Rage In The Analytic Setting

The Moderator opened the discussion by reflecting on the conditions for and the need to experience affect in the clinical situation in order to lift pathogenic repressions. In the case of rage, he questioned whether it was always necessary for the patient to experience it fully, or whether the analyst should help the patient to grapple with the overt experience of very intense rage.

Stanley Coen focused on how analysts bear both their patient's rage and their own. He observed that in a 1991 panel of the American Psychoanalytic Association, entitled ‘Hate in the analytic setting’, each of the highly skilled analysts presenting their cases ‘seemed relieved as soon as his patient had moved away from hatred to some other feeling’. He referred to Merton Gill's stance at that meeting, where he suggested that analysts needed to tolerate and even enjoy being hated. Coen insisted that he took pride in being listed among the most hated analysts in the Americas. His pleasure relates to his conviction that to help patients, analysts must allow themselves fully to experience their feelings for their analysands and become aware of what they want from them. The early understanding of countertransference as pathological may have interfered with many analysts' ability to be open to their own inner needs while immersed in working with their patients. Many analysts are afraid of becoming aware of what they want from their patients as though this might pose an imminent risk of enacting their wishes and feelings. On the contrary, this risk is diminished when the analyst assumes internally full responsibility for his needs and wishes in relation to the analysand. The analyst's discomfort with the rage impedes the patient from fully expressing it and encourages a shift toward sado-masochism. Patients may comply with the analyst's discomfort with expressed rage out of fear of its effect on the analyst's vulnerability. Coen believes that analysts must tolerate their patients' rage and help t