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In practice one finds certain patients who cannot use transference interpretations; the difference between these and other patients is qualitative, not quantitative. They do not form a defined group, but include people suffering from character disorders, sexual perversions, some psycho-somatic conditions, psychopaths, etc., i.e. sane people with a great deal of both persecutory and depressive anxiety.
When a transference interpretation is given to such a patient, either: (i) it is experienced by the patient as meaningless, and no use can be made of it; or (ii) it is accepted by the patient, with apparent understanding, but the analyst realizes later that it has had no effect; no change happens, and no insight has been gained.
In the analysis of these patients several other characteristics are found.
a.Ordinary analysis of their dreams does not work. They bring dreams of two kinds; of one the manifest content leads to innumerable associations, but no meaningful latent content can be found; nothing else exists in the dream but the defensive mechanisms. In the other type of dream the manifest and the latent content are one, and the manifest content is the dream thought.
b.There are defects of thinking. The capacity to symbolize is deficient, there is 'symbolic equation' ('primary process symbolization'), and concrete thinking, and the capacity to make accurate deductions or inferences is largely lacking.
c.Acting-out is violent, or the violence appears negatively as passivity. These patients call a good deal of attention to themselves, involve other people in their affairs, and interfere in the affairs of others.
d.They tend to be very dependent, and find someone else to carry out as many of their ego-functions as possible. There is neither real separateness, nor real fusion, no mutuality; 'tit-for-tat', 'you scratch my back and I'll scratch yours'. Their relationships turn out to be folies-à-deux in which each partner claims preference and precedence; both are viol