From the roots of the concept of transference to the reflections dictated by the new scientific discoveries

From the roots of the concept of transference to the reflections dictated by the new scientific discoveries
Dr.ssa Mara Breno*

MATERIA PRIMA Rivista di Psicosomatica Ecobiopsicologica – Le memorie dell’Anima - Numero XVIII - Dicembre 2019 - Anno IX

In setting out to write this article, I felt the need to respect Freud’s thought and accurately describe the birth of the concepts of transference and countertransference and their development to avoid the risk of an excessively prolix or too much superficial approach. The aim of this essay is that of introducing the general concepts of transference and countertransference for further reflections and amplifications that will emerge in the passages dedicated to the Clinic. In the last years, the psychoanalysis at the basis of the post-modern thought has in fact lived a profound transition towards the social-constructivist conception of the analytic relationship where what remains of the old paradigms merge with indications of openness towards concepts of a relational kind. Today the transition is to be redefined taking into account the theories of other schools even if how is still matter of profound reflections. Our school in particular, is trying to integrate the different psychoanalytical models with an innovative dimension taken from the neurosciences and epigenetics.
The transference has probably its founding myth as reported years later by Freud, in the way Breuer would have concluded the treatment of Anna O, escaping scared from the sexual nature of the transference of his patient.
The previous Studies on Hysteria start from the description of the Case of Dora (Freud: 1905) where according to Freud the transference gets its real meaning. Later on, he will complete his thesis in a number of short articles dedicated to the different aspects of the transference. When Dora began the treatment, Freud thought of finding in his patient the confirmation of his theories on the sexual origin of the hysterical symptoms as well as the role played by the dreams in the unveiling of the symptoms: when Dora prematurely interrupted the analysis after only 11 weeks of treatment, for him it was a real shock. Nevertheless, Freud understood he could take advantage from this therapeutic failure when in retrospect perceived the presence of an intrinsic resistance to the phenomenon of the transference. He concluded that if he had identified the obstacle in time, he could have interpreted it and maybe avoid the interruption.
Therefore according to Freud of that time, the power of the neurosis does not extinguish through the manifestation of the conflicts, but is addressed to a particular “mental” dimension, almost always unconscious, called transference. During the treatment in fact, trying to find the unconscious entanglements underlying the formation of the symptoms, Freud did not realize his explanations could awake in the patient underground resistances and ended up to deal only with the intrapsychic dynamics and Dora’s evolutionary history, completely blind of the transference manifestations of the transference aspects. «If he had […] given them the place they should have, the analysis would be quicker and clearer, instead of “slower and less clear”». In this development phase of the psychoanalysis, Freud is mainly attracted by the “intellectual” aspects of the relationship, and not by the emotional value of the communication. More and more, the transference appears to Freud as the unfolding of a “drama”, a tragedy: a transference, a displacement to the analyst of feelings, desires, fantasies and even complete life scenarios that are the reproduction of experiences previously lived with important people of the past, especially in childhood.
In this phase Freud does not consider transference as the drive for the analytic process, but as an unavoidable phenomenon in the analytic treatment the patient addresses to in order to maintain the pathogenic materials inaccessible: we are dealing with a new creation of the disease to be fought with the previous symptoms. In the Poscript to the Case of Dora, Freud introduces this important concept that from now on will be the foundation of his treatment: the analytic treatment does not create the transference, but discovers it because the transference exists outside and inside the analysis. The only difference is that is the analysis that makes it conscious.
According to Freud, in the analysis of the transference, it is evident an important functioning of the human psyche. In confirmation of the displacement of the past feelings and fantasies of the person to the analyst, is the observation of the Rat Man Case (Freud: 1909) where Freud highlights a valid example of the stereotyped character of the transference. The obsessions of this patient had begun in the army when one day a captain described with a wealth of details and pleasure, an Eastern torture carried out introducing mice in the anus of the convict. Following this testimony, Freud since the second session had come to associate and explain his symptoms to a sexual origin, and more than once “The Rat Man” came to address to him calling him «Oh Captain, my Captain».
Later on in The Dynamics of the Transference (Freud: 1913), Freud will elaborate a first article entirely dedicated to the transference adopting the term imago – proposed by Jung – to identify the inner figure of the past that is the object of the transference to the analyst. Referring to the role of the transference affections of love and hate observed by Ferenczi, the patients tended to make the doctor play the role of the parental figures – loved and hated at the same time -, Freud underlines how important is not only to observe the transference, but also to take into consideration the affective qualities related to the transference.
Therefore the transference from resistance and obstacle to the therapy begins to reveal the affective quality that in the expert hands of a therapist can favour the cure of the neurosis. He distinguishes the tender feelings related to the ‹positive transference›› as going back to erotic sources partly conscious and partly unconscious on the basis that the first relationships of childhood always establish with sexual objects, from the affections characterized by hostile quality or by removed erotic elements, when the transference transforms in a resistance (negative transference).
In 1914, in the article “Remembering, Repeating and Working-Through” (Freud: 1914) Freud goes even further and puts the accent on the function of the repetition of the transference and observes that the greater the resistance is, the more the patient tends to substitute the memory with the action. He writes: «For instance, the patient does not say that he remembers that he used to be defiant and critical towards his parents' authority; instead, he behaves in that way to the doctor. (…) He does not remember the shame experienced for specific sexual practices and the fear he could be discovered, but he now feels ashamed of the treatment undergone and tries to keep it hidden: and so on» (Freud, 1914, p. 356).
In this article Freud better than before, underlines the difference existing among the transferences occurring in everyday life and the transferences as such arising in the psychoanalytic treatment in relation to the person of the analyst. Freud refers to this last kind of transference as ‹‹transference neurosis›› as an «artificial disease developing in the analytic relationship». In this phase of his theory, Freud comes to conceive the transference through the concept of repetition in relation to what had emerged in the clinical cases initially studied, where the reference was only to memory. If the neurosis is a consequence of the repetition, and if it is reactivated in transference dimension, the analysis will permit to transform the repetition into memory and therefore to transform the transference from obstacle in the best ally of the treatment.
But which attitude is to be assumed by the therapist towards the neurosis?
In a contemporary article Observations on Transference-Love (Freud: 1914), Freud considers the attitude to be assumed when a patient falls in love with the analyst and realizes that the interruption of the treatment cannot be the solution - being a situation of transference, it will repeat with the following analyst and so on, because of the phenomenon of the repetition. He also suggests the therapist not to take this love as a true love being related to a resistance that opposes to the development of a real transference, and advises him to take precautions from a possible «countertransference». He contextualizes the concept of countertransference and advises the analyst facing the transference love to assume a behaviour of discretion and abstinence: «[…] For the psychoanalyst surrender is to be excluded. No matter how high he considers love, he has to consider even greater the opportunity he is given to make the patient overcome a decisive phase of his life» (Freud, 1914, p. 373).
In 1920 with the work Beyond the Pleasure Principle, a radical change takes place not only in the concept of repetition, but also in the concept of transference. The repetition that until then had been a descriptive element and completely subordinated to the principle of pleasure, transforms in an explicative and genetic element in the context of a more profound and general reflection of Freud on pleasure and human nature. The reading of the text shows the transference is not any more considered as motivated by the resistance, but by the «compulsion to repeat», in turn at the service to the death drive. Freud observes that the transference repetition, «blind most of the times» and always painful, testifies the existence of a ‹‹demoniac›› impulse that tends to repeat the past situation. The repetition as a principle redefines the transference as a need to repeat the individual opposes to, through a resistance to the transference mobilized by the pleasure principle of the libido. The observation of the behavior of the patients who continue to repeat their failures and their symptoms will open the reflection of Freud to the investigation of the death drive. These new theses will permit him to clarify a difference among the neurotic patients who present a transference neurosis and obey to the pleasure/displeasure principle, and the patients who suffer from depression, perversion or psychosis who instead suffer from a narcissist neurosis and a hostile transference founded on the fundamental conflict between the life and death drive. The talent of Freud who from a therapeutic failure was able to discover and investigate the transference as the emotional reactivation that, elaborated thanks to an insight, can get the subject free from the dependence of his conflict, is a precious heritage for psychoanalysis. Today the limit of this interpretation is to consider the subject as a “closed” system who projects on an impersonal object (the therapist) his conflicts, an object created solipsistically, an object that is not discovered. The concept of countertransference is not frequent in Freud’s works. In The Future Prospects of Psychoanalytic Therapy (Freud:1910), Freud defines it as «the patient’s influence on [the physician's nrd] unconscious feelings» and to permit the doctor to «recognize in itself this countertransference and dominate it», he recommends him to start a self-analysis continuously exploring the situation. In 1912 Freud, in his work Recommendations to the Physician Practising Psychoanalysis underlining how the removals carried out by the analyst can determine «blind spots in the analytic perception», insists on the need for “purification” for the analyst. According to him to be a perfect analyst it is not sufficient to undergo a self-analysis, as Jung suggested at that time « who wants to analyze the others has to undergo an analysis carried out by an expert» (Freud, 1912, p. 536). Later he will warn the analyst in respect to the temptation of communicating immediately what the patient feels, and will recommend him to identify his own countertransference to elaborate it. On this basis, the analyst must be «as the surgeon who puts aside all his feelings, even the human sympathy, and concentrates his mental forces on the single aim of performing the operation as skillfully as possible. […] The doctor should be opaque to his patients […] and create the most favourable conditions for both sides: the doctor will get a desirable protection for his emotional life, while the patient will benefit from the maximum help he can be given» (Freud:1910).
The neutrality that emerges from these reflections and broadly speaking, from the whole Freudian work, becomes a technical expedient for a more profound reflection on the assumption that the unconscious of the patient and that of the analyst constantly interact because as Freud describes in his work The unconscious, the Ego and the Es (Freud: 1922n), the unconscious is an extremely mobile structure in continuous communication not only with the other parts of the endopsychic structure, but also with the outside.
In another passage Freud claims: «It is interesting that the unconscious of a person can react to the unconscious of another eluding the conscious» (Freud, 1915, vol. 8, p. 75), explaining how the unconscious does not appear just as a simple receiver of the emotions, but rather it is able to communicate, it influences and is influenced by the unconscious of the other. Given Freud’s conception of the psyche based on a biological-instinctual and motivational system, he missed the chance to consider the therapeutic relationship also as an inevitable bi-directional dialogue establishing unconsciously between the therapist and the patient. Freud will leave to the post-Freudian psychoanalysts the development of this dimension as a decisive element inside the setting for the elaboration of the transference of the patient.
The development of the psychoanalysis that in the following years will get a more and more evident importance through the model of the Ego psychology, that of the object relationships, of the psychology of the Self, of the relational approaches of psychoanalysis, of the intersubjectivists and of the constructivists will do that, and the transference and the countertransference will increasingly represent a precious theoretical-technical contribution for the comprehension of the therapeutic process both in the classical psychoanalysis and in the modern supportive-expressive psychotherapy.
It is not the task of this article dealing with the concepts of transference, countertransference and resistance from a historical-critical and systematic point of view, but in general it is possible to affirm that all the post-Freudian authors will tend to draw their attention to the set of phenomena arisen from the clinical encounter with the patient. In this perspective, the transference and the countertransference will end up to get the role of a bi-personal field made up by the therapeutic couple and at the same time by every participant.
Today prevails the opinion that not all the observations of the patient in respect to the therapist are to be ascribed to the distortions related to the transference, to the specific unconscious of the patient, but to a transference and countertransference to be considered as an energetic field where the therapeutic relationship takes place; they are to be considered as the depositaries of a living experience, always active and potentially project-oriented linked to the complex game of the interactions between two subjectivities that can build possible opennesses of sense as well as the necessary remedies to the wounds deposited in the existential experience of the one who suffers.
For the purpose, to highlight the most significant contributions that have populated the recent evolution of the concept of transference and countertransference, we will briefly examine the thought of some theories. On the basis of the object relationships, and the idea that the child was born with the predisposition to develop profound relationships with the care-givers, independently of the instinctual drives, the relationship between the patient and the analyst is not anymore seen as a reactivation of childhood desires in the transference, but as an analytic relationship. In this encounter it is in fact possible to establish a new object relationship where it is evident that the transference of the patient is given by the real perception of the relationship.
New elements get value in the setting: the function of holding, of containment and of the therapist himself who in the relationship with the patient, can become the author of a new corrective experience when not acting as the traumatic original object. It is to be observed that in the clinical dimension, the analyst finds more and more in the situation of facing borderline pathologies, where the transference relationship is not given by the transference of intrapsychic conflicts on the figure of the analyst, but arises from a present that overlaps the past so that the analyst is not “as if ” the parent, but is actually the parent.
More and more the transference is to be read as the externalization – external and relational of the world of the analytic relationship – of the world of the inner object relationships. That mainly implies a revision of the concept of countertransference. In a relationship where the person of the analyst gets more and more a real importance, it is evident the contribution of the analyst in the creation and maintenance of the analytic situation. The image of the analyst is not that of a detached observer, he is called to identify the data to be analyzed in his experience of emotional involvement with the patient. In this sense, a great importance has the discovery of the projective identification. Also the exploration of the transference strictly speaking concentrates on the impact that the patient has on the therapist more than on the associations of the patient himself: the sight on the intrapsychic of the patient, on his conflicts or on his limits amplifies in a perspective that reads the intrapsychic dynamics as acted in the interpersonal field between the patient and the analyst.
After the 50s the interest is for a bi-personal approach, diminishing that for the mono-parental and intrapsychic original optic. Over time, the psychology of the Self, the different approaches of the psychoanalysis, the intersubjective school even in their theoretical diversity have increasingly considered central the concept of the analyst/patient relationship meant as the focus of the analytic experience and of its study. The analytic experience is to be considered transformative as such being a new relationship co-created by the two participants. Neither the patient, nor the analyst can be anymore studied separately because the experience of the Self always and only organizes inside an intersubjective-constitutive concept. Particular attention is given to the regulation of the relationship and to the processes of syntonisation, while the interpretation of the transference is that moment of insight the therapist experiences inside and thanks to this relationship. The modality of the interpretation is not anymore through the persuasion of the patient, but tries to communicate beyond the specific content, a reflexive attention and an enriching answer of the analyst having at the same time the function of holding, of support and of symbolic meta-communication. The experiences of the past are to be found and re-read in the attitude the patient has in the analytic relationship, in the way he expresses and configurates his experiences lived in the relationship with the therapist.
The transference defines itself in the here and now relationship of the setting and the form it gets is not only conditioned by the past of the patient, but also by the actual relationship co-created by the analyst and the patient, and each time is unique.
The neutrality in this context is getting other meanings, for example the constant reflection on the “analytic setting” (Odgen, 1999) refers to the intersubjective analytic third and on the dynamics of the relationship with the awareness there is no transference separated from countertransference. The mind of the therapist continuously processes the relationship while experiencing it.
The awareness meant as final product of the analytic treatment, is not only the search for the removed unconscious, but a way to bring to the consciousness of the patient those relational modalities that are the fruit of profound experiences and that continue to determinate the actual relationships. The analytic field enriches today with a particular attention to the complexity of the subject and of all the experiences that have determined his being in the world and his system of relationships. It is thought that the patient who can live the transformation of his suffering and dysfunctional relational modality can as a consequence, comprehend not only his past and traumatic origins, but unblock those personal potentialities getting them free from ancient automatisms and permit a new psychological development.
At the beginning of my reflection I mentioned the social-constructivist need (Hoffmann: 2000) as the most recent approach of psychoanalysis. Terms like «interaction» (Mitchell: 1993), «intersubjective» (Atwood, Branfchaft, Stolorow: 1996), «enactment» (Gill: 1996) are key words for the modern psychoanalytic literature and the study of the patient-analyst interaction related to the terms of countertransference, enactment and projective identification depending on the different schools, represent the main themes of the psychoanalytic debate that has characterized the focus on the relationship. If Freud underlined that in the analytic treatment there was an exchange of words between the patient and the physician, today this exchange of words has become the process of interpersonalization or bi-personalization of the relationships. Therefore referring to the complex problem of the self-disclosure (Renik, 2000, pp. 31-60), of how inevitably the personality of the analyst is continuously revealed in the analytic activity, and of how and how much the humanity of the analyst can be openly be put into play to overcome the stalemate of an isolation of the patient, it is evident that this reflection of the modern psychoanalysis is closer than expected to the modern Jungian concepts of transference and countertransference meant as the creation of a subtle body necessary for a real transformation.
The nature of the transference-countertransference relationship implies today that also the acting-outs are to be considered as narratives put in place that instead of being represented by the words use the body. On this matter, the ecobiopsychology focusing on the body language, has introduced a new reading not only of the psychosomatic diseases, but also of those methods of communication of the patient more than of their contents, that also in the setting get a high value in the exploration of the primary process; that to permit a clearer definition of the problems of the patient and a more specific “answer” able to create a real interactive dialogue.
Lastly, it is not to be ignored the theme of the interpretations, still today at the centre of the debate of the modern psychoanalysis, according to which is underlined how to have a sufficient transformative level they must have a quality of enactment, of suggestion and action able to operate on the psyche of the patient. The ecobiopsychological approach refers to the complex problem of the vital analogy (Frigoli: 2010; 2011), that relationship between the world of the analyst, that of the patient, and the broadest one that contains both of them: the ecobiopsychological field.
I would like to conclude these brief reflections with an observation concerning the therapist-patient relationship. It represents an extremely complex domain, it is needed to answer the suffering of the patient with an emotional and conceptual flexibility to permit the therapist to contribute and model the relationship with a special attention. The therapist contributes in this way to re-build his psychic reality and not only to discover it. This need is determined today by the development of the neurosciences through the dimension of the mirroring and of the dialogue that the genetics entertains with the epigenetics, that is with the environment. It becomes more and more necessary that in the transference/countertransference relationship converge the basic assumptions of these disciplines so as the work on the patient can answer in a coherent way to the complexity of his inner world more and more put into evidence by the convergence among the biopsychosocial approaches that emerge from the epistemological agreement of the different disciplines.

Bibliography
Atwood, G., Branfchaft, B., & Stolorow, R., (1996). La prospettiva intersoggettiva. Roma: Bollati Boringhieri.
Freud, S. (1905). Opere: Vol. 4. Frammento di un'analisi d'isteria (Caso clinico di Dora). Torino: Bollati Boringheri.
Freud, S. (1909). Opere: Vol. 6. Osservazioni su un caso di nevrosi ossessiva (Caso clinico dell'uomo dei topi). Torino: Bollati Boringheri.
Freud S. (1910). Opere: Vol. 6. Le prospettive future della terapia psicoanalitica. Torino: Bollati Boringheri.
Freud S. (1912). Opere: Vol. 6. Consigli al medico nel trattamento psicoanalitico. Torino: Bollati Boringheri.
Freud, S. (1912). Opere: Vol. 6. Dinamica della traslazione. Torino: Bollati Boringheri.
Freud, S. (1914). Opere: Vol. 7. Ricordare, ripetere e rielaborare. Torino: Bollati Boringheri.
Freud S. (1914). Opere: Vol. 7. Osservazioni sull’amore di traslazione. Torino: Bollati Boringheri.
Freud S. (1915). Opere: Vol. 8. Metapsicologia. Torino: Bollati Boringheri.
Freud S. (1920). Opere: Vol. 9. Al di là del principio del piacere. Torino: Bollati Boringheri.
Freud S. (1922). Opere: Vol. 9. L’Io e l’Es. Torino: Bollati Boringheri.
Frigoli, D. (2013). La fisica dell’anima. Bologna: Persiani.
Frigoli, D. (2015). Il linguaggio dell’anima. Roma: Edizioni Magi.
Gill, M. (1996). Psicoanalisi in transizione. Milano: Raffaello Cortina.
Hoffmann, I.Z. (2000). Rituale e spontaneità in psicoanalisi. Roma: Astrolabio.
Mitchell, S. (1993). Gli orientamenti relazionali in psicoanalisi. Torino: Bollati Boringheri.
Ogden, T.H. (1999). Revérie e interpretazione. Roma: Astrolabio.Renik, O. (2000). L’ideale dell’analista anonimo e il problema dell’autodisvelamento. Psicoterapia e Scienze Umane, 33 (1)

*Dr.ssa Mara Breno – Psychologist, psychotherapist, expert in psychosomatics and relaxation theories with particular regard to psychosomatic and symbolic aspects. Teaching responsible and supervisor at the School of Psychotherapy of the Istituto ANEB. EMDR therapist and author of scientific contributions.

Translated by Dr.ssa Raffaella Restelli – Psychologist, member of the British Psychological Society (UK), Ecobiopsychological Counselor and expert in ANEB Psychosomatic Medicine. Linguist in ANEB Editorial area.