Transference-Countertransference Enactment in the Recommendation to Convert Psychotherapy to Psychoanalysis

Two cases in which a recommendation of analysis was made in the course of psychotherapy are summarized and discussed. Although there were strong clinical indications for analysis, the data suggest that in making the recommendation of analysis the therapist participated in a transference-countertransference enactment in which she was drawn into each patient's attempt to actualize his unconscious wishes and fears in the transference. The interaction between the therapist and the patient which led up to and followed the recommendation of analysis had specific meaning as an enactment in the transference of each patient's unconscious conflicts and as a repetition of significant childhood interactions. The process of making a recommendation of analysis to a patient in psychotherapy is examined from the viewpoint of recent literature on transference and countertransference enactment and role-responsiveness, and the multi-determined nature of treatment recommendations is discussed. Our desire to do analysis leaves us susceptible to transference enactment in making a recommendation of analysis particularly, but not uniquely, in the midst of ongoing psychotherapy.