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.