Psychoanalytic Theory as a Form of Countertransference

Contradictions abound when one addresses the question of how theory affects clinical practice and, to stretch the question further, how theory helps analysts be clinically useful to patients. Most analysts, of any school, would like to believe that they can see patients as they really are, free of the analyst's memory and desire (Bion 1967). This might be conceptualized as the analyst's being an empty container or blank screen, a purely empathic observer, or an objective reader of patients' transferences or internalized patterns. Ideally, theory might serve as an anchor or provide some frame to make sense of what might otherwise be an overwhelming input of confusing raw data. Theory might also guide practice enough to control the influence of the analyst's personality or unwitting participation with patients. It would not however, bias analytic inquiry, the nature of the data being sought, or ways of comprehending and interpreting individual patients. Yet early in the development of the profession, Ferenczi and Rank (1924) sharply criticized clinical psychoanalysis for becoming excessively dominated by theory, thereby severely compromising the understanding of the unique individuality of each patient and each dyad (see Wolstein , 1975). In much psychoanalytic writing, it was hard to distinguish one patient from another. Virtually every patient seemed to have the same underlying dynamics or internal structures, discussion confirmed the universal theoretical constructs of the day, and analysts'