The Therapeutic Experience of Psychoanalytical Inquiry

Wolstein, B. (1990). The therapeutic experience of psychoanalytic inquiry. Psychoanalytic

Psychology, 7 (4), 565-580.

Psychoanalysis is moving toward a crossroad that has long been mapped into the deepening
bifurcation of the two distinct sides of its endeavor: the theoretic and the therapeutic. These
competing, yet convergent, movements in the overall coordination of psychoanalytic inquiry,
although they do not so appear on their face, actually cut across the party lines of interpretation
that still separate the various schools of psychoanalytic thought from one another. In all schools,
there are those psychoanalysts who attempt to lay out an elaborate construction of theory in
abstract form, as though its consistent application, if possible, would result in a clearly definable
experience of psychoanalytic therapy; but there are also those who follow the directive
guidelines of the coordinated structure of psychoanalytic inquiry—formal, but not rigidly so—
in the knowledge that every psychoanalytic therapy is unique, and for whom the actual
articulation of those clinical guidelines is a concrete empirical matter. In other words, those who
emphasize the abstract theory of the inquiry as it should be undertaken along with those who
emphasize the concrete experience of the therapy as it is actually undergone, both seek to
identify what is essentially psychoanalytic about the character of the inquiry and experience any
two particular coparticipants live and work through together in their shared effort.

IN HISTORICAL PERSPECTIVE

Lest it be too hastily inferred from the contemporary terms in which this critical divide is being
stated here, that this fork in the road is of recent origin, a few historical comments are in order.
Recall first, for example, Breuer's treatment of Anna O., dating back to 1880-1882. They
reached a therapeutic impasse but only after she had accomplished remarkable personal results
by the original creation of a historicogenetic and autohypnotic procedure, which she described
simply, “as a ‘talking cure”’ (Breuer & Freud, 1895/1957, p. 30). Breuer, to account for these
unprecedented results, formulated the theory of the hypnoid state, which others later
reformulated in terms of the unconscious and still later in terms of unconscious psychic
experience. He, as is rather well known, terminated the therapy with her when she became more
personally involved with him, taking both therapist and patient too far beyond the clinical
psychological knowledge of the time for them to cope with her involvement or with her reaction
to it.

It was, of course, Freud, Breuer's young friend and future co-worker, who brashly suggested
that he understood the core of her personal involvement with Breuer. During the 1890s, he
proceeded to outline his own sexual theory of personality development, in part, to account for
Anna O.'s therapeutic reaction. About that theory, in turn, Breuer parted company with Freud.
At the time, we now realize, neither Breuer, Freud, nor Anna O. knew she was undergoing a
deep positive transference to which the best antidote was, and still is, its intensive exploration
from the standpoint of the psychic center of the self, whether its content of metaphor be sought
in sexual instinct or libido, the struggle for power, the archetypes of the collective unconscious,
the absolute will, the quest for relatedness and communication, or something else. That early
statement was, however, only the beginning of Freud's lifelong preoccupation with setting forth
his sexual theory of personality development, modifying and enlarging the biological aspects of
his approach to personality theory, and sharply focusing his special metapsychology of instinct,
libido, and the id for this purpose.

On the empirical side, for the purposes of clinical psychoanalytic inquiry, not until after
completing his therapy of Dora in 1900 and publishing the case in 1905 (Freud, 1905/1950a),
did he postscribe a passing awareness, as though it were a retrieved afterthought, that she was
undergoing an unobserved—and if even noticed, then still unpsychoanalyzable—experience of
transference with him. From then on, he devoted the major part of his creative energies
throughout his writings to the interweaving of these two sorts of interests, the imaginative study
of instinctual-libidinal metapsychology and the therapeutic study of transference and resistance,
in his quest for a unified body of psychoanalytic knowledge. I am suggesting that this amalgam
of the two worked out for him in the speculative imagination far better than it ever did in his
clinical practice. As Freud (1914/1950c) wrote:

It may thus be said that the theory of psycho-analysis is an attempt to account for two observed
facts that strike one conspicuously and unexpectedly whenever an attempt is made to trace the
symptoms of a neurotic back to their sources in his past life: the facts of transference and of
resistance. (p. 298)

But recognizing the interpretive imbalance of his own amalgam of the two, he continued: “Any
line of investigation, no matter what its direction, which recognizes these two facts and takes
them as the starting point of its work may call itself psycho-analysis, though it arrives at results
other than my own” (p. 298).

I think that imbalance may largely be traced to the obvious fact, not observed frequently
enough, that not all his patients could find their psychic differences and their neurotic sufferings
well enough interpreted within the confines of what later proved to be a metapsychology with
roots idiosyncratic mainly to Freud's own psychology.

Such, it seems, was the preferred fin-de-siècle, middle-European style of offering interpretive
insights to colleagues and patients: absolutism of statement, aimed at a universal range of
application. Clearly, Freud could not successfully impose the acceptance of his metapsychology
on all of his colleagues, some of whom, including Adler, Jung, and Rank, openly challenged the
presumed universality of his perspective with presumably universal perspectives of their own. It
is, therefore, not surprising to learn that patients, serious and courageous enough to take issue
with him, would soon start to resist the surface plausibility of his interpretations. Then, in the
face of his coaxing, cajoling, importuning, and pressure against their resistance, they would
develop deeply negative transferences of hostility and anger, even in some reported cases,
abandoning their psychoanalytic therapy with him. They did so, not because of the psychology
of their transference with him, but because of their resistance to his stubbornly idiosyncratic
metapsychology for interpreting this transference.

In fact, by around 1920, Freud became very pessimistic about the therapeutic possibilities of
psychoanalysis, and devoted the rest of his life to the exploration of other people's lives, instead,
to defend and further extend his sexual theory of personality development. So ended, by 1920,
the pursuit of hypnotic goals of therapy that he carried over into psychoanalysis mainly from
Breuer, but also from Bernheim and Charcot—dynamically, to overcome resistance to recall,
and descriptively, to recover forgotten memories. The first unanalyzed analyst became
uninvolved, finally, with the therapy of others.

Not unlike Adler and Jung on the metapsychological side in 1910-1912, Ferenczi, Rank, and
Reich departed from Freud on the therapeutic side in 1923-1927. These three creative clinical
researchers began to work directly in the living present of their ongoing relationship with
patients. In addition, therefore, to Freud's empirical clinical method of interpreting transference
therapeutically, Reich most of all, during a 1927-1928 clinical seminar at the Viennese
Psychoanalytic Institute, laid the groundwork for the direct methods of relating to resistance
therapeutically. Rank, of course, left Freud with respect to both theory and therapy, developing
both a metapsychology of absolute will and a correlative approach to will therapy which,
ultimately, proved more useful to him than to others who experimented with it. But it was
Ferenczi who, during 1931-1932, in response to a patient's unmovable resistance of 2 years
standing, attempted a short-lived and circumscribed mutual analysis with her, during which
experience they both explored his negative countertransference in a therapeutically constructive
way. Ferenczi's case of R. N., in which the therapeutic study of the psychoanalyst's
countertransference as a functional correlate of the patient's resistance was first carried out in
vivo, takes its place alongside Breuer's case of Anna O., in which the therapeutic study of the
hypnoid state, later to become the study of unconscious psychic experience, was first sighted,
and alongside Freud's case of Dora, in which the probable therapeutic study of transference was
first noted in a postscript.

Even from so brief an outline, as background for this review, it is possible to see why the
continued effort to defend Freud's metapsychology and extend it into the present, has fallen on
hard times. He first alighted upon it, in part, so as to answer Breuer's problems in doing therapy
with Anna O., and he later pursued it into the 1920s in spite of the increasingly limited range of
its applicability, even to the point of gradually abandoning his faith in the possibilities of
psychoanalytic therapy altogether. Later, the sexual theory of personality development became
further removed from the empirical field of therapeutic inquiry, in the hands of such writers as
Hartmann and Rapaport, becoming a general psychoanalytic umbrella for all varieties of
psychology, yet sharply distinguished from clinical psychoanalysis. But we face a radically
different sort of question today: that is, how to deal with a general theory of personality that, in
its standard traditional form, is growing increasingly distant, even alienated, from the actual
practice of clinical psychoanalytic inquiry. The books selected for discussion and review all
throw various measures of light on how this impasse came about, and each, in its own way,
suggests how to deal with it.

1. Ferenczi undertook innovative psychoanalytic experiments in the clinical study of

R. N.'s resistance as a function of his countertransference, without, however, paying
serious attention to its interpretive metapsychology.
2. Edelson, in response to the crisis in traditional psychoanalytic metapsychology,
very quickly states his full adherence to Freud's sexual metaphor, even though he
devotes a number of his original essays to the rationale for the case study approach,
which may, in fact, hold for the individual patient's psychoanalytic therapy whether
or not one follows that metaphor.
3. Goldberg, following Kohut and the Chicago school of self-psychology, instead
chooses to move directly into the patient's world with empathy and without
 suggested procedural provisions for accepting any particular patient's
metapsychology.
4. R. Marshall and S. Marshall develop for close empirical study the design of an
original transference-countertransference matrix, which may be profitably adopted
in all psychoanalytic inquiry without regard for any particular psychoanalyst's
and/or patient's special metapsychology.

The first, Ferenczi's Diary, is, in my opinion, of critical historical importance; the second,
Edelson's Theory in Crisis, is clearly rooted in that history, continuing Freud's heavy emphasis
on sex into contemporary psychoanalysis; the third, Goldberg's Fresh Look, represents an effort
to do psychoanalytic therapy with a group of patients that is explicitly excluded from it by
classical diagnostic metapsychology; and the fourth, R. Marshall and S. Marshall's
Transference-Countertransference Matrix, presents an original contemporary paradigm for
joining together the study of transference, first noticed by Freud after his 1900 work with Dora,
with the study of countertransference, first directly explored by Ferenczi in 1931-1932 with R.
N.

THE FIRST ANALYSIS OF COUNTERTRANSFERENCE

The Clinical Diary of Sandor Ferenczi, written in 1931-1932, did not appear in English
translation until 1988. For students of the history of psychoanalysis, this delay of over 50 years
is a remarkable fact in itself—to which research attention must one day be paid—because this
work is of major historical and clinical significance. Most important, from the vantage point of
the present, is the discovery of the study of countertransference in vivo during clinical
psychoanalytic inquiry in the case of R. N. True, the discovery was made with her in the context
of a mutual analysis, during which Ferenczi ran into ineradicable barriers to the practice of
mutual analysis that have remained in place to this day. Simply, he could not say everything that
came to his mind in free association. He found it impossible because of the principle of
confidentiality to discuss feelings and thoughts that concerned any of his other patients, past or
present. Also, of course, he saw R. N. for 2 hr in sequence, one with him as psychoanalyst and
her as patient, then one with her as psychoanalyst and him as patient, and he found it too
cumbersome to organize an overall schedule of practice around this sort of procedure. Finally,
because mutual analysis is clinically impracticable, he thought it would suffice to take the
patient's resistance seriously from the beginning, instead of holding back for 2 years, as he had
in the case of R. N., before considering its relation to countertransference. He proposed, in the
future, to consider directly what patients and/or psychoanalysts saw as the possible source of
their resistance in the personal psychology of their psychoanalysts.

A decade earlier, in The Development of Psychoanalysis (Ferenczi & Rank, 1923/1950),

Ferenczi, collaborating with Rank, had been among the first to suggest that the distinction
between a therapeutic and a didactic analysis was artificial. Because a didactic analysis of the
psychoanalyst, as it was then termed, had to demonstrate the meaning of psychoanalytic therapy
by direct experience, it was, they believed, no different in kind from the therapeutic analysis of
any other patient. However, by 1931-1932, Ferenczi went even further in the work under review
toward involving the psychoanalyst in the therapeutics of psychoanalysis. He came to the
realization that only those psychoanalysts who as patients had been “there”—that is, had taken
part in the psychoanalytic “dialogue of unconsciouses” (Ferenczi, 1932/1988, p. 84) in a self-
reconstructive way—could seriously consider doing it with other patients; only they knew the
real thing when it happened. This is an original and coparticipant approach, no longer geared on
principle to the patient alone as the center of inquiry; it runs counter to the standard of
procedure still being upheld in the one-way empathic approach of the Chicago school of self-
psychology to be considered. But, as a matter of historical record, it should be emphasized that
when Ferenczi was making this recommendation, many senior psychoanalysts of the day,
including, of course, Freud, had never undergone a personal analysis as essential to their
firsthand preparation for psychoanalyzing others. Until Ferenczi's work with R. N., from the
standpoint of the present, the actual complexities of the relationship that naturally develops
between psychoanalyst and patient hardly evoked any clinical interest. There was no
experiential field of therapy to speak of, let alone explore. Countertransference, in accordance
with the standard view first set forth by the unanalyzed Freud (1910/1950b), had no place in the
therapy. Hence, there could be no interpersonal field of therapy, only the psychology of patients
treated by psychoanalysts who defined themselves as being only mirrors who reflected back
nothing but what their patients showed them—as though that were clinically possible. Classical
psychoanalysts never moved into self-aware relatedness with patients from their side.

Built into Freud's approach was a paradox that could not be clarified without basic modification
of the approach itself. He never thought to bring about the modification, plaguing the
traditionalists ever since. Consider the following way of looking at it. If Freud had, in truth,
consistently kept his countertransference out of his therapeutic work, he could not very well
have introduced his instinctual-libidinal metapsychology for the interpretation of his patients,
because that metapsychology had deep roots in the unconscious dimensions of his own
personality. And if, on the other hand, Freud truly believed that his metapsychology was
universally applicable, he should have considered applying it in a personal analysis to his own
psychology as well, but especially during his work with his patients. Perhaps, one might say, he
wanted to keep his countertransference out as a practical matter, so as not to allow patients to
make their analysis of him take precedence over his analysis of them. But he was, it should be
emphasized, an unanalyzed analyst, so that his patients might seriously have focused attention
on his countertransference because they found him at certain points needing the analysis more
than they did—most likely, after they had already made some progress with their own
transference.

Other things from Ferenczi's Diary may now also be factored into Freud's view of the
therapeutic equation. For example, Ferenczi tells us that Freud privately thought of patients as
“riff-raff” or “rabble (Gesindel),” worth treating for the money and for acquiring further data to
extend his metapsychology (Ferenczi, 1932/1988, p. 93). He, in fact, exerted extraordinary
pressures on Ferenczi to dissuade him from pursuing his clinical experiments in the relationship
of deep resistance to the study of countertransference during the actual therapeutic inquiry.
Freud wanted him to undertake some political activity instead and become president of the
International Psychoanalytic Association in 1932. In Freud's mind, so it appears to me, the
possibilities of psychoanalytic therapy had lost out to its limitations, so that he would not follow
Ferenczi, Rank, or Reich into the study of the actual therapeutic relationship during the 1920s,
nor into the direct clinical study of the ego, object, or interpersonal relations that Anna Freud
and Hartmann, Klein and Horney, and Sullivan and Thompson, among others, were bringing to
mature realization during the 1930s. This innovative work of both decades somehow left him
behind; these new empirical realities were beyond the reach of his clinical compass. Ferenczi, it
is becoming increasingly clear from his recently translated Diary, actually strove to bring Freud
into the orbit of this new clinical research, hoping thereby to overcome Freud's opposition to the
new study of the interpersonal experience of psychoanalytic therapy, and, in addition, to
encourage him to modify his one-sided approach from the perspective of evolutionary biology.

INSTINCTUAL-LIBIDINAL METAPSYCHOLOGY AGAIN

Edelson's Theory in Crisis, in my view, takes off from this point of historical discussion,
holding that the sexual instinct of traditional metapsychology constitutes the central core of that
theory—which is, in short, why I think the theory is in crisis. In Freud's usage, the notion of
sexual instinct is not strictly scientific. It should, instead, more properly be termed a myth or
metaphor of interpretive metapsychology, because sex, as such, is never directly studied under
the conditions of clinical psychoanalytic inquiry. Sex, instinct, libido, id, or drive becomes a
personally preferred metaphor for the understanding of why people get into psychological
trouble, and the focus around which to explore their personal psychology in accordance with a
genuinely psychoanalytic theory—the theory of unconscious psychic experience. This is the real
psychological theory of psychoanalysis as distinct from its diverse metapsychologies, and it
derives from the universally accepted notion that more is going on in our experience than we are
aware of at any given moment. As a theory of experience, it extends of course beyond the
conditions of clinical psychoanalytic inquiry and beyond the aegis of the sexual metaphor.

Edelson construes this crisis in psychoanalytic theory today, however, not as internal in origin
but as the result of two kinds of external criticism. From one side, the philosophy of science (see
especially Grünbaum, 1984), comes the argument that the data of clinical psychoanalytic
inquiry, derived from the direct interpersonal relations of psychoanalyst and patient, have
proved useful in producing new leads for genuinely creative, empirical psychoanalytic
hypotheses, but are not themselves scientific. Clinical psychoanalytic data are, in Grünbaum's
view, irremediably flawed, especially by the power of suggestive influence during therapeutic
inquiry. They are, in addition, flawed by the absence of adequate control of both the initial and
the surrounding conditions of any particular psychoanalytic inquiry. All such conditions are, it
is agreed, hopelessly beyond the psychoanalyst's and the patient's control. So the data are not,
nor are they ever capable of becoming, scientific data comparable to those of the so-called hard
sciences. The subjective element is, all participants in this discussion agree, finally inexpungible
from the clinical psychoanalytic domain. Nor, within the limits of that domain, can the value of
any psychoanalytic hypothesis be tested. Therefore, this argument concludes, psychoanalysts
qua therapists do not meet the conditions and standards for putting the principles of clinical
practice on a defined scientific footing.

On the other side are those hermeneutical critics of psychoanalytic theory who suggest that
psychoanalysis is not a science at all. Any scientific line of inquiry is, in this view, ultimately
fruitless. Psychoanalysts need not, therefore, be concerned with envisioning any large-scale
experimental and epidemiological studies, as the aforementioned philosopher of science
strongly urges, primarily because psychoanalysis is, the hermeneuticists hold, first and last an
interpretive discipline, seeking a narrative kind of truth, rather than an historical and functional,
or real truth. Don't bother with the values of scientific truth: Psychoanalysis is a hermeneutical
concern more closely aligned with various approaches to literary criticism than with scientific
psychology. Psychoanalysis is, in this view, wholly located in the realm of interpretive
metaphor. Aiming to tell the best possible story about the patient's life, psychoanalytic therapists
become, at best, like literary critics when they succeed, or, at worst, like script writers of daily
soap operas when they do not. It is not that psychoanalysts have not been able to make their
work rational yet, as the philosophers of science would hold, but that they need not even make
the effort at all. If psychoanalysis is viewed as the study of personal narration, however, then
literary critics such as Bloom (1973) on the anxiety of influence and de Man (1988) on the
deconstruction of all narrative, I suggest, become far more important to the critical
understanding of the foundations of psychoanalysis than any approach of logic and scientific
method. Psychoanalysis, no longer a branch of psychology in this view, no longer need concern
itself with theories of truth, verification, or falsifiability, or with a coordinated structure of
inquiry. All psychoanalytic theory and practice prior to the rise of this hermeneutical approach
must, therefore, be deconstructed and refashioned from the standpoint of belonging to an
interpretive discipline or a branch of literary criticism. Ferenczi's work, previously discussed,
certainly was not literary criticism; nor was Breuer's, Freud's, Rank's, Reich's, Anna Freud's,
Hartmann's, Sullivan's or Thompson's.

Both lines of criticism, from the philosophy of science and from the hermeneutic discipline, are
developed outside the consulting room of psychoanalysis and brought into its way of thinking
and working in the clinical enterprise. Edelson, accepting their challenge like a happy warrior,
enters the fray with a gutsy defense of the case study method of psychoanalytic therapy. I find
his tightly packed and closely reasoned argument very persuasive. But I am, from direct
experience, already persuaded that the case study method of individual psychoanalysis in a two-
person field of inquiry is workable in its own terms, under its own conditions, toward its own
outcomes. Others not so involved in daily clinical practice may not be as easily persuaded.
Perhaps we must await new traditions in the philosophy of science and literary criticism when
applied to psychoanalytic inquiry, more modest in reach and more open to empirics and
systematics, not to mention the therapeutic experience of psychoanalytic inquiry itself. In
addition, it becomes clear from the collection of papers under review, that the crisis in theory
comes from inside the field, as the author construes it. Its resolution may, I suggest, derive from
an approach to psychoanalysis different from the one adopted here; that is, not so firmly
committed to the sexual metaphor of classical Freudianism, nor so strongly opposed to the later
ego, object, and interpersonal perspectives. (There is, in 364 pages, only one indexed
reference—three sentences—on countertransference, “so-called” still in 1988, despite Ferenczi's
earlier finding of its functional correlation with the patient's resistance.)

Freud's imaginative strength in instinctual—libidinal metapsychology overvalued, yet the

weakness of his clinical and empirical striving overlooked, it is fair to say that Edelson's Theory
in Crisis may not as generally characterize the general psychoanalytic practice of others as it
does the speculative arena of traditional Freudian metapsychology.

A VIEW FROM CHICAGO SELF-PSYCHOLOGY

Responding to the selfsame critical situation in psychoanalytic theory, Goldberg offers A Fresh
Look at Psychoanalysis from the point of view of the recent Chicago version of self-
psychology. He, instead, suggests that all three approaches—the philosophy of science, critical
hermeneutics, and clinical empiricism—each hold up for their own range of theoretical and
practical activities. These approaches are, he continues, not competitive but alternative ways of
looking at the field, the inquiry, and the therapy. They support one another and, he concludes,
therefore become one; hence, his Fresh Look. This expression of empathy and extraordinary
openness toward three hardly compatible, even basically divergent approaches may remind his
readers (this reader at least) of the confirming, supportive, and strongly empathic attitude that
Kohut encouraged his students to adopt in their therapeutic relations with patients. Above all, he
believed, they should remain completely centered on the inner world of their patients. But this
one-way empathic posture is not without its down side; that this psychoanalyst also adopts the
role of a mind-changer, according to Goldberg (p. 203), not that of an explorer of psychic
experience.

In a wide-ranging series of papers, collected under the headings of theory, empathy, character,
and aspects of clinical inquiry, Goldberg throughout takes a rather consistent position with
regard to the inner world of the patient. At one point, he writes: “The patient and the analyst live
in different worlds. Patients arrive with a life history and a perception of life that the
psychoanalyst tries to comprehend by … ‘prolonged empathic immersion”’ (p. 238).

On its surface, it is a point about which we would all find very little to disagree, yet if the
empathy being considered is a generic human trait, one wonders how patients are expected in
this Fresh Look to deal with their own capacity for empathic immersion—a capacity that would
only become even more available to them as their psychoanalytic therapy progresses. Nor is it
clear how psychoanalysts who are mind-changers can respond to their patients empathically.
And what happens to their self-psychological relationship when taken over by this newly
emerged exchange of empathy? Once perceived by their patients as being mind-changers, how
can psychoanalysts continue to perform that function unselfconsciously? Or, with empathy a
two-way experience, does the psychoanalytic therapy move beyond the level of negotiated
settlements to that of Ferenczi's “dialogue of unconsciouses?” Here, then, are empathy and
counterempathy. In the scheme of this work, because the psychoanalysts exercise all the
empathy, it must be the patients who exercise the counterempathy.

The issue becomes even more complicated. Goldberg, as already indicated, believes that a
psychoanalyst and patient occupy two different worlds of treatment, yet with the former
somehow empathically immersed in the world of the latter, the empathy going one way. For it is
the psychoanalyst whom Goldberg considers “the carrier of a more informed reality” (p. 238);
and the purpose of interpreting transference is, therefore, “to make the patient understand the
analyst's view of the world” (p. 239). This Fresh Look quite unexpectedly takes on a very
traditional cast. It is, in my opinion, not easily distinguished from Freud's classical procedure of
choice, recommended in his Introductory Lectures, in which he met his patients on “the
battlefield” (1917/1943, p. 395) of transference and overcame their resistance to his interpretive
metapsychology of instinct and libido, and later the id, which he considered more informed than
theirs. So it is the look of the writing, only, that is fresh here. Although the terminology is 1970s
self-psychology of recent origin, the substance of the psychoanalytic procedure remains most
traditional and relatively unchanged. The patient, traditional or self-psychological, must learn to
accept the psychoanalyst's more informed view of reality as the latter defines it. Thus emerges,
finally, the central point of the surprisingly narrow emphasis placed on the therapeutic uses of
empathy by the Chicago self-psychologists, including Goldberg.

On this point, the leitmotif of this book turns back on itself. Prepared, as we are by the
Introduction, to expect a novel and changed approach to psychoanalytic therapy based on the
psychoanalyst's empathic centeredness on the patient's world, at the heart of the argument we
discover the classical Freudian motif. Patients must surrender their own psychic reality of
fantasy, not on the basis of their own increasing conscious awareness and self-knowledge, but
because they are “made” (why not “forced”?) to see themselves through the eyes of their
psychoanalysts. In the process here, no doubt, patients also have to discover why they
themselves failed to acquire the more informed view of reality their psychoanalysts so readily
ascribe to themselves. Once again, but from another written source, it appears that the
confirming, supportive, empathic selfobject the Chicago self-psychologists offer their patients
in therapy is predicated on the proposition that patients should be treated as though they were
difficult children who have no ideas of reality worth mentioning, and who do not know what it
is all about until they encounter their psychoanalyst's more informed view. By the end of A
Fresh Look, there is a fresh sense of confusion and disappointment. We are finally told that
understanding another—that is, putting ourselves in the other's shoes—is an impossible goal; so
much for the possibility of true empathic immersion.

THE FIELD OF TRANSFERENCE-COUNTERTRANSFERENCE

Turning to the last book under review, The Transference-Countertransference Matrix, is like
moving into a therapeutic atmosphere cleared of excessive theoretical baggage and
metapsychological interpretations, and moving far closer to the bedrock of clinical
psychoanalytic inquiry. It is not that R. Marshall and S. Marshall lose track of the social,
cultural, and philosophical context within which the practice of psychoanalytic therapy is
situated. They see that this context is, and always will be, suggestive of new possibilities in
actual clinical work. But psychoanalysis travels from culture to culture, and each study must
consider the actual terms, conditions, and culture of the experiential field within which it is
done.

The Transference-Countertransference Matrix—note the hyphen, rather than the conjunctive—

is, I am happy to report, a real honest-to-goodness book, and not a collection of previously
published papers revised with some additional material for publication in one volume. It is a
thorough analysis of the field of transference and countertransference from both empirical and
critical points of view. It is well researched and well documented, providing a workable grid,
illustrated by an extended case study, for the careful exploration of transference and
countertransference, and their relationship to one another. Also included is a carefully selected
and exhaustive review of the literature that is up to date and not limited to the beliefs and values
of any one perspective on metapsychology. In other words, you may believe that psychoanalysis
is solely and exclusively an interpretive discipline and still profitably consult this work on
transference and countertransference as a guide to working in the therapeutic experience of
psychoanalytic inquiry. The Transference-Countertransference Matrix is, however, squarely
based on the empirical and systematic orders of psychoanalytic inquiry, and on the centrality of
the shared clinical experience between the two coparticipants in that inquiry.

Interestingly enough, this work links into the chain of psychoanalytic development that reaches
back to Ferenczi's Diary and to its emphasis on the dynamic interrelation of psychoanalyst and
patient in therapy, especially on the explorable correlation of the patient's resistance and the
psychoanalyst's countertransference. Putting the details of metapsychology aside, this sort of
functional correlation leads, as already mentioned, into the “dialogue of unconsciouses,” that the
Marshalls bring directly into the present with the discussion of the unconscious dialogue based
on emotional communication. They suggest that psychoanalysts with a background in gestalt,
phenomenology, system and field theory tend to grasp the clinical significance of the dynamic
interactive approach earlier than those with previous training in the physical, chemical,
biological, and other so called hard sciences. Yet the fact is, no matter what their field of
original interest, practicing psychoanalysts are all trained in psychoanalytic theory and practice
and the tough questions they all face concern the nature of the clinical psychoanalytic data they
select for study. The future, it seems to me, belongs to students in the field of clinical
psychoanalytic inquiry itself. Efforts at interpretive and speculative metapsychology that lack
demonstrable empirical roots in the coparticipant experience of psychoanalytic therapy may, of
course, continue to have a life of their own in some other field of inquiry. When psychoanalysts
arbitrarily introduce such abstract perspective of metapsychology, however, they so transform
the clinical relationship of psychoanalyst and patient as to diminish or practically eliminate
altogether a dynamic consideration of the transference-countertransference matrix. That, in turn,
diminishes or practically eliminates a consideration of the dynamic interactive aspects of
transference becoming manifest in the therapeutic present of the two coparticipants. This
became evident very early, and it is now clear in retrospect, in Freud's personal circumscription
of the therapeutic field, specifically to exclude all manifestations of countertransference from
the active interest of his patients during the actual therapeutic inquiry in which they arose. He
never modified his narrow view of the transference-countertransference matrix. This puts the
work under review, together with the ego, object, and interpersonal perspectives to which it
belongs, in the Ferenczian tradition.

The authors adopt a working definition of countertransference that, in my view, is now

unexceptionable: all feelings and behaviors on a continuum from a purely external source—the
patient—to a purely internal source—the psychoanalyst; hence, the transference-
countertransference matrix. This continuum derives, they say, primarily from the work of
Racker, Spotnitz, and Winnicott. That, of course, represents a reasonably wide enough range of
views on countertransference for their integrative purposes. They also reasonably question why
Winnicott introduced the notion of objective countertransference, and then used it to support his
expression of hate in the countertransference. They consider his suggested terminological usage
“premature and presumptuous” (p. 65). I agree, but would add that the notion of objective
countertransference is oxymoronic, because no experience of hate by a psychoanalyst, whatever
its presumed stimulus from without, can be understood in the absence of some direct reference
to the subjectivity of the psychoanalyst. The countertransference of hate is still a
countertransference—no more, no less than any other felt experience—for which the
psychoanalyst cannot dodge responsibility, no matter how he may later attempt to make its
expression rational. From the other side, of course, the notion of purely subjective
countertransference is tautological, because countertransference, if it is not subjective, is of no
clinical psychoanalytic interest.

Given Winnicott's rather vague, even unintelligible view of countertransference, it is difficult to

see why the authors felt constrained to single out his view and make it central to their fine study.
Clearly, they consider the notion of objective countertransference ambiguous and unworkable,
characterizing it as “a tricky idea and difficult to pin down” (p. 65). Their problem with
Winnicott's proposed notion derives, I suggest, from the fact that they quite naturally look, as
we all do, where he points us—namely, to the outside objective situation created for him by the
psychology of the patient. Look to the inside subjective situation of this object-relational
psychoanalyst instead, and the sources of his hate may be more directly seen as arising in self-
defense against his own unexplored fear and anxiety, against his own intolerable pain and
suffering, and against his own personal failure to consider such felt experience as being at least
equally important reasons for countertransferring hate. In this psychoanalyst's mind, it is the
patient who stimulates that unpleasant feeling; by creating more distance between himself and
the patient, as a direct result of the hate, he hopes to rid himself of the feeling. Obviously, if the
psychoanalyst's hate is not yet psychoanalyzed in subjective terms, given his psychic structure,
also unpsychoanalyzable, the next best thing to do with his hate is to learn how to use it
constructively with the patient.

All psychoanalysts need not, however, accept the personal experience of any single member of
their scientific community and make that one person's procedure the policy they all must follow.
It is, after all, but one person's view of how to proceed in the particular instance with the patient
during clinical psychoanalytic inquiry. Before psychoanalysts uncritically accept this counsel of
despair about penetrating to the dynamic sources of their own hate, anger, rage, hostility, and so
on, they might seriously consider an entry on hate in Ferenczi's Diary: “all hate is projection, in
fact psychopathic” (p. 78, italics omitted). He adds: “If pain is inflicted on someone, or love is
withdrawn, there is suffering. The rational reaction to this would be sadness … The hate
reaction is completely unreal” (p. 78). Hate directed outward, he suggests, simply outplaces the
internal suffering onto its presumptive source, to the fullest extent that the source can appear, or
be transformed, to receive it.

Who in fact directly inflicts this suffering on practicing psychoanalysts? Perhaps it is time to
acknowledge that psychoanalysts do that to themselves, without making the attempt to endure
the suffering long enough to get through to the inner sources of the experience of hate, as being,
by means of inner transformation, an experience of their own making. If psychoanalysts lack the
developed capacity to be alone with their hate, or to see themselves as capable of getting clear to
the sources of their self-generated suffering, they will remain caught up in the reactive
dependency of their own psychology, inextricably intertwined with the otherness of the patient.
It is as though no psychic line of demarcation exists between the psychoanalyst and patient, no
conscious awareness of where one psyche ends and the other begins. With the development of
such individuated awareness, on the other hand, psychoanalysts may also save themselves a lot
of personal anguish. If Winnicott had later returned to a reconsideration of his hate in
countertransference as objective and therefore enactable against its presumed objective source,
the patient, he might have modified this view of countertransferred hate with reference to his
developmental emphasis on the capacity (including his own) to be alone. But he never did.

WHAT HAPPENS NEXT?

Even a cursory reading of the books under review would suggest that the major advances have
always been made in the therapeutic experiments of psychoanalytic inquiry. Thus, a theory or
metapsychology in crisis is a perspective with a slowly waning, at some points even lapsed,
connection to actual therapeutic experience; or a fresh look at psychoanalysis that completely
immerses itself in the patient's world becomes ambiguous and inevitably confused about the
presence of the psychoanalyst's world within the experiential field of therapy co-created by the
two participants; or an empirical view of the transference-countertransference matrix makes it
possible to work effectively within the interpersonal relationship, no matter what the
psychoanalyst's procedure, no matter what the psychoanalyst's and/or patient's
metapsychologies. Now that unconscious psychic experience first defined by Breuer working
with Anna O., transference first sighted by Freud working with Dora, and countertransference
first clarified by Ferenczi working with R.N., are all well established in the structure of
psychoanalytic inquiry, what happens next? Facing the clinical experimental present, we look
forward to major new discoveries comparable in range and depth to the empirical observations
of transference and countertransference, resistance and counterresistance, anxiety and
counteranxiety, and the unique individuality of the two coparticipants in the therapeutic
experience of psychoanalytic inquiry.

REFERENCES

Bloom, H. (1973). The anxiety of influence. New York: Oxford University Press.

Breuer, J. & Freud, S. (1957). Studies on hysteria. New York: Basic Books. (Original work
published 1895).

de Man, P. (1988). Critical writings, 1953-1978. Minneapolis: University of Minnesota Press.

Ferenczi, S. & Rank, O. (1950). The development of psychoanalysis. New York: Dover
(Original work published 1923).

Freud, S. (1943). A general introduction to psychoanalysis. Garden City. NY: Garden City
Publishing Co. (Original work published 1917)

Freud, S. (1950a). On the history of the psychoanalytic movement. In E.Jones (Ed.). Collected
papers (Vol. 1, pp. 286–359). London: Hogarth. (Original work published 1914).

Freud, S. (1950b). The future prospects of psycho-analytic therapy. In E.Jones & J.Riviere
(Trans.). Collected papers. (Vol. 2, pp. 285–296). London: Hogarth. (Original work published
1910).

Freud, S. (1950c). Fragment of an analysis of a case of hysteria. In E.Jones &

A.Strachey.S.Strachey. (Ed.). Collected papers (Vol. 3, pp.13–146). London: Hogarth. (Original
work published 1905).

Grünbaum, A. (1984). The foundations of psychoanalysis. Berkeley, CA: University of

California Press.