Edith Weicert

The doctor-patient relation is built on trust. The physician's trust in the patient's own tendency toward recovery is an important factor in the process of cure. The psychotherapist depends on a trusting collaboration with his patients. The patients who suffer from psychoneuroses and functional psychoses are essentially disturbed in their ability to trust others or themselves. In daily practice we meet a variety of different doctor-patient relations in which distrust, genuine trust, and all kinds of false hopes and fantastic expectations are intermingled in varying degrees.

But only trust can reveal what the patient unwittingly conceals from himself.

Progress in ego psychology inside and outside of classical analysis has increasingly concentrated attention on anxiety. The central position of anxiety in the psychodynamic theories of Horney1, Sullivan2, and Rado3 is well known. Anxiety has become a more central concern in classical psychoanalysis, since Freud had redefined anxiety as a cause and not as an effect of the repression of impulses.

The psychoanalytic concept of transference is well known. Transferences demonstrate the typical forms of distrust which have to be dissolved so that insight can reach the patient and the neurotic pattern can be reversed.

In psychoanalytic literature, the counter-transferences have mostly been treated as private handicaps of the psychoanalyst, residuals of his own uncompleted analysis. I would like to emphasize that counter-transferences are largely codetermined by the patient's concealed excessive anxieties which tend to elicit typical defensive responses in the therapist. The patient unwittingly urges the therapist into the role of the originally harmful significant partner, since he proves thereby the necessity to maintain his habitual defenses. Due to his passive position, the therapist senses a strong tug to yield to the patient's urging, and thus to enter into an unconscious conspiracy with him. But just as the transference give