a case study of transference

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Controversial Xu Bing Work Enters the Guggenheim Museum’s Collection

By Barbara Pollack

• March 13, 2018

Call it the Art Boomerang.

On the eve of the opening last October of its major fall exhibition, “Art and China After 1989: Theater of the World,” the Guggenheim Museum pulled three works after an outpouring of protest from animal-rights activists . Now, one of those works, Xu Bing’s “A Case Study of Transference,” is coming back to the museum, this time as a valued part of its permanent collection, purchased with funds provided by an anonymous donor. The website ARTnews first reported the gift .

The controversial work is a video documentation of a 1994 performance in which two pigs, one imprinted with nonsensical English words and one stamped with fanciful Chinese characters, copulate before a live audience. It is a satirical take on the collision of East and West.

Instead of showing the video, the museum displayed a blank monitor with a wall label explaining, “For Xu, who, like many intellectuals of his generation, had spent time on a farm during the Cultural Revolution and was familiar with animal husbandry, the performance was a literal and visceral critique of Chinese artists’ desire for enlightenment through Western cultural ‘transference.’”

“Xu Bing’s ‘A Case Study of Transference’ is recognized as an iconic work of conceptual and performance art from China during this period and is now part of the exhibition history,” said Sarah Eaton, a spokeswoman for the Guggenheim, who told The New York Times that the museum might show the work there in the future.

It could also be shown elsewhere sometime soon. “Art and China After 1989” will travel to the Guggenheim Bilbao from May 11 to Sept. 23, 2018, and to the San Francisco Museum of Modern Art from Nov. 10, 2018, to Feb. 24, 2019, although neither institution has finalized its checklist yet.

The Guggenheim Abu Dhabi already owns another work that was altered for the exhibition, Huang Yong Ping’s “Theater of the World” (1993), an empty cage that was intended to be filled with live insects, lizards and snakes that would ostensibly feed off each other during the course of the three-month show. In response to the museum’s intervention, the artist scribbled a note of protest in Chinese on an airsickness bag on his flight to New York from Paris where he lives. This work, titled “Vomit Bag” (2017), was displayed in a vitrine at the show and is also under consideration for entering the Guggenheim’s permanent collection.

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More about A Case Study of Transference

Contributor

A Case Study of Transference by Xu Bing might be the most disturbing thing you see today…unless you’re a farmer.

A Case Study of Transference is “a video documentation of a 1994 performance in which two pigs , one imprinted with nonsensical English words and one stamped with fanciful Chinese characters, copulate  before a live audience.” The pros of this piece are that 1) it makes for a very thought-provoking work and 2) no one can ever say that Xu Bing lacked originality. Compassion for animals? Maybe. But originality? Never.

The meaning of the work is heavily reliant on the nationality/gender pairings of the pigs. The male pig is printed with English nonsense, while the female pig is printed with Chinese nonsense. The piece “is a satirical take on the collision of East and West.” Literally, by collision they mean sexual intercourse but metaphorically, collision means the sharing of ideas, languages, and cultures. Xu Bing came of age during the Cultural Revolution   in China, a time when China was completely closed off to the outside world. Xu spent a significant portion of this time working on a farm in the countryside, hence the pigs. Then he worked for China’s propaganda brigade, making big-character posters, hence the calligraphy on the pigs. And lastly he moved to New York after his work in China began to be censored , hence the connecting of the East and the West via calligraffitied  pigs.

This piece was legendary for sure, but not everyone was very excited about it. When the Guggenheim decided to put it in their exhibition titled, Art and China after 1989: Theater of the World along with two other pieces that included the use (or abuse) of animals, PETA flipped. They put together a petition in favor of cruelty free art that got over 820,000 signatures. But this is not what made the Guggenheim decide to pull these artworks from the exhibit. It was threats of violence that put them over the edge. In a statement about the decision the Guggenheim said, “Although these works have been exhibited in museums in Asia, Europe, and the United States, the Guggenheim regrets that explicit and repeated threats of violence have made our decision necessary,” and “as an arts institution committed to presenting a multiplicity of voices, we are dismayed that we must withhold works of art. Freedom of expression has always been and will remain a paramount value of the Guggenheim.” Instead of exhibiting the piece, they displayed a blank TV screen , because DRAMA. 

• "Guggenheim Acquiring Controversial Xu Bing Work Pulled From Recent ‘China’ Show -." ARTnews. N.p., 2017. Web. 27 Apr. 2018.
• "Guggenheim Receives Xu Bing Work, Targeted By Animal Rights Activists, From Anonymous Donor." Artforum.com. N.p., 2018. Web. 27 Apr. 2018.
• Intellectual By Nature, Poet At Heart: Xu Bing | Brilliant Ideas Ep. 15. United States: Bloomberg, 2015. video.
• Pollack, Barbara. "Controversial Xu Bing Work Enters The Guggenheim Museum’S Collection." Nytimes.com. N.p., 2018. Web. 25 Apr. 2018.
• Sutton, Benjamin. "Guggenheim Accused Of Supporting Animal Cruelty In New Exhibition." Hyperallergic. N.p., 2017. Web. 27 Apr. 2018.
• Sutton, Benjamin. "Guggenheim Pulls Three Works From Upcoming Show After Outcry Over Animal Abuse [UPDATED]." Hyperallergic. N.p., 2017. Web. 24 Apr. 2018.

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What Is Transference and How Does It Work?

Your Therapist Can Experience Transference, Too

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

Universal Images Group / Getty Images

What Is Transference in Psychotherapy?

Types of transference, counter-transference.

• Transference Examples
• Talking With Your Therapist

Transference-Focused Therapy

Frequently asked questions.

Transference in psychoanalytic theory is when you project feelings about someone else onto your therapist. A classic example of transference is when a client falls in love with their therapist. However, one might also transfer feelings of rage, anger, distrust, or dependence.

While transference is typically a term for the mental health field, it can manifest in daily life when the brain tries to comprehend a current experience by examining the present through the past. Here we explore the definition of transference in greater detail and the different types.

At a Glance

Transference happens when your feelings for someone else are projected onto your therapist. It's a key part of psychodynamic therapies, and it's something your therapist will likely want to explore to understand your interactions and relationship patterns better. It can also go the other direction; your therapist might experience counter-transference, where they project their feelings for someone else onto you. In either case, it's crucial to understand how it works and how it might affect the therapeutic process—especially if there's a risk that it might hurt the therapeutic relationship.

Transference, in general, is "the process of moving something or someone from one place, position, etc. to another." However, the psychology-based definition of transference is a bit different and applies directly to those engaged in mental health therapy.

In this context, transference is defined as a projection of one's unconscious feelings onto their therapist. The American Psychological Association explains that these feelings are ones that were originally directed toward important figures in the person's childhood, such as their parents.

The concept of transference in therapy came about later in the 20th century, when therapeutic approaches became less strict, giving practitioners more flexibility in how they treated their patients.

Transference is a complex phenomenon and can sometimes be an obstacle to therapy. Based on their feelings, the client may feel tempted to cut off the relationship with their therapist altogether, for instance. Or they might become sullen and withdrawn during therapy sessions, impeding their progress.

Working through transferred feelings is an important part of psychodynamic therapy . The nature of the transference can provide important clues to the client’s issues, while working through the situation can help resolve deep-rooted conflicts in their psyche.

There are three types of transference in therapy:

• Positive transference
• Negative transference
• Sexualized transference

Positive Transference

Transference can sometimes be a good thing. An example of positive transference is when you apply enjoyable aspects of your past relationships to the relationship with your therapist. This can have a positive outcome because you see your therapist as caring, wise, and concerned about you.

The benefits of positive transference can be seen in a case study involving a child with autism . Once positive transference started to occur, the young boy's bond with the therapist started to strengthen and he began following the therapist's directions, reduced his aggressive behaviors, and his learning abilities developed.

Negative Transference

Negative transference involves the transfer of negative emotions to the therapist. Anger and hostility are two emotions that might have been felt in childhood, either toward a parent or other important individual, then reappearing in the therapeutic relationship .

Negative transference sounds bad but actually can enhance the therapeutic experience. Once realized, the therapist is able to use this transference as a topic of discussion, further examining the client's emotional response.

Negative transference can be especially useful if the therapist helps you overcome an emotional response that is out of proportion to what transpired during the therapy session. 

Sexualized Transference

Do you feel attracted to your therapist ? If so, you might be experiencing sexualized transference, also sometimes referred to as erotic transference. Feelings that fall under sexualized transference include those that are:

• Intimate and sexual
• Reverential or feelings of worship
• Romantic and sensual

Some research suggests that sexualized transference may be more common for members of the LGBTQ+ community , especially if the person has few friends or others they can trust or confide in.

Mental health therapists must also be aware of the possibility that their own feelings and internal conflicts could be transferred to the client as well. This process is known as counter-transference and can muddy the therapeutic relationship.

An estimated 78% of therapists have felt sexual feelings toward a client at one time or another, with male therapists experiencing these intimate feelings more often than female therapists.

Despite the negative connotation of counter-transference, some psychotherapists use it in therapeutic ways. The therapist may choose to disclose their feelings if a client mentions that they seem angry, for instance, first crediting the client with recognizing this emotion and then working together to understand how much of the response may have been projected by the client.

Examples of Transference in Therapy

What does transference look like in a therapeutic setting? Here are a few examples to consider.

Example of Positive Transference

Tony's mother was always loving and supportive. Tony has a female therapist and projects these same feelings on her, considering her as a loving, supportive individual as well.

Example of Negative Transference

Michelle became very angry with her therapist when he discussed the possibility of homework activities. Through the exploration of her anger with the therapist, Michelle discovered that she was experiencing transference of unresolved anger toward an authoritarian elementary school teacher.

Example of Sexualized Transference

As therapy progresses, Chris develops sexual feelings toward the therapist. Chris has even had erotic fantasies involving the therapist, sometimes also saying flirtatious things during the therapy session.

Discussing Transference With Your Therapist

Hill Street Studios / Getty Images

If your therapist recognizes that you are experiencing transference, they may not want to discuss it right away. It will, however, be necessary to address the transference at some point because if the topic is avoided, it could lead to an impasse in therapy and negatively impact your relationship with your therapist .

Additional consequences of avoiding transference are that you, the client, may:

• Become embarrassed, uncomfortable, and withdraw from therapy emotionally
• Experience higher levels of stress during therapy sessions due to how you feel
• Regress, which can negate some of the positive progress you already achieved

Talking about the transference when both you and the therapist are ready can help resolve these issues, enhancing the therapeutic process.

Transference-focused therapy is a type of therapy used to treat borderline personality disorder (BPD) . BPD is a personality disorder characterized by unstable emotions, moods, behaviors, and relationships.

Transference-focused therapy utilizes the therapeutic relationship to help people relate better to others. Transference allows the therapist to see how someone with BPD relates to others and then use this information to help the person build healthier relationships .

Once a therapist and client establish a trusting therapeutic relationship, they work to explore behavior patterns, thoughts, and emotions to better understand how the individual responds and copes. As people become more aware of these destructive patterns, they can work to build more effective skills and interactions.

Therapists also utilize transference in other types of psychotherapy . For example, transference is a key component of psychodynamic therapy, but it can also incorporated in other approaches, including relational therapy , integrative therapy , and eclectic therapy . 

Transference is when a client projects feelings on the therapist, while counter-transference is when a therapist projects feelings on the client.

Counter-transference can make it harder for a therapist to be objective during the therapeutic process. It may even skew the therapy in the wrong direction as actions taken during the sessions could be based more on the therapist's feelings than on the feelings of the patient. Additionally, patients may not be able to resolve their issues if they are confused by the emotional response of the therapist.

Some researchers suggest that transference in therapy may be a defense mechanism , such as when the patient is insincere or not ready to face negative emotions. Others contend that whether transference is considered a defense mechanism varies depending on the therapist's interpretation.

If a client is feeling especially vulnerable, such as when dealing with a life-threatening disease that threatens their self-esteem and self-control, it may increase their risk of transference. Additionally, transference may be more common when therapy is conducted in person as opposed to therapy that occurs online .

Cambridge Dictionary. Transference .

American Psychological Association. Transference .

Parth K, Datz F, Seidman C, Löffler-Stastka H. Transference and counter-transference: A review . Bulletin Menninger Clinic . 2017;81(2):167-211. doi:10.1521/bumc.2017;81.2.167

Andersen SM, Przybylinski E. Experiments on transference in interpersonal relations: implications for treatment . Psychotherapy . 2012;49(3):370-83. doi:10.1037/a0029116

Gimenes Rodrigues A, Fiamenghi-Jr GA. Autism and transference: Case study in a Brazilian primary school . EAS J Psychol Behav Sci . 2019;1(5):84-89. doi:10.36349/EASJPBS.2019.v01i05.002

American Psychological Association. Negative transference .

Dharani Devi K, Manjula M, Bada Math S. Erotic transference in therapy with a lesbian client . Ann Psychiatry Mental Health . 2015;3(3):1029.

Dahl HSJ, Hoglend P, Ulberg R, et al. Does therapists' disengaged feelings influence the effect of transference work? A study on countertransference . Clin Psychol Psychother . 2017;24(2):462-474. doi:10.1002/cpp.2015

Capawana MR. Intimate attractions and sexual misconduct in the therapeutic relationship: Implications for socially just practice . Cogent Psychol . 2016;3(1):1194176. doi:10.1080/23311908.2016.1194176

Gabbard G. The role of countertransference in contemporary psychiatric treatment . World Psychiatry . 2020;19(2):243-244. doi:10.1002/wps.20746

Clarkin JF, Caligor E, Sowislo J.  TFP extended: development and recent advances .  Psychodyn Psychiatry . 2021 Summer;49(2):188-214. doi:10.1521/pdps.2021.49.2.188

Locati F, De Carli P, Tarasconi E, Lang M, Parolin L. Beyond the mask of deference: Exploring the relationship between ruptures and transference in a single-case study . Res Psychotherapy Psychopathol Process Outcome . 2016;19(2). doi:10.4081/ripppo.2016.212

Bhatia M, Petraglia J, de Roten Y, Banon E, Despland JN, Drapeau M. What defense mechanisms do therapists interpret in-session? . Psychodynamic Psychiatry . 2016;44(4):567-585. doi:10.1521/pdps.2016.44.4.567

Noorani F, Dyer AR. How should clinicians respond to transference reactions with cancer patients? . AMA Journal of Ethics .

Sayers J. Online psychotherapy: Transference and countertransference issues . Br J Psychotherapy . 2021;37(2):223-233. doi:10.1111/bjp.12624

By Lisa Fritscher Lisa Fritscher is a freelance writer and editor with a deep interest in phobias and other mental health topics.

A Case Study of Transference

2005 Inkjet print 160 x 14 inches (detail)

Transference vs Countertransference in Therapy: 6 Examples

In reality, transference occurs within the context of relationships and represents a complex interplay of emotions, memories, and subconscious actions.

While transference is a phenomenon seen in daily life, relationships, and interactions, we will take a closer look at how it affects professional settings and examine practical ways to make it a beneficial aspect of therapy.

Before you continue, we thought you might like to download our three Positive Relationships Exercises for free . These detailed, science-based exercises will help you or your clients build healthy, life-enriching relationships.

This Article Contains:

What are transference & countertransference, 6 real-life examples, psychology theories behind the concepts, 4 signs to look for in your sessions, 5 ways to manage it in therapy, is countertransference bad ethical considerations, 2 helpful worksheets for therapists and clients, positivepsychology.com’s relevant resources, a take-home message.

Freud and Breuer (1895) originally identified and discussed transference and countertransference within a therapeutic context. These concepts were an important part of psychoanalytic treatment but have since been adopted by most forms of psychotherapy.

These concepts occur within any relationship, and the therapeutic relationship is no exception.

So what exactly are transference and countertransference?

Transference

Transference in therapy is the act of the client unknowingly transferring feelings about someone from their past onto the therapist. Freud and Breuer (1895) described transference as the deep, intense, and unconscious feelings that develop in therapeutic relationships with patients. They analyzed transference in order to account for distortions in a client’s perceptions of reality.

While Freud viewed transference as pathological, repetitive, and unreflective of the present relationship between the client and therapist (Wachtel, 2008), modern psychology has rebuffed this assessment.

Many psychological approaches recognize that the responses of a therapist can evoke reactions in the client, and the process of the interaction can be beneficial or harmful to therapy (Fuertes, Gelso, Owen, & Cheng, 2013).

Transference is multilayered and complex and happens when the brain tries to understand a current experience by examining it through the past (Makari, 1994).

There are three main categories of transference.

• Positive transference is when enjoyable aspects of past relationships are projected onto the therapist. This can allow the client to see the therapist as caring, wise, and empathetic, which is beneficial for the therapeutic process.
• Negative transference occurs when negative or hostile feelings are projected onto the therapist. While it sounds detrimental, if the therapist recognizes and acknowledges this, it can become an important topic of discussion and allow the client to examine emotional responses.
• Sexualized transference is when a client feels attracted to their therapist. This can include feelings of intimacy, sexual attraction, reverence, or romantic or sensual emotions.

A therapist can gain insight into a client’s thought patterns and behavior through transference if they can identify when it is happening and understand where it is coming from. Transference usually happens because of behavioral patterns created within a childhood relationship.

Types of transference include:

• Paternal transference Seeing the therapist as a father figure who is powerful, wise, authoritative, and protecting. This may evoke feelings of admiration or agitation, depending on the relationship the client had with their father.
• Maternal transference Associating the therapist with a mother figure who is seen as loving, influential, nurturing, or comforting. This type of transference can generate trust or negative feelings, depending on the relationship the client had with their mother.
• Sibling transference Can reflect dynamics of a sibling relationship and often occurs when a parental relationship is lacking.
• Non-familial transference Happens when clients idealize the therapist and reflect stereotypes that are influencing the client. For example, a priest is seen as holy, and a doctor is expected to cure and heal ailments.
• Sexualized transference Occurs when a person in therapy has a sexual attraction to their therapist. Eroticized transference is an all-consuming attraction toward the therapist and can be detrimental to the therapeutic alliance and client’s progress.

Countertransference

Countertransference has been viewed as the therapist’s reaction to projections of the client onto the therapist. It has been defined as the redirection of a therapist’s feelings toward a patient and the emotional entanglement that can occur with a patient (Fink, 2011).

While Freud viewed countertransference as dangerous because a psychoanalyst is supposed to remain completely objective and detached, those views have since been challenged (Boyer, 1982).

Racker (1988) built the idea that the therapist’s feelings have significance and can lead to important content to be worked through with the client. His definition of countertransference is “that which arises out of the analyst’s identification of himself with the (clients) internal objects” (Racker, 1988, p. 137).

When these reactions surface, they can be dealt with and lead to a healthy therapeutic relationship .

Below is a selection of examples from real life, and a few excellent videos to illustrate both transference and counter transference.

1. I have a crush on my therapist

This video provides a good description of erotic or sexual transference. This is the most dangerous form of transference and has the potential to harm the therapeutic alliance and process.

2. The Sopranos

The famous TV series The Sopranos provides us with a dramatic example of sexualized transference that would break all ethical codes of conduct for a therapy session.

3. Example of negative transference

Amanda (a 32-year-old woman) becomes furious with her therapist when he discusses assigning homework activities. She sighs loudly and states, “This is NOT what I came to therapy for. Homework? I am not in elementary school anymore!”

The therapist remains calm and states, “It sounds like you are upset about homework assignments. Tell me what you are experiencing right now.”

After exploring the emotions that surfaced, Amanda and her therapist come to realize that she was experiencing unresolved anger toward a verbally abusive authoritarian elementary school teacher.

4. Role-play

This video was created by a therapist to demonstrate several types of transference and countertransference. The therapist plays both roles (clinician and therapist) to act out/role-play examples of how transference can transpire in a session.

5. She’s Funny That Way

In this comical clip of famous actress Jennifer Aniston pretending to be a therapist, we can see exaggerated examples of countertransference. In this case, there are no professional boundaries, ethics, or appropriate therapeutic practices taking place.

6. School counseling

Countertransference is particularly hard in school counseling settings.

According to American Counseling Association (ACA) member Matthew Armes, a high school counselor in Martinsburg, West Virginia, “all counselors went to school and have associated memories.” Armes goes on to say that “working with students who are dealing with their parents’ expectations and relationship struggles can trigger countertransference for him because his parents were divorcing just as he was starting high school” (Notaras, 2013).

Armes initially rejected his father during the divorce but eventually repaired the relationship. He states that because so many students experience divorce, it is an issue he strongly empathizes with. It is important to set strong boundaries around this connection and empathy to effectively “let [students] know [they are] not alone and that there are ways to become a stronger person.”

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Are there theories to explain these specific examples of transference? Transference and countertransference are rooted in psychodynamic theory but can also be supported by social-cognitive and attachment theories .

These theories have different approaches to examine how maladaptive behaviors develop subconsciously and outside of our control.

Psychoanalytic theory

In psychoanalytic theory, transference occurs through a projection of feelings from the client onto the therapist, which allows the therapist to analyze the client (Freud & Breuer, 1895).

This theory sees human functioning as an interaction of drives and forces within a person and the unconscious structures of personality.

Within psychoanalytic theory, defense mechanisms are behaviors that create “safe” distance between individuals and unpleasant events, actions, thoughts, or feelings (Horacio, 2005).

Psychoanalytic theory posits that transference is a therapeutic tool critical to understanding an individual’s repressed, projected, or displaced feelings (Horacio, 2005). Healing can occur once the underlying issues are effectively exposed and addressed.

Social-cognitive perspective

Carl Jung (1946, p. 185), a humanistic psychologist, stated that within the transference dyad, both participants experience a variety of opposites:

“In love and in psychological growth, the key to success is the ability to endure the tension of the opposites without abandoning the process, and that this tension allows one to grow and transform.”

This dynamic can be seen in the modern social-cognitive perspective, which explains how transference can occur in daily life. When individuals meet a new person who reminds them of someone from their past, they subconsciously assume that the new person has similar traits and characteristics.

The individual will treat and react to the new person with the same behaviors and tendencies they did with the original person, transferring old patterns of behavior onto a new situation.

Attachment theory

Attachment theory is another theory that can help explain transference and countertransference. Attachment is the deep and enduring emotional bond between two people .

It is characterized by specific childhood behaviors such seeking proximity to an attachment figure when upset or threatened, and is developed in the first few years of life (Bowlby, 1969). If a child develops an unhealthy attachment style , they may later project their insecurities, anxiety, and avoidance onto the therapist.

The key to ensuring that transference remains an effective tool for therapy is for the therapist to be aware of when it is happening.

1. Unnecessarily strong (or inappropriate) emotions

When clients lash out with anger or distress in a way that seems excessive for the topic that is being discussed, it is a clear sign that transference may be taking place.

Clients may even demonstrate inappropriate laughter surrounding issues that are not funny, which can be a signal for the therapist to intervene (Lambert, Hansen, & Finch, 2001).

The therapist can address the strong or inappropriate emotions and get at core issues.

2. Emotions directed at the therapist

An obvious sign of transference is when a client directs emotions at the therapist. For example, if a client cries and accuses the therapist of hurting their feelings for asking a probing question, it may be a sign that a parent hurt the client regarding a similar question/topic in the past.

3. Unreasonable dislike for the client

Therapists also need to be aware of countertransference, when they are projecting feelings onto a client. One of the most common signs of countertransference is disliking a client for no apparent or obvious reason (Lambert et al., 2001).

This is a good opportunity for the therapist to examine personal values, beliefs, and emotions surrounding the characteristics of the client and past relationships.

4. Becoming overly emotional or preoccupied with a client

Another red flag for countertransference is if a therapist notices that thoughts and feelings for clients are taking up a significant amount of time outside of sessions.

It is natural for therapists to think of their clients outside the therapy room, but when they are joined with strong emotions or become intrusive or obsessive thoughts , the therapist may have to refer the client to another practitioner.

Psychological, spiritual, and emotional issues can trigger the most educated and experienced therapists within the therapeutic dynamic.

Some ways to manage transference and countertransference in therapy include the following.

1. Peer support

Consult a colleague, supervisor, or clinical director when feeling an emotional trigger or response. When a session is especially challenging, it can cause a therapist to sacrifice empathy and objectivity.

Regular peer support and clinical therapy meetings can be helpful. Brickel and Associates has more information on options for finding online peer support.

2. Continual self-reflection

Explore feelings toward individual clients, and write down ways you are consciously or unconsciously reacting to them in session.

Our introspection and self-reflection article outlines practical ways to explore self-reflection.

3. Clear boundaries

Set appropriate boundaries regarding scheduling, payment, and acceptable in-session behavior. Discuss any misunderstandings of intent and emotional projection as soon as it occurs.

4. Mindfulness

Practice mindfulness inside and outside of sessions to explore personal thoughts and feelings.

Gain insight into compassion fatigue, burnout , excessive stress, or an inability to do quality clinical work. Observe the space between stimulus and response, and make appropriate thoughtful reactions.

Lichtenberg, Bornstein, and Silver (1984) formulated that empathy is the foundation of human intersubjectivity, and that failing to demonstrate it is the largest impediment to treatment.

Lack of empathy can be a precursor to countertransference. When we employ empathy as practitioners, we are looking at the situation and client outside of our own view, making countertransference less likely.

The Social Work Dictionary defines “countertransference” as a set of conscious or unconscious emotional reactions to a client experienced by a social worker or professional, and has established specific ethical issues to consider in practice (Barker, 2014).

Just like transference, countertransference is not always bad and can be an effective tool in therapy if used properly. The ethical considerations set forth by the ACA and the Newfoundland and Labrador Association of Social Workers (2018) include:

• Professional boundaries When experiencing countertransference, it is important to consider how professional boundaries can be impacted. Professionals need to ensure that the relationship always serves the needs of the client first.
• Conflicts of interest Countertransference may create a conflict of interest that impedes the professional’s ability to remain unbiased or objective. Practitioners can get wrapped up in their own emotional and personal issues, which interferes with the ability to provide effective treatment and impartial judgement.
• Self-disclosure When considering self-disclosure, a professional must examine the benefits/risks and ask whose needs are being met. It is also important to think about whether the client is experiencing transference and how this influences the therapeutic relationship.
• Competence in practice Professionals in the field of mental health should offer the highest quality service possible, and the therapeutic relationship must be terminated if countertransference affects the ability to practice competently.

Having shared experiences with a client can enhance empathy, but therapists and those in the mental health field must work through ethical considerations to inform decision making.

Self-reflection and self-awareness are some of the most powerful tools to guide ethical decisions. The following worksheets and resources can help with this.

For some helpful materials to strengthen your and your client’s understanding of transference, check out the following worksheets.

1. Awareness Transference Worksheet

This basic worksheet helps both clients and clinicians identify specific people in their life and their cognitive and emotional reactions to them. This exercise can highlight how past relationships are being transferred to the present moment.

2. Transference Exercise

This free exercise was designed to help teach clinical psychology students about transference. It can be a helpful exercise to revisit, even among seasoned clinicians.

17 Exercises for Positive, Fulfilling Relationships

Empower others with the skills to cultivate fulfilling, rewarding relationships and enhance their social wellbeing with these 17 Positive Relationships Exercises [PDF].

Created by experts. 100% Science-based.

You’ll find even more resources around our blog around the topics of transference, communication boundaries, and the therapeutic relationship.

Check out some of the following free materials to get you started:

• 3-Step Mindfulness Worksheet Mindfulness is an important tool for both therapists and clients to practice on a consistent basis. This simple but effective worksheet can bring both parties to a place of self-awareness and decrease the likelihood of unproductive transference.
• Levels of Validation This short self-assessment helps therapists and counselors consider the level at which they typically validate the feelings and experiences of their clients, ranging from mindfully listening to radical genuineness.
• Listening Accurately Worksheet This handout presents five simple steps to facilitate accurate listening and can be used to help establish communication norms at the beginning of a therapeutic relationship.
• Assertive Formula This three-part worksheet lays out a formula to help you or your clients clearly and respectfully communicate when someone else’s behavior is causing a problem.

Besides these tools, these articles are excellent supplemental reading material:

• How to Establish Healthy Boundaries in Therapy
• Therapeutic Relationships in Counseling
• Termination in Therapy

If you’re looking for more science-based ways to help others build healthy relationships, this collection contains 17 validated positive relationships tools for practitioners. Use them to help others form healthier, more nurturing, and life-enriching relationships.

Mental health professionals practice in a very lonely world bound by confidentiality and ethical concerns. We must be simultaneously aware of the emotions and feedback clients project and the emotions and thoughts that are personally experienced.

Transference and countertransference can be a double-edged sword. They can destroy the therapeutic process or provide an avenue to healing. They can break down the therapeutic alliance or become its most effective tool.

Identifying examples of transference and countertransference is a wonderful starting point to prevent negative interference in therapy.

Self-reflection, mindfulness, empathy, and ethical boundaries are excellent tools to ensure that when transference arises in session, it is directed in a helpful and therapeutic way.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Relationships Exercises for free .

• Barker, R. (2014). The social work dictionary . NASW Press.
• Bowlby, J. (1969). Attachment and loss: Volume I attachment . Basic Books.
• Boyer, L. B. (1982). Analytic experiences in work with regressed patients . Unknown publisher.
• Fink, B. (2011). The fundamentals of psychoanalytic technique: A Lacanian approach for practitioners . W. W. Norton & Co.
• Freud, S., & Breuer, J. (1895). Studies in hysteria . Penguin Books.
• Fuertes, J. N., Gelso, C., Owen, J., & Cheng, D. (2013). Real relationship, working alliance, transference/countertransference and outcome in time-limited counseling and psychotherapy. Counseling Psychology Quarterly , 26 (3), 294–312.
• Horacio, E. (2005). The fundamentals of psychoanalytic technique . Karnac Books.
• Jung, C. (1946). The psychology of transference . Princeton University Press.
• Lambert, M. J., Hansen, N. B., & Finch, A. E. (2001). Patient-focused research: Using patient outcome data to enhance treatment effects. Journal of Consulting and Clinical Psychology , 69 , 159–172.
• Lichtenberg, J., Bornstein, M., & Silver, D. (1984). Empathy I . Analytic Press.
• Makari, G. J. (1994). Toward an intellectual history of transference. The Psychiatric Clinics of North America , 17 (3), 559–570.
• Newfoundland and Labrador Association of Social Workers. (2018). Standards of practice for social workers in Newfoundland and Labrador.  Retrieved June 15, 2021, from https://nlcsw.ca/sites/default/files/inline-files/Standards_of_Practice.pdf
• Notaras, S. (2013). Attending to countertransference. Counseling Today , 9 , 29–31.
• Racker, H. (1988). The meaning and uses of countertransference. In B. Wolstein (Ed.), Essential papers on countertransference. New York University Press.
• Wachtel, P. L. (2008). Relational theory and the practice of psychotherapy . Guilford Press.

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Can you please add a work cited page please .

It seems each time I read a Positive Psychology piece, it begins negatively. In this case: “For ages, the term “transference” has been associated with pathology, enmeshed boundaries, and unhealthy therapy sessions.” I have never found this to be true. Its originator found it to be an exciting and useful tool in treatment.

Hello, second time you mention that the references are at the bottom of the article but I don’t see them, looking for the Freud and Breuer (1895) one in particular. Can you post the link to actual reference here maybe? thank you in advance

If you scroll down to where it says “How useful was this article to you?” immediately above this you’ll see a grey button that says ‘References’ with a plus sign you can click (or just search ‘References’ in your browser to find it).

The reference you’re looking for is as follows: Freud, S., & Breuer, J. (1895). Studies in hysteria. Penguin Books.

Hope this helps!

– Nicole | Community Manager

You mention a resource on “low trajectory patient” (Perhaps the phrasing is incorrect). I would love more information on this or the resource. Thank you. Misty

Could you please clarify where in this article you read it? In which section and in what context? Then I can perhaps assist.

Thank you, Annelé

Where are the references cited listed? 1e. Frued, 1895. Seriously. I want to look it up.

Hi Brennan,

If you scroll to the very end of the article, you will find a button that you can click to reveal the reference list.

Well rounded article – thank you

I’d been wanting to learn more about transference so really enjoyed reading this one, Melissa — thank you! 🙂

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• v.22(3); 2019 Dec 19

Transference interpretations as predictors of increased insight and affect expression in a single case of long-term psychoanalysis

Yasemin sohtorik İlkmen.

1 Department of Psychology, Boğaziçi University, Bebek, Istanbul

Sibel Halfon

2 Department of Psychology, Bilgi University, Istanbul, Turkey

Contributions: the authors contributed equally.

Improved insight and affect expression have been associated with specific effects of transference work in psychodynamic psychotherapy. However, the micro-associations between these variables as they occur within the sessions have not been studied. The present study investigated whether the analyst’s transference interpretations predicted changes in a patient’s insight and emotion expression in her language during the course of a long-term psychoanalysis. 449 thematic units from 30 sessions coming from different years of psychoanalysis were coded by outside raters for analyst’s use of transference interpretations using Transference Work Scale, and patient’s insight, positive emotions, anger and sadness were calculated using the Linguistic Inquiry and Word Count System. Multilevel modeling analyses indicated that transference interpretations positively predicted patient’s insight and positive emotion words and negatively predicted anger and sadness. The qualitative micro-analyses of selected sessions showed that the opportunity to explore negative emotions within the transference relationship reduced the patient’s avoidance of such feelings, generated insight into negative relational patterns, and helped form more balanced representations of self and others that allowed for positive feelings. The findings were discussed for clinical implications and future research directions.

Introduction

The role of transference, as the repetition of repressed historical past in a new context with the therapist, has been recognized as an essential element of psychoanalytic therapies since Freud formally introduced the term in 1912. Freud initially thought transference was a form of resistance and disrupts the progress of analysis. As his theories on therapy and technique evolved over time, he considered the analysis of transference to be the most effective element of psychoanalytic treatment (Gay, 1988 ). Consequently, transference became a means to understand and translate the unconscious, and transference interpretations the necessary and primary components of analytic technique by fostering insight. Through this process the patient gains insights into their relationship patterns, and gets a chance to experience a different type of relating with the therapist who provides the conditions to achieve this change (Heimann, 1956 ). More recently, clinicians and researchers started to rely on broader definitions of transference, not solely as enactment of early relationships but also as a new experience influenced by the relationship with the therapist (Cooper, 1987 ). Transference interpretations in most empirical studies are defined as an explicit focus on the here-and-now relationship between the therapeutic dyad and links to earlier relationships (Hoglend, 1993 , 2004 ; Piper, Azim, Joyce, & McCallum, 1991 ). According to psychodynamic theory, transference interpretations are an essential component of psychodynamic technique because of their effectiveness in increasing insight about the nature of the one’s problems and in their immediate affective resonance to the patient as they are practiced in the here and now of the therapeutic relationship (Gabbard & Westen, 2003 ; Messer & McWilliams, 2007 ). However, linking hereand- now issues to earlier experiences is not always necessary, and actually not recommended for patients with severe personality disorders (Levy & Scala, 2012 ). For instance, in Transference Focused Psychotherapy developed particularly for patients with borderline personality disorder, interpretations are utilized to address the present unconscious particularly in the earlier phases of the treatment (Kernberg, 2016 ).

Despite this central position of transference interpretations in psychodynamic therapies, there is conflicting research evidence regarding the relationship between transference interpretations and treatment outcome. Whereas some research shows a direct association between transference interpretations and outcome ( i.e ., Clarkin, Levy, Lenzenweger, & Kernberg, 2007 ; Doering et al., 2010 ; Levy et al., 2006 ), others fail to report such an association ( i.e ., Hoglend, 1993 ; Piper et al., 1991 ). These null findings suggest that rather than a direct association between transference interpretations and outcome, this relation may be mediated by other mechanisms of change, particularly increased affect expression, tolerance, and insight (Johansson et al., 2010 ; Høglend & Hagtvet, 2019). There is converging research evidence that shows that gains in insight on one’s problems during psychodynamic treatment are associated with successful outcome (Grande, Rudolf, Oberbracht, & Pauli-Magnus, 2003 ; Johansson et al., 2010 ; Kivligham, Multon, & Patton, 2000 ) and these results are further strengthened when this is combined with emotional expression (Fisher, Atzil- Slonim, Barkalifa, Rafaeli, & Peri, 2016 ; Kramer, Pascual- Leone, Despland, & de Roten, 2015 ; Solbakken, Hansen, & Monsen, 2011 ) creating a cognitive-emotional processing that would not be possible without either component. It is possible that these change mechanisms are best activated within the transference relationship, where a cognitive-affective restructuring takes place in the here and now of an affectively charged relationship and interventions help the patient to gain insight on his/her own internal world and relationship patterns (Kernberg, Diamond, Yeomans, Clarkin, & Levy, 2008 ). Following these findings, the aim of this study was to investigate the associations between transference interpretations and a patient’s changes in emotion expression and insight as expressed in her language in a single case of long-term psychoanalysis.

Transference interpretations and mechanisms of change in psychodynamic therapies

The association between transference interpretations, affective resonance and insight has been empirically investigated in few research studies. Johansson et al. ( 2010 ) found in a randomized clinical trial that the effect of transference interpretations on interpersonal and overall functioning was mediated by increased insight. In another study, Ulberg, Amlo, Johnsen Dahl, and Hoglend ( 2017 ) demonstrated on two clinical cases that transference interpretations were associated with improved therapy outcome by enhancing insight. Investigating the mechanisms of change, Messer ( 2013 ) demonstrated the positive impact of insight achieved through transference interpretations in a single case study. However, insight needs to be linked to appropriate affect in order for working through to take place (Gabbard & Westen, 2003 ). To the authors’ knowledge, only Høglend and Hagtvet (2019) investigated whether increased affect awareness along with insight mediated the relation between initial functioning and outcome and found support for this model long-term transference focused work.

Contemporary psychoanalytic theories emphasize the importance of the corrective emotional experience within the therapeutic relationship as an essential element of change (Gabbard & Westen, 2003 ). These relational theories regard human psych as emerging within a relational context in which intrapsychic and interpersonal aspects continually shape each other (Mitchell, 1988 ). One of the central themes in the relational theories is the interaction between transference and countertransference, and how they influence each other (Aron, 2006 ). In these views, both analyst and patient contribute to the analytic interaction. The insights gained in therapy are considered specific to the particular analyst-patient dyad because they are co-created by this analytic couple (Renik & Spillius, 2004 ). Since both parties bring their own subjective experiences to this interaction, they both contribute significantly in the co-creation of the patient’s understanding of his/her mental life. In this intersubjective view of the clinical encounter both participants must mutually recognize each other’s subjectivity in order to achieve separation, awareness of the outside reality and ability for attunement with the other (Benjamin, 1990 ). However, recent theories suggest that therapeutic change is facilitated by both insight and therapeutic relationship as well as their interaction in complex ways (Gabbard & Westen, 2003 ).

Linguistic analyses of affect expression and insight

Traditionally, patient’s insight and affect expression have been investigated via self-report scales or observerrated measures, which provide an outside and partial perspective into the immediate experience of the patient in the session. In order to address this problem, computerized linguistic analyses have been employed on session transcripts to understand the psychological, particularly cognitive and affective processes that are associated with patient’s word choices. Pennebaker and coworkers have done pioneering work in the study of different word categories and linking these with various psychological states based on their computer based linguistic program named Linguistic Inquiry Word Count (LIWC) (Pennebaker, Booth, Boyd, & Francis, 2015a ). They have not focused particularly on psychodynamic therapies; however, they extensively analyzed the writing features most strongly associated with enhanced psychological and physiological health and found that it is important for people to generate insight and express affect related to personal experiences, especially ones that are traumatic or stressful (Pennebaker & Seagal, 1999 ). In particular, stories that contained a high rate of emotion words ( e.g ., sad , hurt , guilt , joy ) and insight words ( e.g ., understood , thought , know ) showed the greatest benefit (Pennebaker & Seagal, 1999 ).

Other studies showed that the valence of emotion words affected different facets of psychological health. For example, using a high frequency of positive emotion words in an expressive writing exercise was associated with improved physical health as indicated by decrease in the number of physician visits and self-report symptoms (Pennebaker, Mayne, & Francis, 1997 ). The specific types of negative emotion words also relate to adjustment and can shed light on additional facets of emotional expression. In one study, researchers examined the expression of negative emotions in written texts and found that the expression of anger and sadness were associated with higher quality of life and lower depression scores among breast cancer patients (Lieberman & Goldstein, 2006 ).

Computerized linguistic analyses of psychodynamic treatments

Computerized linguistic analyses of treatment processes provide the means to integrate systematic linguistic analysis of sessions with clinical evaluations. Erhard Mergenthaler and his group focused on the emotional tone (density of emotional words) and level of abstraction (the amount of abstract nouns) within patients’ language in psychodynamic therapies and found that successful outcome in psychodynamic therapy is associated with increased use of emotion and abstraction in language, which shows that the patients have emotional access to conflictual themes and can reflect upon them building insight (Buchheim & Mergenthaler, 2000; Gelo & Mergenthaler, 2012; Lepper & Mergenthaler, 2008 ). Bucci’s multiple code theory is another application of these premises to psychoanalytic research using the concept of Referential Activity (RA; see Bucci, Maskit, & Murphy, 2016 , for a review). Bucci has found that patients initially come to therapy with sensory and somatic emotion schemas not yet associated with words. However, if the treatment is working properly, these schemas are integrated in a narrative, which will include the analyst, sometimes explicitly, almost certainly implicitly and the representations of emotions in the here and now of the therapeutic relationship (Bucci & Maskit, 2007 ; Bucci, Maskit, & Hoffman, 2012 ). Even though Pennebaker and his group have not particularly studied patients’ linguistic choices in psychodynamic treatments, the associations they found between emotion expression and insight in expressive writing tasks have to do with the creation of a narrative that provides a cognitive and affective elaboration of incoherent experiences; an idea that is much akin to the psychoanalytic principles of the talking cure .

In terms of the types of emotions expressed, Mergenthaler ( 2008 ) posits that negative emotion occurs first within a session for problems to be elicited followed by an increase in positive emotion for key helpful moments of problem solving to begin. Similarly, Pennebaker and Francis ( 1996 ) found that students who used more positive emotion words and words indicating insight and causal thinking when writing about thoughts and feelings had better health outcomes.

Some studies examined how therapists’ interventions predicted changes in patient’s linguistic choices. For example, Vegas, Halfon, Cavdar, and Kaya ( 2015 ) looked at the association between the analyst’s interventions and patient’s discourse patterns and found that analytic explorations predicted the patient’s emotional and insight focused language. Recent literature has begun to examine therapist-patient discourse to identify therapist and patient contributions to significant change processes within therapy (Levitt & Piazza-Bonin, 2011 ). In particular, Valdés et al. (2010) found that within change moments patients brought up a number of different emotions and therapists explored these emotions. Valdés Sanchez (2012) found that during change episodes when therapist showed understanding and mirroring of patient’s affective states in the here and now and gave new meaning to emotional material, patient presented novel emotional content. Furthermore, patient responded with cognitive insight words in response to therapist’s emotional processing of transferential material. These studies indicate that patients respond to therapist’s interventions with increased insight and emotion expression in language particularly during change moments. However, to the author’s knowledge, there have been no prior studies that specifically assessed the associations between transference interpretations and patient’s level of insight and emotion expression in language.

The case of study

The sessions examined in the current study were taken from a case known as Mrs. C in the psychoanalytic literature and has been studied previously by various researchers (Ablon & Jones, 2005 ; Halfon, Fisek, & Cavdar, 2017 ; Halfon & Wenstein, 2013 ; Jones & Windholz, 1990 ). Mrs. C was in psychoanalysis for six years, yielding nearly 1,100 hours of which were all audio-taped (Jones & Windholz, 1990 ). Using the Q-technique, Jones and Windholz ( 1990 ) examined Mrs. C’s analysis, and concluded that the outcome of her analysis was successful. They found that over the course of her treatment, Mrs. C exhibited increased capacity for free association and access to her emotions, greater self-disclosure and decreased amount of intellectualization and rationalization. They also reported improvement in her initial complaints of feelings of inadequacy, guilt and anxiety. On the analyst’s part, he became more active in interpreting Mrs. C’s defenses and recurrent relationship patterns over the course of the treatment. More recently, Halfon and Weinstein ( 2013 ) and Halfon, Fisek and Cavdar ( 2017 ) studied 30 sessions from the 70 studied by Jones and Windholz ( 1990 ) and found an improved capacity on the part of the patient to verbally express her emotions throughout her analysis.

These findings indicate that there was an increase in affective expression and elaboration in the case of study, however the specific types of interventions associated with this pattern have not been investigated. Literature has shown that transference interpretations impact outcome through increased insight that is combined with emotion expression in the here and now of the therapeutic relationship. Moreover, some studies show that in change moments, patient expresses more positive affect, whereas other studies show that there is initially negative affect expression. Expression of anger and sadness have most frequently been associated with transference work ( i.e ., Levy et al., 2006 ) that eventually gives way to more positive affect. Therefore, this study will examine the associations of transference interpretations on insight and positive and negative affect (anger and sadness) expression of the patient. Our specific hypotheses are: i) transference interpretations will be associated with an increase in emotional expression (positive emotions as well as anger and sadness), ii) transference interpretations will be associated with an increase in use of insight words.

The patient, Mrs. C, was a married woman in her late twenties. She was a social worker, and gave birth to two children throughout her 6 year-long psychoanalysis. She originally went to analysis with complaints of lack of sexual desire and pleasure, difficulty experiencing her feelings, being self-critical and uncomfortable disagreeing with others, and feeling tense and worried about her mistakes (Jones & Windholz, 1990 ). The patient gave oral consent to be audiotaped as part of her regular, ongoing psychoanalytic treatment. The taping was done unobtrusively in the usual course of a five times per week psychoanalysis. 214 sessions of this patient’s treatment have been published by Sage Press and were systematically deidentified. It is from this published de-identified data set that sampling for the present study was done.

Session selection and segmentation

Sessions were randomly selected over a span of general time period in the treatment from 70 sessions that were already studied in depth by other researchers (Bucci, 1997 ; Jones & Windholz, 1990 ). Sessions 90 to 94 from the first year, Sessions 258 to 262 from the second year, Sessions 431 to 435 from the third year, Sessions 601 to 605 from the fourth year, Sessions 767 to 771 from the fifth year, and finally Sessions 936 to 940 from the sixth year of treatment were chosen.

Each session was divided into thematic units following the procedure developed by Waldron et al. ( 2004 ). This procedure allows the creation of units that take into consideration the turns of speech between the analyst and the patient. Specifically, thematic units consist of clinically meaningful segments of communication that aggregate around a given theme. This procedure yielded different number of units (min=6 to max=24) between sessions ( M =14.97, SD =4.55). To do the segmenting, two clinical psychology doctoral-level students were trained using the segmenting manual developed by Waldron et al. ( 2004 ). Afterwards, they segmented each session with an interrater reliability score of 0.83. Disagreements were resolved upon discussion with the second author.

Transference interpretations

Each unit was scored based on the criteria provided by Transference Work Scale (Ulberg, Amlo, & Hoglend, 2014 ). Ulberg et al. ( 2014 ) define transference interpretation as any intervention aimed to point out the therapistpatient relationship in the therapeutic process. Accordingly, there are five categories of transference interventions, which are not designed to be hierarchical: 1) addressing the transaction between the analyst and the patient, 2) encouraging the exploration of the thoughts and feelings about the therapy and analyst, 3) encouraging the exploration of how patient believes the analyst might think and feel about them, 4) including herself in the interpretation of internal dynamics and transference manifestations, and 5) providing genetic interpretation and linking this with therapeutic interaction. The scale has good interrater reliability for category classification, as kappa values range between 0.60 and 0.90 (Ulberg, Amlo, Critchfield, Marble, & Hoglend, 2014 ). In the current study, the sessions were rated by three independent raters, a doctoral level clinical psychologist with over ten years of experience and two clinical psychology master’s level students, who received ten hours of training from the first author. Interrater reliabilities between three independent raters were excellent ranging between 0.94 and 0.96 ( M =0.96, SD =0.01).Disagreements were resolved with consultation with the first author.

Linguistic analyses

The LIWC (Pennebaker et al., 2015a ) is a computerassisted method for studying emotional, cognitive, and structural aspects of verbal and written speech. The LIWC compares transcripts to its dictionary, providing counts of words, as proportions of the total words analyzed within the transcript that tap into 66 various domains or word categories. The LIWC has been validated across a number of studies as detailed by Pennebaker, Chung, Ireland, Gonzales, and Booth ( 2007 ) with the psychological language categories related to health outcomes. In line with the aims of this study, we used LIWC word categories tapping into insightwords (think, know, realize, meaning, understand), positive emotions (love, fun, good, happy, gift, nice, sweet), sadness (crying, grief, sad) and anger (hate, kill, annoyed, rude) scores. Internal reliability coefficients are 0.84 for insight, 0.64 for positive emotion, 0.70 for sadness and 0.53 for anger categories (Pennebaker, Boys, Jordan, & Blackburn, 2015 b).

Procedures and data analytic strategy

In order to code for the type of intervention in each unit, a score of “0” was assigned if there was no intervention, “2” if analyst used any one of the transference interventions as described by above categories in TWS, and “1” for the remaining interventions that did not meet criteria for transference interventions. These non-transference interventions were analyst’s activities that included explorations, clarifications and questions as well as nontransference interpretations such as addressing patient’s conflicts ( e.g ., So you talked to your mother on the phone , What was your choice? , How do you feel it is connected? Well it’s always been hard for you to imagine feeling opposite ). All units (patient sections) were then entered into the LIWC2015 to calculate the percentage of insight words, positive emotion words, and sadness and anger words.

In our data psychotherapy units ( N =449) were nested within sessions ( N =30) who were nested within years ( N =6). Therefore, we used a multilevel modeling approach using MLwin Version 3 (Rasbash, Steele, Browne, & Goldstein, 2015 ). Since multiple sessions were conducted within the same year, we investigated the degree of interdependency due to years. We used two-level (units nested within sessions) and three level (units nested within sessions nested within years) empty multilevel models, where we entered our dependent variables, that were positive emotions, insight, anger and sadness with no predictor variables. The year level ICCs were 0.00, ns. , for positive emotions, insight, anger and sadness, which showed that years accounted for 0.00% of the variance in positive emotions, insight, anger and sadness suggesting that the variance in the dependent variables is not attributable to differences between years. The variance at the session level was slightly higher, albeit not significant for the dependent variables, such that the session level ICCs were 0.03 for positive emotions accounting for 0.45% of the variance, 0.00 for insight and sadness accounting for 0.00% of the variance, and 0.03 for anger accounting for 0.01% of the variance. Even though the session level variances were not significant, we chose to run two level models to control for the interdependency between units that may be attributable to session characteristics.

Quantitative results

Descriptive statistics.

The descriptive statistics and inter-correlations between the study variables are presented in Table 1 . Table 2 shows the detailed descriptive statistics of the interventions. Over the course of the treatment, of the 226 analytic interventions, 43% of the analyst’s interventions were non-transference type and 57% were transference interpretations. The analyst’s transference interventions increased over the course of treatment. When we look more closely at the types of transference interventions the analyst practiced, the analyst most frequently addressed the transaction between himself and the patient (Category 1; 44%), followed by encouraging the exploration of the thoughts and feelings about the therapy and analyst (Category 2; 36%), including himself in the interpretation of internal dynamics and transference manifestations (Category 4; 10%) and the rest of the categories were practiced only a total of 10% of the time. The frequency of the categories practiced changed over the course of treatment such that in the first three years, the analyst mostly made Category 1 transference interventions, however after the third year, there was an increase in the Category 2 and 4 interventions.

Descriptive Statistics and Pearson’s Correlations for the Study Variables (N=442).

The difference between total number of interventions (n=449) and study variables (n=442) results from the fact that there were 7 incidents of therapist intervention where patient did not respond verbally, so there were no words to analyze.

** P<0.01.

Multilevel modeling

We conducted 4 separate fixed effect multilevel models with maximum likelihood (ML) estimation to analyze the data that nests change in units within the sessions, where positive emotions, insight, anger and sadness were our dependent variables and type of analyst’s activity (transference intervention, non-transference intervention, no intervention) was our predictor. No intervention was the reference category.

The results indicated that ( Table 3 ) both transference and non-transference interventions positively predicted positive emotions. Transference interventions positively predicted insight, and negatively predicted anger and sadness, whereas non-transference interventions were not significant in these models.

Qualitative analyses

The following segments were chosen according to patient’s linguistic markers. We chose segments where there was a transference interpretation and an increase in one of the linguistic markers compared to the session mean.

Year 1, session 93

The patient talks about the difficult things she is facing in her life and reports that she feels uninvolved and unable to deal with these things. The analyst brings her attention to the transference:

Analyst: Including here. (category 1, address transaction)

Patient: … instead of meeting them, I am running away from them.

Analyst: You said, ah, earlier that you’ve been feeling, I think you called it, uninvolved all week. I have a kind of an impression that that’s the way you’re feeling here, now. But I’m not sure. (category 1, address transaction)

Patient: … And both weeks I’ve overslept a great deal, which I never, or very rarely do. And just somehow, as long as I’m in bed, asleep, then these things don’t, whatever it is, don’t bother me… (She elaborates further on her passivity, regressing into sleep to avoid facing difficulties). I was just thinking about the way I’m not feeling involved in anything today. And it’s almost as if wherever I turn my thoughts to, I either have very ambivalent or confused or contradictory thoughts or feelings about different things so that I immediately withdraw from thinking about it, anything.

At this point, the patient expresses negative affect (feeling uninvolved, confused/ambivalent) outside of the transference valation; however, with the analyst’s focus on the transference relationship, she brings up a transference reaction.

Patient: … It’s funny, something just occurred to me that, uhm, seems so little but now it seems that it could have thrown me for this whole time. When, when I came in today, I felt as if when I said hello to you that I looked at, looked at your eyes, really, longer than I ever had before. And I was sort of aware that I wasn’t kind of hiding my face away from you as soon as I said hello, which I usually do. And then afterwards, I felt very, right when I came in, very uncomfortable that I had, well, it was in some way, exposed myself or made myself vulnerable.

Summary of analyst interventions in frequencies and percentages.

Summary of multilevel models predicting emotions and insight by type of intervention.

No intervention is the reference category.

** P<0.01

* P<0.05.

Analyst: How would it make you vulnerable? (Category 2, thoughts and feelings about therapy)

Patient: I don’t really think I understand how, except that I know I feel uncomfortable looking at people. Not always but very often I’m aware of sort of forcing myself to look at people because my inclination is not to.

Analyst: Were you aware of any particular thing you saw? (Category 3,beliefs about therapist)

Patient: When I looked at your eyes?

Analyst: Yeah. I mean, was there any more to it than that? (Category 3 cont.)

Patient: (Pause) Well, it was just sort of a friendly expression that, uhm, I don’t know exactly what it was. But I think it’s an expression I like to see and yet I feel uncomfortable if I see it and, and keep looking at it. (Pause)

She is now actively engaged and present as the analyst explores the transference and tries to keep the patient in the here-and-now by exploring her vulnerability in relation to himself. In response, even though the patient reports on her passivity in her outside relationships, she talks about being active with the analyst (looking him right in the eye) and the accompanying anxiety about exposing herself. She can elucidate these fears only after the analyst invites these responses in the transference relationship. Compared to the beginning of the session where she was talking about experiencing a general lack of involvement, she now shows increased self-focus, increased emotion that is more varied (feelings of discomfort and vulnerability) as well as positive affect (liking the analyst’s friendly expression). She also shows insight into why she may be experiencing these feelings.

Year 3, session 433

This is one of the first sessions after the patient came back to analysis following the birth of her first child. She talks about her distance from her child, which helps her retrieve an important childhood memory:

Patient: (Pause) Well, something occurs to me, and then I’m puzzled about something that’s been said today. What occurs to me is just that uhm, for a long time I found it very hard to speak of FSO (her child) by her name. (Pause) And it seemed like that came out of somehow, my keeping a distance from her emotionally. And I also found, just when my reaction to her being sick reminds me very much of what I always thought my family’s was, or my parents’ reaction was to my being sick, or any of us. That I don’t know, it was as if there was a danger there of something happening to the child. So then you had to make up to the child for all the - maybe it, they were unexpressed things, but at least feelings that you had had - negative feelings.

In this segment, we start to understand patient’s fears of expressing negative feelings, which may be related to hurting the other person (getting her child sick in this case) and the need to make up after such expressions, a pattern that she has inherited from her parents’ reaction to her. At this point, the patient has a transference reaction:

Patient: I’m not sure which came first. But, uhm, I just suddenly felt you were laughing at me, and then I felt angry. (Pause)

Analyst: Why would you think I was laughing? (Category 3, beliefs about therapist)

Patient: (Pause) Well, I mean, it was partly the sound that you made just at that time. But it must be from what I was saying. (Sigh)

In the above unit, patient is able to express her anger towards the analyst. This is a significant turning point in that the patient’s usual position had been one of passivity and avoiding her negative feelings possibly for fear of hurting others, an object-relational pattern that she had learned in her childhood. However, when the analyst invites her to reflect on her negative feelings, the patient, instead of avoiding or excusing her reaction, can elaborate on where her impression came from. In effect, we see increased self-focus and insight. Moreover, even though the patient expresses anger prior to the analyst’s transference intervention, when the analyst invites her to reflect on her anger in reference to himself, she is able to think about where this feeling may have come from, linking it to what she had been saying earlier, which reduces her anger.

Year 4, session 603

Patient starts this session emotionally involved and engaged, disclosing transference material.

Patient: (5-Minute Silence) Mm, when I first came in I was thinking about the fact that today I (Clears throat) when I not only wore this dress, which I don’t know if I think I look as nice in it as I used to, or if it, I feel the way it used to make me feel. But I st-, I think, I still was aware of uh, wanting to appear nice to you and, or, or aware of the fact you might be noticing how I look, or something like that…

Analyst: Why this special effort? (Category 2, thoughts and feelings about therapy)

Patient: Well I, th_ this is when I started thinking about yesterday, and it seemed like it was almost (Sniff), well either, either that I was going back on an attitude I had yesterday, and, or I was trying to make up, sort of be nice to you after not being nice, or, er, for being late yesterday, or I don’t know. But (Sniff, Sigh) I think somehow I felt very rebellious yesterday, and uhm, defiant, I think. I mean it seems like today I’m, I either got scared and I’m now saying that I’m really nice, or I’m denying something that I was feeling yesterday, or –

Analyst: What would you have gotten scared of? (Category 2, thoughts and feelings about therapy)

Patient: (Clears throat, Pause) Well I guess that you would disapprove, and uh show your disapproval by sort of withdrawing from me and being cold…But I remember sort of thinking of how you must be seeing u-, u-, what I was saying, some of the things I said yesterday. And uhm –

Analyst: Which was how? (Category 3, beliefs about therapist)

Patient: Well, that I’m sort of acting like a little child.(Sniff, Pause)

Analyst: This has a very familiar ring to it, I think, you know? It sounds to me like what you used to go through, or the way you at least talked about the way you went through things with your father. You’d show how angry you felt, and rebellious, and then ah, you must have done something very much like this, sort of back off and then feel contrite and want to sort of make amends. (Category 5, repetitive interpersonal pattern)

In this session, we see that the patient repeats an archaic object relational pattern in the transference that is expressing her negative feelings or a rebellious attitude and then needing to be nice afterwards, and fearing that the analyst would disapprove of her anger and withdraw. When the analyst explores her transference reaction, the patient can elaborate on her fears, which in effect reduces her anger and fears of disapproval and paves the way for a genetic transference interpretation, linking her fears of expressing her anger with her childhood experiences with her father. Again, we see that as this experience is reenacted in the transference, and the analyst invites and explores the patient’s reactions, the patient possibly feeling more contained, can focus on and show insight into her relational patterns, and face the negative feelings she has learned to avoid, which helps reduce their intensity.

Year 5, session 767

This session, the patient talks about a conflict she experiences with a friend. She expresses her anger towards him while they were playing bridge and refuses to play bridge with him again. Afterwards she feels very conflicted about what she has done. On the one hand she feels glad that she expressed her annoyance and ended the evening, on the other she feels guilty that she showed her anger. During the session, as she discusses her feelings regarding this conflict, she asks that her analyst say something to help her solve the conflict:

Patient: … Uh, I was thinking back again to what to do about the BFMs (friends). And I think maybe I’ve had this feeling of I came here, uhm, and thought about it here … I wanted you to just tell me something, or, if uhm, I hoped I’d think things here because of just thinking differently than I would if I were thinking it on my own, at home. But, because I think even when it was really bothering me before, and I kept thinking, I’ve got to do something right away, uhm, but then I didn’t know what I wanted to do. And uhm, (sigh) I think I even thought then, well I can wait until after Monday, when I come here.

Analyst: Do you have anything in particular in mind that you wanted me to say? (Category 2, thoughts and feelings about therapy)

Patient: … I, I guess what I was wondering is if I then want you to tell me why I was doing about that, or uhm.

There are two significant developments here; first the patient was able to express her annoyance/anger in a relationship outside of treatment, possibly with the help of the analysis where she was able to express her anger and see that she did not distance the analyst as she feared she would. Second, she openly seeks analyst’s input to help her deal with the resulting feelings. She later reports that she finds this friend similar to her father, yet she was able to express her negative feelings by refusing to continue playing bridge and leaving their house. This is a new object-relational pattern that she was able to achieve via the repetitions and revisions of the old patterns in the transference relationship. Furthermore, unlike her usual avoidant attitude, she is openly asking her analyst to help her solve this internal conflict. The analyst’s openness to explore these feelings with her further facilitates this process.

The current study investigated the relationship between transference interpretations and the changes in level of insight, positive and negative affect expression in the patient’s language in the course of a long-term psychoanalysis. The quantitative results showed that transference interpretations positively predicted patient’s insight and positive affect expression. Contrary to our expectations, we found a negative association between transference interpretations, anger and sadness expression. Non-transference interventions, such as exploration of the patient’s material, positively predicted positive emotions but was not significantly associated with other linguistic indicators. Qualitative analyses indicated that analyst’s transference interventions helped the patient address her avoidance of negative emotions. The analyst’s exploration and active interpretation of the transference helped the patient take a more active stance as she focused on and experienced these negative feelings that she had learned to avoid, and afterwards showed insight into why she may be experiencing these feelings. Patient was able to express her fears of hurting and distancing the analyst if she shows her anger and the need to make amends afterwards, an object- relational pattern that she had learned in her childhood. The analyst’s open invitation to express her anger in relation to him possibly helped her feel more contained in the transference relationship, and form a more integrated image of the analyst as someone towards whom she can both express anger without fear of retaliation and feel supported. This further reduced negative affect and helped her bring more positive affect into her narrative. Towards the final year of the analysis, we saw that the patient was able to engage in new object relational patterns, carrying over what she had learned in the analysis to her outside relationships.

Before attempting to understand these findings in the light of current literature, we would like to comment on the relationship of this particular dyad, namely that of Mrs. C and her analyst. Analytic encounters are intersubjective, and insights gained through this process are specific to the particular patient and analyst dyad based on their particular subjectivities (Renik & Spillius, 2004 ). Even though this case has been studied by various researchers, the focus has been on the patient and the analytic process, and very little has been said about the analyst. Jones and Windholz ( 1990 ) studies 10 sessions from each year (including all the sessions examined in the current study), and demonstrated that the analyst was able to accurately identify the patient’s experience and emotional states, conveyed a neutral and non-judgmental attitude in the therapeutic process, and focused on the patient’s feelings to help her get a deeper understanding of them. The results from the qualitative analysis of the sessions studies in the current study overlaps with these findings. We are not aware of any information regarding the experience of the analyst, but these results indicate that his attuned, non-judgmental and non-defensive therapeutic stance facilitated important changes in patient’s psych.

The associations between transference interpretations, increased positive emotions and decrease in anger and sadness support a mechanism of change that has previously been found in transference focused therapies ( e.g ., Clarkin, Levy, & Schiavi, 2005 ). The reactivation of object relational patterns in the transference, and the therapist’s inviting and nonjudgmental attitude paves the way for experiencing these relational patterns and the concomitant affects in the transference. Afterwards, instead of attempting to deter the negative affect associated with self and other representations by educative means, transference interpretations, via encouraging the patient express negative affect towards the analyst in a non-judgmental context, and exploring of how patient believes the analyst might think and feel about them, helps form a more integrated and complex image of the analyst ( i.e ., someone whom the patient can get angry but won’t retaliate, with whom anger can be expressed in the context of support and intimacy). In fact, our frequency analyses indicated that the analyst most frequently explored the patient’s reactions in relation to himself and encouraged her to express thoughts and feelings relating to the analyst. Thus, eventually, overly negative self and other representations could be integrated with more positive representations, providing more balanced experiences and the opportunity to experience more positive feelings. In effect, it has previously been shown that transference interpretations are especially helpful in reducing anger as well as depression (Clarkin et al., 2007 ). Our findings also supported a decrease in anger and sadness in the sessions. Moreover, the increase in positive emotions point to a broadening in the patient’s experience, which has been found to develop within the context of an emotionally attuned and containing relationship with the therapist (Stalikas, Fitzpatrick, Mistkidou, Boutri, & Seryianni, 2015 ). It is important to note that even though non-transference interpretations, such as exploration were also associated with increased positive emotions, it was only transference interpretations that reduced negative affect expression, further supporting their importance in the containment of negative affect and its neutralization in the context of more integrated and complex object relations. The patient, using the transference relationship as a starting point, was able reflect on similar situations ( i.e ., dinner party) where she had difficulty expressing her anger and the following anxiety.

This sort of increase in insight and cognitive-affective processing was recently validated in a randomized controlled trial that showed that individuals who were diagnosed with borderline personality disorder and received Transference-Focused Psychotherapy (TFT) had a significant increase in their reflective function (Fischer-Kern et al., 2015). Another randomized controlled trial also showed evidence for the improvement in reflective function as a result of TFT (Levy et al., 2006 ). Furthermore, there is evidence showing that insight mediates the link between transference and improvement at the end of treatment (Johansson et al., 2010 ). Future research can investigate the changes in the patient’s reflective function as they occur in the sessions.

It is important to note that the aforementioned findings from transference focused therapies measure global changes in insight and affect at outcome mostly via observer rated interviews. To the author’s knowledge, these results are the first to show an association between transference interpretations, insight and emotion expression within the sessions. Even though it was initially predicted that transference interventions would be associated with increased emotion expression, following findings of Høglend and Hagtvet (2019), our findings indicated that patient’s negative affect decreased in the context of transference interpretations, possibly due to the analyst’s emotional containment. As stated before, our qualitative findings indicated that the analyst’s invitation of the patient’s negative emotional responses in the transference helped decrease patient’s avoidance of the negative feelings and process them with insight. Even though we were not able to perform lagged-analyses to test such results, future research can test whether transference interventions practiced one lag before patient’s expression of insight and emotion expression cause changes in affect experiencing, which predict global changes in affect expression and tolerance at the end of treatment.

These findings also support a recent study that found that negative relationship patterns that the patients unconsciously repeats without awareness, particularly more aggressive and less supportive patterns both within and outside the transference relationship may impede with the therapeutic bond and patient’s progress in treatment (Hegarty, Marceau, Gusset, & Grenyer, 2019 ). These patterns need to be addressed early in treatment for increased therapeutic gains and evocation of positive experiences. Mergenthaler ( 2008 ) found that there is initially evocation of negative emotion associated with negative experiences followed by an increase in positive emotion associated with problem solving. Temporal causal associations cannot be derived from this study, and future research is necessary to investigate whether transference interpretations, particularly interpretation of negative relational patterns early in treatment predicts later improvements in affect expression, specifically an increase in positive affect and whether insight mediates these changes.

Clinical and research implications

On the basis of the results from the current study, transference interpretations with an emphasis on the hereand- now are essential elements of change in psychoanalytic treatment. An open attitude that invites for open discussion of uncomfortable feelings, e.g ., anger and sadness, in the here-and-now context will facilitate linking negative and positive aspects of object relations leading to a more integrated view of both self and others (Kernberg, 2016 ).

We were not able to assess whether specific kinds of transference interpretations were more conducive in generating insight and emotional processing, however, our frequency analyses indicated that the analyst most frequently explored the transaction between himself and the patient (Category 1) followed by encouraging the exploration of the thoughts and feelings about the therapy and analyst (Category 2), and these were most frequently practiced in the initial years of the psychoanalysis. This may have been especially containing for this patient, rather than more interpretative interventions such as genetic interpretations in the first years, allowing her to feel safe to express disturbing experiences in the here and now of the transference. Consistent with this finding, Hoglend, Gabbard, and Gabbard ( 2012 ), in a literature review point out that most transference interpretations do not use linking of current-past object relations. As a matter of fact, Levy and Scala ( 2012 ) suggests that linking here-and-now transference reactions with past relationships is not necessarily needed, and sometimes specifically not recommended, because such linking may be disorganizing for some patients, particularly for those with personality disorders. Future research can specifically examine which kinds of transference interpretations are associated with an increase in insight and emotion expression.

This study has significant implications for psychotherapy process research. Our study is the first, to our knowledge, to show evidence for a link between transference interpretations and therapy process variables using linguistic measures. More specifically, the results demonstrated that the effects of transference interpretations on insight and affective expression within the sessions can be successfully measured by analyzing the fluctuations evidenced in the language use of the patient. If narrating upsetting/traumatizing experiences is considered as an emotion regulation strategy, then linguistic measures used to examine particular language patterns within sessions can be a useful approach in psychotherapy process research. This study suggests that the micro-analysis of the language style used in the interaction between the patient and therapist is conducive in identifying the immediate affective and cognitive changes in the context of treatment interventions.

Limitations and directions for future research

Some limitations of this study has to be considered. First, even though in depth analysis of single case studies are instrumental in therapy process research, drawing general conclusions based on a single case poses a major limitation. The second area of concern with the data set is its small size. An improved methodology would be based on a repeated single case design, preferably with more time points, involving relatively large sample of treatments for adequate comparison. Another limitation is the lack of outcome measures to evaluate the effectiveness of this treatment. The archival nature of this data prevented current researchers to assess the outcome of this treatment using reliable and valid instruments. Furthermore, even though we were able to document that transference interpretations predict linguistic changes, we are not able to tell whether the patient is able to practice this capacity outside of the therapy situation, and directly link these to measures of symptom assessment. Another area of concern is related to the measurement of insight. Insight was measured using a computer program that analyzes words and categorizes them as insight words. This approach does not take independent judgment of the therapist or observers regarding improvement in the level of patient insight into consideration. An alternative method would be to utilize computer aided program together with a well-established measure of insight, e.g ., insight scale completed by independent judges. In a similar vein, we did not assess non-verbal affect expression, which could have yielded a different relationship between transference interpretations and negative affect expression. Future research can overcome this limitation by utilizing assessment instruments to evaluate both verbal and non-verbal affect expression. Furthermore, we were not able to account for other individual factors or therapy variables ( i.e ., alliance) that may have affected the course of treatment. Future studies can also apply other measures of process to understand core therapist factors and therapeutic interaction that aid in the development of insight and affect expression.

Conclusions

This study sought to put forth an empirical model that could be used to deepen our understanding of salient forces such as transference interpretations, insight, and affect expression in a long-term psychoanalysis. Empirical studies in this context are necessary to test the psychoanalytic model using multiple perspectives that involve quantitative ratings of the clinical material, fine-grained linguistic measures as well as a qualitative illustrations based on the authors’ clinical impressions to further psychoanalytic knowledge and technique.

Acknowledgments

The authors thank Dilan Şenlik and Hande Deveci for their contribution in data coding.

Funding Statement

Funding: none.

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Psych Reviews

Psychology, Meditation, and Philosophy book reviews

Case Studies: Dora – Sigmund Freud

The bauer’s and the zellenka’s.

In  Fragments of an Analysis of a Case of Hysteria (1905) , Freud first published a case study on Ida Bauer, under the pseudonym “Dora”, a daughter of parents in a loveless marriage. Her father, a merchant, and mother, immigrated from Bohemia to Vienna. In Freud’s case study, the 18 year old subject was stuck in what could be called an imbroglio, with a couple the family befriended, under the pseudonym “the K’s”: Hans and Peppina Zellenka, also in a loveless marriage.  Dora’s mother was described by Freud as having a “‘housewife’s psychosis’. She had no understanding of her children’s more active interests, and was occupied all day long in cleaning the house with its furniture and utensils and in keeping them clean – to such an extent as to make it almost impossible to use or enjoy them. This condition, traces of which are to be found often enough in normal housewives, inevitably reminds one of forms of obsessional washing and other kinds of obsessional cleanliness.” Fights between the family led to Dora supporting her father and her brother supporting their mother. The typical Oedipus Complex pattern.

Dora was forced to enter analysis by her father, after failed hydro and electro treatments with physicians. With nervous obsessive thoughts, difficulties breathing, a shuffled step, and a persistent nervous cough, Freud put her under the label of hysteria. Dora at the time would introduce to Freud what he termed as transference: See below. Psychologists today are readily aware of how their patients can project emotions they have for other significant people in their lives, onto the them. There is often a difficulty in finding the concealed truth behind the patient’s resistance and transference, or even more difficult to be aware of one’s own countertransference response as an analyst. Reacting with contempt towards the patient naturally leads to them becoming more hostile and quitting early, but in the early days of psychoanalysis it was something new to investigate. Freud delved deeper into Dora’s resistance and eventually found that transferences could be useful for him, and future therapists. Especially to harvest information to make the client aware of their unconscious material, and defenses.

Does Psychoanalysis work?

Freud’s famous and controversial case studies are considered by some critics a fiction, and even to Freud himself to a smaller extent, simply incomplete. Psychoanalysis has the tendency to over-analyze or under-analyze manifesting as a lack of resonance with the patient. On the other hand, what these case studies do well, is to show the reader the different theories, and how they  might   apply. The problem with Freud, and all psychology, and even all science, is understanding the correct context and applying the right interpretation at the right time. As science moves on, and more data is collected, the theories are forced to become more refined. Though, the danger of throwing out a particular psychologist’s entire bibliography, because it’s been surpassed, means throwing out all the good insight already found.

This is the particular the problem with Freud’s work. He conflates experiences together from different clients into theories and then tries to interpret case studies in a way that can be too general, and invites outright dismissal. His insights hit the mark some of the time, and at other times individuals are put into boxes that don’t give the full picture, or are misleading. Also having notes on clients written farther and father away from the session in question can lead to errors by the analyst. Freud did this to avoid distracting the client, but this could lead to forgetfulness and a conflation of material from different patients. Ultimately, interpretations have to predict behaviour and allow others to test their validity to gain wider acceptance. Even more difficult with Freud’s work is that some situations are untestable. For example, can we really test what was running through the mind of a patient at a particular time in the past? Or, how do you test dreams? In those cases, we are only left with theories to rally around. This is even more the case as later critics and authors re-read his case studies with more facts than Freud had, and also with new interpretations based on data from later patients in similar circumstances.

Deliberate falsification and Screen Memories

The opposite extreme of dumping psychoanalysis is believing patients who have resistances and needs for impression management to avoid stigma and ostracism. They will resist correct interpretations because they hit the mark and are threatening. In many cases the reader will never really know which interpretation is more correct, the therapist’s, or the client’s interpretations. For example, Freud talks about forgotten knowledge of the client. “[Patients] can, give the physician plenty of coherent information about this or that period of their lives; but it is sure to be followed by another period as to which their communications run dry, leaving gaps unfilled, and riddles unanswered; and then again will come yet another period which will remain totally obscure and unilluminated by even a single piece of serviceable information.” Accounts from patients can seem realistic, but still untrue.

For Freud this comes from clients being “consciously or unconsciously disingenuous.” Recollections in the first stage of repression are full of doubts trying to disguise the memory. The second stage of repression involves actual forgetting, or a falsification of memory. Here is where screen memories can fill in the blanks. These are narratives from a later period in adolescence, which can include justifications, or disguises caused by displacement and condensation, that are believed by the subject to be situations that actually occurred. [See:  Dreams – Sigmund Freud: https://rumble.com/v1gtf6j-dreams-sigmund-freud.html ]

Freud favours the recollections that are being attacked by doubt over the later censored ones that are comfortable for the client. This is also keeping in mind there is another goal of the analyst: “Whereas the practical aim of the treatment is to remove all possible symptoms and to replace them by conscious thoughts, we may regard it as a second and theoretical aim to repair all the damages to the patient’s memory.”

Psychoanalysis when all else fails

In Freud’s narrative, Dora was emotionally attached to her father, especially during his illnesses. Her mother’s constant attention to domestic affairs, plus her father’s illnesses led to their estrangement. As Dora continued being dissatisfied with her family life, she left a suicide letter in a desk for her parents to find. 

For many people who run away from friendships and romantic relationships it’s often because of the unexpected and unwanted entanglements and expectations. Dora’s family connected with the K’s, and like in many situations, friends start helping each other. Over time, the family roles can get interchanged. For example, Freud says of Dora that she “had taken the greatest care of the K.’s two little children, and been almost a mother to them.” Dora had private conversations and influences from governesses, Frau K., Herr K., on top of her own family’s influence. As the different values are imitated, an ambivalence is already starting. When friends exchange help they naturally think of utility and how these friends can help in other ways. As emotional claims are made unconsciously, some of those claims conflict with the claims of others. This is especially true when values are different and are violated.

Dora’s example was when she was 14, (possibly 13 in reality) she was approached by Herr K., alone in his workplace, and forced into an embrace and a kiss. She ran away in disgust. Later on she was approached again for a kiss by Herr K., at a lake. She rejected him and complained to her father. Herr K. said that she was reading “Mantegazza’s  Physiology of Love  and books of that sort in their house on the lake. It was most likely, he had added, that ‘she had been over-excited by such reading and had merely ‘fancied’ the whole scene she had described.'” When denials like this happen, the result is neurosis for the victim when they can’t find anyone to believe them.

“Dora”

Dora’s father brought her to Freud, a man who helped him with his syphilis in prior appointments, to sort her out. “‘I have no doubt’, [he said], ‘that this incident is responsible for Dora’s depression and irritability and suicidal ideas. She keeps pressing me to break off relations with Herr K. and more particularly with Frau K., whom she used to positively worship formerly. But that I cannot do. For, to begin with, I myself believe that Dora’s tale of the man’s immoral suggestions is a phantasy that has forced its way into her mind; and besides, I am bound to Frau K. by ties of honourable friendship and I do not wish to cause her pain. The poor woman is most unhappy with her husband, of whom, by the way, I have no very high opinion. She herself has suffered a great deal with her nerves, and I am her only support. With my state of health I need scarcely assure you that there is nothing wrong in our relations. We are just two poor wretches who give one another what comfort we can by an exchange of friendly sympathy. You know already that I get nothing out of my own wife. But Dora, who inherits my obstinacy, cannot be moved from her hatred of the K.’s. She had her last attack after a conversation in which she had again pressed me to break with them. Please try and bring her to reason.’”

During their sessions Freud found that, “Dora’s criticisms of her father were the most frequent: he was insincere, he had a strain of falseness in his character, he only thought of his own enjoyment, and he had a gift for seeing things in the light which suited him best.”

Freud concurred: “I could not in general dispute Dora’s characterization of her father; and there was one particular respect in which it was easy to see that her reproaches were justified. When she was feeling embittered she used to be overcome by the idea that she had been handed over to Herr K. as the price of his tolerating the relations between her father and his wife; and her rage at her father’s making such a use of her was visible behind her affection for him.”

These were the early days in psychoanalysis, and Freud was bound to make some big mistakes, including not seeing his own sexism. The year was 1900 and his attitude towards women was irritating Dora. He said that “the two men (Dora’s father and Herr K.) had of course never made a formal agreement in which she was treated as an object for barter; her father in particular would have been horrified at any such suggestion. But he was one of those men who know how to evade a dilemma by falsifying their judgement upon one of the conflicting alternatives. If it had been pointed out to him that there might be danger for a growing girl in the constant and unsupervised companionship of a man who had no satisfaction from his own wife, he would have been certain to answer that he could rely upon his daughter, that a man like K. could never be dangerous to her, and that his friend was himself incapable of such intentions, or that Dora was still a child and was treated as a child by K.” Yet Freud is conscious enough to see. “But as a matter of fact things were in a position in which each of the two men avoided drawing any conclusions from the other’s behaviour which would have been awkward for his own plans.”

That pattern, as can be seen in the Irma injection dream in  The Interpretation of Dreams , shows a willingness for men to collude together, and ignore each other’s actions, while also having an opposite attitude of increased scanning of women and their foibles. Freud emphasizes, in the illicit kisses, how this could arouse sexual feelings in the girl, and be hysterical if rejected. His point was that she should have been more flattered at these attentions. “The behaviour of this child of fourteen was already entirely and completely hysterical. I should without question consider a person hysterical in whom an occasion for sexual excitement elicited feelings that were preponderantly or exclusively unpleasurable; and I should do so whether or not the person were capable of producing somatic symptoms.” Naturally an adolescent would, even in 1900, find this invalidating.

Transference and counter-transference

Freud admitted that he “did not succeed in mastering the transference in good time.” This was his reason for the failure of the treatment. He recounts “at the beginning it was clear that I was replacing her father in her imagination, which was not unlikely, in view of the difference between our ages. She was constantly comparing me with him consciously, and kept anxiously trying to make sure whether I was being quite straightforward with her, for her father ‘always preferred secrecy and roundabout ways.’ But when the first dream came, in which she gave herself the warning that she had better leave my treatment just as she had formerly left Herr K.’s house, I ought to have listened to the warning myself. ‘Now,’ 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. And when this transference had been cleared up, the analysis would have obtained access to new memories, dealing, probably, with actual events…In this way the transference took me unawares, and, because of the unknown quantity in me which reminded Dora of Herr K., she took her revenge on me as she wanted to take her revenge on him, and deserted me as she believed herself to have been deceived and deserted by him.”

Freud also had trouble seeing his own transferences of sexual interest in Dora, calling her “a girl in the bloom of youth, with intelligent and pleasing features,” and his being titillated with the sexual conversation similar to the position of Frau K. talking to Dora about sexuality. He also had trouble seeing his low attitude towards her by using the pseudonym Dora, a name given to a nursemaid of his sister.  

Freud goes on describing the phenomenon of transference. “They are new editions or facsimiles of the impulses and phantasies which are aroused and made conscious during the progress of the analysis; but they have this peculiarity, which is characteristic for their species, that they replace some earlier person by the person of the physician. Some of these transferences have a content which differs from that of their model in no respect whatever except for the substitution.” It becomes difficult to develop rapport if the therapist is dealing with negative transferences, but “psycho-analytic treatment does not  create  transferences, it merely brings them to light… All the patient’s tendencies, including hostile ones, are aroused; they are then turned to account for the purposes of the analysis by being made conscious, and in this way the transference is constantly being destroyed. Transference, which seems ordained to be the greatest obstacle to psycho-analysis, becomes its most powerful ally, if its presence can be detected each time and explained to the patient.” [See: The ‘Ratman’: https://rumble.com/v1gu9qj-case-studies-the-ratman-freud-and-beyond.html ]

The pot calling the kettle black – Projection

In particular Freud was trying to detect a form of projection originating in Dora by her efforts to enable the relationship. One of the clues for Freud is how the person who accuses another person of an indiscretion seems to know every detail about it, and this may in fact tell about similar situations in the accuser, that they also know a lot about, but are repressing. Freud uses the example of her accusations towards her father’s infidelity, “there were no gaps in her memory on this point.”

Just like the ambivalence that Freud often describes, people have similar goals, like romantic love, and it’s easy to point out what others are doing while ignoring that we have the same goals, and similar approaches to them. Our consciousness is like a spotlight and when it’s on someone else, it’s not on ourselves. Freud says, “a string of reproaches against other people leads one to suspect the existence of a string of self-reproaches with the same content. All that need be done is to turn back each particular reproach on to the speaker himself. There is something undeniably automatic about this method of defending oneself against a self-reproach by making the same reproach against some one else. A model of it is to be found in the ‘you too’ arguments of children.” It’s a kind of “I feel better if other people are doing it too.” Pride is maintained if everyone else is guilty. Also if two people make the same claim for another individual, based on an interest like love, they usually have reasons that are justifiable to only to themselves.

Behind these reproaches is also another layer of unconscious material. Freud says, “but it soon becomes evident that the patient is using thoughts of this kind, which the analysis cannot attack, for the purpose of cloaking others which are anxious to escape from criticism and from consciousness.”

The partially conscious, or unconscious agreements happen when a person’s self-interest becomes front and center. Freud used as evidence Dora’s past attitude of leaving her father and Frau K. alone, and taking the K.’s children for a walk, since they would have been sent out anyways. The scene at the lake was when she realized that she was being passed off onto Herr K., to make it convenient for her father and Frau K. Being slighted in that way enraged her. Dora described similar behaviour in her governess. “So long as the governess had any influence she used it for stirring up feeling against Frau K. She explained to Dora’s mother that it was incompatible with her dignity to tolerate such an intimacy between her husband and another woman; and she drew Dora’s attention to all the obvious features of their relations. But her efforts were in vain. Dora remained devoted to Frau K. and would hear of nothing that might make her think ill of her relations with her father. On the other hand she very easily fathomed the motives by which her governess was actuated. She might be blind in one direction, but she was sharp-sighted enough in the other. She saw that the governess was in love with her father. When he was there, she seemed to be quite another person: at such times she could be amusing and obliging. While the family were living in the manufacturing town and Frau K. was not on the horizon, her hostility was directed against Dora’s mother, who was then her more immediate rival. Up to this point Dora bore her no ill-will. She did not become angry until she observed that she herself was a subject of complete indifference to the governess, whose pretended affection for her was really meant for her father. While her father was away from the manufacturing town the governess had no time to spare for her, would not go for walks with her, and took no interest in her studies. No sooner had her father returned from B– than she was once more ready with every sort of service and assistance. Thereupon Dora dropped her.”

Freud said, “the poor woman had thrown a most unwelcome light on a part of Dora’s own behaviour. What the governess had from time to time been to Dora, Dora had been to Herr K.’s children. She had been a mother to them, she had taught them, she had gone for walks with them, she had offered them a complete substitute for the slight interest which their own mother showed in them. Herr K. and his wife had often talked of getting a divorce; but it never took place, because Herr K., who was an affectionate father, would not give up either of the two children. A common interest in the children had from the first been a bond between Herr K. and Dora. Her preoccupation with his children was evidently a cloak for something else that Dora was anxious to hide from herself and from other people.”

Freud at this point offered the conclusion that she was in love with Herr K. more than she let on. This Dora did not assent to. Yet later on “when the quantity of material that had come up had made it difficult for her to persist in her denial, she admitted that she might have been in love with Herr K. at B–‘ but declared that since the scene by the lake it had all been over.” 

Freud then gets caught in a bind. He asks “the question then arises: If Dora loved Herr K., what was the reason for her refusing him in the scene by the lake? Or at any rate, why did her refusal take such a brutal form, as though she were embittered against him? And how could a girl who was in love feel insulted by a proposal which was made in a manner neither tactless nor offensive?”

Oedipus complex, or just envy?

As expected, Freud brought up the Oedipus Complex in how Dora missed her father. The way Freud describes it, it’s a form of envy where the subject is putting themselves in the place of others, imitating their desires, and therefore their identity, and not recognizing the influence. In particular it’s a fear of losing social rewards. Each time you find an object, or person to desire, you step into a similar identity of all the people who want the same things, causing rivalry. This is where you see in the case study people playing people off of each other, and are only nice to people because they get something out of it, like her governess. There was also another governess, but she worked for the K.’s. She had a relationship with Herr K., but he never left is wife, and the governess eventually left. She told Dora about the line he gave her saying “there was nothing between him and his wife.” That was the same line given to Dora at the lake. This is the reason for her rejection of Herr K.

What was not expected was Dora’s possible attraction to Frau K. Freud recounts, “when Dora talked about Frau K., she used to praise her ‘adorable white body’ in accents more appropriate to a lover than to a defeated rival. Another time she told me, more in sorrow than in anger, that she was convinced the presents her father had brought her had been chosen by Frau K., for she recognized her taste. Another time, again, she pointed out that, evidently through the agency of Frau K., she had been given a present of some jewellery which was exactly like some that she had seen in Frau K.’s possession and had wished for aloud at the time.” Yet Frau K. betrayed Dora when she let Herr K. know of her reading of Mantegazza’s  Physiology of Love , without disclosing her influence on Dora. Freud says, “Frau K. had not loved her for her own sake but on account of her father. Frau K. had sacrificed her without a moment’s hesitation so that her relations with her father might not be disturbed. This mortification touched her, perhaps, more nearly and had a greater pathogenic effect than the other one, which she tried to use as a screen for it, – the fact that she had been sacrificed by her father.”

Like an Agatha Christie style extra twist at the end, Freud adds the deeper layer. “I believe, therefore, that I am not mistaken in supposing that Dora’s supervalent train of thought, which was concerned with her father’s relations with Frau K., was designed not only for the purpose of suppressing her love for Herr K., which had once been conscious, but also to conceal her love for Frau K., which was in a deeper sense unconscious. The supervalent train of thought was directly contrary to the latter current of feeling. She told herself incessantly that her father had sacrificed her to this woman, and made noisy demonstrations to show that she grudged her the possession of her father; and in this was she concealed from herself the contrary fact, which was that she grudged her father Frau K.’s love, and had not forgiven the woman she loved for the disillusionment she had been caused by her betrayal. The jealous emotions of a woman were linked in the unconscious with a jealousy such as might have been felt by a man. These masculine or, more properly speaking,  gynaecophilic  currents of feeling are to be regarded as typical of the unconscious erotic life of hysterical girls.”

So Dora is now implicated in desire for her father, Herr K., and now Frau K., albeit in a more unconscious attitude. This ambivalence is very typical of Freud, and is maddening for critics who want something that is more testable and clear. Freud says, “thoughts in the unconscious live very comfortably side by side, and even contraries get on together without disputes – a state of things which persists often enough even in the conscious.” I think Freud’s statement that  “an intention remains in existence until it has been carried out” , is the key to how he views desire. Once desires latches onto a target, but have too many obstacles, it can be repressed, and a new target is chosen. Yet when given the opportunity to be satisfied, the old desire can resurface. In a way, the Oedipus Complex is simply because a child has a lack of objects to pursue, and are around parents most of the time. As soon as other people enter the child’s life new influences are pursued.

Freud describes how this bisexual fluid desire can become convoluted. “In the world of reality, which I am trying to depict here, a complication of motives, an accumulation and conjunction of mental activities – in a word, overdetermination – is the rule. For behind Dora’s supervalent train of thought which was concerned with her father’s relations with Frau K. there lay concealed a feeling of jealousy which had that lady as its  object  – a feeling, that is, which could only be based upon an affection on Dora’s part for one of her own sex…I have never yet come through a single psycho-analysis of a man or a woman without having to take into account a very considerable current of homosexuality. When, in a hysterical woman or girl, the sexual libido which is directed towards men has been energetically suppressed, it will regularly be found that the libido which is directed towards women has become vicariously reinforced and even to some extent conscious.”

Cultural influences on psychological health

This being one of the famous Freud cases, there were other books written about it. One of the great books on this subject belongs to Hannah Decker,  Freud, Dora, and Vienna 1900. It gives the necessary background to Dora’s life and the life of Jewish immigrants and their ordeals in assimilating in Europe. A lot of psychological problems are in fact cultural problems. Survival fears of ostracism and abandonment wreak havoc on the psyche. Hannah says, “historically, hysteria has appeared prominently among groups – such as slaves, soldiers, and servants – who feel they have little control over their lives.” The ups and downs of life take their toll on people who feel constant insecurity, and these can lead to all kinds of desperate behaviour to regain that feeling of security. Learning the backgrounds of clients, and their ordeals helps to explain why they behave the way they do. This is often the weakness of psychotherapy. The therapist only has a small window of time to work in, and client’s lies and resistances keep back important information.

Uncertainty and mental health

Hannah describes the life of the Jews in Bohemia, where the Bauer’s had come from: “Although characterized by cruel social and economic injustices that readily slipped into extremes of murder and massacre, the history of the Jews in Bohemia was not one of unbroken misery. Its particular curse was eternal uncertainty. Frequent expulsions were usually followed by some limited permission to resettle, and life would once more resume, but never with ordinary surety. The legacy bequeathed to Philipp and Katharina Bauer and their two children by centuries of state-decreed inferiority, familial upheaval, and spasms of dubious quiet was the trauma of hopes raised only to be brutally dashed. This pattern appeared yet again once the Jews were formally emancipated, and it colored the background of Freud and Dora’s encounter…The result of many generations’ precarious existence was an inherent sense of vulnerability. Although this psychological state accurately reflected their history, it led to the Jews readily agreeing with anti-Semitic explanations of why they were more disposed to neurosis than the non-Jewish population. Evidence of the Jews’ belief in their own ‘hereditary taint’ is rife…In keeping with Darwinian and anthropological emphases of the time, they discussed their vulnerability in terms of centuries of ‘inbreeding.’ Or, taking refuge with – generally anti-semitic – critics of modernity, that pointed to the Jewish obsession with money or their high-strung, ‘overly civilized’ nature, stemming from generations of ‘cosmopolitan’ living. However, if nineteenth-century Jews felt themselves weaker and more susceptible to life’s risks – and certainly this was not true physically, Jews having a lower mortality rate than that from the surrounding peoples – such notions had to come in part from the sense of imminent danger Jewish parents continued to transmit, in countless small ways, to their children. It is a convergent conclusion of modern psychological, sociological, and historical literature that ethnic discrimination and the stresses of acculturation are sources of mental ill health, and experimental studies have buttressed this view.”

Homeland and Identity

Humans can be very self-critical and look for imperfections naturally, from years of critical upbringing and experiences in school. By the time a person who is a visible minority becomes an adult, there can be a habit of self-hatred. Criticisms from a ruling class can be absorbed into a masochism that emphasizes one’s weaknesses and ignores one’s strengths. A form of splitting against oneself, leading to neurosis. As a visible minority moves from location to location, only to be a minority again, but in a different location, it can bring up the same feelings of alienation. We need to seek approval from those in power to get our needs met, and stay stuck in helplessness.

Hannah describes this very well in her descriptions of Austria’s liberalization of immigration. The pattern of economic collapses, then followed by scapegoating and ostracism. “The old pattern – of the Jews raising their expectations only to be disappointed – reasserted itself.” One doesn’t have to look too deep to see the same pattern throughout history. Economic collapse, then blame and hostility aimed at an ethnic minority. The pattern existed before the NAZIS and the holocaust, and reactions towards immigrants today after the 2008 collapse, however mild compared to the massacres of the past, betray a certain human tendency to blame those who have less power, because they are accessible, and for frustrating the goals of the majority. A lot of the labels of inferiority aimed at immigrants cover another motivation, anti-competition from people who may not be so “inferior.”

Hannah describes the “Viennese artisans [who] reacted with anger and some desperation when faced with the lack of guild protection, encroachment by industrialization, depression following the 1873 crash, and, finally, competition from newly arrived Jews who peddled whatever and whenever they could. Traditionally anti-Jewish, the artisans now held the Jews responsible for the dislocations inflicted by the modern world. Moreover, an unending stream of Eastern Jews – either Austria’s own, seeking relief from the grinding poverty of Galicia, or Russia’s, fleeing for their lives from a czar set on destroying them – fired the native Viennese lower classes to action. By their language, dress, and distinctive customs, the new immigrants were highly visible on the streets of Vienna, and ‘the growth of the Jewish population of Vienna lent exaggerated emphasis to the impression of Jewish omnipotence.’ In 1882 the artisans’ groups amalgamated, forming the Austrian Reform Association, which became the main organ of the Viennese anti-semitism. Speeches at meetings of the Reform Association were highly inflammatory. At one rally in March 1882, the speaker urged the hundreds of workmen to “violence against the [Jewish] capitalists.” The meeting became rowdy, fights broke out, and furniture and beer glasses were smashed.”

Disturbing questions were asked, like “what would the Jewish ‘influence’ do to Austrian life? There was a feeling that a decisive struggle, which would have profound consequences, was taking place in all areas of society.” For the Jews there was a damned if you do and damned if you don’t situation as described by Arthur Schnitzler. He said a jew “had the choice of being counted as insensitive, obtrusive and fresh; or of being oversensitive, shy and suffering from feelings of persecution. And even if you managed somehow to conduct yourself so that nothing showed, it was impossible to remain completely untouched…An assimilated Jew could not avoid being pained.”

As people split hairs, blame got thrown around within the Jewish community. “The questioning of the Jewish right to exist freely often took crude forms. But it also expressed itself in polite Christian society as a condemnation of the Jews’ ‘bad manners.’ Soon Jews, especially youthful ones, were saying the same thing about themselves. Jews began to blame each other for the antisemitism that surrounded them. Assimilated Jews blamed Eastern Jews and vice versa. Intellectual Jews were embarrassed by both. Modern Jewish self-hatred raged.”

Loss of pride, envy and self-destruction

A curious example of self-hatred is described by Hanna, “one of these Jews was the disturbed and brilliant Otto Weininger (1880-1903), Dora’s contemporary. The son of a Jewish anti-Semite. Weininger secured his doctorate in philosophy by the age of twenty-two, immediately converted to Protestantism, achieved fame for his expanded dissertation,  Sex and Character , became depressed, and shot himself in the same house where Beethoven had died. Weininger’s bestseller was a diatribe between his self-hatred as a Jew and his misogyny. Weininger argued that a woman is pure sexuality, contaminating a man ‘in the paroxysm of orgasm.’ All women are prostitutes, even those who appear otherwise. Men could only elude women by avoiding sexual intercourse, and indeed, Weininger took a vow of sexual abstinence several months before he committed suicide. Weininger wrote that even the most superior woman was immeasurably below the most debased man, just as Judaism at its highest was immeasurably beneath even degraded Christianity. Judaism was so despicable because it was shot through with femininity. As women lacked souls, so too did Jews. Both were pimps, amoral and lascivious. Both sought to make other human beings suffer guilt. Women and Jews did not think logically, but rather intuitively, by association. Weininger declared his era to be not only the most feminine but the most Jewish of all eras. Jews were even worse than women; Jews were degenerate women.”

Fliess’ and Freud’s theories of human bisexuality, and even presaging Jung’s work on the Anima and Animus, showed the difficulty people back then had with expressing different sides of themselves. One is compelled by culture to pick a masculine or feminine side and repress the other side in oneself. It’s repressed but never really gone. Hannah describes, probably one of the best examples of psychological projection I’ve ever read. She says “Weininger killed himself because he felt he could not overcome the woman and Jew in him.” With projection one is disturbed by cultural influences found in oneself. One can see that one can live a life possibility that might be attractive, but that possibility may also be dangerous in a society that might punish it. Then the person who is projecting aims contempt at oneself at the same time aims contempt to those cultural influencers. If enough people are caught up in this ambivalence, then the same reaction of self-hatred and projection, with overt contempt, can motivate a cultural movement. A cleansing purge. To clean oneself, and then, if aggravated enough, ethnically cleanse the rest of society. Hannah says, “the truth is that Weininger had only expressed flamboyantly what many believed: that women were an inferior order of being and that all other inferior groups could be compared with women when one was trying to explain the essence of their deficiencies.” The self-hatred in this situation is to look at femininity as weakness and to have contempt towards weakness in part of oneself and blame others for their influence, and also the humiliation. Right here envy can be summed up as the pain of losing pride. In Weininger’s case, the pain was so large that suicide was his escape.

Hannah describes a warning by “Rosa Mayreder, the Austrian feminist, [who] gave a telling example of its widespread and authoritative existence [of these views]. “The Germans,” she pointed out, “ascribe womanly characteristics to the Slavs – a piece of national assumption expressed by Bismarck…in April, 1895. ‘I believe [he declared] that we Germans, by God’s grace, are fundamentally stronger; I mean, manlier in our character. God has established this dualism, this juxtaposition of manliness and womanliness, in every aspect of creation…It is not my wish to offend the Slavs, but they have many of the feminine advantages – they have grace and cleverness, subtlety and adroitness.'” Therefore, the Germans in Austria, Bismarck advised, should remember that they are the superior race and predominate, ‘just as in marriage the man ought to predominate.'”

Modern example of bigotry:   https://ktla.com/2017/09/07/lousy-speaking-immigrant-oklahoma-woman-records-racist-rant-at-goodwill/

David Duke:   https://www.youtube.com/watch?v=6Yx3c0i5Fyk

A reminder that everyone can be traced back as a descendant to someone who was originally an immigrant with the same struggles: White Stripes – Icky Thump:   https://www.youtube.com/watch?v=1OjTspCqvk8

Inferiority or superiority?

Yet if we go to that Bismarck quote extolling “might is always right”, there is an admission that femininity has advantages, meaning not inferior, but different. Since conflict is based on fighting over identities, identities being how well we can feed our pride, what people are complaining about is not inferiority, but superiority. If the Jews were considered “clever women”, then it was simply fear of competing with their cleverness, not their inferiority. Consciously or unconsciously, people want their competitors to be inferior. Going back to Bismarck’s quote one can also see the self-hatred of the feminine side of one self. If what Freud says is true, that most people have some bisexuality, that means this attitude requires a lot of internal and external repression.

Naturally Dora would have been affected by an environment like this and bring her frustrations towards men and aim them at Freud. Freud would also be transferring emotions towards Ida based on his upbringing and the contemporaneous understanding that women should know their place.

There were attempts to change this situation for the Jewish people by socialists. Otto, Ida’s brother, felt socialism was the method to help people integrate harmoniously in European society. By eliminating differences, exacerbated by the competition in capitalism, humanity would mix together in such a way as to make ethnic differences disappear. This motive led him to want to join politics. Yet Freud disagreed with Otto and “advised him to give up politics and become a teacher or university professor, a career better suited to his idealistic temperament than the volatile and hazardous arena of Austrian politics…[He] tried to talk Otto out of changing the world, warning him: ‘Don’t try to make people happy, people don’t want to be happy.'” This attitude would colour much of psychology all the way up to the beginning of positive psychology in the late 20th century. “Because his view that human nature was instinctive and not likely to be changed fundamentally by environmental manipulation, Freud believed that socialist and communist efforts to reform human society could not succeed,” as Otto had wished.

Yet this is partially disingenuous. Freud’s system is that of getting clients to accept the world as it is and to make changes to the environment, and to gain love. To repress the negative affect, and to be helpless, leads to self-destructive emotions. To deal with the world as it is, like a labour of love, or a laboured love in how it feels to make it happen, produces realistic positive emotions that can be achieved. Even if communism as tried, failed, a democratic socialism is accepted in most western countries. There is also generational socialist experiments that get partially accepted by conservative groups, when they are popular enough. If anything this is possibly the reason why there is ambivalence. People don’t actually know what a better future will be, and there will be experiments and failures along the way. There will also be some successes. People do want to be happy, but they are ambivalent on how to go about it, and may go down on paths they think are happiness, but end up being the opposite.

Blur – Tender:   https://www.youtube.com/watch?v=SaHrqKKFnSA

Economic influences

The pattern of ups and downs of life keep repeating throughout humanity, surprising new generations without the experience of loss. The typical pattern: Economic success, a following complacency, reckless investments, economic collapse, scarcity, a gathering together in groups of the same ethnic and cultural backgrounds for safety and pride. Then there’s scapegoating of people of weaker power with excuses that their habits or cultures are at fault, weak and contemptible, but in reality this is a disguise for a fear of competition. This is especially true if some of ethnic minorities manage to achieve status, despite being labeled with contempt, while some from an ethnic majority lose status. If they really were so contemptible, there would be nothing to fear from their competition. What used to be a downward comparison that gave special treatment for some, becomes a painful and humiliating upward comparison. A threat to an identity, is based on emotional feeding and addictions to stable sources of pride and pleasure. Pride needs a core identity that supports it, and when lost, makes people want to identify as a “superior” race, identify with “superior” past generations, a distorted “golden age” nostalgia. The hope to regain a lost identity, is the desire to step into the shoes of some kind of recognition of value. Pride.

Violence and the Sacred – René Girard: https://rumble.com/v1gsnwv-the-origin-of-envy-and-narcissism-ren-girard.html

Emotional Feeding: https://rumble.com/v1gqvl1-emotional-feeding-thanissaro-bhikkhu.html

Conflation of enemies

Now this isn’t to say that Jewish people are perfect, and that there shouldn’t be some assimilation to values, principles and laws of a country, I mean that’s why you want to move to that country, because it has values you like! Yet there’s a tendency to take bad apples, which exist in all cultures, and lump them together with their entire ethnicity. The embarrassment is described very well by Freud. He “attended the funeral of a friend, Nathan Weiss, who had committed suicide. Weiss’s family and friends publicly blamed his death on the family of his new wife. Freud described one censorious funeral orator who ‘spoke with the powerful voice of the fanatic, with the ardor of the savage, merciless Jew.’ The reaction of Freud and his medical colleagues was to be ‘petrified with horror and shame in the presence of the Christians who were among us. It seemed as though we had given them reason to believe that we worship the God of Revenge, not the God of Love.'”

Self-respect

Yet this need for revenge, or at least an assertive response to bigotry, seems to be extremely hard to avoid, and also a qualification for healthy self-respect. This is something that Freud eventually came around to. Freud had to decide what his response to antisemitism would be. When Freud’s father told the story of being told to get off the sidewalk because he was a Jew, and his response to do just that and walk away, was too submissive of a response for him. Freud said,  “I never understood why I should be ashamed of my descent or, as one was beginning to say, my race.” 

“Freud’s son Martin recalled that in 1901, in the Bavarian summer resort of Thumsee, Freud routed a gang of about ten men, and some female supporters, who had been shouting antisemitic abuse at Martin and his brother Oliver, by charging furiously at them with his walking stick. Freud must have found these moments gratifying contrasts to his father’s passive submission to being bullied.”

One doesn’t have to start something with people to feel safe, but if agitated and provoked over and over again, it only stops if there is an assertive response. We have to respect the rights of others, be we also have to respect our own rights. This way we avoid being passive or aggressive, which all involve boundaries being violated.

Assertiveness – An Introduction: https://www.skillsyouneed.com/ps/assertiveness.html

The cycle of disappointment

Freud was right that communism wouldn’t work to eliminate conflict and racism, but he wasn’t able to see much further than that. The 2008 economic crash, as bad as it was, proved that a form of democratic socialism was something that people couldn’t do without. It prevented the fallout on the poor from being as bad as it was in prior generations, vindicating some of Otto’s idealism for a future with more stability. 

Freud’s advice, based on his patient’s inability to deal with reality, and make healthy changes to the environment, was prophetic with his result with Ida. In Hannah’s book, accounts of Ida’s outcome identified her as being similar to her mother, with her “excessive cleanliness. She and her mother saw the dirt not only in their surroundings, but also on and within themselves. Both suffered from genital discharges.” Richie Robertson in the introduction of the Oxford World Classics version, hints that Ida’s mother, instead of having a psychosis of cleaning, was performing a form of revenge, since “you have made me a housewife; very well, I’ll be a perfect housewife and make you suffer for it.” Some of these feminist interpretations are quite modern. Another interpretation was that Ida’s mother wanted revenge for getting syphilis or gonorrhea from her husband. My interpretation is that the obsession to clean is more about cleaning a person’s self-esteem, to avoid rejection from others.

“Nothing is good enough to join us!”

Hannah’s book goes further into Dora’s Christian conversion, and her, and Freud’s escape from the NAZIS. Again the pattern repeated of destroyed hopes for the Jewish. Even when deliberate attempts to imitate the culture of the ruling ethnic groups, her brother Otto said that “assimilated Jews [were] still obviously Jews according to their facial characteristics. Race instincts and race prejudices live on after assimilation.” Otto felt that Christian conversion wasn’t going to work, and only intermarriage with Christians would solve the problem. This differed at the time with the Zionists who felt that the only solution would ultimately be to live in a Jewish nation.

This is a great lesson for all people who want to immigrate to another country. The lesson is that if you compete with the status and identities that others have already claimed, they will split hairs in every way to put you down. “You’re too Jewish! Oh you’re Christian now, but you still look Semitic. Not good enough!”  This goes more into my influences from René Girard’s Judeo-Christian works, but to enter into any new society, even if you are not that different from the culture you are joining, because you are a HUMAN, you have to be different in a way that is useful to others. This means creating new businesses, new products, and have something new to trade with the established identities of others.

Blue Ocean Strategy – W. Chan Kim, Renée Mauborgne: https://www.isbns.net/isbn/9781625274496/

If one can’t create those situations, then filling positions that are needed as opposed to competing for the most alluring hierarchies everyone else wants, creates the harmony that Otto was so desperately trying to seek. There will always be competition for pride and social rewards that leads to conflict, especially in economic crashes and the resulting scarcity of opportunities. People are forced to step on each other’s toes to hold onto an identity in a recession.

Circling around, zeroing in – Thanissaro Bhikkhu:  https://www.dhammatalks.org/Archive/y2018/181116_Circling_Around,_Zeroing_In.mp3

I remember coming out of the Spike Lee movie BlacKkKlansman , and seeing an interracial couple walking out with looks of relief of validation. They were obviously maintaining their identities and going to mind their own business and live their lives, which looks the same as everyone else’s lives. 

But a society where people are trading their advantageous differences with each other means people can see value in those differences, and therefore less bigotry, and if there is intermarriage, it’s more authentic because the marriage isn’t a means to an end, to gain an identity. They have a healthy identity beforehand and appreciate each other’s. There’s always a commonality that can be found if people are willing to look for it. In my travels, most people are worried about the same things. Getting a good job, having their kids find success in school, and trying to gain a good marriage. After a period of culture shock, people eventually find new cultural habits to graft onto the ones they want to keep. Sometimes this takes a couple of generations, but it happens.

Flexible goals

With the help of her son, Ida was able to move to New York. She lived with the same physical problems as before and died of colon cancer in 1945. One can imagine that Dora would have loved to have lived long enough to see how things had changed for women, or visible minorities, but I think she would still notice the same cycles of dissatisfaction in modern people as in the past. As long as people are struggling with identities that have mutual claims, they will be stuck in the same conflicts, regardless of what their success looks like from afar to those followers outside their milieu. “Control of consciousness determines the quality of life,” as Mihalyi Csikszentmihalyi reminds. A lot of people at the top of the pyramid feel they don’t have as much control over their life as they think they do. Having to make appearances, networking, dealing with politics and keeping allies satisfied, reduces a lot of that sense of control. René Girard, also noticed the intensity of the desire, and how it dissipates when the desired object is obtained, or how it intensifies again when the object is lost. The freedom of knowing this is that I can always look for a new object when there’s a rivalry, because ultimately, I will be bored with any possession, because no possession can make you eternally satisfied like an omnipotent God. New objects will always be desired. I can instead look at objects for their actual value, not whether the object will add to social proof that I’m a human deity. I also don’t have to worship an idol, like a missing parent, or pretend to be a God and all the effort at impression management that narcissists go through. The great value of this knowledge is that it doesn’t have to be hidden. I don’t need to hide this knowledge to one-up someone else. The knowledge is flexible, no matter how many people know it, and having more people know this, the better. Much like Galadriel’s “I pass the test” speech in Lord of the rings, we have to see this in ourselves. It’s not so much the ambition, which can be noble, but how aggressively we look at “Others”, as Girard emphasizes, with this ambition. It’s actually hard to let go of the sadomasochism of bullying and revenge. But for the one who does, narcissistic neurosis cools off into a beautiful peace and self-acceptance.

Finding personal meaning

Another solution to a lack of personal meaning and identity in life comes from Viktor Frankl, in  Man’s Search for Meaning .  He emphasized the need for people to actively find their own meanings in their current lives. His message was similar to Freud’s of actively using ingenuity and realistic choices and actions that have personal meaning, to reduce that sense of helplessness that makes people neurotic or violent. These negative feelings come from chasing activities to “be somebody important”, while at the same time putting oneself down for not being there already. Yet there are many important things in our lives we are doing now that should allow us to be as we are, without shame and envy. We remind ourselves what we are trying to achieve when we are taking care of someone who is sick, or serving a customer, or communicating important values. It doesn’t mean we let go of healthy ambitions, but we know that it’s okay to just start somewhere, and all these early activities are important stepping stones to where you want to go.

If we can’t control our consciousness all the time, if we have to change objects of desire, if we choose to see the meaning and importance of our current mundane activities, they become intrinsically satisfying, and then the self-hatred disappears. This meaning doesn’t require imitating a narcissistic idol providing a parental meaning for us. We don’t have to gather into the safety of ethnic groups and scapegoat others for our problems. A lot of Viktor’s message resonates with me, because meaning is found in those overlooked opportunities that are available to us right now. We shouldn’t get locked into objects that we are not ready for or are not available to us. ◊

__________________________________________________________________________________________________________________________

A Case of Hysteria – Sigmund Freud: https://www.isbns.net/isbn/9780199639861/

Freud, Dora, and Vienna 1900 – Hannah S. Decker: https://www.isbns.net/isbn/9780029072127/

Physiology of Love and Other Writings – Paolo Mantegazza: https://www.isbns.net/isbn/9781442691728/

Flow by Mihaly Csikszentmihalyi: https://www.isbns.net/isbn/9780061339202/

Man’s Search for Meaning – Viktor Frankl: https://www.isbns.net/isbn/9780671023379/

Ellis, A. W. & Raitmayr, O. & Herbst, C. (2016). The Ks: The Other Couple in the Case of Freud’s “Dora”.   Journal of Austrian Studies  48(4), 1-26. University of Nebraska Press.

I See Satan Fall Like Lightning – René Girard: https://www.isbns.net/isbn/9781570753190/

René Girard and Creative Mimesis – Thomas Ryba: https://www.isbns.net/isbn/9781498550574/

René Girard and Creative Reconciliation – Thomas Ryba: https://www.isbns.net/isbn/9780739169001/

The Lord of the Rings – J.R.R. Tolkien: https://www.isbns.net/isbn/9780261103207/

A Survey of the Woman Problem – Rosa Mayreder: https://www.isbns.net/isbn/9781330999349/

Psychology:   https://psychreviews.org/category/psychology01/

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