So, for example, if someone has a kundalini experience, they may feel a rush of energy up the chakra system . . . but to say that the energy flow is consciousness is to mistake the object (energy flow) for the subject, for what perceives (consciousness) the object. Note the two importantly distinct words in the phrase "feel the rush of energy . . . " On the one hand there is the "feeling" (or the "feeler"), on the other, there is what is being felt or experienced (the energy). Even our way of talking about it reveals that we detect a distinction between feeling (consciousness) and what we feel (energy). Yes, the two go together, but they are not the same. Unity, or unification, or holism, does not equal identity. To say that one aspect of reality (say, consciousness) cannot be separated from another aspect of reality (say, matter-energy) is not to say both aspects of reality (consciousness and matter-energy) are identical.
Consciousness, is neither identical to energy (monism) nor it a separate substance or energy in addition to physical matter or energy (dualism)-it is the "interiority," the what-it-feels-like-from-within, the subjectivity that is intrinsic to the reality of all matter and energy (panpsychism or radical materialism). If you take a moment to pay attention to what's going on in your own body right now, you'll see-or feel-what I mean: The physical matter of your body, including the flow of whatever energies are pulsing through you, is the "stuff" of your organism. But there is also a part of you that is aware of, or feels, the pumping of your blood (and other energy streams). That aspect of you that feels the matter-energy in your body is your consciousness. We could express it this way: "Consciousness is the process of matter-energy informing itself." Consciousness is the ability that matter-energy has to feel, to know, and to direct itself. The universe could be (and probably is) full of energy flows, vortices, and vibrations, but without consciousness, all this activity would be completely unfelt and unknown. Only because there is consciousness can the flow of energy be felt, known, and purposefully directed.
Over the past three decades, philosophy of science has grown increasingly "local." Concerns have switched from general features of scientific practice to concepts, issues, and puzzles specific to particular disciplines. Philosophy of neuroscience is a natural result. This emerging area was also spurred by remarkable recent growth in the neuroscience. Cognitive and computational neuroscience continues to encroach upon issues traditionally addressed within the humanities, including the nature of consciousness, action, knowledge, and normativity. Empirical discoveries about brain structure and function suggest ways that "naturalistic" programs might develop in detail, beyond the abstract philosophical considerations in their favour
The literature distinguishes "philosophy of neuroscience" and "neurophilosophy." The former concern foundational issues within the neuroscience. The latter concerns application of neuroscientific concepts to traditional philosophical questions. Exploring various concepts of representation employed in neuroscientific theories is an example of the former. Examining implications of neurological syndromes for the concept of a unified self is an example of the latter. In this entry, we will assume this distinction and discuss examples of both.
Contrary to some opinion, actual neuroscientific discoveries have exerted little influence on the details of materialist philosophies of mind. The "neuroscientific milieu" of the past four decades has made it harder for philosophers to adopt dualism. But even the "type-type" or "central state" identity theories that rose to brief prominence in the late 1950s drew upon few actual details of the emerging neuroscience. Recall the favourite early example of a psychoneural identity claim: pain is identical to C-fibre firing. The "C fibres" turned out to be related to only a single aspect of pain transmission. Early identity theorists did not emphasize psychoneural identity hypotheses, admitting that their "neuro" terms were placeholder for concepts from future neuroscience. Their arguments and motivations were philosophical, even if the ultimate justification of the program was held to be empirical.
The apology for this lacuna by early identity theorists was that neuroscience at that time was too nascent to provide any plausible identities. But potential identities were afoot. David Hubel and Torsten Wiesel's (1962) electro physiological demonstrations of the receptive field properties of visual neurons had been reported with great fanfare. Using their techniques, neuro physiologists began discovering neurons throughout visual cortex responsive to increasingly abstract features of visual stimuli: from edges to motion direction to colours to properties of faces and hands. More notably, Donald Hebb had published The Organization of Behaviour (1949) a decade earlier. Therein he offered detailed explanations of psychological phenomena in terms of known neural mechanisms and anatomical circuits. His psychological explananda included features of perception, learning, memory, and even emotional disorders. He offered these explanations as potential identities. One philosopher did take note of some available neuroscientific detail was Barbara Von Eckardt-Klein (1975). She discussed the identity theory with respect to sensations of touch and pressure, and incorporated then-current hypotheses about neural coding of sensation modality, intensity, duration, and location as theorized by Mountcastle, Libet, and Jasper. Yet she was a glaring exception. Largely, available neuroscience at the time was ignored by both philosophical friends and foes of early identity theories.
Philosophical indifference to neuroscientific detail became "principled" with the rise and prominence of functionalism in the 1970s. The functionalists' favourite argument was based on multiple reliability: a given mental state or event can be realized in a wide variety of physical types (Putnam, 1967 and Fodor, 1974). So a detailed understanding of one type of realizing physical system (e.g., brains) will not shed light on the fundamental nature of mind. A psychological state-type is autonomous from any single type of its possible realizing physical mechanisms. Instead of neuroscience, scientifically-minded philosophers influenced by functionalism sought evidence and inspiration from cognitive psychology and "program-writing" artificial intelligence. These disciplines résumé being of themselves away from underlying physical mechanisms and emphasize the "information-bearing" properties and capacities of representations (Haugeland, 1985). At this same time neuroscience was delving directly into cognition, especially learning and memory. For example, Eric Kandel (1976) proposed parasynaptic mechanisms governing transmitter release rates as a cell-biological explanation of simple forms of associative learning. With Robert Hawkins (1984) he demonstrated how cognitivist aspects of associative learning (e.g., Forming, second-order conditioning, overshadowing) could be explained cell-biologically by sequences and combinations of these basic forms implemented in higher neural anatomies. Working on the postsynaptic side, neuroscientists began unravelling the cellular mechanisms of long term potentiation (LTP). Physiological psychologists quickly noted its explanatory potential for various forms of learning and memory. Yet few "materialist" philosophers paid any attention. Why should they? Most were convinced functionalists, who believed that the "engineering level" details might be important to the clinician, but were irrelevant to the theorist of mind.
A major turning point in philosophers' interest in neuroscience came with the publication of Patricia Churchland's Neurophilosophy (1986). The Churchlands (Pat and husband Paul) were already notorious for advocating eliminative materialism. In her (1986) book, Churchland distilled eliminativist arguments of the past decade, unified the pieces of the philosophy of science underlying them, and sandwiched the philosophy between a five-chapter introduction and neuroscience and a 70-page chapter on three then-current theories of brain function. She was unapologetic about her intent. She was introducing philosophy of science to neuroscientists and neuroscience to philosophers. Nothing could be more obvious, she insisted, than the relevance of empirical facts about how the brain works to concerns in the philosophy of mind. Her term for this interdisciplinary method was "co-evolution" (borrowed from biology). This method seeks resources and ideas from anywhere on the theory hierarchy above or below the question at issue. Standing on the shoulders of philosophers like Quine and Sellars, Churchland insisted that specifying some point where neuroscience ends and philosophy of science begins is hopeless because the boundaries are poorly defined. neuro philosophers would carefully choose resources from both disciplines as they saw fit.
Three themes predominate Churchlands philosophical discussion: Developing an alternative to the logical empiricist theory of intertheoretic cause to be connected to property-dualistic arguments based on subjectivity and sensory qualia, and responding to anti-reductionist multiple reliability arguments. These projects have remained central to neurophilosophy over the past decade. John Bickle (1998) extends the principal insight of Clifford Hooker's (1981) post-empiricist theory of intertheoretic reduction. He quantifies key notions using a model-theoretic account of theory structure adapted from the structuralist program in philosophy of science. He also makes explicit the form of argument scientist's employ to draw ontological conclusions (cross-theoretic identities, revisions, or eliminations) based on the nature of the intertheoretic reduction relations obtaining in specific cases. For example, physicists concluded that visible light, a theoretical posit of optics, is electromagnetic radiation within specified wavelengths, a theoretical posit of electromagnetism: a cross-theoretic ontological identity. In another case, however, chemists concluded that phlogiston did not exist: an elimination of a kind from our scientific ontology. Bickle explicates the nature of the reduction relation in a specific case using a semi-formal account of ‘an interior theoretic approximation' inspired by structuralist results. Paul Churchland (1996) has carried on the attack on property-dualistic arguments for the ir reducibility of conscious experience and sensory qualia. He argues that acquiring some knowledge of existing sensory neuroscience increases one's ability to ‘imagine' or ‘conceive of' a comprehensive neurobiological explanation of consciousness. He defends this conclusion using a thought-experiment based on the history of optics and electromagnetism. Finally, the literature critical of the multiple reliability argument has begun to flourish. Although the multiple reliability argument remains influential among nonreductive physicalists, it no longer commanded the universal acceptance it once did. Replies to the multiple reliability argument based on neuroscientific details have appeared. For example, William Bechtel and Jennifer Mundale (1997, in press) argue that neuroscientists use psychological criteria in brain mapping studies. This fact undercuts the likelihood that psychological kinds are multiplying realized.
Eliminative materialism (EM) is the conjunction of two claims. First, our common sense ‘belief-desire' conception of mental events and processes, our ‘folk psychology,' is a false and misleading account of the causes of human behaviour. Second, like other false conceptual frameworks from both folk theory and the history of science, it will be replaced by, rather than smoothly reduced or incorporated into, a future neuroscience. Folk psychology is the collection of common homilies about the causes of human behaviour. You ask me why Marica is not accompanying me this evening. I reply that her grant deadline is looming. You nod sympathetically. You understand my explanation because you share with me a generalization that relates beliefs about looming deadlines, desires about meeting professionally and financially significant ones, and ensuing free-time behaviour. It is the collection of these kinds of homilies that EM claims to be flawed beyond significant revision. Although this example involves only beliefs and desires, folk psychology contains an extensive repertoire of propositional attitudes in its explanatory nexus: hopes, intentions, fears, imaginings, and more. To the extent that scientific psychology (and neuroscience) retains folk concepts, EM applies to it as well.
EM is physicalist in the classical sense, postulating some future brain science as the ultimately correct account of (human) behaviour. It is eliminative in predicting the future removal of folk psychological kinds from our post-neuroscientific ontology. EM proponents often employ scientific analogies. Oxidative reactions as characterized within elemental chemistry bear no resemblance to phlogiston release. Even the "direction" of the two processes differ. Oxygen is gained when an object burns (or rusts), phlogiston was said to be lost. The result of this theoretical change was the elimination of phlogiston from our scientific ontology. There is no such thing. For the same reasons, according to EM, continuing development in neuroscience will reveal that there are no such things as beliefs and desires as characterized by common sense.
Here we focus only on the way that neuroscientific results have shaped the arguments for EM. Surprisingly, only one argument has been strongly influenced. (Most arguments for EM stress the failures of folk psychology as an explanatory theory of behaviour.) This argument is based on a development in cognitive and computational neuroscience that might provide a genuine alternative to the representations and computations implicit in folk psychological generalizations. Many eliminative materialists assume that folk psychology is committed to propositional representations and computations over their contents that mimic logical inferences. Even though discovering such an alternative has been an eliminativist goal for some time, neuroscience only began delivering on this goal over the past fifteen years. Points in and trajectories through vector spaces, as an interpretation of synaptic events and neural activity patterns in biological neural networks are key feature of this development. This argument for EM hinges on the differences between these notions of cognitive representation and the propositional attitudes of folk psychology (Churchland, 1987). However, this argument will be opaque to those with no background in contemporary cognitive and computational neuroscience, so we need to present a few scientific details. With these details in place, we will return to this argument for EM.
At one level of analysis the basic computational element of a neural network (biological or artificial) is the neuron. This analysis treats neurons as simple computational devices, transforming inputs into output. Both neuronal inputs and outputs reflect biological variables. For the remainder of this discussion, we will assume that neuronal inputs are frequencies of action potentials (neuronal "spikes") in the axons whose terminal branches synapse onto the neuron in question. Neuronal output is the frequency of action potentials in the axon of the neuron in question. A neuron computes its total input (usually treated mathematically as the sum of the products of the signal strength along each input line times the synaptic weight on that line). It then computes a new activation state based on its total input and current activation state, and a new output state based on its new activation value. The neuron's output state is transmitted as a signal strength to whatever neurons on which its axon synapses. The output state reflects systematically the neuron's new activation state.
Analysed at this level, both biological and artificial neural networks are interpreted naturally as vector-to-vector transformers. The input vector consists of values reflecting activity patterns in axons synapsing on the network's neurons from outside (e.g., from sensory transducers or other neural networks). The output vector consists of values reflecting the activity patterns generated in the network's neurons that project beyond the net (e.g., to motor effectors or other neural networks). Given that neurons' activity depends partly upon their total input, and total input depends partly on synaptic weights (e.g., parasynaptic neurotransmitter release rate, number and efficacy of postsynaptic receptors, availability of enzymes in synaptic cleft), the capacity of biological networks to change their synaptic pressures to initiate a plastic vector-to-vector transformer. In principle, a biological network with plastic synapses can come to implement any vector-to-vector transformation that its composition permits (number of input units, output units, processing layers, recurrence, cross-connections, etc.)
The anatomical organization of the cerebellum provides a clear example of a network amendable to this computational interpretation. The cerebellum is the bulbous convoluted structure dorsal to the brainstem. A variety of studies (behavioural, neuropsychological, single-cell electros), implicate this structure in motor integration and fine motor coordination. Mossy fibres (axons) from neurons outside the cerebellum synapse on cerebellular granule cells, which in turn project to parallel fibres. Activity patterns' across the collection of mossy fibres (frequency of action potentials per time unit in each fibre projecting into the cerebellum) provide values for the input vector. Parallel fibres make multiple synapses on the dendritic trees and cell bodies of cerebellular Purkinje neurons. Each Purkinje neuron "sums" its post-synaptic potentials (PSPs) and emits a train of action potentials down its axon based (partly) on its total input and previous activation state. Purkinje axons project outside the cerebellum. The network's output vectors is thus the ordered values representing the pattern of activity generated in each Purkinje axon. Changes to the efficacy of individual synapses on the parallel fibres and the Purkinje neurons alter the resulting PSPs in Purkinje axons, generating different axonal spiking frequencies. Computationally, this amounts to a different output vector to the same input activity pattern (plasticity).
This interpretation puts the useful mathematical resources of dynamical systems into the hands of computational neuroscientists. Vector spaces are an example. For example, learning can be characterized fruitfully in terms of changes in synaptic weights in the network and subsequent reduction of error in network output. (This approach goes back to Hebb, 1949, although within the vector-space interpretation that follows.) A useful representation of this account is on a synaptic weight-error space, where one dimension represents the global error in the network's output to a given task, and all other dimensions represent the weight values of individual synapses in the network. Points in this multidimensional state space represent the global performance error correlated with each possible collection of synaptic weights in the network. As the weights change with each performance (in accordance with a biologically-implemented learning algorithm), the global error of network performance continually decreases. Learning is represented as synaptic weight changes correlated with a descent along the error dimension in the space (Churchland and Sejnowski, 1992). Representations (concepts) can be portrayed as partitions in multidimensional vector spaces. An example is a neuron activation vector space. A graph of such a space contains one dimension for the activation value of each neuron in the network (or some subset). A point in this space represents one possible pattern of activity in all neurons in the network. Activity patterns generated by input vectors that the network has learned to group together will cluster around a (hyper-) point or sub volume in the activity vector space. Any input pattern sufficiently similar to this group will produce an activity pattern lying in geometrical proximity to this point or sub volume. Paul Churchland (1989) has argued that this interpretation of network activity provides a quantitative, neurally-inspired basis for prototype theories of concepts developed recently in cognitive psychology.
Using this theoretical development, has offered a novel argument for EM. According to this approach, activity vectors are the central kind of representation and vector-to-vector transformations are the central kind of computation in the brain. This contrasts sharply with the propositional representations and logical/semantic computations postulated by folk psychology. Vectorial content is unfamiliar and alien to common sense. This cross-theoretic difference is at least as great as that between oxidative and phlogiston concepts, or kinetic-corpuscular and caloric fluid heat concepts. Phlogiston and caloric fluid are two "parade" examples of kinds eliminated from our scientific ontology due to the nature of the intertheoretic relation obtaining between the theories with which they are affiliated and the theories that replaced these. The structural and dynamic differences between the folk psychological and emerging cognitive neuroscientific kinds suggest that the theories affiliated with the latter will also correct significantly the theory affiliated with the former. This is the key premise of an eliminativist argument based on predicted intertheoretic relations. And these intertheoretic contrasts are no longer just an eliminativist's goal. Computational and cognitive neuroscience has begun to deliver an alternative kinematics for cognition, one that provides no structural analogue for the propositional attitudes.
Certainly the replacement of propositional contents by vectorial alternatives implies significant correction to folk psychology. But does it justifies EM? Even though this central feature of folk-psychologically posits in the finding of no analogues in one hot theoretical development in recent cognitive and computational neuroscience, there might be other aspects of cognition that folk psychology gets right. Within neurophilosophy, concluding that a cross-theoretic identity claim is true (e.g., folk psychological state F is identical to neural state N) or that an eliminativist claim is true (there is no such thing as folk psychological state F) depends on the nature of the intertheoretic reduction obtaining between the theories affiliated with the posits in question. But the underlying account of intertheoretic reduction recognizes a spectrum of possible reductions, ranging from relatively "smooth" through "significantly revisionary" to "extremely bumpy." Might the reduction of folk psychology and a "vectorial" neurobiology occupy the middle ground between "smooth" and "bumpy" intertheoretic reductions, and hence suggest a "revisionary" conclusion? The reduction of classical equilibrium thermodynamics to statistical mechanics to microphysics provides a potential analogy. John Bickle argues on empirical grounds that such a outcome is likely. He specifies conditions on "revisionary" reductions from historical examples and suggests that these conditions are obtaining between folk psychology and cognitive neuroscience as the latter develops. In particular, folk psychology appears to have gotten right the grossly-specified functional profile of many cognitive states, especially those closely related to sensory input and behavioural output. It also appears to get right the "intentionality" of many cognitive states - the object that the state is of or about - even though cognitive neuroscience eschews its implicit linguistic explanation of this feature. Revisionary physicalism predicts significant conceptual change to folk psychological concepts, but denies total elimination of the caloric fluid-phlogiston variety.
The philosophy of science is another area where vector space interpretations of neural network activity patterns have impacted philosophy. In the Introduction to his (1989) book, Paul Churchland asserts that it will soon be impossible to do serious work in the philosophy of science without drawing on empirical work in the brain and behavioural sciences. To justify this claim, he suggests neurocomputational reformulation of key concepts from this area. At the heart is a neurocomputational account of the structure of scientific theories. Problems with the orthodox "sets-of-sentences" view have been known for more than three decades. Churchland advocates replacing the orthodox view with one inspired by the "vectorial" interpretation of neural network activity. Representations implemented in neural networks (as discussed above) compose a system that corresponds to important distinctions in the external environment, are not explicitly represented as such within the input corpus, and allow the trained network to respond to inputs in a fashion that continually reduces error. These are exactly the functions of theories. Churchland is bold in his assertion: an individual's theory-of-the-world is a specific point in that individual's error-synaptic weight vector space. It is a configuration of synaptic weights that partitions the individual's activation vector space into subdivisions that reduce future error messages to both familiar and novel inputs.
This reformulation invites an objection, however. Churchland boasts that his theory of theories is preferable to existing alternatives to the orthodox "sets-of-sentences" account - for example, the semantic view (Suppe, 1974; van Fraassen, 1980) - because his is closer to the "buzzing brains" that use theories. But as Bickle notes, neurocomputational models based on the mathematical resources described above are a long way into the realm of abstractia. Even now, they remain little more than novel (and suggestive) applications of the mathematics of quasi-linear dynamical system to simplified schemata of brain circuitries. neuro philosophers owe some account of identifications across ontological categories before the philosophy of science community will accept the claim that theories are points in high-dimensional state spaces implemented in biological neural networks. (There is an important methodological assumption lurking in this objection.
Churchlands neurocomputational reformulation of scientific and epistemological concepts build on this account of theories. He sketches "neutralized" accounts of the theory-ladenness of perception, the nature of concept unification, the virtues of theoretical simplicity, the nature of Kuhnian paradigms, the kinematics of conceptual change, the character of abduction, the nature of explanation, and even moral knowledge and epistemological normativity. Conceptual redeployment, for example, is the activation of an already-existing prototype representation - a counterpoint or region of a partition of a high-dimensional vector space in a trained neural network - a novel type of input pattern. Obviously, we can't here do justice to Churchlands various attempts at reformulation. We urge the intrigued reader to examine his suggestions in their original form. But a word about philosophical methodology is in order. Churchland is not attempting "conceptual analysis" in anything resembling its traditional philosophical sense and neither, typically, are neuro philosophers. (This is why a discussion of neuro philosophical reformulation fits with a discussion of EM.) There are philosophers who take the discipline's ideal to be a relatively simple set of necessary and sufficient conditions, expressed in non-technical natural language, governing the application of important concepts (like justice, knowledge, theory, or explanation). These analyses should square, to the extent possible, with pre-theoretical usage. Ideally, they should preserve synonymy. Other philosophers view this ideal as sterile, misguided, and perhaps deeply mistaken about the underlying structure of human knowledge. neuro philosophers tend to reside in the latter camp. Those who dislike philosophical speculation about the promise and potential of nascent science in an effort to reformulate ("reform-ulate") traditional philosophical concepts have probably already discovered that neurophilosophy is not for them. But the charge that neurocomputational reformulation of the sort Churchland attempts are "philosophically uninteresting" or "irrelevant" because they fail to provide "adequate analyses" of theory, explanation, and the like will get ignored among many contemporary philosophers, as well as their cognitive-scientific and neuroscientific friends. Before we leave the neuro philosophical applications of this theoretical development from recent cognitive/computational neuroscience, one more point of scientific detail is in order. The popularity of treating the neuron as the basic computational unit among neural modelers, as opposed to cognitive modelers, is declining rapidly. Compartmental modelling enables computational neuroscientists to mimic activity in and interactions between patches of neuronal membrane. This endorses modelers to control and manipulate a variety of subcellular factors that determine action potentials per time unit (including the topology of membrane structure in individual neurons, variations in ion channels across membrane patches, field properties of post-synaptic potentials depending on the location of the synapse on the dendrite or soma). Modelers can "custom-build" the neurons in their target circuitry without sacrificing the ability to study circuit properties of networks. For these reasons, few serious computational neuroscientists continue to work at a level that treats neurons as unstructured computational devices. But the above interpretative points still stand. With compartmental modelling, not only are simulated neural networks interpretable as vector-to-vector transformers. The neurons composing them are, too.
The Philosophy of science, and scientific epistemology are not the only area where philosophers have lately urged the relevance of neuroscientific discoveries. Kathleen Akins argues that a "traditional" view of the senses underlies the variety of sophisticated "naturalistic" programs about intentionality. Current neuroscientific understanding of the mechanisms and coding strategies implemented by sensory receptors shows that this traditional view is mistaken. The traditional view holds that sensory systems are "veridical" in at least three ways. (1) Each signal in the system correlates with a small range of properties in the external (to the body) environment. (2) The structure in the relevant relations between the external properties the receptors are sensitive to is preserved in the structure of the relations between the resulting sensory states. And (3) the sensory system reconstructively in faithfully, without fictive additions or embellishments, the external events. Using recent neurobiological discoveries about response properties of thermal receptors in the skin as an illustration, Akins shows that sensory systems are "narcissistic" rather than "veridical." All three traditional assumptions are violated. These neurobiological details and their philosophical implications open novel questions for the philosophy of perception and for the appropriate foundations for naturalistic projects about intentionality. Armed with the known neurophysiology of sensory receptors, for example, our "philosophy of perception" or of "perceptual intentionality" will no longer focus on the search for correlations between states of sensory systems and "veridically detected" external properties. This traditional philosophical (and scientific) project rests upon a mistaken "veridical" view of the senses. Neuroscientific knowledge of sensory receptor activity also shows that sensory experience does not serve the naturalist well as a "simple paradigm case" of an intentional relation between representation and world. Once again, available scientific detail shows the naivety of some traditional philosophical projects.
Focussing on the anatomy and physiology of the pain transmission system, Valerie Hardcastle (1997) urges a similar negative implication for a popular methodological assumption. Pain experiences have long been philosophers' favourite cases for analysis and theorizing about conscious experience generally. Nevertheless, every position about pain experiences has been defended recently: eliminativist, a variety of objectivists view, relational views, and subjectivist views. Why so little agreement, despite agreement that pain experience is the place to start an analysis or theory of consciousness? Hardcastle urges two answers. First, philosophers tend to be uninformed about the neuronal complexity of our pain transmission systems, and build their analyses or theories on the outcome of a single component of a multi-component system. Second, even those who understand some of the underlying neurobiology of pain tends to advocate gate-control theories. But the best existing gate-control theories are vague about the neural mechanisms of the gates. Hardcastle instead proposes a dissociable dual system of pain transmission, consisting of a pain sensory system closely analogous in its neurobiological implementation to other sensory systems, and a descending pain inhibitory system. She argues that this dual system is consistent with recent neuroscientific discoveries and accounts for all the pain phenomena that have tempted philosophers toward particular (but limited) theories of pain experience. The neurobiological uniqueness of the pain inhibitory system, contrasted with the mechanisms of other sensory modalities, renders pain processing atypical. In particular, the pain inhibitory system dissociates pains sensation from stimulation of nociceptors (pain receptors). Hardcastle concludes from the neurobiological uniqueness of pain transmission that pain experiences are atypical conscious events, and hence not a good place to start theorizing about or analysing the general type.
Developing and defending theories of content is a central topic in current philosophy of mind. A common desideratum in this debate is a theory of cognitive representation consistent with a physical or naturalistic ontology. We'll here describe a few contributions neuro philosophers have made to this literature.
When one perceives or remembers that he is out of coffee, his brain state possesses intentionality or "aboutness." The percept or memory is about one's being out of coffee, and it represents one for being out of coffee. The representational state has content. A psychosemantics seeks to explain what it is for a representational state to be about something: to provide an account of how states and events can have specific representational content. A physicalist psychosemantics seeks to do this using resources of the physical sciences exclusively. neuro philosophers have contributed to two types of physicalist psychosemantics: the Functional Role approach and the Informational approach.
The core claim of functional roles of semantics holds that a representation has its content in virtue of relations it bears to other representations. Its paradigm application is to concepts of truth-functional logic, like the conjunctive ‘and' or disjunctive ‘or.' A physical event instantiates the ‘and' function just in case it maps two true inputs onto a single true output. Thus an expression bears the relations to others that give it the semantic content of ‘and.' Proponents of functional role semantics propose similar analyses for the content of all representations (Form 1986). A physical event represents birds, for example, if it bears the right relations to events representing feathers and others representing beaks. By contrast, informational semantics associates content to a state depending upon the causal relations obtaining between the state and the object it represents. A physical state represents birds, for example, just in case an appropriate causal relation obtains between it and birds. At the heart of informational semantics is a causal account of information. Red spots on a face carry the information that one has measles because the red spots are caused by the measles virus. A common criticism of informational semantics holds that mere causal covariation is insufficient for representation, since information (in the causal sense) is by definition, always veridical while representations can misrepresent. A popular solution to this challenge invokes a teleological analysis of ‘function.' A brain state represents X by virtue of having the function of carrying information about being caused by X (Dretske 1988). These two approaches do not exhaust the popular options for a psychosemantics, but are the ones to which neuro philosophers have contributed.
Paul Churchlands allegiance to functional role semantics goes back to his earliest views about the semantics of terms in a language. In his (1979) book, he insists that the semantic identity (content) of a term derive from its place in the network of sentences of the entire language. The functional economies envisioned by early functional role semanticists were networks with nodes corresponding to the objects and properties denoted by expressions in a language. Thus one node, appropriately connected, might represent birds, another feathers, and another beaks. Activation of one of these would tend to spread to the others. As ‘connectionist' network modelling developed, alternatives arose to this one-representation-per-node ‘localist' approach. By the time Churchland provided a neuroscientific elaboration of functional role semantics for cognitive representations generally, he too had abandoned the ‘localist' interpretation. Instead, he offered a ‘state-space semantics'.
We saw in the section just above how (vector) state spaces provide a natural interpretation for activity patterns in neural networks (biological and artificial). A state-space semantics for cognitive representations is a species of functional role semantics because the individuation of a particular state depends upon the relations obtaining between it and other states. A representation is a point in an appropriate state space, and points (or sub volumes) in a space are individuated by their relations to other points (locations, geometrical proximity). Churchland illustrates a state-space semantics for neural states by appealing to sensory systems. One popular theory in sensory neuroscience of how the brain codes for sensory qualities (like Collor) are the opponent process account. Churchland describes a three-dimensional activation vector state-space in which all Collor perceivable by humans is represented as a point (or sub value). Each dimension corresponds to activity rates in one of three classes of photoreceptors present in the human retina and their efferent paths: The red-green opponent pathway, yellow-blue opponent pathway, and black-white (contrast) opponent pathway. Photons striking the retina are transduced by the receptors, producing an activity rate in each of the segregated pathways. The characterized Cellos have a triplet of activation frequency rates. Each dimension in that three-dimensional space will represent average frequency of action potentials in the axons of one class of ganglion cells projecting out of the retina. Face-to-face, the Collor perceivable by humans will be a region of that space. For example, an orange stimulus produces a relatively low level of activity in both the red-green and yellow-blue opponent pathways (x-axis and y-axis, respectively), and middle-range activity in the black-white (contrast) opponent pathways (z-axis). Pink stimuli, on the other hand, produce low activity in the red-green opponent pathway, middle-range activity in the yellow-blue opponent pathway, and high activity in the black-white (contrast) an opponent pathway. The location of each colour in the space generates a ‘colour solid.' Location on the solid and geometrical proximity between regions reflect structural similarities between the perceived colours. Human gustatory representations are points in a four-dimensional state space, with each dimension coding for activity rates generated by gustatory stimuli in each type of taste receptor (sweet, salty, sour, bitter) and their segregated efferent pathways. When implemented in a neural network with structural and hence computational resources as vast as the human brain, the state space approach to psychosemantics generates a theory of content for a huge number of cognitive states.
Jerry Fodor and Ernest LePore raise an important challenge to Churchlands psychosemantics. Location in a state space alone seems insufficient to fix a state's representational content. Churchland never explains why a point in a three-dimensional state space represents the Collor, as opposed to any other quality, object, or event that varies along three dimensions. Churchlands account achieves its explanatory power by the interpretation imposed on the dimensions. Fodor and LePore allege that Churchland never specifies how a dimension comes to represent, e.g., degree of saltiness, as opposed to yellow-blue wavelength opposition. One obvious answer appeals to the stimuli that form the ‘external' inputs to the neural network in question. Then, for example, the individuating conditions on neural representations of colours are that opponent processing neurons receive input from a specific class of photoreceptors. The latter in turn have electromagnetic radiation (of a specific portion of the visible spectrum) as their activating stimuli. However, this appeal to ‘external' stimuli as the ultimate individuating conditions for representational content makes the resulting approach a version of informational semantics. Is this approach consonant with other neurobiological details?
The neurobiological paradigm for informational semantics is the feature detector: One or more neurons that are (i) maximally responsive to a particular type of stimulus, and (ii) have the function of indicating the presence of that stimulus type. Examples of such stimulus-types for visual feature detectors include high-contrast edges, motion direction, and colours. A favourite feature detector among philosophers is the alleged fly detector in the frog. Lettvin et al. (1959) identified cells in the frog retina that responded maximally to small shapes moving across the visual field. The idea that these cells' activity functioned to detect flies rested upon knowledge of the frogs' diet. Using experimental techniques ranging from single-cell recording to sophisticated functional imaging, neuroscientists have recently discovered a host of neurons that are maximally responsive to a variety of stimuli. However, establishing condition (ii) on a feature detector is much more difficult. Even some paradigm examples have been called into question. David Hubel and Torsten Wiesel's (1962) Nobel Prize winning work establishing the receptive fields of neurons in striate cortices are often interpreted as revealing cells whose function is edge detection. However, Lehky and Sejnowski (1988) have challenged this interpretation. They trained an artificial neural network to distinguish the three-dimensional shape and orientation of an object from its two-dimensional shading pattern. Their network incorporates many features of visual neurophysiology. Nodes in the trained network turned out to be maximally responsive to edge contrasts, but did not appear to have the function of edge detection.
Kathleen Akins (1996) offers a different neuro philosophical challenge to informational semantics and its affiliated feature-detection view of sensory representation. We saw in the previous section how Akins argues that the physiology of thermoreceptor violates three necessary conditions on ‘veridical' representation. From this fact she draws doubts about looking for feature detecting neurons to ground a psychosemantics generally, including thought contents. Human thoughts about flies, for example, are sensitive to numerical distinctions between particular flies and the particular locations they can occupy. But the ends of frog nutrition are well served without a representational system sensitive to such ontological refinements. Whether a fly seen now is numerically identical to one seen a moment ago, need not, and perhaps cannot, figure into the frog's feature detection repertoire. Akins' critique casts doubt on whether details of sensory transduction will scale up to encompass of some adequately unified psychosemantics. It also raises new questions for human intentionality. How do we get from activity patterns in "narcissistic" sensory receptors, keyed not to "objective" environmental features but rather only to effects of the stimuli on the patch of tissue innervated, to the human ontology replete with enduring objects with stable configurations of properties and relations, types and their tokens (as the "fly-thought" example presented above reveals), and the rest? And how did the development of a stable, and rich ontology confer survival advantages to human ancestors?
Consciousness has reemerged as a topic in philosophy of mind and the cognitive and brain sciences over the past three decades. Instead of ignoring it, many physicalists now seek to explain it (Dennett, 1991). Here we focus exclusively on ways those neuroscientific discoveries have impacted philosophical debates about the nature of consciousness and its relation to physical mechanisms. Thomas Nagel argues that conscious experience is subjective, and thus permanently recalcitrant to objective scientific understanding. He invites us to ponder ‘what it is like to be a bat' and urges the intuition that no amount of physical-scientific knowledge (including neuroscientific) supplies a complete answer. Nagel's intuition pump has generated extensive philosophical discussion. At least two well-known replies make direct appeal to neurophysiology. John Biro suggests that part of the intuition pumped by Nagel, that bat experience is substantially different from human experience, presupposes systematic relations between physiology and phenomenology. Kathleen Akins (1993a) delves deeper into existing knowledge of bat physiology and reports much that is pertinent to Nagel's question. She argues that many of the questions about bat subjectivity that we still consider open hinge on questions that remain unanswered about neuroscientific details. One example of the latter is the function of various cortical activity profiles in the active bat.
More recently philosopher David Chalmers (1996) has argued that any possible brain-process account of consciousness will leave open an ‘explanatory gap' between the brain process and properties of the conscious experience. This is because no brain-process theory can answer the "hard" question: Why should that particular brain process give rise to conscious experience? We can always imagine ("conceive of") a universe populated by creatures having those brain processes but completely lacking conscious experience. A theory of consciousness requires an explanation of how and why some brain process causes consciousness replete with all the features we commonly experience. The fact that the hard question remains unanswered shows that we will probably never get a complete explanation of consciousness at the level of neural mechanisms. Paul and Patricia Churchland have recently offered the following diagnosis and reply. Chalmers offer a conceptual argument, based on our ability to imagine creatures possessing brains like ours but wholly lacking in conscious experience. But the more one learns about how the brain produces conscious experience-and literature is beginning to emerge (e.g., Gazzaniga, 1995) - the harder it becomes to imagine a universe consisting of creatures with brain processes like ours but lacking consciousness. This is not just to bare assertions. The Churchlands appeal to some neurobiological detail. For example, Paul Churchland (1995) develops a neuroscientific account of consciousness based on recurrent connections between thalamic nuclei (particularly "diffusely projecting" nuclei like the intralaminar nuclei) and the cortex. Churchland argues that the thalamocortical recurrency accounts for the selective features of consciousness, for the effects of short-term memory on conscious experience, for vivid dreaming during REM. (rapid-eye movement) sleep, and other "core" features of conscious experience. In other words, the Churchlands are claiming that when one learns about activity patterns in these recurrent circuits, one can't "imagine" or "conceive of" this activity occurring without these core features of conscious experience. (Other than just mouthing the words, "I am now imagining activity in these circuits without selective attention/the effects of short-term memory/vivid dreaming . . . ")
A second focus of sceptical arguments about a complete neuroscientific explanation of consciousness is sensory qualia: the introspectable qualitative aspects of sensory experience, the features by which subjects discern similarities and differences among their experiences. The colours of visual sensations are a philosopher's favourite example. One famous puzzle about colour qualia is the alleged conceivability of spectral inversions. Many philosophers claim that it is conceptually possible (if perhaps physically impossible) for two humans not to differ neurophysiological, while the Collor that fire engines and tomatoes appear to have to one subject is the Collor that grass and frogs appear to have to the other (and vice versa). A large amount of neuroscientifically-informed philosophy has addressed this question. A related area where neurophilosophical considerations have emerged concerns the metaphysics of colours themselves (rather than Collor experiences). A longstanding philosophical dispute is whether colours are objective property's Existing external to perceiver or rather identifiable as or dependent upon minds or nervous systems. Some recent work on this problem begins with characteristics of Collor experiences: For example that Collor similarity judgments produce Collor orderings that align on a circle. With this resource, one can seek mappings of phenomenology onto environmental or physiological regularities. Identifying colours with particular frequencies of electromagnetic radiation does not preserve the structure of the hue circle, whereas identifying colours with activity in opponent processing neurons does. Such a tidbit is not decisive for the Collor objectivist-subjectivist debate, but it does convey the type of neurophilosophical work being done on traditional metaphysical issues beyond the philosophy of mind.
We saw in the discussion of Hardcastle (1997) two sections above that Neurophilosophers have entered disputes about the nature and methodological import of pain experiences. Two decades earlier, Dan Dennett (1978) took up the question of whether it is possible to build a computer that feels pain. He compares and notes pressure between neurophysiological discoveries and common sense intuitions about pain experience. He suspects that the incommensurability between scientific and common sense views is due to incoherence in the latter. His attitude is wait-and-see. But foreshadowing Churchland's reply to Chalmers, Dennett favours scientific investigations over conceivability-based philosophical arguments.
Neurological deficits have attracted philosophical interest. For thirty years philosophers have found implications for the unity of the self in experiments with commissurotomy patients. In carefully controlled experiments, commissurotomy patients display two dissociable seats of consciousness. Patricia Churchland scouts philosophical implications of a variety of neurological deficits. One deficit is blind-sight. Some patients with lesions to primary visual cortex report being unable to see items in regions of their visual fields, yet perform far better than chance in forced guess trials about stimuli in those regions. A variety of scientific and philosophical interpretations have been offered. Ned Form (1988) worries that many of these conflate distinct notions of consciousness. He labels these notions ‘phenomenal consciousness' (‘P-consciousness') and ‘access consciousness' (‘A-consciousness'). The former is that which, ‘what it is like-ness of experience. The latter is the availability of representational content to self-initiated action and speech. Form argues that P-consciousness is not always representational whereas A-consciousness is. Dennett and Michael Tye are sceptical of non-representational analyses of consciousness in general. They provide accounts of blind-sight that do not depend on Form's distinction.
Many other topics are worth neurophilosophical pursuit. We mentioned commissurotomy and the unity of consciousness and the self, which continues to generate discussion. Qualia beyond those of Collor and pain have begun to attract neurophilosophical attention has self-consciousness. The first issues to arise in the ‘philosophy of neuroscience' (before there was a recognized area) was the localization of cognitive functions to specific neural regions. Although the ‘localization' approach had dubious origins in the phrenology of Gall and Spurzheim, and was challenged severely by Flourens throughout the early nineteenth century, it reemerged in the study of aphasia by Bouillaud, Auburtin, Broca, and Wernicke. These neurologists made careful studies (where possible) of linguistic deficits in their aphasic patients followed by brain autopsies postmortem. Broca's initial study of twenty-two patients in the mid-nineteenth century confirmed that damage to the left cortical hemisphere was predominant, and that damage to the second and third frontal convolutions was necessary to produce speech production deficits. Although the anatomical coordinates' Broca postulates for the ‘speech production centres do not correlate exactly with damage producing production deficits, both are that in this area of frontal cortex and speech production deficits still bear his name (‘Broca's area' and ‘Broca's aphasia'). Less than two decades later Carl Wernicke published evidence for a second language centre. This area is anatomically distinct from Broca's area, and damage to it produced a very different set of aphasic symptoms. The cortical area that still bears his name (‘Wernicke's area') is located around the first and second convolutions in temporal cortex, and the aphasia that bears his name (‘Wernicke's aphasia') involves deficits in language comprehension. Wernicke's method, like Broca's, was based on lesion studies: a careful evaluation of the behavioural deficits followed by post mortem examination to find the sites of tissue damage and atrophy. Lesion studies suggesting more precise localization of specific linguistic functions remain a cornerstone to this day in aphasic research
Lesion studies have also produced evidence for the localization of other cognitive functions: for example, sensory processing and certain types of learning and memory. However, localization arguments for these other functions invariably include studies using animal models. With an animal model, one can perform careful behavioural measures in highly controlled settings, then ablate specific areas of neural tissue (or use a variety of other techniques to Form or enhance activity in these areas) and remeasure performance on the same behavioural tests. But since we lack an animal model for (human) language production and comprehension, this additional evidence isn't available to the neurologist or neurolinguist. This fact makes the study of language a paradigm case for evaluating the logic of the lesion/deficit method of inferring functional localization. Philosopher Barbara Von Eckardt (1978) attempts to make explicit the steps of reasoning involved in this common and historically important method. Her analysis begins with Robert Cummins' early analysis of functional explanation, but she extends it into a notion of structurally adequate functional analysis. These analyses break down a complex capacity C into its constituent capacity's c1, c2, . . . cn, where the constituent capacities are consistent with the underlying structural details of the system. For example, human speech production (complex capacity C) results from formulating a speech intention, then selecting appropriate linguistic representations to capture the content of the speech intention, then formulating the motor commands to produce the appropriate sounds, then communicating these motor commands to the appropriate motor pathways (constituent capacity's c1, c2, . . . , cn). A functional-localization hypothesis has the form: Brain structure S in an organism (type) O has constituent capacity ci, where ci is a function of some part of O. An example, Brains Broca's area (S) in humans (O) formulates motor commands to produce the appropriate sounds (one of the constituent capacities ci). Such hypotheses specify aspects of the structural realization of a functional-component model. They are part of the theory of the neural realization of the functional model.
Armed with these characterizations, Von Eckardt argues that inference to a functional-localization hypothesis proceeds in two steps. First, a functional deficit in a patient is hypothesized based on the abnormal behaviour the patient exhibits. Second, localization of function in normal brains is inferred on the basis of the functional deficit hypothesis plus the evidence about the site of brain damage. The structurally-adequate functional analysis of the capacity connects the pathological behaviour to the hypothesized functional deficit. This connection suggests four adequacy conditions on a functional deficit hypothesis. First, the pathological behaviour P (e.g., the speech deficits characteristic of Broca's aphasia) must result from failing to exercise some complex capacity C (human speech production). Second, there must be a structurally-adequate functional analysis of how people exercise capacity C that involves some constituent capacity ci (formulating motor commands to produce the appropriate sounds). Third, the operation of the steps described by the structurally-adequate functional analysis minus the operation of the component performing ci (Broca's area) must result in pathological behaviour P. Fourth, there must not be a better available explanation for why the patient does P. Arguments to a functional deficit hypothesis on the basis of pathological behaviour is thus an instance of argument to the best available explanation. When postulating a deficit in a normal functional component provides the best available explanation of the pathological data, we are justified in drawing the inference.
Von Eckardt applies this analysis to a neurological case study involving a controversial reinterpretation of agnosia. Her philosophical explication of this important neurological method reveals that most challenges to localization arguments of whether to argue only against the localization of a particular type of functional capacity or against generalizing from localization of function in one individual to all normal individuals. (She presents examples of each from the neurological literature.) Such challenges do not impugn the validity of standard arguments for functional localization from deficits. It does not follow that such arguments are unproblematic. But they face difficult factual and methodological problems, not logical ones. Furthermore, the analysis of these arguments as involving a type of functional analysis and inference to the best available explanation carries an important implication for the biological study of cognitive function. Functional analyses require functional theories, and structurally adequate functional analyses require checks imposed by the lower level sciences investigating the underlying physical mechanisms. Arguments to best available explanation are often hampered by a lack of theoretical imagination: the available explanations are often severely limited. We must seek theoretical inspiration from any level of theory and explanation. Hence making explicit the ‘logic' of this common and historically important form of neurological explanation reveals the necessity of joint participation from all scientific levels, from cognitive psychology down to molecular neuroscience. Von Eckardt anticipated what came to be heralded as the ‘co-evolutionary research methodology,' which remains a centerpiece of neurophilosophy to the present day.
Over the last two decades, evidence for localization of cognitive function has come increasingly from a new source: the development and refinement of neuroimaging techniques. The form of localization-of-function argument appears not to have changed from that employing lesion studies (as analysed by Von Eckardt). Instead, these imaging technologies resolve some of the methodological problems that plage lesion studies. For example, researchers do not need to wait until the patient dies, and in the meantime probably acquires additional brain damage, to find the lesion sites. Two functional imaging techniques are prominent: Positron emission tomography, or PET, and functional magnetic resonance imaging, or MRI. Although these measure different biological markers of functional activity, both now have a resolution down to around 1mm. As these techniques increase spatial and temporal resolution of functional markers and continue to be used with sophisticated behavioural methodologies, the possibility of localizing specific psychological functions to increasingly specific neural regions continues to grow
What we now know about the cellular and molecular mechanisms of neural conductance and transmission is spectacular. The same evaluation holds for all levels of explanation and theory about the mind/brain: maps, networks, systems, and behaviour. This is a natural outcome of increasing scientific specialization. We develop the technology, the experimental techniques, and the theoretical frameworks within specific disciplines to push forward our understanding. Still, a crucial aspect of the total picture gets neglected: the relationship between the levels, the ‘glue' that binds knowledge of neuron activity to subcellular and molecular mechanisms, network activity patterns to the activity of and connectivity between single neurons, and behaviour to network activity. This problem is especially glaring when we focus on the relationship between ‘cognitivist' psychological theories, postulating information-bearing representations and processes operating over their contents, and the activity patterns in networks of neurons. Co-evolution between explanatory levels still seems more like a distant dream rather than an operative methodology.
It is here that some neuroscientists appeal to ‘computational' methods. If we examine the way that computational models function in more developed sciences (like physics), we find the resources of dynamical systems constantly employed. Global effects (such as large-scale meteorological patterns) are explained in terms of the interaction of ‘local' lower-level physical phenomena, but only by dynamical, nonlinear, and often chaotic sequences and combinations. Addressing the interlocking levels of theory and explanation in the mind/brain using computational resources that have worked to bridge levels in more mature sciences might yield comparable results. This methodology is necessarily interdisciplinary, drawing on resources and researchers from a variety of levels, including higher levels like experimental psychology, ‘program-writing' and ‘connectionist' artificial intelligence, and philosophy of science.
However, the use of computational methods in neuroscience is not new. Hodgkin, Huxley, and Katz incorporated values of voltage-dependent potassium conductance they had measured experimentally in the squid giant axon into an equation from physics describing the time evolution of a first-order kinetic process. This equation enabled them to calculate best-fit curves for modelled conductance versus time data that reproduced the S-shaped (sigmoidal) function suggested by their experimental data. Using equations borrowed from physics, Rall (1959) developed the cable model of dendrites. This theory provided an account of how the various inputs from across the dendritic tree interact temporally and spatially to determine the input-output properties of single neurons. It remains influential today, and has been incorporated into the genesis software for programming neurally realistic networks. More recently, David Sparks and his colleagues have shown that a vector-averaging model of activity in neurons of superior colliculi correctly predicts experimental results about the amplitude and direction of saccadic eye movements. Working with a more sophisticated mathematical model, Apostolos Georgopoulos and his colleagues have predicted direction and amplitude of hand and arm movements based on averaged activity of 224 cells in motor cortices. Their predictions have borne out under a variety of experimental tests. We mention these particular studies only because we are familiar with them. We could multiply examples of the fruitful interaction of computational and experimental methods in neuroscience easily by one-hundred-fold. Many of these extend back before ‘computational neuroscience' was a recognized research endeavour.
We've already seen one example, the vector transformation account, of neural representation and computation, under active development in cognitive neuroscience. Other approaches using ‘cognitivist' resources are also being pursued. Many of these projects draw upon ‘cognitivist' characterizations of the phenomena to be explained. Many exploit ‘cognitivist' experimental techniques and methodologies. Some even attempt to derive ‘cognitivist' explanations from cell-biological processes (e.g., Hawkins and Kandel 1984). As Stephen Kosslyn puts it, cognitive neuroscientists employ the ‘information processing' view of the mind characteristic of cognitivism without trying to separate it from theories of brain mechanisms. Such an endeavour calls for an interdisciplinary community willing to communicate the relevant portions of the mountain of detail gathered in individual disciplines with interested nonspecialists: not just people willing to confer with those working at related levels, but researchers trained in the methods and factual details of a variety of levels. This is a daunting requirement, but it does offer some hope for philosophers wishing to contribute to future neuroscience. Thinkers trained in both the ‘synoptic vision' afforded by philosophy and the factual and experimental basis of genuine graduate-level science would be ideally equipped for this task. Recognition of this potential niche has been slow among graduate programs in philosophy, but there is some hope that a few programs are taking steps to fill it.
In the final analysis there will be philosophers unprepared to accept that, if a given cognitive capacity is psychologically real, then there must be an explanation of how it is possible for an individual in the course of human development to acquire that cognitive capacity, or anything like it, can have a role to play in philosophical accounts of concepts and conceptual abilities. The most obvious basis for such a view would be a Frégean distrust of "psychology" that leads to a rigid division of labour between philosophy and psychology. The operative thought is that the task of a philosophical theory of concepts is to explain what a given concept is or what a given conceptual ability consist in. This, it is frequently maintained, is something that can be done in complete independence of explaining how such a concept or ability might be acquired. The underlying distinction is one between philosophical questions centring around concept possession and psychological questions centring around concept possibilities for an individual to acquire that ability, then it cannot be psychologically real. Nevertheless, this distinction is, however, strictly one does adhere to the distinction, it provides no support for a rejection of any given cognitive capacity for which is psychologically real. The neo-Frégean distinction is directly against the view that facts about how concepts are acquired have a role to play in explaining and individualizing concepts. But this view does not have to be disputed by a supporter as such, nonetheless, all that the supporter is to commit is that the principle that no satisfactory account of what a concept is should make it impossible to provide explanation of how that concept can be acquired. That is, that this principle has nothing to say about the further question of whether the psychological explanation has a role to play in a constitutive explanation of the concept, and hence is not in conflict with the neo-Frégean distinction.
A full account of the structure of consciousness, will need to illustrate those higher, conceptual forms of consciousness to which little attention on such an account will take and about how it might emerge from given points of value, is the thought that an explanation of everything that is distinctive about consciousness will emerge out of an account of what it is for a subject to be capable of thinking about himself. But, to a proper understanding of the complex phenomenon of consciousness. There are no facts about linguistic mastery that will determine or explain what might be termed the cognitive dynamics that are individual processes that have found their way forward for a theory of consciousness, it sees, to chart the characteristic features individualizing the various distinct conceptual forms of consciousness in a way that will provide a taxonomy of unconsciousness and they, to show how these manifest the characterlogical functions a can to determine at the level of content. What is hoped is now clear is that these forms of higher forms of consciousness emerge from a rich foundation of non-conceptual representations of thought, which can only expose and clarify their conviction that these forms of conscious thought hold the key, not just to an eventful account of how mastery of the conscious paradigms, but to a proper understanding of the plexuity of self-consciousness and/or the overall conjecture of consciousness that stands alone as to an everlasting vanquishment into the ever unchangeless state of unconsciousness, and its abysses are only held by incestuousness.
DUBOISITY
BOOK FOUR
The Plexuity Of Transference
Plexuity Of Transference
Richard J.Kosciejew
Despite radical implications for theory of psychoanalytic techniques and others in a dialectical way, is often without awareness. Where these psychoanalysts disagree in their conceptual frame, create the recognition that analyst and patient cannot simply avoid having an impact on each other. Even so, we cannot be to remove obstructions from whether we have related this to our deliberate technical interventions or intentional aspects drawn upon the conceptual interactions. As for reasons that are useful and necessary to distinguish between theory of techniques, which the interconnectivity established through the conjunctive relationships have in relation of what seemed allowable for us to expand our knowledge of the complex and subtle factors that account for therapeutic action. This, however, can ultimately become the most effective basis for refining and developing our understanding of how best to serve of ourselves to advance the analytic situation and too aculeate more profound and very acute satisfactory depictions in the psychoanalytic engagements, no matter whatever our accountable resultants may be of our theoretical orientation.
An appreciation of the power of interactive forces in the analytic field not only challenges many traditionally held beliefs about the nature of therapeutic action. However, these take upon the requirement for us to recognize the untenability of the traditional view that analysts can be an objective source in the work. They have better to understand it, for example, where patients and analysts may express as a quantity that which the analyst is of a position to be an objective interpreter of the patient's experiential processes. That in this may reflect a form of collusive enactment and a convergence of the needs of both to see the analyst as an authority, and if the patient and analysts' both submit to needs to believe that the analyst is the omniscient other or the benevolent authority to which one can entrust ones' own. As the functional structure of the relationship might serve to obscure recognition of the fact that it is inclined to encourage the belief that, as once put, that wherever a coordinative system is complicating and hardens of its complexities, as recognized of the mind or brain, immediately 'indeterminacy' so then arises, not necessarily because of some preconditional unobtainability but holds accountably to subjective matters' from which grow stronger in obtaining the right prediction, least of mention, that so many things are yet to be known, in that the stray consequences of studying them will disturb the status quo, and of not-knowing to what influential persuasions do really occur between the protective cranial wall of vertebral anatomy. It is therefore that our manifesting awarenesses cannot accord with the inclining inclinations beheld to what is meant in how. History is not and cannot be determinate. Thus, the supposed causes may only produce the consequences we expect, this has rarely been more true than of those whose thoughts and interaction in psychoanalytic interrelatedness are in a way that no dramatist would ever dare to conceive.
In Winnicott (1969) has noted that there are times when 'analysers' can serve as holding operations and become interminable without any real growth occurring.
An interactive perspective also helps to clarify why in some instances the analysers 'abstinence' carriers as much risk of negative iatrogenic consequences as does active intervention. Although silence at time obviously can be respectful and facilitating, at other times it can be cruel and sadistic, or it can be based on fear of engagement, among a host of possible other meanings and equally attributive to the distributional dynamical functions.
An appreciation of interactive factors also allows us to consider that, to whatever degree the patient's perceptions of the analyst are plausible and even valid (Ferenczi 1933, Little 1951, Levenson 1973, Searles 1975, Gill 1982, Hoffman 1983), this may be due to the patient's expertise of stimulating precisely this kind of responsiveness in the analyst. The reverse is true as well thus, though patient and analyst each will have unique vulnerabilities, sensitivities, strengths, and needs, we must consider why such peculiarities have excited the particular qualities or sensibilities of either patient or analyst at a give moment and not at others. At any moment patient or analyst might be involved in some kind of collusive enactment (Racker 1957, 1959, Grotstein 1981, and McDougall 1979), they have held that their considerations explain of reasons that posit of themselves of why clinicians often seem to practice in ways that contradict their own shared beliefs and theoretical positions, least of mention, principles by way of enacting to some unfiltered dialectical discourse.
Yet, these differences, which occur within and between the diverse analytic traditions, in that an interactive view of the analytic field has some theoretical and technical implications that bridge all psychoanalytically perceptively which each among us cannot ignore. Its premise lies in the fact that we recognize that the analyst and patient cannot simply avoid having an impact on each other, even if both are totally silent, require us to realize that even if a treatment is productive or successful, we cannot be clear whether they have related this to our deliberate technical interventions or to aspects of the interaction that have eluded our awareness.
We have premised its owing intentionality that the recognition that analyst and patient cannot simply avoid having an impact on each other, even if both are totally silent, requires us to realize that even if some treatment is productive or successful, we cannot be clear whether we have related this to our deliberate technical interventions or to aspects of the interaction that have eluded austereness.
Psychoanalysts of diverse orientations increasingly have come to recognize that patient and analysts are continually influencing and being influenced by each other in a dialectical way, often without awareness. This has radical implications for abstractive views drawn upon psychoanalytic technique. Where these psychoanalysts disagree is in their conceptions of what the specific implications of an interactive view of the analytic field might be.
It is therefore that distinguishing between theory of technique is useful and necessary, which relates to what we do with awareness and intention, and theory of therapeutic action, which deals with what is healing in the psychoanalytic interaction whether or not it evolves from our ‘technique': That recognizing this can allow us to expand our knowledge of the complex and subtler factors that account for therapeutic action. This can ultimately become the most effective basis for refining and developing our understanding of how best to use ourselves to advance the analytic work and to simplify more profound and incisive kinds of psychoanalytic engagement, no matter what our theoretical orientation.
An appreciation of the power of interactive forces in the analytic subject field not only challenges many traditionally held beliefs about the nature of therapeutic action, but also requires us to recognize the untenability of the traditional view that the analyst can be an objective participant in the work? It also helps us to grasp the extent to which presumably therapeutic interpretations, for example, can be ways of harassing, demeaning, patronizing, impinging on, penetrating, or violating the patient, or particular ways of gratifying, supporting, complying, among several of other possibilities. Where patient and analysts assume that the analyst can be an objective interpreter of the patient's experience, this may factually reflect a form of collusive enactment and a convergence of the needs of both to see the analyst as an authority. If patient and analyst both have needs to believe that the analyst is the omniscient other or the benevolent authority to which one can entrust ones' own, the structure of the relationship might serve to obscure recognition of the fact that they are enacting such a drama. In this regard, Winnicott (1969) has noted that on that point are times when ‘analyses' can serve as holding operations and become interminable, without any real growth occurring.
An interactive perspective also helps to clarify why sometimes the analyst's ‘abstinence' carries as much risk of negative iatrogenic consequences as does actively intervention. Although silence at times obviously can be respectful and facilitating, at other times it can be cruel and sadistic, or it can be based on fear of engagement, among a host of possible other meanings and contributing functions.
The contextual meaning of the patient's free association also has to be reconsidered from such a perspective. Usually viewed as the medium of analytic work, free association may at times be a profound frame of resistance, and to avoid rather than engage in an analytic process. Alternatively it can reflect a form of compliance or collusion, conscious or unconscious, with the analyst's needs, fears, resistances.
Amid the welter of competing or complementary theories that have characterized psychoanalyses over the century of its existence, the ideas of transference and the convictions very important in the therapeutic process are an unfiling theme. None of Freud's epochal discoveries - the power to the dynamic unconscious, the meaningfulness of the dream, the uniformity of intrapsychgic conflict - having been more heuristically productive or more clinically valuable than his demonstration that human regularly and inevitably repeat with the analyst and with other important figures in their current live patterned of relationship, of fantasy, and of conflict with the crucial figures in their childhood - primarily their parents?
Even for Freud, however, the awareness of this phenomenon and the understanding of its specific significance in the analytic situation itself came gradually. The flamboyant transference events in Breuer's patient Anna O and the unfortunate outcome in the patient of Dora served to consolidate in Freud's mind a view of transference as a resistance phenomenon, as an obstacle to the recollection of traumatic events that, in his view at the time, formed the true essence of the psychoanalytic process. Emphasis in this early period, thus, was on the 'management' of the transference, on finding ways to prevent its interference with the proper business of the analysis - recognizing, always, the inevitability of its occurrence. Freud was most concerned about the interferences generate by the 'negative' (i.e., hostile) and the erotised transference, the 'positive' transference he considered 'unobjectable,' the vehicle of success in the psychoanalysis.
Freud was also concerned to distinguish the analytic transference from the effects of suggestion in the hypnotic treatment he had learned in France, where he interdependently studying from Professor Charcot at the Salpêtrière hospital, and had been the forerunner of his own psychoanalysis technique. He, and his early followers and students, were at great pains to define the transference as a spontaneous product of the analytic situation, emerging from the patient rather than imposed by the analyst. Ultimately, Freud came to view as essentially for analytic cures the development of a new mental structure, the 'transference neurosis' - re-creation of the original neurosis in the analytic situation itself, with the patient experiencing the analyst as the object of his or her infantile wishes and the focus of his or her pathogenic conflicts. The crucial importance of the transference neurosis - it's very reality as a clinical phenomenon - has been and continues to be a matter of debate among psychoanalysts to this day.
Over the resulting decades several themes appear and reappear. One to which Freud alluded is that of the uniqueness versus the ubiquity of transference, is it a special creation of the analytic situation or is it an inevitable and universal aspect of all human relation? More central and perhaps more heated in the continuing debate, as the primary of transference interpretation in which Strahey called the 'mutative' effects of analysis - for example, whether such interpretations are simply more convincing than others or are the only kinds that are truly an effective therapy constitutionally begotten. Echoes of this debate have resounded through the years and to be perspectively descendable in most recent literary works. Finally, are all of the patient's reactions to the analyst in the analytic situations to be of counter-transference or do some partake of the 'real' 'non-neurotic' relationship or of the 'working alliance'?
It is only to mention, at the outset that resistance is, in certain fundamental references, an operational equivalent of defence, its scope is really far larger and more complicated. The thoughts of its nature and motivations on resistances to the psychoanalytic process use an array of mechanisms that sometimes defy classification in the way that fundamental genetically determined defences, derived from importantly and common developmental trends, can be classified. From falling asleep too brilliant argument, there is a limitless and mobile of devices with which the patient may protect the current integrations of his personality, including his system of permanent defences. In fact, Resistances of a surface, conscious type, related to individual character and to educational and cultural background, often present themselves are the patient's first confrontations with a unique and often puzzling treatment method. While some of these phenomena are continuous with deeper resistances, a closer, and perhaps balancing equilibrium held in bondage to the mutuality within the continuity that we must meet others at their own level. All the same, it now leaves to a greater extent, the much-neglected faculty of informed and reflective common sense, and moves onto the less readily accessible and explicable dynamism, which inevitably supervene in analytic work, even if these initial surface Resistances have been largely or wholly mastered. Its submissive providences lay order to perfect connectivity, premising with which is the specific influence of the immediate cultural climate, stressed of the general attitude of many young people (Anna Freud 1968) toward the psychoanalytic process and its goals.
When Freud gave up the use of hypnosis for several reasons, beginning with the personal difficulty in inducing the hypnotic state and culminating in his ultimate and adequate reason - that it bypassed the essential lever of lasting therapeutic change, the confrontation with the repressing forces themselves - he turned to the method of waking discourse with the patient, in which insistence, with a sense of infallibility, accompanied by head pressure and release, were the essential tools for the overcoming of resistance (Breuer and Freud 1893-1895). Although the affording the unformidable combinations that are awaiting the presence to the future attributions in which the valuing qualities that allow us the privilege to have observed various forms of resistance ( in a general sense) before, as for example, inability to be hypnotized, ful in totality and a willful rejection of hypnosis, selective refusal to discuss certain topics under hypnosis, adverse reactions to testing for stances, it was the effectiveness of insistence in inducing the patient to fill memory gaps or to accept the physician's constructions that reapproached of extending its lead, in that Freud was to a first and enduring formulation: Since effort
- psychic work - by the physician was required, a physical; evidently force, a resistance opposed to the pathogenic ideas, becomingly conscious (or being remembered), had to be overcome. They thought this to be the same psychic force that had initiated the symptom formation by preventing the original pathogenic ideas from achieving adequate affective discharge and establishing adequate associations - in short, from remaining or becomingly conscious. The motive for invoking such a force would be the abolition (or avoidance) of some form of physical distress or pain, such as shame, self-reproach, fear of harm, or equivalent cause for rejecting or wishing to forget the experience. Such are the appreciative attributions, in that the distributive contributional dynamic functions bestow the factoring understructure of the constellation of ideas, have already comforted us, yet, the later is clearly the ego and especially the character of it. It was thought important to show the patient that his resistance was the same as the original ‘repulsion' which had initiated pathogenesis. The step later was short to the essential equivalent and permanent concept of defence at first repression. That is, though Freud gave tremendous sight to the effectiveness of the hand pressure manoeuver, he saw it essentially for distancing the patient's will and conscious attention and thus simplifying the emergence of latent ideas (or images). From a present-day point of view, one cannot but think of the powerful transference excited by an infallible parental figure in a procedure only one step removed from the relative abdication of will. Consciousnessly involved in hypnosis, and that this quasi-archaic qualitative pattern of relationship was more important to effectiveness or failure than was the exchange of a psychic energy postulate by Freud. In this sense, the ‘laying on of hands' granted its effect on attention, was probably even more significant in inducing transference regression than in the role that the great discoverer assigned to it.
What is important, in whatever way, is the establishment of a viable scientific and working idea of resistance to the therapeutic process as a manifestation of a reactivated intrapsychic conflict in a new interpersonal context. This in its essentials persists to this day in psychoanalytic work, in the concept of ego resistances.
At the same proven capability, as measuring with this development, less explicitly formulated but often described or inferred, was the marginal total rejecting or hostile or unruly attitude of the patient, sometimes evoking spontaneous antagonistic reactions in the physician. In occasional direct references in the early work and in the choice of figurative phraseology for years after that, Freud recognizes this ‘balky child' type of struggle against the doctor's efforts. One needs only recall Elizabeth von R., who would tell Freud that she was not better, "with a sly look of satisfaction" at his discomfiture (Breuer and Freud 1893-1895). When deep hypnosis failed with her, Freud "was glad enough that once, she refrained from triumphantly protesting ‘I am not asleep, you know, and cannot be hypnotized"; in this context that show with which this categorical type of resistance phenomenon that it represents the evolutionary whisper, though Freud and many others found it to come within the evolving gait of steps in a whisper, after-all, the advance of applied science was bringing to light curious new phenomena that, however hard men might try, would not be fitted into the existing order of things. All this is to encourage along the side of the paradigms of science to agree of it achievable obtainability through with of those has witnessed the impregnable future, least mentions, far and above is the first essentially forced finality to agree that fighting a great adventure in thought at lengths to come safely to shore is necessary, in this glare, the human figure has had to apply formally to be enlarged so that the brave stands which make for civic and academic freedom. It also taken to applicate the form to encourage the belief that, as nicely put, 'all men dance to the tune of an invisible piper. Because, we did not attest the big bang, but call its evolution of a particular type of ego-syntonic struggle with the physician that remains potentially important during any analysis by what the negative transference, whatever its particular nuances of motivation. This is, of course, a manifestly different phenomenon from the earnest effortful struggles of the cooperative patient whose associations fail to attend to him, or who forgets his dream, or who comes at the wrong hour, to his extreme humiliation. Still, in that respect is an important dynamic relationship between the two sets of phenomena.
Nonetheless, Freud made the analysis of resistance the central obligation of analytic work and proceeded from primitive beginnings, with rapidly increasing sophistication, both technical and psychopathologic, ideas that remain valid to this day; that conscious knowledge transmitted to the patient may have no, or an adverse, effect in the mobilization of what is similar or identical in the unconscious; that the repressing forces, the resistances, are more like infiltrates than discrete foreign-body capsules in their relation to preconscious associative systems; that the physician must begin with the surface and continue centripetally; that hysterical symptoms are more often serial and multiple than mononuclear, and the resistances participate in all productions and must be dealt with at every step of analytic work, and other matters of equal significance (Breuer and Freud 1893-1895).
Freud always maintained the central concept of resistance, and bequeathed it (reinforced later by the structural theory) to the generations of analysts who have followed him. Still, as the years went on, he elaborated the general scope of resistance far beyond the basic concept of intrapsychic defence, anticathexis that a great variety and range of mechanisms could impede the psychoanalysis as a recognizable process or, beyond this, making it ineffective or reverse expected therapeutic responses, or extend indefinitely the patient's dependence on the analyst. When extended its direct equation with the anticathexis of defences, the variety of sources - not to speak of manifestations - of resistance multiplied rapidly. To remark upon the merely secondary realizations of illnesses (Freud 1905), under which the ‘external' resistances are, for example, the hostility of the unmurmuring family line of treatment (Freud 1917), evenhandedly as the persistence of illness, with its detachment, superciliousness, and mechanical compliance as some weapons system for frustrating the analyst, as with the utterly troubled young girl (Freud 1920). The relevant sense of securing the symptomatic primary modes of perturbation conflict solution, and most crucially, the analysable obtainability of such subtly evolving concept of ‘transference-resistance,' in its oscillating pluralistic sense, for example, (Breuer and Freud 1893-1895: Freud 1912, 1917). In his last writings, conspicuously in Analysis Terminable and Interminable (1937), in considering several possible factors in human personality that obstruct or render ineffectually the successful end of the analytic procedure, Freud offered a variety of psychodynamic considerations that could be fundamental in the extended or broadened concept of resistance: The question of the constitutional strength of instincts and their relation to ego strength; the problem of the accessibility of latent conflicts when undisturbed by the patient's life situation (briefly but pointedly) the impingement of the analyst's personality on the analytic situation and process; the existence of certain qualities of the libidinal cathexes - especially undue adhesiveness or excessive mobility; rigid character structure; the existence of certain sex-linked ‘bedrock' conflicts that Freud regarded as biologically determined (insoluble penis envy in the female, and the male's persisting conflict with his passivity). Finally and most formidable, there was the cluster of dynamism and phenomena that Freud, beginning in, Beyond the Pleasure Principle (1920) and The Ego and the Id (1923), attributed consistently and with deepening conviction to the operation of a death instinct. That is to say, to the ‘unconscious sense of guilt' and demands the need for punishment, the repetition compulsion, the negative therapeutic reaction, and the more general operations of the need to suffer or to die or to seek outer or inner worldly concern. Yet, it remains an inexorable truth that the resistances underlying and hidden of representationally inherent cases or certain limitations implicit like psychoanalytic work, are moderately invincibly formidable, and cannot be disestablished by theoretical position any more than they can be thus created.
The varied clinical manifestations of resistance are dealt with extensively throughout Freud's own writings, in many individual papers of other analysts, and in comprehensive works on analytic technique, for example, those of Fenichel (1941), Glover (1955), and more recently Greenson (1967) of which only makes a selective and occasional reference to their kaleidoscopic variety.
When free association and interpretation displaced hypnosis and derivative primitive techniques, the psychoanalysis as we now construe it came into being. To the extent that free association was the patient's active participation, it was in this sphere that his ‘resistance' to the new technique was most clearly recognized as such, cessation, slowing, circumlocution and a lack of informative or relevant content, emotional detachment, and obsessional doubt or circumstantiality became established as obvious impediments to the early (no longer exclusive but still radically important) topographic goals: To convert unconscious ideas largely via the interpretation of preconscious derivatives into conscious ideas. Only with time and increasing sophistication did fluency, even vividness of associative content, tendentious ‘relevancy' itself evidently can, like over-compliant acceptance of interpretation, conceal and carrying out resistances that were the more formidable because expressed in such ‘good behaviour'.
One may define resistance (and in so doing include a liberal and augmenting paraphrase of Freud's own most pithy definition [The Interpretation of Dreams 1900]) as anything of essentially intrapsychic significance in the patient that impedes or interrupts the progress of psychoanalytic work or interferes with its basic purposes and goals. In specifying ‘in the patient' one is to imply as not underestimate the possibly decisive importance of the analyst's resistances, to separate the ‘counterresistance' as a different matter, in a practical sense, requiring separate study. One may concur, that as a generalized infraction forwarded of a direction with Glover's statement (1955) that "however we may approach the mental apparatus there is no part of its function that cannot serve the purposes of mental defence and therefore give apparency during the analysis to the phenomena of resistances." One may also concur with his formulation that the most successful resistances (in contrast with those employing manifest expressions) are silent, but disagree with the paradoxical sequel ". . . they might say that the sign of their existence is our unawareness of them." For the absence of important material is a given sign, and becoming aware of such an absence is necessary, if possible.
Freud, in his technical papers and in many other writings, despite his reluctance in this direction did lay down the general and essential technical principles and precepts for analytic practice. We must note, however, that the clear and useful technical precepts are largely in that may be regarded as the ‘tactical sphere', i.e., they deal with the manifest process phenomena of ego resistances. Other resistances, those largely contained in the ‘silent' group, for example, detainment or unsuccessful symptomatic alteration, omission of decisive conflict material form free association or [more often] from the transference neurosis, inability to accept cancellation of the analysis, and allied matters. In that saying, the ‘strategic sphere', relating to the depths of the patient's psychopathology and personality structure and to his total reactions to the psychoanalytic situation, process, and the person of the analyst. Its use of the tern ‘strategic' and ‘tactical' differ from their user by others, for example, Kaiser (1934). While it is not to presume to offer simple precepts for the ready liquidation of the massive silent resistances, heedfully to contribute of something, however slight. To understanding them better and thus, potentially, to their better management but some of these considerations, for example, iatrogenic regression, as to context (1961, 1966). In the ‘strategic' arena of resistance, so often manifested by total or relative ‘absence', it is the informed surmise regarding the existence of the silent territory, by way of ongoing reconstructive activity, which is the first and essential ‘activity' of the analyst. Beyond this mindfulness and subtle potentialities of the shaping and selection of interpretative direction and emphasis and the tactful indication of tendentious distortion or absence.
Because of a possible variety of factors, beginning with the estranging dissimulations that magnetism that the verbal statement of unconscious content puts into action of the analysts and patients alike (of itself is a frequent resistance or counterresistance) the priority of the analysis of resistance over the analysis of content, as discretely separate, did not readily come to its carry out quality. This might have been owing to the difficulties of dealing with more complicated resistances or developing an adequate methodology in this arena, or even the fact that an extensive interval over its timed and tactful reference to content (or its overall nature) sometimes seems the only way of mobilizing (reflexively) and thus exposing the corresponding resistance for interpretation and ‘working through', an echo of Freud's early, never fully relinquished diphasic process (1940).
Since this is not a technical paper, the admissive structural functionality, over which an extended discussion of the evolution of views on methods of resistance analysis, although substantiated functions has inevitably related such views to our immediate subject matter. Its mindful approaches that range from the strict systematic analysis of character resistances of Wilhelm Reich (1933) or the absolute exclusion of content interpretation of Kaiser (1934), to the special efforts toward dramatization of the transference of Ferenczi and Rank (1925) or Ferenczi's own experiments with active techniques of deprivation and (on the other hand) the gratification of regressed transference wishes in adults (for example, 1919, 1920, 1930, 1931, 1932). Developments in ego psychology (for example, Anna Freud's classical contribution on the mechanisms of defence [1936] brought the variety and importance of defence mechanisms securely into the foreground of analytic work, and the subsequential extent of which is widely accepted priority of defence analysis has rectified a great deal of the original [and not entirely inexplicable] ‘cultural cover with lagging' in this describing importance, that if not exclusive, spheres of resistance analysis. Concomitant with a more widespread functional acceptance of the essentiality and priority (in principle) of resistance analysis over content interpretation, there is usually a more flexible view of the technical application of the essential precepts, permitting interpretive mobility, according to intuitive certainty or judgement between the psychic structures, according to Anna Freud (1936) principle of ‘equidistance'. Discrete specification may sometimes deal resistance with other than those apart from the intrinsic conceptual difficultly in the latter intellectual process, i.e., the specifying of a resistance without suggesting that against which it is directed (Waelder 1960). There is also a general broadening of the scope of interpretive method. Witness, for example, Loewenstein's ‘reconstruction upward' (1951) and Stone, having his own differently derived but often an allied conception, the ‘integrative interpretation' (1951), both of which recognize that resistance may be directed ‘upward' or against the integration of experience, than against the affirmative extent and exclusively infantile or against the past. Similar considerations are also reflected in Hartmann's ‘principle of multiple appeal' (1951).
It may, nonetheless be of note that while the emphasis on resistance in Freud's early clinical presentations is overall proportionate to his theoretical statements, his methods of dealing with the concealed and more formidable resistances are not clear, except in certain active interventions, such as the magical intestinal prognosis in the "Wolf Man" (1918), or the ‘time limit' in the same case, or the principle that at a certain point patients should confront phobic symptoms directly (1910), or the suggestion to transfer to a woman analyst, with the homosexual woman (1920). In these manoeuvres and attitudes it is recognized that (1) interpretation, the prime working instrument of analysis, may often reach an impasse in relation to powerful ‘strategic' resistances, and (2) an implicit recognition that elements in the personal relationship of the analytic situation, specifically the transference, may subvert the most skilful analytic work by producing massive although ‘silent' resistances to ultimate goals, and that sometimes where energetic elements are formidable, they may have to be dealt with directly and holistically, in the patient's living and actual situation.
Freud's own interest in active techniques stimulated Ferenczi to extreme developments in this sphere (1912, 1920), later combined with his oppositely oriented methods of indulgence (1930). As time presses on, noninterpretative methods, particularly those involving gratifications of transference wishes, whether libidinal or masochistic, were set aside with increasing severity, in recognition of their contravention of the indispensability of the undistorted transference and the unique importance of transference analysis in analytic work. The same has been largely true of tendentious, selective instinctual frustrations (Ferenczi 1919, 1020). However, there is no doubt that the use of interpretive alternatives (sometimes suggests for the deliberate control of obstinate resistance phenomena in this spheric arena) has been sharpened by - partially coloured by - the earlier experiments in prohibition, whose transference implications were fully apparent at the time of their introduction. The type of active intervention introduced by Freud (the time limit, the confrontation of symptoms), confined in actuality to the sphere of the demonstrable clinical relationship, has retained a certain optional place in our work, although the potential transference meaning and impact of such interventions, with corresponding variations or limitations of effectiveness, are increasingly understood and considered. The broad general principle of abstinence in the psychoanalytic situation, stated by Freud in its sharpest epitome in 1919, remains a basic and indispensable context of psychoanalytic technique. The nuances of application remain open to, in fact to require, continuing study (Stone 1961, 1966).
In assent to important developments in ego psychology and characterology (for conspicuous examples, Anna Freud 1936, Kris 1956, Hartmann 1951, Loewenstein 1851, Waelder 1930, the principle factor in deepening, broadening, and complicating the conceptual problem of resistance, and thus modifying the strict latter-like sequential approach (Reich 1933) to the analysis of resistance ad content respectively, even in principle, has been the progressive emergence of transference analysis as the central and decisive task of analytic work. For, to state it over succinctly, and thus to risk some inaccuracy, the transference is far more than the most difficult tool of resistances and (simultaneously) an indispensable element in the therapeutic effort. Given the mature capacity for working alliance, it is the central dynamism of the patient's participation in the analytic process and, while the proximal or remote source of all significant resistances, but those manifest phenomena originating in the conscious personal or cultural attitudes and experiences of the adult patient or those deriving from the inevitable cohesive-conservative forces in the patient's personality, for which we must still summon briefly the Goethe-Freud ‘witch', metapsychology (Freud 1937).
In relation to the ‘tactical', i.e., process, resistances, an overall view of what is immediate and confronting for example, the threatening emergence of ego-dystonic sexual or aggressive material, may be adequate. All the same, to any casual access to what may be called the ‘strategic' sphere of resistance. One must have a tentative working formulation of the total psychic situation in mind, including an informed surmise regarding large and essential unconscious trends. Such suggested procedure is, accessibly open to discussion on more than one scope, and it does involve one immediately in some basic epistemological problems of psychoanalysis. Unfortunately, we cannot become involved in this fascinating sphere of dialectic in this brief essay on a large subject nevertheless, in his early work Freud relied enthusiastically on his own capacity to fill primary gaps in the patient's memory through informed inherences from the available data, and then, with an aura of infallibility, actively persuaded the patient to accept these constructions. However, with the further elaboration of psychoanalysis as process, in the sense of the increasing importance of free association, of the analyst's relative passivity, and other characteristics of the process as we now know it, there have inevitably been some important modifications of the attitudes reelected in such procedures. While, as far as it had never been revised or revoked, Freud's view that the resistances are operatives in every step of the analytic work, and knowing that there exists in many minds paradoxical mystiques to the effect that the patient's free associations as such, unimpeded (and uninterpreted), could ultimately provide the whole and meaningful story of his neurosis, in the sense of direct information. This is, of course, manifestly at variances with Freud's basic assumptions about the role of resistance, and the germane roles of defence and conflict in the origin of illness.
Nonetheless, in Freud's, Recommendations (1912) is his advice against attempting to reconstruct the essentials of a case while the case is in progress. Such a reconstruction, here assumes, would be undertaken for scientific reasons. The caution, nevertheless, rests on both scientific and therapeutic grounds, on the assumption that the analyst's receptiveness to new data and his capacity for evenly suspended attention would be impaired by such an effort. It is true, of course, that rigid preoccupation with an intellectual formulation can impair the capacities. Even so, it is also true that the ‘formulation' or structuring of a case can and largely does go on preconsciously, in some references even unconsciously, and usually quite spontaneously. One must assume at the very least, that some such process reaches the analyst's first perception of a ‘resistance'. Some have thought that Freud would have disagreed with using such a process. Still, its use, whatever the form, is a necessity, and, at times, it requires and should have the hypercathexis of conscious and concentrated reflection? One may, of course, assign the more purposive intellectual processes to periods outside hours, and thus better preserve the other equally important responses to the dual intellectual demand of psychoanalytic technique. The ‘voice of the intellect', all the same, should not be deprived of this essential place in analytic work. It is well known that it must never be allowed to foreclose mobile intuitive perceptiveness or openness to unexpected data. Nor must ongoing formulations in the mind of the analyst be allowed to cram the spontaneity of the patient's association. They should remain ‘in the analyst's head'. To epitomize the technical situation: Strategic considerations require varying degrees of reflective thought, possibly outside hours. Except the perspectives and critiques they silently lend to understanding, they should not influence the natural and spontaneous, often intuitive, responses of the disciplined analyst to the never-ending variable nuances of his patient's ‘tactics'. In relation to any category of clinical psychoanalytic problem. It is the structure of the transference neurosis and its unfolding, with the adumbrative material in characterology, symptom formation, personal and clinical history and the clues from specific data of the psychoanalytic process, taken as an ensemble, which provide the most reliable basis for general tentative reconstruction and thus for the understanding of resistances. While we must marshal our entire body of data, theory, and technology to see the transference neurosis as an epitome of the patient's emotional life, our comprehension of it is nonetheless based essentially on something that is right before us. Again, the total ensemble is essential, and the objectively observable phenomena of the transference neurosis are of crucial and central valences.
In the background data, the large outlines of life history are uniquely important because they do represent, or at least strikingly suggest, the patient's gross strategies of survival and growth, of avoidance and affirmation. One may infer that they will be invoked again in the conformation with the analyst, in his pluralistic significance. Some oversimplified and fragmentary illustrations are chosen in the occupational commitments with children and the mood in which they are carried out, with the general character of manifest sexual adaptation, can contribute to rational surmise about whether neurotic childlessness is based predominantly on disturbances of the Oedipus complex, on an original inability to achieve an adequate psychic separation from parent representations, or on the vicissitudes of extreme sibling rivalry. It must surely crystallize illnesses and analytic process if one knows that some patient lives, by choice, the breadth of an ocean removed from parents and siblings with whom there has been no evident quarrel, when this is not a crucial matter of occupational opportunity or equivalently important reality. Necessarily a male patient's gross psychosexual biography helps us to understand which ‘side' of the incestuous transference is more likely to be surfacing in his first paroxysm of heterosexual ‘acting out'. While it is true that dreams, parapraxes, and other traditionally dependable psychoanalytic material may dramatically reveal the ego-dystonic directions of impulse and fantasy life, and the specific nature of opposing forces, it is, only, the composite situation that historical and current picture that reveals the prevailing or alternative defences, the large-scale economic patterns, and the preferred or stable, i.e., most strongly over determined, trends of conflict solution.
Tactical problems of resistance were earliest observed largely in disturbances of free association, which, in frequent tacit assumptions, would, or in principle could, lead without assistance to the ultimate genetic truth. This truth was construed to be the awareness of previously repressed memory (or the acceptance of convincing and germane constructions). As time went on, in Freud's own writing, terms of conative import appeared - such as ‘tendency' or, more of vividly, ‘impulsiveness'. However, the critical etiological and (reciprocally) therapeutic importance of memory has, of course, never really lost its importance. For, while the recovery of traumatic memories, with an abreaction, is still dramatic in its therapeutic effect, for example, in war neuroses or equivalently civilian experiences and occasionally in isolated sexual experiences of childhood or adolescence, neuroses of isolated traumatic origin are rare in current psychoanalytic experience. Traumata is usually multiple, repetitive, often serving to crystallize, dramatize and fix (something even ‘covers') more chronic disturbances, such as distortions or pathological pressures in the instinct life, against the background of larger problems of basic object relationships. Freud was already becoming aware of the complex structure of neuroses when he wrote his general discussion for the Studies on Hysteria (Breuer and Freud 1893-1895). Thus, to put it all too briefly, when structurized impulses or general reaction tendencies can truly be accepted for memory, i.e., as matters of the past, other than in a tentative explanatory sense, much of the analytic work with the dynamics of the transference neurosis has necessarily been accomplished. One does not readily give up a love or hatred, personal or national, only because one learns that it is based on a crushing defeat of the remote past.
The manifest communicative phenomena of resistance remain very important, just as the common cold remains important in clinical medicine. Morally justified in those of whom walk continuously among the corpsed of times generations, their circulatory momentum around the cross and forever finding its same death but it's comforting solice and refuge, from which, they dwell of the unknown infinity. It will never cease to be important to tell a patient that he is avoiding the emergence of sexual fantasies, that his blank silence covers latent thoughts about the analyst, or (in a measure more sophisticated) that apparent and enthusiastic erotic fantasies about the analyst conceal and include a wish to humiliate or degrade him. However, we can be better prepared, even for these problems, because of ongoing holistic reconstruction. Surely we are better prepared for the formidable resistances of patients who apparently do ‘tell all' or even ‘feel all', in a most convincing way and in all sincerity, yet may finish apparently thorough analysis without having touched certain nuclear conflicts of their lives and characters or, (more often) having failed to meet the transference neurosis, with a sense of affective reality. These instances, for instance refers to the instances described by Freud (1937) in which such conflicts remain dormant because current life does not impinge on them, but to those in which the ‘acting out', in life or the solution in severe symptoms is desperately elected by the personality in apparently paradoxical preferences to the subjective vicissitudes of the transference neurosis (Stone 1966).
In brief, is a tentative formulation of the respective natures of the two peculiar and yet particular groups of resistance phenomena, ultimately and vestigially related and exists in varying degree in all analyses. It is, however, one or the other is usually important and is, in practical and prognostic sense, quite differently as: (1) Those progress to evidently large discernible impediments of the psychoanalytic process in its immediate operational sense. These are usual in the neuroses, in persons who have achieved satisfactory separation of the 'self' from the primary y object. Nevertheless, whose lives are disturbed by the residues of instinctual and other intrapsychic conflicts in relation to the unconscious representations of early objects and thus to transference objects. (2) Those that may be similarly manifested at times but maybe or even exaggeratedly free of them. Where the essential avoidance is of the genuine and effective e diphasic involvement in the transference neurosis, with regard too fundamental and critical conflicted, and thus of the potential relinquishment of symptomatic solutions and the ultimate satisfactory separation from the analyst. In this context, among other phenomena, there may be large-scale hiatuses in analytic material in the usual experiential sense, or there may be a striking absence of available and appropriate cues of connection with the transference, or failure, this complex of phenomena may repeat an original disturbance in ‘separation and individuation' (Mahler 1965). Alternatively of other severe disturbances in early object relationships or related pregenital (particular oral) conflicts can have produced tenacious narcissistic avoidance of transference involvement, to facade involvement, or to the alternative of inveterate regressed and ambivalent dependency. Dependable and largely affirmative secondary identifications have usually not been achieved originally, and this phenomenon, related to basic disturbances of separation, contributes importantly to the variously manifested fears of the transference.
Intuitively, the phenomena of the two groups may overlap. There may be deceptively benign ‘aponeuroses' in the more severe group. In the troublesome phenomenon of ‘acting out', for example, one may deal with a transitory resistance to an emergent transference fragment, in some instances due to a delay of effective interpretation, or one may be confronted by a deep-seated, variably structuralized, and sometimes even ego-syntonic ‘refusal' to accept the verbal mode of communication with an unresponsive transference parent in dealing with insistent disturbing and gross affects implored by impulsive unintelligibility.
Freud (1925), pointed out that everything said in the analytic situation must have some coefficient of reflection to the situation in which it is said. This is, of course, consistent not only with reflective common sense but also with the theory of transference and the current view of the central position of the transference neurosis in analytic work. Furthermore, despite his earliest view of the ‘false connection' as pure resistance (Breuer and Freud 1893-1895) and the continuing high opinion of this aspect of transference, Freud early established the (non-conflictual) positive transference as the analyst's chief ally against resistances. So, he never stretched out in his appreciation of the primitive driving power of the transference and its indispensable function of conferring a vivid and living sense of reality on the analytic process (Freud 1912). However, in past commination, the transfer is the central dynamism of the entire psychoanalytic situation, and the transference neurosis provides the one framework which give essential and accessible form to the potentially panpsychic scope of free association (Stone 1961, 1966). In this frame of reference the irredentist drive to reunion with the primal mother, as opposed to the benign processes of maturation and separation, underlies neurotic conflict in its broadest sense and is the basis of what is called the ‘primordial transference', whose striving renewed physical approximation or merger. Speech, which is the veritable stuff of psychoanalysis, serves as the chief ‘bridge' of mastery for the progressive somatic separations of earliest childhood. The ‘mature transference', in continuum, alternative and contrast, is that series and complex of attitudes contingent on maturation and benign predisposing elements of early object relationships (conspicuously, the wish to be understood, to learn, and to be taught) that enables increasing somatic separation in a continuing affirmative context of object relationship, as later reelected in the psychoanalytic situation. In this interplay, speech - our essential working tool - plays as these oscillating, curiously intermediates roles, ranging from the threat of regression in the direction of its primitive oral substrate to it is ultimately purely communicative-referential function linked with insight (Stone 1961, 1966).
Nonetheless, the origin of the ‘transference' as we usually perceive it clinically, and as the term is traditionally employed, is in the primordial transference. Be it essentially the classical triadic incestuous complex or an oral drive toward incorporation or toward permanent nursing dependency or a sadomasochistic and shriving toward a parent, it will be re-experience in the analytic situation, in good part in regressive response to its derivations (Macalpine 1950), and produce the central, and ultimately the most formidable, manifest resistance, the transference-resistance.
The ‘transference-resistance', while sometimes used in varying references, meant originally the resistance to effective insight into the genetic origins and prototypes of the transference, expressed in the very fact of its emergence (originally, the ‘false connection' described by Freud [Breuer and Freud, 1893-1895]). Afterwards, as the transference became established in its own autochthonous validity, the same resistance could be viewed as an obstruction to genetic understanding of the transference, and thus putatively to its dissolution. Alternatively, such dissolutions (using this word in a relative and pragmatic sense) are contingent on much germane analytic work, on analysis of the dynamics of the attitude as represented in the transference neurosis, on working through, and on complicated and gradual responsive emotional processes in the patient (Stone 1966). Nevertheless, this genuine genetic insight is indispensable for the demarcation of the transference from the real relationship and for the intellectual incentive toward its dissolution within the framework of the therapeutic alliance.
While to the ‘resistance to the awareness of transference' the confrontations of patients are characterized by the immediate emergence of intense (even stormy) transference reactions, most patients experience these emergent altitudes as essentially ego dystopia, except in the sense of the attenuate derivatives that enter (or vitiate) the therapeutic alliance or in the sense of chronic characterological reactions that would appear in other parallel situations, however superficial and approximate the parallel might be.
The clinical actuality of emergent transference requires analysis in its usual technical sense, including the prior analysis of defence. Transference may appear in dreams long before it is emotionally manifest; in parapraxes, in symptomatic reactions, in acting out within the analytic situation, or - most formidable - in acting out in the patient's essential life situation. Except in cases of dangerous acting out, or very intense anxiety or equivalent symptoms, which can form emergencies, the technical approach involves the same patient centripetal address to the surface prescribed for analysis and its comprising it. However, as for this, it would suggest a modification of the classical precept that one does not interpret the transference until it becomes a manifest resistance. At this point, the interpretation is obligatory. The resistance to awareness should be interpreted, and its content brought to awareness, when the analyst believes that the libidinal or aggressive investment of the analyst's person is economically a sufficient reality to influence the dynamics of the analytic situation and the patient's everyday life situation.
Stripping the matter of nuances is useful, reservations, and exceptions, for clarity in an essential direction. The avoidance of awareness of transference derives from all of the hazards that accompany consciousness: Accessibility of the voluntary nervous system, therefore heightened ‘temptation' to action; heightened conflict in relation to the sanctions and satisfactions of impulse materialization; the multiple subjective dangers of communication of "I-you" impulses and wishes or germane fears to an object invested with parental authority; heightened sense of responsibility (in that way, guilt) connected with the same complex, and, very far from least, the fear of direct humiliating disappointment - the narcissistic would have rejection or, perhaps worse of all, no affective response, the avoidance of this helplessness of impact, plays and important part. There is also the exceedingly important fact that the transference conflicts remaining outside awareness retain their unique access to autoplastic symptomatic expression, in compact and narcissistically omnipotent, if painful, solution, without the direct challenge and confrontation with alternative (and essentially ‘hopeless') solutions.
Why, then, if such fears weigh heavily against the analytic effort and the ultimate therapeutic advantage of awareness, does the patient cling tenaciously to his views of the analyst and the system of wishes connected with this view, once it has become established in his consciousness? In the earliest view, where the cognitive elements in analysis were heavily preponderant, not only in technique but also in the understanding of process, such clinging to transference attitudes was thought to be, since the essence of subjective matters' amounted of what was significantly the essential goal of the analytic effort and was thought to be, itself, the essential therapeutic mechanism. Still, why is the patient not willing, like the historian Leaky's dinner partner, to ‘let bygones be bygones'? Unless one accepts this aversion to recall or reconstruction, a preference for ‘present pain', as a primary built-in aversion, in its self of an unexplained fact of ‘human nature', one must look further. Yet, on the person of the patient might informally reject these elements of ‘insight' because they vitiate or diminish both the affective and cognitive significance of this central object relationship, which is a current materialization of crucial unconscious wish and fantasy, originally warded off. If it is to be given up, why was it pried out of its secure nest in the unconscious? Such resolution is always felt, at least incidentally, as an attack on the patient's narcissism and on his secure sense of self, secondarily reestablished. Moreover, to the extent that there is a genuine translation of the subjectively experienced somatic drive elements into verbal and ideational terms related to past objects, there is an inevitable step toward separation from the current object that parallels the original and corresponding development movement.
An essential dynamic difference from the past lies in the different somatic and psychological context in which the renewed struggle is fought. Old desires, old hatreds, old irredentist urges toward mastery, have been reawakened in a mature and resourceful adult, in certain spheres still helpless subjectively but no longer literally and objectively, a fact of which he is also aware. It was pointed out by Freud (1910) that this great quantitative discrepancy between infant conflict and adult resources make possibly and eases therapeutic change, through insight. In many important respects, this remains true. However, the remorseless dialectic of psychoanalysis again asserts itself. Truly effective insight requires validating emotional experience, which is only rarely achieved through recollections alone. The affective realities of the transference neurosis are necessary (now and again, inevitable), and with this experience comes the renewal of the ancient struggle, in which, with varying degrees of depth, the maturity and resources of the analysand often play a role at valiance with his capacity fort understanding. This is true not only of the subjective quality and experience of his striding but of the resources which support his resistances, in either phase of the transference involvement. Whether the wish is to seduce, to cling, to defeat and humiliate, to spite, or to win love, mature resources of mind - sometimes of body - may be involved to start this purpose, including what may occasionally be an uncanny intuitiveness regarding the analyst's personal traits, especially his vulnerabilities?
The persistence of old desires for gratification and the urge to consummate them, or the given urges to restore and maintain an original relationship with an omnipotent (and omniscient) parent, are intelligible to everyday modes of thought. That the transference, like the neurosis itself, may also entail guilt, anxiety, flustration, disappointment and narcissistic hurt are another matter. If it gives so much trouble, why does it reappear? Freud's latter-day explanation involved the complex general theory of primary masochism and the repetition compulsion. One cannot, in a brief discussion, reach a disputation that has already occasioned voluminous writing. In ultimate condensation, the operational view to which are the elements to be understood, as perhaps, of (1) accompanying the renewed unregenerate drive for gratification of previously warded off wishes, whether libidinal or aggressive, based on the presentation of an actual object who bears significant functional ‘resemblances' to the indispensable parent of early childhood, in a climate and structure of instinctual abstinence, and
(2) based on the latent alternative urge to understand, assimilate, perhaps alters parental response, or otherwise master poignantly a painful situation as they were experienced in state of relative helplessness in the past. Both may be viewed as independent of adult motivations, although the power of the first may at times importantly subserve such motivations, and the second may often be phenomenologically congruent with them. Implicit in both, in contrast with the experienced plasticities and varieties of mature ego development, is the persistent and a continuous theme of adhesion to the psychic representation of the decisive original parent figure or a perceptually variant substitute. Still, it is profoundly important against original separation from the primal mother, with its potential phase specifications, as opposed to the powerful urges toward independence development, providing the underlying basis for developmental and later, neurotic conflict, that these conflicting tendencies, in the sense of the profundity that of them provide a certain parallel to the Thanatos-Eros struggle that assumed a decisive role in Freud's final contributions. In a recent study of aggression (Stone 1971), examined Freud's views on this subject. Although - in a paradox - by which the existence of a profound ‘alternative' impulse to die at least conceptually tenable and susceptible to clinical inferential support, it is the conviction of those, that from both observation and inference, that aggression as this is an essential instrumental phenomenon (or can serve self-preservation and sexual impulses alike, and that it is thus, in its original forms, pitted against a postulated latent impulse to die, as it is against external threats to life. These urges and instrumentalities find primal organismic expression and experience in the phenomenon of birth and the immediate neonatal period, the biological prototype of all subsequent specifications, elaborations, and transmutations of the experience of separation. At the very outset the ‘conflict' may find expression in the delay of breathing or, shortly after that, in the disinclination of suck. There is thus an intertwining of the two conceptions of basic conflict. It may characterize that 'time' will validate Freud's latter-day views of the fundament of human conflict. For the time being, however, it has to the presents that are an empirically more accessible and a heuristically more useful view of the ultimate human intrapsychic struggle. Thus the originally unmastered or regressively reactivated struggle around separation, revived by developmental conflict, would in this schema represent the ‘bedrock' of ultimate resistances, although never - at least in theory - utterly and finally insusceptible to influence. If we assume that the vicissitudes of object relationships, initiated by the special relationship of the human infant of his family, are fundamental in the accessible process of personality (thus, structural) development and thus of neuroses, and that, in ‘mirror images'. The transference and thus the transference-resistance has a comparable strategic position in the psychoanalytic process, can we extend these assumptions inti the detailed technical phenomenology of process resistance in its endless variety of expression? Yet it remains that this extension is altogether valid.
What is more, is whether or not one thinks of it as ‘motivation' in its usual sense, one can without extravagance postulate and even more intense cohesiveness at the first signal of that stimulus that contributed to the establishment of the organization and its basic strategies in the first place, i.e., the analyst as transference object. In the subjective good sense, the regressive trend of the transference, by the total structure of the psychoanalytic situation (i.e., the basic rule of free association and the systematic deprivations of the personal relationship) confronts the patient with one who has perceived ultimately as his first and an all-important object, the prototypical source of all gratification, all deprivation, all rejection, all punishment - the object involved in the primordial serial experience of separation (Stone 1961). This may seem an exaggeratedly magniloquent way to view a practitioner who puts himself in a seating position, usually in an armchair, listens, tries to understand, and then interprets, when he can, toward a therapeutic end. To a large portion of the adult's patient's personality, the ‘observing' portions of his ego, the portion that enters the therapeutic alliance, that is just what he is and that of what he should remain. To another portion, largely unchanged from its past, sequestered in the unconscious but influential although in derivative and indirect ways, he is a formidable object. It is in this field of force that, along with the drive toward better solutions, the range of clinical transferences as we know they are awakened. As, the entire efforts to translate the patient's view of drives for reunion and contact, whether libidinal or aggressive, into genuine language, insights and voluntary control (or appropriate conative accomplishment elsewhere) is ‘resisted'. As it was originally, as an expression (or at least precursors) of separation, thus repeating aspects of the original developmental conflict. It is, however, it also true that the later and clinically more accessible vicissitudes of childhood create more accessible resistances within the postulated Metapsychological context created by the infant-mother relationship. Such changes as those patients in whom the phenomena of general the unity or approximations have been largely renounced, not only as a physical fait's accompli in perceptual and linguistic fact but also with deployment of the cathexis among other essential intrapsychic representations. These changes remain subject to regression or to the primary investment of certain phase strivings, conspicuously the Oedipus complex, in an excessive libidinal or aggressive cathexis. Such strivings, paradigmatically the incest complex, are in themselves the narrowed, potentially adaptive, maturational expressions of the basic conflict arouse by separation. If the analyst, to this infantile portion of the patient's personality, an indispensable parent because cognition is, in this reference, subordinate to drive, it follows that the analyst becomes the central object in the complicated infant system of desires, needs, and fears that have previously been incorporated in symptoms and character distortion. The patient must, furthermore, tell these ‘secrets' to the very object of a complex of disturbing impulses. This is a new vicissitude, not usually encountered in childhood and guarded forthwith. Even within the patient's own personality, by the very existence of the unconscious. Ordinarily, he does not even have to ‘tell himself' about them, in the sense that he is to a considerable degree identified with his parents, originally in his ego, then, in a punitive or disciplinary sense, in his superego? To be sure, the adult ‘observing' portion of his personality, except where matters of adult guilt, embarrassments, or shame interfere, usually cooperates with the analyst. It can at least try to maintain the flow of derivative associations, which give the analyst material for informed inferences. The tolerant and accepting attitudes of the analyst tested by patients' rational and intuitive capacities, evened more decisively his interpretative activity, which suggestively an unredeemed child in the patent that he, ‘knows' (or at least surmises) already, ‘gradually overcome the patient's far of his own warded-off material and finally the fear of is frank expression'.
There are, then, three broad aspects of the relationship between resistance and transference. Assuming technical adequacy, the proportional importance of each, one will vary with the individual patient, especially with the depth of psychopathology. First, the resistance awareness of the transference and its subjective elaboration in the transference neurosis; second, the resistance to the dynamic and genetic reductions of the transference neurosis and ultimately the transference attachment itself, once established in awareness; third, the transference presentation of the analyst to the ‘experiencing' portion of the patient's ego, as id object and as externalized super-ego simultaneously in juxtaposition to the therapeutic alliance between the analyst in his real function and the rational ‘observing' portion of the patient's ego. These phenomena give intelligible dynamic meaning to resistances ordinarily observed in the cognitive-communicative aspects of the analytic process. These are the process or ‘tactical' resistances, largely deriving from the ego under the pressure or threat of the superego.
As for this, the word ‘working through' was sometimes, as Freud made mention (1914), that the structure yields only when a peak manifestation of resistance has apparently been achieved. The patient appears to require time, repetition, and a sort of increasing familiarity with the forces involved for real change to occur. In addition, Freud originally thought of the energy transactions as having some relation to the phenomenon of an abreaction in the earlier methods. One is impressed with the insistent recurrence of transference effects, conspicuously irrational anger in essentially rational patients, as though the structuralized tendency from which they derive can be directorially based on repetitive re-enactment and gradual reduction of effect. Since circumscribed symptom formations equivalent forms of neurotic suffering (and gratification) play an ongoing and inevitable economic role in the psychoanalytic situation and process, apart from having usually been the basis for its initiation, one might assume that they bear an important relationship to working through. Even when extinguished short of fear or long since under the influence of the transferee, their continued latent existence (or potentialities) is opposed to the vicissitudes of the current transference neurosis or it through which gradual relinquishment via working. This is true whether one thinks of the symptom in the quasi-neurophysiological sense of Breuer's early formation of pathways of ‘lowered resistance' (Breuer and Freud 1893-1895) or in a more empirical sense as a perennially seductive regressive condensation of impulse, gratification, and punishment, a useful and well-grounded concept, allied with the struggle against separation, is the relationship of working through to the process of mourning (Freud 1917).
While from the adult point of view the gratifications may be small and the crucial change for the worse, the symptom is nevertheless autoplastic, narcissistic in an isolated sense, already structuralized, and subject too no outside interference (except by the analysis), an expression of localized infantile omnipotent fantasy, however large or small this fantasy kingdom may be. Similarly, considering unconscious processes administering both the challenges and sanctions of the world of reality, and from the temporary disruptive intrusions of new elements into the narcissistically invested conscious personality organization. In working through, there is the diphasic and arduous problem of restoring original or potential object cathexes' in the transference neurosis, reducing their pathological intensities or distortions, and the deploying them in relation to the outer world. One may thus think of ‘working through' as opposed to the renewal, symptom formation and as repeating some postulated vicissitude of one of the earliest conceptions of ‘transference', the infantile transition from autoerotism to an object of love (Ferenczi 190-9). In this sense, the clinging to the incestuous object, represented in the clinical transference, would represent an intermediate process.
There is thus a tenacious reluctance of the ‘observing' ego, might seduce the involved portion from its inveterate clinging to the actual transference object or to its autoplastically equivalent symptomatic representation. The postulated two portions of the ego (Freud 1940, Sterba 1934 in different references) are, after all, ‘of the same blood' to put it mildly, and the urge to reunion in integrated function, the libidinal (synthetic) bonds, is quite strong. This affinity between ego divisions may, of course, take an opposite and adverse turn, a triumph of the ‘resistance'. As to instances of chronic severe transference regression, where the adult segment of the ego is ‘pulled down' with the other and remains recalcitrant to interpretative e effort (Freud 1940). While this is, often contingent on the depth of manifest or latent illness, it may be simplified by iatrogenic factors, such as excessive and superfluous derivation in inappropriate and essentially irrelevant spheres. With these considerations, of whose importance is increasingly convincing with the passage of time.
Mentioning it is important, even if briefly, that certain special factors, sometimes extrinsic to analysis as such, may indefinitely prolong apparent satisfactory analyses. Real guilt, for example, may not be faced. Emotional distress based on real-life problems may not be confronted and accepted as such. A person of the type described by Freud (1916) as an ‘exception', who feels of himself as having been abused by the fortune of fate, even if in other respects not more ill than others, may consciously or unconsciously reject the psychoanalytic discipline or the instinctual renunciation derived from its insights. Fixed and unpromising life situations or organic incapacities may permit so little current or anticipated gratification that the attractiveness of the regressive, aim-inhibited analytic relationship is strongly in comparison with the barrenness of the extraanalytic situation. The last general consideration is, of course, always an essential (if silent) constituent of the psychoanalytic field of force, especially in relation to the dissolution of the transference-resistance (Stone 1966). Or alternatively more accessibly, the ‘rules of procedures' of analysis itself may be consciously or unconsciously exploited by the patient. He may, in ‘obedience' to a traditional rule, delay certain decisions to the point of absurdity, invoking the analytic work in support of his neurosis and sometimes in contempt of important obligations in real life. Financial support t of the analysis by someone other than the analysand can provide a basis for chronic, concealed 'acting out'. Usually, the analysis itself can, on occasion, become a lever for subtle erasion of obligations, vicissitudes, and contingent gratifications of everyday life, and thus, paradoxically, become a resistance to its on essential goals and purposes. It may become too much like the dream, to which it bears certain dynamic resemblances (Lewin 1954, 1955). The analyst's perceptive and tactfully illuminating obligation is no less important in these spheres than in other sectors of his commitment.
It is sometimes thought that by the ‘mature transference' is meant, inflects the ‘therapeutic alliance' or a group of mature ego functions that enter such an alliance. Now, there is sone blurring and overlapping the conceptual edges in both instances, but the concept as this is largely distinct from either one, as it is from the primitive transference. Either the concept is thought by others to comprehend a demonstrated actuality is a further question, that this question, is, of course, only to follow on conceptual clarity. In other words, the purposeful nonrational urge is not dependent on the perception of immediate clinical purposes, a true ‘transference; in the sense that it is displaced (in current relearnt form) from the parent of early childhood to the analyst. Its content is nontransitional but largely nonsenual (sometimes transitional, as in the child's pleasure in so-called dirty words) (Ferenczi 1911) and encompasses a special and does not misuse spheric object relationship? : The wish to understand, and to be understood, the wish to be given understanding, i.e., teaching, specifically by the parent (or later surrogate), the wish to be taught ‘controls' in a nonpunitive way, corresponding to the growing perception of hazard and conflict, and very likely to an implicit wish to provide with and taught channels of substitutive drive discharge. With this, there might be a wish, corresponding as the element in Loewald's ascription (1960) by therapeutic process, to be seen as for one's developmental potentialities by the analyst. However, the list could be extended into many subtleties, details, and variations. However, one should not omit to specify that, in its developments, it would include the wish for increasing accurate interpretation and the wish to ease such interpretations by providing sad adequate material: Ultimately, of course, by identification, to participate for being of its interpreter. The childhood system of wishes that underlie the transference is a correlate of biological maturation, and the latent (i.e., teachable) autonomous ego functions appearing with it (Hartmann 1939). However, there is a drive like quality in the particular phenomena that disqualifies any conception of the urge as identical with the functions, no one who has at any time watched a child importunes engendering questions, or experiment with new words, or solicit her interest in a new game, or demand storytelling or reading, can doubt this. That this finds powerful support and integration in the ego identification with a loved parent is undoubtedly true, just like the identification with an analyst toward whom a positive relationship has been established. That functional pleasure' particates, certain ego energies perhaps, very likely the ego's urge to extend its hegemony in the personality (Waelder 1936), however, the drive element, even the special phase patterns and colourations, and with it the importance of object relations, libidinal and aggressive, for a special reason. For just as the primordial transference seeks to into separation, in a sense to prevent object relationships as we know then ‘mature transference' tends toward separation and individuation (Mahler 1965) and increasing contact with the environment, optimally with a large affirmative (increasing neutralized) relationship toward the original object, toward whom (or her surrogates) a different system of demands is now increasingly discrete. The further consideration that has to emphasize the drive like elements in these attitudes as integrated phenomena, as example of ‘multiple function' than as the discrete exercise of function or functions, is the conviction that there is continuing dynamic relation of relative interchangeability between the two series, at least based on the responses to gratification, a significant zone of complicated energid overlap, possibly including the phenomenon of neutralization. That the empirical ‘interchangeability' is limited, but this in no way diminishes its decisive importance. In the psychoanalytic situation, both the gratifications offered by the analyst and the freedom of expression by the patient are much more severely limited and concentrated practically entirely (in as much as the day is demonstrable sense) in the sphere of speech, on the analyst's side, further, in the transmission of understanding.
Whereas the primordial transference exploits the primitive aspects of speech, the mature transference urges seek the heightened mastery of the outer and inner environment, a mastery to which the mature elements in speech contribute importantly. Likewise, the most clear-cut genetic prototype for the free association-interpretation dialogue is in the original learning and teaching of speech, the dialogue between child and mother. It is interesting that just as the profundities of understanding between people often include - ‘in the service of the ego' - transitory interjections and identification, the very word ‘communication' represents the central ego function of speech, is intimately related etymologically, even in certain actual usages, to the word chosen for that major religious sacrament that is the physical ingestion of the body and blood of the Deity. Perhaps, this is just another suggestion that the oldest of individual problems does, after all, continues to seek its solution in its own terms, if only in a minimal sense and in channels so remote as to be unrecognisable.
The mature transference is a dynamic and integral part of the ‘therapeutic alliance', along with the tender aspects of the erotic transference, evens more attenuated (and more dependable) ‘friendly feeling' of adult type, and the ego identification with the analyst. Indispensable, of course, are the genuine adult need for help, the crystallizing rational and intuitive appraisals of the analyst, the adult sense of confidence in him, and innumerable other nuances of adult thought and feeling. With these giving a driving momentum and power to the analytic process - always by it's very nature in a potential course of resistance - and always requiring analysis, is the primordial transference and its various appearances in the specific therapeutic transference. That is, if well managed, not only a reelection of the repetition compulsion in its baleful sense, but a living presentation from the id, seeking new solutions, ‘trying again', so to speak, to find a place in the patient's conscious and effective life, has important affirmative potentialities. This has been specifically emphasized by Nunberg (1951), Lagache (1953, 1954), and Loewald (1960), among others. Loewald (1960) has recently elaborated very effectively the idea of ‘ghosts' seeking to become ‘ancestors', based on an earlier figure of speech of Freud (1900). The mature transference, in its own infantile right, provides some unique quality of propulsive force, which comes from the world of feeling, than the world of thought. If one views it in a purely figurative sense, that fraction of the mature transference that derives from ‘conversion' is like the propulsive fraction of the wind in a boat navigating through close-haulage away from the wind: The strong headwind, the ultimate source of both resistance and propulsion, is the primordial transference. This view, however, should not displace the original and independent, if cognate, origin of the mature transference. To cohere to the figure of speech a favourable tide or current would also be required. It is not that the mature transference is itself entirely exempt from analytic clarification and interpretation. For one thing, like other childhood spheres of experience, there may have been traumas in this sphere, punishments, serious defects or lack or parental communication, listening, attention, or interest. Overall, this is probably far more important than has previously appeared in our prevalent paradigmatic approach to adult analysis, even taking into account the considerable changes die to the growing interest in ego psychology. ‘Learning' in the analysis can, of course, be a troublesome intellectualizing resistance. Furthermore, both the patient's communications and his reception and use of interpretations may exhibit only too clearly, as sometimes with other ego mechanisms, their origin in and tenacious relation to instinctual or analytic dynamism, greediness for the analyst to talk (rarely the opposite), uncritical acceptance (or rejections) of interpretations, parroting without actual assimilation, fluent, ‘rich', endlessly detailed associations without spontaneous reflection or integration, direct demands for solution of moral and practical problems entirely within the patient's own intellectual scope, and a variety of others. Discriminating it between the use of speech by an essentially instinctual demand and an intellectual may not always be easy or linguistic trait, or habit, determined by specific factors in their own developmental sphere. However, the underlying essentially genuine dynamism remains largely of a character favourable to the purposes and processes of analysis, as it was the original process of maturational development, communication, and benign separation. Lagache (1953, 1954) comments that on the desirability of separating the current unqualified usage. ‘Positive' and ‘Negative' transference, as based on the patient's immediate state of feeling, from a classification based on the essential affect on analytic process. In the latter sense, the mature transference is usually, a ‘positive transference'.
A few remarks about clinical considerations in the transference neurosis and the problem of transference interpretation, may be offered at this given directions held within time. The whole structural situation of analysis (in contrast with other personal relationships), its dialogue of frees association and interpretation, and its deprivation as to most ordinary cognitive and emotional interpersonal dispensing tends toward the separation of discrete transference from one another with defences, in character or symptoms, and with deepening regression, toward the re-enactment of the essentials of the infantile neurosis in the transference neurosis. In additional relationships, the ‘cooperative' outlook - gratifying, aggressive, punitive, or in other ways abounding with responsibly, and the open mobility of search for alternative or greater satisfaction - put activities of profound dynamic and economic influence so that the only extraordinary situation or transference of pathologically comparable both, occasion comparable repression.
It is a curious fact that whereas the dynamic meaning and importance of the transference neurosis have been well established since Freud gave this phenomenon a central position in his clinical thinking, the clinical reference, when the term is used, remains variable and ambiguous. For example, Greenson, in his paper of 1965, speaks of it as appearing "when the analyst and the analysis become the central concern in the patient's life." Yet, to specify certain aspects of Greenson's definition, for the term ‘central' is justifiable, in that the term would apply to the analyst's symbolic position in relation to the patient's experiencing ego (Sterba 1934) and the symbolically decisive position that he correspondingly assumes in relation to the other important figures in the patient's current life. Although the analysis is in any case, and for many reasons, exceedingly important to the seriously involved patient, there is a free-observing portion of his ego, as involved, but not in the same sense as that involved in the transference regression and revived infantile conflicts. There is, of course, always the integrated adult personality, however diluted it may seem at times, to whom the analysis is one of many important realistic life activities. Rarely, although it unavoidably does occur, that the analysis factually thrives of importance to other major concerns, attachments, and responsibilities of the patient's life, and, perhaps, it is not as desirable that this should occur. On the other hand, if construed with proper attention to the economic considerations, the idea is important both theoretically and clinically. In the theoretical direction, we are to assume that there is a continuing system of object relationships and conflict situations, most important in unconscious representations but participating often in all others, deriving in a successive series of transferences from the experiences of separation from the original object, the mother. In this sense, the analyst is substantially, the uniquely important portion of the patient's personality, the portion that ‘never grew up', a central figure. In the clinical sense, its importance is felt of the transference neurosis as outlining for us the essential and central analytic tasks, provided by the informatics adjacencies of currents of relative fugaciousness and demonstrability, a secure cognitive base for analytic work. By its inclusion of the patient's essential psychopathological processes and tendencies in their original functional connections, it offers in its resolution or marked reduction, the most formidable lever for an analytic cure. The transference neurosis must be seen in its interweaving with the patient's extra-analytic system of personal contacts. The relationship to the analyst may influence the course of relationships to others, in the same sense that the clinical neurosis did, except that the former is alloplastic, proportionally exposed, and subject to constant interpretations. It is also an important fact that, except in those rare instances where the original dyadic relationship appears to return, the analyst, even in strictly transference spheres, cannot be assigned all the transference roles simultaneously. Other actors are required. He may at times oscillate with confusing rapidity between the status of mother and father, but he usually predominantly in one of these roles for long periods, someone else representing the other. Moreover, apart from ‘acting out', complicate and mutually inconsistent attitudes, anterior to awareness and verbalization, may require the seeking of other transference objects: Husband or wife, friend, another analyst, and so forth. Children, even the patient's own children, may be invested with early strivings of the patient, displaced from the analysis, to permit the emergence or maintenance of another system of strivings. Physicians, of course, may encouragingly be more aware of in their patients and their own strivings, mobilized by the analysis, even experience the impulses that they would wish to call forth in the analyst. Transference interpretation therefore often had inescapably had some sorted paradoxical inclusiveness, which is an important reality of technique. There is another aspect, and that is the dynamic and economic impact of the intimate and actualized dramatis personae of the transference neurosis on the progress of the analysis as such and on the patient's motivations, and his real-life avenues for recovery. For the person in his milieu may fulfill their ‘positive' or ‘negative' roles in transference only too well, in the sense that an analyst motivated by a ‘blind' countertransference may do the same. Apart from their roles in the transference drama, which may ease or impede interpretative effectiveness, they can provide the substantial and dependable real-life gratifications that ultimately ease the analysis of the residual analytic transferences, or their capacities or attitudes may occasion an over-load of the anaclitic and instinctual needs in the transference, rendering the same process far more difficult. In the most unhappy instances, there can be a serious undercutting of the motivations for basic change.
There is also the fundamental question of the role of the transference interpretation, is but nonetheless, the variances reserved as to details and emphasis on the other important aspects of the therapeutic process, in that, there are still many to whom, if not in doubt regardless the quality value of transference interpretation, are inclined doubts their uniqueness and to stress the importance of economic considerations in determining the choice about whether transference or extratransference (In a sense, the necessarily ‘distributed' character of a variable fraction of transference interpretation), there is the fact that the extra analytic life of the patient often provides indispensable data for the understanding of detailed complexities of his psychic functioning, because of the sheer variety of its references, some of which cannot be reproduced in the relationship to the psychoanalyst. For example, there is not repartee (in the ordinary sense) in the analysis. This way the patient handles the dialogue with an angry employer may be importantly revealing. The same may be true of the quality of his reaction to a real danger of dismissal. There are not only the realities' not also the ‘formal' aspects of his responses. These expressions of his personality remain important, though his ‘acting out' of the transference (assuming this was the case) may have been even more revealing and, of course, requiring transference interpretation. Furthermore, these expressions remain useful, if discriminating and conservatively treated, even if they are inevitable always subject to that epistemological reservation, which haunts so much of the data as placed in the analytic situation. Of course, the ‘positive' transference simplifies intensified interpretations, but it is what might render their enabling capabilities that the abling of the patient's acceptably to listen into them and directly take them seriously.
In an operational sense, it seems that extratransference interpretations cannot be set aside or underestimated. However, the unique effectiveness of transference interpretations is not by that disestablished. No other interpretation is free, without reason. Of considering unlikely introduced apart from not substantially knowing the ‘other person's' involvement in a feel deep affection for, quarrelling, criticism, or whatever is being hoped-for. No other situation provides for the patient's combinational sense of cognitive acquisition, with the experience of complete personal tolerance and acceptance, that is implicit in. an interpretation made by an individual who is an object of the emotions, drives or even defences, which are active at the time. There is no doubt that such interpretations must not only (in common with all others) include personal tactfulness but also must be offered with special care as to their intellectual reasonableness, in relation to the immediate context, lest they defeat their essential purpose. It is not too often likely that a patient who had just been jilted in a long-standing love affair and id suffering exceedingly will find useful an immediate interpretation that his suffering is because the analyst does not reciprocate his love, although a dynamism in this general sphere may be ultimate shown, and acceptable to the patient. On the other hand, once the transference neurosis is established, with accompanying subtle (sometimes gross) colourations of the patient's story, transference interpretations are indicative, for, if all of the patient's libido and aggressions are not, in fact, invested in the analyst, he has at least an unconscious role in all important emotional transactions, and if the assumption is correct, that the regressive drive, mobilized by the analytic situation, acceding the directorial restoration of a single all-encompassing relationship, specified pragmatically in the individual case by the actual attained level of development, then there is a dynamic factor at work, importantly meriting interpretation as such, to the extent that available material supports it. This would be the immediate clinical application of the material regarding a ‘cognitive lag'.
Freud's first formal reference to transference (Breuer and Freud 1893-1895) set the tone for all that followed. In discussion resistance and obstacles too effective cathartic (analytic) work, he offers as one possibility that ‘the patient is frightened at finding that she is transferring into the figure of the physician the distressing ideas that arise from the content of the analysis . . . Transference onto the physician takes place through a ‘false connection'. Freud then offers an example of a woman who developed a hysterical symptom based on her wish many years earlier (and now relegated to the unconscious) that the man she was talking to at the time might slowly take the initiative and gives her a kiss. He then described how, toward the end of one session, a similar wish came up within the patient toward himself - Freud. The patient was horrified and unable to work in the next hour, and obstacle to the therapeutic work that was removed once Freud had discovered its basis and pointed it out to the patient. In her response, the patient could recall the pathogenic recollections that accounted for her reactions to Freud the unconscious wish, according to Freud, had become conscious but was linked to the person based on a false connection by the transference,
Importantly, the present of issues is the finding that Freud's monumental discovery of transference was founded upon his realization that his patient's conscious fantasy about him was based on an earlier experience with another man. This displacement from an earlier figure (in later writings this person would often be linked to the patient's father or other childhood figure) was seen as having no foundation in the analyst's behaviours and as based entirely on the patient's inner wish. Freud repeatedly characterized such responses as the real for the patient though unfounded in the actualities of the analytic relationships.
Once, again, in his well-known postscript to the case of Dora, Freud (1905) showed an appreciation of the unconscious basis for transference, though he maintained as his clinical reference point some type of conscious allusion to a reaction toward the analyst. Freud defined transference as a special class of mental structures that for the most parts are unconscious. Descriptively, he identified them as; untried additions or facsimiles of the impulses and phantasies that are suspensefully made conscious during the progression of the analysis. . . . They replace some earlier person by the person of the physician. Freud stared that some transferences differ from their earlier models in no way except the substitution of the physician for the earlier figure. He abstractively supposed of these to be new impressions or reprint, but stated that other transferences are more ingeniously constructed and have been subjected to a modifying influence he termed sublimation, the implication was that these transferences took advantage of some real peculiarity in the physician's person or circumstance and attached themselves to that factor. These transferences he considered revised editions. Through transference, the past of the patient is revived as belonging to the present. Even with the patient Dora, the main transference was seen as a replacement for her father with Freud, and much of this found expression through conscious comparisons such as her question about whether Freud was keeping secrets from her as had her father. Other manifest concerns that Dora expressed in her relationship with Freud were traced to the relationship with Herr K.
Throughout his discussion, Freud maintained the clinical view of transference as involving some direct reference to himself as the analyst. While he clearly stated that transference structures are largely unconscious, his evidently stressed on the role of unrecognized displacement s and an unawareness with the patient of intrapsychic and genetic sources of her direct responses to the analyst. It is this peculiarity of the conceptualization of transference - a recognition of its unconscious basis, which is seldom specified in any detail, and a simultaneous maintenance of the ides that it is expressed through direct references to the analyst - that has contributed too much uncertainty in this area.
Freud and others have treated manifest and conscious fantasies about the analyst as if they represented either the direct awareness of a fantasy influencing the patient's psychopathology or the breakthrough of as previous unconscious fantasy or memory, originally attached to an earlier figure. This has caused considerable confusion; for all practical purposes, conscious fantasies about the analyst and defences against them have been taken as the substance of the patient's transference neurosis, while the role of the unconscious fantasies has been neglected.
While Freud and other analysts have at times stressed the critical role of unconscious fantasy constellations in the development of neurosis, in their actual clinical work conscious fantasies are often taken at face value and held responsibly for the patient's illness. Some of this contradiction has been rationalized away with the idea that these conscious fantasies represent direct breakthroughs of previously unconscious fantasies, a position adopted despite the acknowledgment in other contexts (Arlow 1969, Brenner 1976) that defences and resistances are always at work and that pure breakthroughs are extremely either rare or nonexistent (the conscious product is always a compromise and always contains some degree of disguise).
While this view pats-lip service to the idea of nondistorted reactions by the patient, there has been virtually no consideration of his continuous, essentially sound functioning, or of his conscious and unconscious interventions. This is in keeping with the overriding stress on pathological unconscious fantasies in the etiology of neuroses and in transference, to the neglect of unconscious perceptions and introjects, a factor neglected to this day.
Most of what Freud had to say about unconscious fantasies and derivatives appeared in papers unrelated to technique and transference. In an important contribution in 1908, Hysterical Phantasies and Their Relation to Bisexuality, he specifically identified the role of unconscious fantasies in symptom formation, borrowing heavily from his insights into dreams. Freud had discovered that hysterical symptoms are based on fantasies that represent the satisfactions of wishes. He noted, however, that these fantasies can be conscious or unconscious initially, but that the critical factor in neurosogenesis is the presence of an unconscious fantasy expressing itself through hysterical symptoms and attacks. Freud felt that at times these unconscious fantasies can quickly be made conscious and that both the conscious and the unconscious fantasy may be some derivative of a formally conscious fantasy, suggesting by that the disguise involves the unconscious rather than the conscious fantasy. In this early use of the concept of derivatives, then, it was no the conscious fantasy that was the derivative of the underlying fantasy, but the reverse.
But, nonetheless, his paper on the dynamics of transference, Freud (1912) described transferences as based on a stereotyped plate that is constantly repeated
- repeated afresh - during a person's life. The underlying fantasias were seen as partly accessible to consciousness, and as partly unconscious. Transference, then, is the introduction of one of these stereotypical plates into the patient's relationship with the analyst.
It was also that Freud stated that when associations fail or become blocked. They have become connected with the analyst. Freud stressed the role of unconscious complexes in psychopathology and suggested that they are represented consciously and that their roots in the unconscious have to be traced out. The key to analysis is the distortion of pathogenic material expressed through the patient's transference.
In Remembering, Repeating, and Working Through, Freud (1914) saw transference as involving repetitions of the past in the actual relationship with the analyst. In stressing, once, again, the extent to which the patient experiences these transferences as real and contemporize, Freud again used the term transference to refer to direct reactions to the analyst. In his paper on transference love (1915) Freud is clearly alluding to conscious erotic wishes and fantasies about the analyst. He stated that he was discussing situations in which women patients declare their love for a male analyst and make direct demands for the return of his love, using such demands as resistances. Similar thinking is revealed in An Outline of Psycho-Analysis, (1940), in which Freud discusses how the patient sees the analyst as a reincarnation of figures from his childhood, and transfers feelings and reactions based on this prototype. Freud was to escape an understanding by which, once, again attributive to positive and negative attitudes toward the analyst, and the plastic clarity with which patients experience such transferences.
The clearest evidence for Freud's clinical definition of transference appears in his presentation of the opening phase of the analysis of the Rat Man (1909). The note's of Freud decanting of this example, to reveal that with one exception, each time Freud used the term transference he was calling a conscious knowing fantasied illusion about himself or his family unit of measure. Persistently, Freud would attempt to identify the genetic basis for these transferences, largely, the main unconscious aspect was the mechanisms of displacement. It followed, then, that resistance, and in particular transference resistance, became defined as efforts by the patient to avoid the expression or realization of conscious fantasies about the analyst, and that the term could be extended to include unconscious avoidance as well. This is a reminder that the definition of resistance depends largely on the definition of transference - that is to say, that Freud took allusions toward an outside person as displacements from himself, and from ‘the transference'. In this context, it is well to recall that Freud's original definition o acting out (Freud 1905) alluded to behaviours, directed toward the analyst, such as Dora's flight from analysis, and to a lesser extent as to natural actions involved with other persons.
Freud's narrow view of transference concerning direct references to the analyst is also reflected in one of his rare comments on the nature of material from patients' (Freud 1937). In discussing the kinds of material that patient's put at the disposal of analysts for recovering lost pathogenic memories. Freud refers to dreams, free association, the repetition of effects, actions performed by the patient both inside and outside the analytic situation, and the relation of transference that becomes established toward the analyst. In addition, his archaeological model of repressed unconscious memories can be seen to imply the discovery of previously repressed fantasies integrated as though it were also to leave room for fragmented representations. Finally, we may note a comparable comment by Freud in the Outliner (1940): "We gather the material for our work from a variety of sources - from what communication has been made a reduction by giving us by the patient and by his free associations, from what her shows us in his transference, from what we reason out by interpreting his dreams and from what he betrays by his slips or parapraxes."
Moreover, Freud leaned toward the divorce of his discussion of the transference neurosis and transferences from his consideration of the nature of psychopathology. In keeping with this trend, his discussion of the nature of unconscious fantasies and processes, and of derivative communication, appeared primarily in two metaphysical papers - Repression (Freud 1915) and The Unconscious (Freud 1915). In both papers he was concerned with communication between the unconscious mind and the preconscious or conscious mind? He noted that this takes place by means of derivatives that express and represent unconscious instinctual impulses. He also pointed out that unconscious fantasies can be highly organized and logical even thought outside the awareness of the patient, suggesting again the possibility of the direct breakthrough of such fantasy material. In these writings, it is the unconscious fantasy that expresses itself consciously through derivatives as substitute formations such as symptoms or preconscious thought formations. What has been repressed, Freud noted? Can become conscious only if it is sufficiently disguised? On this basis, unconscious fantasies can be appeared in a patient's free association (the reference to free association rather than to transference), through remote and distorted derivative expressions. These are substitute formations that include the return of the repressed, the repressed instinctual impulses modified by defensive operations such as displacement.
Let it be said, that Freud left considerable room for uncertainty regarding his conceptualization of transference. Theoretically, he implied that transferences are based on unconscious fantasias and memories derived from experiences and brought into play in the relationship with the analyst. He himself never applied his insights into the nature of derivative comminations to the subject of transference. As a result, his clinical referent for transference remained throughout his writings that of a direct reference to the analyst. While he acknowledged the important role of unconscious processes and contented the analyst at face value and to understand them as direct representations displaced from the past. A major contradiction by that unfolded. In that Freud correctly understood neuroses to be based on unconscious fantasy constellations, including unconscious transference fantasies, and yet he worked analytically with the patient's conscious fantasies toward himself as analyst. Freud's contention that sometimes unconscious fantasies break through unmodified into conscious awareness is clearly insufficient justification for this approach. There is abundant clinical evidence that unconscious fantasy constellations are always expressed through derivative formations, and that even when elements of the underlying unconscious fantasy break through in unmodified form - or are recovered through interpretation - there always remains an additional cloak-and-dagger element. Further, at the point of realization of an undisguised unconscious fantasy, it seems likely that its own expression would be itself function as a disguised and defensive derivative of a different and still repressed unconscious fantasy (Gill 1963).
The failure by analysts to maintain the essential definition of transference - as based on an unconscious fantasy constellation expressed, almost without acceptation, through derivatives - has led to many mistaken formulations regarding the nature of psychopathology, the analytic process itself, and the techniques of the psychoanalyst and psychotherapist. In their discussion of neuroses, analysts have consistently maintained and documented the thesis that psychopathological syndrome is based on unconscious processes and contents - fantasy constellations. It seems evident, that analytic work with manifest fantasies per se cannot provide access to, or interpretations of, these unconscious constellations.
The need to clarify the contextual significance of ‘transference' and what it serves to achieve, or prevent, or avoid, and becomes apparent. For example, relating to the analyst based on some preconceived fantasy, rather than as the person he or she is, can function to prevent the possibility of engaging meaningfully and experiencing the anxiety a more mutual and intimate engagement might arouse.
An appreciation of interactive factors also allows us to consider that, to whatever degree the patient's perceptions of the analyst are plausible and eve valid (Ferenczi, 1933; Little, 1951; Levenson, 1972; Searles, 1975; Gill, 1982; Hoffman, 1983), this may be due to the patient's expertise at stimulating precisely this kind of responsiveness in the analyst. The reverse is true as well. Thus, though patient and analyst each will have unique vulnerabilities, sensitivities, strengths, and needs, we must consider why particular qualities or sensitivities of either patient or analyst are begun at a given moment and not at others. At any moment patient or analyst might be involved in some find of collusive enactment (Racker, 1957, 1968; Levenson, 1972, 1983; Sandler, 1976, Bion, 1967, 1983; Ogden, 1979; Grotstein, 1981; McDougall, 1979). These considerations to illuminate why clinicians often seem to practice in ways that contradict their own stated beliefs and theoretical positions.
The powerful impact of unwitting communication between patient and analyst is, of course, one reason the analyst's countertransference experience can be a source of vital data about the patient and may become the ‘key' to understanding aspects of the interactions that might otherwise remain impenetrable (Heimann, 1950).
An appreciation of interactive factors also requires us to reconsider what makes up analytic ‘mistake'. In this regard Winnicott (1956, 1963) has expressed the views that there are times when our patients need us to fail. In the end the patient uses the analyst's failure, often quite: Small ones, perhaps manoeuverer by the patient: The operative factors are that the patient now hates the analyst for the failure that originally came as an environmental factor, outside the infant's area of omnipotent control, that is now staged in the transference. So in the end we succeed by failing the patient's way. This is a long distance from the simple theory of cures by corrective experience (Winnicott, 1963)
From-Reichmann (1939, 1950, 1952), has emphasized that at times the analyst's mistakes may become the basis for a ‘golden (analytic) opportunity'. From this vantage point we might consider that how an analyst deals in the accompaniment with wished, in that he or she has in possession of some inevitable fallibility that maybe on of the defining aspects of his or her techniques.
An appreciation of interactive considerations thus requires us to rethink important issues of technique and the question of how we define ‘analysis'. It also requires us to consider that the pattern's so-called ‘analyzability' may depend on the nature of the analyst's participation than has previously been recognized. The dilemma is how to move into a new mode of thinking about clinical technique that is not beset by the inherent limitations of traditional thinking or by those of more radical new perspectives.
The unformidable combinations of others before have thought that the psychoanalytic situation and process as such have a general unconscious meaning, which reproduces certain fundamental aspects of early developments. For example, in Greenacre and in 1956 Spitz offered ideas of the psychoanalytic situation and of the origins of transference, based largely on the mother-child relationship of the first months of life. Greenacre used the term ‘primary transference' (with two alternatives). As far as the ideas of Greenacre and Spitz emphasize the prototypic position of the first months of life, as reproduced in the current situation, there are subtle but important differences from the view presents. Nacht and Viderman in 1960 extended related ideas to their conceptual extreme, requiring metaphysical terminology. One can readily understand the regressive transference drive set up by the situation as having such general direction, i.e., toward primitive quasi union, a reservation that Spitz accepted and specified, in response to Anna Freud. It is te activation of this drive and its opposing cognate that underlies the construction of the psychoanalytic situation, which is seen primarily as a state of separation, of ‘deprivation-in-intimacy'.
With the prolonged and strictly abstinent contact of the classical analytic situation, there is inevitably for the patient, some growing and paradoxical experience of cognitive and emotional deprivation in the personal sphere, the cognitive and emotional modalities in certain respects overlapping or interchangeable, in the same sense that the giving of interpretations may satisfy to varying degree either cognitive or emotional requirements. The patient, also renounces the important expression of a locomotion. If developed beyond a certain conventional communicative degree, even gesture or other bodily expressions tend, by interpretive pressure, to be translated into the mainstream of oral-vocal-auditory language. The suppression of hand activity, considering both its phylogenetic and ontogenetic relation to the mouth (Hoffer 1949), exquisitely epitomizes the general burdening of the function of speech, regarding its latent instinctual components, especially the oral aggressions.
From the objective features of this real and purposive adult relationship, one may derive the inference that "its representational advance presents of unintentional consciousness, one of disguising itself in its primary and most extensive impact, the superimposed series of basic separation experiences in the child's relation to his mother." In that, the analyst would represent the mother-of-separation, as differentiated from the traditional physician who, by contrast, represent the mother associated with intimate bodily care. This latent unconscious continuum-polarity eases the oscillation from ‘psychosomatic' reactions and proximal archaic impulses and fantasies, up to the integration of impulse and fantasy life within the scope of the ego's control and activities (Stone 1961).
Within this structure, the critical function of speech is seen in a similar perspective, as a continuous telescopic phenomenon ranging from its primitive meanings as physiological contact, resolution of excess or residual primitive oral drive tensions, through the conveyance of expressive or demanding or other primitive communications, on up to its role as a securely established autonomous ego function, genuinely communicative in a referential-symbolic sense. To the extent that an important fraction of human impulse life is directed against separation from birth onward, the role of speech, which develops rapidly as the modalities of actual bodily intimacy are disappearing or becoming stringently attenuated (Sharpe 1940), has a unique importance as a bridge for the state of bodily separation. In the instinctual contribution to speech, considering it as a phenomenon of organic or maturational ‘multiple function' (Waelder 1936), the cannibalistic urges loom large; they, and more manifestly, their civilized cognates (partially, derivative?), Introjection tracings and their preserving capabilities for re-emergence as such, always. In such view, the most primitive and summary form of mastery of separation, fantasized oral incorporation, is in a continuous line of development with the highest form of objective dialogue between adults. The demonstrable level of response of the given patient, in this general unconscious setting, will be determined (in ideal principle) by his effectively attained level of psychosexual development and ego functioning in its broadest sense and by his potentiality for regression.
Advances in our understanding of the therapeutic action of the psychoanalysis should be based on deeper insight into the psychoanalytic process. By ‘psychoanalytic process' is to mean the significant interactions between patient which ultimately leads to structural changes in the patient's personality. Today, after more than fifty years of psychoanalytic investigation and practice, we can appreciate, if not to understand better, the role which interaction with environment plays within the core organizational formation, development, and continued integrity of the psychic apparatus. Psychoanalysis ego-psychology, based on a variety of investigations concerned with
Ego-development, has given us some tools to deal with the central problem of the relationship between the development of psychic and interaction with other psychic structure, and of the connexion between ego-formation and other object-relations.
If ‘structural changes in the patient's personality' mean anything, it must mean that we assume that ego-development is resumed in the therapeutic process in the psychoanalysis. This resumption of ego-development is contingent on the relationship with a new object, the analyst. The nature and the effects of this new relationship are under what should be the fruitful attempt to correlate our understanding of the significance of object-relations for the formation and development of the psychic apparatus with the dynamics of the therapeutic process.
Problems, however, of essentially established psychoanalysis theory and tradition concerning object-relations the phenomenon of transference, the relations between instinctual drives and ego, and concerning the function of the analyst in the analytic situation, have to be dealt with, least of mention, it is unavoidable, for clarification to those who think of a divergent repetition from the cental theme to deal with such problems. Thus and so, the existent discussion is anything but a systematic presentation of the subject-matter. Therefore, in continuing further details of attempting to suggest modifications or variations in techniques, but the psychoanalytic changes for the better understanding of therapeutic action of the psychoanalysis in that it may lead to changes in technique, as anything of such clarification may entail as a technique is concerned should be worked out carefully and is not the topic but its psychometric test?
While the fact of an object-relationship between patient and analyst is taken for granted, classical formulations concerning therapeutic action and concerning the role of the analysts in the analytic relationship do not reflect our present understanding of the dynamic organization of the psychic apparatus, and not merely of ego. In that, the modern psychoanalytic ego-psychology that expressed directly or indirectly, as far more than an additional psychoanalytic theory of instinctual drives. It is however the elaboration of a more comprehensive theory of the dynamic organization of the psychic apparatus, and the psychoanalysis are in the process of integrating our knowledge of instinctual drives, gained during earlier stages of its history, into such a psychological theory. The impact of psychoanalytic ego-psychology has on the development of the psychoanalysis, in that is to suggest that ego-psychology be not concerned with just another part of the psychic apparatus, given but a new continuum to the conception of the psychic apparatus as an undivided whole.
In an analysis, one is to think that we have opportunities to observe and investigate primitively and more advanced interaction-processes, that is, interactions between patient and analyst that leads to or from steps in ego-integration and disintegration. Such interactions, or integrative (and disintegrative) experiences, occur often but do not often as such become the focus of attention and observation, and go unnoticed. Apart from the difficulty for the analyst of self-observation while in interaction with his patient, there is a specific reason, stemming from theoretical bias, why such interactions not only go unnoticed but are frequently denied. The theoretical bias is the view of the psychic apparatus as a closed system. Thus the analyst is seen, not as a co-actor on the analytic stage, on which the childhood development, culminating in the infantile neurosis, is restaged and reactivated in the development, crystallization and resolution of the transference neurosis, but as a reflecting mirror, even if of the unconscious, and characterized by scrupulous neutrality.
This neutrality of the analyst is required (1) in the interest of scientific objectivity, to keep the field of observation from being contaminated by the analyst's own emotional intrusions, and (2) to guarantee an unformed mind for the patient's transferences. While the latter reason is closely related to the general demand for scientific objectivity and avoidance of the interference of the personal equation, it has its specific relevance for the analytic procedure as such in as far as the analyst is supposed to function not only as an observer of certain precess, but as a mirror that actively reflects back to the patient the latter's conscious and particularly his unconscious processes through communications. A specific aspect of this neutrality is that the analyst must avoid falling into the role of the environmental figure (or of his opposite) the relationship to whom the patient is transferring to the analyst. Instead of falling into the assigned role, he must be objective and neutral enough to reflect back to the patient what role the latter has assigned to the analyst and to himself in the transference situation. Nevertheless, such objectivity and neutrality now need to be understood more clearly as to their meaning in a therapeutic setting.
It is all the same that ego development is a process of increasingly higher integration and differentiation of the psychic apparatus and does not stop at any given point except in neurosis and psychosis: although it is true that there is normally a marked consolidation of ego-organization around the period of the Oedipus complex. Another consolidation normally takes place toward the end of adolescence, and further, often less marked and less visible, consolidation occurs at various other life-stages. These later consolidations - and this is important - follow periods of relative ego-disorganization and reorganization, characterized by ego-regression. Erickson has described certain types of such periods of ego-regression with subsequent new consolidations as identity crises. An analysis can be characterized, from this standpoint, as a period or periods of induced ego-disorganization and reorganization. The promotion of the transference neurosis is the induction of such ego-disorganization and reorganization. Analysis is thus understood as an intervention designed to set ego-development in motion, be it from a point of relative arrest, or to promote what we conceive of as a healthier direction or comprehensiveness of such development. This is achieved by the promotion and use of (controlled) regression. This regression is one important aspect under which the transference neurosis can be understood. The transference neurosis, in the sense of reactivation of the childhood neurosis, is set in motion not simply by the technical skill of the analyst, but by the fact that the analyst makes himself available for the development of a new ‘object-relationship' between the patient and the analyst. The patient having a tendency to make this potentially new object-relationship into an old, on the other hand, its total extent from which the patient develops ‘positive transference' (not in the sense of transference as resistance, but in the sense in which ‘transference' carries the whole process of an analysis). He keeps this potentiality of a new object-relationship alive through all the various stages of resistance. The patient can dare to take the plunge into the regressive crisis of the transference e neurosis that brings him face to face again with his childhood anxieties and conflicts, if he can hold to the potentiality of a new object-relationship, represented by the analyst.
We know from analytic s well as from life experience that new spurts of self-development may be intimately connected with such ‘regressive' rediscoveries of oneself as may occur through the establishment of new object-relationships, and this means: New discovery of ‘objects'. Seemingly enough, new discovery of objects, and not discovery of new objects, because the essence of such new object-relationships is the opportunity they offer for rediscovery of the early paths of the development of object-relations, leading to a new way of relating to objects and of being and relating to ones' own. This new discovery of oneself and of objects, this reorganization of ego and objects, is made possible by the encounter with a ‘new object' which has to possess certain qualification to promote the process. Such a new object-relationship for which the analyst holds himself available to the patient and to which the patient has to hold on throughout the analysis is one meaning of the term ‘positive transference'.
What is the neutrality of the analyst? Its significance branches the intangible quantification upon stemming from the encounter with a potentially new object, the analyst, which new object has to possess certain qualifications to be able to promote the process of ego-reorganization implicit in the transference neurosis. One of these qualifications is objectivity. This objectivity cannot mean the avoidance of being available to the patient as an object. The objectivity of the analyst has reference to the patient's transference distortions. Increasingly, through the objective analysis of them, the analyst overcomes not only a potentiality but the subjective expanding activities available are of a new object, by eliminating in stages impediments, represented by these transferences, to a new object-relationship. There is a tendency to consider the analyst's availability as an object merely as a device on his part to attract transference onto himself. His availability is seen as to his being a screen or mirror onto which the patient projects his transference, which reflects them back to him as interpretations. In this view, at the ideal endpoint of the analysis no further transference occurs, no projections are thrown on the mirror, the mirror having nothing now to reflect, can be discarded.
This is only a half-truth. The analyst in actuality does not reflect the transference distortions. In his interpretations he implies aspects of undistorted reality that the patient begins to grasp the successive sequence as the transferences are interpreted. This undistorted reality is mediated to the patient by the analyst, mostly by the process of chiselling away the transference distortions, or, as Freud has beautifully put it, using an expression of Leonardo da Vinci, ‘per via di levare' as, insomuch as of sculpturing, not ‘per via di porre' as, in producing a painting. In sculpturing, the figure to be created comes into being by taking away from the material: In painting, by adding something to the canvas. In analysis, we bring out the true form by taking away the neurotic distortions. However, as in sculpture, we must have, if only in rudiments, an image of that which needs to be brought into its own. The patient, in such a way he contributes of himself to the analyst, and provides rudiment infractions of such a continuous image of fragmented fluctuations imbedded by distortion - an image that the analyst has to focus in his mind, thus holding it in safe keeping for the patient to whom it is mainly lost. It is this tenuous reciprocal tie that represents the germ of a new object-relationship.
The objectivity of the analyst regarding the patient's transference distortions, his neutrality in this sense, should not be confused with the ‘neutral' attitude of the pure scientist toward his subject of study. Nonetheless, the relationship between a scientific observer and his subject of study has been taken as the model for the analytic relationship, with the following deviation: The subject, under the specific conditions of the analytic experiment, directs his activities toward the observer, and the observer expresses his findings directly to the subject with the goal of modifying the findings. These deviations from the model, however, change the whole structure of the relationship to the extent that the model is not representative and useful but, in earnest, very much misleading. As the subject directs his activities toward the analyst, the latter are not integrated by the subject as an observer: As the observer expresses his findings to the patient, the latter are no longer integrated by the ‘observer' as a subject of study.
While the relationship between analyst and patient does not possess the structure, scientist-scientific subject, and is not characterized by neutrality in that sense by the analyst, the analyst may become a scientific observer to the extent to which he can observe objectively the patient and himself in interaction. The interaction itself, however, cannot be adequately represented by the model of scientific neutrality. Using this model is unscientific, based on faulty observation? The confusion about the issue of countertransference relates to this. It hardly needs to be pointed out that such a view in no way denies or reduces the role scientific knowledge, understanding, and methodology play in the analytic process, nor does it have anything to do with advocating an emotionally-charged attitude toward the patient or ‘role-taking'. In that a showing attempt to disentangle the justified and requirement of objectivity and neutrality from a model of neutrality that has its origin in propositions that may be untenable.
One of these is that therapeutic analysis is an objective scientific research method, of a special nature to be sure, but falling within the general category of science as an objective, detached study of natural phenomena, their genesis and interrelations. The ideal image of the analyst is that of a detached scientist. The research method and the investigative procedure in themselves, carried out by unspecified scientists, are said to be therapeutic. It is not self-explanatory why a research project should have a therapeutic effort on the subject of study. The therapeutic effect appears to have something to do with the requirement, in analysis, that the subject, the patient himself, gradually becomes an associate, as it was, in the research work, that he himself becomes increasingly engaged in the ‘scientific project' which is, of course, directed art himself. We speak of the patient's observing ego on which we need to be able to rely to a certain extent, which we attempt to strengthen and with which we collaborate among ourselves. We encounter and make to some functional applicability of what is known under the general title, ‘identification'. The patient and the analyst acknowledge the fact for being equally increasing to the evolving principles that govern the political nature as deployed to the accessorial evolution for a better and mutually actualized understanding, if the analysis proceeds, in their ego-activity of scientifically guided self-scrutiny.
If the possibility and gradual development of such identification are, as is always claimed, a requirement for a successful analysis, this introduces the component factor from which has nothing to do with scientific detachments and the neutrality of a mirror (‘mirror' in this sense, is meant as having been for the most part used to denote the ‘properties' of the analyst as a ‘scientific instrument'. (A psychodynamic understanding of the mirror as it functions in human life may reestablish it as an appropriate description of at least certain aspects of the analyst's function). This identification does relate to the development of a new object-relationship of which is the foundation for it.
The transference neurosis takes places in the influential presence of the analyst and, as the analysis progresses, ever more ‘in the presence' and under the eyes of the patient's observing ego. The scrutiny, carried out by the analyst and by the patient, is an organizing, ‘synthetic' ego-activity. The development of an ego function is dependent on interaction. Neither the self-scrutiny, nor the freer, healthier development of the psychic apparatus whose resumption is contingent upon such scrutiny, takes place in the vacuum of scientific laboratory conditions. They take place in the presence of a favourable environment, by interaction with it. One could say that in the analytic process this environmental element, as happens in the original development, becomes increasingly internalized as what we are to call; the observing ego of the patient.
There is another aspect to this issue. Involved in the insistence that the analytic activity is a strictly scientific one (not merely using scientific knowledge and methods) is the notion of the dignity of science. Scientific man is considered by Freud as the most advanced form of human development. The scientific stage of the development of man's conception of the universe has its counterpart in the individual's state of maturity, according to Totem and Taboo. Scientifically self-understanding, to which the patient is helped, is in and by itself therapeutic, following this view, since it implies the movement toward a stage of human evolution not previously reached. The patient is led toward the maturity of scientific man who understands himself and external reality not animistic or religious terms but as to objective science. There is little doubt that what is called the scientific exploration of the universe, including the self, may lead to greater mastery over it (within certain limits of which we are becoming painfully aware). The activity of mastering it, however, is not itself a scientific activity. If scientific objectivity is assumed to be the most mature stage of man's understanding of the universe, showing the highest degree of the individual's state of maturity, we may have a personal stake in viewing psychoanalytic therapy as a purely scientific activity and its effects as due to such scientific objectivity. Beyond the issue of an investment, to be, as necessary and timely to question the assumption, handed to us from the nineteenth century, that the scientific approach to the world and the self represents a higher and more mature evolutionary stage of man than the religious way of life. However, its questioning pursuit will not be for us to pursue.
Though the objective interpretation of the analyst and the transference distortion, it increasingly becomes available to the patient as a new object. This not primarily in the sense of an object not previously met, but the newest consists in the patient's rediscovery of the early paths of the development of object-relations leading to a new way of relating to objects and of being oneself. Though all the transference distortions the patient reveals rudiments at least of that core (of himself and ‘objects') which has been distorted. It is this core, rudimentary and vague as it may be, to which the analyst has reference when he interprets transferences and defences, and not one abstract idea of reality or normality, if he is to reach the patient. If the analyst keeps his central focus on this emerging core, he avoids moulding the patient in the analyst's own image or imposing on the patient his own concept of what the patient should become. It requires objectivity and neutrality the essence of which is love and respect for the individual and for individual development. This love and respect represent that counterpart in ‘reality'. In interaction with which the organization and reorganization of ego and psychic apparatus take place.
The parent-child relationship can serve as a model, in that the parent ideally is in an empathic relationship of understanding the child's particular stage in development, yet ahead in his vision of the child's future and mediating this vision to the child in his dealing with him. This vision, informed by the parent's own experience and knowledge of growth and future, is, ideally, a more articulate and more integrated version of the core of being which the child presents to the parent. This ‘more' that the parent sees and knows, he mediates to the child so that the child in identification with it can grow. The child, by internalizing aspects of the parents, also internalizes the parent's image of the child - an image mediated to the child in the thousand different ways of being handled, bodily and emotionally. Early identification as part of ego-development, built up through introjection of maternal aspects, includes introjection of the mother's image of the child. Part of what is introjected is the image of the child as seen, felt, smelled, heard, touched by the mother. Adding that what happens would perhaps be correct is not wholly a process of introjection, if introjection is used as a term for an intrapsychic activity. The bodily handling of and concern with the child, the manner in which the child is fed, touched, cleaned, the way it is looked at, talked to, called by name, recognized and re-recognized - all these and many other ways of communicating with the child, and communicating to him his identity, sameness, unity, and individuality, shape and mould him so that he can begin to identify himself, to feel and recognize himself as one and as separate from others yet with others. The child begins to experience himself as a central unit by being centred along.
In analysis, if it is to be a process leading to structural changes, interactions of a comparable nature have to take place. At this point, only to suggest, by sketching these interactions during early development, the positive nature of the neutrality required, which includes the capacity for mature object-relations as manifested in the parents by his or her ability to follow and simultaneously be ahead of the child's development?
Mature object-relations are not characterized by a sameness of relatedness but by an optimal range of relatedness and by the ability to relate to different objects according to their particular levels of maturity. In analysis, a mature object-relationship is maintained with a given patient if the analyst relates to the patient in a tune with the shifting levels of development manifested by the patient at different times, but always from the viewpoint of potential growth, that is, from the viewpoint of the future. It is the fear of moulding the patient in one's own image that has prevented analysis from coming to grips with the dimension of the future in analytic theory and practice, a strange omission considering the fact that growth and development are at the centre of all psychoanalytic concern. A fresh and deeper approach of the superego problem cannot be taken without facing the issue.
The afforded efforts to say that the activities of the analyst, and specifically his interpretations and the ways in which they are integrated by the patient, need to be considered and understood as for the psychodynamics of the ego. Such psychodynamics cannot be worked out without proper attention to the functioning of integrative processes in the ego-reality field, beginning with such processes as introjection, identification, projection (of which we know something), and progressing to their genetic derivatives, modifications, and transformations in later life-stages (of which we understand very little, except in as far as they are used for defensive purposes). The more intact the ego of the patient, the more of this integration taking place in the analytic process occurs without being noticed or at least without being considered and conceptualized as an essential element in the analytic process. ‘Classical' analysis with ‘classical' cases easily leaves unrecognized essential elements of the analytic process, not because they suit the purpose of non-presence, but because they are as different to see in such cases as becoming aware of what was different, ‘classical' psychodynamics in average citizenries. Cases with obvious ego defects magnify what also occurs in the typical analysis of the neuroses, just as in neurotics we see exaggerated in the psychodynamics of human beings overall. However, this is not to say, that there is no difference between the analysis of the classical psychoneuroses and the cases with obvious ego defects. In the latter, especially in borderline cases and psychoses, processes such as explained in the child-parent relationship take place in the therapeutic situation on levels proportionally close and similar to those of the early child-parent relationship. The further we move away from gross ego defect cases, the more do these integrative processes take place on higher levels of sublimation and by modes of communication which show much more complex stages of organization.
The elaboration of the structural point of view in psychoanalytic theory has caused the danger of isolating the different structures of the psychic apparatus from one another. It may look nowadays as though the ego is a creature of and functioning with external reality, whereas the area of the instinctual drives, of the id, ids as such unrelated to the external world. To use Freud's archeological simile, it is as though the functional relationship between the deeper strata of an excavation and their eternal environment were denied because these deeper strata are not in a functional relationship with the present-day environment, as though it were maintained that the architectural structures of deeper, earlier strata are due too purely ‘internal' processes, in contrast to the functional interrelatedness between present architectural structures (higher, later strata) and the external environment that we see and live in. The id, however - in the archeological analogy being comparable to some deeper, earlier strata - as such integrates with its comparable ‘early' external environment as much as the ego integrates with the ego's more ‘recent' external reality. The id deals with and is a creature of ‘adaption' just as much as the ego - but on a very different level of organization.
Having already confronted us, it related to the conception of the psychic apparatus as a closed system, and in addition that this view has a bearing on the traditional notion of the analyst's neutrality and of his function as a mirror. It is in this context of the concept of instinctual drives, particularly as for their relation to objects, as formulated in psychoanalytic theory. Freud writes: "The true beginning of scientific activity consists . . . in describing phenomena and then in proceeding to group, classify and correlate them." Even at the stage of description avoiding applying certain abstract ideas to the material in hand is not possible, ideas derived from somewhere or other but not from the new observations alone. Such ideas - which will later become the basic concepts of the science - are still more indispensable as the material is further worked over. They must at first necessarily posses some degree of indefiniteness: There can be no question of any clear delimitation of their content. If they remain in this condition, we come to an understanding about their meaning by making repeated references to the material of observation from which they appear to have been derived, but upon which, in fact, they have been imposed. Thus, strictly speaking, they are like conventions - although everything depends on their not being arbitrarily chosen but determined by there having significant relations to the empirical material, relations that we seem to sense before we can clearly recognize and discover them. It is only after more thorough investigation of the field of observation that we can formulate its basic scientific concepts with increased precision, and progressively to modify those that become serviceable and consistent over a wide area. Then, the time may have come to confine them in definitions. The advance of knowledge, however, does not tolerate any rigidity even in definitions. Physics furnishes an excellent illustration of the way in which even ‘basic concepts' established in definitions are constantly being altered in their content. The concept of instinct (Trieb), Freud goers on to say, in such a basic concept, "conventional but still partially obscure," and thus open to alterations in its content.
Freud defines instinct as a stimulus: A stimulus not arising in the outer world but ‘from within the organism'. He adds that "a better term for an instinctual stimulus is a need," and says, that such "stimuli are the sign of an internal world." Freud lays explicit stress on one functional implication of his whole consideration of instincts, namely that it implies the concept of purpose in what he calls a biological postulate. This postulate runs as follows: The nervous system is an apparatus that has the function of getting rid of the stimuli that reach it, or of reducing them to the lowest possible level. An instinct is a stimulus from within reaching the nervous system. Since an instinct as an id impulse is a stimulus arising within the organism and acting ‘always as a constant force', it obliges ‘the nervous system to renounce its ideal intention of keeping off stimuli' and compels it ‘to undertaking to involve and interconnected activity by which the external world it so changed as to afford satisfaction to the internal source of stimulation'.
Instinct being an inner stimulus reaching the nervous apparatus, the object of an instinct is 'the thing concerning which or through which the instinct is abler to achieve its aim', this aim being satisfaction. The object of an instinct is further described as ‘what is most variable about an instinct', ‘not originally connected with it', and as becoming ‘assigned to it only in consequence of being peculiarly fitted to make satisfaction possible'. It is, that we see instinctual drives being conceived as an ‘intrapsychic', or originally not related to objects.
In his later writing Freud gradually moves away from this position. Instincts are no longer defined as (inner) stimuli with which the nervous apparatus deals according to the scheme of them reflex arc, but instinct in, Beyond the Pleasure Principle, it is as seen, 'an urge inherent in organic life to restore an earlier state of things that the living entity has been obliged to abandon under the pressure of external disturbing forces'. Freud describes, in that instinct in terms equivalent to the terms he used earlier in describing the function of the nervous apparatus itself, the nervous apparatus, the ‘loving entity', in its interchange with ‘external disturbing forces'. Instinct impulses of an id have no longer an intrapsychic stimulus, but an expression of the function, the ‘urge' of the nervous apparatus ton deal with environment. The intimate and fundamental relationships of instincts, especially in as far as libido (sexual instincts, Eros) is concerned, with objects, is more clearly brought out in The Problem of Anxiety, until finally, in An Outline of Psycho-Analysis, ‘the aim of the first of these basic instincts [Eros] is to establish ever greater unities and to preserve them thus - in short, to bind together'. Making that is noteworthy not only the relatedness to objects is implicit: The aim of the instinct Eros is no longer formulated as to some contentless ‘satisfaction', or satisfaction in the sense of abolishing stimuli, but the aim is clearly seen through integration. It is ‘to bind together'. While Freud feels that applying his earlier formula is possible, ‘to the effect that instincts tend toward a return to an earlier [inanimate] stare'. To the descriptive or death instinct, ‘we are unable to apply the formula to Eros (the love instinct).
The basic concept Instinct has thus changed its content since Freud wrote, Instincts and Their Vicissitudes. In his later writing he does not take as his starting point and model the reflex-arc scheme of a self-contained, closed system, but bases his considerations on a much broader, more modern biological framework. It should be clear from the last quotation that it is not the ego alone to which he assigns the function of synthesis, of binding together. Eros, one of the two basic instincts, is itself an integrating force. This is following his concept of primary narcissism as first formulated in, On Narcissism, an Introduction, and further elaborated in his writings, notably in Civilization and Its Discontents, where objects, reality, far from being originally not connected with the libido, are seen as becoming gradually differentiated from a primary narcissistic identity of ‘inner' and ‘outer' world.
In his conception of Eros, Freud moves away from an opposition between instinctual drives and ego, and toward a view according to which instinctual drives become moulded, channelled, focussed, tamed, transformed, and sublimated in and by the ego organization, an organization that is more complex and more sharply elaborated and articulated than the drive-organization called the id. In whatever way, the ego is an organization that continues, much more than it is opposing, the inherent tendencies of the drive-organization, the concept Eros encircles one term one of the two basic tendencies or ‘purposes' of the psychic apparatus as manifested on both levels of organization.
As a whole, with such a perspective, instinctual drives are as primarily related to ‘objects', to the ‘external world' as the ego is. The organization of this outer world, of these ‘objects', corresponds to the drive-organization than of ego-organization. In other words, instinctual drives organize environment and are organized by it no less than is true for the ego and its reality. It is the mutuality of organization, in the sense of organizing each other, which forms the inextricable interrelatedness of ‘inner and an outer world'. It would be justified to speak of primary and secondary processes not only concerning the psychic apparatus but also about the outer world is for its psychological structure. The qualitative difference between the two levels of organization might terminologically be said by speaking of environment as correlative to drives, and of reality as correlative to ego. Instinctual drives can be seen as originally not connected with objects only in the sense that ‘originally', the world is not organized by the primitive psychic apparatus so that objects are differentiated. Out of an ‘undifferentiated stage' emerge what has been termed part-objects or object-nuclei. A more appropriate term for such pre-stages of an object-world might be the noun ‘shape': In the sense of configurations of an indeterminate degree and a fluidity of organization, and without the connotation of object-fragments.
The preceding excursion into some problems of instinct-theory is intended to were that the issue of object-relations in psychoanalytic theory has suffered from a formulation of the instinct-concept according to which instincts, as inner stimuli, are contrasted with outer stimuli, both, although in different ways, affecting the psychic apparatus. Inner and outer stimuli, terms for inner and an outer world on a certain level of abstraction, are thus conceived as originally unrelated or even opposed to each other but running parallel, as it was, in their relation to the nervous apparatus. While, as Freud in his general trend of thought and in many formulations moved away from this framework, psychoanalytic theory has remained under its sway except in the realm of ego-psychology. The development of ego-psychology unfortunately had to take place in relative isolation from instinct-theory. It is true that our understanding of instinctual drives has also progressed. Yet the extremely fruitful concept of organization (the two aspects of which are integration and differentiation) has been insufficiently, if in a at all, applied to the understanding of instinctual drives, and instinct-theory has remained under the aegis of the antiquated stimulus-reflex-arc conception model - a mechanistic frame of reference far removed from modernly psychological and biological thought. The scheme of the reflex-arc, as Freud says in, Instincts and Their Vicissitudes have been given to us by physiology. Nevertheless, this was the mechanistic physiology of the nineteenth century. Ego-psychology began its development in a quite different climate already, as is clear from Freud's biological reflections in, Beyond the Pleasure Principle. Thus it has come about that the ego is seen as an organ of adaption to and integration and differentiation with and of the outer world, whereas instinctual drives left behind in the realm of stimulus-reflex physiology. This, and specifically the conception of instinct as an ‘inner' stimulus impinging on the nervous apparatus, has affected the formulations concerning the role of ‘objects' in libidinal development and, by extension, has vitiated the understanding of the object-relationship between patient and analyst in psychoanalytic treatment.
In discussing aspects of the analytic situation and the therapeutic process in analysis, dwelling further on the dynamics of interaction in the early stages of development will be useful.
The mother recognizes and fulfils the need of the infant. Both recognition and fulfilment of a need are at first beyond the ability of the infant, not merely the fulfilment. The understanding recognition of the infant's needs for the mother represents some form of accumulating together, and yet undifferentiated urges of the infant, urges which in the acts of recognition and fulfilment by the mother undergo a first organization into some direct drive. In a remarkable passage in the ‘Project for a Scientific Psychology', in a chapter called The Experience of Satisfaction, Freud discusses this constellation in its consequences for the further organization of the psychic apparatus and in its significance as the origin of communication. Gradually, both recognition and satisfaction of the need coming within the range of the growing infant itself. The processes by which this occurs are generally subsumed under the headings identification and introjection. Accesses to them have to be made available by the environment, here the mother, who performs this function in the acts of recognition and fulfilment of the need. These acts are not merely necessary for the physical survival of the infant but necessary while for its psychological development in as far as they organize, in successive steps, the infant's uncoordinated urge. The whole complex dynamic constellation one of mutual responsiveness where nothing is introjected by the infant that is not brought to it by the mother, although brought by her often unconsciously. A prerequisite for introjection and identification is the gathering mediation of structure and direction by the mother in her caring activities. As the mediating environment conveys, structure begins to gain structure and direction in the experience of that entity: The environment begins to ‘taker shape' in the experience of the infant. It is now that identification and introjection plus projection emerge as more defined processes of organization of the psychic apparatus and of environment.
In agreement, . . . the organization of the psychic apparatus, beyond discernible potentialities at birth (comprising undifferentiated urges and Anlagen of ego-facilities, goes by way of mediation of higher organization by the environments to the infantile organism. In one of the same act, in the same breath and the same sucking of milk, drive direction, and organization of environment into shapes or configurations begin, and they Are continued into ego-organization and object-organization, by methods such as identification, introjection, projection? The higher organizational stage of the environment is indispensable for the development of the psychic apparatus and, in early stages, has to be brought to it actively. Without such a ‘differential' between organism and environment no development takes place.
The patient, who comes to the analyst for help through increasingly evidently self-understanding, is led to this self-understanding by the understanding he finds in the analyst. The analyst operates on various levels of understanding. Whether he verbalizes his understanding to the patient on the level of clarifications of conscious material, whether he suggests or reiterates his intent of understanding, restates the procedure to be followed, or whether he interprets unconscious, verbal or other, material, and especially if he interprets transference and resistance - the analyst structures and articulates, or works toward structuring and articulating, the material and the productions offered by the patient. If an interpretation of unconscious meaning is timely, the words by which this meaning is expressed are recognizable to the patient as expressions of what he experiences. They organize for him was previously less organized and thus give him the ‘distance' from himself that enable him to understand, to see, to put into words and to ‘handle' what was previously not visible, understandable, speakable, tangible. A higher stage of organization, of both himself and his environment, is thus reached, by way of the organizing understanding which the analyst provides. The analyst functions as a representative of a higher stage of organization and mediates this to the patient, in as far as the analyst's understanding is attuned of what is, and the way in which it is, in need of organization.
These are experiences of interaction (earlier called integrative experiences), comparable in their structure and significance to the early understanding between mother and child. The latter are some models, and as such always of limited value, but a model whose usefulness has recently been stressed by several analysts (for instance René Spitz) which in its full implications and in its perspective is a radical departure from the classical ‘mirror model'.
Interactions in analysis take place on much higher levels of organization. Communication is carried on predominantly by way of language, an instrument of and fort secondary processes. The satisfaction involved in the analytic interaction is a sublimated one, in increasing degree as the analysis progresses. Satisfaction now has to be understood, not about abolition or reduction of stimulation leading back to a previous state of equilibrium, but as for absorbing and integrating ‘stimuli'. Leading to higher levels of equilibrium. This, it is true, is often achieved by temporary regression to an earlier level, but this regression is 'in the service of the ego', that is, in the service of higher organization. Satisfaction, in the creation of an identity of experiences in two ‘systems', two psychic apparatuses of different levels of organization, thus containing the potential of growth. This identity is achieved by overcoming a differential. Properly speaking, there is no experience of satisfaction and no integrative experience where there is no differential to be overcome, where identity is simply ‘given', that is existing rather than to be created by interaction. An approximate model of a giving existent identity is perhaps provided in the intra-uterine saturation, and decreasingly the early months of life in the symbiotic relationship of mother and infant.
Analytic interpretations represent, on higher levels of interaction, the mutual recognition involved in the creation of identity of experience in two individuals of different levels of ego-organization. Insight gained in such interaction is an integrative experience. The interpretation represents the recognition and understanding which is driven to consumable patients as previously unconscious material. ‘Making it available to the patient' means lifting it to the level of the preconscious system, of secondary process, by the operation of certain types of secondary processes by the analyst. Material organized on or close to drive-organization, of the primary process, and isolated from the preconscious system, is made available for organization on the level of the preconscious system by the analyst's interpretation, a secondary process operation that mediates to the patient secondary process organization. Whether this mediation is successful or not depends, among other things, on the organizing strength of the patient's ego attained through earlier steps in ego-integration, in previous phases of the analysis. Ultimately in his earlier life. To the extent to which such strength is lacking, analysis - organizing interaction by way of language communication - becomes less feasible.
An interpretation can be said to comprise two elements, inseparable from each other. The interpretation takes with the patient the step toward true regression, compared with the neurotic compromise formation, thus clarifying for the patient his true regression-level covered and made unrecognizable by defensive operations and structures. Secondary, by this very step it mediates to the patient the higher integrative level to be reached. The interpretation thus creates the possibility for freer interplay between the unconscious and preconscious systems, under which the preconscious regains its originality and intensity, lost to the unconscious in the repression, and the unconscious retains access to land capacity for progression in the direction of higher organization. Put with Freud's Metapsychological language: The barriers between unconscious and preconscious, consisting of the archaic cathexis (repetition compulsion) of the unconscious and the warding-off anticathexis of the preconscious, are temporarily overcome. This process may be seen as the internalized version of the overcoming of a differential in the interaction process described earlier as an integrative experience. Internalization itself is dependent on interaction and is made possible again in the analytic process. The analytic process then consists in certain integrative experiences between patient and analyst as the foundation for the internal version of such experiences: Reorganization of ego, ‘structural change'.
The analyst in his interpretation reorganizes, reintegrates unconscious material for himself and for the patient, since he has to be attuned to the patient's unconscious, using his own unconscious as a tool, to arrive at the organizing interpretation. The analyst has to move freely between the unconscious and the organization of its thought and language, for and with the patient. If this is not so - a good example is most instances of the use of technical language - language is used as a defence against leading the unconscious material into ego-organization, and ego-activity is used as a defence against integration. It is the weakest of the ‘strong' ego - strong in its defences - that it guides the psychic apparatus into excluding the unconscious (for instance by repression or isolation) than into lifting the unconscious to higher organization and, simultaneously, holding it available for replenishing regression to it.
Language, when not defensively used, is employed by the patient for communication that attempts to reach the analyst on his presumed or actual level of maturity to achieve the integrative experience longed for. The analytic patient, while striving for improvement as to inner reorganization, is constantly tempted to seek improvement about unsubliminated satisfaction through interaction with the analyst on levels closer to the primary process, rather than concerning internalization of integrative experience as it is achieved in the process that Freud has described as: Where there was id there will be ego. The analyst, in his communication through language, mediates higher organization of material as far as less, higher organized, to the patient. This can occur only if two conditions are fulfilled as in, (1) the patient, through sufficiently strong ‘positive transference' to the analyst, becomes again available for integrative work with himself and his world, compared with defensive warding-off of psychic and external reality manifested in the analytic situation in resistance, and (2) The analyst must be in tune with the patient's productions, that is, he can regress within himself to the organization on which the patient is stuck, and to help the patient, by the analysis of defence and resistance, to realize this regression. This realization is prevented by the compromise formations of the neurosis and is boomed potentially plausibly by dissolving them into the proper structural composite components as characterized by a subjugated unconscious and superimposed preconscious. By an interpretation, both the unconscious experience and a higher organisational level of that experience are made available to the patient: Unconscious and preconscious are joined in the act of interpretation. In a well-going analysis the patient increasingly becomes enabled to perform this joining himself.
Language, in its most specific function in analysis, as interpretation, is thus a creative act similar to that in poetry, where language is found for phenomena, contents, connexions, experiences not previously known and speakable. New phenomena and new experience are made available because of reorganization of material according to this point of unknown principles, contexts, and connexions.
Ordinarily we operate with material organized on high levels of sublimation as ‘given reality'. In an analysis the analyst has to retrace the organizational steps that have led to such a reality-level so that the organizing process becomes available to the patient. This is regression in the service of the ego, in the service of reorganization - a regression against which there is resistance in the analyst plus in the patient. As an often necessary defence against the unorganized power of the unconscious, we have a tendency toward an automatization higher in organizational levels and resist regression out of fear lest we may not find the way back to higher organization. The fear of reliving the past is fear of toppling off a plateau we have reached, and fear of more archaic cuckoos' nest of past experiential insensitivities not only in the sense of past content not more essentially of past, fewer stable stages of organization of experience, whose genuine reintegration requires new integrative tasks and the risk of losing what had been secured. In analysis such fear of the future may be manifested in the patient's defensive clinging to regressed, but seemingly safe levels.
Once the patient can speak, nondefinely, from the true level of regression that he has been helped to reach by analysis of defences, he himself, by putting his experience into words, begins to use language creatively, that is, begins to create insight. The patient, by speaking to the analyst, attempts to reach the analyst as a representative of higher stages of ego-reality organization, and thus may be said to create insight for himself in the process of language-communication with the analyst as such a representative. Such communication by the patient is possible if the analyst, by way of his communications, is revealing himself to the patient as a more mature person, as a person who can feel with the patient what the patient experiences and how he experiences it, and who understands it as something more than it has been for the patient. It is this something more, not necessarily more in content but more in organization and significance, that ‘external reality', here represented and mediated by the analyst, had to offer to the individual and for which the individual is striving. The analyst in doing his part of the work, experiences the cathartic effect of ‘regression in the service of the ego' and performs a piece of self-analysis or re-analysis. Freud has remarked that his own self-analysis went on by way of analysing patients, and that this was necessary to gain him psychic distance required for any such work.
The primordial transference as considered would be literally and essentially derive from the effort to master the series of crucial separations from the mother, beginnings with the reactions to birth, as noted by Freud, and, in his own inimitable way, much earlier, by the poet William Blake (1757-1827). This in mention to Freud's sense of original traumatic situations (1926) and with due cognizance of his and other's disavowal of the fallacious psychological adaptation of the concept, notably in the one-time therapeutic system of Rank. This drive is present thence forward, and participates importantly in all of the detailed complexities of each infantile phase experience, with their inevitable context of warmth complexities of each infantile phase experience, with their inevitable contexts of warmth ful pressure, skin, special sense, and speech contacts, in the problems of object relationship, separation and individuation, the manifold of some determined crisis of adolescence, the specific neuroses, and many ‘normal' involvements and solutions to the conventionally healthy individual. One may assertively simulate the important hesitiorially as participators that are embodied, that even if nonmanifest, in castration anxiety, also in ‘aphanisis' (Jones 1929). The striving, in short, is to establish at least symbolic bodily reunion with the mother. Further, the striving is to substitute this relationship for the kaleidoscopic system of relationships that have, in good part and inevitably, replaced it. This is a transference to the extent that actual and concrete.
- later, intrapsychic - barriers prohibit even part or derivative manifestations of this drive, in reflation to the mother, requiring that, in varying modes and degrees, it be displaced to other individuals, sometimes even their undergoing secondary repression or otherwise warded off. In the instance where the drive actualization remains attached to the person of the actual mother, it is a primitive symbolic urge, only a potentiality in relation to transference. This does of course exist clinically in very sick children (Mahler 1952). It is rare, in its explicitly primitive modalities, in adults, although not at all infrequent in its psychological expressions. That such striving may come about in a narcissistic solution (or more primitive regressive state, such as autism or primary identification) is inescapably true, then only fundamental anaclitic strivings will persist, in psychotic states, even these may disappear. For the moment, if one is to ask indulgence for the tentative concept that both erotic and aggressive strivings may, in various ways, express ease, or subserve this basic organismic personality, apart from the empirical fact that disturbances in these spheres may be observed to initiate or augment it. One may think of the original urge as having an undifferentiated or oscillating instinctual quality, like the bodily approaches described for psychotic children (Mahler 1952), or it may find more mature expression in the neutralized need for closeness that causes the normal toddler, at a certain point, to recoil from his own adventurous achievement (Mahler 1965). While it is a universal ingredient of human personality, in tremendous range and variety of expressive dialectic discourse will decisively influence the quality and quantity of this reaction, apart from innate elements, by earlier vicissitudes, faultlessly in the neonatal experience with the mother, possibly in the organismic experiences of birth itself (Greenacre 1941, 1945).
The primordial transference only rarely appears as such in our clinical work. When it does appear, it leaves an impression not readily forgotten. This is the case when the underlying (as opposed too symptomatic) transference of the psychotic patient appears, displacing his symptoms, if only transitorily, or at times interpretations conjunction with them. However, in the usual neuroses or character disorders with them. However, in the usual neuroses or character disorders, even most so-called ‘borderlines', this transference is in the sphere of influence, closest to the surface in the separation experience of termination, or in earlier interpretations, or in periods of extreme regression. It may be implied at times in inveterate avoidance of transference emotion, in extreme and anxious exploitation of the formalized routines of analysis, or in inveterate acting out. Seemingly enough, we have usually dealt with what, in the working transference and the transference neurosis, are the phase representations and integrations of this phenomenon, and the large and more subtle complexes of emotional experience clustering around them? Only some types of psychological need (or, demand) which sometimes assumes resemblance to original anaclitic requirements (for example, to exhibit indirectly the wish - rarely, to state it explicitly - that the analyst, in effect, think for the patient, and would be attested to frequently, and often demonstrably allied to the original struggle against separation.
In a great majority of instances, the operational transference will come to display an intimater and crucial relationship to the Oedipus complex. For the primordial transference finds and especially important phase specification. The oedipus transference repeats, in terms appropriate to the child's state of psycho-physiological maturation, the invertebracy. The urge to kill if need be, to cling to the original object as the source of a basic gratification, which b comprehends residual elements of past libidinal phases in its organization as such, intimately bound with complex attitudes of object constancy in a large sense. It is, of course, the infantile prototype of the most general and comprehensive adult solution of the problem of separation, i.e., the institution of marriage. That this usually occurs in the birth of children tends to close a circle in unconscious fantasy, by way of identification with the children. Obviously, in the healthy parent, this plays a small economic role, comparable to that of the residual and repressed incest in the oedipal striving that are collaboratively given up, in varying degree, referring to its persists unconscious fractionate major energetic sources of everyday dream and infant life, neurosis, or creative achievement. It is also used for the general thesis to suggest that the important positions of the Oedipus complex in reflation too unconscious, the dream, provide a link between this climactic experience of childhood separation and the most primitive psycho-physiological separation. It has been shown that the neurophysiological phenomenons that are the objective correlates of dreaming are of striking high development in the neonatal period (Fisher 1965). The recently established prevalence of dream erection (Fisher 1966) awakened memories of and further reflections on Ferenczi's Thalassa (1938), at least in its ontogenetic aspects. At this point, one might ask: "What of the young woman whom, development brings favourably, turns to her father with comparable striving?" If we recognize the important element of biologically determined faute de mieux in the girl's psychosexual development, i.e., the castration complex, and the multiple intrinsic and environmental factors usually favouring heterosexual orientation, in that this represents one of the early focal instances of reality-syntonic transference, which becomes integrated in healthy development. This is the other side in which the boy's displacement of unneutralized hostility from his mother, as the first frustrating authority (even in relations to his access to her person), to his father? In optimal instances (again, allowing for inevitable unconscious residues), such reorientations become the dominant conscious and unconscious realities of further development.
This type of reality-syntonic development displacement is to be distinguished from the primordial transference problem, which is ubiquitous in the very beginning of relations to proto-objects, i.e., the question of whether perceptual and linguistic displacement (or deployment) is accompanied by merely ‘token' displacement of libido and aggression away from the psychic representation of the original object, as opposed to genuine and proportionate shifts of a cathexis. In other terms, is the ‘new object' really a person other than the mother who is loved and hated (to tinctorius simplicity), or is the other person literally a substitute for the original object, a mannikin for that object's psychic representation? In the latter instance, the father is given cognitive status s a father. What is sought and sometimes found in him is a mother. This may be strikingly evident in the oral sphere, and may be maintained for a lifetime. This is true transference (of primordial type), not ‘transfer', (to borrow the word tentatively from Max Stern [1957]), or ‘normal developmental transference', or ‘reality-syntonic transference'. This deficit of varying degree, in instinctual and affective investment of the new and presenting real object, finds its mirror-image problem in the analytic situation, where a cognitive cover with lagging, must be repaired by the analyst's interpretative activity, especially in the anticipatory transference interpretation. By this latter activity, recognition of the persisting importance of the original object, rediscovered in the analyst, can be established in consciousness, in relation to his current or developing affective-instinctual importance.
It remains beyond the complication and complexities in the mother-infant reciprocal symbiosis that may be thought to exacerbate the primordial transference tendency, however, the matter remains complicated, oversimplification is to be avoided. The same is even more true of reconstructions from adult (or even the child) analytic work. The analytic work does provide a certain access to the residues of subjective experience in the period of infancy. Probably the eventual synthesis of the two will permit more dependable clarification. Obviously the relationship to a mother has many facets, even within each developmental phase, each can, to varying degree, introduces further complications, sometimes new solutions, furthermore, the life of an individual, beginning very soon after birth, will include other individuals, conspicuously the father, usually siblings, often adult parental surrogates, who can decisively influence development for good or ill. However, these considerations do not disestablish the general and critical primacy of the original symbiosis with the mother. In relation to the primordial transference striving (in the sense that we have mentioned), by which the relevant reconstructive inferences from adult analyses point with an overall consistency but only to the persistence of a variety of anaclitic needs and diffuse bodily libidinal needs (or, cause to result of demands) accompanied by or permeated with augmented aggressive impulses and fantasies. These, apart from innate infantile disposition, seem likely that something like the Zeigarnik Effect, stressed by Lagache (1953) regarding transference usually, operate from earlier infancy? Thus the mother who responds inadequately, or who interrupts gratification prematurely or traumatically, is sought repeatedly in others, in the drive to settle ‘unfinished business'. That an opposite or very different tendency may sometimes appear to have prevailed in certain segments of relationship (oversimplification, seduction, satiation, and sudden disappointment, for example) or perhaps, represent the demonstrably complex spheres of the object relationship (parental possessiveness, undue demands, capricious harshness, failure to meet maturational development requirement, or myriad subtle variants) testifies only to the challenging complexity of the problem. Intuitively its certainty drawn upon the phenomenon of regression, on the one hand from the oedipal conflicts, or - possibly more often than realized - from parental failures to meet the complex problems of proportionally ‘neutralized' spheres of development, often contributes importantly to the clinical manifestations. Still, the anterior elements must be, conceded at least a logical priority in shaping the child and his contributions to the pattern of later conflict.
The same, degree to which there is actual deployment of a cathexis from the original object to other environmental objects, including the inanimate, determine (inversely) the power and tenacity of the primordial transference and probably deals with the basic predispositions to emotional health and illness, respectively. In other words, if there is true transfer of interest and expectation to the environment, with its growing perceptual (and ultimately linguistic) clarity, it exists for the infant largely in its own right, along with the primary object, the mother, whose unique importance is never entirely lost, in the development of most individuals. That there is also an organismic drive toward the outer environment is most assuredly true, and this contributes to what is ‘mature transference.' Based on resemblances which progress from extreme primitiveness to varying grades of derail, the original object or part objects are sought by the primordial transference and often ‘found'; in other aspects of the environment. It may be in some specified condition for that this urge provides an important dynamic element in primary process, and in the mature universal symbolic faculty. In any case, it is the actual power of this regressive drive, fraught at every step with conflict and anxiety, down to the ultimate fear of loss of ‘selfness', which can determine (in the light of other factors) whether the transference neurosis, and the given Oedipus complex itself, or the involvement in life in general, is a play of shadow-shades or a system of proportionally genuine reactions to real persons, perceived largely in their own right? That is to say, that in comparing this latent (dyadic) sides of the transference neurosis - its ‘primordial transference' aspect - with Lewin's ‘dream screen' (1946), which really achieves full ascendancy only in the ‘black dream'.
Emphasizing that the primordial transference includes the actual or potential duality of body and mind within it is important own scope, and the distinction is of great psychodynamic, sometimes nosologic importance. However, it is deservingly taken to as seceding of the therapeutic transference (a specification, a derivative of the primordial transference) may have been analysed, there is, for practical purposes (at least, an unimpeachable exception), an inevitable residue of longing, of the research for the equivalent of some omnipotent, sapient, all-providing, and equally yielding of a parent. The important issue for the individual's health and productiveness is that the critique of accurate perceptions and other autonomous functions is as actively participant as possible and that the social representations of this urge are as constructive and as consistent with successful adaptation as possible. The capacity to translate original bodily strivings into mental representations of relations with an original object, as literal needs are met in other ways, at least opens the endless realm of symbolic activities for possible gratification of the residual and irreducible primordial transference strivings. The anterior requirement, regarding affirmative viability, is that such strivings, in their literal anaclitic reference, are detached from literal transference subrogates and carried over to appropriate materials functionally, processes, individuals, and transactions, the responsibility for their direction or execution essentially assumed by the individuated dividual, in early ego identification with the original object. As for sexual gratification, the persistent clinging to the primordial object or to literal transference surrogates (in the sense previously specified) leads through the pregenital conflicts to the peak development of the Oedipus complex, and (apart from other more specific factors) to its probable failure of satisfactory resolution.
If sexual interest is genuinely deployed to other objects, even as unconscious representations, to the extent usually achieved, it remains nonetheless an important fact that bodily gratification is sought, usually by both individual and social preference, with another person who, at least in a generic organic sense, resembles the original incestuous object, most often including cultural-national ‘kinship'. This holds a dual interest, as (1) the general acceptance of the principle of symbolic ‘return' to the original object, if no father (or a mother) must be thereby destroyed, or such aggression suggested by close blood kinship and (2) the paradoxical relation to the centrifugal tendency of the taboo on cannibalism. The latter, of course, with the advance of civilization, finds persistent representation only in symbolic ritual. In relation to the actual eating of flesh, the taboo tends to spread, not only to protect human enemies but also to include other animals with whom man may have an ‘object-relationship', conspicuously the dog and horse. ‘Vegetarianism', of course, includes all animal life. There is no reason to doubt that the mother is the original object of cannibalistic impulse and fantasy, as she is the first object of the search for genital gratification. In the infantile cannibalistic impulse, the physiological urge of hunger, the drive for summary union, and the prototype of relatively extensively-determinantal fixated oral erotic and destructive drives may find conjoint expression. That energies and fantasies derived from this impulse contributes importantly to the phallic organization was an early opinion of Freud (1905), which may be profoundly true. Except where severe pregenital disturbances have infused the phallic impulse as such with impulses (subjectively) dangerous to the object, the latter are not only not menaced with destruction (as in the cannibalistic impulse), but preserved, even enhanced. No doubt the critical difference in the cultural evolution of the two great taboos lies in the problem of the preservation of the object, as opposed to his or her destruction.
The Oedipus complex, in a pragmatic analytic sense, retains its position as the ‘nuclear complex' of the neuroses. For reasons that the climatic organizing experience of early childhood, apart from its own vicissitudes, can under favourable circumstances provide certain solutions for pregenital conflicts, or in the suffering from them, in any case, include them in its structure. Only when the precursor experiences have been of great severity is acherontic in the organically determined new ‘frame of reference', which hardly has independent and decisive significance of its own. Nonetheless, its attendant phallic conflicts must be resolved in their own right, in the analytic transference. From the analyst (or his current ‘surrogate' in the outer world), thus from the psychic representation of the parent, the literal, i.e., bodily, sexual wishes must be withdrawn and genuinely displaced to appropriate objects in the outer world. The fraction of such drive elements that can be transmuted to friendly, tender feeling toward the original object or too other acceptable (neutralized?) Variants, will have course influence the economic problem involved. This genuine displacement is opposed to the sense of ‘acting out', where other objects are perceptually different substitutes for the primary object (thus for the analyst). This may be thought to follow automatically on the basic process of coming to terms with (‘accepting') the childhood incestuous wishes and its paricidal connotations. Such assumptions do not do justice to the dynamic problem implicit in tenaciously persistent wishes. To the extent that these wishes are to be genuinely disavowed or modified, rather than displaced, a further important step is necessary: The thorough analysis of the functional meaning of the persistent wishes and the special etiologic factors entering their tenacity, as reflected in the transference neurosis. Thus, in principle, the lateral accuracy of the concept phrased by Wilhelm Reich (1933), "transference of the transference," as the final requirement for dissolving the erotic analytic transference, although the clinical discussion, which is its context, is useful. This expression would imply that the object representation that largely determines the distinctive erotic interests in the analyst can remain essentially the same, while the actual object changes. Though a semantic issue may be involved to some degree, it is one that impinges importantly on conceptual clarity. Yet the truth is that the fortunate ‘average man', who has, even in his unconscious, yielded his sexual claim to his mother and father's prerogative, can, if he very much admires his mother's physical and mental traits, seek someone like her. The neurotic cannot do this, and may fail in his sexual striving (in its broadest sense), even when the subject is disguised by the other appearance e of remote race or culture.
It is nevertheless, that the patient, being recognized by the analyst as something more than he is at present, can attempt to reach this something more by his communications to the analyst that may establish a new identity with reality. To varying degrees patients are striving for this integrative experience, through and despite their remittances. To varying degrees patients have given up this striving above the omnipotent, magical identification, and to that extent are less available for the analytic process. The therapist, depending on the mobility and potential strength of integrative mechanisms in the patient, has to be mostly explicit and ‘primitive' in his ways of communicating to the patient his availability as a mature object and his own integrative processes. Yet, we call analysis that kind of organizing, reconstructuring interaction between patient and therapist that is predominantly performed on the level of language communication. It is likely that the development of language, as meaningful and coherent communicating with ‘objects', is related to the child's reaching, at least in a first approximation, the oedipal stage of psychosexual development. The inner connexions between the development of language, the formation of ego and of object, and the oedipal phase of psychosexual development, is still to be explored. If such connexions exist, then it is not mere arbitrariness to distinguish analysis proper from more primitive means of integrative interaction. To set up rigid boundary lines, however, is to ignore or deny the complexities of the development and of the dynamics of the psychic apparatus.
In contrast to trends in modern psychoanalytic thought and narrow the term transference down to a very specific limited meaning, an attemptive efforts to regain the original richness of interrelated phenomena and mental mechanisms that the concept encompasses, and to contribute to the clarification of such interrelations is afforded when Freud speaks of transference neuroses in a contradistinction to narcissistic neuroses, and two meanings of the term transference are involved as in: (1) The transfer of a libido, contained in the ‘ego', to objects, in the transference neuroses, while in the narcissistic neuroses the libido remains in or is taken back into the ‘ego', not ‘transferred' to objects. Transference in this sense is virtually synonymous with object-cathexis. To quote from an important early paper on transference: "The first loving and hating are transference of autoerotic pleasant and unpleasant feelings onto the objects that evoke these feelings. The first ‘object-love' and the first ‘object-hate is, so top speak, the primordial transference. . . ." (1) And (2), the second meaning of transference, when distinguishing transference neuroses from narcissistic neuroses, is that of transfer of relations with infantile objects onto later objects, and especially to the analyst in the analytic situations.
The second meaning of the term is today the one most frequently referred to, the exclusion of other meanings. Two recent representative papers on the subject of transferences are such that Waelder, in his Geneva Congress paper, Introduction to the Discussion on Problems of Transference, saying: "Transference may be said to be an attempt of the patient to revive and re-enact, in the analytic situation and in relation to the analyst, situations and phantasies of his childhood." Hoffer, in his paper, presented at the same Congress, on Transference and Transference Neuroses states: "The term ‘transference' refers to the generally agreed facts that people when entering any form of object-relationship. . . . Transfer upon their objects. Those images that they encountered during previous infantile experience . . . The term ‘transference', stressing an aspect of the influence our childhood has on our life as a whole, thus refers to those observations in which people in their constants with objects, which may be real or imaginary (or unreal), positive, negative, or ambivalent, ‘transfer' their memories of significant experiences and thus ‘change the reality' of their objects, invest them with qualities from the past. . . . '
The transference neuroses, thus, are characterized by the transfer of the libido to external objects compared with the attachment of the libido to the ‘ego' in the narcissistic affections, and, secondly, by the transfer of libidinal cathexes (and defences against them), originally related to infantile objects, onto contemporary objects.
Transference neurosis as distinguished from narcissistic neuroses is a nosological term. Just when, the term ‘transference neurosis' is used in a technical sense to designate the revival of the infantile neurosis in the analytic situation. In this sense of the term, the accent is on the second meaning of transference, since the revival of the infantile neurosis is due to the transfer of relations with infantile objects on the contemporary object, the analyst? It is, however, only based on transfer of the libido to (external) objects in childhood that libidinal attachment to infantile objects can be transferred to contemporary objects. The first meaning of transference, therefore, is implicit in the technical concept of transference neurosis.
The narcissistic neuroses were thought to be inaccessible to psychoanalytic treatment because of the narcissistic libido cathexis. The psychoanalysis was considered feasible only where a ‘transference relationship' with the analyst could be established: In that group of disorders, in other words, where emotional development had taken place to the point that transfer of the libido to external objects had occurred significantly. If today we consider schizophrenics capable of transference, we hold (1) that they do relate in some way to ‘objects', i.e., to pre-stages of objects that are less ‘objective' than oedipal objects (narcissistic and object libidos, ego. Objects are not yet clearly differentiated. (This implies the concept of primary narcissism in its full sense). We hold (2) that schizophrenics transfer this early type of relatedness onto contemporary ‘objects', which objects thus become less objective. If ego and objects are not clearly differentiated, if ego boundaries and object boundaries are not clearly established, the character of transference also is different, in as much as ego and objects are still largely merged: Objects - ‘different objects' - are not yet clearly differentiated one from the other, and especially not early from contemporary ones. The transference is much more primitive and ‘massive' one. Thus, as for child-analysis, at any rate before the latency period, it has been questioned whether one can speak of transference in the sense in which adult neurotic patients manifest it. The conception of such a primitive form of transference is fundamentally different from the assumption of an unrelatedness of ego and objects as is implied in the idea of a withdrawal of the libido from objects into the ego.
The modification of our view on the narcissistic affections in this respect, based on clinical experience with schizophrenics and on deepened understanding of early ego-development, leads to a broadened conception of transference in the first-mentioned meaning of that term. To be more precise, transference in the sense of transfer of the libido to objects is clarified genetically, it develops out of a primary lack of differentiation of ego and objects and thus may regress, as in schizophrenia, to such a pre-stage. Transference does not disappear in the narcissistic affections, by ‘withdrawal of libido cathexes into the ego'. It's propositioned undifferentiated regressive is direction toward its origin in the ego-object identity of primary narcissism.
An apparently relational narrative conjuncture from which their unrelated meanings of transference are well founded in Freud's, The Interpretation of Dreams, gave a discussion of the importance of day residues in dreams. Since this last meaning of transference is fundamental for a deeper understanding of the phenomenon of transference, it may prove to some significance to quote the relevant passages. "We learn from the psychology of the neuroses that an unconscious idea is as such quite incapable of entering the preconscious and that it can only exercise any effect there by establishing a connection with an idea that already belongs to the preconscious, by transferring its intensity onto it and by getting itself ‘covered' by it. In this context, the fact of ‘transference' from which provides an explanation of so many striking phenomena in the mental life of neurotics? The preconscious idea, which thus finding an undeserved degree of intensity, may be left either unaltered by the transference, or it may have a modification forced upon it, derived from the content of the idea that affects the transference." Once, again, referring to a day residue, '. . . . That the fact that recent elements occur with such regularity points to the existence of a need for transference. "It will be seen, then, that the day's residue . . . not only borrows something from the Ucs when they succeed in taking a share in the formation of the dream - namely the instinctual force that is at the disposal of the repressed wish - but that they also offer the unconscious something indispensable - namely, the necessary points of attachment for transference? If we wished to penetrate more deeply at this point into the processes of the mind, we should have to throw more light upon the interplay of excitations between the preconscious and the unconscious - a subject toward which the study of the psychoneuroses draws us, but upon which, as it happens, dreams have no help to offer."
One parallel between this meaning of transference and the one mentioned under (2) transference of infantile object-cathexes to contemporary objects - emerges: The unconscious ideas, transferring its intensity to a preconscious idea and getting itself ‘coveted' by it, corresponds to the infantile object-cathexis, whares the preconscious idea corresponds to the contemporary object-relationship to which the infantile object-cathexis are transferred.
Transference is described in detail by Freud in the chapter on psychotherapy in Studies on Hysteria. It is seen there as due to the mechanism of ‘false (wrong) connection'. Freud discusses this mechanism in Chapter two of Studies on Hysteria where he refers to a ‘compulsion to associate' the unconscious complex with one that is conscious and reminds us that the mechanism of compulsive ideas in compulsion neurosis is of a similar nature. In the paper on The Defence Neuro-Psychoses, the ‘false connection', of course, is also involved in the explanation of screen memories, where it is called displacement. The German term for screen memories, "Deck-Erinnerungen," uses the same word ‘decken', to cover, which is used in the above quotation from The Interpretation of Dreams where the unconscious idea gets itself ‘covered' by the preconscious idea.
While these mechanisms involved in the ‘interplay of excitations between the preconscious and the unconscious' have reference to the psychoneuroses and the dream and were discovered and described in those contexts, they are only the more or less pathological, magnified, or distorted versions of normal mechanisms. Similarly, the transfer of the libido to object and the transfers of infantile object-relationships to contemporary ones are normal processes, seen in neurosis in pathological modifications and distortions.
The compulsion to associate the unconscious complex with one that is conscious is the same phenomenon as the need for transference in the quotation from the Interpretation of Dreams. It relates to the indestructibility of all mental acts that are truly unconscious. This indestructibility of unconscious mental acts is compared by Freud to the ghosts in the underworld of the Odyssey - ‘ghosts that awoke to new life when they tasted blood', the blood of conscious-preconscious life, the life of ‘contemporary' present-day objects. It is a short step from here to the view of transference as a manifestation of the repetition compulsion - a line of thought that we cannot follow up connectively. The transference neurosis, in the technical sense of the establishment and resolution of it in the analytic process, is due to the blood of recognition that the patient's unconscious is given to taste - so that the old ghosts may awaken to life. Those who know ghosts tell us that they long to be released from their ghost-life and led to rest as ancestors. As ancestors they live forth in the present generation, while as ghosts they are compelled to haunt th present generation with their shadow-life. Transference is pathological in as far as the unconscious is a crowd of ghosts, and this is the beginning of the transference neurosis in analysis Ghosts of the unconscious, imprisoned by defences but haunting the patient in the dark of hides defences and symptoms, is allowed to taste blood, are let loose. In the daylight of analysis the ghosts of the unconscious are laid and led to rest as ancestors whose power is taken over and transformed into the newer intensity of present life, of the secondary process and contemporary objects.
In the development of the psychic apparatus the secondary process, preconscious organization, are the manifestation and result of interaction between additional primitivities as organized psychic apparatus and the secondary process activity of the environment: Through such interaction the unconscious gains highly organization. Such ego-development, arrested or distorted in neurosis, is resumed in analysis. The analyst helps to revive the repressed unconscious of the patient by his recognition of it: Though interpretation of transference and resistance, through the recovery of memories and through reconstruction, the analyst, in the analytic situation, offers himself to the patient as a contemporary object. As such he revives the ghosts of the unconscious for the patient by fostering the transference neurosis, which comes about in the same organizational root-direction from which the dream comes about: Through the mutual attraction of unconscious and ‘recent', ‘day residue' elements. Dream interpretation and interpretation of transference have this function in common: both attemptive efforts to re-establish the lost connexions, th buried interplay, between the unconscious and the preconscious.
Transference studied in neurosis and analysed in therapeutic analysis are the diseased manifestations of the life of that indestructible unconscious whose ‘attachments' to ‘recent elements', by way of transformation of primary into secondary processes, constitute growth. There is no greater misunderstanding of the full meaning of transference than the one most clearly expressed in a formulation by Silverberg, but shared by many analysts. Silverberg, in his paper of the Concept of Transference, writes: "The wide prevalence of the dynamism of transference among human beings is a mark of man's immaturity, and it may be expected in ages to come that, as man progressively matures, . . . transference will gradually vanish from his psychic repertory." Nevertheless, surreally from being, as Silverberg puts it, "the enduring monument of man's profound rebellion against reality and his stubborn persistence in the ways of immaturity," transference is the ‘dynamism' by which the instinctual life of man, the id, becomes ego and by which reality becomes integrated and maturity is achieved. Without such transference - of the intensity of the unconscious, of the infantile ways of experiencing life that has no language and little organization, but the indestructibility and power of the origins of life
- to preconscious and to present-day life and contemporary objects - without such transference, or to the extent to which such transference, miscarries, human life becomes sterile and an empty shell. On the other hand, the unconscious needs present-day external reality (objects) and present-day psychic reality (the preconscious) for its own continuity, least it is condemned to live the shadow-life of ghosts or to destroy life.
Earlier, that in the development of preconscious mental organization - and this is resumed in the analytic process - transformation of primary into secondary process activity is contingent upon a differential, a (libidinal) tension-system between primary and secondary process organization, that is, between the infantile organism, its psychic apparatus, and the more structured environment: Transference in the sense of an evolving relationship with ‘objects'. This interaction is the basis for what has been called in the ‘integrative experience'. The relationship is a mutual one - as is the interplay of excitations between unconscious and preconscious - since the environment not only has to make itself available and move in a regressive direction toward the more primitively organized psychic apparatus, the environment also needs the latter as an external representative of its own unconscious levels of organization with which communication is to be maintained. The analytic process, in the development and resolution of the transference neurosis, is a repetition - with essential modifications because taking place on another level - of such a libidinal tension-system between a different primitivists and a more maturely organized psychic apparatus.
The differential, implicit in the integrative experience, as the tension-system making up the interplay of excitations between the preconscious and the unconscious, we are to postulate thus, internalization of an interaction-process, not simply internalization of ‘objects', as an essential element in ego-development and in the resumption of it in analysis. The double aspect of transference, the fact that transference refers to the interaction between psychic apparatus and object-world and to the interplay between the unconscious and the preconscious within the psychic apparatus, thus becomes clarified. The opening of barriers between unconscious and preconscious, as it occurs in any creative process, is then to be understood as an internalized integrative experience - and is in fact experienced as such.
The intensity of unconscious processes and experiences is transferred to preconscious-conscious experiences. Our present, current experiences have intensity and depth to the extent to which they are in communication (interplay) with the unconscious, infantile, experiences representing the indestructible matrix of all subsequent experiences. Freud, in 1897, was well aware of this. In a letter to Fliess he writes, after recounting experiences with his younger brother and his nephew between the ages of one and two years: "My nephew and younger brother determined, not only the neurotic side of all my friendships, but also their depth."
The unconscious suffers under repression because its need for transference is inhibited. It finds an outlet in neurotic transference: ‘Repetition' which fails to achieve higher integration (‘wrong connections'). The preconscious suffers no less from repression since it has no access to the unconscious intensities, the unconscious prototypical experiences that give current experiences their full meaning and emotional depth. In promoting the transference neurosis, we are promoting a regressive movement by the preconscious (ego-regression) from the unconscious and to allow the unconscious to recathect, tendencies of interaction with the analyst, preconscious ideas and experiences so that higher organization of mental life can come essentially. The mediator of this interplay of transference is the analyst who, as a contemporary object, offers himself to be the patient's unconscious as a necessary point of attachment for transference. As a contemporary object, the analyst represents a psychic apparatus whose secondary process organization is stable and capable of controlled regression so that he is optimally in communication with both his own and the patient's unconscious, to serve as a reliable mediator and partner of communication, of transference between unconscious and preconscious, and thus a higher, interpreting organization of both
The integration of ego and reality consists in, and the continued integrity of ego and reality depends on, transference of unconscious processes and ‘contents' on to new experiences and objects of contemporary life. In pathological transference the transformation of primary into secondary processes and the continued interplay between them have been replaced by superimpositions of secondary on primary processes, so that they exist side by side, isolated from each other. Freud had described this constellation in his paper on The Unconscious: "In effect, there is no lifting of the repression until the conscious ideas, after the resistances have been overcome, have entered connection with the unconscious memory-trace. It is only through the making conscious of the latter itself that success is achieved." In an analytic interpretation ‘the identity of the information given to the patient with whom hide' a repressed memory, id is only apparent. To have heard something and to have experienced something is in their psychological nature two different things, although the content of both is the same. Later, in the same paper, Freud speaks of the thing-cathexes of objects in the Ucs, whereas the ‘conscious presentation comprises the presentation of the thing [cathexis] further: "The system Pcs come about by this thing-presentation being hyper-cathected through being linked with the word-presentations corresponding to it. These are the hyper-cathexes, we may suppose, that causes a higher psychical organization and make it possible for the primary process to be succeeded by the secondary process that is dominant in the Pcs. Now, too, we are unable to state precisely what it is that repression goes unchallenged boundless to the presentational id of the transference neurosis: What it denies to the presentation bin translation into words that will remain attached to the object."
The correspondence of verbal ideas to concrete ideas, which is to thing-cathexes in the unconscious, is mediated to the developing infantile psychic apparatus by the adult environment. The hyper-cathexes which ‘cause a higher psychical organization', consisting in linking of unconscious memory traces with verbal ideas corresponding to them, are, in early ego-development, due to the organizing interaction between primary process activity of the infantile apparatus and secondary process activity of the child's environment. The terms ‘differential' and ‘libidinal tension-system' which designate energy-aspects of this interaction, sources of energy of such hyper-cathexes are clearly approached by Freud's awakening problem of interaction between psychic apparatuses of different levels of organization when he spoke of the linking up of concrete ideas in the unconscious with verbal ideas as been the hyper-cathexes which ‘cause a higher psychical organization'. For this ‘linking up' id the same phenomenon of the mediation of higher organization, of preconscious mental activity, by the child's environment, to the infantile psychic apparatus. Verbal ideas represent preconscious activity, representatives of special importance because of the special role language plays in the higher development of the psychic apparatus, but they are, of course, not the only ones. Such linking up occurring in the interaction process becomes increasingly internalized as the interplay and communication between unconscious and preconscious within the psychic apparatus. The need for resumption of such mediating interaction in analysis, so that new internalisation may become possible and internal interaction b e reactivated, results from the pathological degree of isolation between unconscious and preconscious, or - to speak as for a later terminology - from the development of defence processes of such propositions that the ego, rather than maintaining or extending its organization of the realm of the unconscious, excluded ever more from its reach.
Transference and the so-called ‘real relationship' between patient and analysts have been said that one should distinguish transference (and countertransference) and an analyst in the analytic situation from the ‘realistic' relationship between the two. That is well known, however, it is implied in such statements that the realistic relationship between patient and analyst has nothing to do with transference. (Keeping in mind that there is neither such a thing as reality nor a real relationship, without transference). Any ‘real relationship' involves transfer of unconscious imagines to present-day objects. In fact, present-day objects are objects, and thus ‘real', in the full sense of the word (which comprises the unity of unconscious memory traces and preconscious idea) only to the extent that this transference, in the sense of transformational interplay between unconscious and preconscious, is realized. The ‘resolution of the transference' at the termination of analysis means resolution of the transference neurosis, and in that way of the transference distortions. This includes the recognition of the limited nature of any human relationship and of the special limitations of the patient-analyst relationship. However, the new object-relationship attuned with the analyst, which is gradually being built during the analysis and constitutes the real relationship between patient and analyst. Which serves as a focal point for the establishment of healthier object-relations in the patient's ‘real' life, is not without transference in the sense clarification, . . . to the extent to which the patient developed a ‘positive transference' (not in the sense of transference as resistance, but in the sense of the ‘transference' which carries the whole process of analysis) he keeps this potentiality of a new object-relationship alive through all the various stages of resistance. This meaning of positive transference tends to be discredited in modern analytic writing and teaching, although not in treatment itself.
Freud, like any other man who does not sacrifice the complications and complexity of life to the deceptive simplicity of rigid concepts, has said many contradictory things. He can be quoted in support of many different ideas, which is to say, in writing to Jung on 6 December, 1906: "It would not have escaped you that our cures come about through attaching the libido reigning in the subconscious (transference) . . . Where this fails the patient will not attempt or else does not listen when we translate his material to him. It is in essence a cure through love. Moreover, it is transference that provides the strongest proof, the only unassailable one, for the relationship of neuroses to a lover. He writes to Ferenczi, on the 10th, of January 1910: "I will present you with some theory that has occurred to me while reading your analysis [referring to Ferenczi's self-analysis of a dream]. It seems to me that in our influencing of the sexual impulses we cannot achieve anything other than exchanges of the sexual placements, never renunciation, relinquishment or the resolution of a complex (Strictly secret!). When someone brings out his infantile complexes, he has saved part of them (the effect) in a current form (transference). He has shed a skin and leaves it for the analyst. God forbid that he should now be naked, without a skin."
One of Freud's proudest achievements was the transformation of the therapeutic relationship that takes place in psychoanalysis into a tool of scientific investigation. Freud also believed that "the future will probably attribute far greater importance to psychoanalysis as the science of the unconscious than as a therapeutic procedure" (Freud, 1926). Nevertheless in recent years the importance of clinical research has been underestimated and a growing cleavage has developed between the researcher and the clinician. Scientific investigation, in common with all other forms of human group endeavours, is subject to moods and to whom the impetus of fashion, and this has led to some disappointment with the contribution of psychoanalytic psychiatry to the problem of schizophrenia, which has resulted in a turning away from the investigation of the psychology of schizophrenia, with the hope that biochemistry and neurophysiology will solve its riddle.
This imploring us to consider the relation between clinical research in psychiatry and the investigations of basic science. Every generation of psychiatrists seems to have faced this problem. C. Macfie Campbell (1935) was in saying that, "the prestige attached to research dealing with the impersonal process of diseases leads some to hold that further progress in psychiatry investigation must await advances in the basic sciences." Taking this dependent attitude toward the solution of its special problems is dangerous, however, for psychiatry and to demand too much from other disciplines . . . Human nature cannot be adequately analysed by methods of chemistry and physiology and general biology.
Some knowledge of the history of science in general, and of medicine in particular, is useful, since it puts these issues in their proper perspective. We, in our vanity, trend to believe that the problems of our day are unique. It is understandable that we are impressed with the rapid expansion of biochemistry in its application to medicine, which in a short time has transformed some aspects of medicine from an art to a science. However, suppose that biochemistry had achieved its present state of maturity when medical knowledge was no further advanced than it was in the eighteenth century, when the description and differentiation of clinical syndromes as we know them today were just beginning. Had biochemistry been available to the clinician of that day, it could not have been applied, since the medical syndromes themselves had not yet been sorted out. It would have been as if botany had adopted a physical-chemistry theory of living organisms before it had established a systematic typology (Nagel, 1961). In some respects' psychiatry is at a stage comparable to medicine in the eighteenth century, in that modern clinical observation is still in its infancy, as it was born with the work of Kraepelin, Bleuler, and Freud. The application of basic science is possible only when there is clinical knowledge. It would be serious indeed if the clinician were to relinquish his investigative role to the basic scientist.
The tendency to undervalue and neglect clinical research is only part of the problem. As there has been some discouragement with psychoanalytic therapy s an investigative method, and this has resulted in premature attempts to substitute the methods of the more precise disciplines. The history of science documents the phenomenon on the awe of the mature sciences experienced by those whose own discipline is less precise. The awe of success is something with which we are all familiar in our own lives: Science, and the individual, adopts a similar response - imitation of the more mature. Nagel (1961) notes the adverse effect of the attempt to reduce prematurely the less advanced to the more precise science, since this diverts needed energies away from what are the crucial problems at a particular period in a discipline's expansion. To provide for an example as of: Newton's influence on the chemistry of his day was catastrophic (Bronowski and Mazlish, 1960), for mathematics became the model of all sciences, and chemistry, in their attempt to imitate Newton, dropped their own more appropriate techniques. Advances in chemistry in England came entirely from outside the Royal Society, because the scientists within the Society attempted to apply mathematic problems that could not yet be dealt within that way.
The inspiring awe of Newton's systematic description of the physical universe influenced medicine as well. For shortly after Newton's discoveries, it became fashionable to construct speculative systematic explanations of diseases that were sterile since they were divorced from direct clinical observation (Garrison, 1929, and Guthrie, 1946).
Within the last few decades, physics has undergone a second major revolution, and those of us whose disciplines are less mature have been subjected to similar influences. We are bedevilled with the trend toward quantification before we know what we are quantifying or have the instruments with which to measure. The theoretical achievements of physics are imitated in our day, as in Newton's, by the development of highly abstract theoretical systems that tend to become a form of scholasticism as the abstractions become increasingly removed from observation. Psychoanalysis also has not been entirely immune from these dispositional tendencies.
Schizophrenia is not a disease entity, but represent a symptom complex that could be considered ‘a final common pathway', that is, the outcome of variety of pathological conditions (Jackson, 1960). In this sense schizophrenia is comparable to the eighteenth-century diagnosis of dropsy. To apply the more precise techniques of te biological sciences to the problem of schizophrenia things must first be sorted out. The derailed clinical observations that are the daily work of the psychoanalytic psychiatrist should help to sort out the variety of clinical syndromes that we call schizophrenia. Careful psychological observations of the schizophrenias and related disorders may uncover clues about where a purely psychogenic rationale and a purely biological hypothesis fall down. It is therefore, that analytic psychiatry must prepare the way for the application of the more precise techniques of biological investigation. To paraphrase what has been said in another text. , Although clinical description fails to satisfy the standards of precision achieved by modern physics, it is prepared to prevent inconclusive evidence than no evidence at all (Somerhoff, 1950).
For the past three decades, psychoanalysts have become increasingly better acquainted with the group of patients who fall between the designation of neurosis and that of a psychosis. Calling these patients borderline cases is customary. These individuals display a variety of symptom complexes: They may be eccentric, withdrawn people who could be properly called schizoid, or they may be depressed, addicted, or perverted, or any combination of it. One might question to whether many differing symptomatic syndromes can be brought together under a single heading. If we are to consider the issuer, not as presenting symptoms but as for the similar nature of their object relationships, wee find many threads uniting these seemingly disparate disorders.
The conflicts of these people in relation to external objects bear a striking similarity to those observed in the schizophrenic patient. As wit the schizophrenic patient, there is a significant disorder in the sense of reality. This tends, in the borderline case, to be more subtle than and not so advanced as in schizophrenia. Nevertheless, for these principle reasons are we to considering this group to be homogeneous is that they develop a consistent and primitive form of object relationship in the transference. For the moment, let us say that it more closely resembles the transference of the schizophrenic than that of the neurotic patient. As to be learnt, more of psychopathology, we should expect to find that nosological entities will be based not so much on overt symptomatogy, but more upon the less overt psychopathological structure and not a symptomatic diagnosis.
The differences between the group and the schizophrenias also need to be emphasized: For in them, unlike most schizophrenic patients, we do not observe widely fluctuating ego states. There is, however, evidence of a certain stability of character and, as Gitelson (1058) has emphasized, their defences operate exceedingly well. They may at times regress into psychosis, but as a rule this is a circumstance's psychosis: It does not involve the total personality. They may, for example, develop ideas of reference, but they do not develop a major schizophrenic syndrome as described by Bleuler (1911) with a relative abandonment of object relationships. Although their difficulties' wit other people are serious, they tend to retain their ties to objects and, as Gitelson has expressed it, they ‘place themselves in the way of object relations'. It should bar to mind, that using the term ‘borderline'; not, as it has sometimes been used (Knight, 1953 and Zilboorg, 1941), to refer to incipiently or early schizophrenia.
The fact that the pathologies of borderline cases are relatively stable and that they maintain the object relationships that make it more possible to use the transference relationship as an investigative tool. It is both their closeness to and their difference from the schizophrenias that provides a certain contrast that may prove illumination.
Hendrick and Helene Deutsch were among the first to explore psychoanalytically this group of warping disorders. Both authors were aware that they were observing a group of character disorders that may be more closely related to schizophrenia than to neurosis. Although their clinical material was by no identical means of both what is believed in that they were observing a developmental disorder of the ego that placed a special strain on the processes of identity and identification. Helene Deutsch's (1942) description of the ‘as if' personality has become a classic. She described a group of people who superficially seem normal but whose life lack's genuine feeling. They can form relationships, but these are based more on identification that on love. As such that their object relationships have a primitive quality corresponding to the child's tendency to imitate. Their sense to identify is borrowed from the partner, so that their emotional life lacks genuineness. Not for all borderline mechanistic procedures as for: When we as to assume that the ‘as if' traits' are a syndrome within the borderline designation. Deutsch was not certain whether she was describing a personality type predisposed to schizophrenia or whether the symptoms were rudimentary symptoms of schizophrenia itself.
Hendrick (1936) described three different character types - the schizoid, the passive feminine man, and the paranoid character. He stressed the fact that these three had an elementally different ego structure that was closer to schizophrenia than to the neurosis? He understood this structural pathology to result from a failure of the normal maturational process. He noted the prominence of primitive destructive phantasies that interfere with the ego's executant functions, and offered an explanation confronted by recent observation. Hendrick speculated that these primitive, infantile, aggressive phantasies would normally have been terminated by a process of identification that had failed to occur.
Using the term borderline to refer to a symptomatically heterogeneous group of patients who nevertheless form a nosological entity because of their similar transference relationships. In older literature the term ‘schizoid personality' was employed to designate a similar nosological group, placed somewhere between neurosis and psychosis. This character type was considered most predisposed to develop schizophrenia. The schizoid individual is one who is described as aloof, irritable, and unable to form close relationships. It was further believed that such an individual was unable to form the transference. However, we now know that this view is incorrect. The withdrawal, an aloof person is only one of the many personality types who may become borderline. These patients do form a transference relationship, which is frequently extremely intense, but differs significantly from that formed by neurotic patients. This transference has specific features recognized as a useful operational method of diagnosing the borderline patient.
The relationships established by these people are of a primitive order, like the relationship of a child to a blanket or teddy-gear, yet they owe their lives, so to speak, to processes arising within the individual. Their objects are not perceived according to the ‘true' or ‘realistic' qualities. (As borrowed from Winnicott's concept of the transitional object, which he applied to the child's relation to these inanimate objects (Winnicott, 1951), from which having applied this designation to the borderline patient's relation to his human objects). The relationship is transitional in the sense that the therapist is perceived as an object outside the self, yet as someone who is not fully recognized as existing as a separate individual, but invested almost entirely with qualities emanating from the patient. Thus and so, that as placed of this object relationship midway between the transference of the neurotic (where the object is perceived as outside the self, whose qualities also disported by phantasies arising from the subject. However, the object exists as a separate individual). The experience of certain schizophrenics, who are unable to perceive that there is something outside the self. For these reason's posit of the term transitional to be accurate, as it truly designates a transitional stage.
With that, a further description describing this state of affairs in the borderline patient will now be acknowledged. The relationship of the borderline patient to his physician is analogous to that of a child to a blanket or a teddy bear. We can observe that there is a uniform, almost monotonous, regularity to the transference phantasies, especially in the opening phases of treatment. The therapist is perceived invariably as one endorsed with magical, omnipotent qualities, who will, merely by his contact with the patient, affects a cure without the necessity for the patient himself to be active and responsible. We may question why this should be considered characteristic of the borderline patient, since most people attributes to their physicians certain omnipotent powers, especially if their need is great. The wish for an omnipotent protector may exist in everyone: The difference resides in the fact that the borderline patient really believes the wish can be gratified. Finding that the borderline patient's belief in the physician's omnipotence corresponds to a belief in his own omnipotent powers, for he thinks that he can transform the world by means of a wish or a thought without the necessity for taking action, that is, without the need for actual work. He said, in contrast to the neurotic patient, unable to perceive that after all the physicians are only a human being like himself: The idiosyncrasies of the physician's personality, which make the physician a separate individual, do not seem to register. This intuitive awareness causing the certainty that many borderline patients share with some schizophrenics an uncanny ability to perceive accurately some aspects, mistakes the part for the whole, as these patients are not able to place what they note in its proper context. For example, Hendrick (1936) observed that the paranoid is correct in perceiving the hostility in others, but that is all he can perceive. It is striking that, no matter the many different personality types represented by a group of residents treading these patients, this phantasy of omnipotence uniform remains. It is soon found that the patient is unable to perceive the therapist as he is, for he is unable to perceive himself as he is. The omnipotent therapist corresponds to the omnipotence of his self-image, so that although the therapist is perceived as outside the self, he is endowed with qualities identical with those of the self, and the distinction between self and object is only partial.
The therapist is endorsed with qualities that are according to the patient's own primitive and undifferentiated self-image composed in part of both omnipotently creative and omnipotently destructive portions. There is then constant danger that the omnipotently benevolent and protective physician may be transformed into his opposite. These people's experience the harrowing dilemma of extreme dependence adjoined with an intense fearfulness of closeness. It is the familiar central conflict in both borderline and schizophrenic patients. The differences between these groups lie not so much in the content of the conflict as in the psychic structure available to mediate the conflict.
If one faces the belief that one's safety in the world depends on another human being, and this is coupled with the conviction that closeness to this other person will be mutually destructive, the solution lies in maintaining the proper distance. This dilemma is beautifully illustrated by Schopenhauer's famous simile of the freezing porcupines, quoted by Freud in his Group Psychology (1921?): ‘A company of porcupines crowded them very close together on a cold winter's day to profit from one anther's warmth and to save themselves from being frozen to death. Nevertheless, soon they felt one another's quills, which induced them to separate again, and the second evil arose again. So that they were driven backwards and forwards from one trouble to the other, until they discovered a mean distance at which they could most tolerably exist.
The quills of the porcupine correspond to the anger of these patient, which is, like the quills most defensive. Although mutual destruction is feared, when we examine their anxiety closely we recognize that the true danger arises not so much from their aggression, as from the more tragic fact that they fear that their love is destructive (Fairbairn, 1940). Fairbairn observed that phantasy that can be easily confirmed: To give love is to impoverish ones' self - and to love the other person is to drain him. What is of not is that the hostility is expressed easily. It is only after a long and successful treatment that we can observe the genuine expression of positive or tender feedings.
It may be thought that to certain extent this is present in all of us, that a fear of closeness may be part of the human condition. This would appear to weaken the case that it is a specific characteristic of transitional relationships. If we grant that what has been described is part of the transitional object relation, and if what may have some
understanding agreement to have the quality of being a representative for the observation of all human beings, then how can it be maintained that transference based on a transitional object is diagnostic of the borderline group? So if that is, to resolve this question: The growth of object love is a development process co-determined by the development both of the instincts and of the ego (Anna Freud, 1952). There are three phases of object love that have been implicit in this discussion. We assume that the earliest phase exists in the young infant who responds to the mother but is yet unable to make any psychological distinction between the self and the object: The middle stage has been described as the stage of the transitional object relation: The more mature stage of object love is the stage where there is a distinct separation between self and object. This is, of course, a condensed and oversimplified view, but it should suffice to give a demonstration of a developmental sequence in the growth of object relations. This view is not merely implied from the observation of adults, but is also based on the direct observation of children. For example, Mahler (1955) has convincingly shown that in the developed of the normal child there is a continuing phase where self and object are imperfectly differentiated? The stage that she has described as symbiotic corresponds in a general way o what we have described as the transitional object. Further evidence that the stage of the transitional object is an advance beyond the earliest stage of object relations is presented by Provence and Ritvo (1961). They are able to confirm the observations of Piaget and others (Rochlin, 1953) that the child's relationship to inanimate projective objects covering the interior of latitudinal liberation finds to his relation to the human object: Infants who were institutionalized and deprived of mothering did not develop transitional objects. Their observations suggest that some certain degrees of gratification from the material object have to be present for the child to reach the stage of the transitional object: The stage of the transitional object is not therefore the earliest stage of object relations. Freud wrote (1930) ": . . In mental; life, nothing that has once been formed can perish [that] everything is somehow preserved and [that] in suitable circumstances (when, for instance, regression continues back far enough) it can again be brought to light."
If applicable, we would then have in been as the remnants of earlier, more primitive stages of object relations are present in all of us to a greater or less degree. The difference between the borderline and the neurotic patient resides in the fact that for the most part the psychic development of the former became arrested at the stage of the transitional object, whereas the neurotic patient has passed through this stage, to develop love for objects who are perceived as separate from the self. It is true that, in the neurotic, remnants of these earlier stage may be found, and this is especially so when we look at certain creative processes where we can observer feelings of fusion and merging of the self with an object similar to those described in borderline patients. This is also the true religious experience, as Freud noted (1930), the experience of religious ecstasy may be sensed as an appreciable fusion and may exist in otherwise normal persons. William James (1902) describes the conviction of the religious person as a belief that no harm can befall him if he maintains his relation to God. This relation is also experienced as a partial fusion and mingling of identities, which seems quite similar to our description of a transitional object reflation.
We cannot avoid using the concepts of fixation and regression. Freud's analogy of the deployment of an advancing army, used to describe instinctual fixation and regression (Knight, 1953), is particularly apt for in describing the deployment of an army we introduce a quantitative factor, that is, where are most of the troops - are they in the forward, middle, or rear positions? In the borderline cases we would say that most of the troops are at the position of the transitional object, though a few may have achieved a more advanced position. In the neurotic individual, most of the troops have advanced beyond the position of the transitional object, though a few may be left behind.
Nevertheless, to what measure is played of the relation of these clinical observations to their problem of schizophrenia. Earlier reflections have stated that observations of the borderline patient may help to clarify certain nosological issues and may show where purely psychological or pure biological explanations fail. We have to consider the above material by this larger problem.
Clinical observations suggest that a nosological distinction be made between two groups of patients: One consists of those individuals whose defences are unstable, who display fluctuating ego-states, who appear to posses a capacity to suspend or abandon relations to external objects, as occurs normally in infantile fixational states of sleep. We would say that in these cases the illness appears to involve almost the total personality. In the contrasting group, of which the borderline patients form a portion, psychotic illness appears to occur only a part of the personality, and the defences of the ego are more stable: These patients might be unable to suspend or abandon their relations to external objects in a total sense. Their relation to external objects is impaired and distorted but somehow maintained.
The presence of psychosis is loss of ability to test reality. We know that the failure to deal; with reality is a consequence of an altered ego function (Hendrick, 1939), it is the consequence and not the cause of a psychotic deficiency (Federn, 1943), we know that the testing of reality depends upon the fact that the ego's growth distinction, and has been made between self and object (Freud, 1925). It is only when this distinction has been made that there can be a differentiation of what arises from within from what arises from without. In an earlier paper (Modell, 1961) as it is presented of many clinical observations that suggest that there are degrees of alteration of this function of testing reality hat correlate with the degree to which self and object can be differentiated. Self-object discrimination is a dynamic process with no absolute fixed points. The borderline transference is based on a transitional object relation where there is some self-object discrimination, but where this discrimination is imperfect. That is, the therapist is perceived as something outside the self, but is invested with qualities that are identical with the patient's own archaic self-image. Reality testing, then, is a process where degrees of alteration of functioning can be observed. If the definition of psychotics is based on the loss of the capacity to test reality, it would then follow that the points at which we designate a phenomenon as psychotic is not a fixed point but a broader area.
The dynamic that is the mobile nature, of this process needs to be emphasized. For example, borderline individuals may at certain times in their dealings with others can maintain a sense of reality. In the transference relationship this function may undergo a regression that may last only during the therapeutic hour. In these instances, the distinction between self and object that has ben maintained, although imperfectly, becomes obliterated. When this occurs the patient could be said to be technically psychotic in the transference situation. This dynamic regressions observed in the transferences is intermittently timed, in that they are unfortunately not limited to the treatment hour, and may extend into the patient's life. When this occurs we should judge the patient to be not only technically but clinically psychotic. The step backward that some borderline patient needs to take to be judged clinically psychotic are a short one. This step may be adequately understood as for a dynamic and structural psychological regression involving a further loss of self-object differentiation. If the etiology of what we call psychosis results from a further loss of self-object differentiation, there is no need to introduce the hypothesis that the induction of psychosis in these patients is the result of a neurochemical process that operates at the point in time at which the psychosis becomes manifest. The crucial etiological issue is that there is no emergence of psychosis, but those factors that have interfered with the growth of the ego, which in turn have resulted in the imperfect self-object differentiation. For the etiology of psychosis in the borderline group would appear to result from a developmental disorder of character that leads to an arrest of object relationships at the stage of the transitional object.
We know that the growth of object relations is the result of the interaction of two broad forces: The one relates to the quality of mothering: And the other to the child's biological equipment. Now it is conceivable that inherited or prenatally acquired variations in the biological equipment may significantly interfere. For example, it has been observed that some infants may be born with an unusual sensitivity of their perceptual apparatus. It is conceivable that such an oversensitive child would find the stimulation of nursing less pleasurable than a normal child. If this were true, a biological factor in this instance could conceivably interfere with the child's capacity to form his first object relationship. This is similar to Hartmann's (1952) suggestion that neutralization of instinctual energy is a biologically determined process, and an inherited impairment of this process could also lead to an impaired capacity to form object relationships. Jones (Zetzel, 1949) proposed that some individuals have a relative incapacity to tolerate frustration and anxiety. He thought that this might be an inherited feature similar to intelligence. Others, such as Greenacre (1941), have suggested that the operation of biological processes may not be transmitted in the chromosomes but may be the result of specific prenatal or birth experiences. She suggested that a traumatic birth experience may lead to an excessive level of anxiety in the development of the child.
It must be to admit that all these proposals, while plausible, remain unproved. However, they suggest that if we do establish a biological etiology in the borderline psychotic group, it will refer to those factors that interfere with the establishment of object relations in infancy and therefore lead to an arrest of ego development. Although those biological factors that interfere with the growth of object relations remain unproven - though probable - there is considerable clinical observation tending to support the view that some failure in maternal care is present in all those casers where there has been an arrest of the growth of the ego. This failure may take many forms. It may be actual loss of the mother or separation from the mother, as Bowlby (1961) has emphasized. However, from clinical experiences it does not seem to have been actual physical loss of the mother that took more subtle forms. Occasionally the mothers were unable to contact their children, as they themselves were severely depressed or even psychotic. In others reconstructing the fact that there had been significant absence of the usual amount of holding and cuddling was possible. In still other patients the physical care appeared to have been adequate, but there was a profound distortion in the mother's attitude toward the child. For example, mothers' incapacity to perceive the child as a separate person may induce a relative incapacity on the child's part to differentiate a self form object. We are not, however, able to state that these deficiencies of mothering will in themselves, without the contribution of other biological factors form within the child, lead to an arrest of the ego's growth at the stage of the transitional object.
It may prove important to emphasize that the crucial issue in the borderline patient and the related group of circumscribed psychoses is not the onset of the psychosis or psychotic-like condition, but is the developmental arrest that results in the impaired differentiation of self form objects. A loss of reality testing that defines the onset of psychosis is but a slight further accentuation, or regression, of an already impaired characterological formation.
The difference between the group that we have in describing and to those ‘other schizophrenias' appears in a certain instability of defences that followed a fluctuating ego state, and the culmination in the ability to suspend relations with objects in a manner analogous to dreaming while in the waking state. It's evolving impression that these two groups are separate nosological entities, and that a member of one does not become a member of the other. It's interpretation that this observation is to suggest the fact that something must be added to permit an individual to sever his relations to the external world by means of a dream-like withdrawal. As Campbell (1935) stated it,
- "I prefer to think of the schizophrenic as belonging to a Greek letter society for which the conditions for admission remain obscure." In that the capacity to suspend relations to external objects, which the borderline group does not posses, is determined by the presence of something that is unknown, and something that may be of biological and not of psychological origin. Some can gain admission to this fraternity, and others simply cannot, no matter how hard they try.
A biological hypothesis seems as to be unnecessary to explain the onset of psychosis in the group whose defences are stable, that is, in the borderline group, however, something must be added to develop a ‘major schizophrenia', and, yet, that the differences between the borderline and schizophrenic groups have been explained about the strength of the defence structure operating in the former group. For example, Federn (1947) has suggested that the schizoid personality protect the person from becoming a schizophrenic? Glover (1932) believed that a perversion that may frequently be observed in the borderline group also acts as a prophylaxis against psychosis and is, in his words, ‘the negative of certain psychotic formation'. If we could assume that the strength of defences was entirely psychologically determined, we would have no need to introduce a biological hypothesis. The argument that certain defensive structures protect against a greater calamity seems reasonable, but to believe that such an assertion begs the issue. For the remaining is the question to why these defences are effective: What is it that permits such defences to be maintained? If we wished to maintain the argument for a purely psychological determination, we might say that the strength of the defences is simply the consequence of the degree to which the ego has matured. The gist of this argument would be that the difference between the schizophrenic and the borderline is the result of the fact that the arrest in ego development is more extensive in the schizophrenic patient, perhaps because of an even greater disturbance in the early mother-child relationship. This may be a plausible argument: But the fact that many schizophrenics do not develop until mature adult life negates this hypothesis. For observation does not show that ego development in the schizophrenic is necessarily more primitive or more severely arrested than that of the borderline patient. We know that individuals who develop schizophrenia can come to the conclusion in adjoined agreement: often they have distinguished careers before the onset of their illness. It is inconceivable that such accomplishments could be possible in an individual whose growth had been arrested at the earliest levels. Schreber (Freud, 1911) was a distinguished jurist and was thirty-seven years old at the time of his first illness. There is, in that way, no evidence that the ego-arrest of schizophrenic patients is in all instances greater than in borderline actions. So, the possibility is not to assume of any difficulty of explaining the differences between the borderline and the schizophrenic group on purely psychological grounds.
Clinical observations suggest that we are dealing with at least two separate problems. One is a problem of character formation, which is a consideration of those factors that have interfered with the ego's growth so that love relationships become arrested at the stage of traditional objects. The other is probably a biological problem,
- What is it added to permit an individual to suspend his relations to his love objects? Whether the character development of the borderline and schizophrenic patient proceeds along separate or similar lines is a question that awaits further exploration. Its representation of a suspended emphasis would continue from what can be reconstructed from the history of schizophrenic patients that their love relationships from the history of schizophrenic patients that their love relationships went no further than that of the transitional object: That is, it is quite likely that they are unable to make a complete separation between themselves and their love objects. There is undoubtedly wide individual variation concerning the age at which ‘that certain biological something' is added. It is likely that the early presence of this hypothesized biological process in the schizophrenic group would produce certain divergences in character development as compared with the borderline group. The consulting psychiatrist, however, rarely has an opportunity to see a schizophrenic patient before the onset of his psychosis, so that there are few clinical data that can be used to clarify these questions.
Although we are unable to state to what extent the pre-psychotic development of the schizophrenic is similar to or different from that of the borderline patient, and it is likely that an arrest of the development of object relations at the transitional level is predisposing the factors for the development of schizophrenia. We might hypothesize that the unknown biological something that must be added will result in schizophrenia only where the ground has been prepared, that is, only whee there has been some arrest in the ego's growth. To state it another way: Transitional self-transactional object modulation is a necessary but not a sufficient cause of schizophrenia.
Placing special emphasis on the ‘ability to suspend relations to objects', in using an analogy of a normal state of sleep. This analogy is, however, inaccurate, at an important point. In sleep do not find substitutes for relations to objects suspended to show elsewhere (Modell, 1958) that auditory hallucinations serve as substitutes for the ‘real objects' lost, although in a certain sense, as Rochlin (1961) has emphasized, objects are never entirely relinquished. It is very important to know whether these objects are other human beings or are, in Schreber's terms, ‘cursorily improvised. The capacity to conjure up substitutes for other human beings is one that we do not all posses.
Lastly, to gather up some loose strands of our argument. Psychoanalytic exploration of the borderline states suggests the hypothesis that they represent a syndrome separate from the major schizophrenia. The essential difference rests in their lack of capacity to suspend or abandon relations to external objects. It is possible that this capacity is the result of a biological variation of the central nervous system and is not psychologically determined. In their character development, individuals who develop the major schizophrenias hare with the borderline group the fact that their object relations tend in the main to be arrested at the stage of their transitional object. Whether the pre-schizophrenic and borderline character disorders can be further distinguished from each other is question that we are not prepared to answer. This hypothesis suggests at least two different orders of possible biological determinants in schizophrenia: The one relates to an impaired capacity to develop mature object relations and is presumably operative from birth onwards: The other concerns the capacity to suspend relations with objects, and this anomaly could become apparent at varying ages in the life of an individual, in some instances not too full maturity or middle age. The arrest of ego development at the level of transitional objects is a necessary but not a sufficient determinant for the development of major schizophrenia.
If our nosological criteria are based on the capacity to suspend object relations and enter a dreamlike state, it can be seen that the concepts of reactive and process schizophrenia need to be re-evaluated. Our hypothesis suggests that the distinction between psychological and biological factors in the development of schizophrenia relate to the outcome or prognosis. For example, following Kraepelin has been customary (1919) in the belief that the more severe and deteriorating disorders are organic in origin, while the transient schizophrenias are psychogenic or reactive. This way of thinking receives no support from medicine, where an acknowledged organic disorder may run the gamut from mild and transient to severe and debilitating without leading one to assume differing etiologies. Therefore, no reason to link chronicity with the biologic, and transient states with the psychogenic, although we can discern that an individual may enter transient schizophrenic turmoil because of reality identifiable psychological Traumata, we should not therefore assume that the schizophrenia itself is explainable on purely psychological grounds. Whether such a person recovers, may also be observed to be again the outcome of psychological factors, i.e., whether the environment affords him any real satisfaction: This observation, however, should not lead us to conclude that the disorder is entirely psychogenic, for in medicine we know of many instances where recovery from organic illness influenced by environmental factors. We can further note that psychoanalytic observation of character disorders provides no support for the notion that what is transient is psychogenic and what is stable or unchanging is of biological origin. For psychoanalysis is well acquainted with a variety of extremely rigidly, unmodifiable character disorders that do not require, because of their poor prognosis, the introduction of a special biological hypothesis. There is no reason to connect a prognosis with etiology. From this pint of view the individual with a circumscribed paranoid character development who may have the poorest prognosis might have a considerably purer psychogenic disorder as compared with an acute but transient schizophrenic turmoil state. So, that our hypothesis would explain the paradox that Jackson (1960) noted, namely that the chronic paranoid who has nearly as bad a prognosis as the simplex patient shows the least variation from the norm in psychological terms, in weight and intactness of intelligence, dilapidation of habit patterns, etc.
So that our argument is that psychological knowledge has a certain priority over the biological, a priority in the sense of sequence of observation, that is, that the more all-inclusive, imprecise psychological observations must precede the less inconclusive, more precise biological observations. The psychoanalytic psychiatrist has first to sort things out so that the biologist may know where to look. This hypothesis is one that is not proved, but is still, quite testable.
The term ‘borderline state' has achieved almost no official status in psychiatric nomenclature, and conveys no diagnostic illumination of a case other than the implication that the patient is quite sick but not frankly psychotic. In the few psychiatric textbooks where the term is to be found at all in the index, it is used in the text to apply to those cases in which the decision is difficult about whether the patients in question are neurotic or psychotic, since both neurotic and psychotic phenomena are observed to be present. The reluctance to make a diagnosis of psychosis on the one hand, in such cases, is usually based on the clinical estimate that these patients have not yet ‘broken with reality?': On the other hand the psychiatrist feels that the severity of the maladjustment and the presence of ominous clinical signs preclude the diagnosis of a psychoneurosis. Thus the label ‘borderline state' when used as a diagnosis, conveys more information about the uncertainty and indecision of the psychiatrist than it does about the condition of the patient.
Indeed the term and its equivalents have been frequently attacked in psychiatric and psychoanalytic literature. Rickman (1928) wrote: "hearing of a case in which a psychoneurosis is common in the discretionary phraseology of a Mental Out Patient Department ‘masks' a psychosis, using the term with inward misgiving, there should be no talk of masks if a case is fully understood and is intuitively not so, having not received a tireless examination - except, of course, as a brief descriptive term comparable too ‘shut-in' or ‘apprehensive' which carry our understanding of the case no further." Similarly, Edward Glover (1932) wrote "I find the term ‘borderline' or ‘pre'-psychotically, as generally used, unsatisfactory. If a psychotic mechanism is present at all, it should be given a definite label. If we merely suspect the possibility of a breakdown of repression, this can be shown in the term ‘potential' psychotic (more accurately a ‘potentially clinical' psychosis). As for larval psychoses, we are all larval psychotics and have been such since the age of two." Again, Zilboorg (1941) wrote: "The despicable base advanced cases (of schizophrenia) have been noted, but not seriously considered. When of recent years such cases engaged the attention of the clinician, they were usually approached with the euphemistic labels of bonderising cases, incipient schizophrenias, schizoid personalities, mixed manic-depressive psychoses, schizoid maniacs, or psychopathic personalities. Such an attitude is untestable either logically or clinically" . . . ,. Zilboorg goes on to declare that schizophrenia should be recognized and diagnosed when its characteristic psychopathology is present, and suggests the term ‘ambulatory schizophrenia' for that type of schizophrenia in which the individual is able for the most part, to conceal his pathology from the public.
It is not to be wished to defend the term ‘borderline state' as a diagnosis, however, it leaves room to discuss the clinical conditions usually connoted by this term, and especially to call attention to the diagnostic, psychopathological, and therapeutic problems involved in these conditions. Therefore this is the limit of which the functional psychiatric conditions where the term is usually applied, and more particularly to those conditions that involve schizophrenic tendencies of some degree.
Thus and so, it s the common experience of psychiatrists and psychoanalysts to see and treat, in open sanitariums or even in office practice, many patients whom they regard, in a general sense, as borderline cases. Often these patients have been referred as cases of psychoneuroses of severe degree who have not responded to treatment according to the usual expectations associated with the supposed diagnosis. Most often, perhaps, they have been called severe obsessive-compulsive cases: Sometime an intractable phobia has been the outstanding symptom: Occasionally an apparent major hysterical symptom or anorexia nervosa dominates the clinical picture, and at times it is a question of depression, or of the extent and ominousness of paranoid trends, or of the severity of a character disorder.
What remains is the unsatisfactory state of our nosology that contributes to our difficulties in classifying these patients diagnostically, and we legitimately wonder at a touch of schizophrenia; is of the same order as a ‘touch of syphilis or a ‘touch of pregnancy?'. Consequently, we flounder so that all of such pronouncing correspondent terms as footing of latent or incipient (or ambulatory) schizophrenia, or accentuate in that of its severe obsessive-compulsive neurosis or depression, adding full coverage, ‘with paranoid trends' or ‘with schizoid manifestations'. Concerns for the most part, we are quite familiar with the necessary of recognizing the primary symptoms of schizophrenia and not waiting for the secondary ones of hallucinations, delusions, stupor and the like.
Freud (1913) made us alert to the possibly of psychosis underlying a psychoneurotic picture in his warning: "Often enough, when one sees a case of neurosis with hysterical or obsessional symptoms, mild in character and of short duration (just the type of case, that is, which one would see as suitably for the treatment) a doubt that must not be overlooked arises whether the case may not be one of the so-called incipient dementia praecox, so-called (schizophrenia, according to Bleuler), and may not eventually develop well-marked signs of this disease." Many authors in recent years, among them Hoch and Polatin (1949). Stern (1945), Miller (1940), Pious (1950), Melitta Schmideberg (1947), Fenichel (1945), H. Deutsch (1942), Stengel (1945), and others. Have called attention to types of cases that belong in the borderline band of the psychopathological spectrum, and have commented on the diagnostic and psychotherapeutic problems associated with these cases.
In attempting to make the precise diagnosis in a borderline case there is three often used criteria, or frames of reference, which are to lead to errors if they are used exclusively or uncritically. One of these, which stems from traditional psychiatry, is the question of whether or not there has been a ‘break with reality': The second is the assumption that neurosis is neurosis, psychosis is psychosis, and never the twain will be met: A third, contributed by psychoanalysis, is the series of stages of development of the libido, with the conception of fixation, regression, and typical defence mechanisms for each stage. Transference problems concerning to most psychoanalytic authors maintain that schizophrenic patient cannot be treated psychoanalytically because they are too narcissistic to develop with the psychotherapist an interpersonal relationship that is sufficiently reliable and consistent for psychoanalytic work. Freud, Fenichel and other authors have recognized that a new technique of approaching patients psychoanalytically must be found if analysts are to work with psychotics. Among those whom hae worked successfully in recent years with schizophrenics, Sullivan, Hill, and Karl Menninger and his staffs have made various modifications of their analytic approach.
We think of a schizophrenic as a person who has had serious traumatic experience in early infancy at a time when his ego and its ability to examine reality were not yet developed. These early traumatic experiences seem to furnish the psychological basis for the pathogenic influence of the flustrations of later years. Earlier the infant lives grandiosely in a narcissistic world of his own. Something may take his needs and desires care of vague and indefinite which he does not yet differentiate. As Ferenczi noted they are expressed by gestures and movements since speech is yet undeveloped? Frequently the child's desires are fulfilled without any expression of them, a result that seems to him a product of his magical thinking.
Traumatic experiences in this early period of life will damage a personality more seriously than those occurring in later childhood such as are found in the history of psychoneurotic. The infant's mind is more vulnerable the younger and less used it have been in furthering the trauma is a blow to the infant's egocentricity. In addition early traumatic experience shortens the only period in life in which an individual ordinarily enjoys the moist security, thus endangering the ability to store up as it was a reasonable supply of assurance and self-reliance for the individual's late struggle through life. Thus is such a child sensitized considerably more toward the frustrations of later life than by later traumatic experience. Therefore many experiences in later life that would mean little to a ‘healthy' person and not much to a psychoneurotic, mean a great deal of pain and suffering to the schizophrenic. His resistance against frustration is easily exhausted.
Once he reaches his limit of endurance, he escapes the unbearable reality of present life by attempting to reestablish the autistic, delusional world of the infant, but this is impossible because the content of his delusions and hallucinations are naturally coloured by the experiences of his whole lifetime.
How do these developments influence the patient's attitude toward the analyst and the analyst's approach to him?
Due to the very early damage and the succeeding chain of frustrations that the schizophrenic undergoes before finally giving in to illness, he feels extremely suspicious and distrustful of everyone, particularly of the psychotherapist who approaches him with the intention of intruding into his isolated world and personal life. To him the physician's approach means the threat of being compelled to return to the frustrations of real life and to reveal his inadequacy to meet them, or - still worse - a repetition of the aggressive interference with his initial symptoms and peculiarities that he has encountered in his previous environment.
In spite of his narcissistic retreat, every schizophrenic has some dim notion of the unreality and loneliness of his substitute delusionary world. He longs for human contact and understanding, yet is afraid to admit it to himself or to his therapist for fear of further frustration.
That is why the patient may take weeks and months to test the therapist before being willing to accept him.
However, once he has accepted him, his dependence on the therapist is greater and he is more sensitive about it than is the psychoneurotic because of the schizophrenic's deeply rooted insecurity; the narcissistic seemingly self-righteous attitude is but a defence.
Whenever the analyst fails the patient from reasons to be of mention - one severe disappointment and a repetition of the chain of frustrations the schizophrenic has previously endured.
To the primitive part of the schizophrenic's mind that does not discriminate between himself and the environment, it may mean the withdrawal of the impersonal supporting forces of his infancy. Severe anxiety will follow this vital deprivation.
In the light of his personal relationship with the analyst it means that the therapist seduced the patient to use him as a bridge over which he might be led from the utter loneliness of his own world to reality and human warmth, only to have him discover that this bridge is not reliable. If so, he will respond helplessly with an outburst of hostility or with renewed withdrawal that one may be seen as most impressively in catatonic stupors.
Through reasons of change, this withdrawal during treatment is a way the schizophrenic has of showing resistance and is dynamically comparable to the various devices the psychoneurotic uses to show resistance. The schizophrenic responds to alterations in the analyst's defections and understanding by corresponding stormy and dramatic changes from love to hatred, from willingness to leave his delusional world to resistance and renewed withdrawal.
As understandable as these changes are, they nevertheless may come to the conclusion of quite a surprise to the analyst who frequently has not observed their source. This is quite in contrast to his experience with psychoneurotic whose emotional reactions during an interview he usually predicts. These unpredictable changes may be the reason for the conception of the unreliability of the schizophrenic's transference reactions, yet they follow the same dynamic rules as the psychoneurotic's oscillations between positive and negative transference and resistance. If the schizophrenic's reactions are more stormy and seemingly more unpredictable than those of the psychoneurotic, perhaps this may be due to the inevitable errors in the analyst's approach to the schizophrenic, of which he himself may be aware, than to the unreliability of the patient's emotional response.
Why is it inevitable that the psychoanalyst disappoints his schizophrenic patients time and again?
The schizophrenic withdraws from painful reality and retires to what resembles the early speechless phase of development where consciousness is yet crystallized. As the expression of his feelings is not hindered by the conventions he has eliminated, so his thinking, feeling, behaviour and speech - when present - obey the working rules of the archaic unconscious. His thinking is magical and does not follow logical rules. It does not admit to any, and likewise no yes? : There is no recognition of space and time, as ‘I', ‘you' and ‘they' are interchangeable. Expression is by symbols, often by movements and gestures rather than by words.
As the schizophrenic is suspicious, he will distrust the words of his analyst. He will interpret them and incidental gestures and attitudes of the analyst according to his own delusional experience. The analyst may not even be aware of these involuntary manifestations of his attitudes, yet they mean a great deal of the hypersensitive schizophrenic who uses them for orienting himself to the therapist's personality and intentions toward him.
In other words, the schizophrenic patient and the therapists are people living in different worlds and on different levels of personal development with different means of expressing and of orienting themselves. We know little about the language of the unconscious of the schizophrenic, and our access to it is blocked by the very process of our own adjustment to a world the schizophrenic has relinquished. So we should not be surprised that errors and misunderstandings occur when we undertake to the spoken exchange and strive for a rapport with him.
Another source of the schizophrenic's disappointment arises from the following: Since the analyst accepts and does not interfere with the behaviour of the schizophrenics, his attitude may lead the patient to expect that the analyst will assist in carrying out all the patients' wishes, although they might not be his interest, or to the analyst's and the hospital's in their relationship to society. This attitude of acceptance so different from the patient's experiences readily fosters the anticipation that the analyst. As to carry out the patient's suggestions as to take upon his dispense ways, even against the established controversial change in a society of which should occasion to arise. Frequently, agreeing with the patient's wish to remain unbathed and untidy will be wise for the analyst until he is ready to talk about the reasons for his behaviour or to change spontaneously. At other times, he will unfortunately be unable to take the patient's part without being able to make the patient understands and accept the reasons for the analysts' position. If, however, the analyst is not able to accept the possibility of misunderstanding the reactions of his schizophrenic patient and in turn of being misunderstood by him, it may shake his security with his patient. The schizophrenic, once accepted the analyst and wants to rely upon him, will sense the analyst's insecurity. Being helpless and insecure he - in spite of his pretended grandiose isolation - he will feel utterly defeated by the insecurity of his would-be helper. Such disappointment may furnish reasons for outbursts of hatred and rage that are comparable to the negative transference reactions of psychoneurotic, yet more intense than these since they are not limited by the restrictions of the actual world.
These outbursts are accompanied by anxiety, feelings of guilt, and fear of retaliation that in turn lead to increased hostility. Thus, lay the groundwork for a vicious circle: We disappoint the patient: He hates us, is afraid we hate him for his hatred and therefore continues to hate us. If in addition he senses that the analyst is afraid of his aggressiveness, it confirms his fear that he is effectively considered dangerous and unacceptable, and this augments his hatred.
This establishes that the schizophrenic is capable of developing strong relationships of love and hatred toward his analyst. After all, one could not be so hostile if it were not for the background of a very close relationship, once to emerge from an acutely disturbed and combative episode. In addition, the schizophrenic develops transference reaction in the narrower sense that he can differentiate from the actual interpersonal relationship.
What is the analyst's further function in therapeutic interviews with the schizophrenic? As Sullivan has stated, he should observe and evaluate the entire patient's words, gestures, changes of attitude and countenance, and he does the associations of psychoneurosis. Every production - whether understood by the analyst or not - is important and makes sense to the patient. Therefore the analyst should try to understand, and let the patient feel that he tries. He should as to preclude and not attempt to prove his understanding by giving interpretations because the schizophrenic himself understands the unconscious meaning of his productions better than anyone else. Nor should the analyst ask questions when he does not understand, for he cannot know what trend of thought, far off dream or hallucination he may be interpreting. He gives evidence of understanding, whenever he does, by responding cautiously with gestures or actions appropriate to the patient's communication, for example, by lighting his cigarette from the patient's cigarette instead of using a match when the patient seems to say a wish for closeness and friendship.
What has been said against intruding into the schizophrenic's inner world with superfluous interpretation's also holds unswerving for untimely suggestions? Most of them do not mean the same thing to the schizophrenic that they do to the analyst. The schizophrenic who feels comfortable with his analyst will ask for suggestions when he is ready to receive them. If he does not, the analyst does better to listen, least of mention, the schizophrenic's emotional reactions toward the analyst have to be met with extreme care and caution. The love that the sensitive schizophrenic feels as he first emerged, and his cautious acceptances of the analyst's warmth of interest are really most delicate and tender things. If the analyst deals uncleverly with the transference reactions of a psychoneurotic, it is bad enough, though as a rule is separable but if he fails with a schizophrenic in meeting positively feeling by pointing it out for instance before the patient shows that he is ready to discuss it, he may easily freeze to death what had just begun to grow and so destroy any further possibility of therapy.
Sometimes the therapist's frank statement that he wants to be the patient's friend but that he is going to protect himself should him be assaulted may help in coping with the patient's combativeness and relieve the patient's fear of his own aggression. As, too, some analysts may feel that the atmosphere of complete acceptance and strict avoidance of any arbitrary denials that we recommend as a basic rule for the treatment of schizophrenics may not accord with our wish to guide them toward reacceptance of reality. This may not be as apparently so. Certain groups of psychoneurotics have to learn by the immediate experience of analytic treatment how to accept the denials life has in store for each of us. The schizophrenic has above all to be cured of the wounds and frustrations of his life before we can expect him to recover.
Other analysts may feel that treatment as we have outlined it is not psychoanalysis. The patient is not instructed to lie on a couch, and he is not asked to give free associations (although frequently he does), and his productions are seldom interpreted other than by understanding acceptance. Freud says that every science and therapy that accept his teachings about the unconscious, about transference and resistance and about infantile sexuality, may be called psychoanalysis. According to this definition we believe we are practising psychoanalysis with our schizophrenic patients.'
Whether we call it analysis or not, successful treatment clearly does not depend on technical rules of any special psychiatric school but on the basic attitude of the individual therapist toward psychotic persons. If he meets them as strange creatures of another world whose productions are non-understandable to ‘normal' beings, he cannot treat them. If he realizes, however, that the difference between himself and the psychotic is only one of degree and not to kind, he will know better how to met him. He can probably identify himself sufficiently with the patient to understand and accept his emotional reactions without becoming involved in them.
Amid the welter of competing or complementary theories that have characterized psychoanalysis over the century of its existence, the concept of transference and the conviction so important in the therapeutic process may be a unifying theme. None of Freud's epochal discoveries - the power of the dynamic unconscious, the meaningfulness of the dream, the universality of intrapsychic conflict, the critical role of repression, the phenomena of infantile sexuality - is more heuristically productive or more clinically valuable than his demonstration that humans regularly and inevitably repeat with the analyst and with other important figures in their current lives patterns of relationship, of fantasy, and of conflict with the crucial figures in their childhood - primarily their parents.
Even for Freud, however, the awareness of this phenomenon and the understanding of its specific significance in the analytic situation itself came only gradually. The flamboyant transference events for Anna O and the unfortunate outcome with Dora served to consolidate in Freud's mind a view of transference as a resistance phenomenon, as an obstacle to the recollection of early traumatic events that, in his view at the time, formed the true essence of the psychoanalytic process. Emphasis in this early period, thus, was on the 'management' of the transference, on finding ways to prevent its interference with the proper business of the analysis - recognizing, always, the inevitability of its occurrence. Freud was most concerned about the interference generated by the 'negative' (i.e., hostile) and the erotised transference; the 'positive' transference he considered 'unobjectionable', "the vehicle of success in the psychoanalysis."
Freud was also concerned to distinguish the analytic transference from the effects of suggestion in the hypnotic treatment he had learned in France and that gad been the forerunner of his own psychoanalytic technique. He, and his early followers and students, were at great pains to define the transference as a spontaneous product of the analytic situation, emerging from the patient rather than imposed by the analyst. Ultimately, Freud came to view as essentially for an analytic cure the development of a new mental structure, the "transference neurosis" - a re-creation of the original neurosis in the analytic situation itself, with the patient experiencing the analyst as the object of his or her infantile wishes and the focus of his or her pathogenic conflicts, the crucial importance of the transference neurosis - it's very reality as a clinical phenomenon - has been and continues to be a matter of debate among psychoanalysts to this day.
Over the resulting decades several themes appear and reappear. One to which Freud eluded is that of the uniqueness versus the ubiquity of transference; is it a special creation of the analytic situation or is it an inevitable and universal aspect of all human relations? To a considerable degree, are transference phenomena always based on a repetition of experiences? More central and perhaps more heated is the continuing debate about the primacy of transference interpretation in what Strachey has called the 'mutative' effects of analysis - for example, whether such interpretations are simply more convincing than others or are the only kinds that are truly effective therapeutically. Echoes of this debate resound through the years and are to the spoken exchange in some of most recent literature. Finally, are all the patients' reactions to the analyst in the analytic situation to have the quality of being construed as transference or do some partake of the "real," "non-neurotic" relationship or of the "working alliance."
The theoretical explanation of the transference and transference phenomena have undergone significant changes over the years. The transference has become a sort of projective device, a vessel into which each commentator poured the essence of his or her approach to the clinical situation and to the understanding of what unique interactional process that forms the analytic situation.
The introductory group (1909-36) that of the pioneers, shows the afforded efforts of Freud and his early followers to grasp and deal with the powerful phenomenon they were only beginning to recognize and to attempt to understand. The middle period (1936-60) reflects the consolidation of therapeutic technique and he attempts of both European and American analysts to bring the concept of transference into consonance with the increasingly important constructs of ego psychology. In the latest period of which (1960-87), basis the groundwork for a balance between reassertion of traditional views and various revisionist statements and reconsiderations of some classical positions.
Freud's awareness of the actuality of transference phenomena - that is, of the development in the patient of powerful feelings and wishes toward the therapist in the "talking cure" - began when he first learned from Joseph Breuer of the events that occurred in his treatment of Anna O. It was not, however, until the debacle with Dora that they brought the full force of this phenomenon home to him - if not of his own countertransference feelings as well. Transferences are, Freud said, "new editions or facsimiles of the impulses and fantasies aroused and made consciously during the progress of the analysis; up to the present time they have this peculiarity, . . . that they replace some earlier person by the person of the physician." "Psychoanalytic treatment does not create transference, but it merely brings them to light like so many other hidden psychical factors."
Freud did not again deal in detail with the subject of transference until 1912, in The Dynamics of Transference. In fact, the first paper devoted specifically upon its subject matter was in Ferenczi's "Introjection and Transference," and published in 1909. Ferenczi offered an exposition on the topic, drawing his stimulus from Freud's reference to "transferences" in The Interpretation of Dreams and the Dora case. Transference, he states, is a special case of the mechanism of displacement, is ubiquitous in life but especially pronounced in neurotics, and makes explicitly the form of an appearance in the relationship of patient to the physician - in or outside the psychoanalysis. He relates the transference to other psychic mechanisms, most particularly projection and introjection, and defends the psychoanalysis against accusations of improperly generating transference reactions in its patients. "The critics who look on these transferences as dangerous should." He says, "condemn the non-analytic modes of treatment more severely than the psychoanalytic method, since the former really intensifies the transference, while the later shrives to uncover and to resolve them when possible."
It was not until 1912, in The Dynamics of Transference, that Freud returned to the subject. Here he explains about libido economy, and given that the topographical model of the mind the inevitable emergence of the transference in the analytic situation and its role as an all-important crucial mode of resistance. "The transference-idea penetrated into consciousness in front of any other possible association because it satisfies the resistance, but only if it is a negative or erotic transference. The analyst's role is to ‘control' or' ‘remove' the transference resistance. It is, Freud said, "on that field that we must be win the victory?"
We have substantially explored the problem posed by the erotic transference on Observations on Transference-Love. Freud speaks systematically about the dangers of unregulated countertransference, and he admonishes his colleagues on the need to maintain analytic neutrality in the face of the patient's importunate demand for fulfilment of the erotic longings. Here, again, he coins the much-debated aphorism, they must carry "the treatment out in abstinence." He makes it clear that "transference lover" is not to occupy the inescapable position by some spatial moment of the some insignificant or deviant, as it draws on the same infantile well-springs as the love of everyday life. It is the analyst's business to deal with it analytically rather than by gratifying or rejecting it.
Freud's illumination of the phenomenon of transference although, little appeared in the literature bearing specifically on the topic for several of years. Yet it seems that,
as Strachey points out, this was due to the preoccupation of most analysts, particularly in the rise of ego psychology, with the analysis of resistance and of character traits. It was, therefore, not until 1934 that the most important and, to this day, the most influential post-Freudian contribution to the analysis of transference appeared -. Strachey's "Nature of the Therapeutic Action of Psycho-Analysis." Strongly reflecting the influence of Melanie Klein, Strachey outlines the notion that the central analytic task is the resolution of archaic superego elements in the structure of the mind, and that the definitive instrument for affecting this is what he terms "mutative interpretation." Such an interpretation must, he says, "be emotionally immediate" and "directed to the point of urgency'; "the point of regency is nearly always to be found in the transference." "Therefore, only transference interpretations are likely to be mutative. Conversely, we are still hearing the reverberations of this shot today."
Freud's early view of the transference as Sterba echoed and exemplified a resistance to the analytic work by Sterba, in his report of a case that obviously derived from his European experiences, for example, the description of goose stuffings. Here he explains technical measures for the dissolution of such resistances, which include explanations similarly that "the hostility toward his father, . . . may not have had the quality of being analysed if he developed the unconscious hostility and consequent anxiety toward the analyst that he formally had for his father" In other words, they essentially enjoined the transference, rather than analysed, by appealing to what Sterba came to calling the "observing ego," as opposed to the "experiencing ego."
Among the first to apply psychoanalytic principles outside the consulting room was August Aichhorn? Trained as an educator, Aichhorn undertook to work with delinquent adolescents in Vienna and established the first therapeutic school based on psychoanalytic principles; in this setting, he became the mentor for a generation of child analysts, including Erikson, Blos, Ekstein, Redl, and others. In his classical text, Wayward Youth, Aichhorn displayed some extraordinary techniques he devised for treating dissocial adolescents - in particular, ways of manipulating the transference to establish a positive relationship at the outset of treatment.
The appearance in 1936 of Anna Freud's the Ego and the Mechanisms of Defence represented a landmark in the evolution of psychoanalytic theory and technique. Ms. Freud's specific codification of the defensive apparatus and her emphasis on the necessity of analysing not merely the id elements but the ego elements of the mind signalled major changes in the way analysts thought about and carried on their clinical work. Nonetheless, her observations on the role of transference analysis, trenchant as they were, remain within the framework of the traditional view of transference phenomena as "repetitions and not new creations." The function of the analysis of transference is to put the "transferred effective impulse . . . back into its place in the past." Ms. Freud drew the valuable distinction among the transferences of "libidinal" impulses, the transference of defence, and acting in the transference. Her contribution emphasized the critical value of the analysis of defence transference, which, ads she explained, is far more difficult than that of transferred drive impulses because the patient experiences it as ego-syntonic.
The dominant trend in early discussions was the presumption that the transference is an "autogenous" product of the patient induced, no doubt, by the special character of the analytic situation but emerging out of the patient's own needs and unfulfilled infantile wishes. Bibring-Lehner (later simply as Bibring) was unitarily to suggest those particular characteristics of the analyst or his or her behaviour can so shape the emerging transference as to create an impenetrable resistance that might. Require a change of analysts. In particular, Bibring-Lehner addressed the matter of the gender of the analyst, but clearly other factors might suffice to blur the patient's distinction between transference and reality and thus to create an unanalysable stalemate. She spoke, too, of the necessity of a "predominantly positive transference based on confidence, without whose help we cannot overcome the transference neurosis," this clearly prefigured the concept of the "therapeutic" or "working" alliance that later becomes a focus on controversy.
During the interval (1936-1960), the concerns of those who contributed to the ongoing discussions of transference and its place in analytic theory and technique, in which time this period was to relate its phenomenological growth in understanding of the ego, both in its defensive and (Hartmanns) 'autonomous' aspects, to new theories of early development and to a growing concern in some quarters with "interpersonal" as opposed too purely "intrapsychic" aspects of personality function. A subsequent stimulus was Alexander's (1946) advocacy of active role playing by the analyst to give the patient a "corrective emotional experience," at least in psychoanalytic psychotherapy if not in analysis proper.
Of a well-oriented paper, Greenacre emphasizes the distinction, first stated by Freud, between the analytic transference and that which characterizes other modes of therapy. All manipulation, exploitation, we have excluded all use of transference for "corrective emotional experience" from the psychoanalytic situation, which relies exclusively on interpretation to achieve its therapeutic goal. Greenacre's view of the analyst's role in analysis and in the world outside as ascetically in agreement; she would preclude the analyst from publicly participating in social or political activities that might have a possessive tendency to reveal aspects of the analyst's person that would contaminate the transference. Like Freud, Stone, and others she distinguishes between a "basic," essentially non-conflictual transference derived from the early mother-child relationship and the analytic transference proper, which involves projection onto the analyst of unconscious conflictual material, yet, others (for example, Brenner) challenge this distinction.
It is, however, echoed in Elizabeth Zetzel's masterful review of what were, the dominant trends in the field. She proposed, following the usage of Edward Bibring, the concept of the "therapeutic alliance," derived, as was Greenacre's "basic transference," from the positive aspects of the mother-child relationship. Like most other commentators she asserted the centrality of transference interpretation in the analytic process, but she resorts by a schismatically oriented sharping detail of some differences in the form and content of such interpretations between Freudian and Kleinian analysis - that is, between those who are concerned with the role of the ego and the analysis of defence and those who emphasize the importance of early object relations and primitive instinctual fantasy.
Like Greenacre and Zetzel, Greenson distinguishes between what he calls the "working alliance" sand the "transference neurosis." He contends that without the development of the former they cannot analyse the latter effectively. The "working alliance" depends not only on the patient's capacity to establish adequate object ties and to assess reality. However, also on the analyst's assumption of an attitude that permits such an alliance to emerge, and, also to Greenson who advocates an analytic stance that, while holding fast to the rule of abstinence, allows for more "realistic" gratification that is no less ascetical than Greenacre would encourage. Gill will later challenge Greenson's definition of transference - that it always represents a repetition of experiences and that it is always "inappropriate to the present," - who contends that transference reactions may be appropriate responses to aspects of the analytic situation of which both patient and analysts are not necessarily aware.
In contrast to these views, Brenner categorically rejects the notions of "therapeutic" and "working" alliances as distinct from the analytic transference, and with them the admonition to the analyst to be "human" or "empathic" to encourage such states. In his view, "both refer to aspects of the transference that neither deserve a special name nor require special treatment." "In analysis," he says, "it is best for the patient if one approaches everything analytically. It is as important to understand why they have closely ‘allied a patient' with his analyst . . . as, it is to understand why there is no ‘alliance' at all."
In an extremely thoughtful, systematic exploration of the topic, Macalpine argues that the infantile situation induces transference in patients in which the analysis, by its rightfully hidden nature, places them. As do hypnotic subjects, analysands adapt by regression and, if we have predisposed them to do so, will experience the present as to their infantile past. What distinguishes analysis from hypnosis is the nonparticipation of the analyst in the process - that is, the analyst's avoidance, by the management of his or her countertransference, of active suggestion. "The analytic transference relationship had respectably spoken not as to make up the relationship between analysand and analyst, but more precisely as the analysand's relations to his analyst." In these Macalpine stands apart from more recent object relations theorists who stress the mutual dyadic aspect of the analytic situation.
Nurnberg, too, analogizes the analytic situation to that of hypnosis, in its induction of a regressive state in which the patient submits to the analyst's implicit parental power and authority. The patient then projects onto the analyst his or her unconscious representation of the parent, seeking to achieve an "identity of perception" between the two images. Primarily it is the superego, he contents, that is in such a way projected, and it is through the analysis of these projections that we have enabled the patient to deal more effectively with reality. It must be of note that in Nunberg's tendency to denote the source of the superego as exclusively presented as "the father" and the transference projection as that of the "father image."
They have rooted Melanie Klein's approach to the transference, of course, in her conception of the developmental process and the role of early object relations, which, she maintains, exists from the beginning of life. The transference represents the displacement of not only the actual aspects of parents but also of split-off projected and introjected part-object representations from early infancy - prosecutory "bad" objects or benevolent "good" ones. Like Gill, Klein both emphasizes the importance of attending to and interpreting subtle or disguised references to the analyst and maintains that therapeutic necessity of relating all associative content to transference fantasies and wishes, with special emphasis on the negative transference (another lucid exposition that of his, a Kleinian approach to the transference is that of Paula Heimann [1956] ).
Under the influence of Mrs. Klein many British analysts, D. W. Winnicott among them, have undertaken to analyse patients with what Americans would speak of as severe ego disturbances - borderline and psychotic in nature. Winnicott's too repressed at the time of the original experience, she appears to anticipate Winnicott's ideas about "true" and "false" selves.
Freud distinguished between the "transference neuroses" and the "narcissistic neuroses," which included schizophrenia. He contended that patients in the latter group did not establish transferences and thus were inaccessible to psychoanalytic therapy. Like Winnicott, Fromm-Reichmann, from her experience with schizophrenics at Chestnut Lodge, challenges this dictum. Though clearly not adaptable to the conventional analytic situations, such patients do, she contends, from intense. Transference reactions and are susceptible too analytically informed, though often unorthodox, therapeutic intervention. Though many would question the ultimate effectiveness for such a therapy that pose to pass on (McGlashan 1984), Fromm-Reichmann's description of her special techniques for establishing contact with persons in profound states of narcissistic regression and for understanding their transference reactions are impressive and are still of value.
Recent decades have witnessed a resurgence of interest in the transference in its aspects - theoretical and technical. Stimulated by new analytically perceptive both in Europe and the United States and by influences stemming from linguistics and philosophy, several commentators have sought to reconsider traditional viewpoints and to satisfy new observational data.
In his long, densely written paper Stone undertakes a comprehensive statement of his views on the varied aspects of the transference from developmental and clinical perspectives. In particular, he sets forth a distinction between the "primordial" and the "mature" transference "from which," he says, we have derived "the various clinical and demonstrable forms," where they have "derived the "primordial" transference from the effort to master the series of crucial separations from the mother," the mature transference "encompasses . . . the wish to understand, and to be understood" and "in its peak development, . . . the wish for increasingly accurate interpretations." The "mature" transference draws then on autonomous ego functions and is a "dynamic and integral part of the ‘therapeutic alliance.'" Stone also deals in extensor with the Stracheyian question of the special "mutative" value of transference interpretation, while not devaluing these, he argues persuasively for the importance of the patient's real life experiences and the analytic value of interpretations related to them.
One of the most forceful statements of the centrality of the transference to the analytic experience is that of Brian Bird. In his view, there is something unique about the analytic transference; for him, everything that occurs in the analysis for both patient and analyst partakes of transference elements. Yet for Bird, what is essential for the therapeutic effect is not merely the analysis of transference "feeling" but the evolution and analysis of a full-blown transference neurosis. He asserts, the quintessence of the transference neurosis is an analytic stalemate, in which one's interpersonal replaced be as an intrapsychic conflict involving the patient and a split-off aspect of his or her neurosis assigned to the analyst. The true work and the "hardest part" of analysis go on, and it is in the interpretation and resolution of such stalemates - including a rigorous analysis of the patient's hostile, destructive wishes.
Gill, in basic agreement, carries the argument even in a major way. He distinguishes between the patient's resistance to awareness of transference and the resistance to the resolution of the transference. It is the former, where transference experiences are largely unconscious and ego-syntonic, that is the more difficult. It is the analyst's task to allow the transference to evolve and flourish so that we can make the patient aware of it. To do so, the analyst must be alert to interpret indirect and veiled allusions to the transference and, to a considerable degree, seek out those elements of the analytic situation, including the analyst's own behaviour, that serve as the "day-residue" for such transference responses. Gill strongly advocates a focus on the here-and-now factors, allowing genetic determinants to emerge on their own rather than interpreting them.
The distinction between what has been called the "basic" transference, or the "therapeutic alliance" or the "working alliance," on the one hand and the analytic transference or transference neurosis in the other has been a staple of controversy. Stein, reflecting on Freud's term "the unobjectionable part of the transference," takes issue with this distinction. Insisting of the entire transference phenomena that he so then encourages the forethought against the practice of leaving the "unobjectionable" or "basic" transference unanalysed: They are, he says, "the manifest resultant of a complex web of unconscious conflicts that must be, and are unably effective of being, sought and described." The speculative assumption was that they were to personify of some underlain realization as rooted merely in early infant development as he believes unwarranted.
From his reassessment of basic psychoanalytic concepts, Schafer, influenced by British analytic philosophers, provides a revised view of transference and transference interpretation - in particular, of the character of transference as "repetition." As Schafer sees it, transference experiences are new ones, created by the analytic situation. It is the act of analytic interpretation that forms them as repetition. More properly they can see them as metaphoric communications; thus, "they represent movement forward, not backward." Interpretation does not merely recover or uncover old meanings; it creates new meanings that help the patient to make sense - psychoanalytic sense - of his or her life and modes of relating to others. Transference, Schafer says, is "the emotional experiencing of the past as it is now remembering," not as it "really" happened.
Loewald considers the status of the transference neurosis in the setting of contemporary practice, in which the modal patient suffers from a character neurosis rather than from the "classical" symptom neuroses of an earlier era. Given the more diffuse developmental etiology of the character disturbances, transference manifestations are so inclined as to be modestly definite and less focussed; a transference neurosis in the classical sense may not appear at all. Thus, "transference neurosis is not so much an entity to be found in the patient, but an operational concept, . . . a creature of the analytic situation." Even where a full-blown transference neurosis does not develop, however, we can accomplish much? "The repercussion of what has occurred," Loewald states, "may turn out to be deeper and more extensive than anticipated."
Strachey's pivotal advocacy of the exclusively "mutative" value of transference interpretation has led to one major controversy in the literature. In its extreme form, the position taken was not only that transference interpretations were crucial but that interpretations addressed to extra-transferential experiences were in principle ineffective and useless. Leites, a non-clinician, survey the literature to argue strongly for the other side - for the view, that is, that the analysis of current and experiences with others can be as effective and meaningful as can the unifocal address to the transference. Without reducing the special impact of transference interpretations, Leites seeks to undo the dogmatism and rigidity he sees inherently in what he calls "Strachey's Law."
In the evolution of what came to his "psychology of the self," Heinz Kohut demarcated a topology of transference reactions that were, in his view, characteristic of patients with narcissistic personality disorders. This, the "idealizing" and "mirror" transferences, reflected specific types of deprivation in early parent-child interactions that generated a persistent need for special types of what came to call "self-object" attachments - in and out of the analytic situation. Kohut's meticulous descriptions of these transference phenomena and of their analytic management were a source of stimulation and instruction to many analysts, even to those who were unwilling to follow some later developments in his theoretical and technical thinking.
Of recent commentators, perhaps the most gnomic, the least penetrable, and the most devoted to paradoxes were Jacques Lacan. Here, he takes exception to what he regards as the "American" concept of appealing, through the therapeutic alliance, to the "mature" portion of or (anathema to him) the "autonomous functions." Lacan does share the general view that the transference is central to the analytic experience and seems to echo Freud in conceiving it primarily as a resistance - as, "closing" of the unconscious, and is characteristically by obscurity and linguistic play and leaves one uncertain as to his actual technical approach, but the central thread of his focus on language as the basic element in the structure of mental life, - we have structured "the unconscious like language" - is affirmatively defended by Lacan, 1978.
They couch Kernberg's reflections on the transference through his "ego psychological-object relations" though sharing the recent emphasis on here-and-now aspects of transference interpretation. He regards the links with infantile precursors, conceived in early internalized object relations, as essential. He urges openness of mind and tolerance of uncertainty, however, rather than imposing on the patient preconceived ideas about etiology and pathogenesis. In particular, he distances himself from what he regards as the restrictive concepts of "self-psychology," especially regarding the role of aggression. What is more, while attending closely to all aspects of communication in the session, Kernberg aligns himself with those who regard both extra-analytic and intra-analytic experience as valid material for interpretation.
The alternative views of transference as a repetition of infantile experience and as a new creation in the setting of the analytic situation have evidently formed the basis of a continuing debate from the earliest years. In his assessment of current ideas of transference, Cooper calls these respectively the "historical" and the "modernist" views attributing recent interest able to changing philosophical concepts of reality and the rise to prominence of object relations theories in analysis. Cooper comes down squarely for the "modernist" views, maintaining, like Gill, that the actuality of the analyst's individuation and behaviour are a powerful determinant of the patient's transference reactions and need be accorded to the attention of at least the equal to that any given reconstructed infantile determinant, for he admixtures for a "synchronic" rather than a "diachronic" view of the transference and like Spence (1982), Schafer (1983). Others question the possibility of re-creating from the analysis of the transference or from anything else a "true" version of the life history.
Still, they must remember it, that it was as a therapeutic procedure that psychoanalyses originated. It is in the main as a therapeutic agency that it exists today. It may be of a surprise to us, in that the per capita of equal measure prove equivalent to the minor preposition of psychoanalytical literature of which is concerned with the mechanisms by which they achieve its therapeutic effects. They have accumulated a very considerable quantity of data during the last thirty or forty years that throw light upon the nature and workings of the human mind: we have made perceptible progress in the task of classifying and subsuming such data into a body of generalized hypotheses or scientific laws. Nevertheless, there has been a remarkable hesitation in applying these findings in any great detail to the therapeutic process itself. Seemingly probable, one cannot help feeling that this hesitation has been responsible for the fact that so many discussions upon the practical details of analytic technique seem to leave us at cross-purposes and at an inconclusive end. How, for instance, can we expect to agree upon the vexed question of whether and when we should give a "deep interpretation," while we have no clear ideas of what we mean by a "deep interpretation," while, we have no exactly formulated view of the idea of ‘interpretation' itself, no precise knowledge of what interpretation' is and what effect it has upon our patients? We should gain much, least of mention, from a clearer grasp of problems such as this. If we could arrive at a more detailed understanding of the workings of the therapeutic process, we show; if be less prone to those occasional feelings of utter disorientation that few analysts are fortunate enough to escape, and the analytic movement itself might be less at the mercy of proposals for abrupt alterations in the ordinary technical procedure - proposals that derive much of their strength from the prevailing uncertainty as to the exact nature of the analytic therapy. At present, it is a tentative attack upon this problem, and although it should turn out that they cannot maintain its very doubtful conclusions. Some analysts, however, are anxious to draw attention to the agency of the problem itself. Sometimes, however, make clear that what follows is not a practical discussion upon psychoanalytic technique. Because, its impending bearings are merely theoretical, since the considerable individual deviation that we would generally regard as the various sorts of procedures. As within the limits of ‘orthodox' psychoanalysis and various sorts of effects which observation shows that the applications of such procedures bring to a trend about having set up a hypothesis which endeavours to explain almost coherently why these particular procedures cause this effectiveness and if possible it hypotheses about the nature of the therapeutic action of a psychoanalysis are valid, certain implications follow from it that might serve as criteria in forming a justifiable judgement of the probable effectiveness of any particular type of procedure?
It will be the object, nonetheless, that exaggeration and the novelty of its topic, are after all, it leaves to be said, "we do understand and have long understood the main principles that governs the therapeutic action of analysis." To this, of course, is, the start of what I having as shortly as possible the accepted views upon the subject. For this purpose, we must go back to the period between the years 1912 and 1917 during which Freud gave us the greater part of what he has written directly on the therapeutic side of the psychoanalysis, namely the series of papers on technique and the twenty-seventh and twenty-eight chapters of the Introductory Lectures.
The systematic application characterized this period of the method known as ‘resistance analysis'. The method in question was hardly a new one even. It was based upon ideas that had long been implicit in analytic theory, and in particular upon one of the earliest of Freud's views of the dynamic function of neurotic symptoms. According to that view (which was computably essential to the study of hysteria) the function of the neurotic symptom was to defend the patient's personality against an unconscious tread of thought that was unacceptable to it, while simultaneously gratifying the trend up to a certain point. It seems to follow, therefore, that if the analyst were to investigate and discover the unconscious trend and make the patient aware of it - if he were to make what was unconsciously conscious - the whole raison d être of the symptom would cease and it must automatically disappear. Two difficulties arose, however. In the first place some part of the patient's mind was found to raise obstacles to the process, to offer resistance to the analyst when he tried to discover the unconscious trend, and it was easy to conclude that this was the same part of the patient's mind as had originally repudiated the unconscious trend and had thus necessitated the creation of the symptom. But, in the second place, even when this obstacle might be surmounted, even when the analyst had succeed in guessing or deducing the nature of the unconscious trend, had drawn the patient's attention to it and had apparently made him fully aware of it - even then, it would often happen that the symptom persisted unshaken. The realization of Difficultness has led to important results both theoretically and practically. Theoretically, there were evidently two senses in which a patient could become conscious of an unconscious trend, and the analyst could make him aware of it in some intellectual sense without becoming ‘really' conscious of it. To make this state of things more intelligible, Freud devised a kind of pictorial allegory. He imagined the mind as a kind of map. They pictured the original objectionable trend as moved to one region of this map and the newly discovered information about it, expressed to the patient by the analyst, in another. It was only if these two impressions could be "brought together." Whatever exactly that might mean, in that the unconscious trend would be "really" made conscious. What prevented this from happening was a force within the patient, a barrier - once, again, evidently the same "resistance" which had opposed the analyst's attempts at investigating the unconscious trend that had contributed to the original production of the symptom. The removal of this resistance was the essential preliminary to the patient's becoming "really" conscious of the unconscious trend. It was at this point that the practice lesson emerged: As pertained to the psychoanalysis the main task is not so much to investigate the objectionable unconscious trend as to get rid of the patient's resistance to it.
Still, how are we to set about this task of demolishing the resistance? Once, again, by the same process of investigation and explanation that we have already applied to the unconscious trend. However, this time such difficulties do not face us as before, for the forces that are keeping up the regression, although they are to some extent unconscious, do not belong to the unconscious, in the systematic sense, they are a part of the patient's ego, which is co-operating with us, and are thus more accessible. Nonetheless, the existing state of equilibrium will not be upset. The ego will not be induced to do the work of readjustment required of it, unless we are able by our analytic procedure to mobilize some fresh force upon our side.
What forces can we count upon? The patient's will to recovery, in the first place, which led him to embark upon the analysis, are again of an intellectual consideration that we can bring to his notice. We can make him understand the structure of his symptom and the motives for his repudiation of the objectionable trend. We can point out the fact that these motives are out-of-date and no longer valid: That they may have been reasonable when he was a baby, but are no longer so now that he is grown up. Finally, we can insist that this original solution of the difficulty has only led to illness, while the new one that we propose remains in a certain state ousting of the prospect of health. Such motives these may play a part in inducing the patient to abandon his resistance, nevertheless, it is from an entirely deafened quarter that the decisive factor emerges. This factor, need be, is that of the transference.
Although from very early times Freud had called attention to the fact that transference manifest of itself in two ways - negatively and positively, a good deal less was said or known about the negative transference than about the positive. This, of course, corresponds to the circumstance that interest in the destructive and aggressive impulses overall, is only a comparatively recent development. They regarded transference predominantly as a ‘libidinal' phenomenon. They suggested that in everyone there subsisting to several unsatisfied libidinal impulses, and that whenever some new person came upon the scene these impulses were ready to attach them to him. This was the account of transference as a universal phenomenon. In neurotics, owing to the abnormally large quantities of unattached libido presents in them, the tendency to transference would be correspondingly greater, and the peculiar circumstances of the analytic situation would further increase it. It was evidently the existence of these feelings of love, thrown by the patient upon the analyst, that provided the necessary extra force to induce his ego to give up its resistances, undo the repressions and adopt a fresh solution of its ancient problems. This instrument, without which no therapeutic result could be obtained, was at once seen to be no stranger: It was in fact the familiar peer of suggestion, which had ostensibly been abandoned long in advance. Now, however, it was being employed in a very different way, in fact in a contrary direction. In pre-analytic days it had aimed at cause an increase in repression, now overcoming the resistance of the ego was put-upon, that is to say, to allow the repression to be removed.
However, the situation became ever more complicated as more facts about transference became known. In the first place, the feelings transferred turned on to be as various sorts, besides the loving ones there were the hostile ones, which were naturally far from helping the analyst's efforts. Nevertheless, even apart from the hostile transference, the libidinal feelings themselves fell into two groups: Friendly and affectionate feelings that could be conscious, and purely erotic ones that have usually to remain unconscious. These latter feelings, when they became too powerful, stirred up the repressive forces of the ego and thus increased its resistances instead of diminishing them, and in fact produced a state of things that was not easily distinguishable from the damaging negative transference. Beyond all this, in that respect arises in the entireness in the question in a deficiency of permanence of all suggestive treatments. Did not the existence of the transference threaten to leave the analytic patient in that same? In that, by the unending dependence is reliant upon the analyst?
The discovery that the transference itself could be analysed got over these difficulties. Its analysis, was soon found the most important part of the whole treatment. Making consciously its roots in the repressed unconscious was just possible as making conscious any other repressed material was possible - that is, by inducing the ego to abandon its resistance - and there was nothing self-contradictory in the fact that the force used for resolving the transference was the transference itself. Once it had been made conscious, its unmanageable, infantile, permanent characteristics disappeared: What was left was like any other "real" human relationship. Still, the necessity for constantly analysing the transference became still more apparent from another discovery. It was found that as work went on the transference tended, as it was, to eat up the entire analysis. Often of the patient's libido became concentrated upon his relation to the analyst, the patient's original symptoms were drained of their cathexis, and there appeared instead an artificial neurosis to which Freud gave the name the 'transference neurosis'. The original conflicts, which have on the onset of neurosis, begun to be
re-enacted in the relations to the analyst. Now this unexpected event is far from being the misfortune that at first sight it might be. In fact it gave us our great opportunity. Instead of having to deal as best we may with conflicts of the remote past, which are concerned with dead circumstances and mummified personalities, whose outcome is already determined, we find ourselves involved in an actual and immediate situation, in which we and the patient are the principle character and the development of which is to some extent at least under our control. Yet if we bring it about that in this revivified transference conflict the patient choses a new situation instead of the old one, a solution in which behaviour more replaces the primitive and unadaptable method of repression in contact with reality, then, even after his detachment from the analysis, he can fall back into his former neurosis. The solution of the transference conflict implies the simultaneous solution of the infantile conflict of which it is a new edition. "The change," says Freud in his Introductory Lectures, is made possible by alternations in the ego occurring consequently of the analyst's suggestions. At the expense of the unconscious, the ego becomes wider by the work of interpretation that brings the unconscious material into consciousness: Through education it becomes reconciled to the libido and is made willing to grant it a certain degree of satisfaction, and its horror of the claims of its libido is lessoned in sublimation. The additional are nearly the courses of the treatment that corresponds with this ideal description, and the greater will be the success of the psychoanalytic therapy. At the time Freud had written these words, was made quite clear that in writing this script he held that the ultimate factor in the therapeutic action of the psychoanalysis was suggestion by the analyst acting upon the patient's ego in a way that makes it more tolerant of the libidinal trends.
In the years that have passed since he wrote this passage Freud was to produce an extremely small bearing that had been directly on the subject, and that little goes to show that he has not altered his views on the main principles involved. However, it is, nonetheless, the additional lectures published most recently that he explicitly states that he has nothing to add to the theoretical discussion upon therapy given in the original lectures fifteen years earlier. While there has in the interval been a considerable further development of his theoretical opinions, and especially in the region of ego-psychology. He had, in particular, formulated the idea of the super-ego. The restatement in super-ego terms of the principles of therapeutics that he laid down in the period of resistance analysis may not involve many changes. It is, nevertheless, the anticipating that information about the super-ego will be of special interest from our give directions to orient the view as is reasonable: And in two ways. In the first place, it would at first sight seem highly probable that the super-ego should play an important part, direct or indirect, in the setting-up and maintaining of the repressions and resistances the demolition of which has been the chief aim of analysis? An examination confirms this of the classification of the various kinds of resistance made by Freud in Hemmung Symptom und Angst (1926). Of the five sorts of resistance there mentioned it is true that only one is attributed to the direct intervention of the super-ego, but two of the ego-resistances - the repression-resistance and the transference-resistance - although originating from the ego, are as a rule set up by it out of fear of the super-ego? It seems likely enough therefore that when Freud wrote the words that have been of a quotation, to the effect that the favourable change in the patient is made possible by alternations in the ego, he was thinking, in part at all events, of that portion of the ego that he subsequently separated off into the super-ego. Quite apart from this, moreover, to a greater extent Freud's most recently published works, the Group Psychology (1921), there are passages that suggest a different point - namely, that it may be largely through the patient's super-ego that the analyst could influence him. These passages occur in his Discussions on the nature of hypnosis and suggestion. He definitely rejects Bernheim's view that all hypnotic phenomena are traceable to the factor of suggestion, and adopts the alterative theory that suggestion is a partial manifestation of the state of hypnosis. The state of hypnosis, again, is found in certain respects to resemble the state of being in love. There is "the same humble subjection, but the same compliance, the same absence of criticism toward the hypnotist as toward the loved object," in particular, there can be no doubt that the hypnotist, like the loved object. "Having become abounding with the place of the subject's ego-ideal, in the sense that it's most recent of suggestions is a partial form of hypnosis and of suggestion. In that it seems to follow that the analyst owes his effectiveness, at all events in some respect, to his having stepped into the place of the patient's super-ego. Thus, there are two convergent lines of argument that point to the patient's super-ego as occupying a key position in analytic therapy: It is a part of the patient's mind in which a favourable alteration would be likely to lead to an overall improvement, and it is a part of the patient's mind that is especially subject to the analyst's influence.
Such plausible notions are they followed these up almost immediately after the super-ego made its first debut. Ernest Jones developed them, for instance, in his paper on The Nature of Auto-Suggestion. Soon afterwards Alexander launched his theory that the principle; aim of all psychoanalytic therapy must be the complete demolition of the super-ego and the assumption of its functions by the ego. According to his account, the treatment falls into two phases. Its first phase asserts that they have handed over the function of the patient's super-ego to the analyst, and in the second phase they are passed back again to the patient, but this time to his ego. The super-ego, according to this view of Alexander's (though he explicitly limits his use of the word to the unconscious parts of the ego ideal). Is some fundamental apparatus that is essentially primitive, out of date? And out of touch with reality, which is incapable of adapting itself, which operates automatically, with the monotonous uniformity of a reflex? Any useful functions that it takes measures to put into effect the ego can carry out an action that, and there is therefore nothing to be done with it but to scrap it. This wholesale attack upon the super-ego might be of questionable validity. Its abolishment would probably become more even if that were pragmatically political, and would involve the abolition of most highly desirable mental activities. However, the idea that the analyst temporarily takes over the functions of the patient's super-ego during the treatment and by doing in some way alters it agrees with the tentative remarks that have already been of mention.
So, too, do some passages in a paper by Radó upon The Economic Principle in Psycho-Analytic Technique. The second part of this paper, which was to have dealt with the psychoanalysis, has unfortunately never been published, but the first one, on hypnotism and cantharis, contains much that is of interest. It includes a theory that the hypnotic subject introjects the hypnotist if the form of what Radó calls a "parasitic super-ego," which draws off the energy and takes over the functions of the subject's original super-ego. One feature of the situation brought out by Radó is the unstable and temporary nature of this whole arrangement. If, for instance, the hypnotist gives a command that is too much opposing the subject's original super-ego, the parasite is promptly extruded. In any case, when the state of hypnosis ends, the sway of the parasite super-ego also ends and the original super-ego resumes its dynamical function.
However debatable may be the details of Radó's description, it not only emphasizes again the notion of the super-ego as the fulcrum of psychotherapy, but it draws attention to the important distinction between the effects of hypnosis and analysis concerning permanence. Hypnosis acts essentially in a temporary way, and Radó's theory of the parasitic super-ego, which does not really replace the original one but merely throws it out of action, gives a very good picture of its apparent workings. Analysis, on the other hand, in so as far as it seeks to affect the patient's super-ego, aims at something very much more afar in reaching and becoming permanent - namely, at an integral change like the patient's super-ego itself. Some even more recent developments in psychoanalytic theory give a hint, so it seems, in that of the kind of line of reasoning, along which we might agree of the question.
This latest growth of theory has been very much occupied with the destructive impulses and has brought them for the first time into the centre of interest: And attention has art the same time been concentrated on the correlated problems of guilt and anxiety. Especially, are those influenced by such of an idea depicting the elaborate development of the super-ego and recently developed in retaining Melanie Klein and the importance that she displays the attributes that the narrative and cognitive process of introjection and projection in the development of the personality. The individual, she holds, is perpetually introjecting and projecting the object of its impulses, and the character of the introjected objects depends on the character of the id-impulses directed toward the external object. Thus, for instance, during the stage of a child's libidinal development in which feelings of oral aggression dominate it, its feelings toward its external object will be orally aggressive, and it will then introject the object, and the introjected object will now act (in the manner of a super-ego) in an oral aggressiveness toward the child's ego. The next event will be the projection of this orally aggressive introjective object back onto the external object, which will now in its turn may be orally aggressive. The fact of the external object being thus felt as dangerous and destructive withal lead to the id-impulse as to adopt an even more aggressive and destructive attitude toward the object in a self-defence. They thus establish a vicious circle. This process seeks to account for the extreme severity of the super-ego in small children, and for their unreasonable fear of outside objects. During the development of the normal individual, his libido eventually reaches the genital stage, at which the positive impulses predominate. His attitude toward his external objects will thus become more friendly, and accordingly his introjected objects (or, the super-ego) will become less severe and his ego's contact with reality will be less distorted. In the neurotic, however, for various reasons - whether because of frustration or of an incapacity of the ego to tolerate id-impulses, or of an inherent excess of the destructive components - development to the genital stage does not occur. However, the individual remains of a savage id on the one hand and a correspondingly savage super-ego on the other, and the vicious circle distinguish its perpetuation. The hypothesis as stated may be useful in helping us to form a visualization upon which not only of the mechanism of a neurosis but also of the mechanism of its cure. There is, nonetheless, nothing new in regarding a neurosis as essentially an obstacle or deflecting force in the path of normal development: Nor is there anything new in the belief that a psychoanalysis, owing to the peculiarity of the analytic situation can reassign the obstacle and so allow the normal development to continue. That being said, it is, nonetheless, in lead to appear of intentions to make our conception a little more precise by assuming the pathological obstacle to the neurotic individuals' further growth is like a vicious circle of the kind the same. If a breach could somehow or other be made in the vicious circle, they would preview the processes of development upon their normal course. If, for instance, they could make the patient less frightened of his super-ego or introjected object, he would project less terrifying imagos onto the outer object and would therefore have less need to feel hostile toward it: The object that he then introjected would in turn be less savage in its pressure upon the id-impulses, which could probably lose something of their primitive ferocity. In short, a benign circle would be set up instead of a vicious one, and ultimately the patient's libidinal development would go on to the genital level, however? As with a normal adult, his super-ego will be comparatively mild and his ego will have a proportionally undistorted contact with reality.
Nonetheless, at what point in the vicious circle is the breach to be made and how is it to be effected? Altering the character of a person's super-ego is easier said is obvious that than done. Nevertheless, the quotations from earlier discussions have in suggesting that the super-ego will be found to play an important part in the solution of our problem. However, presumption qualities are yet to quantities imputed in the positing affirmation in which they have described considering not to a greater extent then besides a closer nature of what as the analytic-situation will be necessary, the relation between the two persons concerned in it is a highly complex one, and for our present purposes, we are to isolate two elements in it. In the first place, the patient in analysis has of a tendency to centralize the whole of his id-impulses upon the analyst, all the same, no further comment upon this fact or its implications, since they are so immensely familiar, but only to emphasize upon their vital importance to all that follows and go at once to the second element of the analytic situation, which, again will be of an isolate. The patient in analysis tends to accept the analyst in some way or other as a substitute for his own super-ego. At this point, to imitate with a slight difference the convenient phase with which Radó used in his account of hypnosis and to say that in analysis the patient has a propensity to put forth the analyst into an "auxiliary super-ego." This phrase and the relation decided by it evidently require some explanation.
When a neurotic patient meets a new object in ordinary life, according to our underlying hypothesis he will be inclined to project onto it his introjected archaic objects and the new object will surmount the extent of an illusory object. It is to be presumed that his introjected objects are essentially separated out into two groups, which function as a 'good' introjected object (or, a mild super-ego) and a 'bad' introjected object (or, a harsh super-ego). According to the degree to which his ego maintains contacts with reality, will project the "good" introjected object onto benevolently real outside objects and the?"bad" one onto malignantly real outside objects. Since, however, he is by hypothesis neurotic, the 'bad' introjected object will predominate, and will lean heavily toward an externalization of that of which have projected the "good" one, and there will further be a tendency, even where to the generative began with the 'good' object, for the 'bad' one after a time to take its place. Consequently, saying that usually the neurotic's phantasy objects in the outside world will be predominantly dangerous and hostile will be true. Moreover, since even his 'good' introjected objects will be 'good' according to an archaic and infantile standard, and will be to some extent maintained simply for counteracting the ‘bad' object, even his ‘good' phantasy objects in the outer world and its containing surrounding surfaces will be very much out of touch with reality. Going back now to the moment when our neurotic patient meets a new object in real life and supposing (as will is the more usual case) that he projects his 'bad' introjected object onto it - the phantasy external object will then seem to him to be dangerous, he will be frightened of it and, to defend himself against it, will become more angry. Thus, when he introjects this new object in turn, it will merely be adding another terrifying imago to those he has already introjected. The new introjected imago will in fact simply be a duplicate of the original archaic ones, and his super-ego will remain almost exactly as it was. The same will be also true with the necessary changes made where he begins by projection with which his "good" introjected object onto the new external object he has met. No doubt, as a result, there will be a slight strengthening of his kind super-ego at the expense of his harsh one, and to that extent from which will improve his condition. Burt there will be no qualitative change in his super-ego, for the new "good" object introjected will only be a duplicate of an archaic original and will only reinforce the archaic "good" super-ego already present?
The effect when the neurotic patient contacts a new object in analysis is from the first moment to create a different situation. His super-ego is in any case either homogeneous or well organized: we have previously oversimplified the account we have given of it and schematic. Effectively, it has derived the introjected imago that goes to make it up from a variety of stages of his history and function to some extent independently. Now, owing to the peculiarities of the analytic circumstance and of the analyst's behaviour, the introjected imago of the analyst tends in part to be quite definitely separated off from the rest of the patient's super-ego. (This, of course, presupposes a certain degree of contact with reality on his part. Here we have one fundamental criterion of accessibility to analytic treatment: Another, which we have already implicitly noticed, is the patient's ability to attach his id-impulses to the analyst.) This separation between the imago of the introjected analyst and the rest of the patient's super-ego becomes evident at quite an early stage of the treatment, for instance, about the fundamental rule of free-association. The new bit of super-ego tells the patient that benevolent characteristics have allowed him to say anything that may come into his head. This works satisfactorily for a little, but soon there comes a conflict between the new bit and the rest, for the original super-ego says: "You must not say this, for, if you do, you will be using an obscene word or betraying so-ans-so's confidences." The separation off the new but - we have generally called what the "auxiliary" super-ego - as been inclined to persevere the very reason that it usually operates in a different direction from the rest of the super-ego. This is true not only of the "harsh" super-ego but also of the "mild" one. For, though the auxiliary super-ego is in fact kindly, it is not kindly in the same archaic way as the case's patients introjected "good" imagos. The most important characteristic of the auxiliary super-ego is that its advice to the ego is consistently based upon real and contemporary considerations and this serves to differentiate it from the greater part of the original super-ego.
In spite of this, the situation is nonetheless extremely insecure. There is a constant tendency for the whole distinction to break down. The patient is liable at any moment to project this terrifying imago onto the analyst just as though he were anyone else he might have met in his life. If this happens, the introjected imago of the analyst will be wholly incorporated into the rest of the patient's harsh super-ego, and the auxiliary super-ego will disappear. Even when the content of the auxiliary super-ego's advice is realized as different from or contrary to that of the original super-ego, very often its quality will be felt for being the one. For instance, the patient may feel that the analyst has said to him: "If you do not say whatever comes into your head, I will give you an unconnective cause to end," or "If you do not become conscious of this piece of the unconscious I will turn you out of the room." Nevertheless, labile though it is, and limited as its authority, this peculiar relation between the analyst and the patient' s ego seems to preserve the analyst's appreciation upon that of his main instrument in helping the development of the therapeutic process. What is this main weapon in the analyst's armoury? Its name springs at once to our lips. The weapon is, of course, interpretation.
What, then, is interpretation? How does it work? Extremely little may be known about or more than is less likened to it, but this does not present an almost universal belief in its remarkable efficacy as a weapon: Interpretation has, it must be confessed, many qualities of a magic weapon. It is, of course, felt as such by many patents. Some of them spend hours at a time in providing interpretations of their own - often ingeniously, illuminating, correct. Others, again, derive a direct libidinal gratification from being given interpretations and may even develop something parallel to a drug addition to them. In non-analytical circles interpretation is usually either scoffed at as something ludicrous, or being revealed of some raging or as a frightening danger. This attitude is shared, in many more tan is often realized, by most analysts. This was particularly revealed by the reactions shown in many quarters when the idea of giving interpretations to small children was first turned over by Melanie Klein. Nonetheless, saying that analysts are inclined to feel interpretation as something extremely powerful whether for good or ill would be true in an overall census, as, perhaps, of our feelings about interpretation as distinguished from our reasoning beliefs. There may be many grounds for thinking that out beliefs seem superficially to be contradictory, and the contradictions do not always spring from different schools of thought. Nevertheless, are manifest of sometimes held simultaneously by one individual. By that, we are told that if we interpret too soon or too rashly, we run the risk of losing a patient: That unless we interpret promptly and deeply we run the risk of losing a patient: That interpretation may cause intolerable and unmanageable outbreaks of anxiety by "liberating" it, that interpretation is the only way of enabling a patient to cope with an unmanageable outbreak of anxiety by ‘resolving' it, which interpretations must always refer to material on the very point of emerging into consciousness, that the most useful interpretations are really deep ones? : "Be cautious with your interpretations" says one voice: "When is doubt, interpreted" says another? Nevertheless, although there is evidently a good deal of confusion in all of this, but it is nonetheless, that the various pieces of advice that may turn out to refer to different circumstances and different cases and to imply in the different uses of the word 'interpretation'.
For the word is evidently used in more than one sense. It is, after all, perhaps, only a synonym for the experienced form as we have already come across - "making what is unconsciously conscious," and it shares all of that phrase's ambiguities. For in one sense, if you give a German-English dictionary to someone who knows no German, you will be giving him a collection of interpretations, and this, is the kind of sense in which the nature of interpretation has been discussed in a recent paper by Bernfeld. Such descriptive interpretations have evidently no relevance to our present topic. We will continue without much ado to define as clearly as made possible the particular yet peculiar sort of interpretation, of which seems significantly relevant as an actively fundamental instrument of psychoanalytic therapy and to which for convenience makes known by name of 'mutative' interpretations.
It seems at first glace to give but a schematized outline of what is understood by a mutative interpretation, leaving the details to be filled afterwards, and, with a view to clarify of expositional purposes as an instance the interpretation of a hostile impulse. By virtue of his power (his strictly limited powers) as auxiliary super-ego, the analyst gives permission for a certain small quantity of the patient's id-energy (in our instance, as an aggressive impulse) to become conscious. Since the analyst is also, from the nature of things, the object of the patient's id-impulses, the quantity of these impulses that is now released into consciousness will become consciously directed toward the analyst. This is the critical point. If all goes well, the patient's ego will become aware of the contrast between the aggressive character of his feelings and the real nature of the analyst, who does not behave comparably as the patient's "good" or "bad" archaic object? The patient, which is to say, will become aware of a distinction between his archaic phantasy object and the really external object. The interpretation has now become a mutative one, since it has produced a breach in the neurotic vicious circle. For the patient, having become aware of the lack of aggressiveness in the really external object, can probably diminish his own aggressiveness: The new object that he introjected will be less aggressive, and consequently the aggressiveness of his super-ego will also be diminished. As a further corollary to these events, and simultaneously with them, the patient will obtain access to the infantile materials by which is being re-experienced by him in his relation to the analyst.
This is the overall scheme of the mutative interpretation. You will hold of notice that in its accountable process in the appearance that fall into two phases. For descriptive purposes it may, or perhaps may be to exceed the question of whether these two phases are in temporal sequence or whether they may not really be two simultaneous aspects of a single event, nonetheless, dealing with them is easier as though they were successive. First, then, there is the phase in which the patient becomes conscious of a particular quantity of id-energy as directed toward the analyst, and secondly, there is the phase in which the patient becomes aware that this id-energy is directed toward an archaic phantasy object and not toward a real one.
The first phase of a mutative interpretation - that in which part of the patient's id-relation to the analyst is made conscious in virtue of the latter's emplacements as auxiliary super-ego - is complicated and complex. In the classical model of an interpretation, the patient will first be made aware of a state of tension in his ego, will next be made aware that there is a repressive factor at work (that his super-ego is threatening him with punishment), and will only they are made aware of the id-impulse that has stirred upon the protests of his super-ego and so lead to the anxiety in his ego. This is the classical scheme. In actual practice, the analyst finds himself working from all three sides at once, or in irregular succession. At one moment a small portion of the patient's super-ego may be revealed to him in all its savagery, at another the shrinking defencelessness of his ego, yet another form of his attentions may be directed to the attempt that he is making maybe at compensating for his hostility occasionally a fraction of id-energy may even be directly encouraged to break its way through the last remains of an already weakened resistance. There is, however, one characteristic that all these various operations have in common, they are essentially upon a small scale. For the mutative interpretation is inevitably governed by the principle of minimal doses. It is, probably, a commonly agreed clinical fact that alternations in a patient under analysis appear usually to be extremely gradual: We are inclined to suspect sudden and large changes as an indication that suggestive rather than psychoanalytic processes ate at work, the gradual nature of the changes caused in the psychoanalysis will be explained if, in at all, those changes are the result of the summation of most minute steps, each of which correspond to a mutative interpretation. The smallness of each step is in turn imposed by the very nature of the analytic situation. For each interpretation involves the release of a certain quantity of id-energy, and as if by a deficiency of possibilities, the quantity released is too large, the higher unstable of equilibrium that enables the analyst top function as the patient's auxiliary super-ego is bound to be upset. The whole analytic situation will be imperilled, since it is only in virtue of the analyst's acting auxiliary super-ego that these releases of id-energy can occur at all.
The analyst's attemptive efforts toward consciousness of all at once bring too crucially a quantity of id-energy into the patient's consciousness as a total elucidation that sometime the given juncture that nothing may bechance, or on the other hand there may be an unmanageable result: But in either event will be a mutative interpretation has been effected. In the former case (in which there is apparently no effect) the analyst's power as auxiliary super-ego will not have been strong enough for the job he has set himself. Still, this again, may be for two very different reasons. It can be that the id-impulses he was trying to bring out were not in fact sufficiently urgent at the moment of relative incidence: For, after all, the emergence of an id-impulse depends on two factors - not only on the permission endorsed of the super-ego, but also on the urgency (the degree of cathexis) of the id-impulse itself. This, then, may be one cause of an apparent negative response to an interpretation, and evidently a harmless one. Still, the same apparent result may also be due to something else, in spite of the id-impulse being really urgent, their strength of the patient's own repressive forces (the repression) may have been too great to allow his ego to listen to the persuasive voice of the auxiliary super-ego. Now here we have a situation dynamically identical with the next one we have to consider, though economically different. This next situation is one in which the patient accepts the interpretation, that is, allows the id-impulse into his consciousness, but is immediately overwhelmed with anxiety. This may show itself in several of ways: For instance, the patient may produce some manifest anxiety-attacks, or he may exhibit signs of 'real' anger with the analyst with complete lack of insight, or he may break off the analysis. In any of these cases, the analytic situation will, for the moment at least, have broken down. The patient will be behaving just as the hypnotic subject behaves when, having been ordered by the hypnotist to perform an action too much at variances with his own conscience, he breaks off the hypnotic relations and wakes up from his trance. This stare of things, which is manifest where the patient responds and to render, with which an actual outbreak of anxiety or one of its equivalents, may be latent was it for the patient to show no response. This latter case may be the more awkward of the two, since it is masked, and it may sometimes, be the effect of a greater overdoes of the interpretation than where manifest anxiety arises (though obviously other factors will be determining importance here and in particular the nature of the patient's neurosis). In ascribing this threatened collapse of the analytic situation to an overdose of interpretation, might be more accurate in some ways to ascribe it to an insufficient dose. For what happened is that the second phase of the interpretation process has not occurred: The phase in which the patient becomes aware that his impulse is directed toward an archaic phantasy object and not toward a real one.
In the second phase of a competed interpretation, therefore, a crucial part is played by the patient's sense of reality, for the successful outcome of that phase depends upon his ability, at the critical moment of the emergence into consciousness of the released quantity of id-energy, to distinguish between his phantasy object and the real analyst. The problem is closely related to one of the extremely liable of the analyst's position as auxiliary super-ego, as the analytic situation is convoked as the time threatening to generate into a ‘real' situation. Nonetheless, this means the opposite of what it appears to the naked eye. It means that the patient is all the time on the brink of turning the ‘real' external object (the analyst) into the archaic one: That is to say, he is on the threshold of projecting his primitive introjected imagos onto him. As far as, the patient effectively does this, the analysts become correspondingly to anyone else that he meets in real life - a phantasy object. The analyst then ceases to posses the peculiar advantage derived from the analytic situation, he will introject like all other phantasy objects into the patient's super-ego, and will no longer be able to function in the particular yet peculiar ways that are essential to the effecting of a mutative interpretation, in this difficulty the patient's sense of reality is an indispensable but a very feeble ally: Yet finds of an improvement in it are on of the things that we hope the analysis will cause. Not submitting it to any unnecessary strain is significantly important, therefore, and that is the fundamental reason that the analyst must avoid any real behaviour that is likely to confirm the patient's view of him as a 'bad' or a 'good' phantasy object. This is perhaps more obvious regarding to the 'bad' object. If, for instance, the analyst were to a shrew that he was really shocked or frightened by one of the patient's id-impulses, the patient would immediately treat him in that respect as a dangerous object and introject him into his archaic severe super-ego. Thereafter, on the one hand, there would be a diminution in the analyst's power to function as an auxiliary super-ego and to allow the patient's ego to become conscious of his id-impulses - that is to say, in his power to cause the first phase of a mutative interpretation, and, on the other hand, he would, as a real object, become sensibly less distinguishable from the patient's ‘bad' phantasy objects and to that extent the carrying through of the second phase of a mutative interpretation would also be made more difficult? Once, again, there are accessorial cases. Supposing the analyst behaves in an opposite way and actively urges the patient to give a free rein to his id-impulses. There is then a possibility of the patient confusing the analyst with the imago of a treacherous parent whose initiatory anticipation encourages him to seek gratification, and then suddenly turns and punishes him. In such a case, the patient's ego may look for defence by itself sudden turning upon the analyst as though he were his id, and treating him with all the severity of which his privileged position. Yet acting really in a way that encourages the patient to project his may be equally unwise for the analyst ‘good' introjected object onto him. For the patient will then experience a tendency to regard him and a good object in an archaic sense and will incorporate him with his archaic 'good' imagos and will use him s a protection against his "bad" ones. In that way, his infantile positive impulses and his negative ones may escape analysis, for there may no longer be a possibility for his ego to make a comparison between phantasies external objects than there is real one. It will perhaps be argued that, with the best will in the world, the analyst, however, careful he may be, will be unable to prevent the patient from projecting these various imagos onto him. This is of course, indisputable, and the whole effectiveness of analysis depends upon its being so. The lesson of these difficulties is merely to remind us that the patient's sense of reality having the narrowest limit. It is a paradoxical fact that the best way of ensuring that his ego will be abler to distinguish between phantasy and reality is to withhold reality from him as much as possible. What is more, it is true. His ego is so weak - so much of the mercy of his id and super-ego - that he can only cope with reality if it is administered in minimal doses. These doses are in fact what the analyst gives him, as interpretation.
It appears more than possible that an approach to the twin practical problems of interpretation and reassurance may be simplified by this distinction between the two phases of interpretation. Both procedures may, it would appear, be useful or even essential in certain circumstances and inadvisable or even dangerous in others. With interpretation, the first of our hypothetical phases may be said to 'liberate' anxiety, and the second to 'resolve' it. Where a quantity of anxiety is already present or on the point of breaking out, an interpretation, owing to the efficacy of its second phase, may enable the patient to recognize the unreality of his terrifying phantasy object and so to reduce his own hostility and consequently his anxiety. On the other hand, to induce the ego to allow a quantity of id-energy into consciousness is obviously to court an outbreak of anxiety in a personality with a harsh super-ego. This is precisely what the analyst does in the first phase of an interpretation. Regarding "reassurance," Briefly some problems that arise are in the belief that it is an incidental term in need to be defined as almost as urgently as ‘interpretation', and that it covers several different mechanisms. Nevertheless, in the present connection reassurance may be regarded as behaviour by the analyst calculated making the patient regard him as a 'good' phantasy object rather than as a reason. It might, however, be supposed at first sight that the adoption of some generally felt procedures that are sometimes psychotic cases, nonetheless, an attitude by the analyst might directly favour the prospects of making a mutative interpretation. Yet it is believed that it will be seen on reflection that this is not in fact the case: For precisely, as far as the patient regards the analyst as his phantasy object, the second phase of the interpretation effects that do not happen - since it is of the essence of that phase that in it the patient should make a distinction between his phantasy object and the real one? It is true that his anxiety may be reduced: But, this result will not have been achieved by a method that involves a permanent qualitative change in his super-ego. Thus, whatever tactical importance reassurances may be posses. It cannot claim to any regarded as an ultimate operative factor in psychoanalytic therapy.
Still, it must in this place be of notice, that certain other sorts of behaviour by the analyst may be dynamically equivalent to the giving of a mutative interpretation, or to one or other of the two phases of that process. For instance, an ‘active' injunction of the kind contemplated by Ferenczi may amount to an example of the first phase of an interpretation: The analyst is using his peculiar positions to induce the patient to become conscious in an exceptionally self-asserting way of distinct id-impulses that one objection to this form of procedure must be expressed by saying that the analyst has very little control over the dosage of the id-energy that is thus released, and very little guarantees that the second phase of interpretation will follow. He may therefore be unwittingly precipitating one of those critical situations that are always liable to arise, for an incomplete interpretation. Incidently, the same dynamic pattern may arise when the analyst requires the patient to produce a ‘forced' phantasy or even (particular at an early given direction in an analysis) when the analyst asks the patient a question. Here, again, the analyst is in effect giving a blindfold interpretation, which it may prove impossible to carry beyond its first phase. On a different deal in, situations' constantly arising during an analysis in which the patient becomes conscious of small quantities of id-energy without any direct provocation by the analyst. An anxiety situation might then develop, if it were not that the analyst, by his behaviour or, one might say, absence of behaviour, enables the patient to mobilize his sense of reality and make the necessary distinction between an archaic object and a real one. What the analyst is doing before we are equivalent to cause the second phase of an interpretation, and the whole episode may amount to the kind of mutative interpretation. Estimating what proportion of the therapeutic changes that occur during analysis may not be is difficult due too implicit mutative interpretation of this kind. Incidentally, this type of situation seems sometimes to be regarded, incorrectly as an example of reassurance.
A mutative interpretation can only be applied to an id-impulse that is in a state of bearing down, or of a cathexis. This seems self-evident, for the dynamic changes in the patient's mind inferred by a mutative interpretation can only be caused by the operation of a charge of energy originating in the patient himself: The function of the analyst is merely to ensure that the energy will flow along one channel rather than along another. It follows from this that the purely informative ‘dictionary' type of interpretation will be non-mutative. However, useful it may be as a prelude to mutative interpretations, and this leads to several practical inferences. Each must be emotionally "immediate," the patient must experience it s something actual. This requirement, that the interpretation must be 'immediate', may be expressed in another way by saying that interpretations must always represent a directed point of urgency'? At any given moment noticeable of a particular id-impulse will be in activity, this is the impulse that is susceptible of mutative interpretation then, and no other one. It is, no doubt, neither possible nor desirable to giving mutative interpretations at the time, as Melanie Klein has pointed out, it is a most precious quality in an analyst to be able to be at any moment to pick out the point of urgency.
Still, the facts that every mutative interpretation must deal with an ‘urgent' impulse take us back another to the commonly felt fear of the explosive possibilities of interpretation, and particularly of what is vaguely called "deep" interpretation. The ambiguity of the term, however, need not bother us. It describes, no doubt, the interpretation of material that is either genetically early and historically distant from the patients experience or under an especially heavy weight of repression - material, in any case, which is to arrive at the normal course of things exceedingly inaccessible to his ego and remote from it. There seems reason to believe, moreover, that the anxiety that is liable to be aroused by the approach of intensified material is consciousness and may be of peculiar severity. The question is whether its ‘safe' to interpret such material will, as usual, mainly depend upon whether the second phases of the interpretation can be carried through. In the ordinary run of case, the material that is urgent during the earlier stages of the analysis in not deep. We have to deal first with only the essentially far-going displacements of the deep impulses, and the deep material itself are only reached later and by degree, so that no sudden appearance of unmanageable quantities of anxiety is to be anticipated. In exceptional cases, least of mention, are owing to some peculiarity in the structure of the neurosis, deep impulses may be urgent at some very early stages of the analysis. We are then faced by a dilemma. If we give an interpretation of this deep material, the anxiety produced in the patient may be so great that his sense of reality may not be sufficient to permit of the second phase being accomplished, and the whole analysis may be jeopardised. Nonetheless, it must not be the thought that, in such critical cases as we are now considering, the gruelling necessarily being to an excessive degree avoid the simple but not giving any interpretation or by giving more superficial interpretations of non-urgent materiel or by attempting reassurances. It seems probable, in fact, that these alternative procedures may do little or nothing to avoid the trouble, on the contrary, they may even exacerbate the tension created by the urgency of the deep impulses that are the actual cause of the threatening anxiety. Thus, the anxiety may break out in spite of these palliative efforts and, if so, it will be doing so under the most unfortunate conditions, that is to say, outside the mitigating influences afforded by the mechanisms of interpretation, it is possible, therefore, that, of the two alterative procedures that are open to the analyst faced by such difficultly, the interpretation of the urgent id-impulses, deep though they may be, will be the safer.
A mutative interpretation must be 'specific', which is to say, detailed and concrete. This is, in practice, a matter of degree. When the analyst embarks upon a given theme, his interpretations cannot always avoid being vague and general to begin with, but working out will be necessary eventually and interpret all the details of the patient's phantasy system. In proportion as this is done, the interpretations will be mutative, and must have the necessity fort apparent repetitions of interpretations already made is readily to be explained by the need for filling the details. So, then, it is possible that some delays which despairing analyst's attribute to the patient's id-resistance could be traced to this source. Apparently vagueness in interpretation gives the defensive forces of the patient's ego the opportunity, for which they are always on the lookout, of baffling the analyst's attempt at coaxing an imploring id-impulse into consciousness, a similarity blunting effect can be produced by certain forms of reassurance, such as the tacking onto an interpretation of an ethnological parallel or of a theoretical explanation: A procedure that may at the last moment turn a mutative interpretation into a non-mutative one. The apparent effect may be highly gratifying to the analyst, but later experience may show that nothing of permanent use has been achieved or even that the patient has been given an opportunity for increasing the strength of his defences. On the face of it, Glover is to argue that, whereas a blatantly inexact interpretation is likely to have no effect at all, an inexact one may have a therapeutic effect of a non-analytic, or anti-analytic, kind by enabling the patient to make a deeper d more efficient repression. He uses this a possible explanation of a fact that has always seemed mysterious, namely, that in the earlier days of analysis, when much that we know of the characteristics of the unconscious was still undiscovered, and when interpretation must therefore have often been inexact, therapeutic results were nevertheless obtained.
The possibility that Glover argues to serve, is to remind ‘us' more generally of the difficulty of being certain that the effects that follow any given interpretation are genuinely the effects of interpretation a non-transference phenomenon or one kind of another. Reiteratively, it has already confronted us, that many patients derive direct libidinal gratification from interpretation as such: Also, that some striking signs of an abreaction that occasionally follows an interpretation ought not necessarily to be accepted by the analyst as evidence of anything more than that the interpretation has gone home in a libidinal sense.
The problem is, nonetheless, that of the relation of an abreaction to the psychoanalysis in which is a disputed one. Its therapeutic results seem, up to a point, undeniable. It was from them, that the analysis was born, and even today there are psychotherapists who rely on it almost exclusively. During the War [World War I], in particular, its effectiveness was widely confined in cases of "shell-shock." It has also been argued often enough that it plays a leading part in cause the results of the psychoanalysis. Rank and Ferenczi, for instance, declared that in spite of all advances in our knowledge abreaction remained the essential agent in analytic therapy. More recently, Reik has supported a similar view in maintaining that "the element of surprise is the most important part of analytic techniques." A great deal less extreme mental attitude is taken abreactions as one component factor in analysis and in two ways. In the first place, Nunberg in the chapter upon therapeutics in his textbook of the psychoanalysis. However, he, too, regards that the improvement caused by abreaction in the ususal sense of the word, which he plausibly attributes the relief of endo-psychic tensions as due to a discharge of accumulated affect. In the second, he points to a similar relief of tinstone upon a small arising from the actual process of becoming conscious of something previously unconscious, basing himself upon a statement of Freud's that the act of becoming conscious involves a discharge of energy. Yet, Radó appears to regard abreactions as opposed in its function to analysis. He asserts that the therapeutic effect of catharsis is top be attributed to the fact that (with other forms of non-analytic psychotherapy) it offers the patient an artificial neurosis in exchange for his original one, and that the phenomena observable when abreactions occur are akin to those of a hysterical attack. A consideration of the views of these various authorities suggests that what we describe as ‘abreaction' may cover two different processes: One is to a completed discharge as when a dismantling of other libidinal gratifications is first of these that might be regarded (like various other procedures) as an occasional adjunct to analysis, sometimes, no doubt, a useful one, and possibly even as an inevitable accompaniment of mutative interpretations? : Whereas, the second process might be viewed with more suspicion, as an event likely to impede analysis - especially if its true nature were unrecognized. Nevertheless, with either form there seems good reason to believe that the effects of an abreaction are permanent only in cases in which the predominant aetiological factor is an external event: That is to say, that it does not cause any radical qualitative alternation in the patient's mind. Whatever part it may play arriving at the analysis is thus unlikely to be of anything more than an ancillary nature.
. . . Is it to be understood that no extra-transference interpretation can set in motion the chain of events suggested as the essence of psych-analytic therapy? That is one objective opinion to send forth the relief - what has, of course, already been observed, but never, with enough explicitness - the dynamic distinctions between transference and extra-transference interpretations. These distinctions may be grouped adjoining two heads. The first, extra-transference interpretations are far less likely to be given at the point of urgency. This must necessarily be so, since during an extra-transference interpretation the object of the id-impulse brought into consciousness is not the analyst and is not immediately present, whereas, apart from the earliest stages of an analysis and other exceptional circumstances, the point of urgency is nearly always to be found in the transference. It follows that extra-transference interpretations are proved of being concerned with impulses that are distant both in time and space and are thus likely to be without immediate energy. In extreme instances, they may approach very closely to what has already been described as the handling-over to the patient of a German-English dictionary. However, in the second place, when far since the object of the id-impulse is not existently present, becoming directly aware of the distinction between the real object and the phantasy object is less easy for the patient, extending to emerge of an extra-transference interpretation. Thus it would appear that, with extra-transference interpretations, on the one hand what in having been described as the first phase of a mutative interpretation is less likely to occur, and on the other hand, if the first phase does occur, but the second phase is less likely to follow? In other fields, an extra-transference interpretation is liable to be both less effective and more risky than a transference one. Each of these points deserves a few words of separate examination.
It is, of course, a matter of common experience among analysts that it is possible with certain patients to continue undefinedly giving interpretations without producing an apparent effect whatever. There is an amusing criticism of this kind of "interpretation-fanaticism" in the excellent historical chapter of Rank and Ferenczi. However, it is clear from their words that what they have in mind are essential extra-transference interpretations, for the burden of their criticism is that such a procedure implies neglect of the analytic situation. This is the simplest of cases, where some wastes off time and energy ids the main result. Still, there are other occasions, on which a policy of giving strings of extra-transference interpretations are apt to lead the analyst into more positive difficulties. Attention was drawn by Reich a few yeas ago in some technical discussions in Vienna to a tendency among inexperienced analysts to get into trouble by eliciting from the patient great quantities, are carried to such lengths that the analysis is brought to an irremediable state of chaos. He pointed out very truly that the material we have to deal; with is stratified and that it is highly important in digging it out not to interfere more than we can help with the arrangement of the strata. He had in mind, of course, the analogy of an incompetent archaeologist, whose clumsiness may obliterate the possibility of reconstructing the history of an important excavation site. Pessimism about the results inwardly imbounding of a clumsy analysis, since there are the essential differences that our material is alive and well, as it was, re-stratify itself of its own accord if it is given the opportunity: That is to say, in the analytic situation. While, some analysts agree as to the presence of the risk, and it may be particularly likely to occur where extra-transference interpretation is excessively or exclusively resorted to. The means of preventing it, and the remedy if it has occurred, lie in returning to transference interpretation at the pint of urgency. For if we can become aware of which of the material is 'immediate' in the sense described, the problem of stratification is automatically solved, and it is a characteristic of most extra-transference material that it has no immediacy and that consequently it is stratification is far more difficult to decipher. The measures suggested by Reich himself for preventing the occurrences of this state of chaos are consistent with or to reassemble of abounding orderly fashion for he stresses the importance of interpreting resistance every bit as the antipathetical essential essence of the id-impulses themselves - and this. It is substantially a policy laid down at an early stage in the history of analysis. Nonetheless, it is, of course, characterized as a resistance that rise up in relation to the analyst: Thus, the interpretation of a resistance will almost inevitably be a transference interpretation.
Nonetheless, the most serious risks that arise from the making of extra-transference interpretations are due to the inherent difficulty in completing their second phase or knowing whether their second phase has been completed or not. They are from their nature unpredictable in their effects. There seems, to be a special risk of the patient not carrying through the second phase of the interpretation but of projecting the id-impulse made consciously to the analyst. This risk, no doubt, applies to some extent also to transference interpretations. However, the situation is less likely to arise when the object of the id-impulse is to actualize the present and is moreover the same person as the maker of the interpretation. (We may again recall the problem of ‘deep' interpretation, and point out that its dangers, even in the most unfavourable circumstances, are greatly diminished if the interpretation in question is a transference interpretation.). Moreover, there is more chance of this whole process occurring silently and so being overly looked of an imbounding extra-transference interpretation, particularly in the earliest stages of an analysis. Therefore, being it specially on the alert for transference complications seem important after giving an extras-transference interpretation. This last peculiarity of extras-transference interpretations is in a sense that one of an explicitly important faculty from which is a practical point of view. Because of an account of it that they can be made to act as 'feeders' for the transference situation, and so to pave the way for mutative interpretations. In other fields, by giving an extra-transference interpretation, the analyst can often provoke a situation in the transference of which he can then give a mutative interpretation.
It must be supposed that because of its attributing qualities to transference interpretations, is therefore maintaining that no others should be made, on the contrary, most of our interpretations are probably outside the transference - though it should be added that it often happens that when on is ostensibly giving an extra-transference interpretation one is implicitly giving a transference one. A cake cannot be made of nothing but currants, and, though it is true that extra-transference interpretations are not for the most mutative parts, and do not of themselves bring a decline about the crucial results that involve a permanent change in the patient's mind, they are not much more than are essential. As to analogy, the acceptance of a transference interpretation corresponds to the capture of a key position, while the extra-transference interpretations correspond to the general advance and to the consolidation of a fresh line of descent made possibly by the capture of the key position. However, when this general advance goes beyond a certain point, there will be another check, and the capture of a further key position will require the progress of its own resuming statue. An oscillation of this kind between transference and extra-transference interpretations will represent the normal course of events in an analysis.
Although the giving of mutative interpretations may occupy a small portion of psychoanalytic treatment, it will, upon its hypothesis, be the most important part from the point of view of deeply influencing the patient's mind. It may be of interest to consider how a moment that is important to the patient affects the analyst himself. Mrs. Klein has suggested that there must be some quite special internal difficulty to be overcome by the analysts in giving interpretations. This, applies particularly to the giving of mutative interpretations. Showing in their avoidance by psychotherapists of non-analytic schools, but many psychoanalysts will be aware of traces of the same tendency in themselves. It may be rationalized into the difficulty of deciding whether or not the particular moment has come for making an interpretation. However, behind this there is sometimes a lurking difficulty in the actual giving of the interpretation, for in that respect it may be a constant temptation for the analyst to do something else instead. He may ask questions, or he may give reassurances or advice or discourse upon theory, ir he may give interpretations - but, interpretations that are not mutative, extra-transference, interpretations that is non-immediate, or ambiguous, or inexact - or, he may give two or more alternative interpretations simultaneously, or he may give interpretations and show his own scepticism about them. All of this strongly suggests and for the patient, and that he is exposing himself to some great danger in doing so. This in turn, will become intelligible when we reflect that at the here-and-now of interpretation that the analysis is in fact deliberately evoking a quantity of the patient's id-energy while it is aware and factually unambiguous and aimed directly at himself. Such a moment must above all others put to the test, and his relations with being own unconscious impulses.
In his Fragments of an Analysis of a Case of Hysteria, Freud defines the transference situation in the following major way: "What are transferences?" They are new editions or simulations in the tendencies. Phantasies aroused and made consciously during the progress of the analysis. However, they have this peculiarity, which is characteristic for the species, that they replace some earlier person by the person of the physician. To put it another way: A whole series of psychological experiences is revived, not as belonging to the past, but as applying to the physician presently.
In some form or other transference operates first from the last price of life and influence's all human relation, but here I am only concerned with the manifestations of transference in psych-analysis. It is characteristic of psychoanalysis procedure that, as it begins to open roads into the patient's unconscious, his past (in its conscious and unconscious aspects) is gradually being revived. By that his urge to transfer his early experiences, object-relations and emotions, is reinforced and they come to focus on the psychoanalyst: This implies that the patient deals with the conflicts and anxieties reactivated, by making use of the same mechanisms and defences as in earlier situations.
It follows that the deeper we can penetrate into the unconscious and the further back we can take the analysis, the greater will be our understanding of the transference. Therefore, a brief summary of conclusions about the earliest stages of development is mostly the immediate surface of our field of study.
The first form of anxiety is of a prosecutory nature. The working of the death instinct within - which according to Freud is directed against the organism - causes the fear of annihilation, and this is the primordial cause of prosecutory anxiety. Furthermore, from the beginning of post-natal life (our concerns are with pre-natal processes) destructive impulses against the object stir up fear of retaliation. Painful external experiences intensify these prosecutory feelings from inner sources, for, from the earliest days onward, frustration and discomfort arouse in the infant the experienced by the infant at birth and the difficulties of adapting him entirely new conditions give to prosecutory anxiety. The comfort and care given after birth, particularly the first feeding experience, are left to come from good forces. In speaking of 'forces', it use is as an alternative adult word for what the young infant dimly conceives of as objects, either good or bad. The infant directs his feelings of gratification and love toward the "good" breast, and his destructive impulses and feelings of persecution toward what he feels to be frustrating, i.e., the 'bad' breast. At this stage splitting processes are at their height, and love and hatred and the good and bad aspects of the breast are largely kept apart from one another. The infant's relative security is based on turning the good object into an ideal one as a protection against the dangerous and persecuting object. This processes - that is to say splitting, denial, omnipotence and idealization - are prevalent during the first three or four-month of life, which we can term the 'paranoid-schizoid position', in these ways at a very early stage prosecutory anxiety and its corollary, idealization, elementally influence object relations.
The primal processes of projection and introjection, being inextricably linked with the infants' emotions and anxieties, initiate object-relations, by projecting, i.e., deflecting libido and aggression on the mother's breast, and on this given occasion has on achieving to establish the basis for object-relations, by introjecting the object, first the breast, relations to internal objects come into being. The use of the term 'object-relations' is based on the contention that the infant has from the beginning of post-natal life a relation to the mother (although focussing primarily on her breast) which is imbued with the fundamental elements of an object-relation, i.e., loves, hatred, phantasies, anxieties and defences.
The introjection of the breast is the beginning of superego formation that extends over years. We have grounds for assuming that from the first feeding experience onward, and the infant introjects the breast in its various aspects. The core of the superego is thus the mother's breast, both good and bad. Owing to the simultaneous operation of introjection and projection, relations to external and internal objects interact. The father too, who in a short while plays a role in the child's life, quickly becomes part of the infant's internal world. It is characteristic of the infant's emotional life that there are rapid fluctuations between love and hate: Between external and internal situations: Between perception of reality and the phantasies relating to it, and, accordingly, an interplay between prosecutory anxiety and idealization - both refereeing to inherent or representations of internal and external objects, the idealized object being a corollary of the prosecutory, extremely bad one.
The ego's growing capacity for integration. Synthesis leads ever more, even during these first few months, to states in which love and hatred, and correspondingly the good and bad aspects of objects, are being synthesized. This gives to the second form of anxiety - depressive anxiety - for the infant's aggressive impulses and desires toward the bad breast (mother) is now felt to be a danger to the good breast (mother) as well. In the second quarter of the first year they have reinforced these emotions, because at this stage the infant increasingly perceives and introjects the mother as a person. In this, are the unduly influences that are most intensified of depressive anxiety, for the infant feels he has destroyed or is destroying a whole object by his greed and uncontrollable aggression. Moreover, owing to the growing syntheses of his emotions, he now feels that these destructive impulses are directed against a loved person, just as the interchangeable relation to the father and other members of the family. These anxieties and corresponding defences are the "depressive position," which comes to a head about the middle of the first year whose essence is the anxiety and guilt relating to the destruction and loss of the loved internal and external objects.
It is at this stage, and bound up with the depressive position, that the Oedipus complex sets in. Anxiety and guilt add a powerful impetus toward the beginning of the Oedipus complex. For anxiety and guilt increase the need to externalize (project) bad figures and to internalize (introject) good ones: To attach desire, love, feelings of guilt, and reparative tendencies to some objects, and dislikened intensely and anxiety too other, to find representatives for internal figures in the external world. It is, however, not only the search for new objects that dominates the infant's needs, but also to drive toward new aims: Away from the breast toward the penis, i.e., from oral, desires toward genital ones. Many factors contribute to these developments, the forward drive of the libido, the growing integration of the ego, physical and mental skills and progressive adaptation to the external world. These trends are bound up with the process of symbol formation, which enables the infant to transfer not only interest, but also emotions and phantasies, anxiety and guilt, from one object to another.
The process described is linked with another fundamental phenomenon governing mental life. It is believed that the pressure exerted by the earliest anxiety situation agrees of the constituent causing to find repetition compulsion. However, its first conclusions about the earliest stages of infancy are a continuation of Freud's discoveries, on certain points, however, divergencies have arisen, one of which is irrelevant to our topic of discussion. I am referring to the contention that object-relations are operative from the beginning of post-natal life.
Believing it in that the view that autoerotism and narcissism are in the young infant contemporaneous with the first relation to objects - external and internalized may be feasible. Briefly, autoerotism and narcissism include the love for and relation with the internalized good object with which in phantasy forms part of the loved body and self. It is to this internalized object that in autoerotic gratification and narcissistic states a withdrawal takes place? Concurrently, from birth onward, a relation to objects, primarily the mother (her breast) is present. This hypothesis contradicts Freud's notion of autoerotic and narcissistic stages that preclude an object-relation. However, the difference between Freud's view in this is that the statements on this issue are equivocal. In various contexts he explicitly and implicitly expressed opinions that suggest a relation to an object, the mother's breast, preceding autoerotism and narcissism. One reference must suffice, in the first of two Encyclopaedia articles, Freud said? : "In the first instance the oral component instinct finds satisfaction by attaching Itself to the sating of the desire for nourishment, and its object is the mother's breast? It then detaches itself, becomes independent. Just when autoerotic, that is, it finds an object in the child's own body."
Freud's use of the term object is to some extent quite different from its usage of its same term, however, Freud is referring to the object of an instinctual aim, while, otherwise, in addition, an object-reaction involving the infant's emotions, fantasises, anxieties and defences are nevertheless, in the sentence referred to, Freud clearly speaks of a libidinal attachment to an object, the mother's breast, which precedes auto-ergotism and narcissism.
Additionally, in this context, Freud's findings are about early identification. In the Ego and the Id, speaking of abandoned object cathexes, Freud said,‘ . . . the effect of the first identification in earliest childhood will be profound and lasting. This leads us back to the origin of the ego-idea . . . '. Wherefrom, Freud then defines the first and most important identifications that lie hidden behind the ego-ideal as the identification with the father, or with the parents, and places them. As he expressed it, in the ‘prehistory of every person'. These formulations come close to what is at first, the introjected object, for by definition identifications is the result of introjection. From the statement, least of mention, and passage quoted from the Encyclopaedia article we that can deduce that Freud, although he did not pursue this line of thought further, did assume that in earliest infancy both an object and introjective processes play a part.
That is to say, as for autoerotism and narcissism we meet with an inconsistency in Freud's views. Too so extreme a degree of inconsistences that exist on sufficiently acceptable points of theory clearly show, which on these particular issues Freud had not yet decided. In respect of the theory of anxiety he sated this explicitly in Inhibitions, Symptoms and Anxiety. His speaking also exemplifies his realization that much about the early stages of development was still unknown or obscure to him of the first years of the girl's life "as, . . . lost in a past so dim and shadowy."
I do not know Anna Freud's view about this aspect of Freud's work. Yet as for the question of autoerotism and narcissism, she seems only to have taken into account Freud's conclusion that autoerotic. Some narcissistic stages precede object-relations, and not to have allowed for the other possibilities implied in some of Freud's statements such as the ones referred to above. This is one reason that the divergence between Anna Freud's conception as compared among others, concerning notions of early infancy in which are far greater than that between Freud's views, taken as a whole, it may be to mention, because clarifying the extent and nature of the differences between the two schools of psychoanalysis thought represented by Anna Freud and those of the representational statements in visual attractive features implied to this paper is essential. Perhaps, entertaining, but such clarification is required in the interests of psychoanalytic training and because it could help to open fruitful discussions between the psychoanalysis and by that contribute to a greater general understanding of the fundamental problems of early infancy, however.
The hypothesis at a stage extending over several months precedes object-relations implies - but the libido attached to the infant's own body - impulses, phantasies, anxieties. Defences are either not present in him, or not related to an object, that is to say they would operate in vacua. The analysis of very young children has taught us that there is no instinctual urge, no anxiety situation, no mental process that does not involve objects, external or internal, in other words, object-relations are at the centre of emotional life? Furthermore, love and hatred, phantasies, anxieties and defences are also operative from the beginning of and is Eudunda initio indivisibly linked with object-relations. This insight shows the attractive attention of a new light from which these phenomena are illuminated.
The immediate conclusion on which the present paper rests holds that transference originates in the same processes that in the earlier stages determine object-relations. Therefore, we have to go back repeatedly in analysis to the fluctuations between objects, love and hatred, external and internal, which dominate early infancy. We can fully appreciate the interconnection between positive and negative transference only if we explored the early interplay between love and hated, and the vicious circle of aggression, anxieties, feelings of guilt and increased aggression, and the various aspects of objects toward whom the conflicting emotions and anxieties are directed. On the other hand, through exploring these early processes it seems convincing that the analysis of the negative transference, which had received proportionally little attention in psychoanalysis technique, is a precondition for analysing the deeper layers of the mind. The analysis of the negative with of the positive transference and of their interconnection is, as analysts have held for many years, an indispensable principle for the treatment of all types of patients, children and adults alike.
This approach, which in the past made possible the psychoanalysis of very young children, has in recent years proved extremely fruitful for the analysis of schizophrenic patients, until about 1920 the general assumption was assumed that schizophrenic patients were incapable of forming the transference and therefore could not be psychoanalysed. Since then, various techniques had attempted the psychoanalysis of schizophrenics. The most radical change of view in this respect, however, has occurred more recently and is closely connected with the greater knowledge of the mechanisms, anxieties, and defences operative in earliest infancy. Since some of these defences, evolved in primal object relations against love and hatred, have been discovered, the fact that schizophrenic patients can develop both a positive and a negative transference had flowered through its own actualization under which were founded in all its blossoming obtainments, in that of its achieving a better understanding that came into the transference: This finding is confirmed if we consistently apply in the treatment of schizophrenic patients the principle that it is as necessary to analyse the negative as the positive transference, which in fact the one cannot be analysed without the other.
Retrospectively it can be seen that Freud's discovery of the Life and Death instinct supports these considerable advances in technique in psychoanalytic theory, which has advanced beyond the understanding of the origin of ambivalence. Because the Life and Death instincts, and therefore love and hate, are at bottom in the closed interaction, as we have simply interlinked negative and positive transference.
The understanding of earliest object-relations and the processes they imply has essentially influenced technique from various angles. It has long been known that the psychoanalyst in the transference situation may stand for mother, father, or other people, that he is also at times playing in the patient's mind the part of the superego, at other times that of the id or the ego. Our present knowledge enables us to penetrate to the specific details of the various roles allotted by the patient to the analyst. There are in fact very few people in the young infant‘s life, but he feels them to be enough objects because they appear to him in different aspects. Accordingly, the analyst may at a given moment represent a part of the self, of the superego or any one of a wide range of internalized figures. Similarly it does not put into effect as far enough if we realize that the analyst stands for the actual father or mother, unless we understand which aspect of the parents has been revered. The picture of the parents in the patient's mind has in varying degrees undergone distortion through the infantile processes of projection and idealization, and has often retained much of its fantastic nature. Although, in the young infant's mind every external experience is interwoven with his phantasies and on the other hand every phantasy contains elements of experience, and is only by analysing the transference situation to its depth that we can discover the past both in its realistic and fantastic aspects. It is also the origin of these fluctuations in easiest infancy that accounts for their strength in the transference, and for the swift changes - sometimes even within one session - between father and female parents, between omnipotently kind objects and dangerous persecutors, between internal and external figures. Sometimes the analyst appears simultaneously to express indirectly of the patient's parents -. There often in a hostile alliance against the patient, under which the negative transference finds great intensity. What has then been revived or has become manifest in the transference in the mixture in the patient's phantasy of the parents as one figure, the "combined parent figure," results as the phantasy formations characteristics of the earliest stages of the Oedipus complex that, if maintained in strength, are detrimental both to object-relations and sexual development. The phantasy of the combined parents draws its force from another element of early emotional life -, i.e., from the powerful envy associated with flustrational oral desires. Through the analysis of such early situations we learn that in the baby's mind when he is frustrated (or, dissatisfied from inner causes) his frustration is coupled with the feeling that another object (soon represented by the father), is to its line of descent from proceeding from the mother, the coveted gratification and love denied to themselves at that minute. In this context is one root of the phantasies that has combined the parents in an everlasting mutual gratification of an oral, anal, and genital nature. Having then, been regainfully employed as having been viewed in this enlightened manner, is presumptuously the prototype of situations of both envy and jealousy.
For many years - and this is up to a point still true today - transference was understood as to direct transferences to the analyst in the patient's material. My conception of transference as rooted in the earliest stages of development and in deep layers of the unconscious is much wider and entails a technique by which from the whole material presented the unconscious elements of the transference are deduced. For instance, reports of patients about their everyday life, relations, and activities not only give an insight into the functioning of the ego, but also reveal - if we explode their unconscious content - the defences against the anxieties stirred up in the transference situation. For the patient is bound to deal with conflicts and anxieties' re-experience toward the analyst by the same methods used in the past, which is to say, he turns away from the analyst as he attempted to turn away from his primal objects: He tries to split the relation to him, keeping him either as a good or a bad figure: He deflects some feelings and attitudes experienced toward the analyst onto other people in his current life, and this is part of ‘acting out'.
It is at this time that the earliest experiences, situations, and emotions from which transference springs. On these foundations, however, are built the later object-relations and the emotional and intellectual developments that require the analyst's attention no less than the earliest ones, that is to say, our field of investigation covers all that lies between the current situation and the earliest experiences. In fact finding access to earliest emotions and object-relations exclude by examining their vicissitudes in the light of later developments is not likely. Its possibilities are only by linking repeatedly (That it means hard and patient work) later experiences with earlier ones and vice versa, it is only by consistently exploring their interplay, that present and past can come together in the patient's mind. This is one aspect of the process of integration that, as the analysis progresses, encompasses the whole of the patient's mental life. When anxiety and guilt diminish and love and hate can be better synthesized, "splitting processes" - a fundamental defensive structure against anxiety - and repression's lesson while the ego gains in strength and coherence: The cleavage between the idealized and prosecutory objects diminishes, the fantastic aspects of objects lose in strength, all of which implies that unconscious phantasy life - less sharply divided off from the unconscious part of the mind - can be better used in ego activities, with a consequently general enrichment of the personality. These differences - as contrasted with the similarities - between transference and the first object-relations cause the repetition compulsion as the pressure put into action by the earliest anxiousness of some situations. When prosecutory and depressive anxiety and guilt diminishes, there is less urge to repeat fundamental experiences over and again, and therefore early patterns and modes of feelings are maintained with less tenacity. These fundamental changes come about through the consistent analysis of the transference: They are bound up with a deep-reaching revision of the earliest object-relations and are reflected in the patient's current life plus the altered attitudes toward the analyst.
It is however, that we have used the term "transference" several times, and in the last case we attributed the therapeutic results to the transference without further definition of the word. Transference is an integral part of the psychoanalysis. A vast, widely scattered, literature exists on the subject. In most contributions on any psychoanalytic theme there is to be found, often tucked away from easy access, some reference to it. It forms of necessity the main topic of papers and treatises on psychoanalytic technique, but" . . . it is amazing how small some very extensive psychoanalytic literature is devoted to psychoanalytic technique', states Fenichel, "and how much less to the theory of technique." No single contribution comprehends all the facts known and the various opinions. This is much more remarkable as differing opinions are held about the mechanism of transference, and its mode of production seems particularly little understood. Without a comprehensive critical evaluation, the student might be bewildered at finding that most authors, before getting to their subject matter, deem it necessary to give their personal interpretations of what they mean by ‘transference' and ‘transference neurosis'. This is well illustrated by Fernichel's book on the theory of the neurosis, which containing more than one thousand six hundred and forty references, quotes only one reference in the sections is on Transference.
During a psychoanalytic treatment, the patient allows the analyst to play a predominating a role in his emotional life. This is a great import analytic process, after the treatment is over, this situation is changed. The patient builds up feelings of affection for and resistence to his analyst that, in their ebb and flow, so exceed the normal degree of feeling that the phenomenon has long attracted the theoretical interest of the analyst. Freud studied this phenomenon thoroughly, explained it, and gave it the name "transference."
All the same, the lack of knowledge of the causation of transference appears largely to have gone unnoticed. It seems tacitly to be assumed that the subject is fully understood. Fernichel for instance, writes Freud was at first surprised when he met with the phenomenon of transference, today, Freud's discoveries make it easy to understand it theoretically. The analytic situation induces the development of derivatives of the repressed, and simultaneously a resistance is operative against, . . . the patient misunderstands the present as to the past. If one scrutinizes this frequently quoted reference, one realizes that it does not explain the factors that produce transference. However, illuminating and pointed this and other similes may be, they are descriptive rather than explanatory. The causes of the limited understanding of transference are historical, inherent in the subject matter, and psychological.
Historically, psychoanalyses developed, a natural way of striving to differentiate it from hypnosis, its precursor, similarities between the two and having to a tendency to be overlooked. The modes of production and the emergence of the transference (positive, negative, and the transference neurosis) were considered and entirely new phenomenon peculiar to the psychoanalysis, and altogether distinct from what occurred in hypnosis.
In this differentiation from hypnosis, psychoanalysis had to come to terms with the idea of "suggestion." Many psychoanalytic writers, and more particularly others, have complained about the inaccurate ands inexact use of this term. The greater impetus toward research into "suggestion" came from the study of hypnosis. With the appearance (1886) of Bergheim's book, hypnosis ceased to be considered a symptom of hysteria, the nucleus of hypnosis was established as the effect of suggestion, and it is Bergheim's merit that he showed that all people are subject to the influence of suggestion and that the hysterias differ chiefly in his abnormal susceptibility to it. This seemed to Freud a great advance in recognizing the importance of a mental mechanism in the production of disease. In the introduction he wrote (1888) to his translation into German of Bergheim's book, which is of historical interest because it is believed to be Freud's first publication on a psychological subject. Freud emphasizes the distinguishable importance of Bernheim's, . . . insistence upon the fact that hypnosis. Hypnotic suggestion can be applied, not only to hysterics and to seriously neuropathic patients, but also to most of healthy persons, and his belief that this ‘is calculated to extend the interest of physicians in this therapeutic method far beyond the narrow circle of neuropathologists. The significance of suggestion was thus established, but its meaning had yet to be clarified. Freud tried to find a link between the psychological (somatic) and mental (psychological) phenomena in hypnosis: "I think," he stated, "the shifting and ambiguous use of the word "suggestion" lend to this antithesis a decretive sharpness that it does not in reality posses." He then set out to give a definition of suggestion to embrace both its psychological and mental manifestations. Considering what it is worthwhile we can legitimately call a 'suggestion'. No doubt some kind of mental influence is implied by the term, and should correspondingly be put forward the view that what distinguishes the suggestion from other kinds of mental influence, such as a command or the giving of a piece of information or instruction, is that with a suggestion an idea is aroused on another person's brain that is not examined as for its origin but is accepted just as though it had arisen spontaneously in the grain. Freud did not succeed in giving the term a clear and unequivocal definition.
The psychological phenomena (vascular, muscular, etc.) have yet to be brought under the roof of suggestion, if hypnosis and hysteria were to be claimed for psychology. Psychology functions not subject to conscious control, and Freud's earlier definition of suggestion, did not cover them, so, in this pre-analytic paper, Freud widens the meaning of suggestion by introducing "indirect suggestion." He says, "Indirect suggestions, in which a series of intermediate linked out of the subject's own activity are implied between the external stimulus and the result, are none the less mental posses, but they are no longer exposed to the full light of consciousness that falls upon direct suggestion." Noting that the factor of an unconscious operation of suggestion is now introduced for the first time in Freud's whitings is important. If, for example, it is suggested to a patient that he close his eyes, and if then he falls asleep, he has added his own association (sleep follows closing of the eyes) to the initial stimulus. The patient is then said to be subjected to ‘indirect suggestion' because the suggestive stimulus opened the door for a chain of associations in the patient's mind, in other words, the patient reacts to the suggestive stimulus by a series of autosuggestions Freud in his paper, and later, uses the "indirect suggestion" as synonymous with "autosuggestions."
When suggestion was found by Bernheim to be the basis of hypnosis, it remained to be explained why most but not all persons could be hypnotized, or were susceptible to suggestion, and why some was more readily hypnotizable than others: Thus, besides the activity of the hypnotist, a factor inherent in the patient was established and had to be examined. The factor was called the patient's suggestibility. The nature of what went on in the patient's mind during hypnosis was soon made the subject of extensive psychological process. Ferenczi showed that the hypnotist when giving a command is relacing the subject's parental imagos and, more important, is so accepted by the patient. Freud concluded that hypnosis is a mutual libidinal tie. He found that the mechanism by which the patient becomes suggestible is a splitting from the ego of the ego-ideal transferred to the suggesters. As the ego-ideal normally has the function of testing reality, this faculty is greatly diminished in hypnosis, and this accounts both for the patient's credulity and his further regression from reality toward the pleasure principle. According to Freud, the degree of a person's ego and ego-ideal, from which to the greater extent is readily an identification with authority. Thus, we find that in the understanding of hypnosis and suggestion the subject's suggestibility came to outweigh the suggesters activities. Earnst Jones, showed that there is no fundamental difference between autosuggestion and allosuggestion, and both make up libidinal regression to narcissism. Abraham, in his paper on Coué, shows that the subjects of this form of autosuggestion regressed to states of obsessional neurosis. McDougal speaks of "the subject's attitude of submissiveness as suggestibility." As the common factor brought out by all these investigations is regression, defining suggestibility as adaptability by regression seems justifiable.
In the investigations of hypnosis, the stress has been placed at different times on extrinsic factors (The implanting of an idea or the hypnotist's activities) or on intrinsic factors, i.e., the patient's suggestibility. In fact, whereas the ‘implantation' of a foreign idea, independent of any factors operative within the patient, was first considered to form the whole process of suggestion, the pendulum soon swung to the others extremer, and the endo-psychic process (capacity to regress ) were considered the essence of hypnosis. Through this historical development "suggestion" and "suggestibility" became confused, although suggestibility clearly distinctly infers a state or readiness as opposed to the actual process of suggestion. Unfortunately, however, these two terms have crept into psychoanalytic literature as having the same meaning. It is in part due to this fact that the transference phenomenons became considered as a spontaneous manifestation to the neglect of precipitating factors. These ambiguities have never been overcome, moreover, they are to same extent responsible for the lack of understanding of the genesis and nature of transference.
To differentiate the new psychoanalytic technique from hypnosis there was a repudiation of suggestion in the psychoanalysis. Later, however, this was questioned, and the term, suggestion, was reintroduced into psychoanalysis terminology. Freud says that," . . . and we have to admit that we have only abandoned hypnosis in our methods to discover suggestion again in the shape of transference," and, in another paper, "Transference is equivalent to the force called "suggestion." Still later, "It is quite true that a psychoanalysis, like other psychotherapeutic methods, works by means of suggestion, the difference being, however, that it (transference or suggestion) is not the decisive factor." While Freud equates here transference and suggestion, he says a little earlier in the same paper: "One easily recognizes in transference the same factors that the hypnotists have called "suggestibility. Which is the carrier of the hypnotic rapport?" In his Introductory Lectures, Freud also uses transference and suggestion interchangeably, equally it recognizes that sometimes a given guarantee upon its meaning of suggestion in psychoanalyses by stating that ‘direct suggestion' was abandoned in the psychoanalysis, and that it is used only to uncover instead of covering it, Ernest Jones states that suggestion covers two processes ‘ . . . This, taken for granted is given to the spoken exchange of which is persuasively an "affective suggestion," of which the latter are the more primary and are necessary for the action of the former. "Affective suggestion" is a rapport that depends on the transference (Übertragung) of certain positive affective processes in the unconscious region of the subject's mind . . . Suggestion plays a part in all methods of treatment of the psychoneurosis except the psychoanalytic one." This new terminology does not seem clear. "Affective suggestion" obviously represents "suggestibility." In the way it is expressed it plainly contradicts Freud's statement about the role of ‘suggestion' in psychoanalysis Freud and Jones was probably in full agreement about what they meant. Nevertheless, this confusing and haphazard use of terms could not but influence adversely the full understanding of analytic transference. One might even take it as proof that transference is not fully understood: If it were, it could be stated simply and clearly.
That Freud was dissatisfied about the definition of transference and suggestion is confirmed by his statement: "Having kept away from the riddle of suggestion for thirty years, I find on approaching it again that there is no change in the situation . . . The word is finding an ever more extended use, and a looser and looser meaning." He introduces yet another differentiation of suggestion "as used in the psychoanalysis" from suggestion in other psychotherapies. As used in psychoanalyses argued Freud - and one is tempted to say by way through the fact that transference is continually analysed in a psychoanalysis and so resolved, inferring that the effects of suggestion are by that undone. This statement found its way into psychoanalysis literature in many places, and gained acceptance as a standard valid argument: The factor of suggestion is held to be eliminated by the resolution of the transference, and this is regarded as the essential difference between the psychoanalysis and all other psychotherapies. However, including it in the definition of suggestion is dubiously scientific, the subsequent relations between therapist and patient, neither is it scientifically precise to qualify ‘suggestion' by its function: Whether the aim of suggestion is that of covering up or uncovering, it is either suggestion or it is not. Little methodological advantage could be gained by using "suggestion" to fit the occasion, and then to treat the terms "suggestion," "suggestibility," and "transference" as synonymous. It is therefore not surprising that the understanding of analytic transference has suffered from this persisting inexact and unscientific formulation.
One must agree with Dalbiez, when he said, "The Freudians" deplorable habit (which they owe, to Freud himself) of identifying transference with suggestion has largely contributed to discrediting psychoanalytic interpretations. The truth is that positive transference causes the most favourable conditions for the intervention of suggestion, but it is hardly identical with it. Dalbiez, gives definition to suggestion as
" . . . unconscious and involuntary realization of the content of a representation." This neatly condenses the factors that Freud postulated, namely, autosuggestion, direct and indirect suggestion, and their unconscious operation.
In this historical review, it may be stated, despite ambiguities, it may be generally accepted that in the classical technique of psychoanalysis, suggestion so defined is used only to induce the analysand to realize that he can be helped and that he can remember.
An important factor responsible for the neglect of the theory of transference was the early preoccupation of analysts with showing the various mechanisms involved in transference. Interest in the genesis of transference was sidetracked by focussing research on the manifestations of resistance and the mechanisms of defence. These mechanisms were often explained as the phenomenon of transference, and their operation was taken to explain its nature and occurrence.
The neglect of this subject may in part be the result of the personal anxieties of analysis. Edward Glover comments on the absence of open discussion about psychoanalytic technique, and considers the possibility of subjective anxieties.
": . . Seemingly much more likely in that so much technical discussion centres round the phenomena of transference and countertransference, both positive and negative." There may in addition reach and unconscious endeavour to avoid any active "interference" or, more exactly, to remove any suspicion of methods reminiscent of the hypnotist.
A survey of the literature within the strict limits of psychoanalysis would simply summarize what has been said about the causation of psychoanalytic transference. Nevertheless, although this can be done, however, it is of doubtful value without a survey first of the literature about transference manifestoes in general, and without a survey of what transference is held to be and to mean. Many and varying differences of opinion obviously coexist and as a result, many differing interpretations would have been to give. However, unfortunately, without a comprehensive critical survey of the subject, in fact, would prove impossible because there are no clear-cut definitions and many differences of opinion about what transference is. This is in part attributable to the state of a growing science and to the fact that most authors approach the subject from one angle only.
To begin with, there is no consensus about the use of the term "transference" which is called variously 'the transference' 'transference' 'transferences' 'transference state' sometimes as 'analytic rapport.'
Does transference embrace the whole affective relationship between analyst and analysand, or the more restricted ‘neurotic transference' manifestation? Freud used the term in both senses. To this fact Silverberg recently drew attention, and argued that transference should be limited to ‘irrational' manifestations, maintaining that if the analysand says ‘good morning' to his analyst, including such behaviour under the term transference is unreasonable. The contrary view is expressed: That transference, after the opening stage, is everywhere, and the analysand's every naturally formed process can be given a transference interpretation.
Can transference be adjusted to reality, or are transference and reality mutually exclusive, so that some action can only be either the one or the other, or can they coexist so that behaviour in accord with reality can be given a transference meaning as on forced transference interpretation? Alexander comes to the conclusion that they are' . . . truly mutually exclusive, just as the more general notion "neurosis" is quite incompatible with that of reality adjusted behaviour.
Freud divided transference into positive and negative. Fernichel asks this subdivision, arguing that, "Transference forms in neurotics are mostly ambivalent, or positive and negative simultaneously." Fernichel states further that manifestations of transference ought to be valued by their "resistance value," noting that " . . . positive transference, although acting as a welcome motive for overcoming resistance, must be looked upon as a resistance in as far as it is transference." Ferenczi, on the contrary, after stating that a violent positive transference is, especially in the early stages of analysis, as it is often nothing but resistance, emphasizes that in other cases, and particularly in the later stages of analysis, it is essentially the vehicle by which unconscious striving can reach the surface. Most often the inherent ambivalence of transference manifestations is stresses and looked upon as a typical exhibition of the neurotic personality.
The next query arises from one special aspect of transference, ‘acting out' in analysis. Freud introduced the term "repetition compulsion" and he says: "for a patient in analysis . . . it is plain that the compulsion to repeat in analysis the occurrence of his infantile life disregards the in bounding in every way the pleasure principle." In a comprehensive critical survey of the subject, Kubie comes to the conclusion that the whole conception of a compulsion to repeat for the sake of repetition is of questionable value as a scientific idea, and were better eliminated. He believes the conception of "repetition compulsion" involves the disputed death instinct, and that the term is used in psychoanalytic literature with such widely differing connotations that it has lost most, if not all, of its original meaning. Freud introduced the term for the one variety of transference reaction called acting out, but it is, in fact, applied to all transference manifestations. Anna Freud defines transference as: ‘. . . in all, those impulses experienced by the patient in his relation with the analyst that are not newly created by the objective analytic situation but have their sources in early . . . early relations and are now merely revived under the influence of the repetition compulsion. Ought, then, the term "repetition compulsion" be rejected or retained and, if retained, as it applicable to all transference reaction, or to acting out only?
This leads to the question of whether transference manifestations are essentially neurotic, as Freud most often maintained: "The striking peculiarity of neurotics to develop affectionately and hostile feelings toward their analyst are called ‘transference." Other authors, however, treat transference as an example of the mechanism of displacement, and hold it to be a "normal" mechanism. Abraham considers a capacity for transference identical with a capacity for adaption that is ‘sublimited sexual transference', and he believes that the sexual impulse in the neurotic is distinguishable from the normal only by its excessive strength. Glover states: ‘Accessibility to human influence depends on the patient's capacity to establish transference, i.e., to repeat undulate current situations . . . Attitudes developed in early family life'. Is transference, then, consequent to trauma, conflict, and repression, and so exclusively neurotic, or is it normal?
In answer to the question, is transference rational or irrational, Silverberg maintains that transference should be defined as something having the two essential qualities: That it is ‘irrational and disagreeable to the patient'. Fernichel agrees that ‘transference is bound up with the fact that a person does not react rationally to the influence of the outer world'. Evidently, no advantage or clarification of the term ‘transference' has followed its assessment, justly as ‘rational' or otherwise. Unfortunately, the antithesis, ‘rational' versus irrational', was introduced, as it was precisely a psychoanalysis that protested that rational behaviour can be traced to "irrational" roots. What is transferred? Affects, emotions, ideas, conflict, attitudes, experiences? Freud says only effect of love and hate is included. Nevertheless, Glover finds that "Up to that date [1937] discussion of transference was influenced for the most part by the understanding of one unconscious mechanism only, that of displacement." He concludes "that an adequate conception of transference must reflect all the individuals' development . . . he takes upon the place of the analysts, not merely affects and idealizes but all he has ever learned or forgotten throughout his metal development." Are these transferred to the person of the analyst, or also to the analytic situation? Is extra-analytic behaviour to be classed as transference?
Are positive and negative transference felt by the analysand to be an "intrusive foreign body," as Anna Freud states, in discussing the transference of libidinal impulses, or are they agreeable to the analysand, a gratification so great that they serve as resistance? Alexander concludes that transference gratifications are the greatest source of unduly prolonging analysis, he reminds his readers that whereas Freud initially had the greatest difficulty in persuading his patients to continue analysis, he soon had equally great difficulty in persuading them to give it up.
Freud divides positive transference into sympathetic and positive transference. The relation between the two is not clearly defined, and sympathetic transference is sometimes called analytic rapport. Do the two merge, or remain distinct: Is sympathetic transference resolved with positive and negative transference? Discussions in the importance of positive transference are the beginning of analysis and as carrier of the whole analysis had lately been revived among child analysts. This has extended to the question of whether or not a transference neurosis in children is desirable or even possible. While this dispute touches on the fundamentals of psychoanalytic theory, the definitions offered as a basis for the discussion are not very precise.
The contradictions in the literature about transference could be multiplied, but as exemplifying the conspicuous absence of a unified conception they will suffice. Alexander's make to comment that ‘Although it is agreed that the central dynamic functional problem in psychoanalytic therapy is the handling of transference, there is a good deal of confusion about what transference really means'. He comes to the conclusion that the transference relationship becomes identical with a transference neurosis, except that the transient neurotic transference reactions are not usually dignified with the name of "transference neurosis." He thus questions the need for the term transference neurosis together. As to the transference neurosis itself, there is a similar haziness of the conception. Definitions usually begin with "When symptoms loosen up . . . ," or "When conflict is reached . . . ," or "When the productivity of illness becomes centred round one place only, the relation to the analyst . . . ," yet, strictly speaking, such pronouncements are descriptions, not definitions. Freud's definition of transference neurosis implicitly and explicitly refers only to the neurotic person, so that one is left with the impression that only neurotics form a transference neurosis. Sachs, on the contrary,' . . . found the difference between the analyses of training candidates and of negligent neurotic patients.
It may be historically held that many contradictions in the literature are largely semantic, which in enumerating them haphazardly, discrepancies' brought into false relief. A truer picture, it may be argued, would have been given is historical periods had been made the principle. Developmental stages in a psychoanalysis were of course reflected in current concepts of transference.
In the very first allusion (1895) to what developed into the notion of transference, Freud says that the patient made ‘a false connection' to the person of the analyst, when an effect became conscious which related to memories that were still unconscious. This connection Freud thought to be due to ‘the associative force prevailing in the conscious mind'. It is interesting that with this first observation Freud had already noted that the effect precedes the factual material emerging from repression. He adds that nothing is disquieting in this because " . . . the patients gradually come to appreciate that in these transferences onto the person of the physician they are subject to a compulsion and a misrepresentation, which vanquishes with the cancellation of analysis."
In 1905 Freud stresses the sexual nature of these impulses felt toward the physician. What, he said, are transferences? "They are new editions or facsimiles of the tendencies and fantasies aroused and made consciously during the progress of the analysis . . . Fantasies now added to affect. If one goes into the theory of analytic technique," he continues, "transference is evidently an inevitable necessity." At this historic point Freud established the fundamental importance of transference in the psychoanalysis with its specific technical meaning. The importance of this passage is confirmed by a footnote added on 1923. It is noteworthy that Freud mentions in its passage that transference impulses are not only sympathetic or affectionate, but that they can be hostile.
About 1906 transferences were regarded as a displacement of effect. Analysis was largely interested in unearthing forgotten Traumata and in searching for complexities. Much of the theory was still influenced by the cathartic method. The psychoanalysis was then, says Freud,‘ . . . the next aim was to compel the patient to confirm the reconstruction through his own memory. In this endeavour the chief emphasis was on the resistance of the patient: The art now lay in unveiling these when possible, in calling the patient's attention to them . . . and teaching him to abandon this resistance. It then became increasingly clear, however, that the bringing into consciousness of unconscious material was not fully attainable by this method either. The patient cannot recall all that lies repressed . . . and so gains no conviction the reconstruction is correct. He is obliged to repeat as a current experience what is repressed instead of recollecting it as a part of the past'. The importance of resistance as acting out is now introduced (repetition compulsion).
Beyond the Pleasure Principle (1920) was followed by Group Psychology and the Analysis of the Ego (1921) and The Ego and the Id (1923). The new concepts introduced were the superego, and the more specific function of the ego, and the conception of the id as containing not only repressed material, but also as a reservoir of instincts. Resistance was extended to ego and superego and it resistance. This caused some confusion, because it can be used as meaning the resistance of one psychic instance to analysis, or the resistance of one psychic instance, say the ego, to another psychic instance, say the id, but the term resistance has been used chiefly as resistance to the progress of analysis generally. The id was shown to offer no resistance, but to lead to acting out, which in turn, however, is a resistance to recollection. At times, the unconscious can only be recovered in action, and while it is therefore "material" in the strict sense of the word, it is still resistance to verbalized recollection.
The mechanisms considered operatives in transference were displacement, projection and introjection, identification, compulsion to repeat. The importance of "working through" was stressed. In 1924 discussions took place about the relative values of intellectual insight versus affective re-experiencing as the essence of analytic experience, an issue very important in interpreting the transference to the patient.
In the period following, this added knowledge was gradually integrated, but with overemphasis on some new aspects as they first arose. Without a comprehensive critical survey of the subject, authors found it necessary to explain what they meant when they used the term "transference."
With this integration new factors of confusion arose. Viewed arbitrarily form, lets us say 1946, the conception of transference has been influenced by (1), child analysis, (2), undertaking at treating psychotics, (3) psychosomatic medicine, and (4) the disproportions between the number of analysts and the growing number of patients seeking analysis, leading to attempts to shorten the process of analysis.
Direct interpretation of unconscious content is again being stressed by some analysts of children so that the methods are reminiscent of the beginning of psychoanalysis. Yet on closer examination, there may be a difference in principle: Unconscious material that presents itself in play is given a direct transference meaning from the beginning. The therapist interprets forward, as it was. The interpretation is not from current material, but from the allegedly presented unconscious material to an alleged immediacy of the transference significance. This, it should be noted, is a mental process of the therapist and not of the patient, therefore in the strict scientific sense, it is a matter of countertransference than of transference. Something similar takes place in the classical technique when forced transference interpretations are given, the important difference being that these are used in the classical method only sparingly and never until the transference neurosis is well established, and analysis has become a compulsion. It is precisely at this theoretical, that the dispute is centred among child analysts about the possibility or existence of a transference neurosis among children.
In the treatment of psychotics the idea of transference is developing a new orientation. In some of these techniques the therapist interprets to himself the meaning of the psychotic fantasy and joins the patient in acting out. Strictly speaking, this is active countertransference.
In psychosomatic medicine, particularly in ‘short therapy', transference is either discounted as an actively manipulated way that, from a theoretical point of view, amounts to an abandonment of Freud's "spontaneous" manifestations.
All and all, changes in the idea of transference are not constructively progressive. Critical attention needs to be drawn to the fact that not only is there no consensus about the concept of transference, but there cannot be until transference is comprehensively studied as a branch of knowledge and as a functional dynamic process. The lack of precision is to some extent due to a disregard of its historical development. Nor can there be a consensus while the relation of transference manifestations to the three stages of analysis is neglected, it is to the detriment of scientific exactitude that divergent groups do not sharply define but as an alternative, it glosses over fundamental differences, there is a tendency to claim orthodoxy, and to hide the deviation behind one tendentiously and arbitrarily selected quotation from Freud.
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