On transference as an ego function

Occasionally you come across a paper that is an order of magnitude better than others of its ilk. "Notes on Transference: Universal Phenomenon and Hardest Part of Analysis"* delivers original insights, page after page, yet you rarely hear it mentioned. You can know the literature and practice dynamic psychotherapy in an academic setting for decades without ever hearing of it. Ironically, one of the points of the paper is how little is made of transference, not least of all by Freud himself. (And, because you will wonder at some point, for your information, he never cites DW Winnicott.)

I. Bird posits transference as a little-understood but universal mental quality that is "the basis for all human relationships." He speculates that it is "a major ego function" and, moreover, that it is "one of the mind's main agencies for giving birth to new ideas." Although it is generally universal, transference is nonetheless

... unique as it occurs in the analytic situation ... [T]he analysis and resolution of a transference neurosis is the only avenue to the farthest reaches of the mind. ...in one form or another [it] is always present, active, and significant in the analytic situation. [E]verything that goes on in analysis has a transference meaning. [A]nalysts themselves regularly develop transference reactions to their patients, including periods of transference neurosis, and ... these transference reactions play an essential role in the analytic process. p 267

II. Bird makes big claims ("unique ... only ... farthest ... essential ....") and provocative assertions:

• Freud's important writing on transference began in 1905 and was mostly over by 1917.
• His four-year delay in publishing "Dora" was owing to difficulty understanding the transference.
• The 1905 publication of "Dora" also had to await Freud's progressing in his own self-analysis.
• Analysis requires a transference object, and the transference object in his self-analysis was Fliess.
• In 1905 his observations on transference are confident and his opinions declarative and firm.
• In his later writings he scants, muddies, or mostly neglects the subject of transference.
• Yet from the first, Freud stated that the role of transference is the sine qua non of analysis.
• Except for "Dora" his writing on transference is not up to his usual level of analytical thought.
• The three papers in which it is the specific focus come across as perhaps his least significant.
• A vastly less important subject -- free association -- has received much more recognition.
• Most divergences among the early analysts had to do with differences on handling the transference.
• On the issue of transference, Freud was passive and failed to exercise leadership of his followers.
• Sometimes, especially later, Freud seems to refer to transference merely as a technical matter.
• After 1917 Freud seems to see transference in generic terms, as mere doctor-patient rapport.
• Several times he demonstrates obvious blind spots in connecting clinical data to the transference.
• In 1937 Freud pessimistically alluded to his own personal frustrations with the subject.
• Yet, even at the end, he tacitly put transference at the center of success versus failure in analysis.

III. Using Freud himself as an example Bird proceeds to link creativity with the formation and the resolution of transferences. (He also has an interesting speculation on Isaac Newton's creative flood years as related to a transference to an absent, idealized mentor.)

This fluid, inconstant, and ever-shifting state of Freud's views on transference may be explained, I believe, by the fact that for so much of his life he was himself deeply engaged in transference situations with many different persons. Freud's discoveries were made primarily on himself. His primary sources were his own transference experiences. This, I suspect, was the principal executive agent of Freud's genius: his great capacity to become deeply involved in and to resolve myriad transference feelings, and then, to derive from such experiences the basic principles governing them. ... Perhaps all great discoveries, or at least all "creative leaps," are made, via the transference, within the discoverer's own person. Perhaps all monumental breachings of the confines of the known depend not only on the basic givens of genius but upon a capacity for greatly heightened cathexis of certain ego apparatuses, a development which, in turn, may require the kind of power generated by the ego only in a transference situation. pp 275-276

IV. Bird next proceeds historically to describe the deterioration of rigorous technique in transference analysis through the mid-twentieth century and to link this loss of rigor to the transference as indeed "the hardest part of analysis."

• Analysts see "handling of the transference" as still the psychoanalytic sine qua non.
• Yet 'handling' has come to mean manipulation and attenuation of the transference neurosis.
• Rigorous handling of the transference neurosis requires great strength of the analyst's will.
• We tend to forget consciously that a neurosis is based on conflict, painful, painful conflict.
• What is specific about a transference neurosis is the mindful involvement of the analyst.
• The analyst is necessarily and by definition at the center of the "crunch of this conflict" p 278.
• The original drives and defenses causing the neurosis are immune to extraneurotic influences.
• Only if the analyst allows it wholeheartedly can the patient develop a transference neurosis.
• Emotional wear and tear must be one of the major reasons analysts avoid transference neuroses.
• Potential dangers attend the analyst's becoming (even therapeutically) involved in the neurosis.
• The worst danger is the analyst's own reciprocal transference neurosis to the patient.
• But the transference neurosis can only be interpreted from within, with the analyst in it too.
• This is risky and dangerous to the analyst, there is no "safe" analysis that can reach the patient.
• But the alternative to risk is to allow analysis to attenuate to merely an "explanatory art."

V. Bird implies that it is intellectually dishonest to equate transference with the transference neurosis, that it is a rationalization to merely say "transference is transference." The transference neurosis is something more.

But before explaining how it is 'more,' he digresses to what seems to be a personal observation, one that appears paradoxical yet makes intuitive sense: The reality of the analytic situation -- the real relationship, the facts of the day-to-day meeting of the doctor-and-patient -- these all work against the formation of a transference neurosis. In other words, the necessary humanity of the analyst works against the process of development of a transference neurosis. The simple contact-support of the analyst's being human somewhat undermines the formation of a transference neurosis.

VI. But once the transference neurosis is established, it becomes an intrapsychic structure unto itself. Bird --  most concisely -- describes it from the inside:

When I think of transference, I think of feelings, reactions, and of a repetition of past events; but when I think of transference neurosis, I think literally of a neurosis. A transference neurosis is merely a new edition of the patient's original neurosis, but with me in it. p 281

Transference in its universal sense is the displacing of feelings and attachments from one object to another, and of repeating the past in the present. In this process two separate identities -- the patient's parent and the analyst -- are merged, but the patient's own identity and the analyst's identity remain clear and separate.

Not so with a transference neurosis, where the patient includes the analyst somehow in the structure. As a result, the identity difference between patient and analyst is lost, and for the moment, the analyst comes to represent the patient himself or herself. It is as if the analyst mysteriously becomes for the patient a piece of the patient's superego (criticizing the patient, for instance) and a piece of the patient's ego (defenses, executive functions, etc., acting for the patient). Bird describes it as if the analyst, now inside the patient's ego, speaks to the whole patient. "I come to represent the patient himself." p 281, his emphasis. The analyst can now interpret what is going on, showing the patient these chunks of ego and superego. (Reading it, one gets the image of the analyst-inside-patient's-ego as being like an amplifier of the voice of the ego.)

What now happens, ideally -- and Bird himself admits he doesn't know exactly how -- is that there is a process of change (described like a figure-ground flip-flop) resulting in the patient accepting responsibility for feelings and actions in the repetition compulsion. This sudden shift marks the patient's acquiring a new sense of agency and selfhood.

The case illustration he uses here is a young man with procrastination whose controlling mother had always nagged him and then, when he was passive aggressive, took over and did things for him, making him inadequate. Naturally, in the analysis, he came to see the analyst as like his mother and the very process of analytic interpretation itself as the voice of his mother, either nagging or taking over in his behalf. This rendered Bird's interpretations useless. The content of the analysis became unimportant, only the process of interpretation had emotional energy. (This was the transference.)

Bird then decided to become quite silent (but apparently still very connected) and the patient himself began to make the interpretations, just as if the analyst were doing it. These discourses became for the patient either his mother's voice nagging or his mother doing his work for him. (This was the transference neurosis.) Bird could now comment on this self-to-self dialog of the patient, p 283: "What seemed most apparent was that in this way he was revealing a significant capacity to take over his own affairs and to be effective in getting things done, and that indeed the very strength of this drive might be a central factor causing his ego in his neurosis to react against it. The patient responded to this formulation with a sense of its aptness. He began to appreciate the internal, personal, and conflicting nature of his neurosis and to accept some responsibility himself for his troublesome behavior."

The process of the development of a transference neurosis is a spotty thing, on again, off again, and it is built up by "the persistent and effective handling of the daily transference reactions" (p 284) that sets the stage for the appearance of episodes of transference neurosis.

VII. Next is commentary on inherent limitations of the phenomenon of transference itself -- factors which are the 'enemy' to the formation of the transference neurosis:

• the direct here-and-now effect of the analyst on the patient, which may be the worst limitation
• the analyst's need to be directly helpful and the patient's identification with the analyst's real self
• a pseudotransference at the beginning of the analysis, too good to be true, a false transference
• the analyst's taking this "transference" for real and prematurely interpreting the genetic material
• attenuation or tapering off of the end of the analysis, or casual or tentative stopping
• conversely, an overly rigorous termination, which is probably too difficult for the analyst to bear
• the patient's resistance used as a weapon against the analyst, the "negative therapeutic reaction"
• the analyst's failure to recognize the "negative therapeutic reaction" as an attack upon the analyst
• using euphemisms --"hostile," "aggressive," "negative" -- rather than "chapter and verse" details
• not using strong words to "confront;" not detecting "actual attempts to injure us, the analyst" p 291
• and failure to recognize the analyst's concealed attacks on the patient -- or retaliatory counterattacks

VIII. Unanalyzed countertransference around negative issues, and denial of such, leads to failure pp 293-295. (He never uses the word "hatred.") These paragraphs are so rich that they defy summarizing and require quotation. He speaks first of the patient, then the analyst, then the transference neurosis:

The analysis of neurotic libidinal elements may gradually bring about, through a defusion-like process [sic], a freeing of hostile-aggressive elements, which may then be increasingly applied to the analyst and to the analysis itself. [A] stalemate ... should be suspected of consisting of a silent, secret, but actual destructive act engaged in by both patient and analyst.

To me, the analytic setting, in which the analyst remains constant as an objective, detached, uninvolved interpreter of the patient's productions, is almost sure to bring about a silent but significant build-up of the analyst's own unconscious negative-destructive impulses. As this goes on, the analyst can rarely avoid putting some of these impulses into action, and, like the patient, the analyst, being unable to represent these negative feelings fully in his own transference [to the patient], will be forced to put them into action and will do so in about the only way available to him: by using elements of the analytic situation as a weapon. ...

My suspicion here is that we tend to lean too far backward on this issue, so far backward that our not confronting the patient becomes in itself not merely an unfriendly act but a destructive one. By not confronting the patient with the actuality of the patient's secret, silent obstruction of analytic progress, the analyst himself silently introduces even greater obstructions.

[T]o me, analysis, especially as it concerns negative destructive elements, is not merely an intellectual or an emotional experience; rather, it is as well a conflict, a conflict starting out within the patient's neurosis as an intrapsychic event and gradually becoming a conflict within the analytic situation. Only then, only when the analytic situation becomes, in a sense, an adversary situation, should we expect the kind of transference neurosis to develop that can admit to it a representation of destructive impulses strong enough and faithful enough to permit this aspect of the patient's neurosis to be effectively analyzed.

[P]erhaps only when the analytic situation becomes an adversary situation should we suspect that a transference neurosis adequate enough to represent destructive impulses has developed. [F]or this to happen ... the analyst's own transference involvement is necessary. [T]he patient's literal attacks upon him, the patient's literal attempts to destroy the analyst, probably represent in the transference neurosis the patient's own intrapsychic destructive struggles, the patient's own attempts to destroy certain aspects of himself, and his own equally destructive attempts to preserve himself and instead to destroy others.

Bird seems to imply that knowing this map of battle will of itself allow the analysis to proceed and succeed through this "dark and ominous time, when both patient and analyst are about ready to call it quits." But arriving at this place may be the only way to get to the heart of the patient's neurosis.

IX.  He closes with "Notes on Transference as an Ego Function" pp 296-300. Embedded there are ideas about how the analyst may have a transference neurosis to the patient, yet analyze both that and the patient's transference neurosis. He proceeds from a cascade of cause-and-effect statements:

• He had suggested that an analyst's transference reactions are essential to the analysis.
• If true, this suggests the notion that transference is an ego function, as he stated at the outset.
• If one hypothesis is true, then both are true, and proof of this begins with Freud's 1905 "Dora" case.
• Freud's description of transference in "Dora" was such that it could be attributed only to the ego.
• So, though paradoxical, it makes sense to see transference as the ego's main antirepressive device.
• Transference has an inextricably close relationship to the drives, so it's powerful and special.
• Such antirepressive action is clearly shown by the usefulness of the transference in analysis.
• This power in a general sense endows the ego with its crucial capacity to evoke the past.
• The ego therefore must function to evoke, maintain, and put to use the past-in-the-present.
• The ego uses this unique capacity for bringing past into present as a major adaptive tool.
• This antirepressive force enables transference to activate and expedite other parts of the ego.
• Particularly, transference activates the ego's conflict-free givens and synthetic creativity.
• Analysis doesn't "cause" transference, yet it uniquely shapes the choice of content of transference.
• Also, because of its exclusiveness, analysis focuses the transference upon the person of the analyst.
• Thus in analysis, neurotic and historical complexes in the transference may be resolved.
• But the function of the transference is not resolved -- transference never goes away.
• So the analyst's transference goes on all the time too, it has not been resolved in his own analysis.

X.  At this forlorn juncture, Bird injects some hope: Although it never goes away, transference is an ego function, therefore durable and powerful. The problem is that it's by definition unconscious and ever-active. But there is a solution p 299:

[T]he simplest position for the analyst to take, and the one most likely to be helpful, may be to assume that all feelings and reactions of the analyst concerning the patient are prima-facie evidence of the analyst's transference. [E]very feeling of warmth, pity, sadness, anger, hope, excitement, even interest; every feeling of coldness, indifference, disinterest, boredom, impatience, discouragement; and every absence of feeling, should be assumed to contain significant elements of the analyst's transference as focused on the patient... [We must always assume] that nothing represents merely the analyst's "real" reaction to his patient, and that especially when something seems most real it can be counted on to contain important aspects of the analyst's transference.

[T]ransference, if it indeed belongs to the family of ego functions can be counted on to possess many of this family's characteristics. ... The ego's ways of reality testing [and] responses to internal and external stimuli, its uses of defense mechanisms, may all reveal much about the basic phenomenology of transference .... [T]ransference suffers the same general developmental and neurotic deficiencies, distortions, limitation, and fixations to which various other functions of the ego are susceptible. [So there must be a way to exploit] the special strengths of transference functioning, especially its way of joining with other agencies to serve and facilitate the individual's idiosyncratic interest and developments.

Bird concludes by musing on why it was little noticed that transference is an ego function: It was assumed in a certain way, assigned a place. "Assigned, without even wondering why, to neither ego nor id, it is usually dropped somewhere in between." Transference "as a major member of the ego family ... may be involved in all the ego's differentiating, integrative, and creative capacities."

XI. This summary began by noting the irony of Bird's tour de force being so little known, since the paper is about transference being so little known. Maybe the reason is the same: The ideas are not just difficult to understand, they're hard to bear.

-- J Groves

groves.james@mgh.harvard.edu