Meetings of the Psychoanalytic Association of New York

February 26, 1979. ON ASPECTS OF COUNTERTRANSFERENCE IN TREATING THE REGRESSED PATIENT. (Melitta Sperling Memorial Lecture.) L. Bryce Boyer, M.D.

Dr. Boyer discussed his experience with the psychoanalytic treatment of the regressed patient. Regarding the term "regressed patient," he acknowledged a lack of diagnostic clarity: the patients he was considering appear to range from borderline to overtly psychotic. His main thesis was that the major obstacle in the treatment of these patients is the countertransference evoked in the analyst, but that these reactions can be turned to therapeutic advantage. Dr. Boyer gave a brief historical survey of countertransference, seen as both a facilitator and inhibitor of analytic work. Freud introduced the term and considered it to be the repetition of the analyst's previously acquired irrational attitudes now directed toward the patient. It was assumed to result from the analyst's being inadequately analyzed. Fanny Hann-Kende in 1936 was the first to suggest that the analyst's reactions could be used to advantage in psychoanalytic treatment. Many authors, including Melitta Sperling, have pointed out the importance to the therapeutic process of the patient's perceptions of emotional reactions in the analyst. She wrote specifically about the psychosomatic patient in whom perception of anxiety in the analyst could lead to an exacerbation of symptoms which, she believed, were intended to elicit love from the analyst, viewed as a mother surrogate. But the exacerbation of symptoms might then be used by the anxious analyst as a reason to stop analysis, thus abandoning the patient.

The regressed patient's major mechanisms of defense were discussed next by Dr. Boyer. He presented Kernberg's concept of splitting in borderline patients: loving, fantasized relationships and hating ones are activated in the transference, but they must be split to avoid the overwhelming anxiety that would ensue if the corresponding affects of love