118. Развитие идеи трансфера после Фрейда: реальность и неосознаваемые процессы. Р. Лангс (118. Transference Beyond Freud: Reality and Unconscious Processes. Robert J. Langs)
Mount Sinai School of Medicine, New York, USA
Transference, as is well known, is the central therapeutic vehicle for psychoanalysis as a treatment form. Similarly, its investigation is perhaps the single most fruitful means of clarifying the functioning of the human mind, especially the unconscious processes that prevail within its confines. The discovery of transference was crucial to the conception and elaboration of Freud's theory of the mind, and proved to be the wellspring for his insights into the nature of the psychoanalytic process - his basic clinical theory. Similarly, subsequent investigations of transference (here defined as the patient's total reactions to the analyst; see Langs, 1976b) have offered a major tool for refining our conception of the analytic interaction and for developing fresh insights into clinical processes.
In keeping with this tradition, the present paper will offer a discussion of transference and the related unconscious processes as developed by psychoanalysts after (and occasionally simultaneously with) Freud. Because I have elsewhere (Langs, 1976b) presented a comprehensive survey of these writings and in recognition of the necessity of providing a special focus for the present paper, I shall concentrate this discussion on what seems to be one of the most crucial elaborations of, and addenda to, Freud's writings in this area: the interplay between the patient's unconscious transference fantasies and external reality; this will lead to a special investigation of the interaction between the patient and analyst.
In his relatively sparse clinical writings (see especially Breuer and Freud, 1893-95; Freud, 1905, 1912a, b, 1913, 1914, 1915, 1920, 1940; see also Langs, 1976b), Freud documented his discovery of transference and derived a series of implications for psychoanalytic technique from this monumental finding. In brief, Freud suggested that transference is based on unconscious fantasies and memories, and he saw it as the central distorting factor in the patient's relationship with the analyst. Displacement onto the analyst from early important figures was viewed as the central psychic mechanism, and interpretations of these displacements - and reconstuctions - were seen as the definitive vehicle of symptom resolution and cure. Resistances to the analysis of transference and the function of transference as a resistance were discovered, as was the crystallization of the transference neurosis. A special issue involved the patient's propensities to act out his unconscious transference fantasies, either directly with the analyst or with others; such behaviors, while meaningful, served mainly as a resistance to the recollection of the crucial memories on which the unconscious transference fantasies were based.
As an outgrowth of his consideration of the important problem of acting out, in a brief section of Beyond the Pleasure Principle, Freud (1920) stressed his finding that the patient will actually revive earlier unwanted situations and painful emotions "in the transference" - i. e., in his relationship with the analyst - endeavoring to evoke reactions in the analyst comparable to those of earlier figures and to gratify his infantile fantasies and instinctual wishes. It is here, then, that the interactional dimensions of transference first found their specific recognition.
It is generally overlooked that Freud, despite his overriding intrapsychic focus, approached a second dimension of interaction in his final commentson transference in An Outline of Psychoanalysis (Freud, 1940), a book written some years after Strachey's (1934) landmark comments on this subject to which Freud did not directly refer (see below). In this work, Freud noted that the analyst is placed by the patient in the role of his superego and he stated that this provided a kind of after-education for the analysand that would modify the detrimental influences of his parents - so long as the analyst maintained his interpretive role. Here, although Freud did not specifically elaborate, the curative aspects of an unconscious component of the analytic interaction was defined, a process in which identification and introjective identification are the salient mechanisms.
On the whole, analysts who have investigated transference on the basis of Freud's key discoveries can be divided into two groups: first, those who elaborated upon the intrapsychic dimensions of transference, such as the nature of unconscious transference fantasies, the delineation of the transference neurosis, the mental mechanisms involved in transference, the classification of transference responses, the manifestations of transference in different diagnostic groups, and the nature of transference resistances; for these analysts, interpretations and reconstructions of unconscious transference fantasies and memories are seen as the central vehicle of analytic cure. The second group has tended to stress the nature of unconscious processes and mechanisms as they prevail within the analytic interaction, deriving their writings more from Strachey (1934) than from Freud (1940), and, with notable exceptions (see below), have been followers of Melanie Klein - rather than classicists; these analysts, while acknowledging the importance of interpretation, have stressed the curative potential of projective and introjective identifications - and especially the identificatory processes within the patient derived from his relationship with the analyst. It is these studies, in which the influence of actuality and interaction on the patient's intrapsychic and unconscious processes is considered, that I shall now explore; remarkably, a careful consideration of reality factors will prove to be extremely illuminating in regard to unconscious mechanisms. Initial
As early as 1909, Ferenczi stressed the role of introjection in the phenomenology of transference. For this author, through introjection the neurotic takes into his ego large segments of the outer world, making them the object of his unconscious fantasies. There is a consistent search for persons who will serve as objects for introjection, a mechanism that operates unconsciously and which also involves self-taught attempts by the patient to cure himself.
It remained for Strachey (1934), in his investigation of the nature of the therapeutic action of psychoanalysis, to more fully delineate the role of both projection and introjection in the psychoanalytic situation. It was Strachey's main thesis that an introjection of the analyst into the patient's superego based on the former's actual traits and behaviors was basic to the resolution of the latter's symptoms - a thesis later extended by Rosenfeld (1972) to include modifications in the ego and in internal objects, good and bad parts of the self.
Strachey described what he termed the "neurotic vicious circle", in which the patient projects an id impulse or superego fantasy and subsequently reintrojects it essentially unmodified from the external object. In order to break such a vicious circle, there must develop a benign circle based on positive introjections. Thus, in the analytic situation, the patient tends to make the analyst into an auxiliary superego onto whom he projects his introjected archaic objects, and from whom, as a new object, he in turn accepts introjects.
Significantly, this process is based on real and contemporary considerations that enable the patient to differentiate benign introjects derived from the analyst from the destructive introjects that comprise the original superego. Further, these modifications require first, that the analyst maintain a basically interpretive stance and in no way endeavor to behave like the patient's good or bad archaic objects - an effort that will confirm the patient's inner fantasies rather than enabling him to modify them; and second, the use of "mutative interpretations" which are offered when the patient has actively invested id energies toward the analyst. Through such an intervention the analysand becomes aware that these energies are directed toward an archaic fantasied object and not toward a real one - the analyst as he is actually behaving.
These formulations indicate that Strachey viewed both interpretation and introjective identification as essential to the resolution of the patient's neurosis, although he did not attempt to distinguish their respective functions. However, Strachey did call to our attention the importance of the actual object relationship with the analyst and of the nature of the unconscious interaction between analyst and analysand; he saw the actual behaviors of the analyst as crucial, since any correspondence to the patient's pathological inner objects would vitiate the effectiveness of his interpretive efforts. Here, then, we find that the resolution of a transference neurosis entails considerably more than the interpretation of unconscious fantasies. The realities of the analyst's demeanor, his adherence to the basic ground rules of the analytic situation, and his ability to tolerate and interpret fantasies directed toward him all play a vital role.
Some Later Interactional Studies
Strachey's (1934) paper paved the way for many investigations of what we may now term the interactional component of transference. It generated a shift from thinking of transference solely as an intrapsychic phenomenon to a recognition of a strong interactional dimension. Ultimately, it led to the distinction of two basic forms of transference (Langs, 1976a, b): classical transference, in which the primary mechanism is displacement from past figures onto the analyst; and interactional transference, in which the main mechanisms active in the analytic exchange are those of projective ident fication and introjective identification - with genetic factors playing a secondary role (Langs, 1976a, b). Let us now turn more definitively to this latter form of transference.
While a number of Kleinian writers have discussed the role of projective identification (first defined by M. Klein in 1946) and introjective identification in the analytic interaction (see Langs, 1976b), the most definitive presentations appear to have been those of Malin and Grotstein (1966), Segal (1967), and myself (Langs, 1976a). The first pair of authors afforded projective identification a central role in the analytic interaction. They carefully defined the term, which has been a source of considerable confusion both because of the nature of the mechanisms involved and because the word identification is used in an unusual manner. Thus, these writers - and later Segal (1967) and myself (Langs, 1976 a, b) - suggested that transference can both be viewed only in terms of a transference-countertransference interaction, since transference is inseparable from the analyst's reactions.
Malin and Grotstein (1966) defined transference as the patient's conscious and unconscious relation with the analyst based on all prior and current object relations, internal and external, beginning with the primary relationship with the breast-mother that has subsequently been internalized. In this context projective identification is defined as an early primitive mechanism through which the infant splits off hidden bad internal parts, and omnipotently places them into the object, usually the mother. It is a mental mechanism that matures with later development, though its earliest expressions occur before self-object differentiation; its later forms occur within the context of clear object relatedness and constitute basic interactional efforts to place partso one's inner self - structures, fantasies, and introjects - into others, so as to manage intrapsychic disturbances outside of oneself (see also Segal, 1967). Thus, while projection is essentially an intrapsychic mechanism in which parts of the inner self are attributed to others without direct interactional pressures toward the object (see Langs, 1976a, b), projective identification constitutes an actual interactional effort to psychologically place some aspects of one's inner self and contents into an external object.
We can see, then, that the term identification in projective identification refers both to an effort by the subject to evoke an identification with himself in the object and to the fact that the subject remains identified with the projected parts that are placed into theobject. It should be noted, however, that 464 the object may or may not accept the proejective identification and is free to process the contents and to reproject them into the subject according to his own intrapsychic needs and defenses. Recently (Langs 1976 a, b), in an effort to clarify the concept, I suggested the term interactional projection for projective identification in order to stress the actualities involved.
Introjective identification is the complementary process through which the object incorporates into his own self-representation, self, and inner world the projective identifications of the subject. In the analytic situation, the Kleinians have stressed the role of the patient's projective identifications. I have attempted a more balanced view (Langs, 1976a, b) which considers pathological projective identifications (in keeping with the function of any defense, this mechanism may take pathological and nonpathological forms) initiated by either the patient or the analyst - leading as a rule to a sequence of projective identification, introjective identification, reprojection, and reintrojection.
One other facet of this process has come under special scrutiny, especially by Bion (1962, 1963, 1965, 1970, 1977; see Grinberg et al. 1975) and myseli (1976a, b) - that of the relationship between the container and the contained. This metaphor, initially developed by Bion, alludes to the contents thaare projectively identified as the contained, while describing the object who incorporates these contents as the container. In the analytic interaction, one important function of the analyst is to contain the patient's pathological projective identifications, accepting them consciously into himself, and metabolizing them into understanding and interpretations to the patient.
Failures in this process, especially those in which the analyst unconsciously introjects aspects of the patient's pathology and becomes involved in a noninsightful exchange of projective and introjective identifications have been described by Grinberg (1962) as projective counteridentifications. Bion (1977) too has described disturbances in the containing function, such as compression and denudation, which deprive the contained contents of their meanings, and he has also suggested that pressures from the contained may lead to a disintegration of the container - and the reverse. He (1977) defined three types of links between the container and the contained: commensal, in which there is coexistence without mutual influence or in which two objects share a third for mutual benefit; symbiotic, in which one object depends on another for mutual benefit; and parasitic, in which envy plays a characteristic role and there is destruction of both objects. In a later work (Langs, 1976a), I attempted to define clinically the manifestations of disturbances in containing functions, especially as they pertain to the countertransference difficulties of the analyst.
Returning to our focus on the subject of transference, these studies and the conceptions derived from them are relevant in a number of ways. First, they offer one means of recognizing the intensity with which unconscious transference fantasies and memories are expressed directly in the interaction with the analyst. Second, in regard to analytic technique, they call for an appreciation of the actualities of the unconscious interaction between patient and analyst, and for the need to interpret not only displacements from earlier figures, but also the nature of the actual interactional efforts by the patient toward the analyst in the current situation. Third, they indicate that in addition to his interpretative functions, the analyst has an important role as a container for the patient's projective identifications, and that the patient's, experience of this actual containing capacity has a curative potential - in addition to the interpretations so derived. Fourth, they point to the danger of unconscious interactional vicious circles of projective identification, introjection, reprojection, and reintrojection. When this occurs on an unconscious level for both participants so that conscious insight is not achieved, it will also constitute actual interactional confirmation of the patient's inner pathology. In this respect, it is not only interpretive insight that leads to inner change for the patient, but the actual experience of the analyst's containing capacities and his ability to not be drawn into pathological vicious circles with the patient - an occurrence which only tends to confirm the patient's pathological inner mental life and to repeat in some derivative form the pathogenic behavior of earlier parental figures (see too Racker, 1968). Thus, these papers demonstrate the great influence of external realities on the patients's transference constellations, and point to the possibility of interactional modification of transference-related pathology.
Classical Freudian Studies of the Analytic Interaction
There has been a gradual, but unmistakable, trend among classical analysts- toward recognizing interactional aspects of transference. A major contribution was offered by Loewald (1960), whose main thesis was that there is a resumption of ego development in analytic treatment which is contingent on the relationship that the patient has with the new object - the analyst. The latter not only interprets transference distortions, but also implies aspects of undistorted reality which the patient grasps and subjects to the process of identification, especially in the context of such transference interpretations (see the earlier contribution by Strachey, 1934). Loewald also suggested that the development of various adaptive ego functions within the patient is dependent upon his interaction with the analyst and can only occur in the favorable environment that becomes increasingly internalized by the analysand.
In two more recent papers (Loewald, 1970, 1972), this author elaborated upon his basic position, viewing the analytic relationship as creating a matrix that provides a psychic field for the development of the patient. His stress was on interaction processes and the patient's internalization of such processes, rather than external events and phenomena. Considerable stress was placed on the parallels between this interaction and the mother-infant matrix, and on the manner in which the patient ultimately differentiates himself out of this interactional field with the analyst into a separate psychic sector.
Another notable contribution was offered by Wangh (1962), who described a form of transference interaction which he termed the evocation of a proxy, in which the patient, mainly for purposes of unconscious defense, attempts to mobilize in the analyst libidinal and instinctual drive needs, threatening superego reactions, and a variety of self-experiences and ego functions that the patient himself does not wish to experience, utilize, acknowledge, or is unable to generate - the analyst thereby serving as a proxy. This mechanism, which appears to be identical with certain forms of projective identification, is unconsciously designed to evoke adaptive responses in the analyst which the patient may then introject, strengthening his own adaptive resources and resolving his own intrapsychic conflicts. Wangh emphasized the extent to which these efforts constitute interactional pressures on the analyst, and he suggested that an unresolved symbiotic phase contributes significantly to their utilization. In addition to stressing the importance of interactional expressions of transference, Wangh's contribution highlighted the adaptive aspects of interactional projection, an element that is often overlooked by the Kleinian group.
Another avenue for the study of transference and interaction developed when analysts began to recognize important differences in the imanifestations and management of unconscious transference fantasies in patients with various clinical diagnoses (see Sandler et al., 1S73 and Langs, 1976 b). There was a growing recognition that borderline and psychotic patients manifested relatively more primitive and action-oriented transference expressions than those seen with neurotics, and that patients with narcissistic pathology showed a distinctive and often difficult to handle form of transference (see too Kern berg, 1975, 1976; and Kohut, 1971, 1972, 1977). Further, the more impaired the patient's ego functions, the greater his difficulty in managing these transference expressions and the more they were either intensely concentrated in wishes for direct gratification and interactional pressures on the analyst or strongly denied. Many aspects of transference were clarified through investigations of these more relatively primitive forms, and this is especially true of the interplay between transference and reality.
Among the many analysts who investigated this area, the work of Winnicott (1958, 1965), Searles (1S65), Kernberg (1975, 1976) and Kohut (1971, 1972, 1977) is perhaps the most outstanding. Winnicott (1958, 1965) stressed the importance of the analyst's actual hold of the patient - his basic mode of relating, his management of the ground rules, his steadiness and realiability - in promoting both transference regression and analysis. In relatively nonneurotic patients, according to Winnicott, there is a need to experience the analyst in a special way that unfreezes earlier environmental failures and provides a current opportunity for the resumption of the patient's arrested psychic development. Rather than reviving the memory of dependence, these patients respond to the analytic situation with actual dependence and rely on the analyst's ability to create a proper environmental setting. The setting therefore becomes an essential vehicle for the patient's progress, especially during the period of regressed dependence, and it offers an opportunity for the patient's true self to meet current versions of early environmental failures and to modify the false self that had been previously developed in response to such failures.
In regard to transference, then, Winnicott stressed the central contribution of early failures in "good-enough mothering" in creating pathological forms of transference which are then expressed directly in the analytic interaction. Further, while acknowledging the ultimate importance of interpretive efforts, Winnicott saw the actual good-enough behavior of the analyst, especially in offering a secure hold for the analysand, as crucial to the resolution of these transference-based disturbances.
It becomes clear that those analysts who have afforded a significant role to the analytic interaction have done so in regard to both its role as a vehicle for the patient's transference expressions and the importance of the analyst's actual handling and management of these derivatives. While interpretation of unconscious transference fantasies, and especially their direct expression in the analytic interaction, remains a sine qua non, considerable importance is placed on the actualities of the analyst - who he is, how he conducts himself, the manner in which he manages the analytic setting, his basic relationship with the patient, his capacity to tolerate and introject the patient's interactional pressures and projective identifications - his ability to consciously metabolize them toward interpretation - his interactional failures based on countertransference problems, and his basic assets and limitations as a human being. Two fundamental but interrelated vehicles of conflict resolution, growth, and adaptation are thereby identified within the analytic experience: specific cognitive insights based on definitive interpretations, and ego-enhancing growth based on unconscious introjective identifications derived from the valid functioning of the analyst.
Searles (1958, 1959, 1965, 1972) offered an extensive series of studies of transference manifestations in schizophrenic patients which he felt were applicable to the study of transference in all patient populations. His basic approach was interactional, and he showed a special sensitivity to the role of reality as it serves as a precipitant for transference reactions, is unconsciously incorporated into transference manifestations, and proves to be a factor in the actual interaction between the patient and analyst. Thus, Searles (1972) demonstrated the extent to which a patient's psychotic transference manifestations incorporates unconscious perceptions of the analyst, including aspects of the latter's own inner state of which he may, himself, be unaware. Technically, such a situation can be successfully analyzed and resolved only if there is an actual modification of the dissociated urges within the analyst - an important consideration that demonstrates how an appreciation of realities is vital both for the delineation of distorted and pathological unconscious fantasies, and for their analytic resolution (see below).
Searles also described in considerable detail the patient's unconscious introjection of both pathological aspects of the analyst and those that are nonpathological and constructive. He paid considerable attention to the actual analytic interaction - the therapeutic symbiosis, as he termed it - and described a variety of pathological and nonpathological forms. For example, Searles (1959) identified a form of transference reenactment in which the schizophrenic patient creates in actuality a struggle in which either he or the analyst, or both, attempt to drive the other crazy. Throughout these considerations, Searles stressed the role of identificatory and projective processes, and conceptualized transference as essentially one component of a transference-counter transference interaction.
Along different lines, Sandler (1976) studied classical transference from an interactional vantage point. He suggested that on the basis of his unconscious transference fantasies, the patient actually attempts to manipulateor prod the analyst into behaving in a particular way that is related to needs, gratifications and defenses derived from early relationships - a restatement and elaboration of the earlier ideas of Freud (1920). Sandler viewed these efforts as endeavors to actualize in the analytic interaction in some disguised way unconscious images and fantasies, and as a means of imposing both interactions and roles onto the analyst. He also suggested that the analyst should be open to controlled responses to these role-evocations by adopting an attitude of free-floating responsiveness which would permit a sensitivity to these transference-based efforts, a controlled response in which mutual acting cut does not occur, and the opportunity to interpret these endeavors. Many of these efforts are quite subtle and call for considerable sensitivity on the part of the analyst.
Some Recent Approaches to the Interplay Between Reality and Transference
I will conclude this survey by presenting the highlights of two current approaches to selected dimensions of transference: investigations of the relationship between transference and reality, and explorations of transference as it unfolds within the interactional field with the analyst - the bipersonal field. The first group of studies has included consideration of both the reality antecedents of transference responses and their realistic consequences, especially in the interaction with the analyst. They have led to a stress on the clinical importance of distinguishing primarily transference-based reactions from those that are primarily nontransference-based; and they have led analysts to more clearly separate the distorted and valid components in the patient's responses to the analyst.
As for the reality pr?cipitants of transference responses, recent investigations (see especially Searles, 1965; Greenson, 1971, 1972; and Langs, 1973 a, b, 1974, 1976 a, b) have demonstrated that in addition to his neurotic functioning and transference responses, the analysand has a capacity for considerable nontransference-based and valid functioning within the analytic relationship. He is remarkably, though as a rule unconsciously, sensitive to and perceptive of the unconscious elements in the analyst's communications, including the latter's personality and character, his errors in interpreting, and his mismanagements of the ground rules. This capacity for 'unconscious perception is central to the analysand's non transference reactions to the analyst in a manner that is comparable to the role of unconscious fantasies and memories in his transferences. However, these studies have also shown that the patient's unconscious perceptiveness and appropriate responses to the analyst's traumatizing behaviors, attitudes, and interventions will, as a rule, eventually extend into the transference realm because of subsequent distortions based on the patient's own pathological inner needs. Similarly, every essentially transference response is based on some reality precipitant and contains a kernel of valid perceptiveness and responsiveness within it.
In my own investigations of the specific stimuli for transference reactions (Langs, 1973, 1974, 1976a, b), I stressed the importance of the interactional approach to transference, and commented especially upon the need to distinguish traumatic-pathological attitudes and interventions by the analyst from those that are essentially constructive and nonpathological, however hurtful to the patient. Through such a distinction, one can more carefully clarify the transference and nontransference components in the patient's associations and behaviors. Technically, in those situations where the analyst's behavior has been largely based on countertransferences, rectification of the actual error in technique, modification of the underlying transference problem, and implicit acknowledgment of the patient's valid perceptions were seen as important components to the analyst's response to the patient - elements which are, on the whole, unnecessary when the analyst has not behaved traumatically and the patient's reaction is essentially founded on his own intrapsychic pathology.
In regard to the realistic consequences of transference-based communications and behaviors from the patient, it is striking that writers were quite slow to discover the actual impact and consequences of such behaviors, especially on the analyst. While Freud (1915) had indeed commented that the patient's transference love may express a wish to destroy the analyst's authority, so long as transference was seen primarily as belonging to the realm of fantasy and as an illusion, and the analyst viewed primarily as a screen rather than an active participant in the analytic experience, there was little appreciation for the effects of transference expressions on the analyst himself.
Searles (1959, 1965) was among the first contributors to recognize that at times, based on unconscious transference fantasies and memories, the analysand makes actual efforts to hurt the analyst - e. g., by attempting to actually drive him crazy or to otherwise harm and threaten him. Searles also recognized that these transference-based repetitions of past pathogenic interactions contain within them the hope for an interpretive and nonparticipating response in the analyst, and therefore for the cure of the patient's neurosis or psychosis.
Remarkably, it was not until 1972 that Bird offered an initial specific discussion of actual harmful intentions by the patient toward his analyst. Bird pointed out that these efforts are тэге successful than is generally recognized. He suggested that transference-based resistances are often used as weapons against the analyst and constitute attacks upon him, as may stalemates and negative therapeutic reactions. He described the actual destructive elements in the patient's behavior that are designed to injure the analyst, noting that they are considerably more than mere mental representations of hostile fantasies, wishes, and reactions. Bird also indicated that it is essential to differentiate transference-based attacks on the analyst from retaliations on the analyst for his actual, often unconscious, attacks on the analysand.
Writing before and subsequent to Bird, I (Langs, 1973 a, 1974, 1976 a, b) attempted to delineate the destructive elements in both erotized and aggressivized - instinctualized - transferences, and to define various unconscious efforts by the patient to inappropriately seduce or attack the analyst based on his transference-based needs. Interactionally, I viewed these disruptive efforts as an attempt to create sectors of therapeutic misalliance. In contrast to the therapeutic alliance which is designed toward insight and inner structural change, misalliances are created to maintain and gratify the patient's neurosis, and to involve the analyst in a countertransference-based participation in such endeavors. I too stressed the patient's positive wishes to be analyzed and cured that are contained within these destructive efforts, and went on to elaborate upon the harmful elements in the patient's interactional projections or projective identifications - aspects that create intense stresses for the analyst.
It is a most revealing aspect of the history of the psychoanalytic study of transference - and more broadly, of the analytic relationship - that the last aspect of transference to be clearly defined entails the patient's unconscious efforts to help or cure his analyst. While there are, as a rule, noncountertransference contributions to such efforts, as early as 1951, Little had identified both the patient's great unconscious sensitivity to the analyst's difficulties and the analysand's offer of countertransference interpretations when these problems prevail.
In 1958, in the context of a study of the schizophrenic's vulnerability to his therapist's unconscious processes, Searles noted the possibility that the patient may respond with therapeutic efforts toward his therapist. These endeavors are based upon the patient's introjections of his therapist's problems and constitute unconscious efforts toward therapeutic help.
It was not, however, until 1975 that Searles wrote specifically and extensively on this subject - the patient as therapist to his analyst. Searles suggested that innate among man's most powerful endeavors is an essential psychotherapeutic striving toward others, beginning with the infant in his relationship with his mother. He further stated that the patient is ill because these strivings have been frustrated and unduly mixed with components of hate, envy, and competitiveness, and therefore repressed - thereby becoming an aspect of transference. Transference itself, in this context, is viewed as an expression of both the patient's illness and of unconscious attempts to cure the doctor. Involved here is a genuine concern about whether the analyst grows and thrives as a result of the patient's therapeutic ministrations to him, and the entire effort relies on the patient's unconscious sensitivity and introjection of flaws within the analyst.
My own investigations (Langs, 1975, 1976 a) further - and independently - confirmed and developed the observations and concepts offered by Searles. For example, I delineated the patient's unconscious perceptions of his therapist's errors (Langs, 1973 b, 1974), and defined efforts by the patient to help the therapist correct these errors and the underlying problems on which they are based. Among the means of effecting the cure of the therapist I identified the patient's unconscious interpretations to the analyst, indirectly communicated interventions that have all of the hallmarks of interpretive work, though they were offered without the patients's awareness.
Interactionally, I stressed the extent to which the therapist's counter- transference difficulties are expressed in both misinterventions and mismanagements of the frame, and how these constitute pathological efforts at projective identification by the analyst which the patient then, as a rule, introjects and metabolizes. Under these circumstances, the pathological introjects will blend into the inner disturbances within the patient - his transferences - and the consequent self-curative response is the equivalent of an unconscious effort to cure the analyst.
These investigations of the antecedents and consequences of transferences have demonstrated the importance of an interactional approach, and the extent to which transferences are indeed both influenced by, and have an influence on, reality. This realization is also implicit in the essentially interactional approaches to the analytic relationship to which I will now turn.
A full interactional conception of transference requires a three-dimensional concept of the analytic situation itself, the field within the analytic interaction occurs. In this way, it is recognized that transferences are not isolated intrapsychic elements, but are in an open and continuous interaction with the influences from the surroundings, especially the analyst - i. e.,countertransference in its broadest sense. Considerable understanding of transference and of the relevant analytic techniques have accrued through the work of such analysts as the Barangers (1966), who defined the bipersonal field of the analytic interaction (see also Langs, 1976 a), and Viderman (1974) who wrote of the analytic space.
In brief, the Barangers saw the bipersonal analytic situation as a basically asymmetrical field that is primarily two-person oriented, although triangular relationships are also introduced. The field is structured according to three configurations: the analytic contract; the nature of the manifest associations of the patient; and the unconscious fantasies of both patient and analyst that determine the emergence of this material, including their fantasies about the analytic situation itself and their concept of cure. The analyst, they stated, exerts a continuous influence on the patient's unconscious transference fantasies and their communication, since all such fantasies must be defined in terms of contributions from both participants - even where the patient is the preponderant contributor, as in transference. The bipersonal field concept therefore calls for a careful study of the gromd rules since they define the field and its communicative properties (see Langs, 1976a,b); any manifestation within the field, sich as transference, must be investigated in terms of the properties of the entire situation and the contributions of both participants.
Interactionally, then, the analytic pair will tend to create within their relationship a repetition of their own unresolved neurotic pasts. In a properly structured bipersonal field, the pathological contributions from the patient will predominate; however, both the patient and analyst must be cured through interpretations. Insight thus becomes a process of comprehension of unconscious aspects of the field which reduces the pathology of the field and rescues the respective pathological parts - transferences - of each participant. Insight and interpretation (see also de Racker. 1961) are interactional processes, and resistances which interfere with these curative efforts also have interactional dimensions. For example, the Barangers described bastions, which are split-off aspects of the field created by both patient and analyst that divide the communication between the pair. This split-off sector will enclose the patient's transference resistances and the analyst's unconscious resistances, and interfere with the communication between them; it can only be modified through the resolution of the respective pathology within both participants. In this way, the concept of a transference neurosis is supplemented by one of an interactional neurosis (Langs, 1976 a), and transference resistances are complemented through a concept of interactional resistances - each pertaining to the interactional components of the patient's disturbance and the relevant unconscious contributions of the analyst.
It is remarkable to discover that Freud had anticipated virtually every major area of study related to transference. Historically, in keeping with Freud's basically intrapsychic conception of transference, most early investigators offered elaborations of this dimension. By and large, classical psychoanalysts have maintained this intrapsychic focus, and while they have slowly developed a supplementary understanding of interactional influences and consequences that have a bearing on transference, they still afford the interactional elements a secondary position. Despite this limitation, these analysts have shown a growing sensitivity to the interactional aspects of transference. Their approach calls for an adaptational-interactional approach to transference so that this important intrapsychic constellation is properly viewed within the totality of the external influences that help to shape it.
It is the Kleinians who most clearly have stressed the influence of unconscious transference fantasies and memories on the immediate object relationship between the patient and his analyst, and who more sensitively defined a variety of basic transference-based interactional mechanisms, especially those of projective and introjective identification. One difficulty with the Kleinian approach has been their biased focus on the patient's transferences and pathological projective indentifications to the relative exclusion of the analyst's pathological countertransferences and his own pathological projective identifications. While I have in this presentation focused on transference and thereby on the patient's pathological contributions to the analytic interaction, I have elsewhere (Langs, 1976 a, b) placed considerable emphasis on the need to recognize that in the actual analytic experience, to the extent that every analyst remains open to the influence of unresolved countertransference difficulties, he too may initiate important disruptive processes within both that interaction and his patient. A careful appraisal of the communications from the patient and of the inner state of the analyst, one that includes a search for both fantasied and realistic elements, is an essential part of the analyst's continuous therapeutic work. As I have described elsewhere (Langs, 1976 b), this calls for the ongoing use of the validating process, through which virtually every communication from the patient - as well as from the analyst - is assessed in depth. So long as we maintain our basic psychoanalytic methodology, with its stress on an extensive use of the validating process and on unconscious processes and communication, we can be assured of further refinements in our conception of transference and of a continual broadening of our ideas about the patient-analyst relationship. Among the important consequences of such developments will be further refinements in analytic technique, and a deeper understanding of the essentials of human nature.
After indentifying the highlights of Freud's contribution to the study of transference, the present paper studies subsequent developments in the analytic investigations of this crucial phenomenon. Stress is placed on the influence of reality on transference expressions, on the manner in which transference derivatives exert an influence on reality - and especially on the analyst - and on studies of the form of transference that are expressed directly in the interaction between the patient and his analyst.
The basic paper by Strachey (1934) is reviewed, as are important later investigations. The role of the mechanisms of projective and introjective identification in the analytic interaction is defined and clarified, as is the relationship between the container and the contained. The implications of these investigations for the conception and analysis of transference is detailed.
The work of a number of classical psychoanalysts who adopted an interactional approach to the study of transference is also considered. The impact of the patient's transference expressions upon the analyst has its counterpart in the actuality of the analyst's basic stance, interpretive capacities and management of the ground rules - the framework of the analytic situation.
Among the reality precipitants of transference expressions, those derived from the patient's interaction with the analyst are afforded special importance. Recent investigations have also demonstrated transference-based seductive and destructive pressures from the patient toward the analyst, and the implication of these findings are discussed. In addition, the patient's transference-based endeavors to help and to cure his analyst have been the subject of a number of papers which are also considered here.
In concluding, the unfolding of the patient's transference constellation within the bipersonal analytic situation is discussed. In this approach, the continuous influence of the analyst on the patient's unconscious transference fantasies and their communication is recognized, and a series of interactional syndromes and resistances are conceptualized, stressing contributions from both the patient's transferences and the analyst's countertransferences.
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