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Dr. Wahl has performed a service in calling attention in his well-written, straightforward paper to an important and long neglected problem in analytic therapy. However, perhaps the word “countertransference” should appear in the title, for this is the main emphasis of the paper, although it is all part of the general problem of the effects of a patient's position and status in life upon his psychoanalysis.
If a black patient is analyzed by a white therapist, the factor of race must be dealt with from the beginning—not the analyst's feelings, but the patient's. And in addition, the patient's dynamics, transference, and resistances can all be strongly influenced by poverty and prejudice, as well as by wealth, fame, and influence. For example, a wealthy man has a problem with alcohol, and also in his marriage. These stem from a childhood pattern of rejection by his mother and hostility to her, with masochistic acting out by seducing and rejecting women. If this man is an indigent clergyman, the situation will have entirely different effects than if he is very wealthy, able to go to any length in seducing women, and secure enough financially to be completely free of the necessity to support himself by working.
It was, I believe, in one of his first introductory lectures that Freud cited his reaction to a patient of high socal position; he told the man almost rudely to close the door. This was a sort of test: if the patient could not accept a situation in which he was not a great personage, then he would not likely be suitable for analysis. It is to be hoped that Dr. Wahl's call for more research on this increasingly important and most interesting subject will be responded to by sound, perceptive studies.