Varieties of the Transference Neurosis

The Insoluble Transference Neurosis in PRP

The dangers of the development of a so-called “insoluble transference neurosis,” leading to a stalemated treatment in certain classes of passively dependent or masochistic individuals, have been well-known to the psychoanalytic literature ever since they were focused upon and given that name by Alexander and his coworkers, who used this risk as a theoretical justification for many of their proposed modifications of the classical psychoanalytic technical precepts (see Alexander & French, 1946). Given the large number of alcoholic and/or drug-addicted, characterologically masochistic, and orally hysterical patients in the PRP sample, it is no surprise that the danger of this kind of development bulked large in the diagnostic and prognostic thinking with a very significant segment of our PRP population sample—actually, 16 out of 42, or almost 40% (9 men and 7 women, 8 in psychoanalysis and 8 in almost equally prolonged psychotherapies). And in fact it was the effort to avoid just this untoward treatment development that played a determining role in allowing some patients a treatment plan and course with either no concomitant hospitalization, or an inadequate hospital period, which on other grounds (the seriousness and self-destructiveness of their symptomatic behaviors, usually alcoholism and drug addiction, would have been strongly contraindicated. With two of the patients, the Addicted Doctor and the Car Salesman, this specific concern and the consequent willingness to allow trials of outpatient treatment figured importantly in the ultimate total failures of their treatments.

Actually, of the 16 patients “at risk” in this regard, the development of such entrenched dependency and masochistic gratifications was avoided with 6—though, as just indicated, at too high a price with some. Of the remaining 10, these issues posed a serious treatment problem with 7 (4 men and