Therapeutic Passion in the Countertransference

Abstract

The place of the analyst's “influence” in psychoanalytic theory and practice is explored. There is a current in the literature in which it is welcomed as an aspect of “corrective experience,” although usually legitimized by being forced into the narrow channel of interpretation and understanding. A taboo on influence persists despite theoretical shifts that would seem to clear the way for greater acceptance of its importance. Among other factors, the aversion to influence is traced to its association with hypnotic “suggestion,” which implies little room for the patient's autonomy. Opening the door to embracing the possibility of influence goes hand in hand with, on one hand, the analyst respecting the patient as a competent free agent and, on the other hand, the analyst combining willingness to take a stand with willingness to reflect critically on his or her participation. In that context, and with those caveats, the analyst takes on the responsibility to combat destructive introjects and to become an inspiring, affirmative presence in the patient's life. The analyst's passion for the patient's well-being and for changes that entail the realization of dormant potentials now has its place. Different kinds of expression of therapeutic passion in the countertransference are described and illustrated.

Notes

¹Opposition to that desire has its roots in Freud. He wrote, for example, “The feeling that is most dangerous to a psycho-analyst is the therapeutic ambition to achieve by this novel and much disputed method something that will produce a convincing effect upon other people” (Freud, 1912/1958, p. 115).

This paper was the keynote address, Division of Psychoanalysis, American Psychological Association, Toronto, Canada, April 22, 2007.

²There are no doubt other factors as well, such as the interest in depriving the patient of an object relationship in order to induce regression (Macalpine, 1950) and the positivist interest in avoiding “contaminating” the object of study, the patient's mind, with anything coming from the analyst-investigator (see Hoffman, 1998). But I believe the two factors identified in the text would be enough, in themselves, to ensure relative detachment.

³For examples in my own work of complicated enactments in which either the patient or the analyst can be seen as identified, at least partially and temporarily, with the “bad object” so that complex efforts on the parts of the participants are required to work their way out of those predicaments, see the case of Diane (Hoffman, 1998, chap. 8 and 10); the case of Ken (Hoffman, 1998, chap. 9 and 10) the case of Manny (Hoffman, 1998, chap. 10; Hoffman, 2000), and the case of Sarah (Hoffman, 2006a). The combinations of the enactments themselves and the struggles to transcend them constitute potentially transformative therapeutic action.

⁴ Freud's (1963) statement reads precisely as follows: “The decisive part of the work is achieved by creating in the patient's relation to the doctor—in the ‘transference’—new editions of the old conflicts; in these the patient would like to behave in the same way as he did in the past, while we, by summoning up every available mental force [in the patient], compel him to come to a fresh decision” (p. 453).

⁵For my own and others' writings showing that various theorists commonly regarded as “relational” or “intersubjectivist” are, at least sometimes, if not more generally, objectivist in their thinking; see, for example, the following: on Winnicott—Hoffman, 1998, pp. 7–8, 171; Mitchell, 1993, pp. 68–73; on Fairbairn, Klein, Winnicott, Sullivan, and Schwaber—Hirsch, 1987; on Levenson and Sullivan—Hoffman, 1990; on Clara Thompson—Hoffman, 1998, p. 139; on Benjamin—Hoffman, 1991, 1999, pp. 911–913; on Racker—Hoffman, 1991, p. 542; 1998, p. 158n.; on Kohut—Black, 1987; Eagle, 1984, pp. 64–65; Hoffman, 1998, pp. 7–8, 110–111, 141; on Stolorow—Hoffman, 1998, p. 141; on Loewald—Hoffman, 1998, pp. 7–8; on Bollas—Hoffman, 2006b, p. 50; on Fonagy—Hoffman, 2004. Let me add that there are probably instances of objectivist thinking in my own work. The struggle against our craving for transcendent knowledge is ongoing for all of us.

⁶I cannot emphasize enough that this type of expression of passion in the countertransference is of no less importance than the kinds I've identified and illustrated that are more dramatic and more obviously contrasting with common practice.

⁷What if I actually didn't like them? Is a “white lie” ever called for? I think often careful, honest, straight talk is the better route, even if potentially problematic and narcissistically injurious. For an example in my own work of disapproval of something a patient intended consciously to be an act of kindness, see the extended work with Manny after he comes to my home, ostensibly to deliver a check for as yet unbilled sessions the day of my return from the hospital following cardiac surgery (Hoffman, 2000).