An Attempt to Differentiate a Typical Form of Transference in Neurotic Depression—A Description of Three Stages1

If a psycho-analyst tried to imagine a patient who was never 'depressed' in analysis, I think his heart would sink at the prospect of treating him. Not only, as Fenichel (1945) pointed out, is a depressive mood an expectable affect in neurosis; it is in part by virtue of this mood that patients become amenable to influence (Winnicott, 1941). The serious difficulties with which patients present themselves, and the analytic process which challenges their narcissistic defences, make it impossible, in my opinion, for anyone still undergoing the formal process of analysis to reach his optimum level of freedom from depression in this sense.

The term 'depression' is also used, as has often been noted, to refer to a spectrum of psychopathological conditions and to describe an affective state which may be fully appropriate to reality. In spite of the looseness in the use of the term, a class of neurotic patients can be recognized who react acutely and chronically with a depressive mood and who present a childhood history characterized by feelings of isolation. They complain of a failure to derive satisfaction from life and, to some degree, from analysis and they constantly assert their feelings of inadequacy or hopelessness. These are sometimes temporarily compensated by denial, leading to an over-estimation of their personality and abilities. The type of depression which such patients show is often designated as 'neurotic' or 'reactive'. Though this type of depression is contrasted with the self-accusatory melancholic depressions in which drive defusion has taken place and the self is attacked by its ideal, a melancholic substratum seems to me always to be detectable. In this paper I shall attempt to isolate some elements of the depressive transference and transference-neurosis from the other elements of the neurotic transference.

The elements which I shall consider concern chiefly the relationship of various parts of the ego to one another, or rather the relations of