On
Counter-Transference (1)
Paula Heimann
(1950) On Counter-Transference.
Int. J. Psycho-Anal., 31:81-84 (IJP)
This short note on counter-transference
has been stimulated by certain observations I made in
seminars and control analyses. I have been struck by the
widespread belief amongst candidates that the counter-transference
is nothing but a source of trouble. Many candidates are
afraid and feel guilty when they become aware of feelings
towards their patients and consequently aim at avoiding
any emotional response and at becoming completely unfeeling
and 'detached'.
When I tried to trace the origin of this ideal of the
'detached' analyst, I found that our literature does indeed
contain descriptions of the analytic work which can give
rise to the notion that a good analyst does not feel anything
beyond a uniform and mild benevolence towards his patients,
and that any ripple of emotional waves on this smooth
surface represents a disturbance to be overcome. This
may possibly derive from a misreading of some of Freud's
statements, such as his comparison with the surgeon's
state of mind during an operation, or his simile of the
mirror. At least these have been quoted to me in this
connection in discussions on the nature of the counter-transference.
On the other hand, there is an opposite school of thought,
like that of Ferenczi, which not only acknowledges that
the analyst has a wide variety of feelings towards his
patient, but recommends that he should at times express
them openly. In her warm-hearted paper 'Handhabung der
bertragung auf Grund der Ferenczischen Versuche' (Int.
Zeitschr. f. Psychoanal., Bd. XXII, 1936) Alice Balint
suggested that such honesty on the part of the analyst
is helpful and in keeping with the respect for truth inherent
in psycho-analysis. While I admire her attitude, I cannot
agree with her conclusions. Other analysts again have
claimed that it makes the analyst more 'human' when he
expresses his feelings to his patient and that it helps
him to build up a 'human' relationship with him.
For the purpose of this paper I am using the term 'counter-transference'
to cover all the feelings which the analyst experiences
towards his patient.
It may be argued that this use of the term is not correct,
and that counter-transference simply means transference
on the part of the analyst. However, I would suggest that
the prefix 'counter' implies additional factors.
In passing it is worth while remembering that transference
feelings cannot be sharply divided from those which refer
to another person in his own right and not as a parent
substitute. It is often pointed out that not everything
a patient feels about his analyst is due to transference,
and that, as the analysis progresses, he becomes increasingly
more capable of 'realistic' feelings. This warning itself
shows that the differentiation between the two kinds of
feelings is not always easy.
My thesis is that the analyst's emotional response to
his patient within the analytic situation represents one
of the most important tools for his work. The analyst's
counter-transference is an instrument of research into
the patient's unconscious.
The analytic situation has been investigated and described
from many angles, and there is general agreement about
its unique character. But my impression is that it has
not been sufficiently stressed that it is a relationship
between two persons. What distinguishes this relationship
from others, is not the presence of feelings in one partner,
the patient, and their absence in the other, the analyst,
but above all the degree of the feelings experienced and
the use made of them, these factors being interdependent.
The aim of the analyst's own analysis, from this point
of view, is not to turn him into a mechanical brain which
can produce interpretations on the basis of a purely intellectual
procedure, but to enable him, to sustain the feelings
which are stirred in him, as opposed to discharging them
(as does the patient), in order to subordinate them to
the analytic task in which he functions as the patient's
mirror reflection.
If an analyst tries to work without consulting his feelings,
his interpretations are poor. I have often seen this in
the work of beginners, who, out of fear, ignored or stifled
their feelings.
We know that the analyst needs an evenly hovering attention
in order to follow the patient's free associations, and
that this enables him to listen simultaneously on many
levels. He has to perceive the manifest and the latent
meaning of his patient's words, the allusions and implications,
the hints to former sessions, the references to childhood
situations behind the description of current relationships,
etc. By listening in this manner the analyst avoids the
danger of becoming preoccupied with any one theme and
remains receptive for the significance of changes in themes
and of the sequences and gaps in the patient's associations.
I would suggest that the analyst along with this freely
working attention needs a freely roused emotional sensibility
so as to follow the patient's emotional movements and
unconscious phantasies. Our basic assumption is that the
analyst's unconscious understands that of his patient.
This rapport on the deep level comes to the surface in
the form of feelings which the analyst notices in response
to his patient, in his 'counter-transference'. This is
the most dynamic way in which his patient's voice reaches
him. In the comparison of feelings roused in himself with
his patient's associations and behaviour, the analyst
possesses a most valuable means of checking whether he
has understood or failed to understand his patient.
Since, however, violent emotions of any kind, of love
or hate, helpfulness or anger, impel towards action rather
than towards contemplation and blur a person's capacity
to observe and weigh the evidence correctly, it follows
that, if the analyst's emotional response is intense,
it will defeat its object.
Therefore the analyst's emotional sensitivity needs to
be extensive rather than intensive, differentiating and
mobile.
There will be stretches in the analytic work, when the
analyst who combines free attention with free emotional
responses does not register his feelings as a problem,
because they are in accord with the meaning he understands.
But often the emotions roused in him are much nearer to
the heart of the matter than his reasoning, or, to put
it in other words, his unconscious perception of the patient's
unconscious is more acute and in advance of his conscious
conception of the situation.
A recent experience comes to mind. It concerns a patient
whom I had taken over from a colleague. The patient was
a man in the forties who had originally sought treatment
when his marriage broke down. Among his symptoms promiscuity
figured prominently. In the third week of his analysis
with me he told me, at the beginning of the session, that
he was going to marry a woman whom he had met only a short
time before.
It was obvious that his wish to get married at this juncture
was determined by his resistance against the analysis
and his need to act out his transference conflicts. Within
a strongly ambivalent attitude the desire for an intimate
relation with me had already clearly appeared. I had thus
many reasons for doubting the wisdom of his intention
and for suspecting his choice. But such an attempt to
short-circuit analysis is not infrequent at the beginning
of, or at a critical point in, the treatment and usually
does not represent too great an obstacle to the work,
so that catastrophic conditions need not arise. I was
therefore somewhat puzzled to find that I reacted with
a sense of apprehension and worry to the patient's remark.
I felt that something more was involved in his situation,
something beyond the ordinary acting out, which, however,
eluded me.
In his further associations which centred round his friend,
the patient, describing her, said she had had a 'rough
passage'. This phrase again registered particularly and
increased my misgivings. It dawned on me that it was precisely
because she had had a rough passage that he was drawn
to her. But still I felt that I did not see things clearly
enough. Presently he came to tell me his dream: he had
acquired from abroad a very good second-hand car which
was damaged. He wished to repair it, but another person
in the dream objected for reasons of caution. The patient
had, as he put it, 'to make him confused' in order that
he might go ahead with the repair of the car.
With the help of this dream I came to understand what
before I had merely felt as a sense of apprehension and
worry. There was indeed more at stake than the mere acting-out
of transference conflicts.
When he gave me the particulars of the car-very good,
second-hand, from abroad-the patient spontaneously recognized
that it represented myself. The other person in the dream
who tried to stop him and whom he confused, stood for
that part of the patient's ego which aimed at security
and happiness and for the analysis as a protective object.
The dream showed that the patient wished me to be damaged
(he insisted on my being the refugee to whom applies the
expression 'rough passage' which he had used for his new
friend). Out of guilt for his sadistic impulses he was
compelled to make reparation, but this reparation was
of a masochistic nature, since it necessitated blotting
out the voice of reason and caution. This element of confusing
the protective figure was in itself double-barrelled,
expressing both his sadistic and his masochistic impulses:
in so far as it aimed at annihilating the analysis, it
represented the patient's sadistic tendencies in the pattern
of his infantile anal attacks on his mother; in so far
as it stood for his ruling out his desire for security
and happiness, it expressed his self-destructive trends.
Reparation turned into a masochistic act again engenders
hatred, and, far from solving the conflict between destructiveness
and guilt, leads to a vicious circle.
The patient's intention of marrying his new friend, the
injured woman, was fed from both sources, and the acting-out
of his transference conflicts proved to be determined
by this specific and powerful sado-masochistic system.
Unconsciously I had grasped immediately the seriousness
of the situation, hence the sense of worry which I experienced.
But my conscious understanding lagged behind, so that
I could decipher the patient's message and appeal for
help only later in the hour, when more material came up.
In giving the gist of an analytic session I hope to illustrate
my contention that the analyst's immediate emotional response
to his patient is a significant pointer to the patient's
unconscious processes and guides him towards fuller understanding.
It helps the analyst to focus his attention on the most
urgent elements in the patient's associations and serves
as a useful criterion for the selection of interpretations
from material which, as we know, is always overdetermined.
From the point of view I am stressing, the analyst's counter-transference
is not only part and parcel of the analytic relationship,
but it is the patient's creation, it is a part of the
patient's personality. (I am possibly touching here on
a point which Dr. Clifford Scott would express in terms
of his concept of the body-scheme, but to pursue this
line would lead me away from my theme.)
The approach to the counter-transference which I have
presented is not without danger. It does not represent
a screen for the analyst's shortcomings. When the analyst
in his own analysis has worked through his infantile conflicts
and anxieties (paranoid and depressive), so that he can
easily establish contact with his own unconscious, he
will not impute to his patient what belongs to himself.
He will have achieved a dependable equilibrium which enables
him to carry the rôles of the patient's id, ego, super-ego,
and external objects which the patient allots to him or-in
other words-projects on him, when he dramatizes his conflicts
in the analytic relationship. In the instance I have given
the analyst was predominantly in the rôles of the patient's
good mother to be destroyed and rescued, and of the patient's
reality-ego which tried to oppose his sado-masochistic
impulses. In my view Freud's demand that the analyst must
'recognize and master' his counter-transference does not
lead to the conclusion that the counter-transference is
a disturbing factor and that the analyst should become
unfeeling and detached, but that he must use his emotional
response as a key to the patient's unconscious. This will
protect him from entering as a co-actor on the scene which
the patient re-enacts in the analytic relationship and
from exploiting it for his own needs. At the same time
he will find ample stimulus for taking himself to task
again and again and for continuing the analysis of his
own problems. This, however, is his private affair, and
I do not consider it right for the analyst to communicate
his feelings to his patient. In my view such honesty is
more in the nature of a confession and a burden to the
patient. In any case it leads away from the analysis.
The emotions roused in the analyst will be of value to
his patient, if used as one more source of insight into
the patient's unconscious conflicts and defences; and
when these are interpreted and worked through, the ensuing
changes in the patient's ego include the strengthening
of his reality sense so that he sees his analyst as a
human being, not a god or demon, and the 'human' relationship
in the analytic situation follows without the analyst's
having recourse to extra-analytical means.
Psycho-analytic technique came into being when Freud,
abandoning hypnosis, discovered resistance and repression.
In my view the use of counter-transference as an instrument
of research can be recognized in his descriptions of the
way by which he arrived at his fundamental discoveries.
When he tried to elucidate the hysterical patient's forgotten
memories, he felt that a force from the patient opposed
his attempts and that he had to overcome this resistance
by his own psychic work. He concluded that it was the
same force which was responsible for the repression of
the crucial memories and for the formation of the hysterical
symptom.
The unconscious process in hysterical amnesia can thus
be defined by its twin facets, of which one is turned
outward and felt by the analyst as resistance, whilst
the other works intrapsychically as repression.
Whereas in the case of repression counter-transference
is characterized by the sensation of a quantity of energy,
an opposing force, other defence mechanisms will rouse
other qualities in the analyst's response.
I believe that with more thorough investigation of counter-transference
from the angle I have attempted here, we may come to work
out more fully the way in which the character of the counter-transference
corresponds to the nature of the patient's unconscious
impulses and defences operative at the actual time.
1-
Paper read at the 16th International Psycho-Analytical
Congress, Zürich, 1949. After presenting this paper
at the Congress my attention was drawn to a paper by
Leo Berman: 'Countertransferences and Attitudes of the
Analyst in the Therapeutic Process, ' Psychiatry, Vol.
XII, No. 2, May, 1949. The fact that the problem of
the counter-transference has been put forward for discussion
practically simultaneously by different workers indicates
that the time is ripe for a more thorough research into
the nature and function of the counter-transference.
I agree with Berman's basic rejection of emotional coldness
on the part of the analyst, but I differ in my conclusions
concerning the use to be made of the analyst's feelings
towards his patient.
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