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Roth finds that four different levels of transference interpretation operate simultaneously. The analyst must choose what is to be interpreted to the patient, that is, at what level the interpretation is most useful at a given moment. In focusing her attention on one aspect of the patient's communication, the analyst must also hold on to and be aware of the other aspects as well.
Level 1 refers to a direct interpretation, for instance, that a figure in a dream may be a figure from the patient's primary objects.
Level 2: Some associations may not be ego-syntonic to the patient who has no knowledge or recognition underlying what she is saying. In such cases, the analyst may try to introduce to the patient aspects of herself and her internal object relationships not known to her.
Level 3: Often, the patient unwittingly tries to enact with the analyst aspects of her inner world, to defensively maintain an internal status quo.
Level 4: Then, the analyst must try to be aware of her own anxieties and what defence mechanisms were at stake for her to have been pulled into enacting such scenarios.
The reader is presented with material from four consecutive sessions to illustrate how all four levels of transference interpretation may be a necessary part of a meaningful analysis, and how the level of interpretation may change as the level of understanding deepens.
The patient is a 35-year-old woman, married, with three children. Her mother is described as a beautiful Bohemian, who loved her, and the father as their rock, who would do anything to please the mother. The patient has her own company and, at the time of the analysis, was engaged in a project which was underfinanced. As a result, the patient had not paid Roth her fees for several months. Roth allowed this, feeling responsible for the patient who needed analysis badly, and fearing for the children if it were to stop. Roth confesses that she was content to be idealised and not aware of the patient's