It is a curious feature of the history of psychoanalytic ideas that both sides of most controversies can be derived from Freud's writings. Whether or not a particular author chooses to trace his lineage to Freud is consequently more often a matter of politics than scholarship. And this is no less true for controversies in contemporary technique. In this light, I would like to take up the now nearly worldwide focus on the analysis of the transference in the here and now and, in particular, the analysis of action of the transference.
In doing so, I do not mean to exclude the other side of this debate, which, of course, can also be derived from Freud, namely the analysis of what is sometimes called the extratransference. In fact, to speak of these as opposing points of view is misleading, as both are necessary to the analysis of the whole person, and even the most ardent advocates of the here and now, from the relational to the contemporary Kleinian, make room for the there and then in one form or another.
North American psychoanalysis was slow to join the trend toward the analysis of action in the here and now, because it was viewed as having a Kleinian taint. Such taints, like the one interpersonalism once held for ego psychology (and ego psychology still holds for the French), have been instrumental in solidifying schools and sects.
There were two critical moments in Freud's career that laid the groundwork for the focus I have in mind, moments of clinical frustration. Frustration, if not outright failure, was always the impetus for Freud's modifications of theory and technique. I am thinking, first, of his initial articulation of the transference in his postscript to the Dora case. Here, several years after Dora had left him, Freud (1905) tells us what he wishes he had said to her, and it foreshadows all contemporary emphases on the patient's experience of the analyst in the here and now.
“‘Now,’” Freud writes, “I ought to have said to her, ‘it is from Herr K. that you have made a transference on to me. Have you noticed anything that leads you to suspect me of evil intentions similar…to Herr K.'s? Or have you been struck by anything about me or got to know anything about me which has caught your fancy, as happened previously with Herr K.?’ Her attention would then have been turned to some detail in our relations, or in my person or circumstances, behind which there lay concealed something analogous but immeasurably more important concerning Herr K.” (p. 118).
Freud was clearly groping here for a way to convert his new discovery into an intervention that might have made sense to his young patient—and it may sound clumsy to our ears—but his emphasis on the actual person of the analyst has a peculiarly contemporary ring. We can hear its echo, for example, in the contemporary work of Gill (1982) and Schwaber (1983), as they both, from somewhat different epistemological positions, pursue the patient's experience of the analyst's participation in the transference. Schwaber, in fact, traces the lineage of her approach directly to this comment of Freud's.
A decade later in his papers on technique, Freud's analytic focus was shifting from the recovery of memory toward viewing analysis as a “passionately committed experience,” as Friedman (1991, p. 564) has put it. Ironically, however, it was Freud's very interest in the recovery of memory that led him at this time to his most articulate description of the role of action in the here and now when he noted that patients put into action what they do not want to remember (Freud 1914). I believe this is one of his most important observations, but we have never known quite what to do with it. Much of contemporary work can be seen as a dialogue on its theoretical and technical implications. The fact that we no longer see action and thought as mutually exclusive the way Freud did only makes the problem more complex. For if patients are always putting into action what they do not want to remember, and we cannot simply stop the action to recover the idea, then what are we to do?
Henry F. Smith, M.D., is editor of The Psychoanalytic Quarterly. He is training and supervising analyst at the Psychoanalytic Institute of New England, East (PINE), and a member of the Boston Psychoanalytic Society and Institute.
Many of us in this country would say that we interpret action in the transference just as we would any other communication—as a compromise formation, for example (Brenner 1982)—and we cite Freud's papers on technique and, later, the structural theory. But the French argue that the meaning of any such action cannot be interpreted because it has not yet been represented in words, and they cite Freud's earlier papers on the necessity for action or thing presentations to be attached to word presentations in order to gain access to consciousness, according to the topographic theory. I oversimplify here, but it is an important theoretical bone of contention.
Anna Freud (1936) issued a related warning. Partly in response to the growing Kleinian emphasis on transference interpretation, she wrote that “a technique which concentrated too much on the transference” would overwhelm the ego, which would then itself become “swept into action” (p. 27), relinquishing its analyzing function. It was from Anna Freud's more considered look at the ego that Gray (1994) based his contribution to transference analysis in the here and now. I am thinking of his meticulous focus on the sequence of drive derivatives in the patient's associations, especially aggressive drive derivatives in the transference, and the moment patients shift away from the transference to something less risky. To some North Americans Gray's focus on transference aggression sounded suspiciously Kleinian. But to Kleinians Gray sounded quite unfamiliar with his attention to the conscious capacities of the ego and his disregard of the countertransference and the interactive components of the work.
In my view, while each of these approaches has its value, what none of them, including that of the contemporary Kleinians, fully acknowledges is the analyst's inevitable and ongoing participation in the patient's transference fantasy or the dilemmas this phenomenon poses, regardless of the analyst's favored technique. A brief clinical vignette, presented in a different form elsewhere (Smith 2001), will illustrate what I mean.
An analysand in her early forties, who wishes that I would encourage her sexual excitement rather than focusing on its angrier edge, senses that I have become momentarily distracted. “What are you doing?” she asks, before answering her own question. “You are simply adjusting your chair. I am so good. I don't turn around and look.” She is commenting—somewhat provocatively, I think—on a defensive “goodness” in her behavior, which I then link to her fear of her own destructiveness, something she and I have indeed been discussing recently. “Looking would be too aggressive,” I say. You will notice that I am focusing on her conflictual response to aggression, as Gray might, but finding it in her affect and activity, rather than in the content of her associations.
My patient seems to agree. “It would startle you,” she says, and then falls silent. After a minute, she tells me she has just become “aroused.” I look for what in my own behavior might have prompted this change in affect and infer that her arousal may be a response to her experience of my distractedness, which is still on my mind, if not on hers; in other words, that her sexual excitement is a reaching out to someone she has just lost. And so I say, “Notice that you got aroused just after you felt you had lost me.” “Perhaps,” she says, sounding unconvinced. I sense that I am off the mark, and that I have been led astray by my guilt and by my theory about her excitement. Suddenly, it occurs to me that it was not my distractedness but my comment that was the immediate precipitant for her arousal, and so I say, “Or perhaps your arousal started when I said that looking at me would be too aggressive.” “Yes,” she says with rising passion, “The sound of your voice got me excited,” and this discovery marks the beginning of a long journey in which we explore her wish that I might invite her into forbidden pleasures.
But notice what has happened. The erotic excitement that my patient complains she needs me to facilitate is now being played out right before our eyes. She has found a way to experience this excitement, stimulated by the sound of my voice, at the very moment when I am speaking about her aggression, the thing she wishes I would not do. In fact, my effort to identify what excited her only excites her further.
So here we have a technical dilemma. If the sound of my voice arouses the erotic experience I am trying to analyze, then how can I speak about it without arousing her? The very fantasies my patient and I are analyzing are being enacted through the words we use to analyze them, and I cannot help but be a participant in my patient's effort to actualize them.
Persistent efforts to actualize such fantasies are sometimes thought to be characteristic of patients who have been severely traumatized, but it is my sense that to one degree or another, such enactments are an inevitable and continuous accompaniment of all analytic work, especially under conditions of intense transference experience. For if we look at the exchange between analyst and patient at the finest level of detail, every comment on the part of the analyst will be heard by the patient in terms of one transference fantasy or another and experienced as an
actualization of it. And more often than not, analysts can, with a little care, identify precisely how they are participating wittingly and unwittingly in that very fantasy.
As patients enter into the odd task we ask of them, they begin to live double lives (Smith in press), for despite their apparent pursuit of analytic understanding, they continue to use the words, setting, and activity of analysis to actualize the very wishes they are analyzing. As Friedman (2005) has pointed out, this is precisely what we encourage them to do, as we tease their wishes into the open at the same time as we unceremoniously interpret them. Actualizing their wishes is to be sure the more natural of the two lives we invite them to lead. Moreover, if the analyst is not only analyzing but also inevitably participating in the gratification of the patient's wishes, then the ego, in Anna Freud's terms, is inevitably caught up in the action, both the patient's ego and the analyst's. There is no absolute way out of the loop.
What then am I to do about my patient who insists on finding erotic meaning in my every word? It is easier to say what I will not do. I will not try to drain my voice of every note of recognizable affect, as analysts for a time recommended as a wishful solution. What I will try to do is what we have always done, analyze what is transpiring within the patient and between us—including what the patient is doing to and with my comments—analyze the patient's experience, that is, even as I am participating in that experience; and I will do that by using all of the devices available to me, some of which I have detailed above. Only when we do away with the idea that the analyst can be outside this doing, can we begin to ask not when am I participating in an enactment, but how am I participating at any given moment. Only then does the analyst's participation become an ongoing part of the data of observation, so that we can analyze what is being actualized in the real time of the hour. In this way, as Freud (1905) said of the transference, an apparent obstacle to our work can be turned to its advantage.