinché si tramuti in uno psicoanalista. Questa trasformazione avviene su due assi, ambedue prodotti dall'elaborazione in analisi del futuro analista e che saranno la base per operare in quanto tale. Si tratta dell'asse del sapere inconscio e dell'asse di ciò che egli è e deve essere nella cura con i suoi pazienti.

Reading Harold Searles

Through a close reading of two of Searles's papers, the author explores not only what Searles thinks, but the way he thinks and how he works with patients. Searles makes use of a form of emotional responsiveness to the transference-countertransference that entails a seamless continuity of conscious and unconscious receptivity and thought. His unflinchingly honest descriptions of what is occurring in the transference-countertransference seem, as if of their own accord, to generate original clinical theory, for example, a reconceptualization of what is entailed in the successful analysis of the Oedipus complex. He demonstrates his own distinctive form of analytic thinking and interpreting, which the author describes as 'turning experience inside out'. Searles, in clinical example after clinical example, transforms what had been the invisible, unnameable emotional context of the patient's experience into verbally symbolized psychological content that is thinkable and speakable. In the final section of the paper, the author discusses an important (and unexpected) complementarity of the work of Searles and Bion. Searles's work provides clinical shape and vitality for Bion's often abstract theoretical constructions, such as the concept of the container-contained, the human need for truth, and the relationship of conscious and unconscious experience. At the same time, Bion's work provides a broader theoretical context for Searles's work.

The analyst's way of being: recognizing separable subjectivities and the pendulum's swing

Whether the analyst finds the patient's emerging transference affectively tolerable or intolerable plays an important role in the analytic couple's negotiation of the configuration that the transference-countertransference relationship ultimately assumes. If the analyst is deeply repelled by transference-related roles to which he is assigned, patient-ascribed attributions, or projection-drenched interactions, he may react in violent protest, engaging in enactments that say more about his separable subjectivity than about the intersubjective situation. While there has been a recent trend to view enactments as a crucial aspect of psychoanalytic technique, this trend risks overlooking the way in which the analyst's way of being comes into play in the treatment.

Spontaneous "cures": Norman Reider's forgotten paper, part II

Part I of this paper combined an introduction to Norman Reider's original 1955 paper with a republication of the paper itself. Part II is a discussion of the complexities of a comparison of past and present psychoanalytic literature. The concept of enactment is proposed as one of many possible alternative views in considering Reider's notion of spontaneous "cures." A careful consideration of these spontaneous cures within the ordinary ups and downs of any psychoanalytic treatment sheds important light on our continuing confusion about how we define the term cure, and therefore about the nature of change during psychoanalytic treatment. This alternative perspective is only one of many plausible ones for present-day readers. The purpose of this republication is not to propose an explanation for "what really happened" with Reider and his patients; rather, it is to reconsider the fallacy of evaluating his paper outside its historical context and thereby failing to appreciate his courage in presenting what at the time were radical views. Questions about the complexity and confusion regarding cure and change require reexamination of the neglect of epistemology on the part of psychoanalysis in prolonging the confusion about distinguishing psychotherapy and psychoanalysis.

Special problems for the elderly psychoanalyst in the psychoanalytic process

The psychoanalytic process takes on a special ambience when the analyst is clearly elderly. The effects of this ambience on the the aging analyst's patients are discussed, and the sparse literature on the subject is reviewed. Clinical vignettes illustrate a number of these effects on the analytic process. Dealing with these special problems requires not only the analyst's awareness of their existence but a continual monitoring of the transference-countertransference in order to avoid a silent collusion of patient and analyst to pretend these problems do not exist. The dangerous consequences of being unaware of the situation, for both patient and analyst, are discussed. If the influence of the patient's perception of the analyst's aging is ignored, it may lead to destruction of the treatment either through massive acting out or by a hopeless stalemate with or without the development of an endless psychoanalysis.

The crossroads of countertransference and attribution theory: reinventing clinical training within an evidence-based treatment world

Social Psychological research on Person Perception/Attribution Theory has concluded that an individual responds to interpersonal situations based upon their interpretation of the "nature" of that situation. For example, physically attractive people are often attributed niceness and capableness even without any basis in reality. The observer, guided by percepts cum attributions, may treat the attractive participant "as though" these qualities are about them rather than about the observer's internal bias. In psychoanalysis, this social phenomenon takes on individual meaning as countertransference. Therapists seem to experience irrational feelings during the psychotherapy exchange, which remain, whether or not the therapist is conscious of these responses or whether their technical objective includes or ignores their own transference. The attributional tendency to act upon these feelings "as though" they were wholly about the patient may lead to therapeutic disasters. Therefore, clinical training of psychotherapists needs the early inclusion of this concept to prevent subsequent dogmatic and untherapeutic attitudes. This paper will discuss the possibility of disarming the damage rendered by medicalized parsimonious "healing" and the latest fashion, Evidence-Based Treatment, via a translation of assumedly unmeasurable psychoanalytic tenets into multiply measured, investigated areas of social research.

The concept of objective countertransference and its role in a two-person psychology

Objective countertransference comprises those feelings the analyst experiences with the patient that are repetitions of feelings from the patient's life outside the analysis. It is viewed as being induced by the patient and is understood in the context of the patient's life, not the analyst's. The concept is used to understand the relationship of some of the analyst's feelings to recurrent interpersonal patterns in the patient's life. It has often been viewed as being incompatible with a two-person psychology. Here, in contrast, it is argued that objective countertransference is only one current within the analyst's total emotional response to the patient, and that it should be conceptualized as a component of a broader two-person psychology. However, the use of objective countertransference as a conceptual tool highlights aspects of the analytic relationship that differ from those emphasized in current two-person models. A case example is analyzed from both perspectives to illustrate their similarities and differences. Although the concept of objective countertransference can enrich the analyst's understanding of certain dimensions of the analytic relationship, it is not a theory of technique and it is not wedded to any particular style of psychoanalytic intervention.

Is there a special psychoanalytic love?

Although the analyst's role mandates a degree of detachment, analysts have often said that they offer patients a special kind of love. They have tended to equate that love with understanding, thus neutralizing the paradox but also diluting the love. When something more resembling a loving affect is sought, the suggestions include the love a scholar feels for his subject, the love that accompanies immersion in great literature, and love that is self-generated by deliberate efforts to move toward the patient or to generate empathy in oneself. But a form of love may also arise from the analyst's unique and relatively pure acquaintance with a person's "appeal," by which is meant the patient's effort to elicit responses from the analyst. Although the awareness of transference most obviously tends to immunize him, it also gives him a poignant "insider's" feel of the patient's appeal, since he is the target of that appeal while being unencumbered by the myriad considerations that would color his perception were he to regard himself as a proper object.

Psychoanalytic peregrination VI: "the effect on countertransference of the collapse of civilization"

There is an aspect to countertransference that has not been discussed very much in the literature of psychoanalysis, one that is becoming increasingly important. This centers around the effect on the analyst's countertransference of the deterioration of the culture in which he or she is immersed. I discuss the decline of Western civilization as it is described by a number of contemporary authors in order to show how changes in the value system of the psychoanalyst or his or her turning a blind eye to the injustices and barbarism of the cultural surround both affect the capacity to immerse in the creative process of psychoanalysis, and send a tacit message to the patient about the permissability of hiding certain material. All this contradicts the "fundamental rule" of psychoanalysis, and disturbs the analyst's listening process. The impact of the dumbing down and deterioration of the educational, cultural, and home upbringing milieu of the new generation of psychoanalysts will be profound in influencing the future practice of psychoanalysis.

Countertransference, conflictual listening, and the analytic object relationship

Analytic listening is an ongoing conflictual process, containing all the components of conflict and shaped in every moment by both the patient's and the analyst's conflicts. The mutual responsiveness that develops between analyst and patient stems from a complex conflictual object relationship, fundamentally no different from any other object relationship, in which countertransference at all times simultaneously facilitates and interferes with the analytic work. Detailed clinical process is used to illustrate these and related phenomena, including the use of signal conflict, the benign negative countertransference, the function of countertransference structures, and the analyst's use of projection. The analyst's affects, thoughts, and actions trace the shifting nature of the patient's transference and resistance, and the level of the object relationship continuously being created between patient and analyst.

Love in the therapeutic alliance

Volumes have been written about the patient's love for the therapist, but there has been relatively little discussion of the therapist's love for the patient. In an attempt to create a theoretical and technical space for discussing the appropriateness and role of love in the therapeutic relationship, a revised concept of the therapeutic alliance is applied to provide technical guidelines and understanding of two kinds of love between patient and therapist, corresponding to two systems of self-esteem regulation: an open, reality-oriented system and a closed, sadomasochistic system organized according to omnipotent beliefs. Examples of the role of love through the phases of treatment illustrate the interrelationship of love and the accomplishment of therapeutic alliance tasks.

Counteridentification, comprehensive countertransference, and therapeutic action: toward resolving the intrapsychic-interactional dichotomy

Two dichotomous trends in thinking about countertransference and therapeutic action can be delineated historically as well as in clinical practice: the intrapsychic and the interactional. The author proposes a new usage of the concepts of counteridentification and comprehensive countertransference to help transform these dichotomizing tendencies into more useful, integrative therapeutic action across the broad spectrum of psychoanalytic treatment for patients from the neurotic to the most severely disturbed.

Where the action is: the enacted dimension of analytic process

Enacted processes--variously addressed in the current literature by such terms as enactment, actualization, and interaction--represent the conceptual reuniting of Freud's concepts of transference and acting out. These various concepts include a recognition that transference may be represented not only on the verbally symbolized level but also on the enacted level, through psychic organizations and processes that use behavior, silence, and even speech as symbolic vehicles. Countertransference too finds representation within the enacted realm, in response to and in concert with the patient's enacted processes, though in more attenuated fashion. Enacted transference-countertransference processes are conceptualized as a continuously evolving second dimension of analytic treatment. This enacted dimension of analytic process exists alongside, and inextricably interwoven with, the treatment's verbal content, with characteristics unique to each analytic dyad. It occurs naturally and inevitably, without conscious awareness or intent, and is outside the domain of explicit technical interventions. The observable outcroppings or end points of processes within the enacted dimension are what are currently referred to as enactments. Attention to these unintended but meaningful and often elaborately developed characteristics of the treatment process furthers our understanding of the therapeutic action of psychoanalysis. The process of integrating the enacted with the verbal dimension of treatment enables the analysand to achieve higher levels of psychic organization.

Desire and the female analyst

The literature on erotic transference and countertransference between female analyst and male patient is reviewed and discussed. It is known that female analysts are less likely than their male colleagues to act out sexually with their patients. It has been claimed that a) male patients do not experience sustained erotic transferences, and b) female analysts do not experience erotic countertransferences with female or male patients. These views are challenged and it is argued that, if there is less sexual acting out by female analysts, it is not because of an absence of eros in the therapeutic relationship. The literature review covers material drawn from psychoanalysis, feminist psychotherapy, Jungian analysis, as well as some sociological and cultural sources. It is organized under the following headings: the gender of the analyst, sexual acting out, erotic transference, maternal and paternal transference, gender and power, countertransference, incest taboo--mothers and sons and sexual themes in the transference.

Impasses in psychoanalysis: overcoming resistance in situations of stalemate

Many impasses occur in treatment when the patient fears that analysis will repeat frightening or disappointing experiences. These stalemates result from the patient's conviction that the analyst has confirmed a preexisting belief that is central to the patient's primary conflict. Frequently, this belief involves an unacceptable or frightening self- or object representation. At these times, intense resistance and strong negative transference/countertransference reactions may develop. Impasses are differentiated from these strong negative reactions only by virtue of the fact that they remain unanalyzed. The factors that create these negative states can best be understood in instances where the potential impasse is resolved. When impasses persist, most often patients leave treatment. Under these circumstances, we can try retrospectively to understand what has gone wrong, but without the patient's confirmation, our conclusions must remain speculative. Four cases illustrate varying degrees of analysis and resolution of resistance and transference/countertransference binds.

Use of the group in resolving the subjective countertransference

Subjective countertransference can sharply limit any group leader's effectiveness. However, a therapist can use the group itself to identify such a bias and to remove it as an influence. A five-step method for doing this is presented. These steps begin with introspection but hinge upon the analyst's turning to the group for the vital information that, in the end, clarifies the analyst's own perceptions and helps him or her free the group from the harmful effects of any bias.

Negative oedipal transference of a male patient to his female analyst during the termination phase

There has been some debate in the literature concerning the ability of the male patient to experience his paternal, and particularly negative oedipal, transference feelings directly toward his female analyst. In this context, the author describes paternal transference manifestations evident throughout her male patient's analysis, and presents detailed process material from the termination phase. At this time the patient's obsessional neurosis was revived in the context of setting a termination date, and transference to the negative oedipal father could be clearly demonstrated. The paper illustrates that even the negative oedipal component of the paternal transference can be experienced directly in the male patient/female analyst, dyad, and interpretation of this material can bring it into clearer focus. The author discusses some possible influences of her sex on the timing and intensity of the material.