Concept
Countertransference
The analyst's emotional responses to the patient, including those evoked by the transference.
Development
1910
Sigmund Freud introduced by
Names the analyst’s countertransference and asks analysts to recognise and overcome it.
1948
Heinrich Racker developed by
From his 1948 papers to the Argentine Psychoanalytic Association onward, Racker treated countertransference as a technical instrument for understanding the patient as well as a danger. In 1957 he argued for taking it as the totality of the analyst's psychological response, within which concordant and complementary identifications are distinguished. He reached this independently of Paula Heimann, who was working along similar lines.
1949
Donald Winnicott developed by
Argues that the analyst, especially with psychotic and antisocial patients, must acknowledge his own hate, sort out what is objective in it from personal residues, and keep it available for the work.
1950
Paula Heimann reworked by
Recasts countertransference as an instrument of research into the patient’s unconscious.
1965
Otto F. Kernberg developed by
Kernberg argued for a broad, "totalistic" view of countertransference as the analyst's whole emotional response to the patient, rather than only the analyst's own unresolved conflicts, and held it to be especially telling with borderline and other severely disturbed patients.
Undated
Harold Searles developed by
Searles treated the analyst's own feelings, including love, hate and confusion, as central information about the patient and about the relationship. His selected papers on the subject appeared as Countertransference and Related Subjects (1979).
Relations
introduced by
- 1910 Sigmund Freud
Names the analyst’s countertransference and asks analysts to recognise and overcome it.
derives from
- 1910 Transference
developed by
- 1948 Heinrich Racker
From his 1948 papers to the Argentine Psychoanalytic Association onward, Racker treated countertransference as a technical instrument for understanding the patient as well as a danger. In 1957 he argued for taking it as the totality of the analyst's psychological response, within which concordant and complementary identifications are distinguished. He reached this independently of Paula Heimann, who was working along similar lines.
- 1949 Donald Winnicott
Argues that the analyst, especially with psychotic and antisocial patients, must acknowledge his own hate, sort out what is objective in it from personal residues, and keep it available for the work.
- 1965 Otto F. Kernberg
Kernberg argued for a broad, "totalistic" view of countertransference as the analyst's whole emotional response to the patient, rather than only the analyst's own unresolved conflicts, and held it to be especially telling with borderline and other severely disturbed patients.
- Harold Searles
Searles treated the analyst's own feelings, including love, hate and confusion, as central information about the patient and about the relationship. His selected papers on the subject appeared as Countertransference and Related Subjects (1979).
reworked by
- 1950 Paula Heimann
Recasts countertransference as an instrument of research into the patient’s unconscious.
gave rise to
Works
- 1949
Hate in the Counter-Transference
In this short paper, published in the International Journal of Psycho-Analysis in 1949 (vol. 30, pp. 69–74), Winnicott examines one aspect of ambivalence: the hate that analysts, psychiatrists and mental nurses feel towards their patients. He argues that work with psychotic and antisocial patients is inherently burdensome, and that it becomes impossible unless the analyst's own hate is "extremely well sorted-out and conscious". He separates three kinds of counter-transference. The first is abnormal feelings, set relationships and identifications kept under repression in the analyst, which call for more analysis. The second is the identifications and tendencies from the analyst's personal history, which give his work its own character. The third is the "truly objective counter-transference": the analyst's love and hate in reaction to the patient's actual personality and behaviour, based on objective observation. He adds that patients credit the analyst only with what they themselves can feel. For example, a psychotic patient in a state of "coincident love-hate" is convinced that the analyst too is capable only of that crude and dangerous mixture. In ordinary analysis of neurotics, Winnicott writes, the analyst's hate stays latent. The main reason is that his own analysis has freed him from large reservoirs of unconscious hate. The rest is absorbed by the satisfactions of the work: it is his chosen way of dealing with guilt, he is paid, he discovers things, and he identifies with the patient's progress. The hate also finds a quiet outlet in the setting itself, above all in the very existence of the end of the hour. Psychotic patients impose a strain of a different kind and degree. Winnicott illustrates this with his own "counter-transference anxiety": after several days of bad work with all his patients, he dreamt that he had no right side to his body. He read the dream as a response to a patient for whom any reference to her body produced paranoid anxiety. He also describes a nine-year-old wartime evacuee, a habitual runaway, whom he and his wife took into their home for three months. At moments of crisis Winnicott would put the boy out of the front door, without anger or blame, telling him that what had happened had made him hate him. The boy could ring a special bell and be readmitted with nothing said about the past. Winnicott held that saying this mainly let him bear the situation without losing his temper. From such cases he concludes that some patients actively seek objective hate: "If the patient seeks objective or justified hate he must be able to reach it, else he cannot feel he can reach objective love." The core of the paper is the analogy between the analyst of a deeply regressed patient and the mother of a newborn. Freud had said that love and hate belong to the relations of the ego as a whole to objects. Winnicott infers that the infant can hate only once integrated; before that it loves with a "ruthless love". The mother, by contrast, "hates her infant from the word go". He lists eighteen reasons, among them the danger the baby poses to her body, its interference with her private life, its ruthlessness and its treating her as an unpaid servant. She must tolerate this hate without acting on it or expressing it to the baby. If she cannot, she falls back on masochism, which Winnicott sees as the origin of the false theory of a natural masochism in women. Nursery rhymes such as "Rock-a-bye Baby" may give her hate a harmless outlet. Sentimentality denies hate and is therefore useless to parents, and a child may be unable to tolerate the full extent of his own hate in a sentimental environment: he needs hate in order to hate. Likewise, a psychotic patient cannot be expected to tolerate his hate of the analyst unless the analyst can hate him. Interpreting the analyst's hate to the patient is dangerous and needs the most careful timing. Even so, Winnicott holds that an analysis is incomplete if, at least towards its end, the analyst cannot tell the patient what he did for him, unbeknown to him, in the early stages of the illness. The paper also speaks to psychiatrists. However much they love their patients, they cannot avoid hating and fearing them, and the better they know this, the less hate and fear will dictate what they do to their patients. Winnicott sets this beside his criticism of "too easy" electric shocks and "too drastic" leucotomies.
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- 1975
Borderline Conditions and Pathological Narcissism
Kernberg's first book gathers and reworks the papers he wrote in the late 1960s and early 1970s, largely out of his clinical and research work at the Menninger Foundation, into a single account of the patients who fall between the neuroses and the psychoses. Its first part argues that these patients have a borderline personality organization: a specific and stable structure, not a passing state on the way to psychosis. Behind a wide range of symptoms (diffuse anxiety, multiple phobias, perverse and impulsive trends, addictions, lower-level character disorders) Kernberg finds a common structure: nonspecific ego weakness, a pull toward primary-process thinking, primitive defences centred on splitting, and a pathology of internalized object relations that leaves the patient without an integrated identity, while reality testing is largely kept. He traces it to excessive early aggression, especially oral aggression, which prevents the loving and hating images of self and others from being brought together and draws pregenital conflicts into the oedipal ones. The book draws practical conclusions from this. It weighs the factors that make the prognosis better or worse, and sets out an expressive psychoanalytic psychotherapy for most of these patients: the primitive defences are confronted and interpreted as they emerge in the transference, the negative transference is taken up in the here and now, and acting out is limited, with the patient's life structured from outside when necessary. A chapter on countertransference argues for treating the analyst's whole emotional response as a source of knowledge about such patients. The second half turns to the narcissistic personality, which Kernberg sees as a special form of the same organization, its surface held steady by a pathological grandiose self that fuses the real self, the ideal self and the ideal object and wards off envy, rage and dependence. He distinguishes it from normal adult and normal infantile narcissism, describes its idealizing and devaluing transferences, recommends psychoanalysis proper with systematic interpretation of the grandiose self for those who do not function at an overt borderline level, and sets his views against Heinz Kohut's.
- 1979
Countertransference and Related Subjects: Selected Papers
Countertransference and Related Subjects (New York: International Universities Press, 1979; paperback 1999) is the second collection of Harold F. Searles's papers, following his Collected Papers on Schizophrenia and Related Subjects (1965). Its twenty-four chapters, with an introduction, come from his later career. Most concern the intensive psychoanalytic psychotherapy of schizophrenic and borderline patients, and the analyst's own emotional participation in that work. Searles treats the analyst's feelings, including guilt, hope, dedication and the urge to heal, as clinical evidence about the patient and the relationship rather than as interference to be eliminated. Several papers trace the phases of treatment from autism and pathological symbiosis, through ambivalent symbiosis, to a therapeutic symbiosis from which individuation can develop. Others take up delusional transference and the patient's realistic perceptions of the analyst; identity formation and dual or multiple identity in borderline functioning; paranoid processes within a hospital treatment team; violence in schizophrenia; and transitional phenomena. The volume also includes the long paper "The Patient as Therapist to His Analyst". Searles argues there that every person has a therapeutic striving toward others, that psychological illness is bound up with the frustration of that striving, and that the analyst must allow the patient to help them. Book reviews, discussions and an essay on unconscious processes in the environmental crisis widen the range. Library Journal praised its plain, jargon-free prose and vivid clinical portraits, and its sense of the humanity patients share with their therapists.
- 2007
Through a close reading of two of Harold Searles's papers, Ogden considers what Searles thinks, how he thinks and how he works with patients. He finds in Searles an emotional responsiveness to the transference-countertransference in which conscious and unconscious receptivity and thought are continuous, and frankly honest clinical descriptions from which new theory seems almost to arise by itself, as in Searles's rethinking of what a successful analysis of the Oedipus complex involves. Ogden calls Searles's characteristic way of thinking and interpreting 'turning experience inside out': transforming the unseen and unnamed emotional context of experience into verbal content that can be thought and spoken. In a final section he identifies an unexpected complementarity between Searles and Bion: Searles gives clinical form and life to Bion's often abstract ideas, among them container-contained, the human need for truth and the relation of conscious to unconscious, while Bion offers a broader theoretical frame for Searles's clinical work.
See also
References
- The Future Prospects of Psycho-Analytic Therapy1910 Evidence for a relation
- On Counter-Transference1950 Evidence for a relation
- Hate in the Counter-Transference1949 Evidence for a relation
- Borderline Conditions and Pathological Narcissism1975 Evidence for a relation
- Countertransference and Related Subjects: Selected Papers1979 Evidence for a relation
- Oedipal Love in the Countertransference1959 Evidence for a relation
- Reading Harold Searles2007 Evidence for a relation
- The Meanings and Uses of Countertransference1957 Evidence for a relation