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Kamlesh Singh. Interdisciplinary Working in Mental Health. Di Bailey. Sexual Difference. Stephen Frosh. Murdered Father, Dead Father. Rosine Jozef Perelberg. Ancient Views on the Quality of Life. Alex C. Psychoanalysis in Context. Anthony Elliott. Well-Being and Cultures. Hans Henrik Knoop. Dictionary of Existentialism. Haim Gordon. The Positive Psychology of Personal Transformation. James Garbarino. Antonella Delle Fave. Phenomenology and the Social World. Laurie Spurling.

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The Revision Of Psychoanalysis

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The Revision of Psychoanalysis

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Kamlesh Singh. Interdisciplinary Working in Mental Health. Di Bailey. Sexual Difference. Stephen Frosh. Murdered Father, Dead Father. Rosine Jozef Perelberg. Ancient Views on the Quality of Life. Alex C. Psychoanalysis in Context. Anthony Elliott. Well-Being and Cultures. Hans Henrik Knoop. Dictionary of Existentialism. Haim Gordon. The Positive Psychology of Personal Transformation. James Garbarino. Antonella Delle Fave. The examination of the transference should begin with a careful clarification of exactly what the patient's experience is, including whatever influences in the current situation are involved.

The therapist must not ever assume that he necessarily clearly understands the patient especially if the patient is vague, indefinite, and elusive. It is commonly not recognized that transference is ubiquitous because the resistance to becoming aware of it on the part of both patient and analyst leads to its appearance in disguised form in associations not manifestly about the current relationship.

The clarification of what the patient is experiencing requires seeking out these allusions to the present relationship and making them explicit. I suggest that this activity be designated interpretation of resistance to the awareness of transference in contrast to interpretation of resistance to the resolution of transference. The analysis of transference, after the clarification of what the patient's experience of the relationship is, should begin with a search for what makes the patient's experience at least somewhat plausible to him.

This amounts to a major change from the usual emphasis on how the patient's experience is a distortion of the situation to an emphasis on how the patient's experience can be understood as a plausible understanding of the situation [Footnote 2]. The compulsion to re-experience and re-enact the past is a major motivation for the selective attention with which the patient experiences the present as he constructs his plausible understanding of it.

Footnote 2: Work in the resolution of the transference analogously should seek the plausibility in the patient's experience of past relationships Hoffman, A major role in the resolution of transference is played by the patient's coming to see that this plausible meaning of the situation is indeed no more than only plausible and not unequivocal, that is, that his experience of the situation is based to a greater or lesser degree on determinants within himself.

The awareness that there are such determinants will probably sooner or later lead to data from the past which help explain how they came to be. Such explanation falls into the familiar category of the resolution of the transference by the examination and re-evaluation of the past. The patient not only experiences the analytic situation in a way which conforms to his preconceptions, whether conscious or not.

He also behaves in a way designed to get the therapist to justify these preconceptions which in turn lends further plausibility to them. The extent to which the therapist is unaware of how he is being experienced may well be a measure of his unwittingly responding to pressure from the patient and coming to behave in a way which increasingly justifies and makes plausible the patient's preconceptions.

Sandler has described this phenomenon as the analyst's role responsiveness. Otherwise expressed, the patient stimulates countertransference. I add a point about countertransference, to which I directed little attention as such in my monograph. It is that the most important aid to the therapist in discerning his countertransference is the patient's interpretation of it, to a large extent in disguised references in his associations.

Langs and Hoffman have described how the patient can be seen as an interpreter of the analyst's experience. This similarity between Langs' views and the view which Hoffman and I share must not be permitted to obscure a crucial difference. Langs sees the patient as correctly perceiving the analyst's unconscious intent whereas we see the patient as only constructing a more or less plausible view of the analyst's motivations. A frequent criticism of my view of transference and its analysis is that it is said to be in opposition to what many others believe to be the essence of the psychoanalytic method, namely the recovery of the patient's history.

I believe it is not a matter of opposition but of technical priority. When I spoke of the important role played in the resolution of the transference by the recognition that the patient's experience of the relationship is plausibly but not unequivocally determined by the actuality of the analytic situation, I did not mean to derogate the role of the patient's awareness and integration of his history in resolving the transference.

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I do believe, however, that priority of attention to the recovery of the history can lead to important inadvertent effects on the transference. Such priority is often a defensive flight by either patient or analyst or both from the discomfort aroused by explicating, examining, and interpreting the transference phenomena in the here-and-now. To the extent to which this is true the recovery of the past may exert its effect by way of inadvertent suggestion.

The issue which I am discussing has a long history in analytic technique in another regrettably and unnecessarily polarized controversy over the relative importance of experiencing and remembering. While I am not discounting the value of remembering, I believe that an analysis in which priority of attention goes to the transference expressed in the here-and-now, including the analyst's contribution, will be much freer of lasting effects of inadvertent suggestion than one in which priority of attention goes to genetic interpretation which may bypass transference.

The analysis of the transference may be defined as attempts to understand the patient's current experience, in relation to the analyst, including its plausible sources in the here-and-now, so that its sources in the past experience, wishes, and conflicts can be illuminated and more conscious, and flexible integration of past and present is brought about.

Much of the analyst's behaviour which from the patient's point of view leads him to a plausible interpretation of the analyst's motivations is from the analyst's point of view inadvertent. For initial illustrations I turn to two of Freud's cases. First, the Dora case Freud defended himself against the possible criticism that he should not have talked about intimate sexual matters with a young woman by arguing that to do so was not necessarily prurient or harmful.

True enough. But would it not have been plausible for Dora to interpret his obvious interest in her sexual life and the possible apparent concomitant relative lack of interest in what was consciously her primary concern, the hypocrisy in her family as a more subtle variant of Herr K's sexual interest in her?

Second, the Rat Man Freud, Would it not have been plausible for the Rat Man to have interpreted Freud's interest in getting the details of the rat torture to be a form of torture? Freud has been criticized Kanzer, for influencing the transference by trying to guess what the torture was. We may infer from Freud's explicit disavowal that he wanted to torture him that he was trying to dispel any such feeling on the Rat Man's part.

I am not saying that Freud should not have inquired into Dora's and the Rat Man's mental content.

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I disagree with those who believe that all such material can emerge spontaneously in free association, and that they should wait for it to so emerge so that the patient has no rational basis for imputing sexual or aggressive intent to the analyst [Footnote 3]. I am suggesting on the contrary that such plausible imputation is unavoidable precisely because of the multiple interpretations to which human behaviour lends itself and because the patient is primed by his past selectively to interpret the present. Rather than to pursue such impossible avoidance on the basis of a mistaken premise as to the nature of the analytic situation, the analyst should bend his energies to detecting the implicit indications that the patient is making such imputations and bring them into the open by interpretations of their plausibility in the light of the here-and-now with the ultimate aim of elucidating the patient's own contribution.

The latter stems from the patient's past, the there-and-then. Footnote 3: How directly and openly something needs to be expressed, in order to be able to say that it is "emerged"? This has always been a hot topic in clinical discussions, due to the differences in evaluating the role played by inference in assuming that something is presumably present in a masked way.


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Here is an illustration from a recent paper by Rangell He writes that for a period of time a patient's response to every interpretation or achievement of a piece of insight was "So what? He does not describe any investigation of the meaning of the "So what? So he made the following intervention: "You ask so what and not so why". He considers that the patient needed this suggestion to stimulate progress in the analysis.

OPTIMAL MARGINALITY: Innovation and Orthodoxy in Fromm's Revision of Psychoanalysis

He explicitly disavows that the patient was being reprimanded or ordered to think along these lines. I believe this disavowal betrays Rangell's peripheral awareness that the feeling of being reprimanded or ordered to think along these lines might well have been plausibly experienced by the patient as an inadvertent effect of his interpretation on the expression of the transference.

In fact he introduces the vignette to the reader by saying he wants to make the point that an active role on the part of the patient must be enlisted continually. This was therefore probably the implicit message both as intended by the analyst and experienced by the patient. I believe he should not have assumed that he knew what the "so what? He should have attempted to understand its meaning in the transference. Furthermore, once having made his remark he should have been alert to its possible repercussion on the expression of the transference.

Rangell says the interpretation was successful and cites some subsequent insights about the patient's relation to his mother. He does not provide enough data to say how these insights may have combined disguised references to the patient's past and to the analyst's intervention. I believe the example illustrates a typical failure to recognize that primary attention should be directed to the examination of the transference in the here-and-now, in this instance first to the "so what? The examples I gave all illustrated how the patient experienced interventions.

What is also often not focused upon by analysts is the role they have played in the common transference responses to features of the analytic setting themselves. The fact that these features may be experienced very differently by different patients or by the same patient at different times, or even simultaneously, probably increases the likelihood that the analyst will regard the patient's experience as essentially or even entirely self-determined.

But the analyst's attitude is also a determinant of how the patient experiences these features of the analytic situation. The couch may be a welcome indication that the patient need not concern himself with the therapist's reactions or it may mean that the patient is deprived of the cues he must have to the analyst's reactions without which he is too frightened to speak. The manner in which the analyst brings it about that the patient lies down will to a varying extent co-determine whether the patient experiences the couch as a relief from fear of meeting the therapist as an equal or as a degrading submission.

The way the frequency of sessions is settled will co-determine to a greater or lesser extent whether frequent sessions mean a promise of indulgent unending care or a loss of respite from a relentless invasion of privacy. Similarly, open-ended duration may be a reassurance that there is adequate time but it could also be experienced as an indeterminate sentence without possibility of probation. Jacobson writes:.