Psychiatry 77(1) Spring 2014
18
Commentary on “Transference as a Therapeutic Instrument” Michels
Commentary on “Transference as a Therapeutic Instrument”
Transference Then and Now Robert Michels As a discipline evolves, it develops new concepts, and the meaning and significance of old ones change. Psychoanalysis and transference provide an elegant illustration. Clara Thompson, writing in 1945 (1945/2014), closer to the origin of the concept than to today, provides a clear view of the midpoint in the evolution of our notion of transference. Some basic things have not changed. First, transference is a characteristic of all relationships, not unique to psychoanalysis or psychotherapy. What may be unique to these disciplines is how they use it, but we will return to that later. Second, it is particularly marked in certain relationships, those involving dependency or authority, of which patient-therapist relationships are an example. Third, transference is central to important tactics of psychotherapy—particularly suggestion and insight. These three points are clear in Thompson’s paper, were important in her day, and continue to be clear and important today. However there have been important changes as well as important continuities. For Thompson, transference “consists entirely of irrational attitudes,” it “endow[s] the analyst with characteristics and feelings which he does not possess” (p. 1). Furthermore, implicitly, the analyst is an authority
on the truth, the facts, what the analyst (or other significant figures) is really like. Thompson is comfortable with her authority—“I can vouch for the fact that the first analyst was not vicious and the second was not perfect” (pp. 2–3). Today most of us would see the analyst as an expert on the process of inquiry, but not on the truth about reality. We wouldn’t privilege his or her view over the patient’s. But this means that we can no longer define transference as irrational, an error, or a mistake. In contemporary thinking, we link it to the concept of unconscious fantasy, and think of it as the contribution of unconscious fantasy, stemming from past relationships, to our perception or selection of meanings in a contemporary relationship. A choice influenced by transference is not thereby right or wrong or true or false. Rather, it reflects a consistent bias, a preferred interpretation, shaped by past relationships and experience. The goal in analysis is not to correct an error, but rather to educate the patient as to its nature, its origin, and the extent to which an unconscious bias pervades his or her life. Thompson discusses two transferencebased tactics in therapy—suggestion and insight—the former exploiting the transference, the latter employing it as a laboratory for analytic inquiry. At about the time that
Robert Michels, MD, is the Walsh McDermott University Professor of Medicine and University Professor of Psychiatry, Weill Medical College of Cornell University. Address correspondence to Robert Michels, M.D., 418 E. 71st St., Suite 41, New York, NY 10021. E-mail: [email protected]
© 2014 Washington School of Psychiatry
Commentary on “Transference as a Therapeutic Instrument” 19
she was writing, a third tactic was being developed and discussed, that of “corrective emotional experience,” most often linked to the work of Franz Alexander. This involves neither suggestion nor insight, but rather the direct effects of the therapeutic relationship, differing from and countering the earlier effects of a primary pathogenic relationship, and offering a new opportunity for growth or the resumption of arrested development. Initially criticized by the psychoanalytic community, today many would view it as a psychotherapeutic method, but prefer to reserve the label “psychoanalysis” when it is accompanied by an attempt to combine it with insight into the reason that it is necessary.
Thus we have refined our notion of transference so that it reflects our evolving view of the universality of unconscious fantasies persisting from earliest relationships and influencing all later relationships, determining not simply when we are “right” and when we were “wrong,” but the texture, flavor, and nuance of everything in life. We can no more erase our transferences then we can erase the traces of accent from our first language. The psychoanalyst’s goal is to recognize and understand transferences and the unconscious fantasies that underlie them, to loosen their automatic hold on everything that follows, and to integrate them into our personality.
REFERENCE Thompson, C. (2014). Transference as a therapeutic instrument. Psychiatry, 77(1), 1–7 (Original work published 1945).
Copyright of Psychiatry: Interpersonal & Biological Processes is the property of Guilford Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
18
Commentary on “Transference as a Therapeutic Instrument” Michels
Commentary on “Transference as a Therapeutic Instrument”
Transference Then and Now Robert Michels As a discipline evolves, it develops new concepts, and the meaning and significance of old ones change. Psychoanalysis and transference provide an elegant illustration. Clara Thompson, writing in 1945 (1945/2014), closer to the origin of the concept than to today, provides a clear view of the midpoint in the evolution of our notion of transference. Some basic things have not changed. First, transference is a characteristic of all relationships, not unique to psychoanalysis or psychotherapy. What may be unique to these disciplines is how they use it, but we will return to that later. Second, it is particularly marked in certain relationships, those involving dependency or authority, of which patient-therapist relationships are an example. Third, transference is central to important tactics of psychotherapy—particularly suggestion and insight. These three points are clear in Thompson’s paper, were important in her day, and continue to be clear and important today. However there have been important changes as well as important continuities. For Thompson, transference “consists entirely of irrational attitudes,” it “endow[s] the analyst with characteristics and feelings which he does not possess” (p. 1). Furthermore, implicitly, the analyst is an authority
on the truth, the facts, what the analyst (or other significant figures) is really like. Thompson is comfortable with her authority—“I can vouch for the fact that the first analyst was not vicious and the second was not perfect” (pp. 2–3). Today most of us would see the analyst as an expert on the process of inquiry, but not on the truth about reality. We wouldn’t privilege his or her view over the patient’s. But this means that we can no longer define transference as irrational, an error, or a mistake. In contemporary thinking, we link it to the concept of unconscious fantasy, and think of it as the contribution of unconscious fantasy, stemming from past relationships, to our perception or selection of meanings in a contemporary relationship. A choice influenced by transference is not thereby right or wrong or true or false. Rather, it reflects a consistent bias, a preferred interpretation, shaped by past relationships and experience. The goal in analysis is not to correct an error, but rather to educate the patient as to its nature, its origin, and the extent to which an unconscious bias pervades his or her life. Thompson discusses two transferencebased tactics in therapy—suggestion and insight—the former exploiting the transference, the latter employing it as a laboratory for analytic inquiry. At about the time that
Robert Michels, MD, is the Walsh McDermott University Professor of Medicine and University Professor of Psychiatry, Weill Medical College of Cornell University. Address correspondence to Robert Michels, M.D., 418 E. 71st St., Suite 41, New York, NY 10021. E-mail: [email protected]
© 2014 Washington School of Psychiatry
Commentary on “Transference as a Therapeutic Instrument” 19
she was writing, a third tactic was being developed and discussed, that of “corrective emotional experience,” most often linked to the work of Franz Alexander. This involves neither suggestion nor insight, but rather the direct effects of the therapeutic relationship, differing from and countering the earlier effects of a primary pathogenic relationship, and offering a new opportunity for growth or the resumption of arrested development. Initially criticized by the psychoanalytic community, today many would view it as a psychotherapeutic method, but prefer to reserve the label “psychoanalysis” when it is accompanied by an attempt to combine it with insight into the reason that it is necessary.
Thus we have refined our notion of transference so that it reflects our evolving view of the universality of unconscious fantasies persisting from earliest relationships and influencing all later relationships, determining not simply when we are “right” and when we were “wrong,” but the texture, flavor, and nuance of everything in life. We can no more erase our transferences then we can erase the traces of accent from our first language. The psychoanalyst’s goal is to recognize and understand transferences and the unconscious fantasies that underlie them, to loosen their automatic hold on everything that follows, and to integrate them into our personality.
REFERENCE Thompson, C. (2014). Transference as a therapeutic instrument. Psychiatry, 77(1), 1–7 (Original work published 1945).
Copyright of Psychiatry: Interpersonal & Biological Processes is the property of Guilford Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
