Transference and transference interpretation revisited: Why a parsimonious model of practice may be useful

ABSTRACT

What psychoanalysts consider psychoanalytic interpretation, in what setting it emerges and specifically why, when and how transference should be interpreted, have become increasingly unclear and controversial. In this paper I set out, elaborate, illustrate and argue the value for post-session reflection, certainly within the object relations traditions, of adopting a parsimonious model of practice. The model rests on the foundations of a specific understanding of free association, evenly suspended attention, resistance and transference and separating two epistemologically distinct intentions in transference interpretation. One, transference construction, aims to make a patient aware of the unconscious ways a patient is behaving in sessions (and then outside them) and how and why that is happening. A second, transference designation, focuses on the more limited aim of making patients aware of how they unconsciously experience the psychoanalyst at specific moments of resistance in sessions. Both types of interpretation may help but, I argue, it is the latter that must form the bedrock for fundamental change.

Ce que les psychanalystes considèrent comme étant une interprétation proprement psychanalytique, suivant le cadre et les conditions spécifiques de son émergence, le quand et le comment de l'interprétation du transfert, tout cela est devenu de plus en plus obscur et sujet à controverse. L'auteur de cet article expose, élabore, illustre et argumente la valeur de la réflexion pour l'après-coup de la séance, selon la tradition de la relation d'objet, de l'adoption d'un modèle étroit de la pratique. Ce modèle a pour fondement une compréhension particulière de la libre association, de l'attention également flottante, de la résistance, du transfert, ainsi qu'une séparation de deux intentions épistémologiquement distinctes dans l'interprétation du transfert. L'une, la construction transférentielle, vise à ce que le patient prenne conscience des motifs inconscients de son comportement en séance (et en dehors des séances), et de leur comment et pourquoi. L'autre, la désignation transférentielle, poursuit un objectif plus limité; faire prendre conscience au patient de la façon dont il ressent inconsciemment sa relation au psychanalyste dans un moment particulier de résistance en séance. Ces deux types d'interprétation peuvent s'avérer utiles, mais, selon l'argument que l'auteur développe, seul le second doit constituer le socle d'un changement fondamental.

Was Psychoanalytiker unter psychoanalytischer Deutung verstehen, in welchem Setting sie Anwendung findet und insbesondere warum, wann und auf welche Weise Übertragung gedeutet werden sollte, ist zunehmend unklar und umstritten. In meinem Beitrag stelle ich dar und argumentiere dafür, dass die Wahl eines am Sparsamkeitsprinzip orientierten Modells für die Nachbetrachtung nach der therapeutischen Sitzung nützlich ist – jedenfalls bei Orientierung an der Objektbeziehungstheorie – und führe das weiter aus. Dieses Modell stützt sich auf ein definiertes Verständnis von freier Assoziation, gleichschwebender Aufmerksamkeit, Widerstand und Übertragung. Es differenziert erkenntnistheoretisch zwischen zwei unterschiedlichen Zielsetzungen für die Übertragungsdeutung. Daraus ergibt sich als erster Typus einer Übertragungsdeutung die Konstruktion der Übertragung mit dem Ziel, dem Patienten seine unbewussten Verhaltensweisen innerhalb und außerhalb der Sitzungen sowie ihr Wie und Warum bewusst zu machen. Der zweite Typus wäre die Benennung der Übertragung. Sie hat das begrenztere Ziel, dem Patienten bewusst zu machen, wie er den Psychoanalytiker in den Sitzungen unbewusst dann wahrnimmt, wenn er einen Widerstand entwickelt. Beide Deutungsformen sind vermutlich hilfreich, aber meine Argumente laufen darauf hinaus, dass nur die letztere begrenztere Form die Basis für grundlegende Veränderungen sein kann.

In questo lavoro descriverò l’ubiquità della dimensione musicale – e musicale in senso non metaforico, bensì letterale – nell’ambito dell’incontro psicoanalitico. Si tratta di un aspetto che merita di essere sottolineato in quanto, stranamente, fino a pochi anni fa è stato per lo più trascurato nella letteratura psicoanalitica – un fatto le cui radici vanno cercate a mio parere nell’avversione dello stesso Freud nei confronti della musica. Passerò qui in rassegna un ampio repertorio di letteratura analitica in cui la musica è evocata in senso metaforico, trascurando però al contempo la musicalità nel suo significato letterale; esaminerò quindi la possibile dimensione musicale di testi che esplorano l’emotività non verbale; considererò infine gli effetti a lungo termine della musicalità preverbale infantile e finanche di quella dell’esistenza prenatale sulle relazioni oggetuali interne e sulla personalità, concludendo poi l’articolo con un lungo esempio clinico.

Cada vez es más controversial y menos claro lo que los psicoanalistas consideran una interpretación psicoanalítica, en qué encuadre surge esta y, específicamente, por qué, cuándo y cómo debe ser interpretada la transferencia. En este artículo se propone, elabora, ejemplifica y argumenta el valor de la adopción de un modelo parsimonioso de práctica psicoanalítica para la reflexión postsesión, dentro de la tradición de las relaciones objetales. El modelo se basa en los fundamentos de una determinada comprensión de la asociación libre, la atención libre flotante, la resistencia y la transferencia, y en la separación de dos intenciones epistemológicamente distintas en la interpretación de la transferencia. Una, la construcción de la transferencia [transference construction], que busca que el paciente se percate de su comportamiento inconsciente en las sesiones (y luego fuera de ellas) y cómo y por qué está sucediendo eso. La otra, la designación de la transferencia [transference designation], que se centra en el propósito más limitado de hacer que el paciente se percate de cómo experimenta inconscientemente al psicoanalista en momentos específicos de resistencia en las sesiones. El autor sostiene que ambos tipos de interpretación pueden ser útiles, pero este último, es el que debe constituir la base para un cambio fundamental.

KEYWORDS:

• Transference
• interpretation
• technique

Acknowledgement

This paper is based on earlier versions presented at the UCL Bion conference (2016), the European Psychoanalytic Federation conference in the Hague (2017), the Klein Study Group of the British Society (2017), the Australian Psychoanalytic Society conference (2018) and the Münchner Arbeitsgemeinschaft für Psychoanalyse (2019). I would like to thank the audiences on all occasions for their comments and the Editor, Associate Editor and three anonymous reviewers of this journal for comments that helped me clarify the argument. I would also like to thank Dana Birksted Breen and Cathy Bronstein for ongoing clinical support and Jorge Ahumada, Ron Britton and Liz Allison for encouragement.

Notes

1 I am grateful to Paul Denis for the term, introduced by him during many meetings of the European Psychoanalytic Federation (EPF) Comparative Clinical Methods working party.

2 See for example, Sandler (1976).

3 See Talamo (1997) for an elaboration of the connections between Bion's admonition and Freud's view.

4 For careful reviews of different approaches to transference interpretation in the, we might say, British independent tradition, for instance, see Keene (2012) and Budd (2012). See also Canestri (2006, 2012). A search for the main terms in PePWeb (http://www.pep-web.org/) will reveal numerous definitions and discussions.

5 See Tuckett et al. (2008 and forthcoming).

6 Although the German term freischwebende Aufmerksamkeit (free-floating attention) is used by some German-speaking analysts today and has escaped into the English literature (even being used by Bion [Tuckett 1997]), Michael Diercks (personal communication, 2017) has pointed out to me that in fact freischwebende Aufmerksamkeit was not used by Freud.

7 The structural asymmetry appears to demarcate the psychoanalytic setting as defined by Freud from at least some of the recent theoretical elaborations in psychoanalysis (such as relational psychoanalysis, self-psychology or perhaps Mentalization-based Therapy (MBT)) at least insofar as they advocate taking a normative appropriate stance to the patient.

8 Strachey (1955b) writes: “The phrase ‘thing that occurred to him’ here stands for the German word ‘Einfall’, for which there is no satisfactory English equivalent. The word appears constantly in the course of these lectures—two or three times in the present passage, repeatedly in Lecture VI, and at many points elsewhere—so that some comment on it will be useful. It is customarily translated ‘association’—an objectionable term, since it is ambiguous and question-begging. If a person is thinking of something and we say that he has an ‘Einfall’, all that this implies is that something else has occurred to his mind. But if we say that he has an ‘association’, it seems to imply that the something else that has occurred to him is in some way connected with what he was thinking of before. Much of the discussion in these pages turns on whether the second thought is in fact connected (or is necessarily connected) with the original one—whether the ‘Einfall’ is an ‘association’. So that to translate ‘Einfall’ by ‘association’ is bound to prejudge the issue. Nevertheless it is not always easy to avoid this, more especially as Freud himself sometimes uses the German ‘Assoziation’ as a synonym for ‘Einfall’, especially in the term ‘freie Assoziation’, which must inevitably be translated ‘free association’. Every endeavour will be made in the present discussion to avoid ambiguity, even at the cost of some unwieldy phraseology; later on, the need to avoid the word ‘association’ will become less pressing” (SE 15, 47).

9 In the “Outline” (Freud, 1938), he discusses the rule again but does not discuss how the analyst attends to the material.

10 In this paper from within the Rio de la Plata tradition first presented in 1953, the author gives an account of the phenomena that occur when the meaning of “associating,” “interpreting” and “words” is investigated.

11 Andre Green (2000, 441) wrote: “Following Freud's model in the ‘Project’ (1895), I conceive of a patient lying on my couch as in a state of mental activity impelled to produce ideas that emerge with quantitative characteristics emphasised, stimulated by the transference experience of the analyst and expressing them through associations that are the result of psychic work. The analyst's openness and receptive capacity render these associations meaningful and facilitates their expression.”

12 A “big shot” is a colloquial English expression for an important and powerful person, at that time certainly a man. The word shot is also used for firing a gun and for the contents (pellets) in some guns used for shooting game. “Big” game are tigers, lions, etc.

13 Concerning a man who Bion came to think had experienced an impulse to attack him via attacking his furniture on the way to the couch but believed Bion could not tolerate knowing it so that he wanted to get far away and did so mentally, becoming more and more incoherent.

14 One can notice a general tendency in psychoanalysis to use concepts by their metaphoric associations rather than their locations in a specified theory, so transforming their meaning.

15 See the “Transference” section below.

16 I asked: “I have become interested in the very different things people conducting a ‘psychoanalysis’ say to patients which they consider ‘transference interpretation’. Would you help? What I would like is for you (quickly and without too much thought) to think of the last transference interpretation you made, to jot it down and to send it to me. (It could be one word or many words). For this purpose, I don’t need to know context or any other details. [If you are not currently seeing a psychoanalytic patient then something said in the past or by a supervisee will do perfectly well].”

17 Strachey (1955a, 256) writes: “The record is remarkable in that it provides the only picture we have of the kind of raw material on which the whole of Freud's work rested and of the piecemeal manner in which that material came to light. Finally, it gives us a unique opportunity of observing the detailed working of Freud's technique at the date of this analysis.”

18 A problem, he stresses, that cannot be mitigated by encouraging the patient to think of his analyst as “good.”