Adjunctive Marital Therapy: A Possible Solution to the Split-Transference Problem

Psychoanalytic interest in those patients with treatable self pathology has peaked in the last decade. Kohut's (1971) elaboration of the entire narcissistic schema heralded a new clinical and theoretical era. At first there was an excessive use of narcissistic diagnoses. But recently these concepts have been integrated, so that we now routinely identify self pathology in all analysands and treat them accordingly. We have thus ambitiously broadened the scope of psychoanalysis as a therapy, and have expanded our patient population as a result. Since our criteria for analyzability have changed, we now analyze patients with different and earlier pathology, whose transference reactions are more primitive and dyadic. Naturally, their personal relationships are infiltrated with archaic elements, too, so that they often experience varying degrees of family and marital tension. Their spouses are frequently transference objects, and often have complimentary or reciprocal archaic pathology. Because of the nature of their developmental and neurotic lesion, they have a tendency to act out in their interpersonal life. If the marriage is not a chief complaint, it often becomes an important focus of the manifest content; and at a deeper level, becomes a crucial arena for a split-transference reaction.

I am referring in this paper to that familiar situation that every experienced psychoanalyst has encountered, where it is clear that a portion of the patient's pathology and cathexis is attached to some other important person or object relationship. Most of us can see the transference split at the beginning of analysis, when our analysands reveal their relationships with others—boss, employee, children,