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THE UNCONSCIOUS IN THE THERAPEUTIC PROCESS

by Robert M. Young

SUMMARY: We all know that in psychoanalytic psychotherapy we are supposed to interpret the unconscious. But how do we gain access to it? Whose unconscious do we interpret? What are the roles of transference, countertransference and projective identification? How have the ideas about interpreting the unconscious changed in the history of psychoanalysis? In particular, what new ideas can we make use of re: primitive/psychotic processes, containment and therapeutic symbiosis?

I’ll give succinct versions of my own answers to those questions and then explore and justify them at some length. We gain access to the patient’s unconscious by interpreting what they evoke in us, that is, by interpreting the countertransference, which is our unconscious response to what the patient projects into us. The patient experiences his or her relations with us or, at least, aspects of them, as repetitions of their experience of their primary object relations - mainly parents or parent figures. Patients transfer these onto us by projecting their reactions into us. What they accuse us of has its appropriate counterpart in the repertoire of our possible responses, but they bring it to the surface and hoik it out. It’s rather like fly-fishing. Their lure brings it up, and they can say, ‘I told you so!’ But - on a good day - we do not merely reproject what they put into us and shoot back from the hip. We bide our time, ponder and alter what we have been caused to feel. We contain it, metabolize it and draw its sting. We detoxify it and give it back in a potentially mutative interpretation, in a form which will not just repeat the cycle but will offer them food for thought, something which might - usually after many repetitions in varying formulations - lead them to take back the projections or at least diminish them to manageable intensity, i.e., bring them from outside the space of civil relations to inside that perimeter.

I have said in that paragraph that our access to the unconscious is via our countertransference, which is the effect of the patient’s transference. The relationship between these is one of projective identification. My point here is that the basis of the therapeutic relationship is projective identification. But not merely so, since the moment of unconscious identification on the therapist’s part is followed by an elongated process (not always long in time but long in emotional processing) during which the therapist susses out what he or she is being taken for. This is the process of interpreting the countertransference. Then - and I think this is the part of the therapeutic process which calls for the most creativity - we have to think of something to say which will help the patient to climb down and let go of the way they see us and life. Irma Brenman Pick says in her excellent article (which I’ll mention again), ‘Working Through in the Countertransference’ (Brenman Pick, 1985), that getting the patient to take back their projections is the goal of every interpretation. (To be more precise, she says that moving from the paranoid-schizoid to the depressive position is the goal of every interpretation, but that shift importantly involves taking back projections - p.158, quoted below.) Until they can manage this they are caught up in a symbiotic bind which means that, although they think they have got rid of the feeling by putting it into the therapist, they are bound to it and diminished and impoverished, as well.

The blaming child is not free unless and until he or she can let go of the hatred for the parent, no matter how guilty that parent may be. The hating racist is in the same bind, as is his victim. I have a psychotic patient who has been blaming his parents throughout every session of all the years he has been coming to me. It is as if he will never finish the bill of particulars in his indictment. I have another who received utterly inadequate parenting and cannot bear to have a child, even though this will likely lead to his losing the woman he really loves. He cannot find the resources to give what he never had and identifies with the unloved and deprived baby, whose needs he cannot imagine meeting. And he is right. He has already walked away from one baby in an earlier relationship. Whether more therapy will mitigate the forms of failure to entitle themselves in those patients is still in the balance. Unless and until they take back the projections, they will lead emotionally impoverished lives in these and other spheres. All have low self-esteem, all have sexual dysfunctions, all have failed or strained love relationships. I currently see seventeen patients from one to three times per week. All have baleful stories about their families of origin. Several were orphaned at an early age, and several had parents who divorced or had very strained marriages. My patients’ primary object relations were damaged, and they find that they cannot effect what they intend.

I want to turn for a time to the concept of the unconscious (Freud, 1915). Then I’ll try to characterize its contents. The Unconscious was without doubt Freud’s most original contribution to the understanding of human nature. Although present in the writings of some earlier thinkers’, in the form we have it from him, it was deeply original. On precursors you can consult Lancelot Law Whyte on The Unconscious before Freud (1959), Henri Ellenberger on The Discovery of the Unconscious (1970) and Eduard von Hartmann’s The Philosophy of the Unconscious (1868), all three of which are superficial and largely and justifiably unread. I even have an article entitled ‘Freud Among the Philosophers’ (Sours, 1961). Freud found aspects of it in his work with Charcot and at Nancy (Bernfield, 1944, 1949, 1951; Jeliffe, 1937; Kris, 1950; Riese, 1958, 1958a). But you cannot find anything which is as systematic and far-reaching as his conceptualisation. Note that its contents are repressed or, in some cases, inherited. Note that it is rooted in primitive impulses. Laplanche and Pontalis (1973) tell us that it is characterized by primary processes, absence of negation, of doubt, of degrees of certitude. It is indifferent to reality and subordinated to the pleasure principle (pp. 474-76), later paired by Freud with an equal subordination to the death wish, so that constructive and destructive forces are evenly balanced in human nature. It is also important to stress that it is not equivalent to the Id. In fact, most of the functioning and content of the ego and superego are also unconscious, with the overall result that most of the mind is. The unconscious is determinate in matters large and small. Indeed, if you want to be convinced of the ubiquity and efficacy of unconscious motivation, two of the best places to look are Freud’s writings on humour and parapraxes: The Psychopathology of Everyday Life (1901) and his Jokes and Their Relation to the Unconscious (1905), the former of which invites us to trace, by systematic use of free association, the unconscious motivation of the most trivial slips of the tongue and apparently random mistakes and accidents. I have tried it and it works. It is here that Freud makes his most sweeping claims for mental determinism, as well.

I need hardly say that the concept of the unconscious is shared in watered down forms by many schools of psychotherapy, e.g., ones calling themselves psychodynamic or humanistic or integrative. On the whole they differ from Freud and other psychoanalytic approaches in thinking that destructive and aggressive impulses loom less large in us that Freud thought and Kleinians think. Anna Freud, her followers, the so-called Contemporary Freudians, and their allies, the Neo-Freudians or Ego Psychologists, shied away from the baleful view of human nature adopted by Freud and the Kleinians, and so have many so-called Independents. For example, Winnicott admired Klein’s concept of the depressive position but would not give equal status to the paranoid-schizoid position or embrace the idea of the death wish.

I said that the concept of the unconscious is shared, in various concentrate and dilute forms by many schools of psychotherapy. Before moving on to characterize it further I should add that it is decidedly not accepted by most current forms of psychotherapy, since they are behavioural and explicitly eschew the whole idea of unconscious motivation. Many stress the cognitive and treat the rest as the result of unclear thinking or bad habits.

I now want to turn to the content of the unconscious. If we ask what we try to do in the process of interpreting the unconscious, it is important to know what we are up against. What I have to say first is that the unconscious consists of primitive and psychotic processes which are ubiquitous. In the light of recent events I don’t suppose I will have much trouble convincing you that primitive aggressive and destructive feelings are widespread or that massive splitting and projection loom large in human relations and world events. Nor, I suppose, will you disagree with the claim that envy, diabolization, vengefulness and hatred are rampant in many, many people’s minds and in the public sphere. However, there is a quite fundamental disagreement lurking just below the surface of various doctrinal positions in the psychotherapeutic world. I said a moment ago that primitive and psychotic processes are ubiquitous. No one whose orientation is psychodynamic or psychoanalytic would dispute that primitive processes are in all of us. That is what happens in the Id - the ‘it’ of instinctual and infantile impulses. That is what happens in the unconscious. Freud painted a picture of the two horses of the Id and the Superego with the Ego given the difficult job of reining them in and giving them direction. Another basic psychoanalytic conceptualisation bearing on this is the distinction between primary processes, which are primitive, and secondary processes, which are more civilized and rational. For Freud, psychoanalysis has as the goal of therapy the lovely image, ‘Where id was, there ego shall be. It is a work of culture - not unlike the draining of the Zuider Zee' (Freud, 1933, p. 80).

Among psychodynamic approaches there is much dispute about the origins of destructive and aggressive feelings. Humanistic approaches have as a defining characteristic that people come into the world innocent and good and become unpleasant and worse only as the result of bad and traumatic experiences. Some psychoanalysts, including Wilhelm Reich and John Bowlby, also take this view. Some say that the aggressive and destructive parts of the personality are innate, given, part and parcel of human nature, prior to experience. This was certainly Freud’s position, and it was Melanie Klein’s.

He said that ‘Man is a wolf to other men’ and that destructiveness was half of human nature, not less. People are innately aggressive and hence must be tamed by institutions (Freud, 1930, p. 111; Gay, 1988, p. 546). The constitutional inclination to aggression is the greatest hindrance or impediment to civilization (Freud, 1930, pp. 129, 142). It is in this context that the space within which civilization occurs is described as bounded by the great opposition between love and destructiveness. Freud wrote, 'Civilization is a process in the service of Eros, whose purpose is to combine single human individuals, and after that families, then races, peoples and nations, into one great unity, the unity of mankind... But man's aggressive instinct, the hostility of each against all and all against each, opposes this programme of civilization' (p. 122). The aggressive instinct is derivative of the death instinct. 'The history of civilization is the struggle between Eros and Death. It is what all life essentially consists of' (Ibid.).

This is a dour doctrine: life consists of - is - a struggle between love and destructiveness. Civilization consists of renunciation. He says elsewhere that 'love and necessity are the parents of civilization' (p. 101). We live our lives in a space between the two great meta-instincts, and the main forces at work are rapacious sexual and destructive instincts, guilt, renunciation and sublimation. Melanie Klein says that the interaction of the life and death instincts governs all of life (Klein, 1958, p. 245).

Guilt is the means civilization employs to inhibit aggressiveness. The aggression is turned from external authority to internal prohibition and makes up the stern conscience or superego (Freud, 1930, p. 123). Freud sees 'the sense of guilt as the most important problem in the development of civilization' and claims 'that the price we pay for our advance in civilization is a loss of happiness through heightening of the sense of guilt'. He calls this 'the final conclusion of our investigation', thus making vivid the juxtaposition of civilization and discontent in his title (p. 134). His biographer, Peter Gay comments, 'Social institutions are many things for Freud, but above all they are dams against murder, rape, and incest' (Gay, 1988, p. 547).

Freud paints with a broad brush. To focus on the fine texture of the primitive, unconscious processes in human nature we need to turn to the ideas of Klein and people influenced by her, who devoted themselves to the close examination of these matters. In general, I want to suggest that they are speaking of processes which are deeper than Freud’s accounts. In Wilfred Bion's view, for example, what matters in individual and group behaviour is more primitive than the Freudian level of explanation. The ultimate sources of our distress are psychotic anxieties, and much of what happens in individuals and groups is a result of defences erected against psychotic anxieties, so that we do not have to endure them consciously (Bion, 1955, pp. 456, 476). Klein described schizoid mechanisms as occurring 'in the baby's development in the first year of life characteristically... the infant suffered from states of mind that were in all their essentials equivalent to the adult psychoses, taken as regressive states in Freud's sense' (Meltzer, 1978, part 3, p. 22). Klein says, 'In early infancy anxieties characteristic of psychosis arise which drive the ego to develop specific defence-mechanisms. In this period the fixation-points for all psychotic disorders are to be found. This has led some people to believe that I regard all infants as psychotic; but I have already dealt sufficiently with this misunderstanding on other occasions' (Klein, 1975, vol. 3, p. 1). Meltzer comments that 'Although she denied that this was tantamount to saying that babies are psychotic, it is difficult to see how this implication could be escaped' (Meltzer, 1978, part 3, p. 22).

Kleinian thinking evolved in three stages. As in the above quotation, Klein saw schizoid mechanisms and the paranoid-schizoid position as fixation points, respectively, for schizophrenia and manic-depressive psychosis. Then the paranoid-schizoid and depressive positions became developmental stages. Her terminology included 'psychotic phases’, 'psychotic positions' and then 'positions' (Klein, 1975, vol. 1, pp. 275n-276n, 279). Thirdly, in the work of Bion and other post-Kleinians, these became economic principles and part of the moment-to-moment vicissitudes of everyday life. The notations 'ps' and 'd' were connected with a double-headed arrow to indicate how easily and frequently our inner states oscillate from the one to the other and back again: ps«d (Meltzer, 1978, part 3, p. 22). In Bion's writings on schizophrenia an ambiguity remained as to whether or not the psychotic part of the personality is ubiquitous or only present in schizophrenics, but Meltzer concludes his exposition of Bion's schizophrenia papers by referring to the existence of these phenomena in patients of every degree of disturbance, even 'healthy' trainees (p. 28). If you read the writings of Klein, Bion, Riviere, Elmhurst, Meltzer, Segal, Rosenfeld and other Kleinians, what you find is psychotic processes from the beginning and operating in our minds all the time. The difference between an ordinary person and a diagnosably psychotic one is how much of the personality is in the grip of psychotic functioning and for how long.

You will, I hope, recall that I said a few minutes ago that there is a quite fundamental disagreement lurking just below the surface of various doctrinal positions in the psychotherapeutic world. I characterized the Freudian position in which Id, Ego and Superego and primary and secondary processes were the terms of reference. In the Kleinian approach life in the inner world is not so neatly categorized. It is more like a bubbling cauldron with deeply mad feelings rising to the surface moment by moment. The unconscious is fraught, and finding relative tranquillity in one’s inner world is a constant struggle. That’s true of mine, at least, and also of the others I am privy to. Contemporary Freudians and Neo-Freudians believe that there is a sphere which is free of such turmoil, which they call ‘the conflict-free sphere of the ego’.

For Kleinians, the inner world is more efficacious than the outer one. As a part of the issue over the primacy of the inner world, I believe that people were genuinely spooked by the sheer craziness and nastiness of the inner world as described by Klein and her supporters in the 1930s and 1940s. The unconscious is replete with 'phantasies'. Klein’s colleague, Joan Riviere, writing in one of the essays that Kleinians offered as a statement of their defining position on psychoanalysis, appeals to Freud's hypothesis that the psyche is always interpreting the reality of its experiences - 'or rather, misinterpreting them - in a subjective manner that increases its pleasure and preserves it from pain' (Riviere, 1952, p. 41). Freud calls this process 'hallucination; and it forms the foundation of what we mean by phantasy-life. [Note, on the Kleinian view hallucinations, a process characteristic of psychotic mentation, lie at the bottom of our unconscious life.] The phantasy-life of the individual is thus the form in which the real internal and external sensations and perceptions are interpreted and represented to himself in his mind under the influence of the pleasure-pain principle'. Riviere adds that 'this primitive and elementary function of his psyche - to misinterpret his perceptions for his own satisfaction - still retains the upper hand in the minds of the great majority of even civilised adults' (p. 41).

This general function is repeated in Susan Isaacs' definition. The '"mental expression" of instinct is the unconscious phantasy... There is no impulse, no instinctual urge or response which is not experienced as unconscious phantasy' (Isaacs, 1952, p. 83). The first mental processes... are to be regarded as the earliest beginnings of phantasies. In the mental development of the infant, however, phantasy soon becomes also a means of defence against anxieties, a means of inhibiting and controlling instinctual urges and an expression of reparative wishes as well... All impulses, all feelings, all modes of defence are experienced in phantasies which give them mental life and show their direction and purpose' (Ibid.).

When we turn to the content of the phantasies a problem of communication arises: 'they are apt to produce a strong impression of unreality and untruth' (Riviere, 1952, p. 20). This is because when we write or speak about them we are clothing preverbal and very primitive mental processes in the language of words in dictionaries. My way round this is to share some images and experience from my own clinical and personal experience. Phantasies are rendered as black holes, nameless dread, part objects, offal, shit, urine, a patients' dreams of wet cinders or barren desert mindscapes, pus, slime, feelings of being overwhelmed, engulfed, disintegrated, in pieces, devoured, falling through empty space, spiders, bugs, snakes. Language drawn from work with autistic patients but indicating processes in all of us includes dread of falling apart, falling infinitely, spilling away, exploding away, threat of total annihilation, unintegration (as distinct from the disintegration of schizophrenia), experiencing a missing person as a hole (rather than 'missing' them as not present).

Each of us has his or her own version of what Klein calls 'a cave of dangerous monsters' (Klein, vol. 1, p. 272). My general point is that if you ask the question, 'What is a psychotic anxiety when it's at home and not in the pages of an implausible and nearly unfathomable text by Melanie Klein?’, you'll be able to be less sceptical if you interrogate the fringes of your own memories and distressing experiences and, of course, your dreams. You will recall that Freud called dreams ‘the royal road to the unconscious’. The reason is that it is in dreams that we are nearest to unconscious mentation per se, though, of course, the experienced content of the dream is made palatable to consciousness by the disguises and secondary elaboration of the dream work. In summary, I want to assert that psychotic anxieties are ubiquitous, underlie all thought, provide the rationale for all culture and institutions and, in particular cases, help us to make sense of especially galling ways of being.

Klein's views on these matters are based on Freud’s and Karl Abraham's notions of oral libido and fantasies of cannibalism (Gedo, 1986, p. 94). She refers to sadistic impulses against the mother's breast and inside her body, wanting to scoop out, devour, cut to pieces, poison and destroy by every means sadism suggests (Klein, 1975, vol. 1, p. 262). Once again, the projective and introjective mechanisms of the first months and year give rise to anxiety situations and defences against them, 'the content of which is comparable to that of the psychoses in adults' (Ibid.). Orality is everywhere, for example, in the 'gnawing of conscience' (p. 268). Riviere says that 'such helplessness against destructive forces within constitutes the greatest psychical danger-situation known to the human organism; and that this helplessness is the deepest source of anxiety in human beings' (Riviere, 1952, p. 43). It is the ultimate source of all neurosis. At this early stage of development, sadism is at its height and is followed by the discovery that loved objects are in a state of disintegration, in bits or in dissolution, leading to despair, remorse and anxiety, which underlie numerous anxiety situations. Klein concludes, 'Anxiety situations of this kind I have found to be at the bottom not only of depression, but of all inhibitions of work' (Klein, 1975, vol. 1, p. 270). Once again, it should be recalled that these are pre-linguistic experiences developmentally, and sub-linguistic in adults. It is a characteristic of the world view of Kleinians that the primitive is never transcended and that all experiences continue to be mediated through the mother's body. Similarly, there is a persistence of primitive phantasies of body parts and bodily functions, especially biting, eating, tearing, spitting out, urine and urinating, faeces and defecating, mucus, genitals.

Kleinians went on to propose elements of a general psychology, including the claim that there is 'an unconscious phantasy behind every thought and every act' (Riviere, 1952, p. 16). That is, the mental expression of primitive processes 'is unconscious phantasy' (Ibid.). It is not only a background hum, as it were. Isaacs claims that 'Reality thinking cannot operate without concurrent and supporting unconscious phantasies' (Isaacs, 1952, p. 109). And again: 'phantasies are the primary content of unconscious mental processes' (pp. 82, 112). 'There is no impulse, no instinctual urge or response which is not experienced as unconscious phantasy' (p. 83). 'Phantasies have both psychic and bodily effects, e.g., in conversion symptoms, bodily qualities, character and personality, neurotic symptoms inhibitions and sublimations' (p. 112). They even determine the minutiae of body language (p. 100). The role of unconscious phantasy extends from the first to the most abstract thought. The infant's first thought of the existence of the external world comes from sadistic attacks on the mother's body (Klein, 1975, vol. 1, p. 276; vol. 3, p. 5). 'Phantasies - becoming more elaborate and referring to a wider variety of objects and situations - continue throughout development and accompany all activities; they never stop playing a great part in mental life. The influence of unconscious phantasy on art, on scientific work, and on the activities of everyday life cannot be overrated' (Klein, 1975, vol. 3, p. 251; cf. p. 262).

In the last few minutes I have given you a highly condensed summary of several of the key papers in which Klein and some of her most ardent and talented followers spelled out the basics of their position and published in 1952 under the title Developments in Psychoanalysis. A further volume followed three years later entitled New Directions in Psychoanalysis: The Significance of Infant Conflicts in the Patterns of Adult Behaviour. Another two volumes called Melanie Klein Today appeared in 1988 under the editorship of Elizabeth Spillius. Next came A Dictionary of Kleinian Thought by R. D. Hinshelwood (2nd ed., 1991), which offers admirably clear and accessible short essays on all the main Kleinian concepts.

Having done my best to give you a feel for the contents of the unconscious, I have two further tasks. The first is to sketch how ideas of interpreting the unconscious have changed, and the second is to talk briefly about some concepts which describe how we can abet change: symbiosis, containment and the analytic frame.

Freud was very keen to be considered a natural scientist. He spent as long as he could in the lab as a neuroanatomist and neurophysiologist and only ventured into the murky waters of psychological treatment because he had exhausted his prospects as a pure academic. Even so, his first general conceptualizations were in neuropathology and an attempt to characterize his and Breuer’s findings in neuronal and neurophysiological terms. He continued in this vein until he put it aside - or better, postponed it indefinitely - in Chapter Seven of The Interpretation of Dreams (1900), entitled ‘The Psychology of the Dream Process’. He was prone to speak in terms of measuring and to use imagery from scientific observation, e.g., microscopes and telescopes. Even when he was referring to resonances in the analyst elicited by the patient, he drew on a new instrument, the telephone, and alluded to the vibrations of the diaphragm of that instrument. The analyst was an objective observer. Countertransference was a perturbation of that objectivity and called for more analysis.

This remained the orthodox view for decades. Then a number of people - Donald Winnicott (1947), Paula Heimann (1949-50, 1959-60), Margaret Little (1950, 1957, 1985), Roger Money Kyrle (1956) and (in America) Harold Searles (1978-79), among others (Young, 1994, ch. 4) - looked again at countertransference and asked, with varying degrees of departure from the Freudian model - if there wasn’t more to countertransference than met the eye. Winnicott said we have to bear it and to be able to experience real hate in the countertransference. Heimann said we should attend to it as a message, but her aim was to reduce its incidence. Money Kyrle went much further and said it was completely normal in the analytic process and that we had to attend to its vicissitudes. Margaret Little in England and Harold Searles in America were inclined to go with it and make a close study of what the patient stirs up in us. Indeed, Searles said that there came a point of symbiosis in every good therapeutic process where is was unclear whose madness was being examined. Little’s original paper was turned down for publication by The International Journal of Psycho-analysis, because it was so obvious that she was writing about severe disturbance in her inner world when in training analysis with Winnicott and in her own work as an analyst. When it was eventually published, one of those who had objected to the earlier submission said how glad he was that she had revised it. In fact, she hadn’t changed a word: the climate of opinion about countertransference had changed.

Indeed, as I mentioned at the beginning, it changed to the point that in the mid-1980s, Irma Brenman Pick could take the normality of countertransference to its logical extreme, without a trace of seeing it as something to be got rid of. She carefully considers it as the basis of understanding throughout the session: 'Constant projecting by the patient into the analyst is the essence of analysis; every interpretation aims at a move from the paranoid/schizoid to the depressive position' (Brenman-Pick, 1985, p. 158). She makes great play of the tone, the mood and the resonances of the process: 'I think that the extent to which we succeed or fail in this task will be reflected not only in the words we choose, but in our voice and other demeanour in the act of giving an interpretation...' (p. 161). Most importantly, she emphasises the power of the projections and what they evoke countertransferentially: 'I have been trying to show that the issue is not a simple one; the patient does not just project into an analyst, but instead patients are quite skilled at projecting into particular aspects of the analyst. Thus, I have tried to show, for example, that the patient projects into the analyst's wish to be a mother, the wish to be all-knowing or to deny unpleasant knowledge, into the analyst's instinctual sadism, or into his defences against it. And above all, he projects into the analyst's guilt, or into the analyst's internal objects.

'Thus, patients touch off in the analyst deep issues and anxieties related to the need to be loved and the fear of catastrophic consequences in the face of defects, i.e., primitive persecutory or superego anxiety' (p. 161). As I see it, the approach adopted by Brenman Pick takes it as read and as normal that these powerful feelings are moving from patient to analyst and back again, through the processes of projection, evocation, reflection, interpretation and assimilation. Ronald Britton has spelled out the minutiae of these interactions (Britton, 1998, ch. 6). Moving on from the more limited formulations of an earlier period in the writings of Winnicott, Heimann and even Money-Kyrle, these feelings are all normal, as it were, in the processes of analysis. More than that, as she puts it, they are the essence.

Penultimately, what about the other concepts I mentioned? In my first comments I spoke about being able to bear what the patient projects into us. Bion write about this in terms of ‘container and contained’ and made it the basis of a whole psychology. I cannot elaborate it here (Hinshelwood does that well in his dictionary), but I will mention that containment on the part of the therapist is central to the process, as is being able to think while being violently projected into. Bion, the recipient of the Military Cross as a tank commander in World War I (Bion, 1982; Bléandonu, 1994), called this ‘being able to think under fire’, a very apt analogy. But, of course, self-containment is also what we wish to impart to the patient - to cease spilling out and projecting all over the place and bear and contain one’s feelings and keep the cauldron of emotions from boiling over. We don’t have to neutralize those psychotic anxieties; we just have to bring them into the realm of ordinary human unhappiness, to help them to become manageable so we can get on with it. Freud never promised cure, only the hope of a shift from unbearable to bearable.

The analytic frame is part of the essence of containment. (I have written at length about this in a paper at my web site (Young, 1998), as I have about much else I have said today.) It may seem to be about the room, one’s demeanour, the forms of abstinence required of a principled therapist. But it is much more. It is an environment, both physical and emotional, in which the patient can take the risk of looking at things he or she has spent a lifetime not being able to face - letting the repressed return in a form which allows it to be expressed without sundering them and pondered so that better ways of dealing with pain - ones which are not incapacitating - can be substituted for the self-limiting ones which constitute neurotic symptoms. Lord knows, the world is in a mess, and so are we much, perhaps most, of the time, but we offer a haven, a retreat, a respite wherein hope may be recovered and love and constructive impulses can perhaps get a small edge over hate and destructive ones.

In closing I want to try to convey something that is, in the last instance, ineffable. I do a lot of supervising. In particular, at Sheffield, where I teach psychotherapy trainees, it has become customary to ask students in trouble, those who have not yet ‘got it’, to work with me. I take this as a compliment, but it is a tough assignment. What I often find is that the transference is in their face, plain to see, but the student therapist won’t/can’t see it, yet what they do and don’t do conveys to me that they are in the grip of the relevant countertransference but cannot make the move from being in the grip to having a grip on it, that is, being able to think about it and formulate a potentially helpful interpretation. To borrow the title of a book I know, they are ‘lost in a familiar place’; they don’t know what’s going on. When I was in supervision with Alex Tarnopolsky he would gently ask, ‘What were you feeling?’ Simple, but it never failed. I was able to say what I felt, hence, on reflection, what I felt was going on. I then found myself. I’ll give you an example. I had a patient who had seen her father murdered by racists in another country. She told me this in a matter-of-fact, split off way in the first session. Her mother was not there when the murder occurred. The parents were divorced, and my patient was visiting her father. A few sessions later she told me a dream in which it was obvious that she felt down by her mother who was by that time having a successful career in this country. I interpreted the dream in those terms. The next day she came in and straightaway turned the chair, on which she routinely sat, toward the wall so that it and her back were facing me. I was totally non-plussed by her acting out and muttered this and that. She never came back. With Alex’s help, the interpretation was clear: ‘There is something you don’t want to face and cannot speak about to me - at least not yet’.

It takes time and a growing sense of competence to ask one’s self what one is feeling, especially since the relevant feeling may be at the edge of consciousness or may be experienced as entirely ones’ own, getting in the way of the work or ‘just a feeling’ without a big label marked ‘countertransference’ pasted on it. It’s so easy to experience the thing itself as a product of incompetence or preoccupation with something outside that session: tone, mood, discomfort, embarrassment. Learning to trust the countertransference is not easy, but it is at the centre of good analytic work. It is the unconscious in the therapeutic process.

This is the text of a paper presented to the annual conference of the Institute for Psychotherapy and Social Studies entitled ‘The Unconscious: How Does It Inform our Work? Approaches and Applications in Clinical Practice’, at the Tavistock Centre, London 24 November 2001.

REFERENCES

(Place of publication is London unless otherwise specified.)

Bernfield, S. (1944) 'Freud's Earliest Theories and the School of Helmholtz', Psychoanal. Quart.13: 341-62.

______ (1949) 'Freud's Scientific Beginnings', Amer. Imago 6: 3-36.

______ (1951) 'Sigmund Freud, M.D, 1882-1885', Internat. J. Psycho-anal. 32: 204-17.

Bion, Wilfred R. (1955) 'Group Dynamics - a Re-view', in Klein et al., eds. (1955), pp. 440-77.

______ (1982) The Long Week-End 1897-1919: Part of a Life. Fleetwood Press; reprinted Free Association Books pb, 1986.

Bléandonu, Gerard (1994) Wilfred R. Bion: His Life and Works 1897-1979. Free Association Books.

Brenman Pick, Irma (1985) 'Working Through in the Counter-transference', Internat. J. Psycho-anal. 66: 157-66; reprinted in Spillius, ed. (1988), vol. 2, pp. 34-47.

Britton, Ronald (1998) Belief and Imagination: Explorations in Psychoanalysis. Routledge.

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