On: transference, countertransference and projective identification

In this essay, I define the psychoanalytic concept of transference and its development in the hundred plus years since Freud’s discovery. I illustrate it with a clinical example of a patient’s transference to me. I follow by using the same structure; define, historicise and illustrate, for the concepts of countertransference and projective identification. How countertransference is used differs by analytic school and I make a reference to the differences between Freudians, Kleinians and Independents. These foundational concepts do not belong to the consulting room only. I reference how they inform the psychosocial worlds, notably race, before concluding.

Transference is a process. Its key is ‘displacement’, displacing an unconscious idea, from the object to which it was once attached, and on to the analyst. For Freud, what was transferred was a window into unconscious assumptions, via feelings that properly belong elsewhere (Frosh, 2012). In his ‘Dora’ case study, Freud (1905) had defined transference as “new editions or facsimiles of the impulses and phantasies … aroused during the progress of the analysis”. Transference, then, is the “actualisation of unconscious wishes” (Laplanche and Pontalis, 1967) and a form of the mother-infant dyad (Winnicott, 1960), an illusion where someone, not consciously recognised, represents something, which forms the basis for a repetition of a relationship with an important historic figure (Sandler, Dare and Holder, 1973). The impulses (Freud, 1937) have their source in the earliest object relations and come forth as a consequence of the compulsion to repeat. The analyst works to strengthen the analysand’s ego, so that there is less displacement and the gap between fantasy and reality becomes better understood.

Its discovery and its evolution began with the attachment formed by a patient of Freud’s colleague, Breuer, later anonymised as ‘Anna O’. (Freud, 1893). Freud’s original frustration with transference, that it was a resistance to the analysis, shifted to recognition that it made the therapeutic alliance about emotion (Freud, 1910, 1912, 1914). Freudians consider that treatment is about recognising how the analysand’s transference is informed by an attempt to gratify drives, designed to reduce unpleasure (Lemma, 2016). Freud’s initial focus, was on erotic and romantic transference. Therapy was effected by love, and early appreciation of what is now described as positive transference. The negative transference, (Klein, 1952) when an analysand brings forth hostile feelings from developmental relationships, was not really considered until Klein’s work. Kleinians believe hostility is linked to the death instinct, and that hatred and envy are innate. Klein also hypothesised that what might be transferred on to the analyst might be parts of the analysand’s self, such as the superego, rather than historic relationships. (Klein, 1952, 1957). Transference today is more a projection (Kleinian) model than a displacement (Freudian) one. Post-Kleinians, including Winnicott and Bion, look at the transference developmentally. Just as the mother receives the projections of the infant and moderates and mitigates, so that the infant can receive them back, so the analyst behaves for the patient. The analyst needs to remain alert and thoughtful, in a state of ‘reverie’ (Bion, 1962). All of the communications from the patient “contain something relevant to the transference situation”. (Segal, 1981)

To illustrate the concept, I share an experience from my personal clinical work: I have been working with a patient, ‘A’, who was largely raised by a disciplinarian stepfather, who appears to have had little affection for his stepson. His biological father left when he was three. In the transference, I am sometimes the stepfather: ‘A’ splits an eagerness to please me, to get it ‘right’, but also an anxiety that he will draw my ire. ‘A’’s childhood in his stepfather’s home was, as he recalls it, dominated by the demands to be useful, by completing a number of chores. At the outset of the therapy, he talked about decorating the NHS consulting room, if he had the right tools. I understood A’s inner world to be shabby and neglected, and his need to show he could be useful, and compliant. This is evidence of displacement, as are other times, when I sense I become A’s father, albeit idealised, as someone who was understanding and interested. What emerges then, is A’s infantile desire to be interpreted and loved. In my countertransference, I feel something parental and am reminded of the unconscious desire many therapists have to repair, something Klein (1952) highlights.

Countertransference like mine, is unresolved, unconscious elements within the analyst (Freud, 1910), evoking intense feelings. (Carpy, 1989) The analyst has an unconscious reaction, identifies the analysand’s role in bringing it about, and then examines the effect on both parties (Money-Kyrle, 1956). Freud had regarded it as an impediment that should be resolved by the analyst developing more ego strength in their own analysis. No analyst is “wholly free of infantile dependence” (Racker, 1948) and feelings and impulses are determined by the past, meaning that aspects of the Oedipal situation are repeated in every countertransference. Forty years after Freud’s anxieties about countertransference, Heimann (1950) redefined it as “an instrument of research” into the patient’s unconscious, because the analyst’s unconscious understands that of his patient. The analyst, is both an interpreter and an object of the impulses felt by the patient. Klein (1952), although prioritising the child’s phantasy life and unconscious phantasies, held similar views to Freud, claiming that only by analysing “the transference situation to its depths” could the past in both real and phantasy be understood. However, it is the ‘post-Kleinians’ (Bion, 1959, Segal 1975, Rosenfeld, 1987) that have been at the forefront of countertransference’s development. Currently, it is usually defined as being both the analyst’s own transference and the analyst’s response to the analysand’s transference.

Despite the significance of Ferenczi and Alice Balint’s views, that the analyst’s own feelings should be shared with the analysand (Heimann, 1950), little was written about countertransference until the end of the 1940’s (Racker, 1948). In developing Klein (1946), Winnicott (1947), had been amongst the first to grasp its significance for working with psychotic patient populations when describing hatred towards the patient. This is relevant for our contemporary understanding of issues like racism, founded upon the “irrationality of the unconscious” (Timimi, 1996). It was Heimann, though, that encouraged a more constructive view of something she felt was created by the patient; the aforementioned instrument of research. Klein (1952), who prioritised the child’s phantasy life and unconscious phantasies, rarely used the term countertransference until writing about the infantile roots for both parties in seeking ‘reassurance’ (1957). Ten years after Heimann, writing that the analyst needed to ‘sustain’ and not ‘discharge’ feelings, the word countertransference was “in danger of losing its identity” according to Winnicott (1960). He was inclined to Freud’s view and defined countertransference as “neurotic features” disturbing the analysis and spoiling the analyst’s “professional attitude.” Independents and post-Kleinians have been at the forefront of subsequent development, making it a “fertile, intersubjective field” (White, 2006). Winnicott (1963) and Bion (1965) looked at it developmentally, and Ogden (1994) has made it more about intersubjectivity, with his concept of the ‘analytic third’. More contemporary views are that the analyst should allow themselves to participate in the enactment required by the patient’s projections, in order to become conscious of the phantasy and emotion (Rosenfeld, 1971, Joseph, 1989, Bollas, 1987,1992).

In my work with a woman, ‘B’, I often find myself struggling to concentrate. I wonder if she is making me mad (Winnicott, 1960). I find myself wanting the sessions to come to an end and notice her need for attention, but how I seem to be resisting giving it. Her mother was diagnosed as schizophrenic, after ‘B’ reached adulthood. Her father left pre-adolescence and had a second family, so she has half-brothers. Everything about her world and world view appears to be influenced by splits. Her maternal care and her parents’ divorce concretised her views, I believe, and pulled her back from a developing depressive position to paranoid schizoid (Klein, 1946). I experience her as happiest when complaining about her family, friends, colleagues, and employment. I, guilty with inattention, sense a whining child, starved of gratification. Racker (1953) would suggest the patient is emotionally blocking and I am succumbing to “pampering”, initiated by my guilt at my wandering attention. By pampering, I re-focus intently and become a good Object for ‘B’, as the father was before he left. Sometimes my countertransference is paternally protective, (Money-Kyrle, 1956), but I think I often act out the neglectful mother, creating a guilt, which is a consequence of my inability to be a necessary container for her anxieties (Bion, 1959, 1962). This acting out has made me sympathetic to the Joseph, Rosenfeld and Bollas approaches.

Projective Identification, (PI), pre-dates Heimann’s constructive view of countertransference but had already transformed the transference/countertransference dynamic from a displacement to a projection focus (Klein, 1946). PI is an unconscious, omnipotent phantasy best captured by the lay phrase ‘giving someone a piece of my mind’. It is not everything that makes up the countertransference, (Heimann, 1950), but invariably seems to be the dominant feature in a therapeutic relationship; most commonly manifested as a part of the patient’s self, projected into the object (Segal, 1964) and where the projector is psychically aligned with the person into whom it has been projected. This is done, with the aim not simply of expulsion, but of using the projection to control the therapist, (Segal, 1981) inducing feelings or thoughts or by provoking forms of enactment. The object is transformed by the projection (Feldman, 2009). The projector fantasises taking over the therapist and influencing the recipient so that they think and respond in a way that is congruent with the projection (Ogden, 1982). The therapist processes what is projected, so that it can be palatably returned and the projector can introject what had needed expelling.

PI has been taken up by many theoreticians, notably Bion (1959, 1970), who adapted it by identifying what was projected as ‘beta elements’ that the therapist made sense of thanks to utilising ‘alpha function’, and then being able to reproject them. He considered that PI was understood as ‘a three-dimensional space’, into which patients projected the parts of their personality that they had split off. Klein thought that this was ‘observable’ in psychotic and borderline patients and Bion agreed with her that the ‘degree of fragmentation’ and the distance to which split-off fragments were projected was a measure of the distance a patient had from contact with reality. In his studies of the containment process (1959,1962), he observed how a mother takes in and allows herself to be affected by her infant’s projection of distress. The mother/analyst has not only contained an experience but transformed it. For some, enactment opens analytical work to “deep unconscious identifications and primitive levels of functioning” which are beyond the reach of the intellect, (Tuckett, 1997) albeit recognising one’s own feelings can be difficult (Brenman-Pick, 1985)

One of my experiences of PI came from a patient, ‘C’, presenting as depressed and unable to develop relationships. ‘C’ earned his PhD at Oxford, where his father was a fellow, while his grandfather was a celebrated and distinguished medic. He now edited a well-known scientific magazine, but felt his achievements were inferior to his family history, and he was ‘phoney’. (Winnicott, 1960). In our early work, he let me know that he thought that psychotherapy was “pointless”. Anyone working in the NHS, was probably unable to develop a private practise. He projected feelings of inferiority into me, in order to rid them from himself (Rosenfeld, 1987) and to enable him to adopt the superior status he associated with his father and grandfather. I found myself identifying with the intellectual inferiority, responding by making theoretical and technical interventions in the sessions. I became the boy he had been, desperately trying to show my academic and intellectual accomplishments to a demanding father. I was compliant and beginning a “defensive collusive arrangement” (Feldman, 2009). I had acted out something congruent with what had been projected into me, seeking attention and admiration. Once I became aware of what was happening, we were able to think about the competitive need for superiority. Eventually, he was able to introject the split off part and to accommodate it, recognising that he was still seeking parental love.

The concepts of transference, splitting and PI are fundamental to our psychosocial world. Klein (1952) asserted that transference operated throughout our lives influencing all relationships. Transference includes other significant figures beyond the parental couple, taking in the realm of the collective social unconscious. The social world contains multiple projected and introjected transference contents. External events, such as those affecting race or gender often catalyse a regression in psychic functioning activating defences. (Hamer, 2006) ‘D’, a Pakistani male patient of mine, projected his feelings of being unwelcome, on to outbursts against the Polish builders working on his apartment block, because of their use of their native tongue. He wanted to rid himself of being identified as an immigrant Other, and identify with my white, native born status. Reciprocal projective identifications can establish a preferred element of the self in the white. (Timimi, 1996). He may also have harboured suspicions of my unconscious and unexpressed attitudes to race. Racism might be transference in a regressed state (Hamer, 2006) characterised by splitting of the self, obscuring the ‘true self’ (Winnicott, 1960) to protect it from annihilation. Splitting is the psychoanalytic basis for racism (Timimi, 1996)

I have defined and illustrated the concepts of transference, countertransference and projective identification. In my work, I find I incline more to the Freudian displacement of past relationships, than to Kleinian split off parts of the self, but appreciate the contemporary use of enactment, intellectually and affectively. I like Racker’s (1948) observation that psychoanalysts choose their work based on “the object relations of infancy” and because of its reparative nature (Money-Kyrle, 1956), which seems rather Kleinian. Her assertion that transference operates all through our lives, influencing every relationship, is why I believe we need to apply what we can learn in the clinic to the world beyond; what the IPA’s podcast characterises as psychoanalysis “off the couch”. It requires a longer essay to do justice to the great psychosocial themes of race, ethnicity, religious marginalisation, sexual identity and fluidity, as well as social constructs around ‘normality’, disability and social class, but I have demonstrated the power of the unconscious, and how something once perceived as an impediment, is now a critical therapeutic tool.

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What if I am wrong?

A few things came together for me in the past few days which made me think about what I thought; why I sometimes choose not to express my thoughts; why I sometimes feel sensitive and defensive about what I think; what do I fear will happen if I am truly open and candid, and how it relates to who I am, that is, my sense of identity, what is my ‘self’?

I think it begins very early. We are brought up to distinguish between ‘wrong’ and ‘right’ and we are rewarded for being right. Sometimes if we are wrong, or do something wrong, we are punished. So, the fear of getting something wrong, of being ‘in the wrong’, develops from infancy.

Two books I have been reading, and two conversations recently, as well as some work in my analysis all seemed to come together. The conversations began on Sunday. The previous day I had seen the ‘Women in Revolt’ exhibition, with my daughter, at the Tate. I liked it. It stirred up some feelings and memories when I looked at the photographs of the women supporting the miners, or the Greenham Common protests, and the snaps from various punk concerts and venues. I recalled that it tended to produce some contemptuous harrumphing in my home when it came on the early evening news.

I liked the exhibition, not least because it made me get in touch with a period of adolescence, but also for reminding me of a time of forming political and social views. Back then, with the confidence of youth, perhaps that should be ‘arrogance of youth’, I had little doubt that my opinions were ‘right’; they also tended to be ‘Right’. I did not expect to have to defend them, but was sure that I could.

My Sunday conversation was with one of my fellow training candidates, who told me she had seen it too, and I was lazily assuming that she would have enjoyed it, but I was taken aback by the vehemence of her response. To be fair, it was not the content that she objected to, but the way the exhibition had been curated, but I was surprised. Not that it was a difficult conversation and certainly not uncomfortable, which is what this piece is really about.

A couple of days later I was with two Jewish colleagues and friends. The responses to Jonathan Glazer’s acceptance speech at the Academy Awards has garnered a great deal of attention, much of it unfavourable, and was one moment that had started me down this road of thinking about my thoughts, and especially, my willingness to express them. Deep down, am I rather cowardly? Or just conflict-avoidant, or more generously, thoughtfully trying not to offend? I did not think it was really about not offending, it was about avoiding a Glazer-outcome of being attacked.

These two gentlemen comprised an Israeli, who has lived here for a handful of years and did his three years of military service when in Israel. The other, might be characterised as a representative of the diaspora. Good English public school education, and a mixed Arab and European background. They started to talk about Gaza, then about Israel, the West Bank, many of the historic events post-1948, what ‘self-defence’ meant, colonisation, rights, entitlement. I listened intently and with fascination.

What was striking was that though they disagreed, and the passion in their responses, was the fact that they kept talking. I thought at one point that one of them might get up and walk away. I think about how I might have responded. In Stephen Frosh’s book “Anti-Semitism and Racism”, he writes about Jewish culture and a particular capacity for debate, discourse, dialogue. He suggests that the Torah is riddled with ambiguity, precisely so that it generates debate. The importance of arguing over points of history, of law, is fundamental to co-existence.

We were interrupted by someone wanting the room we had been in, and so we walked on. Despite the contra-opinions and the vehemence with which they had been expressed, we did not part, but all went and had a cup of tea together. It was only then that I joined the conversation. I said how I admired their determination to go on talking. That things were not reduced to personal insults and antipathies. I explained that since the Hamas atrocity of October 7, I have tried very hard to read as much as possible, to educate myself about the politics and the history of the region. As well as Frosh, I have read Jacqueline Rose, Susan Neiman, and Adam Schatz and I feel that I have educated myself sufficiently to be able to express an opinion. However, I had not wanted to. Why?

I think it was because I did not want to be seen by either of my colleagues to be taking sides, one against the other. So, it was not about the subject of the debate, it was about my fear of being aligned, and more unimpressively, the thought that it might lead to me being attacked. Perhaps I thought that Jewish voices have priority over mine in this debate, but more likely it was my anxiety of drawing attention to myself, to my opinions, and of fearing that if I was attacked, that I was not sufficiently well-armed, by intellect and associations, to fight back.

It comes up in my analysis. I find ‘free associating’ quite difficult. What gets in the way of “saying whatever comes to mind” is my inner authority figure, censoring and policing what I have to say. What do I fear? What can I say? Words have power. With misuse, they become weaponry. What do I avoid? Scorn, attacks, contempt, ostracisation, perhaps. Some of my friends tease me about my ‘wokery’, but that does not feel threatening. What I think I fear, when I take care over choosing what I want to share, is to avoid being wounded.

I attended a brilliant meeting recently with Alessandra Lemma, reading a paper to our psychoanalytic association’s Scientific Committee. It was about use of photographic images in therapy. Much of her work in the past couple of decades has been with transgender youths, and she was talking about the “natal body” and what photographic images do to, and for, the psyches of young people working through the pain of thinking that they might have been born into the “wrong body”. I thought about her, when she had said that writing about her experiences, and doing the work she has done, required the armour to deal with the sure knowledge that she would be vilified, “from all sides”.

I sometimes discuss the various trans debates with my children. One has a very developed sense of thinking around these issues, two tend to regard their sibling as “attention seeking” and perhaps with a misdirected focus on what they think are more important issues. Lemma, full of poise and demonstrating empathy, analysis and intellect gave a superb example of expressing and holding views that are likely to lead to attacks. She is so much more advanced down the road I am thinking about – candour, empathy, honesty, expression. I admired her a great deal.

I think this is one of the reasons that I love theatre and cinema so much. I can let artists speak for me and then decide whether I appreciate or share their sentiments. Seeing plays like ‘Grenfell’, or ‘For Black Boys who have considered Suicide when the Hue gets too Heavy‘, last year, helped me shape my thinking, about minorities, injustices and oppression. Recently, watching ‘Nye’ helped me think about the importance and significance of the welfare state and the NHS in a way I would once have let go by. The revival of ‘far-right’ movements and attitudes is brilliantly captured in the subversive ‘Nachtland’, or the imaginative ‘‘Merchant of Venice, 1936‘ and ‘Cable Street’. Thinking about mistreatment of Jews, and then about Jewish oppression, and being able to form robust views that I could share with men like my two colleagues, is what I am trying to consider.

Religion was one of those topics I was discouraged from opining about when I was younger. In truth I learned little and would have been hard-pressed to debate. Apart from the murderous clashes of the extremists who claim to represent their faiths, most religious fervour and debate is more muted these days and in many people, like me, it arouses little by way of emotion. However, I am reading Iain McGilchrist’s “Master and His Emissary” at the moment, and concurrently, Dietrich Bonhoeffer’s “Letters from Prison”, and on the same day found myself reading about Luther, Lutherans, Protestantism, and the Reformation.

Bonhoeffer wrote to his parents during his incarceration in 1943 on Reformation Day. He mused upon Luther’s doubts about the value of his work toward the end of his life and wrote “He wanted a real unity of the Church and the West – that is, of the Christian peoples, and the consequence was the disintegration of the Church and of Europe; he wanted ‘freedom of the Christian man’, and the consequence was indifference and licentiousness; he wanted the establishment of a genuine secular social order free from clerical privilege, and the result was insurrection, the Peasants’ War, and soon afterwards the gradual dissolution of all real cohesion and order in society.”

McGilchrist, who develops his left hemisphere overwhelming its ‘master’, the right hemisphere, hypothesis, felt that there was a shift away from metaphor and right hemisphere dominance at the time of the Reformation, and observed that though Luther was a tolerant and conservative figure with a concern for authenticity, and a return to experience, he was a “tragic figure” because his attitude to images in worship and in churches themselves, whilst “balanced and reasonable”, unleashed “forces of destruction that were out of his control, forces which set about destroying the very things he valued, forces against which he inveighed finally without effect”. He catalysed a period of fanaticism which led Erasmus to note about the crowds, “I have seen them return from hearing the sermon, as if inspired by an evil spirit”.

On being misunderstood, or misinterpreted, wilfully or otherwise, McGilchrist writes this about Luther, he decried “the emptiness that results when the outer and inner worlds are divorced. But his followers took it to mean that the outer world was itself empty, and therefore authenticity lay in the inner world alone”. They took to decapitating statues. I found myself thinking about the Colston statue , here in the UK, and especially, of the ‘Christian Right’ in the US, when reading Erasmus’s observation.

One last long quote from McGilchrist, because it made sense to me, and because his academic breadth and depth in his extraordinary book requires he gets all the promotion I can muster:

“There are several ways in which the Reformation anticipated the hermetic self-reflexivity of post-modernism, perfectly expressed in the infinite regress of self-referral within some of the visual images which Koerner examines (pictures which portray the setting in which the picture stands, and contain therefore the picture itself, itself containing a further depiction of the setting, containing an ever smaller version of the picture, etc.) One of Cranach’s masterpieces, discussed by Koerner, is in its self-referentiality the perfect expression of left hemisphere emptiness, and a precursor of post-modernism. There is no longer anything to point to beyond, nothing Other, so it points pointlessly to itself. Rather paradoxically for a movement that began as a revolt against apparently empty structures, it is in fact the structures, not the content, of religion, that come into focus as the content. But such is the fate of those who insist on ‘either/or’, rather than the wisdom of semi-transparency”

This brings me back to my feelings. Why do I feel the need to censor what I say? I think it goes back to the fear of being ‘wrong’, but maybe the thing is about a deeper search for ‘the truth’. I think about so many issues where I feel wary of sharing my opinion, one for risking offence, but two, for fear of having my sense of being right destroyed by someone else. I realise in my vanity I fear ‘losing the argument’.

More McGilchrist, “Whereas for the Enlightenment, and for the workings of the logical left hemisphere, opposites result in a battle which must be won by ‘The Truth’, for the Romantics, and for the right hemisphere, it is the coming together of opposites into a fruitful union that forms the basis not only of everything we find beautiful, but of truth itself”. Perhaps, I am mentally structured as a Romantic?

Opening a conversation with “I am not convinced I am right about this, and I look forward to hearing the contra views, but this is how things have formed in my mind thus far” – thereby inviting opinion, but not setting up something adversarial, is a possible way to approach this. Seeking synthesis. A desire to be educated. A way of overcoming a fear of being ignorant, or worse bigoted, and thoughtless. I want to be better at this. I recall my polarised thinking in 2016, regarding Brexit, and I regret not thinking harder about why anyone might have a different view to mine. I was amongst the worst of Remainers for being dismissive and patronising towards Leavers.

I recall the thought that to understand something means to be able to explain it, to teach it to another, and I sense that my reluctance on many issues is that I am not confident that I could explain or teach them to another. I would then be exposed for having built an idea-set that, in truth, I could not defend. But the issue is my need to defend. Perhaps if I saw my opinions less as the vulnerable castle, and more as an open space where listening better to alternative views would allow something better to be built in common…or is that rather idealistic and too hopeful?

Anyway, what if I am wrong? The sun will rise again…