The transference

Sandler (1973, 1992) defined transference as " a specific illusion which develops in regard to the other person, one which, unbeknown to the subject, represents, in some of its features, a repetition of a relationship towards an important figure in the person's past or an externalization of an internal object relationship".

The keywords in the abovementioned are 'illusion', 'unbeknown', 'repetition of past relationship' and 'internal object relationship'. The aforesaid definition includes both the Freudian and the Kleinian view of the clinical factor, that is 'transference', around which this paper evolves.

Transference is considered to be one of the major agents of change and many different conceptions of it vary greatly among psychoanalytic theorists and observers. All analysts assert that transference is an essential instrument of treatment.

Breuer and Freud (1985) saw transference as an obstacle. Freud was afraid that transference was a result of excessive influence that the doctor has on the patient and that assuming that psychoanalysis was focused on such phenomenon, it could be assumed that it is a modifying form of hypnosis. In ???? , when he first talked about transference he mentioned: "But here I will pause, and let you have a word: for I see an objection boiling up in you so fiercely that it would make you incapable of listening if it were not put into words: 'Ah! So you have admitted it at last! You work with the help of suggestion, just like hypnotists!'" (Freud, 1973).

However, he soon realised that transference is of vital important for the understanding of the psyche. The transference at that time was adopted as an expression of the pathological oedipal adherence to the analyst, who represents the primitive relations of the patient to the parental figures (Freud, 1905c).

This ascertainment led to the transference neurosis (Freud, 1914c, 2001) which include positive and negative transference. These transferences correspond to feelings and wishes of the initial oedipal situation which now relives in the analytic relationship.

According to the classic analysis, transference can be described as the procedure in which the patient transfers his past experiences and feelings to the analyst without knowing about this illusory connection and while understanding that these feelings are connected to the present.

According to this theory, transference reveals and allows the reliving??? Or reformation of the past to the present and this is how the patient can overcome the trauma of the past.

Here, the analyst is presented as a neutral screen on which the primitive wishes of the patient are appeared. At the same time, transference could be a source of resistance.

The principal meaning of transference has changed from the patient's projections onto and distortions of a passive analyst to the idea that the patient's transference reactions represent reasonable implications based on signals that the analyst consistently and necessarily emits (Morris N. Eagle, Psychoanalytic Psychology, 2000, A critical evaluation of current conceptions of transference and countertransference).

On the contrary, according to the Kleinian theory, transference is not just a representation of unconscious psychic impulses but it is an emertion of latent meanings who are organized in the analytic relationship and they are recalled because of the relationship per se.

Here, transference has a wider meaning in which the interaction between the patient and the analyst is included, it represents the conflicts and it reflects the interaction between the internal object representations. It constitutes a scene where the internal drama of the patient acts with the analyst.

According to the abovementioned, Freudian psychoanalysis' definition of transference evolves around the replacement of the past to the present which is shaped from the experiences from the past, whereas kleinian's definition is associated with the fact that the organization of the present situation is based on the internal objects. Frosh (1987) states that: "The analyst is involved in the patient's psychological processes and he becomes an internalized object bringing about changes in the structure of the mind".

According to the classical theory, reality regarding transference is objective and based on distortion, in contrast to kleinian where the reality is subjective.

Betty Joseph (1985) includes much emphasis on the analysis of defenses and is focused very much on the here-and-now aspects of analytic work, particularly on indications of transference in analysis of the total situation. She states: "By definition it must include everything that the patient brings into the relationship". The "total situation" is not limited to the content of the patient's remarks; it includes the manner of speaking, physical conduct, selection of material and its sequences, and stated and implied fantasies about the immediate relationship with the analyst (Schafer Roy, 1999).

Moreover, motives behind transference in Freud's theory are the aggressive and libidinial impulses connected to the primitive wishes, fantasies and fears. Conversely, in Kleinian theory, motives' aim is adaptation so they organize emotional experiences that are demanded for the cohesion of the self.

The Freudian analyst is objective like a neutral, blank screen but the kleinian analyst contributes through interaction with the patient and he is subjective. Whereas the Freudian analyst functions as a mirror onto which the patient displaces his impulses, Kleinians describe the analyst as a receptacle into which internal figures are projected (Segal, 1981, cited in Freud, 1973). The analyst in the Freudian scenario, looks like a 'passive recipient' of the patient's impulses and drives. Therapy for Forsh (1987) should include 'the interplay of projection and integration' in relation to the analyst who acts as the 'container and transmuter' of the patient's feelings, rather than just trying to make the patient see himself precisely.

While the classic analyst intervenes, uses interpretations of distortion, whereas the kleinian analyst is more directive and once the material is understandable, he intervenes immediately (Greenson, 1974). According to Freudian's concept, interpretation will only be effective if the patient's ego is strong enough and they interpret from the surface to the depth, while Kleinians believe that transference should take place immediately without having to know the background of the patient regarding siblings etc. The Kleinian analyst is characterized with omniscience, he interprets deep material in the first times and he acts with an air of certainty.

Rosenfield (1974) assumes that "analytic intervention at the right level is particularly necessary when the anxiety is threatening to overwhelm the patient's ego and interrupt of the present analysis... Some transference phenomena will attach themselves to the analysis form the beginning".

In my opinion, when the analyst is interpreting transference, dreams, memories, feelings, desires, or therapeutic change, helps the patient to view himself or herself as a contributing participant and not just as a passive party to all the difficulties of existence. Nonetheless, we have to bear in mind that each case is different and there is not one way to interpret or intervene.

We should be very careful while using transference and being aware of it. Gabbard (1994, p. 104 cited in The many faces of analytic interaction, Meissner W., 2000) wrote, "the patient's relationship to the therapist is a mixture of a transference relationship and a real relationship. The real relationship has been termed the therapeutic alliance (Zetzel, 1970) or the working alliance (Greenson, 1965/1978)".

Meissner's position (2000) is quite interesting: "My contention is that there is a point in keeping transferential and countertransferential processes at least conceptually distinct from other levels of interaction in terms of the real relationship or alliance. I prefer to think that psychic reality, whether of patient or therapist, does not undermine or abolish the real relationship and its vicissitudes, nor is it simply synonymous".

In addition, when we refer to the change in psychoanalysis we refer to the reduction of primitive wishes and less distortion, while in Kleinian perspective the rough psychological schemas become more flexible and new schemas are coming up as a result of the analytic procedure.

Until about 1920, it was assumed that schizophrenic patients were incapable of forming a transference and therefore could not be psycho-analysed (Klein, 1986). Freud (1973) said: "Observation shows that sufferers from narcissistic neuroses have no capacity for transference or only insufficient residues of it. They reject the doctor, not with hostility but with indifference. For that reason they cannot be influenced by him either; what he says leave them cold, makes no impression on them; consequently the mechanism of cure which we carry through with other people - the revival of pathogenic conflict and the overcoming of the resistant through repression - cannot be operated with them. They remain as they are".

Norbert Freedman and Michael Berzofsky (1995, Shape of communicated transference in difficult and not-so- difficult: Symbolized and Desymbolized Transference) suggested that the absence of symbolization (i.e., desymbolization) is a challenge to the unfolding transference and represents an obstacle to psychoanalysis or to psychoanalytic psychotherapy. There are many schizophrenic and borderline patients who are symbolizers, and there are patients with narcissistic character disturbances who are desymbolizers.

Cultural issues

Cultural and ethnic aspects of behaviour often make the evaluation of transference difficult and may be a great obstacle to the therapeutic progress, particularly when the therapist fails to acknowledge such differences.

Factors such as gender, sexual orientation, physical appearance, and personal experience can act as catalysts for the acceptance of parts of the self. Ethnicity, culture, and race can touch deep unconscious feelings in most individuals and may become matters for projection by both patient and therapist, usually in the form of transference and countertransference. The Kleinian and contemporary Kleinian ideas (Tan, 1993 cited in Transference and race: An intersubjective conceptualization. By: Yi, Kris Y., Psychoanalytic Psychology, 0736-9735, 1998, Vol. 15, Issue 2) view the patient's negative racial transference as a defensively motivated projection of the undesirable aspects of the self onto the race of the therapist. Yi, Kris (1998) stated that: "The "opposite" race creates a category of people who are "not me" into which one can project unwanted psychic content, such as aggression, which is then introjected by the other racial category of people".

Comos Diaz and Frederick M. Jacobsen (1991) discuss about some characteristics of ethnocultural transference. Overcompliance and friendliness happens when the societal power between the patient and the therapist is different, for example, a white therapist working with a patient from an ethnic minority or reversely. Moreover, denial of ethnicity and culture - probably coming from the patient's fear confronting racism within the self - ambivalence as well mistrust, suspicion and hostility could be also types of ethnocultural transference. Furthermore, some patients idealize their therapist and they fantasized him as the perfect all-good parent, facilitated by the ethnic similarity. At this point the therapist appears as omniscient-omnipotent. On the other hand, the therapist could be a traitor, and the patient shows signs of dissatisfaction and envies the therapist's success. One last factor that can influence transference is the autoracism, which occurs when the patient experiences negative feelings toward themselves and project these feelings onto an ethnically similar therapist.

Both therapist and patient as each of them are inclined to misinterpret the other's nonverbal communication in terms of his or her own cultural reality. Given the complexity and multiplicity of ethnocultural factors, therapists need an understanding of their own ethnicity and culture as well as of their patients' so they protect the process and outcome of psychotherapy.

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