Discussion of Ralph B. Little's Article, Transference, Countertransference and Survival Reactions After an Analyst's Heart Attack

This is a distinct contribution to the scanty literature on countertransference, which is an area more often spoken about in confident abstractions than documented with clinical candor. Dr. Little was worried about his own

survival, but his countertransference became an obstacle only in contending with this patient. She was forced into being a nurse by her exacting and demanding mother who wanted to use the patient for her own care and was prepared to attempt suicide to get her wish. By realizing that he, too, wanted his patient to take care of him, Dr. Little also recognized that the analysis was heading for trouble. The parallel between the analyst and the patient's mother was unmistakable, even without the cooperation of fate. The mother attempted suicide on the same day that the analyst was stricken with a coronary thrombosis!

The patient's transference anger, the analyst's countertransference fear of her resentment, and the deliberate shift of emphasis from resentment of his departure to day by day examination of her mother's behavior enabled the analysis to survive, and the analyst to survive as well. He also deflected the analytic course to a consideration of the patient's father, who had died so early in her life and from causes that were so clearly not his fault that identification of the analyst with her father was an innocuous ploy, intended to prevent too close an identity between the mother and the analyst himself. In other words, despite an obvious association between the demanding mother whom the patient resented and his own demands, he found himself doing everything he could to forestall resentment. This kind of resentment came from two sources: from the patient, and from Dr. Little himself. He avoided an antagonistic confrontation and spared himself the potentially destructive effect of mutual resentment.

There is another side. Dr. Little and his patient had comparable transference reactions: both feared desertion, resentment, and hostile abandonme