Working in the transference represents the cornerstone of analytic technique. A transference interpretation makes explicit reference to the patient-therapist relationship and is intended to encourage an exploration of the patient's conflicts and internalised object relationships as they manifest themselves in the therapeutic situation. This exploration is facilitated by the therapist availing herself to become the receptacle for primitive projections. Fairbairn captures this process very well:
Psychoanalytic treatment resolves itself into a struggle on the part of the patient to pressgang his relationship with the analyst into the closed system of the inner world through the agency of the transference and a determination on the part of the analyst to effect a breach in this closed system (Fairbairn, 1958: 385).
If we allow ourselves to be used in this manner by the patient, we can utilise our understanding of what is projected into us as the basis for the transference interpretation.
We infer the transference from different sources: the patient's associations, his affect in the room and the wishes and phantasies that are implicit in the patient's narratives and dreams. We also infer it from our own counter-transferential responses. Taken together, these sources of information help us generate hypotheses about who we become in the patient's mind at different stages and the underlying anxieties that are generated in response to these different versions of an "other" and the states of mind or feelings that are projected into us. For example, the therapist may be experienced as a "judgmental other'' or as a "seductive other''. Every transference situates the therapist and patient in an idiosyncratically prescribed relationship to each other, for example, as the critical parent/therapist of a very frightened child/patient who fears abandonment. The transference interpretation attempts to elucidate these two interconnected roles and the affect that links them.
Working in the transference is based on a belief that important aspects of the past manifest themselves in the present. This is quite different, however, from the idea that the adult patient can return to an infantile state as such, that is, a concrete view of regression; rather, the patient's childish worries and ways of coping are said to be active in the patient's present reality as implicit procedures and can be helpfully articulated in therapy as they become manifest in the therapeutic situation as transference reactions.
The patient transfers not just actual figures from the past but internal phantasy figures that have been construed from the interaction between real experiences and the patient's own internal reality. This means that in order to make a transference interpretation, we do not need to know the actual experiential origins that may have shaped the phantasies our patient may have developed. In many instances, it will be impossible to access these facts given what we now understand about the workings of the mind and of memory in particular. The transference interpretation merely seeks to capture the emotional, psychic reality of the patient in the grip of a particular phantasy.
There is not a single type of transference interpretation; rather, there are what Roth (2001) has helpfully described as ''levels of transference interpretation'', namely:
• Interpretations that reflect on links between here-and-now events in the therapy and events from the patient's past history;
• Interpretations that link events in the patient's external life to the patient's unconscious phantasies about the therapist;
• Interpretations that focus on the use of the therapist and the therapeutic situation to enact unconscious phantasy configurations.
As Joseph (1985) has suggested, the transference takes into account what goes on in the room, what went on in the past and what goes on in the external world. All three aspects are important but they are not necessarily all included within one interpretation. Sometimes they are, but generally speaking over the course of a therapy I think of the content of the transference interpretation as undergoing an evolution. It often begins by restricting its focus on the here-and-now interaction, drawing attention to the patient's phantasies and enactments with us. This firmly locates the emotional heat in the therapeutic relationship without diluting it by making links to past or other current figures in the patient's life. This restricted focus is justified since we are unlikely to have a lot of information about the patient in the early stages of therapy, such that links with the past and/or external figures are even more tentative than links to the here-and-now situation, which rely on our first-hand experience of being in a relationship with the patient. Once we become more familiar with the patient's past and current life, our transference interpretations will move on to help the patient identify these patterns in his current external relationships and with past figures in his life.
Although there are varying views on this, in my experience making links between the transference and the current and past external figures in the patient's life is very helpful so as to allow the patient to integrate his emotional experience in the transference with both current and past experience. Riesenberg-Malcom describe the usefulness of such reconstructive interpretations:
By analysing the past in the present, the ego of the patient becomes more integrated and therefore stronger. By linking interpretations to the historical past we also allow the patient to distance himself both from the immediacy of his experience and from the closeness to the analyst. The distancing from his own immediate experience helps the patient to gain perspective on his problems... the distancing from the immediacy of the relationship to the analyst allows the patient at moments to view his analyst as separate and different from his internal object, as someone with whom he is working out his problems (1986: 87).
Reconstructive interpretations offer an opportunity to ally ourselves with the patient's ego. They invite the patient to join us in thinking about him in a way that allows for more distance from the intensity of the patient's feelings. One clinical advantage of these interpretations is that they allow for a de-escalation of the emotional intensity of the transference in situations where the patient may be in the grip of a more psychotic state of mind and can no longer appreciate the as-if quality of the transference, or where the patient is too fragile to reflect on what he may be projecting into us.
In clinical work, both kinds of interpretations are helpful at different stages. It is important, nevertheless, to monitor the use we make of these kinds of interventions. Just as an overemphasis on the here-and-now may detract attention away from the ''there-and-then'' in a defensive attempt to avoid addressing the pain of a real trauma in the past, tying an interpretation to the patient's past may represent a defensive manoeuvre to avoid current, live feelings in the therapeutic relationship.
When we make a transference interpretation, we are neither interpreting the past nor the present - we are interpreting the past in the present. This is a new experience even if it is organised around relationship patterns that have their roots in the past. When we interpret the transference, we are articulating the actualisation of developmental models that organise the patient's current interactions. In the therapeutic relationship, the so-called ''real child of the past is lost''. ''What survives'', writes Green, ''is a mixture of the real and the fantasised or, to be more precise, a ''reality'' re-shaped through fantasy.'' (2000: 52). This means that in therapy we do not work with a still-life picture of the patient but with an ever changing, interactive system. Our analysis of a patient's historical past is coincident with, and is influenced by the context of remembering. As therapists, we are active contributors to the context in which remembering takes place, and hence to the shaping of the memories that the patient recounts. Our patients' recollections emerge in the context of a highly charged emotional relationship with us. The stories or memories that our patients report have to be considered for their transference relevance - that which may appear in therapy as a recovered memory may be also understood as an indirect, metaphoric, statement about the patient's here-and-now experience with us.
That our patients have memories about the past, which are dependent upon the motivation and context in which they are remembered, was the central message contained in Freud's (1899) notion of screen memories. Freud said that vivid early memories were not just historical facts recalled in an archaeological mode but were repeatedly constructed and reconstructed during life. He argued that childhood memories developed like "works of fiction'' and were moulded to serve current preoccupations.5 This means that the patient may locate something in the past in order to avoid analytic turmoil in the present, especially as it concerns something we may have done or not done. This is why, Freud suggested that certain memories "screen defend'' against dynamics in the analytic present.6
The notion of screen memories has important practical implications. It suggests that if a patient tells us, for example, ''I remember that when I was four my mother told me off and I could not stop crying. I went to hide under the stairs", we need to attend to this memory not only as a representation of an experience which is meaningful to the patient, but also as a possible vehicle for unconscious communication about the therapeutic relationship. In this hypothetical scenario, the patient may be feeling "told off'' by something we have said in the session. Rather than directly challenging us about this or discussing how it has made the patient feel, he unconsciously uses a memory from the past to communicate to us a current preoccupation in the session.
Johnny was an eighteen-year-old young man referred because of an acute psychotic breakdown. I was seeing him at the time as part of a multidisciplinary team. An implication of this was that I once had to sit in a case conference that he also attended. I felt uncomfortable about this, yet it was felt important by the rest of the team that I attend since I was also Johnny's key-worker.
In our session the week following this meeting, Johnny arrived feeling despondent about therapy. He told me that he felt he had gained all he could from the therapy and that it might be better for him to just keep on attending the day hospital. He spoke some more about this and how fed up he was with everyone meddling in his business. He envied his peers who would soon be off to university. He then paused for a few minutes. He resumed, expressing anger at his mother, whom he felt always meddled in his affairs, not allowing him to develop his own ideas about life and what he should do with it. He then said that he remembered getting very angry with his mother when he was younger. She had this infuriating habit of knocking on his door but opening it even if he had not given her permission to do so. In an exasperated tone, he said to me: "What was the point of
5A screen memory differs from a phantasy in that it contains some objective perceptual material (Britton, 1998).
6This is related to his original concept of "nachtraglichkeit". The latter referred to occurrences in the past which are invested retrospectively with meaning from the present (Good, 1998).
writing in large capital letters 'PRIVATE' if she couldn't even be bothered to read it.''
I understood this memory as reflecting not only something important about Johnny's relationship with his mother and his experience of her as intrusive but also as conveying something about our relationship. Clearly, the boundaries of our therapeutic relationship were far looser than is ideal and this is a recurring problem when working in multidisciplinary teams that undermines the confidentiality of the therapeutic relationship. In this sense, we could say that Johnny used a memory from the past to communicate to me something about his experience of me in the present as ignoring his need for privacy and that this intrusion was leading him to want to disengage from the therapy. He could not see the point of continuing with the therapy just as he could not see the point of writing PRIVATE on his bedroom door as his mother did not respect it. He was thus letting me know something of his experience of me as an object he felt he couldn't get through to.
In this clinical vignette, if we were to interpret the transference, we would be essentially aiming to formulate - that is, to make explicit for the patient - the emergence, in the present, of implicit models of relationships that continue to organise the patient's current relationships, simultaneously acknowledging that this model is triggered by a ''real'' event in the therapeutic relationship, namely, my attendance at the case conference.
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