Bryce Boyer - Countertransference

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V O L U M E S {149}U M B E R 2 {149}P R IN G 19 94

C o u n t e r t r a n s f e r e n c e

onden sed is to ry and P erson a l V iew

of Issu es W ith R eg ressed P a tien ts

L . B R Y C E B O Y E R , M . D .

Freud’s am fr iva len tly nega tive a tti tud e to -

ward countertra nsference d iscouraged s y s tem-

a tic s tud y un til s om e p sy ch oa na ly st s,

predominantly K le in ia ns , b egan to trea t pa -

tients w ith na rciss is tic n eu roses . R ecogn iz ing

th e need to und ers ta nd th e un consc iou s and

conscio us co ntrib ution of th e ana lys t to th e

therapeu tic p rocess, H e im ann , R osen feld ,

Ba lin t , and Racker p ioneered in ser ious

s tu dy o f countertran sference. R acker and

B oyerfound tha t u nreso lve d c ou nte rtra nsfer-

ence prob lems con tr ib u ted s ig na fican tly to un-

fa vo rab le respon ses to psychoana ly sis in

serio usly d istu rbed patien ts. Searles,

G io va cch in i, O gden , and Vothan have like -

w ise furthered coun tertran sferen ce r e s earch .

Follow ing a his tor ical rev iew, the au thor d e-

lin ea tes h is p ersona l a pp roach to unders tand-

ing pa tien ts , esp ec ia lly ser io usly d is turb ed

ones , in te rm s o f the ongo ing in tro jec tion o f

pa tien t and ana lys t o f ea ch oth er’s p ro jec -

tions . Th is approa ch stem s from Rosen feld ’s

in itia l p rop os itions.

(T he Jou rn al o f P sy ch o the rap y P rac tice

and R esearch 1 99 4 ; 3 :12 2-137 )

M y train ing , w h ich began in th e 194 0s,

o ccu rred in an u ltraco nse rv ativ e insti-

tu te w here the psychoana ly tic trea tm en t o f

reg re ssed d iso rde rs w as stro ng ly d isapp ro ved

an d an y d iscuss ion o f cou n te rtransference

issues inv o lved in the ir the rapy w as deem ed

irre levan t. C ou n te rtransference w as con sid -

ered an em barra ssing top ic , o ne to be

av o ided . I do ub ted F reud ’s g ro und s fo r e s-

ch ew ing psy ch oana ly tic trea tm en t o f the na r-

c issis tic d iso rde rs , no tin g h is am biva lence

and con trad ic tio ns,’ an d I to le ra ted w ith d is-

cou ragem en t an d so m e tim es despa ir th e

o pen rid icu le and co n tem pt o f m y m en to rs

w h ile I pu rsu ed m y resea rch in de term in ing

th e e ffectiv eness, in m y hand s, o f th e p sycho -ana lys is o f ser iou sly d istu rb ed p atien ts .2 ”

D oin g so inev itab ly req u ired s tudy ing m ore

th oro ug hly th e tra ns fe re nc e- co un te rtra ns fe r-

ence in te rac tions in w ork in g w ith such

p atien ts . W h en I su ggested tha t co un te r trans-

fe rence n eu ro ses o r psy ch oses w ere a m a jo r

cause o f fa ilu re in the trea tm en t o f reg re ssed

p atien ts , I w as trea ted as an en fan t terr ib le ,

p erson a non gra ta in m y in stitu te and so cie ty .

T h e e go psyc h o lo g ic a l l ite ra tu re o n the

su b ject w as p ractica lly no nex isten t, a ltho ugh

the re w ere som e stud ie s’2 ’8 from w hich u se -

fu l u nde rs tan d ing cou ld be g leaned .

R ece ive d A p ril 1 , 1 99 3; re v isedJune 20 , 199 3; ac cep ted

Jun e 2 4 , 19 93 . F ro m th e C e nte r fo r the A dva nce d S tu dy

of the P sy cho se s, S an F ranc isc o , C a lifo rn ia . A ddress re-

prin t req ues ts to D r. B o yer , 30 21 T e leg rap h A v enu e,

B e rke ley , C A 9 470 5 .

C o pyr igh t © 19 94 A m eric an P syc h ia tric P res s, Inc.



JO U R N A L O F P S Y C H O T H E R A P Y P R A C T IC E A N D R E S E A R C H

B O Y E R

It w as no t un til I w as exp osed to K lein ian

and n eo-K le in ian th ink ing , in itia lly th roug h

con tac ts w ith L a tin A m erican s and the ir psy -

cho an aly tic lite ratu re , th at the sub jec t o f

trans fe ren ce -co un te rtransference b ecam e

m o re und erstandab le to m e. T h is n ew

un de rstand ing fac ilita ted m y psy choana ly tic

w ork w ith pa tien ts w h o had na rciss is tic

d iso rders .

T h e past qu arte r-cen tu ry h as seen tre -

m end ous ch anges in clin icians ’ a ttitudes

abo u t the types o f pa tien ts w h o can be trea ted

w ith psychoana lys is . In g en era l, th a t a ltered

a ttitude has been ascr ibed to ou r exp an ded

kn ow led ge of cha rac te r struc tu re and psy ch o-

pa tho logy an d our inc rea sed un de rs tan d ing

of ea rly deve lopm en ta l p rocesses and prim i-

tive in te rn alized ob ject rela tion s.

T h e c ru c ial im portance o f h ow th e the r-

ap ist u se s h is ow n co nsc iou s an d uncon sc ious

re sp onses to the p atien t, w he the r psy ch ical o r

so m a tic, v erba l o r non ve rb al, ha s been c lea r ly

recog n ized ; th is reco gn itio n is p ro bab ly due

to th e in creased use o f p sycho an a ly tic p sycho -

the rap y fo r seve re cha rac tero lo g ical, na rc is-

s is tic , and bo rd erline d iso rd ers and p sycho tic

d is tu rb ances , as w e ll a s p sycho som atic an d

a lex ithy m ic d iso rde rs .

T o day it is g ene ra lly accep ted tha t actio n

(a side from verb al sy m bo liza tion ) con stitu te s

an im portan t m ed ium th rou gh w hich th e

ana lysand in d icate s spec ific uncon sc ious

m ean in gs to the ana lyst, as th roug h the ac -

tion s m ed ia ting pro jec tive id en tific a tions,’92# {17 6}

“ ro le re spo nsiven ess ,”2 ’ “evo ca tion by

prox y ,”2 2 and “enac tm en ts .”23 H o w eve r , it is

12 3

le ss w e ll recog n ized th a t m any o f the an aly st’s

m o st cr itic al tran sfe ren ce in te rp re ta tions a re

con veyed to th e an a lysand by m eans o f th e

ana lyst’s in te rp reta tive actio ns tha t have re -

su lted fro m h is p ro cessin g , p rob ab ly p red om -

inan tly unco nsc ious ly , h is in tro jec tion s o f th e

pa tien t’s p ro jectiv e iden tif ica tion s.2 4

S im ila rly , p sy ch oana lysts have changed

the ir v iew o f the ir o w n m etho d . A cco rd ing to

O ’S h au ghn essy ,25 m an y ana lysts no w h o ld

tha t “ instead of be ing abo u t the p atien t’s

in trapsy ch ic d ynam ics, in te rp re ta tion s

sh ou ld be m ad e abou t the in te rac t ion o f p a-

tien t and an aly st a t an in tra psych ic leve l”(p .

281 ; see a lso V o lkan26 ).

H e igh ten ed in te res t in cou n te rtransfer-

ence has p ara lle led the rap id ly ex pand in g

use o f psy ch oana ly tic the rapy fo r seve re ly re -

g re ssed ind iv idu als , n o d oub t in la rge pa rt

because trea tm en t o f pa tien ts w ith p rim itive

d iso rd e rs d em an ds he igh tened un de rs tan d -

ing o f tha t in teractio n .

In the A m erica s, R acke r and B o ye r2 in -

dep en den tly in trodu ced the no tion tha t u n -

reso lved co un te r transfe rence p rob lem s

often p re sen t the p rin cip a l im ped im en t to

the e ffectiv e psychoana ly tic trea tm en t o f se -

ve re ly reg re ssed pa tien ts . T he ir con tribu -

t ions,4 ’9’ 32 in co n jun ctio n w ith th e w o rk o f

G iovacch in i,33 G ro ts te in K ern be rg

S ea rle s ,ss and o the rs , have been cen tra l in

e stab lish in g the con cep tion tha t the un de r-

stand ing o f coun ter tran sfe ren ce in w ork w ith

deep ly reg ressed pa tien ts is o f co m parab le

im p ortan ce to , an d insepa rab le from , th e

ana lysis o f th e tran sfe ren ce.

T h e firs t f ive vo lum es of T he I nd ex o f P sy ch oa na lytic Writings27 lis t 2 9 re fe rences to stu d ie s w hose title s

in clu de th e w o rd counter trancference. T hose vo lu m es lis t writ ings from the o rig in s o f psy ch oana lysis

th ro ugh 1 952 . V o lum es 6 th ro ugh 9 , cov ering 19 53 th roug h 19 60 , lis t 6 1 p ub lica tions th at h av e the

w o r d counter trans ference in the title .28 A part fro m those c ita tion s, such re ferences a re a lm ost no nex is-

ten t in psycho lo g ical lite ra tu re up to 196 0 . B y stark con tra st, a b r ie f rev iew of the title s o f th e psy -

cho log ica l and social w ork lite ratu re o f E urope an d the A m erica s fo r th e y ea rs 1 98 8 throug h 19 91

reveals refe rences in the th ousan ds to p ub lica tion s tha t inc lud e the w ord counter irans ference in th e

title.

T h e L a tin A m e r i c a n , p articu la rly the S o u th A m erican , p sycho an a ly tic lite ratu re , un kno w n to m e

u nti l th e 19 60s , ha s b een rich in stu d ie s o f transfe rence an d coun ter trans fe rence invo lv ing sp lit-




1 24 C O U N T E R T R A N S F E R E N C E

H I S T O R Y T o TH E

M ID -T W E N T IE T H C E N T U R Y

T he re is a la rge litera tu re pertain ing to c ou n-

te rtransference reac tion s in th e analyses of

pa tien ts w ith neuro tic d istu rbances, inc lud -

in g a nu m b e r o f rev iews.’3 ’40 3 T he fo llo wing

sec tion , a b rie f h is to ry o f m o re m od ern ideas

in c lu d in g a ttitudes to w ard cou n te rtransfer-

e nc e an d its u se s w i th reg ressed pa tie n ts, is to

b e a dd ed to o the r s tud ie s suc h as th ose o f

B oyer,5 7 E ps tein and Fe ine r , E t c he goye n ,45

a nd S ch arf f.4 #{ 17 6} It m u s t be s tre ssed th at b efo re

the m id -tw en tie th ce n tu ry , very fe w c on tr ib u-

to rs d isag reed w ith the v ie w th at c ou n te r-

tran sfe re nc e w as a n in te rfe ren ce in the

analy t ic pro ce du re . T h ose suc h a s F ere nc z i

w ho c om m u nic a ted th eir e m o tiona l re ac -

t ion s to the ir p atien ts in w ord o r a ctio n w ere

rep rimanded sev ere ly ; se e M . B a lin t (pp .

14 9-156 ) and S t# {2 27} rcke .47

Fre ud in tro duced the te rm coun te r t r ans -

fe rence in th e co n te x t o f d isap p ro va l. A l-

tho ug h the p he no m e no n co n tin ue d to

conce rn h im , he n eve r devo ted a sp ec if ic

stud y to it, n o r w as a th eo ry of cou n te rtran s-

fere n ce elab o ra ted u n til m uc h la ter.

F reu d seld om if eve r to ta lly re nounc e dan y th eo retic a l p os ition h e h a d in tro duc e d .

F o r e x am ple , he c on tin ue d in h is la st w o r k s

to co m b in e th e top og rap h ic a l an d the s tru c-

tu ra l the o rie s a s ex p lan ato ry models .49 W e

sha ll see th at th is ho lds true w ith rega rd to

c oun te rtran sfere nc e as w e ll. H e n ev er re -

can ted h is positio n tha t coun ter tran sfe ren ce

w a s an u nd es ira b le im pe d im e n t . In 1 91 2 , in

a le tte r w ritten to F er en cz i, F re ud 5# {1 76 }m p lie d

th at h is fa ilu re to o ve rco m e h is p os itiv e , pa -

te rn al coun te rtran sfe ren ce h ad m ade im -

p ossib le the in te rp re ta tion to F erenczi o f a

nega tive trans fe rence . F reud m ay h av e been

jok in g w hen in 193 7 h e spo ke o f h is answ er

to a pa tien t’s co m pla in t tha t the m en to r had

no t in terp re ted th e nega tive transfe rence ;

F reu d rep lied th at if it h ad no t been in te rp re -

ted , it h ad no t app ea red .5 ’

H e im ann 52 sug gested tha t F reud’s d is-

cov ery o f re sis tance w as based on h is co un te r-

trans fe ren ce , h is feelin g th at h e w as m eetin g

a re sis tan t fo rce in th e p atien t. I ag ree w ith

G ro ts te in 53 tha t it is m ore p ro fitab le in the ra -

peu tic situa tions to th ink of m any so -ca lled

res is tan ces as com m unica tions , no t o n ly

abo u t th e p re sen t bu t abou t th e past, e sp e-

c ia lly in the case s o f , fo r exam ple , p sychoso -

m atic p rob lem s an d alex ith ym ia .5 I ag ree

a lso w ith D . R osen fe ldM and O gd en ,2 4 w h o

h o ld tha t in trea ting seve rely reg res sed pa -

tien ts it is th e ta sk o f th e ana lyst to con ta in ,

th rou gh the co un te r transfe rence , a p re -

su m ed p ictu re o f the p atien t’s in fan tile past

to be rev is ed during trea tm en t and com m u-

n ica ted to the pa tien t a t ap p ropria te late r

t i m es .

I t is w e ll kno w n tha t F reud ’s c lin ical

fa ilu re s som e tim es w ere the p ro duc ts o f

co un te r transfe rence in te rfe rences.6 7

F reu d in tro duced the w ord counter trans -fe rence w hen w riting tech n ical ad v ice to un an -

aly zed and large ly u n train ed phy sic ian s w h o

w e re p ra c tic ing p sy ch oa n aly s is ; dou b tless he

ho pe d tha t the da ng er o f th e clin ic ia n ’s e m o -

tion a l inv o lve m e n t a nd a cting o u t w ith the

pa tien t cou ld be redu ced . H e d efined co un-

ter tran sfe ren ce as a fun ctio n of the ana ly -

sand , the p ro duc t o f th e in f luence of th e

pa tien t’s ve rba l an d no nve rba l com m uni-

catio ns on the un co nsc iou s o f th e an aly st.

T w o years la te r he5#{ 17 6}pecif ically recom -

m end ed tha t the rap is ts und e rgo tra in in g

tin g and pro jec tive and in tro jec tive id en tific a tion sin ce the ea rly 1 950 s. In 196 6 , in the ir a r ticle

“T h e P sy ch oana ly tic S itu atio n ,” A rlow an d B ren ne r3 7 m ade no d irec t re ference to cou n te rtransfer-

en ce , a lth ou gh it constitu ted the m a in top ic o f the ir A rgen tin ean d iscussan ts .ss

W ald inge r an d G un de rson scarcely m entio n coun ter tran sfe ren ce in th eir recen t Effec t ive

P sycho th erapy w ith the Bo rderline P atien t.



B O Y E R 1 25


analysis: an d th a t the “ the rap is t tu rn h is ow n

uncon sc ious like a recep tive o rgan tow ard s

th e tran sm itting u nconscio us o f th e pa -

t ien t . . .so tha t th e doc to r’s u ncon scio us is

ab le.. .to recon stru ct the pa tien t’s un co n-

sc io us” (pp . 1 15-11 6) . T h is p osition is an

ex am ple o f F reud’s am b iva len ce o r a ref lec-

tio n of h is d ia lec tica l m od e of th ink ing , o f

w h ich h e w as la rge ly uncon sc ious . T h is am -

b iva lence co n tinu es to cha rac ter ize th e d is -

ag reem en t be tw een the c lass ic an d th e

to talis tic ap pro ach es to co un te r transfe rence .

A t the sam e tim e th at F reud insis ts th at the

an aly st b e p urif ied so tha t h e has n o b lind

spo ts , he says tha t the an a ly st’s un co nsc iou s

shou ld be in con tac t w ith tha t o f the ana ly -

san d .

P robab ly h av ing b een in flu enced b y

Jane t w h ile s tudy ing w ith C ha rco t, F reu d w as

m uch in tere sted in the sub jec t o f te lepa thy ,

pub lish ing on rela ted sub jec ts in 189 9 , 1 904 ,

and 1 921 671 S o on afte r the appea ran ce o f

S tekel’s72 The Te lepa th ic D ream , F reud7 3 w ro te

spec ifica lly abou t te lep ath y ; o the r p ub lica -

tions app eared in 1 925 and 193 3 . In h is

ear lie st a r ticle on telepa thy , F reud7 ’ w ro te ,

Psychoanalysts. . . stud y o ccu lt m a teria l

o n ly b eca use th ey h ope tha t th is w ou ld

enab le them to e lim in ate once and fo r

al l th e c rea tion s o f th e h um an w ish fro m

the rea lm o f m ate r ial rea lity . .. . If, in the

cou rse o f h is w o rk , [ the p sycho an a lyst] is

o n the lo oko u t fo r o ccu lt ph en om en a,

h e run s the risk o f ove rlook ing every-

th in g w h ich is c lose r a t hand . .. . T he

a nalyst’s se lf-d isc ip line can p ro te ct h im

a gainst the su b jec tiv e risk o f hav ing his

in te rest ab sorbed by oc cu lt phe no m e na.

T h ing s are d ifferen t , ho w e ver , as reg ard s

the ob jec tive dange r . It is p ro bab le tha t

th e stu dy of occ u lt p hen om en a w il l resu lt

in the a dm ission that so m e o f th ese phe -

n om ena are real .. .. “ (p . 58 )

H is a ttitu des d id n o t chang e in subse-

quen t a rtic le s . E isenbu d ,77 in h is su rv ey of

F reud ’s con tribu tions to psy ch oana lysis an d

te lepa thy , sum m arized F reud ’s po sition :

W ha t F reud says , in e ffec t, is : “D isto r tion

o f pe rcep tio n is on e of the cha rac te ris tics

o f m en ta l fu nc tion in g d om in ated by u n-

con sc ious need s. B u t th is d is to r tion is

purposefu l and o ccurs a long d ynam ic ,

d ete rm in istic line s. T h e re is no reaso n to

supp ose tha t te lep ath ic p erc ep t ion s

shou ld b e free from th is un iv ersa l effec t.”

(p .9 )

T he Te lepa th icDream w as based on S teke l’s

d ream s w h ile w o rk ing w ith neuro tic pa tien ts ,

d ream s th at today w ou ld b e stron g ly su s-

pected of be in g assoc ia ted w ith co un te r trans-

fe ren ce p henom en a .3 2 ’5 961 78 H ow eve r, a

fo o tno te to F reud ’s 192 2 a r tic le ack now l-

edg in g h is aw areness o f S tek el’s boo k m akes

no a llu sion to cou n te rtransference . In a ll o f

F reud ’s com m unica tions the qu es tion o f the

v alid ity o f ex tra senso ry pe rcep tio n rem a ined

op en . O dd ly , the w ord counter trans ferencedoes

no t ap pea r in any o f F reud’s com m un ica tion s

dea ling w ith telepa thy an d the occu lt. O n e

w on de rs w he the r F reud thou gh t, p erhaps u n-

consc iou sly , th at telep ath y con stitu ted som e

a sp ec t o f tra ns fe re nc e- co un te rtra ns fe re nc e

in te rac tions. S u re ly m any o th er ana lysts

have im plied the ir s im ila r be lief , nam e ly tha t

T he re seem s am p le ev id en ce tha t F reud , a t lea st a t tim es, h ad d is ap po in ting c lin ica l resu lts be -

cause o f un re so lved cou n te rtransference p ro b lem s.67 M ay h as sug gested tha t F reud ’s fo rm ula -

tion s, techn iq ue , and sty le d em ons tra ted in th e case h isto ry o f th e W o lf M an w ere large ly p ro duc ts

o f un ana lyzed tran sfe ren ce -co un te r transfe rence pheno m ena .

E x cerp ts o f h is firs t tw o a rtic le s and h is la st th ree con trib u tion s appea r in D eve reux .7 6

It w as lon g co m m on for m any K le in ia n p syc hoa na lysts, p articu larly in L atin A m eric a , suc h a s

G ar m a7 9 a nd G oldbe rg ,8#{ 17 6} to sp eak of pro jec tiv e iden tificat ion a s co nsti tu t ing the pa tie n t’s actu al





un co nsc iou s com m un icatio n in vo lves ex tra -

senso ry pe rcep tio n . In h is su m m ary of th e

th eo ries o f Is tv#{225}nH ol l#{243}s ,D ev ere u x76 w rite s ,

“ T e lep a th ic inc ide n ts be ca m e e spe cia lly nu -

m ero us du rin g a d ifficu lt p eriod in the

ana lyst’s life” (p . 20 0), su re ly link ing th em

w ith coun te rtran sfe ren ce , alth oug h th e w o rd

w as no t u sed b y H oll# {24 3} so r D eve reu x in th is

con tex t .

A na lysts h av e lo ng b een co nce rn ed w ith

the m ean s by w h ich th e psych o log ica l a ttr i-

bu tes o f o ne pe rson a re assum ed by ano the r.

M an y , fo llow ing F reu d’s82 lead , h av e w ritten

abou t the in fluence of pa tien ts’ in tro jec tio n

of ana lysts’ a ttr ibu tes on the transfe rence re -

la tionsh ip . F en iche l83 w as th e firs t to n o te tha t

ana lysts’ coun ter tran sfe ren ces a re large ly d e-

term in ed b y th e in f luences on the ir uncon -

sc ious conflic ts o f in tro jectio ns o f p atien ts’

a ttribu te s-a frequen tly a ff irm ed obse rva -

t ion .8486

M eltze r87 (p . 14 ) called in tro jec tion “ the

m o st im po rtan t and m y ster iou s concep t in

psy cho-an a lysis” and said w e have n o t ye t de -

sc rib ed the p rocess by w hich the ch ild ’s expe -

rien ce o f the ex te rn al ob jec t is taken in .

M en z i e sL y thss ad ded , “in tro jec tion and in -

tro ject have in no w ay fo und in the p sycho -ana ly tical lite ra tu re a p lace co m parab le to

p ro jec tion and pro ject” (p . 1 ). S he agrees

w ith M eissne r an d cou n tle ss o the rs in no t-

ing tha t “P ro jectio n tu rns o u t to b e m ore

exc iting , m o re inn ova tive , m ore illum in a t-

ing , to our und e rstand ing o f norm a l an d

pa tho log ica l deve lop m en t” (p . 3 ) . H in ting ,

pe rhaps, a t a reason th a t m an y ana lysts h ave

been so relu ctan t to study cou n te rtran sfe r-

ence, p re fe rring instead to in vestiga te “in -

tu itio n” an d “enac tm en t,” M en zie s-L y th

sug gests th at th e in tro jec tive p rocess has

been und erinv estig a ted becau se o f in te rfe r-

ence fro m the effec ts o f th e pa tien t’s se lec tive

in tro jec tion of the an aly st’s na rciss ism .

S cha rff4 #{1 76}w ou ld ad d tha t th e an aly st’s na rcis -

s ism m ay affec t w ha t the pa tien t f inds ava il-

ab le fo r in tro jec tion , su ggesting tha t “ the

ana lyst censo rs th e in tro jec tive p rocess be -

fo re and afte r it occu rs , becau se it is g ra tify in g

insid e the se lf” (p . 52 ).

T h e stud y of in tro jec tion , w h ich has p ro -

ceeded fro m th e b eg inn ings o f psy ch oana ly -

sis , ha s d e te rm ined th at the m eans b y w hich

the an alys t a nd th e an alysan d m ay in tro je ct

the o th er’s q ua lities a re leg io n . In T he P sycho -

pa tho logy of E veryday L [e , F r eu d 9 # { 1 7 6 } o m m en t ed

on sen so ry prefe rence in re ferrin g to fo rm s

of m em o ry , an d in Ins tinc ts and The ir V icis si-

tudd2 h e no ted th at eve ry pe rcep tive m o de

is re la ted to in tro jec tion . In 191 7 , he in tro -

du ced th e co ncep t o f o ral inco rpora tion as a

step in iden tif ica tion , a s d id A brah am 92 w ith

ana l in co rp oratio n , a ff irm ing the in fe ren ces

o f van O p hu ijs en 93 an d S t#{2 27} rcke ,47 w h o had

w ritten in dependen tly o f th e en em a as th e

in fan tile p ro to type of the p arano id ’s equa -

tion of pe rsecu to r and feces. A braham 92

fo und ep id e rm a l inco rpo ra tion to co rre -spo nd to feces-sm earing ; la ter L ew in9 4 v iew ed

it to be an eq u iva len t o f o ra l inco rpo ra tion .

L eo na rd9 5 w ro te o f v isu al inco rporatio n .

F en iche l83 m ade re sp ira to ry inco rpora tio n a

spec ia l s tu dy an d sta ted tha t th e re sp ira to ry

trac t h as an au ton om o us e ro tog en icity . It is

com m on kno w led ge th at eve ry p e rcep tive

m o d e can a lso be used in the se rv ice o f p ro -

jec tion ; M a lco lm w ro te o f th e u se o f v ision

fo r the a ttem p ted un ifica tio n o f fragm en ted

in te rn a l ob jec ts .

ra ther than fan ta sied p ro jec tion in to the ana ly st, a p henom en on tha t su re ly re sem ble s te lep ath y .

T h is m a te ria l h as been rev iew ed a t g rea t leng th in D eve reux ,7 6 w h ere relevan t a r ticle s b y H e len e

D eu tsch , H itschm an n , R # {24 3}h eim ,S ch ilde r, Z u llig er , and o the rs are rep ub lished and the E isen bud -

P ede rson -K rag -F odo r-E llis con trov ersy is rev iew ed , an d in V olu m e 1 0 of C on fro nta tio n: T ele pa th ie,8 ’

w h ere sev era l o f those artic les an d m ore recen t con tribu tions by B ergson , C o sta d e B eaurega rd ,

D err ida , D um as, F a rre ll, M ign o tte , and o the rs a re rep rin ted .




B O V E R

It has lon g been as sum ed tha t coun ter-

transfe rences a re de term in ed large ly by the

ana lyst’s in tro jec tion o f qu alitie s o f the p a-

tien t th at co m e in to con tac t w ith th e

the rap ist’s un re so lved in fan tile con flic ts (see

F ede rn ,84 F en iche l, an d F liess ss). In G iov ac -

ch in is ,ss O g den’s ,2 4 S ea rles ’s , an d V o lkan’s26

ex pe rience and m y ow n,’7 ’# {17 6} b o th the m ost

effec tive in te rp reta tion s and the recove ry o f

th e m o st relevan t rep re ssed m em orie s a re

freq uen tly b ased on in fo rm a tion ga the red

th rou gh coun te rtran sfe ren ce reac tio ns, th at

is , in te rp re ting th ro ugh th e co un te r transfe r-

en ce . U n til the past few yea rs , in te rp re ting

th rou gh the coun ter tran sfe ren ce appea rs to

have b een ve ry unu sua l in the p ractice o f

N o rth A m erican ana lysts . In fac t, it m ay h av e

been lim ited to th e ana lysts c ited ab ove . B u t

it w as no t un co m m o n am ong neo-K le in ians,

as illu strated by the case h is to rie s selec ted by

Sp i l l iu s .98 ’

T he re w ere alm ost no d irec t s tud ies o f

co un ter trans fe rence fo r ap prox im ate ly fo rty

yea rs fo llo w in g th e in tro duc tion of the te rm .

T o m y k now ledg e, th e f irs t to sugg est th a t the

an a lyst’s reac tion s to th e p atien t’s p rod uc -

tio ns co u ld be used as he lp fu l d ata w as H ann -

K en de ,’ w ho w as fo llow ed by S trachey’#{ 176 }’w ith h is concep t o f th e “m uta tiv e in te rp re ta-

tion ,” w h ich w as la te r red is co ve red by

Kohu t . ’#{176}2

A lth oug h coun ter tran sfe ren ce w as no t

inv es tiga ted , cu rio sity abou t “ in tu ition ” w as

activ e, a s it is today . T hro ug hou t h is w orks,

Reik ’#{176} #{176}5nd ica ted th at if th e ana lys t h as a

recep tive a ttitu de and trusts in tu ition m o re

than m ere rea so n ing , he w ill be su rp ris ed

w ith a su dden u nde rstan d ing o f a m essag e

fro m th e ana lysan d’s un co nsc iou s, an in tu -

itiv e g ra sp from uncon sc ious to u nconscio us,

a s F reud5 082 ind ica ted p rev io usly . W hen

127

R eik ’#{1 76} 6m en tio ns co un te r transfe rence , he

v iew s it a s a re sis tance and does n o t in d ica te

tha t th e ana lyst’s re spo nse is n ourish ed by a

con flic t o f h is ow n . S im ila rly , W . R e ich ’#{ 176 }7

refe rs to h is ow n affec tive reac tion s as

in tu itions . R acke r3 #{ 176 } w ou ld call them co un-

te rtransferen tia l reactio ns, and E tch eg oyen 45

w ro te , “ the ana lyst’s m itierconsis ts in lis ten ing

to and sc ru tin iz ing h is co un te r transfe r-

e nc e -tha t is h is in tu ition” (p . 16 3 ).

A n aly sts h av e so ugh t to un de rstand w ha t

con stitu te s R eik ’s ’#{ 17 6}4“ lis ten in g w ith the th ird

ea r,” o r Isakow er’s “ana lyz ing instrum en t.”

S p ieg el’#{ 176 }8 n oted tha t ana lys t and an aly sand

o pe ra te in s im ila r sta te s o f m ind (free -floa t-

in g a tten tion an d free asso c iatio n , re spec -

tiv ely ) and tha t the re su ltan t conv ersa tion is

u n iqu e to p sychoan aly sis . B a lte r et a l.’# {17 6} 9p eak

of the ana lyz ing instrum en t a s op era ting

w ith in a su bsys tem of the ego o f th e ana lys t,

w ho “is m o re like ly to p e rce ive co nnec tions

be tw een w ords, id eas and im ages w hich a re

th e p rod uc ts o f th e pa tien t’s p r im ary proces s,

becau se h is sub system is in p art freed fro m

th e con stra in ts o f secon da ry process th in k -

ing , reality te sting , and so on ” (p p . 490 -49 1) .

T hey n o te “ the reg res sion in the (ego) sub -

sys tem of the an aly st is e ssen tia lly o f the sam ena tu re a s tha t w h ich ob ta ins in the su bsy stem

of the ana lysand ” (p . 48 6).

M E L A N IE K L E IN ’S

C 0 N T R I B U T I 0 N

T he vast m a jo rity o f tod ay ’s au tho rs w ho w rite

abo u t transfe rence -cou n te rtransference in -

te rac tions u se o ne or an o the r ve rsio n of

K le in ’s”0 co ncep ts o f sp litting an d pro jec tive

and in tro jec tive id en tific a tion” in th eir a t-

tem pts to un de rs tan d th e pheno m ena . T h is

is true w he the r the ir d om in an t o rien ta tion

A s does O gden ,” I use the term pro jec t ive identi f ica tion to re fe r to a w ide ran ge o f p sycho local-

in te rp erso na l ev en ts , inc lud in g the ea rlie st fo rm s o f m othe r-in fan t com m un ica tio n (B ion ’ ) , fan ta-

sied co erc ive incu rsion s in to and occup atio n o f th e pe rsona lity o f ano the r pe rson , sch izoph ren ic

co nfu sion al s ta te s (R ose nfe ld” 3), an d hea lthy “em p a th ic sh a ring ” (P ick”4) .





s te m s fro m th e id ea s a b ou t ob jec t re la tio ns

de riv ing from th e stru ctu ra l theo ry o r fro m

theories o f the B ritish Ind ependen t S cho o l.

A ltho ugh M elan ie K le in h erse lf f irm ly he ld

the trad itio na l v ie w tha t co un tertra nsfe ren c e

constitu ted so le ly a n o bs ta cle to tre a tm e n t

(G rossku rth ,” 5 pp . 37 8 -3 79 ), ac c o rd ing to

O ’S ha ug hn essy ,2 5 “ he r w o rk h as b ee n the

m o st po w e rfu l s ing le in flu en ce fo r” the “sh ift

o f pe rsp e ctiv e ” (p . 281 ) tha t ha s le d to in te r-

p re ta tion s no w b eing d irec te d tow a rd the in -

tera c tion o f p atien t an d a na lys t a t a n

in trap sych ic leve l. T h is sh if t ha s p o ten tia ted

m od ern un de rs tan d ing of coun ter trans fe r-

e nc e , w ith its em ph as is o n the p os it ive th e ra-

pe u tic u ses o f the an aly s t’s re a ction s to the

pa tien t’s ve rb al and no nve rba l p rod uc tion s .

O bvio usly , th e im po rtance o f B ion’s”2 e x te n -

s ion o f K le in ’s w o rk m ust b e re co gn iz ed a s

w ell: h e fo un d p ro je c tive ide n tifica tio n to b e

no t on ly a de fense m echan ism , bu t a lso an

in fan t’s firs t w ay o f com m un ica ting w ith its

ob jec ts , an d h e p osited the ro le o f the m o the r

and the ana lys t a s m e tabo lizin g co n ta ine rs

(see also W m nico tt”6”7 ) .

A s ea rly as 196 1 , S to ne”8 ascr ibed to th e

neo-K le in ian R acke r’s 32 w o rk a gro w ing ap -

p rec ia tion o f th e co un te r transfe rence as ana ff irm a tiv e in stru m en t tha t fac ilita te s pe rcep -

tion . In R a ck er’s v iew , c ou n te rtra nsfe ren ce

enhances aw areness o f th e an a ly st’s inc ip ien t

reactio ns to the p a tien t and lead s to a riche r

an d m ore sub tle u nd ers ta nd ing o f th e

pa tien t’s transfe rence str iv ing . M o re recen t

K le in ian con trib u to rs to th is are a o f analy t ic

th ou gh t inc lu de G rinbe rg ,” 2 ’ Jose ph ,’”

M eltze r,’2 25 M oney-K yrle,’26 O ’S h au gh-

n es sy , an d S eg al.’

T hrou gh th e inc lu sion of v iew s of co un-

te r transfe rence to be d iscussed be low , th e

p sycho an a ly tic trea tm en t o f reg re ssed p a-

tien ts is b ecom ing revo lu tion ized in N orth

A m erica , desp ite the seem ing ly adam an t op -

p ositio n o f m any H artm ann -in f luenced ego

p sycho log is ts w ho a lso op pose reg re ssion to

p rim itive sta tes d u ring trea tm en t.”

C O U N T E R T R A N S F E R E N C E

A N D IN T R O JE C T IO N S IN C E

M I 0 C E N T U H Y

I tu rn n ow to th e d efin itio n o f coun ter t rans-

fere nc e a s it is u sed h ere and a h isto ry o f the

d eve lopm en t o f tha t v iew . M y con cep t o f

tran sference-coun ter tran sfe ren ce fo llo w s

con cep t o f the con stan t in -

te rp lay be tw een ana lyst an d an aly sand tha t

in vo lv es the ir m u tua l in tro jec tion of the

o the r’s p ro jec tive iden tif ica tion s. R eg ard in g

co un te rtransfe rence , p ro jec tiv e id en tific a -

tio n fun ctio ns as a m eans o f com m unica tion ,

o f le a rn in g from the pa tie n t w ha t he ca nn o t

th ink co nsc iou sly . T h e an a lyst seeks to fin d

w ord s to fo rm a bridge be tw een th e sub jec tive

s tate s o f the ana lyst and the pa tien t w h ile

u nde rstand in g th at th e space tha t sepa ra te sth em is th e m ost po te n tia lly po w erfu l link

b etw een the pa tien t’s d issoc ia ted sta te s .

F a im berg ’3 9 a rgues tha t w h at the an a ly -

sa nd c an no t sa y th rou gh pa rap raxes, d ream s ,

silences, an d sym ptom s can be h ea rd o n ly

from the coun ter tran sfe ren ce positio n o f the

ana lys t. A s B rom berg ’4 #{1 76} sugg es ts , w h en w ords

a re foun d an d n eg o tia ted , they can beco m e

p art o f the p atien t’s creativ e e ffo r t to sym bo l-

ize an d en un cia te in w o rd s w ha t he had n o

A sim ila r revo lu tion is gain ing im pe tus am o ng th e th in k ing an d fie ld techn iq ues o f inv estig ato rs o f

pe rso na lity deve lop m en t. O v er 30 yea rs passed b etw een th e w ritin g and th e pu b licatio n of

D eve reu x’s’2 8 land m ark From Anx iety to M ethod in th e Beha vio ra l S c ien ces because he in trod uced th e

unp opu lar them e of cou n te rtransference d isto r tions in to an th rop o log ical fie ldw ork , a s had R acke r

an d B oye r in to psy ch oana ly tic trea tm en t. S ince th en , th e und e rstand ing and even the techn ique of

fie ldw ork h ave b een heav ily in f luenced by psy ch oana ly tica lly kn ow ledgeab le an th rop o log ists w h o

are tak ing in to acc oun t the effects o f cou nte rtra nsfere nce (see C rapanzano ,’ G o od e t a l.

K rack e,’ R . L ev ine ,’3 2 S . L ev ine ,’3 3 P a rsons ,’T M S tein ,’35 and T ob in15.




B O Y E R

w ay of exp re ssin g . H e fin ds th at the pa tien t is

no t in n eed o f ins ig h t tha t w ill co rrect fau lty

rea lity , b u t, ra the r , need s a re la tionsh ip w ith

ano th er pe rson th rou gh w hich w o rd s can be

foun d fo r th at w h ich has no ve rb al lan gu ag e.

A s he fin ds w ords tha t rep re sen t h is exp eri-

ence, he “kn ow s h im se lf.” E . B alin t’4 ’ ad ds

tha t a s th e p atien t kno w s abou t m utu al expe -

rience , he k no w s abou t the ana ly st, too . S he

ho ld s th at in th e transfe rence -cou n te rtran s-

ference rela tion sh ip , ano the r pe rson is th e re

to enab le the pa tien t to pu t h im se lf toge the r ,

p rov id ed the ana lyst can u se h is em otio na l

resp onses to the pa tien t’s com m un ica tion s

w itho u t coun te rtran sfe ren ce d isto rtio n ;

O gden2 4 w o u ld ad d tha t w ith som e p atien ts

the an aly st’s in terp re tive actio ns a re o f m ore

use than h is w ords .

A m ajo r th read in the deve lopm en t o f

ana ly tic un de rstand ing of th e in te rd ep end-

ence of trans fe ren ce an d cou n te rtransfer-

ence em erged fro m W in n ico tt’s ideas

conce rn ing the in te rdependence o f the su b-

jec tiv itie s o f m oth er an d in fan t”7 an d the

c rea tion o f a “ th ird a rea o f ex pe rienc ing ” in

the po ten tia l space “th at ex ists (bu t cann o t

ex ist) be tw een the baby an d th e ob ject” ’42 (p .

1 07) . Su bsequ en t au th o rs have sig n if ican tly

expand ed the u nde rstand in g o f th e ana ly tic

p rocess as tak ing p lace in th e “ov e rlap o f tw o

a reas o f p lay ing , tha t o f the pa tien t an d tha t

o f the the rap ist” (W inn ico tt,’42 p . 38 ;

O gden’43 ). W inn ico tt’ h eld the re to b e “no

such th in g as an in fan t (apa rt from th e m a-

terna l p rov ision )” (p . 39 fn ) , and O g den b e-

liev es the re to be n o such th ing as an

ana lysand ap art from the re latio nsh ip w ith

the ana lyst o r th ere to b e an ana ly st apa rt

from his re latio nsh ip w ith th e an aly sand .

O gden2 4”45 h as deve loped th e co ncep t o f the

ana ly tic th ird . H e w rites ,

the in te rsu b jectiv e en tity d esc r ibed as

th e a nalyst-ana lysand co ex ists in d ia lect i-

c al ten sio n w ith the ana lys t and a naly-

sand as se para te ind iv id uals w ith th eir

ow n th oug h ts , fee lings , sensa tion s, co r-

po ral re ali ty , p syc ho log ical ide n ti ty a nd

129

so on . N eith er th e in te rsu b je ctiv ity o f th e

m othe r-in fan t n o r th at o f the an a lyst-

ana lysan d (a s sepa ra te p sycho log ica l en -titie s) ex ists in pure fo rm . T h e

in tersub jectiv e and the in d iv id ua lly su b-

jec tive each c rea te, n eg ate an d pre se rve

the o th er . In b o th the re la tion sh ip o f

m othe r and in fan t an d th e re latio nsh ip

o f ana lyst and ana lysan d , the ta sk is no t

to tea se ap art the elem en ts constitu ting

the re la tionsh ip in an e ffo r t to d ete r-

m ine w h ich qua lities b elo ng to ea ch in-

d iv idua l pa rtic ipa ting in it; ra ther , from

th e po in t o f v iew o f th e d ia lec tica l in ter-

d ep endence of sub jec t and ob jec t, the

ana ly tic ta sk inv o lves an e ffo r t to d e-

scr ibe as fu lly a s one can th e sp ec if ic

n atu re o f the in te rp lay o f ind iv idua l su b -

je ctiv ity a nd in te rs ub je ctiv ity .’ 45

T h e G add in is’ 49 and B oy er’5 0 have d is-

cu ssed and dem o nstrated w ith case ex am ples

the em ergence o f w ords fro m the psy -

ch esom a d uring com plem en ta ry reg re ssion

of pa tien t an d the rap ist.

I t is h eld h ere th at w ha teve r the an a lyst

ex pe riences du rin g th e ana ly tic s ess ion con -

stitu te s h is id iosy nc ra tic in tro jectio n of the

pa tien t’s ve rb a l and non ve rb al com m un ica -

tions, co n ta in ing the pa tien t’s p ro jec tion s

and the an aly st’s p redom inan tly uncon sc ious

reactio ns to th ose in tro jec tion s. In add ition ,

the ana lyst ex ists as a pa rt o f th e ana ly tic th ird ,

expe rien cin g and sim ultaneous ly obse rv ing

h im se lf , th e ana lysand , and the an aly tic th ird

as th ey in te rac t w ith o ne an o the r . W e sho u ld

no t be m isled in to th in k ing ou r stray , app ar-

en tly u nrela ted thou gh ts , fan ta sie s , an d phy s-

ica l o r em otio na l reactio ns can be d ism issed

as id le p reo ccu pa tions , tak ing u s aw ay fro m

the busin es s a t h an d , in te rfer ing w ith o ur

free-flo a tin g or ev en ly ho ve rin g atten tio n .

D row siness is a reac tion of the an aly st tha t

has been d ism is sed often as irre levan t o r e x -

p la inab le fo r “ra tiona l” re aso ns . M cL au gh lin ’5 ’

an d o the rs have em ph as ized its co un ter trans -

fe ren ce im plica tions , an d B oye r”#{1 76} i llu strated

how sleep in ess p rov ided h igh ly im po rtan t clu es

to p atien ts’ uncon sc ious con flic ts .





It is ob v iou s tha t the an aly st’s p reva iling

em otio na l sta te an d ind iv idua l co nflicts ,

rep re ssed o r o the rw ise , w ill de te rm ine h is

deg ree o f op enness to th e an aly san d’s p ro jec -

t ions.

T he m en ta l se t o f th e ana lyst is f irm ly

em bedd ed in h is life h isto ry , w h ich w ill in f lu -

ence stro ng ly h is recep tiv ity . T o c ite a few

exam ples w ill su ff ice . M y life lon g expe rien ces

w ith psycho tic p eo p le h ave cond itioned m e

to b e automatica lly aw are o f ve ry early stag es

o f reg res sion as po ssib ly p rem o n ito ry o f psy -

cho tic o u tb reak . H ere I no te o n ly su b tle m an -

ife sta tion s, leav in g asid e such obv ious even ts

a s slip s o f the tong ue and the in se rtion in to

speech o r ac tion o f fa lse m em ories o r o f fan -

ta sies m om en ta r ily he ld to b e facts . W h en a

pe rson w ho regu la rly uses goo d g r a m m a r be -

g in s to u se p ron oun s inco rrec tly , such as say -

ing “to h im an d I, ” I beco m e ale r ted and keep

track of po ssib le repe titions an d the circum -

stances in w hich th ey o ccur . F requ en tly , m y

even tua lly callin g th e ana lysan d’s a tten tion to

the e rroneo us use o f (fo r in stance ) I rather

than m e le ads to h is aw aren es s tha t h is in co r-

rec t use o f I signa ls a p o ten tia l p ro fou nd

reg re ssion , a speak ing from a positio n in

w hich he h ad no t ye t becom e d iffe ren tia tedin to an land a m e (see E . B a lin t’52 ). S im ila r ly ,

w hen an ana lysand beg ins to u se sca to lo g ical

langu ag e, I am esp ec ia lly aw are o f re levan t

bod ily sen sa tions and th e ir p o ten tia l m ean-

ings.

W e a ll kn ow o f F reud ’s’53 ho ld ing th at

som e dream s canno t be in te rp re ted o n the

basis o f th e pa tien t’s a ssoc ia tions , y et tha t th e

ana lyst is cer ta in tha t he und erstand s sign if i-

can t e lem en ts . M y m any yea rs o f fie ld re -

search in an th ro po lo gy and stu dy of fo lk lo re

and the c ro ss-cu ltu ra l u se o f the R orschach

T est’ 5 0 have led m e , in ag reem en t w ith

F reud , to be lieve f i rmly tha t each sym b ol has

a t leas t on e b asic m ean in g , appa ren tly in -

bo rn , in ad d ition to w h ateve r ad d ition a l

m ean ings have b een add ed b y lea rn ing . M y

au tom atic sub lim ina l tho ugh t, “fem a le-

m oth er ,” w hen a pa tien t b egan to b e preoc -

cu p ied w ith th e w ood o f fu rn itu re near h im

in the co nsu ltatio n roo m , led m e to m ak e an

in terp re tatio n tha t bo th relieved m y inne r

ten sion an d lif ted h im fro m a deep , sud den

psy ch o tic reg re ssion (B o ye r,7 pp . 121 -1 37) .

A u tom atica lly th in k ing o f sib ling riv alry

w hen pa tien ts beg in to ta lk o f tiny an im als o r

in sects ,’T M o r C h ris tm as o r E aste r,’ o f ten

leads to a q u ickened in tro jectio n and und er-

s tan d ing of a p ro jec tion .

T he an a lyst’s in vo lv em en t in h is coun ter-

transference m ay prove d is trac ting at tim es,

e sp ec ia lly w hen h is pa tien ts succeed each

o the r w ith on ly a few m in u te s’ b reak be tw een .

I t m ay be d ifficu lt fo r th e an a ly st to m ak e th e

in terna l ch an ges req u isite fo r und isto r ted

p e rcep tion of th e conflic ts and em o tiona l

sta tes o f the second pa tien t w ho en te rs the

co nsu lta tion room . T h is is m ore true if the

p a tien ts’ cha rac te ro lo g ica l s truc tu res and the

co n tem po ra ry na tu re o f th e transference -

co un te rtransfe rence re la tion sh ips a re

similar .

F o r ex am ple , tw o w om en had su ffe red

s im ila rly seve re ly trau m a tic in fanc ie s and

ch ild ho ods, an d each had u nde rgon e fre -

q uen t ca ta tono id ep isodes, in vo lv ing in tense

w ithd raw a l and ob v iou sly psy ch o tic th ink ing ,

u n til they lef t h om e to a tten d schoo l. S ub se-q uen tly , each w ithd rew fro m s tre ssfu l s itu a-

tio ns, hav in g sim ilar ep isodes tha t m igh t las t

fo r days o r w eek s. N eith er h ad been ho sp ita l-

ized , bu t bo th h ad u nde rgon e rep eated psy -

ch o the rap y an d p sychoan aly sis in th e ca re o f

h igh ly respected tra in in g ana lys ts in N orth

A m erica . N e ithe r con side red h er ana lyse s to

h ave b een u sefu l c lin ically ; each had stop ped

th em vo lun ta r ily w hen th e ana lysts w o u ld no t

a llow reg re ssion in the serv ice o f trea tm en t.

A n ex trem e exam p le fo llow s. W hen o ne of

th ese pa tien ts a sked he r an aly st w hy she w as

b e ing d iscourag ed from a ttem pting to re-

co ve r fan ta sie s tha t had im m edia tely p re -

ceded a fr igh ten in g d issoc iated sta te du ring

th erapy , th e an aly st to ld h e r th at the recov ery

o f the fan tas ies m igh t lead to he r su ic ide . It

w as m ore usu al fo r th e ana lyst to d iscou rage

co ve rtly th e p a tien t’s a ttem pt to reg re ss , u su -

a lly by ask ing q uestions tha t changed the




B O Y E R

sub ject ; it has lo ng b een com m on kn ow ledge

tha t the the rap ist o ften seek s to re lieve h is

o w n anx iety in th is w ay .’58

W inn ico tt’4 2 an d O gden ’5 6 ’ have

stre ssed the need fo r the ana lys t to allo w the

ex is ten ce o f po ten tia l space in w hich c rea tiv -

ity can occur , and B io n’62 the need fo r th e

ana lys t to en te r in to a “reve rie” a llo w in g a

sim ila r deve lopm en t. I f ind tha t m y m o st ex -

h ilara ting an d p ro duc tive p eriod s in w ork ing

w ith reg res sed pa tien ts o ccu r du ring tho se

unu sua l occasio ns w hen , w h ile in a slig h t sta te

o f reve rie , I p lay W inn ico tt’s’49 ”6 3 “squ ig g le

gam e” w ith th e pa tien t. W e d o no t use p enc ils

bu t in stead create o ur “d raw in gs” v e rba lly

th ro ugh assoc iatin g to each o the r’s a ssoc ia -

tio ns. It is a t th ese tim es tha t the th ink ing o f

bo th ana lysand an d ana lyst m ost ea sily and

und erstandab ly sw itch es w itho u t conflic t to

the sim u ltan eo us use o f th e au tis tic -co n tigu -

ous , sch izo -pa ran o id , and depre ssive m o des

o f gene ra ting exp e rience (O gden’6 ’). It is

dou b tfu l tha t such an in te rchang e cou ld take

p lace in a th erapeu tic endeavor in w h ich the

an a ly tic fram e h ad no t b een con sisten tly

m a in ta ined ; no r w ou ld it be like ly if the the r-

ap ist w as u ncom fortab le , p resum ab ly b e-

cause o f anx ie ty conce rn ing h is ow n

agg re ssive o r lib id ina l u rg es, du rin g the

pa tien t’s som etim es psy ch o tic reg re ssion s.”

E sp ec ia lly im po rtan t in th is in te rchang e

a re th e d is tin c tive fea tu res o f the depres sive

po sition as “ the in teg ra tion o f pa rt o b jec ts to

fo rm th e w h o le ob jec t an d the p ain fu l reco g-

n itio n by th e in d iv id ua l tha t h is fee ling s o f

13 1

lov e and h ate a re d irected to the sam e , w ho le

o b ject. T h e them e o f con ce rn fo r the ob jec t

is cen tra l to th e idea” (S p illiu s ,9 8 p . 4 ). T h ere

is a lso recog n ition of the ob jec t’s sepa rate -

n ess and the in tr in sic re la tionsh ip be tw een

the d ep re ssiv e positio n , sy m bo lic tho ugh t,

and c rea tiv ity A t such tim es

b o th ana lysand an d ana lys t re ta in su ffic ien t

o b jectiv ity tha t a p art o f the ir m in ds can ob -

se rve the in te rp lay am ong p rim itiv e m en tal

func tion s. D uring such a pe rio d , o ne o f the

fem a le p atien ts m en tio ned ab ove laug hed

alo ud and said if an y o the r ana lyst sh e kn ew

lis tened in on our con ve rsa tion , he o r she

w o u ld su re ly deem us m ad .”””

F or a few m on ths, the se tw o p atien ts ’

ses sions w ere co nsecu tive o ne d ay each w eek ;

the ir o th er fou r hou rs w ere at sep a ra te tim es

o f the day . D uring tha t few m onth s’ p e riod ,

each h ad brave ly reg res sed to a p rim itive state

du ring he r in te rv iew s; th is reg re ssion b o th

fr igh ten ed an d g rea tly en co urag ed each be -

cau se sh e deem ed it a neces sary re liv in g in

th e se rv ice o f he r ana lysis . F o r sev era l days,

each o f them h ad been p lay in g a ve rba l sq u ig -

g le gam e w ith m e . O ur in te rac tion s c rea ted a

sta te tha t w e fou nd to be sim ila r to the p o ten -

tia l space o f w h ich W in n ico tt an d O g den

w ro te, w ith in w h ich c rea tions occu r w hen

m oth er an d in fan t are p rope rly a ttuned . I t is

m y im p ressio n th at m an y ana lysts becom e

un easy w ith the o nse t o f reve rie and seek to

term in ate the state .

O n e n igh t, a fte r one o f th e w om en and I

had expe rien ced su ch an ep iso de , I d ream ed

I a m un able to ci te an e xam ple be cau se at suc h tim es I am q uite lost in m y in te rac tion w ith the

a nalysa nd and c ann ot kee p d ep end able no tes .

A lthou gh th is in te rch ang e betw ee n the a nalyst and the a nalysa nd ca n b e tho ugh t o f a s fre ely inv o lv -

ing co m b ina tion s o f p rim ary a nd sec on dary pro ces s th ink ing ,’6 7 v iew ing th e in te rch ang e in th ese

term s fai ls to con ve y th e richn ess im p lied in O gde n’s th re e m od es o f exp erienc e.’6 ’

E xcep t fo r the pe riods o f reve rie du ring w hich th e ana lysan d and I p la y “sq u ig g le ,” I am e asi ly ab le

to re tain m y observ in g eg o w hile s im u ltaneou sly in teractin g w ith th e pa tien t du rin g m y alte red ego

sta te , an d I am ab le to reco rd d eta iled p ro cess n o te s during the in terv iew ”5 1’-a p rocedure tha t v ery

rare ly d is tu rbs m y an aly san ds , e ven those w ho a re o th erw ise q u ite parano id . M y n o te s inc lud e m y

con scious fan tas ies a nd m y e m o tion al an d phy sic al reac tion s.




132 C O U N T E R T R A N S F E R E N C E

tha t sh e and I w ere S iam ese tw ins, con nected

so lely by o ur o cc ip ita l co rtice s . O ne of m y

w ak ing as soc ia tio ns w as tha t w e had been

seein g “ey e to eye” an d d id indeed sha re

v isua l co rtice s . F o r m e, the se tw o w om en had

becom e S iam ese tw in s, con nec ted b y m y

h ead .

T he fo llo w in g day I to ld the pa tien t m y

dream , som eth ing I had neve r d one w ith an y

ana lysand , o n ly to rem em b er su bsequen tly

and sec re tly th at I h ad in fact had the d ream

abou t the o th e r p a tien t.

In th is in stance, no h arm w as don e. H ow -

eve r, on o the r occasio ns I have in deed fe lt

fo o lish an d de layed ana ly tic p ro g ress w h en I

have u nw itting ly ca rried m y em otio na l sta te

and p reoccupa tion w ith the fo rm er transfe r-

ence-coun ter tran sfe ren ce in te rac tion s in to

the success ive hou r. S uch ex pe riences,

am on g o the rs , led m e to seek to v iew each

ana ly tic se ssion as if it w e re a d ream , in w hich

the m a jo r u n reso lved transfe rence -cou n te r-

transfe rence issu e o f th e la st o r la st few

session s com poses th e “day re sidu e. “ A cco r d -

ing ly , I a ssu m e tha t every com m unica tion o f

the in te rv iew is in som e w ay rela ted to tha t

day re sidu e in the con tex t o f the ensu ing

“dream ” and am particu la r ly in tere sted in th esym bo lic m ean ings o f the o pen ing v erba l

and /o r n onv erba l co m m u nicatio ns. O ften ,

to re fre sh m y m em ory , I rev iew m y no te s in

ad vance o f th e in te rv iew , n o te s tha t in clu de

m y ow n fan tas ies , em otion a l ex pe rien ces,

an d ph ysica l sensatio ns.

C ou n te rtransference in te rp re ta tions can

ev en enab le a reac tive ly ho stile , f righ ten ed

pa tien t to beg in trea tm en t. A w om an w as

co nv in ced tha t he r ch a rac tero log ical d is-

tu rban ce an d m ultip le psy ch oso m a tic sy m p-

to m s, p red om in an tly g astro in te stina l, w e re

p rod uc ts o f he r hav in g been sexu a lly m o-

le sted du ring h er ear ly ch ildh oo d , a ltho ugh

sh e h ad no m em o ry o f su ch an ev en t. S he

re fused to en ter p sycho the rapy w ith any of a

se r ies o f ana lysts w h om she consu lted a fte r

d rug the rapy h ad p ro ved in effec tive , because

no ne o f them w o uld vo uchsa fe th at h e be -

lieved th a t h er sy m pto m a to log y w as the re su lt

o f such early m ole sta tio n . F in ally I cho se no t

to d ea l w ith h e r d em an d a t face va lue bu t

in stead d ep en ded o n m y ex pe rienc in g in ter-

n a l anx ie ty an d gastro in te stina l c ram ping

w hile lis ten in g to he r litany and o bse rv ing

h e r ten sion . I to ld he r tha t I cou ld no t kn ow

o n the basis o f h er s tated h isto ry o r m y m ed-

ica l and p sych ia tric kn ow led ge tha t h er be lie f

w as accu ra te , bu t tha t I fe lt ce rta in th at she

h ad been seve rely psych ica lly trau m a tized

w hile v ery yo ung on the basis o f m y em otion al

an d p hysica l reac tion s to he r p resen ta tio n of

h e r co m pla in ts . R elieved an d in trig ued , she

p ro m ptly en tered psych oana ly tic treatm en t,

w h ich w as rem arkab ly succes sfu l.

K ha n’ 50 ”7 #{ 17 6} co nc eiv es o f c ou nte rtr an sf er-

en ce as an ins trum en t o f pe rcep tio n , and

M cD o uga ll6 ’ ho ld s tha t sh e a rticu late s he r

in tro jec tion s o f the pa tien t’s p rev erba l and

p re sym bo lic expe rien ces. A t tim es she be -

co m es aw are o f coun ter tran sfe ren ce d istu r-

b ances th rou gh d ream s o f h er ow n , a s d o I.

A t m id cen tu ry , ana lysts began su dden ly

to p resen t and p ub lish stu d ie s devo ted spec if-

ica lly to cou n te rtran sfe ren ce, p erhaps b eg in -

n ing w ith W inn ico tt’s’7 ’ “H a te in the

C o un te r transfe rence” and fo llow ed by co n-

tr ib u tion s such as tho se o f L acan ,’7 2 L it-tle ,’73 ”7 4 N ach t,’T h and A . R e ich .4 3

M any psych oana lysis ag ree tha t the ea rli-

e st system a tic and va luab le w ork tow ard de -

v e lop in g a th eo ry o f co un te r transfe rence w as

d one by H e im ann5 2”76 and R acke r,32 w ho

app aren tly w ork ed indepen den tly , each w ith -

ou t kno w led ge o f the o the r’s th ink in g . T he

con tribu tions o f R osen feld ’7 7 have been ove r-

loo ked b y m any . T h is m ay b e a ttrib u tab le to

h is no t h av ing used the w o rd caunter trans fer -

once in an y title u n til ve ry la te in h is ca ree r’37

(chap . 12 ). A lthou gh he dep ic ts h im self a s an

ortho dox K le in ian , in h is ear lie st pub lica tion

dea ling w ith psy ch o tic sta te s (19 47)

R osenfe ld ’78 n o te s h is use o f co un te r transfe r-

ence reac tion s as gu ides to in te rp re ta tion . H e

firs t u se s the w o rd coun te r t r ans fe r ence in

1 952 ” w h ile d iscussin g the d ifficu ltie s in in -

terp re tin g to p atien ts w ith sch izop hren ia :

“O ur cou n te rtransference is frequen tly th e




B O Y E R

on ly gu id e” (p . 126 ). N o do ub t R o sen feld

w an ted to p ro tect h is re la tions w ith M elan ie

K le in (h is an aly st), w ho w as so incensed w ith

P au la H e im ann tha t the ir p rev iously co rd ia l

rela tion sh ip w as te rm ina ted w hen H e im ann

de live red h er 19 50 pap er a t the Z urich con -

ference (D eP ao la ’79 ). S im ila r ly , K le in w as

ho stile tow ard L ittle ’7 3”74 a fte r sh e ad voca ted

the use o f cou n te rtransference reactio ns in

trea tm en t, a s , it ha s been said , she w ou ld be

even tu ally tow ard H an na S ega l’ (chap . 6 ) .

In th e ea rly 1 950 s B a lin t’ 8 2 adv oca ted the

ana lyst’s con sc ious use in the rap y of h is em o-

tion al reac tions to pa tien ts . B a lin t’s pos itio n

has also b een ov erloo ked gene ra lly .

S U M M A H V

D uring the past h alf cen tu ry , co un te r trans-

ference h as com e to b e seen as a va luab le too l

in our the rap eu tic arm am en ta r ium , ra the r

than so le ly as an im ped im en t to p sycho an a -

ly tic trea tm en t. T h is change of a ttitude re -

su lted from psy ch oana lysis’ com in g to v iew

the ir task as in terp re tin g th e in te rac tions o f

bo th p a tien t and the rap is t o n an in trapsych ic

leve l, ra the r than the p a tien t’s in trap sych ic

d ynam ics, and u nd erstand in g those in te rac -

tion s in te rm s of th e constan t in te rp lay b e-

tw een an aly san d and ana ly st, in vo lv ing th e ir

m u tua l in tro jec tion o f the o the r’s p ro jec tive

133

iden tif ica tion s. A n im po rtan t e lem en t in the

chang e in the rap is ts’ a ttitud es reg ard ing th e

types o f pa tien ts w h o sho u ld b e inc lud ed as

ana ly tic su b jects is th e inc rea sed un de rstand -

ing of th e na tu re o f th e in teractio n b e tw een

the rap is t and pa tien t du ring the in ev itab le

reg re ssion s in th e serv ice o f trea tm en t-an

un de rs tan d ing tha t can be usefu lly in te rp re-

ted .

A lthou gh it is g en e ra lly be liev ed th at

F reud o rig ina lly v iew ed coun te rtran sfe ren ce

so lely as an im ped im en t to an a ly sis , h e w as

a lw ay s am b iva len t on th is issu e. H e m ay have

be lieved th ere is a rela tion sh ip be tw een trans -

ference and coun ter tran sfe ren ce an d ex tra -

senso ry pe rcep tio n .

H e im ann and R acke r are usua lly cred -

ited w ith hav in g th e m a jo r ro les in th e

dev elo pm en t o f a sy stem a tic th eo ry o f cou n-

ter tran sfe ren ce , and the im po rtan t w o rk of

o th ers , su ch as R osenfe ld an d B a lin t, h as

p robab ly been und erem ph asized .

L .D oty assis ted in m anu scrip t p repara tion . A

versio n o f th is artic le w a s p re se nt ed at t he C e ’n te rf or

th e Advanced Stu dy o f the P sychoses, S an Fran-

cisco , June 1992 , a nd at the G raduate Seminar ,

D epar tm ent o f P sych ia try , A lta B ates-H errick M e-

mo ria l H osp ita l, B erke ley, CA , D ecem ber 1992 . It

is a com panion to a c lin ica lly focused a rtic le a s yet

unpublished .

R F F F R E N C E S

1 . B oy er L B : R ole s p lay ed by m us ic a s re vea led th rou gh

cou nte rtra nsfere nce fac ilita ted tra nsferen ce re gre s-

sio n . In tJ P syc hoa na l 199 2; 7 3 :5 5-7 0 a nd in P sy cho -

therapy o f S ch izo phren ia: F a cil ita t ing an d

O b stru ctive F actors, ed i ted by W e rba rt A , C ullbe rgJ.

O s lo , S can din av ian U niversity P res s, 199 2 , p p 63-74

2 . B oy er L B : P ro v is ion al ev alu atio n o f psych o-a nalysis

w ith few pa ram ete rs in th e treatm en t o f sch izop hre -

n ia . In tJ P sych oan al 1 96 1; 42 :38 9-4 03

3 , B oy er L B : O n m atern al o verstim ulatio n an d e go d e-

fects . P sy cho ana l S tu dy C hild 19 56 ; 11 :23 6-2 56

4 , B oy er L B , G iova cch in i P L : P sy cho ana ly t ic T re atm en t

of S c h iz oph ren ic a nd C h ara cte ro lo g ic al D iso rders.

N ew Y ork , S cie nce H ou se, 196 7; P syc hoa naly tic

T re atm en t of S ch izo phren ic , B o rd erline , a nd C ha r-

actero log ical D isorders , 2n d ed itio n , re v is ed an d e n-

larg ed . N ew Y ork ,Ja son A ron son , 1 98 0

5 . B oy er L B : C ou nte rtra nsfere nce w ith seve rely re-

gre sse d p atien ts, in C o untertrans ferenc e: T he

T h erap ist’s C on trib u tion to the T h era peu tic S itu a-

t ion , ed i ted by E p ste in L , F einerA F . N e w Y o rk ,Jaso n

A ronson , 1 979 , p p 3 47 -37 4

6 . G io va cch in i P L , B o yer L B (e ds ): T e ch nica l F a cto rs in

the T re atm en t of th e S ev ere ly D istu rbed P atien t. N ew

Y o rk ,Jaso n A ronson , 19 82

7 . B o yer L B : T h e R eg res sed P a tie n t. N ew Y ork , Jaso n

A ro nson , 1 983

8 . B oy er L B : T e ch nica l aspec ts o f tre atin g th e regressed

p atie n t. C on tem po rary P syc ho ana lys is 1 986 ; 22 :25 -

44

9 . B oy er L B : T h ink ing o f th e in te rv iew a s thou gh itw e re

a dream . C on tem po rary P sych oan aly sis 1 988 ; 24 :27 5-



V O L U M E S # {1 49 }N U M BE R 2 .S P R IN G 1 99 4

134 C O U N T E R T R A N S F E R E N C E

28 1

10 . B o ye r L B : Coun ter t ransference an d te chn iqu e in

w ork in g w ith the re gre sse d p atien t fu rth er rem arks.

In tJ P sy ch oan al 19 89 ; 70 :701 -71 4

11 . B o ye r L B , G io va cch in i P L (eds .): M as ter C lin ic ian s

on T reat ing th e R e gre sse d P atien t. N orth va le , N J,

J aso n A ron son , 1 99 0

12 . G io va cch in i P L : In tegrativ e aspec ts ofob ject re la tio n-

s hip s. P sy ch oa na l Q 1 96 3; 3 2:3 93 -4 07

13 . G lo ve r E : T he T e chn iqu e of P syc ho-A na lys is. L on -

do n: B alli#{ 23 2} re , Tinda ll an d C o x, 1 95 5

14 . H o ed em ake r E : T he th era pe utic p ro ce ss in the t reat-

m en t o f sch izo ph ren ia .J A m P sych oan al A ssoc 19 55 ;

3 :89-109

15 .Jac ob son E : T he S e lf an d the O b ject W orld . N ew

Y ork , In ternat ion al U n ive rsit ies P ress, 196 4

16 . L ew in B D : T h e P sy cho an aly sis of E latio n . N e w Y ork ,

N o rto n , 195 0

17 . L oe w ald H : O n the th era peu tic a ctio n o f psy ch oan al-ys is (196 0), in T h e W ork of H an s L oew ald : A n In tro -

duc tio n an d C om m entary , e d ite d by F o gel G I.

N o rth vale , N J,J aso n A ron so n , 199 1 , p p 13 -60

18 . S ea rle s H F : O ed ip al lov e in the co untertrans fere nc e,

in C olle cte d P a pers on S c hiz oph ren ia an d R ela ted

S u bjec ts. N e w Y o rk , In tern ationa l U niversities P res s,

1 959 , pp 28 4-3 03

19 . O g den T H : P ro je ctiv e Iden tificat ion and P syc hother -

ape u tic T ech niq ue. N ew Y ork ,Ja son A ron son , 198 2

2 0 . R o sen feld H A : C o ntr ibu tion to the psych opa tho log y

of p sy cho tic sta tes : the im po rta nce o f pro jec tiv e id en -

t ific atio n in the eg o s tru cture an d the o bje ct re la tio ns

of th e psy ch otic pat ien ts, in P rob lem s of P syc hos is,

ed i ted by D o uce t P , La ur in C . E x ce rp ta M ed ica 19 71;

155-178

2 1 . S an dle rJ: C oun ter tran sfe ren ce an d ro le resp on siv e-

n ess . In ternat ion al R e vie w o f P sy cho -A naly sis 19 76;

3 :43-47

2 2 . W ang h M :T he “ evo cat ion o f a p rox y” : a p syc holog ical

m an euv er, its use as a d efe nse , i ts p urp ose an d gen e-

s is. P sy ch oan al S tu dy C hild 196 2; 17 :45 1-4 72

23 . M cL au ghlinJT : C lin ic al a nd th eo retical asp ects of a n

e nac tm ent .J A m P sych oa nal A ssoc 1 991 ; 3 9 :5 95-61 4

24 . O gd en T H : T he con cep t o f in terp ret ive act ion . P sy-

c h o a n a l Q (in p res s)

25 . O ’S hau gh nes sy E : W ord s an d w o rk ing throug h . In tJ

P sy cho ana l 1 98 3; 6 4 :2 81 -29 0

26 . V o lka n V D : T rans fere nce and cou nte rtra nsfere nce :

a n exa m inat ion from the p oin t of v iew of in te rna lize d

o bje ct re la t ion s, in O bject a nd S elf A D eve lop m e nta l

A p pro ach , e d ited by T uttm an S , K a ye C , Z im m erm a n

M . N ew Y ork , In tern atio na l U niv ers itie s P ress , 19 81 ,

pp 429-451

27 . G rin ste in A : T he Inde x o f P sy ch oan aly tic W ritin gs,

v o ls I -V . N ew Y o rk , In ternat ion al U niv ers itie s P ress ,

1960

28 . G rin ste in A : T he Inde x of P sy cho ana ly t ic W riting s,

v o ls V I-IX . N ew Y ork , In tern atio nal U n ive rsit ies

P ress , 1 96 6

29 . R ack er E : O b servac ion essob rela con tra tran sfe ren cia

co m o ins tru m e nto t# {2 33} cn ico ; com un ica ci# {2 43} n p re-

lim ina r. R evista de P sicoa n# {2 25} lisis 195 2; 9 :3 42 -35 4

3 0 . R a ck er E : A c ontribu tio n to the prob lem o f cou nte r-

t ran sferenc e. In tJ P sy cho an al 19 53 ; 34 :313 -32 4

3 1 . R ac ke r E : T h e m e anin gs an d u ses o f co untertrans fer -

enc e. P sych oa nal Q 1 95 7; 2 6: 30 3-3 57

3 2 . R ac ker E : T ran sfe ren ce an d C o untertrans ferenc e.

N ew Y ork , In ternat ion al U niv ersi tie s P re ss, 196 0;

pub lished in itia lly a s E s tud ios sob re T # {2 33} cn ica

P sic oan alI tica . B uen os A ire s, P aid #{ 24 3} s, 1 960

3 3 . G io vac ch in i P L : C ou nter tra nsfe ren ce T riu m p hs a nd

C atastrop hes . N orth va le , N J ,Ja son A ron son , 198 0

34 . Gro tstein JS : S p litt ing an d P ro ject ive Id en t ific ation .

N ew Y ork ,Jaso n A ronson , 1 98 1

3 5 . K ern be rg O F : O b jec t R e lat ion s T h eory a nd C lin ica l

P syc ho ana lys is. N ew Y ork ,Jason A ron son , 1 976

3 6 . S ea rle s H F : C o un tertran sferenc e and R ela ted S u b-

jec ts. N e w Y ork , In te rna tion al U niversities P ress , 19 79

3 7 . A rIow JA , B re nne r C : T h e psy cho an aly tic situ ation , in

P syc ho ana lys is in the A m eric as, ed i ted by L itm a n R E .N ew Y o rk , In tern ationa l U niv ers itie s P res s, 196 6 , p p

23-43

3 8 . A b eras tu ryA , C es io F R , L iberm a n D , eta l: D iscus sio n

o f A rlo w an d B re nn er, in P syc hoa nalysis in the A m e r-

ic as, ed i ted by L itm an R E . N ew Y ork , In tern atio na l

U niv ers itie s P ress , 19 66

39 . W ald in ger R J, G un derson JG : E ffe ctive P syc hother -

a py w ith B ord erline P atie n ts . N ew Y ork , M a cm illa n ,

1987

40 . S ch arffJS : P ro jective an d In tro je ctive Id en t ific atio n

a nd the U se of th e T he rap ist’ s S elf. N o rth vale , N J,

J aso n A ro nson , 19 92

41 . L ang sJ: T h e T h era peu tic In te rac tion , I I: A C ritic al

O verv ie w and S y nth esis. N ew Y ork , Ja son A ron son ,

1976

42 . O rr D W : T rans ferenc e an d c oun ter tran sfe ren ce: ah isto rica l su rve y .J A m P sych oa nalA ssoc 19 54; 2 :6 21 -

67 0

43 . R e ich A : O n C ou nte r-trans ferenc e. In tJ P sych oa nal

195 1; 32 :2 5-3 1

44 . E pstein L , F ein er A H (ed s): C ou nter tra nsfe ren ce:

T he T he rap ist’s C ontribu tio n to the T he rap eu tic S it-

ua tio n . N ew Y ork ,Jason A ronson , 1 97 9

45 . E tch ego yen R H : L o s fun dam en tos d e la t#{ 23 3} cn ica

psicoa nalItic a , B u eno s A ires , A m orrortu e d ito re s;

a lso as T h e F un dam en tals of P sy cho ana ly t ic T ech -

n iq ue . L on do n , K arnac , 199 1

46 . B alin t M : T h e B a sic F au lt: T h era peu tic A sp ects of

R egress ion . N ew Y ork , B ru nne r/M az el, 1 97 9

47 . S t#{ 22 7} rck eA : A rev ersa l o f the lib id o s ign in de lus ion s of

persec u tion . In tJ P sych oa nal 1 920 ; 1 :2 31-234

48 . F reu d 5 : T h e fu ture p rosp ec ts for p syc ho -an aly t ic

the rap y (1 91 0), in T he S tan dard E d itio n of th e C o m -

ple te P sy ch olo g ic al W o rks of S igm u nd F reu d (here-

after, “S E ” ), vo l 11 , tran sla ted an d ed ite d b y S trac hey

J. L on don , H oga rth P re ss, 1 95 7

4 9 . F re ud 5 : N e w in trod uctory le ctu res (19 33) . S E , vo l 2 2

5 0 . F re ud 5: R ec om m e nda tio ns to phy sic ian s p rac tic ing

psy cho -an aly sis (1 912 ). S E , v o l 11

51 .Jones E : T he L ife and W o rk of S igm und F reud : 190 1-

19 19 , Y ears of M atu rity . N ew Y ork , B asic B oo ks, 195 5



B O Y E R 135

J O U R N A L O F P S Y C H O T H E R A P Y P R A C T I C E AN D R E S E A R C H

52. H eim ann P : C oun ter -tra nsfere nce . ln tJ P syc ho ana l

1 95 0; 3 1:8 1-8 4

53 . G ro tste inJS : S pli ttin g and P ro je ctive Id en t ific atio n .

N ew Y o rk ,Jason A ronson , 1 981

54 . E dgc um be R M : M od es o f co m m un ica tio n . T he d if

fe ren tia tion o f som atic and v erb al exp res sio n . P sy -

c hoa nal S tu dy C hild 19 84 ; 39 :137 -15 4

55 . K rys ta l H : A lex ithy m ia and psych oth era py . A m J P sy -

c ho ther 1 979 ; 33 :17 -3 1

56 . K rys ta l H : A le x ith ym ia a nd th e e ffe ctiv en ess o f psy -

c hoa naly tic trea tm e nt. In tern ationa l Jou rnal of P sy -

c hoa naly tic P syc ho the rapy 1 98 2/8 3 ; 9 :353 -37 8

57 . M arty P , de M ’U z an D C , D avid C : L ’ inv estigat ion

p syc hosom atique . P aris , P resses U n ive rsi ta ires de

F ran ce, 19 63

58 . M cD ou gallJ: T h e psych eso m a and th e psych oa naly tic

p roc ess . In ternat ion al R e vie w of P syc ho-A n aly sis

1 97 4; 1 1:4 37 -4 59

5 9. M cD ou ga ll J: C o un tertran sferenc e an d pr im itiv ec om m u nic ation , in P le a for a M ea sure of A bn orm al-

ity . N ew Y ork , In terna tio nal U niv ers itie s P res s, 19 78 ,

p p 247 -29 8

6 0. M cD ou ga ll J: A lex ith ym ia: a p sy cho ana ly t ic v iew -

p oin t, P syc hotherapy and P syc ho som atics 1 98 2;

38 :81-90

61 . M cD oug allJ: T h eate rs o f th e B o dy . A P syc hoa naly tic

A p pro ach to P sy cho som atic Il lnes s. N e w Y o rk , N or-

to n , 198 9

62 . S h ip ko 5 : A lex i thy m ia an d som atizat ion . P syc hother -

a py an d P syc ho som atics 19 82; 3 8 :1 93 -20 1

63 . W ilson C P , M in tz IL (ed s): P sy ch oso m a tic S ym pto m s :

P syc hod yn am ic T reatm e nt o f th e U n der ly in g P erson -

a lity D isorder . N o rthv ale , N J,J aso n A ro nson , 1 989

64 . R ose nfe ld D : T he P syc ho tic A sp ects o f the P erson al-

ity . L o ndo n , K a rnac , 19 92

65 . B insw a nge r H : F re ud s P sych osen th era p ie . P syc he

H eid elb erg 19 56 ; 10 :35 7-3 66

66 . B oy er L B , G iov ac ch in i P L : P sy cho an aly t ic T re atm en t

o f S c h izo ph ren ic , B o rder lin e a nd C ha rac tero log ica l

D isord ers, 2 nd e d it ion , re v ise d an d e nlarged . N ew

Y o rk ,Jason A ro nson , 19 80 , pp7 5-77

6 7 .Jone s E : T he L ife and W o rk of S ig m u nd F reud : 18 56 -

19 00 , T he F orm ative Y ea rs and the G rea t D isc ov erie s.

N ew Y ork , B a sic B o ok s, 19 53 , p p 221 -26 7

6 8 . M ay R : T he id ea of h isto ry in p syc ho ana lys is: F re ud

a nd the “ W o If-M a n.”P sy cho ana ly t ic P sy cho log y 1 990 ;

7 :163-183

6 9 . F reu d S : A p rem on ito ry dre am fulfille d (18 99 ). S E ,

vo l 5

70 . F re ud S : P rem onition s an d c han ce: a n ex cerp t

(1 904 ), in P syc hoa nalysis and th e O ccu lt, ed ite d b y

D ev ere ux G . N ew Y ork , In ternat ion al U n ive rsit ies

P res s, 1 95 3 , pp 52 -55

71 . F re ud 5: P sych oa naly sis and telepa thy (192 1), in P sy-

cho an aly sis a nd the O ccu lt, ed i ted by D ev ere ux G .

N e w Y ork , In te rna tion al U niv ersi ties P ress , 1 95 3 , pp

56 -68 . O rig in ally pu blished w ith no title in “S c hriften

aus d em N ac hla ss,” G e sam m elte W erke 1 7:2 5-4 4 .

L on don , Im a go . S ee also S E , v o l 18

7 2 . S te ke l W : D er te lep ath isc he T raum . B erl in ,Joha nn es

B a um , 1 920

73 . F reu d S : D rea m s an d te lep athy (19 22) . S E , v o l 18

74 . F reud 5: T he o ccu lt sig n ifican ce of dre am s (19 25 ).

S E , vo l 1 9

75 . F reu d 5: D ream s an d th e oc cu lt. N ew In tro du ctory

L ecture s: L ecture X X X (19 33 ). S E , vo l 22

76 . D eve reu x G (ed) : P sych oa nalysis an d the O c cult. N ew

Y ork , In ternat ion al U n iversit ies P re ss, 1 953

77 . E ise nbu dJ: P syc h ia tric co n tr ibu tion s to p ara psy ch ol-

o gy : a rev iew , in P sy cho ana lys is and the O c cult , ed ited

b y D e ve reu x G , N e w Y o rk , In tern ationa l U niversities

P res s, 19 53 , pp3 -1 5

78 . B ollas C : T he S ha do w o f the O bject : P sy cho ana lys is

o f the U nk now n T hou gh t. L o ndo n , F ree A sso ciat ion

B oo ks, 198 7

79 . G arm a A : E l P sic oan #{ 22 5} lisis: T eorla , C lIn ic a, y T #{ 23 3} cn ica .

B uen os A ires , P aid# {2 43 }s, 196 2

80 . G oldbe rg L : R e m a rks o n the tran sfe ren ce-c ou nte r-

trans ferenc e in psych otic sta te s. In t J Psychoanal1 97 9; 6 0: 34 7- 35 6

81 . M ajo r R (ed) : C ah iers C on fro n tat ion , no 10 . P aris,

A u bie r-M on taig ne , 198 3

82 . F reu d S : In stincts a nd T h eir V icis situde s (19 15) . S E ,

vo l 1 4

83 . F en iche l 0 : R e sp ira to ry in tro ject ion (19 31) , in T he

C ollected P ap erso fO tto F eniche l. N e w Y ork , N or ton ,

195 3 , pp 221 -24 0

84 . F ed ern P : E g o P sych ology and th e P sy cho se s. N ew

Y o rk , B asic B oo ks, 195 2

85 . F lie ss R C o unter-t ran sfe ren ce and c oun ter -ide n tifi-

c ation .J A m P sy cho ana l A sso c 195 3; 1 :268 -28 4

86 . W e ige rt E : C ou nte r-tra ns fere nce a nd self-ana lys is. In t

J P syc hoa nal , 1 95 4; 3 5 :2 42 -24 6

87 . M eltze r D : A note on in tro jec tive p roc esses, in the

B ulle tin of th e B r itish P sych o-A na ly tical S ociety , 14 -

2 1 O c tob er 1 978 , p riva te ly circu late d

88 . M e nz ies-L y th I: S om e pa tho log ica l aspec ts of in tro -

jec tio n . U n pub lished p ape r rea d a t th e 9 th B razil ian

P sy cho ana ly t ic C on gre ss, 1 983

8 9 . M eissn er W W : P ro ject ion an d p ro jective ide n tif ica-

t ion , in P ro ject ion , Id en t ific atio n , P ro je ctiv e Ide n tifi-

cat ion , ed i ted b y S and ler J. M adison , C T ,

In te rna tion al U niv ersi tie s P res s, 19 87 , pp 27 -49

9 0 . F reu d 5 : T he psych opa tho log y of eve ryd ay life

(1 901 ). S E , vo l 6

9 1 . F reu d S : M ou rn ing an d m e lan cho lia (19 17 ). S E , vo l

14

9 2 . A b rah am K A sh ort s tu d y of th e d e ve lop m en t o f th e

lib ido , v iew ed in the lig h t of m enta l d iso rde rs (192 4),

in S e lec ted P ap ers of K a rl A bra ham . L on don , H o-

ga rth P ress , 1 94 8 , pp 418 -47 9

9 3 . van O phu ijs enJH W : O n the orig in o f th e fe eling of

persec u tion . In tJ P syc hoa na l 192 0; 1 :2 35 -23 9

9 4 . L e w in B D : K otschm ieren , M enses und w e ib l ich es

U e ber -Ich . In tern ationa ler Z ei tsc hrif t f# {2 52 }r sy -

ch oan aly se 19 30; 16 :43 -56

9 5 . L e ona rd M : P rob lem s in id en tific atio n a nd eg o d e-

ve lop m e nt in tw ins . P sy cho ana l S tud y C hild 1 96 1;

16 :300-320

9 6 M a l c o l m R R E l e spe jo : un a fa n ta sIa sex ual p erv ersa





en u na m u jer , v ista com o d efe nsa co ntra un

d er ru m be p si c# {2 43 }t ic o. e vi st a d e P si co an #{ 22 5} li si s1 97 0;

27:793-78297 . F en iche l 0 : T he P syc hoa naly tic T h eory of the N eu -

rose s. N ew Y ork , N o rto n , 19 45

98 . S p il liusE B (e d): M elan ie K lein T o day : D ev elo pm ents

inT h eo rya nd P ract ice ,vo l I : M ain ly T he ory . L on do n ,

R outled ge, 1 988

99 . S p il liusE B (e d): M elan ie K lein T od ay: D ev elo pm ents

in T he ory an d P ra ctice , v o l II : M a in ly P ract ice . L on -

d on , R o utledg e, 19 88

1 00 . H an n-K en de F : O n the ro le o f tra nsfere nce an d co un -

tertrans ferenc e in psy cho an aly sis, in P sy cho ana lys is

a nd th e O ccu lt, e d ited by D ev ere ux G . N ew Y ork ,

In te rna tion al U n ive rsit ies P re ss, 1 953 , p p 158 -1 67

1 01 . S tra che yJ: T he na ture o f th era peu tic a ctio n in p sy -

c ho-ana lys is. In tJ P sy cho ana l 19 34; 15 :12 7-1 59

10 2 . K ohu t H : T he A na lysis of the S elf. N ew Y ork , In terna-

tio na l U n ive rsit ies P re ss, 1 97 110 3 . R eik T : N ew w a ys in psy ch oan aly tic te chn iqu e. In tJ

P sych oa nal 1 93 3; 1 4 :3 21 -33 4

10 4 . R eik T : L isten ing W ith th e T h ird E a r. N ew Y o rk ,

Far rar -Straus, 1948

10 5 . R eik T : T he H au nting M elo dy . P sy cho ana ly t ic E xpe -

rie nc es in L ife and M us ic . N ew Y ork , F a rra r, S traus

a nd Y ou ng , 1 953

10 6 . R eik T : S o m e re m a rks on the s tud y of re sis tan ces . In t

J P sy ch oa na l 1 92 4; 5 :1 41 1 54

107. Reich W: C haracter A naly sis . N e w Y ork , O rg one

P ress , 1 93 3

10 8 . S p ieg el L A : T he fun ctio ns o f f ree associatio n in psych o-

an aly sis : th eir re la t ion to tech n iq ue an d the rap y . In ter-

nat ional R e vie w o f P sych o-A na lys is 19 75; 2 :379 -38 8

10 9 . B ake r L , L oth ane Z , S pe nce rJH Jr: O n th e a nalyzing

in stru m e nt. P sych oan al Q 1 98 0 ; 4 9: 47 4 50 4

11 0 . K lein M : N ote son som e sch izo id m ec han ism s (1 946 ),

in E nv y an d G rat itud e an d O ther W ork s, 1 946 -19 63 ,

pp 1-2 4 . N ew Y o rk , D ela cor te P re ss/S ey m o ur L a u-

re nce , 197 5

11 1 . O gde n T H : O n the d ia lec tic of su b jec tiv ity and in ter-

su b je ctiv ity , II: p ro je ctive id en tification an d th e sub-

ju ga ting th ird . In tJ P sy cho an al (in p res s)

11 2 . B ion W R : L earn in g fro m E xp erienc e. L o ndo n ,

H e ine m a n, 196 2

11 3 . R o sen feld H A : N ote s on th e p syc ho-ana lys is o f the

su perego co nfl ic t o f an acu te sch izo phren ic pat ien t.

In tJ P syc ho ana l 19 52; 3 3 :1 11 -13 1

11 4 . P ic k IB : W ork ing th rou gh in the c oun ter tra nsfe r-

en ce . In tJ P syc hoa nal 19 85 ; 66 :157 -1 66

11 5 . G rosskur th P : M elan ie K lein : H e r W o rld a nd W o rk .

N e w Y ork , K nop f, 1 98 6

11 6 . W inn ico t t D W : C o llec ted P a pers : T hroug h P aed iat-

tic s to P sy ch o-A nalysis. N ew Y o rk , B as ic B oo ks, 1 958

11 7 . W inn ico tt D W : T he M atu rat ion al P roc esses and the

F a cili ta ting E nv iro nm ent . N ew Y ork , In tern ationa l

U n ive rsit ies P re ss, 1 965

11 8 . S to ne L : T h e P syc hoa na ly tic S itu atio n . N ew Y ork ,

In tern atio na l U niv ersi tie s P ress , 19 61

11 9 . G rinbe rg L : P ertu rb aci# {2 43 }n es e n la in terp reta ci# {2 43 }n p or

Ia co n traid en t ific aci#{ 243 }n p roy ect iva . R e vis ta d e

P si co an #{ 22 5} li si s 1 95 7; 1 4: 23 -2 8

1 2 0. G r in b er g L: O n a s pe ci fi c a sp ec t o f c ou nt er tr an sf er

en ce du e to the pat ien t’s pro ject ive iden tificat ion . In t

J P sy c h o a n a l 1962; 43:436-440

12 1 .G rin be rg L : C oun tertran sfe ren ce and c ou n-

te ride n tifica tio n . C ontem porary P sych oan aly sis

1 97 9; 1 5:2 26 -2 47

12 2 .Jose ph B : T he p atie n t w ho is d if fic u lt to rea ch , in

T act ics a nd T ec hnique in P syc hoa naly tic T he rap y , II:

C oun ter tran sfe ren ce, ed ite d by G iov acc h in i P L ,

F larsheim A , B oy er L B . N ew Y o rk , Jason A ron son ,

1 97 5, p p2 05 -2 16

12 3 .Jose ph B : A ddictio n to ne ar de ath . In tJ P syc hoa nal

1 98 2; 6 3: 4 49 4 5 6

124. Meltzer D: Th e relation of anal m a stu rba tio n to pro -

j e ct iv e i d en ti fi ca ti on . I nt J P sych oa nal 1 96 6; 47 :33 5-

34 2

1 25 . M el tz er D : A dhe siv e id en t ific atio n . C o nte m p ora ry

P sych oan aly sis 1 975 ; 11 :289 -31 012 6 . M o ne y-K yrle R : N orm a l cou nte r-trans fere nc e a nd

so m e of i ts d ev iations . In tJ P syc ho ana l 19 56; 37 :36 0-

36 6

12 7 . S e gal H : T he W ork of H a nna S eg al. N ew Y ork ,Ja son

A ron son , 1 98 1

12 8 . D e vereux G : F rom A n xie ty to M ethod in th e S o cia l

S c ienc es. T h e H agu e, M outon , 1 96 7

12 9 . C rapa nza no V : T u ha m i: P or tra i t o f a M oro cca n . C h i-

cag o , U niv ers ity of C hic ago P re ss, 198 0

130. G o od B J, H errara H , G o od M JD , et a l: R e flex iv ity an d

cou nte rtrans fere nce . C ultu re , M edicin e a nd P syc h i-

atry 198 2; 6 :2 81 -30 3

13 1 . K rack e W : K a gw ahiv m ourn in g : dre am s o f a be rea ved

father . E th os 1 98 1; 9 :25 8-2 75

1 32 . L e vin e R A : D ream s and D ee ds. C hic ago , U niv ersi ty

of C h ica go P res s, 1 96613 3 . L ev ine 5 : D ream s o f th e info rm a nt ab out the re -

sea rch er. E thos 198 1; 9 :2 76 -29 3

13 4 . P a rson s A : B elief, M a gic , a nd A no m ie : E ssay s in P sy -

cho so cial A n throp olo gy . N e w Y o rk , F ree P res s, 1 96 9

1 35 . S te in H F : M assiv e social ch ang e a nd the ex perienc e

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in a N o rth A m er ica n G rea t P lains co m m un ity . P sy -

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Bryce Boyer - Countertransference

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