Perception or Fantasy? A New Clinical Theory of Transference
© By V. A. Bonac (Apr. 1996; Aug. 1998 - Reprinted from the Electronic Journal of Communicative Psychoanalysis)
"What is life, after all? The future isnt here yet and you cannot foresee what it will bring. The present is only a moment and the past is one long story." (Isaac Bashevis Singer, "Naftali the Storyteller and His Horse, Sus", 1962.)
Transference is the sine qua non of psychoanalysis. I think that all analysts would agree that the interpretation of transference is the primary clinical task and that it is of central interest to psychoanalytic meta-psychology. When we interpret transference, we are conducting treatment in a fashion that is essentially different from psychotherapy as it is practiced by clinicians not trained in things psychoanalytic. No matter what psychoanalytic school we belong to we know that, at some point in therapy, the patients transference must be explained if we are to hope for the patients lasting improvement.
It is therefore ironic that this very pivotal psychoanalytic concept of transference has been used so loosely and inconsistently in psychoanalytic literature. (For a succinct discussion of the problems arising from a lack of clear definition, see Thomas Szaszs 1963 paper, The Concept of Transference.) In much of present writing, as well as in professional discussions, the term is still often used to encompass the totality of the patients relationship with the therapist. It is astonishing that there have been so few efforts to work out a clear definition of transference and that there have been so few psychoanalytic voices raised in protest to the continuing state of ambiguity which has, in my opinion, impeded the progress of psychoanalytic theory and practice. As we know, writers from other fields have not spared their arrows aimed at psychoanalysis, most often centering their merciless criticism on issues related to transference. Almost twenty years have passed since Langs (1981) attempted to bring this issue into renewed investigative focus by publishing a selection of salient papers, representing of the historical progression of psychoanalytic thinking on transference.
The psychoanalysts who did publish papers, calling for a clearer delineation of the concept of transference in relation to what was real in the treatment process, were only a few. Freud himself made several direct references concerning the effects of reality - to be distinguished from the patients transference on the unfolding of the therapeutic relationship (Freud, 1912a, 1912b, 1913, 1915, 1920). Later, seminal discussions of similar concerns appeared in the psychoanalytic literature: Strachey (1934) pointed out the effects of the actualities on the analytic interaction, A. Balint and M. Balint (1939) wrote about the impact of the analytic setting on the patient and Ticho (1972) stressed that the personality of the analyst does have effect on the therapeutic process. Later, in more detail and with greater force, Searles (1965), Bird (1972), Langs (1975, 1976 a, 1976b, 1978a, 1978b) and Greenson (1978) wrote, respectively, about the patients sane and salutary functioning, about the effects of the analysts errors on the patient and about dangers to the patient when transference is confused with non-transference.
Nowadays, it appears fashionable and common in most psychoanalytic circles to make good use of terms like, the therapeutic interaction, mutual experiences of the patient and the therapist, inter-personal phenomena, the "real" therapeutic relationship, the analytic frame. Ironically, these terms were originally introduced by innovative authors to denote their new discoveries and were met with irrational opposition or worse, with deadening silence, by most in the analytic world. Although many contemporary psychoanalytic texts may have adopted the terminology, the content of their papers still does not seem to reflect the changes, brought to the field by the original findings of these papers, and the borrowed terms are de facto misused. The deeply unconscious meaning of the therapeutic interaction is rarely considered in contemporary literature (see: Berns, 1994; Bonac 1993a, 1993b; Brown & Krausz, 1984; Langs, 1984, 1982; Smith 1991) and, as a result, the critical source of the current therapeutic disturbance is often missed. A significant clinical consequence of this shortcoming is that transference is often interpreted without sufficient verification whether the process might in fact be non-transference, i.e. the patients correct experience of reality. It is generally assumed and taken for granted that psychoanalysts work within such an analytic frame that practically all disturbances within the bi-personal field of the therapeutic interaction must be the result of the patients transference and are interpreted as such.
What is Transference?
The question, " Has the final word on transference been said", does not seem to arise in psychoanalytic literature as a serious challenge. Have we truly exhausted our observation, explanation, and clinical interpretation of the phenomenon of transference? Can we believe, as many seem to imply, that traditional psychoanalysis is correct about transference while communicative psychoanalysis is correct about perception of reality? Has the psychoanalytic field become divided in two camps: those who interpret transference the classical psychoanalysts and those who interpret reality the communicative psychoanalysts? The psychoanalysts, who did challenge the traditional position on transference, and more recently, the authors trained in communicative psychoanalysis, have accumulated a wealth of empirical evidence on the existence of the phenomenon of human unconscious perception and its clinical manifestation. They have repeatedly invited writers in the traditional psychoanalytic field to take it seriously by joining in its systematic investigation. A quite common classical proposition that unconscious perception is only a metaphor, with its inherent limitations, continues to contradict much of clinical evidence and fails to explain communicative findings like perceptive resolution (Bonac, 1993b), universality of experience (Bonac, 1994; Langs, 1988) and above all, cannot repeat the predictability of patients responses to changes in the analytic frame (Bonac, 1991; Langs, 1982, 1988).
My understanding of Quinns (1995) report that his research findings did not confirm the claim of universality of patients responses to frame changes is the following: The effects of the therapists self-revelations and confrontations in the sessions, on the variables of the patients verbal content, were not the most powerful aspects of the analytic frame and thus were drowned, in their effect, by the other, far more influential, aspects of the frame. I propose that the acceptance of video-taping of encounters with two vulnerable patients (1) would not qualify as psychotherapy, (2) was driven by the therapists pathological motives of such enormous magnitude, and (3) the encounters made available such minimal opportunity for rectification of any aspect of the horrendously crazy frame that these three aspects of the interpersonal frame took priority over any other therapists interventions. Since both, the patients and the therapists, came together for reasons other than therapy, they had formed an a priori firm "bastion" (Baranger & Baranger, 1966) against any attempts to understand these acts. My starting hypothesis about predicted responses would be that the predominant effort by both parties would be to survive the time-limited ordeal by not driving each other further into insanity. It looks like this proposition was confirmed by the research.
Taking stock of the communicative literature, it seems to me that communicative psychoanalysis has reached the point where all clinical phenomena are interpreted as perception and where the concept of transference appears all but useless. The word itself is curiously absent from many communicative texts. Transference is rarely mentioned by Robert Langs, the founder and by far the most prolific contributor to the field, especially in his later works. I doubt that any psychoanalyst would want to take seriously a psychoanalytic text, lacking the word transference,.
What is the trouble - is anything wrong? I believe that we must assume that the request for a re-examination of transference is not trivial and that the answers to these basic concerns might not be obvious. I think that the new clinical evidence and the new discoveries, made in the fertile decades of the 60s and the 70s, require that the very fundamentals of psychoanalysis be re-assessed. I have attempted to resolve the impasse in the dialogue between the two schools of psychoanalytic thought and to find a resolution to the problem of transference with a three-year research project of detailed observation and systematic analysis of clinical data which focused on the manifestation of transference.
When Freud abandoned (but never refuted) his seduction hypothesis, the field of psychoanalysis took a turn (for a historical overview, see: Langs, 1992). Freuds seduction hypothesis explained that a real event, i.e., the seduction of a child, was the pathogenic trauma which led to adult neurosis. The abandonment of the seduction hypothesis seemed to have brought with it a radical shift in focus which grew in time: From the study of the interactional processes (e.g., between the patient and the seducer), to the study of the patients intra-psychic world as observed by the neutral analyst. Thus, the clinical and theoretic interest moved away from studying the impact of reality events on the patient. The vast majority of psychoanalytic writing centers on the patients fantastical experience of their analysts and of themselves. Paradoxically, with the growing interest in the intra-psychic realm, i.e. of the system unconscious, the emphasis on the interpretation of truly unconscious processes is almost totally lost in the clinical practice as most of the patients material is taken at face value while the active derivative meaning of free associations is neglected (see Langs, 1984, l985, 1992b).
Starting with Freuds (1925) definition of psychoanalysis as the science of unconscious mental processes I asked the following basic question, "Is psychoanalysis about unconscious reality or about unconscious fantasy? Is the patient responding to the reality of the therapeutic situation, or to something fantastical within the patient that has nothing to do with the therapist?" Langs (1973) was propelled into his extensive research, and into the formation of communicative psychoanalytic theories, by his repeated observations that much of the patients verbal material involved unconscious perceptions of the reality of the therapists actions.
In response to the unresolved questions addressing the very fundamentals of psychoanalysis, classical and communicative, I started my investigation with a re-assessment of the basic psychoanalytic premises. Patients psychological difficulties in living have three sources: social, interpersonal and intra-psychic. As psychotherapists, we can do nothing to improve the patients social and interpersonal world outside our consultation room. Wilfred Bion called these influences on the patient, "Facts of Life". All we can do is improve the patient. By this we mean that we help the patient b through healing such sources of difficulties which lie within the patient as they become observable in our relationship with the patient. How to achieve intra-psychic change is the fundamental question of psychoanalytic technique.
The Limitations of Clinical Research
In clinical research, as in therapy sessions, we must first provide a clear observational field so that we can be sure that what we observe is the patients transference and not our own. As human beings respond to changes they make in the analytic frame, as well as to changes introduced by others, sensitive listening is necessary in order to determine who is creating the pathogenic situation in therapy to which the patient is struggling to adapt: the patient or the therapist. Only this specific knowledge makes it possible for us to recognize with clarity a situation in which it is the patient who creates his or her own pathological situation. Only when we can be clear about current, dynamic-in-session (Bonac, 1993b), sources of pathological functioning, are we in a position to offer an interpretation which does not blame the innocent, does not distort reality and does not re-enforce the patients difficulties.
For me, a central question of psychoanalytic technique is therefore this: do we have the clinical means to distinguish between the perceptions of reality and the expressions of fantasy, both conscious and unconscious, in the patient and in the therapist, at every moment of the therapeutic process? I believe that communicative psychoanalysis has given us such means. We now have a reliable method to investigate empirically the realities of the analytic relationship. This research method was the outcome of the discoveries of the principles of unconscious human verbal communication by the American psychoanalyst, Robert Langs (1976, 1978a, 1978b, 1979a, 1979b). Langs opened new doors for all of us so that we might observe the vicissitudes of the patients unconscious perception of reality. Most importantly, this method not only stands up to attempts at refuting it (Smith, 1991), it is a vehicle for the on-going development of the clinical technique of communicative psychoanalysis.
New understanding of the powerful and ever-present impact of the analytic frame on the therapeutic process (Langs, 1975, 1984) was fundamental to all that followed. We now have the knowledge and the technical means to observe, on our own in our own sessions, how the changes in the analytic frame influence the free-associations, the resistances, the actions and the symptoms in our patients. We can see for ourselves that instances of resistance in the patient might not always be resistance to our "correct" interpretations, but that they might be the patients unconscious refusal to accept a specific damage to the analytic frame: the patient is observed to be defending against real harm, not against an imagined trauma.
I believe that in every psychoanalytic session, we are faced with the following dilemma: is the patient responding to something the therapist has truly done in reality, or is the patient transferring his or her feelings from an object belonging to the patients past onto the therapist. And, can all this occur while the reality of the current situation in the patients therapy has nothing at all to do with what the patient is unconsciously experiencing? Let us put this question another way: When we listen to the patient, does the meaning of the free associations reflect the perception of what is going on in the reality of the session, or is the patient truly talking about someone else, somewhere else, at some other time even at the very moment when the patient is consciously convinced that it is all about the therapist?
Communicative empirical studies show that the patients verbal and behavioral responses are exquisitely sensitive to the state of the analytic frame, the most powerful frame changes over shadowing the effects of the minor ones. We can always observe this with remarkable clarity in the flow of derivatives by making a cognitive link between the displaced symbolic meaning of the patients narratives and the concurrent changes in the analytic frame. When the patient has not been driven to stubborn or depressive silence or to acting-out by overwhelming breaks in the frame, we observe that the meaning of the verbal responses matches every time.
It was Langss great empirical discovery that the patients and their therapists respond negatively to certain frame conditions which are different from what he called the "ideal frame". It is interesting to note that this "ideal frame" is almost identical to the sum of the technical rules which Freud (1912b, 1913) advised, over eighty years ago, that the analysts follow for the benefit of their patients.
The Persisting Question: Perception or Transference?
Paradoxically, the innovative work of Robert Langs brought both clarity and confusion to the field of psychoanalysis. Langss writing on the gravity of the therapists responsibility for the harm done to their patients by "mismanagement of the frame" created grave upheavals in the psychoanalytic community. The numerous articles by Langs disturbed the analytic universe and everyone was upset. How can Langs say that the therapist is responsible for his or her patients mental health, including serious pathology, when there is transference to consider and to interpret? This question might be less trivial and less obvious than it sounds.
There are two, now rather famous books confronting not only two analytical views about the analytic frame, but also confronting the authors directly: one is a clinical dialogue between Robert Langs and Leo Stone (1980), the other between Robert Langs and Harold Searles (1980). They discuss the analytic frame, transference, and reality. In the first book, Langs challenges Stone regarding the therapists obligation to "secure the frame" by actively preventing the patient from breaking the frame. The situation involves a patient who brings her therapist a greeting card and Stone takes it. Langs says he would have refused to accept it. Stone responds by stating that when the patient is able to accept the secure analytic frame, the patient is cured. This directly implies that the therapist must work within a broken frame, as determined by the patient, because the patient cannot tolerate to work in the ideal frame. Stone goes on and says that refusing the patient in this manner (i.e., refusing to accept the card) would repeat the patients suffering as a child when her parents behaved in a hurtful manner while giving the deceptive appearance of behaving properly and to the benefit of the child: her parents were "beyond reproach" which made the child even more helpless before them.
In the second book, Searles starts to present to Langs a session with a chronically schizophrenic patient. He introduces the session with a detailed background information about the patient and says that the patient felt suicidal in the last session. For this session the patient comes a little late. Langs stops Searles saying, "So here we have a patient who is suicidal, comes a bit late." Searles corrects Langs by saying, "She is chronically - severely, chronically psychotic, is the main thing she is, and I am concerned about how suicidal she may be." While Langs focuses on the frame, Searles concentrates on the severity of the patients illness. The two books reflect two very different views of the same clinical situation, views by famous, classically trained, innovative and creative American psychoanalytic writers. In my view, their views reflect two fundamentally different kinds of understanding of the function of the psychoanalytic frame in psychoanalytic treatment.
Langs, in his writing on technique, demands that the therapist "manage" the analytic frame no matter what the patient is doing, no matter what the patients state of mind. Therapy, he says, involves two tasks: the therapist has to manage the fame and interpret the frame, in that order (Langs, 1982). The second, traditional analytic view allows the therapist to go along with almost whatever state of the frame the patient dictates at a certain moment, while waiting for the opportunity to interpret the patients transference. Langs responds by pointing to the patients derivatives. Look, he says, every time the analytic frame is "broken" (i.e., changed away from the "ideal") the patients derivatives tell you clearly not only that the break is harmful to them but also that it needs to be "secured" (i.e., changed back to the "ideal") - no matter who "breaks the frame". In his later writings, Langs talks about the need to "tighten the frame" with no discussion about what happens to the patient - as if the frame were in treatment, not the patient.
In essence, the communicative technique, as defined by Langs, demands that the patients must adapt their in-session and out-of-session functioning to the ideal analytic frame and thus be cured. Classical psychoanalytic technique, on the other hand, as represented by such diverse authors as Stone and Searles, allows the therapists to adapt to their patients current state of the frame. The interesting questions are these: Are these views significantly different? Which method of treatment is better? Who is right?
Langss monumental work stands as a powerful critique of classical psychoanalytic technique. He is saying that psychoanalytic technique too often disregards the actual harm done to patients by the therapists breaks in the analytic frame. This is aggravated by further harm done by the therapists insistence on their version of reality. With this, I wholeheartedly agree: one only has to listen to the unconsciously communicated meaning of the patients verbal material after the therapist has broken the frame to be convinced that all patients, no matter what their age, gender or diagnosis, tell us compellingly that the breaks in the ideal analytic frame are harmful to them. This is a clinical fact for all to discover in the derivative meaning of their own sessions. Many analysts would agree in principle - after all, the "ideal frame" was recommended by Freud.
In spite of the many unresolved fundamentals in the field of psychoanalysis the dialogue between classical and communicative psychoanalysis has been cut off. The communicational gap creating the split has persisted to the point where there is now no professional discussion between the two schools of thought. This situation might not come as a surprise to the student of psychoanalytic history. Harold Searles pointed out that Margaret Mahler "never knew he existed" until late 70s (see Langs & Searles, 1980). His first paper, describing the ability of gravely mentally ill patients to unconsciously perceive their analysts, was rejected by two psychoanalytic journals in 1948. Melanie Klein was not recommended reading in American psychoanalytic institutes until fairly recently, while the current world-wide black-out of referencing Robert Langs (but not his terminology!) has been almost total in spite of the fact that so many contemporary authors make use of a large number of his original ideas as if they have somehow always been there.
Unresolved Issues of Transference
I think this situation is unfortunate on the educational level: students of psychoanalysis do not get a chance to engage in live discussions with the most creative minds of contemporary psychoanalysis. More importantly, I am convinced that this autistic split on both sides is causing serious damage to the advancement of psychoanalysis as a serious human endeavor and as a method of treatment. I am convinced that we cannot make progress in the area of understanding the unconscious functioning of human beings and that we cannot improve treatment of psycho-pathology, if do not consider the empirical findings of communicative psychoanalysis.
The non-communication between the two new schools of thought has brought a curious situation in which the following two complementary myths seem to be developing: (1) Classical psychoanalysis can treat mental illness because it offers explanation of transference; (2)Communicative psychoanalysis can safeguard this classical promise of treatment because it has the means to monitor the analytic frame. Still, I think it is absurd to support the impression that classical psychoanalysts unwittingly damage their patients because they do not "keep the frame", while their communicative colleagues can do no harm because they do "keep the frame". Are communicative psychoanalysts "beyond reproach" the way Stone understood his patients parents? Are we more concerned with the sanctity of the analytic frame than we are about the well being of our patients? Are we trying to be saints at all cost even when the cost means the suppression of new developments in psychoanalysis?
If you read the article written by Langs, called "The Contributions of the Adaptational-Interactional Approach to Classical Psychoanalysis" (1984) you will see that communicative psychoanalysis offers such remarkable new insights which no clinician would want to disregard. What then is the nature of the problem which keeps traditional and communicative psychoanalysis apart? In my view, the problem is not a confrontation of two rival philosophical views in need of restraint. It is, I believe, that both schools of thought have a persisting problem with the concept of transference which cannot be reduced to academic, abstract arguments.
For me, transference is an essential, old area in need of new investigation. Transference needs to be researched anew as a clinical phenomenon and revised as a psychoanalytic theory. Empirical research of transference, in light of new discoveries of unconscious perception and of interactional processes, is long overdue. I am convinced that Langss method of clinical research can effectively guide the scientific study of transference. And, that this method is the only existing means, which psychoanalysis has at present, to investigate deeply unconscious phenomena of which transference is the most significant.
My own research of transference provides consistent evidence that the theory of transference, as originally defined by Freud, is valid in principle if, and only if, a detailed consideration is given to the impact of the reality of the analytic frame on the therapeutic process. I have developed a new theory of transference out of my empirical research by using Langss method of investigating unconscious mental processes. My theory of transference gives credence to both of Freuds views on transference, i.e., to the seduction hypothesis and to the fantasy hypothesis. The theory of transference which I developed is about the reality of the past as it drives the fantasy about the future, while the present is always correctly perceived. My theory combines fantasy and perception as distinct functions of time.
Monumental Contribution of Robert Langs
Communicative psychoanalysis has contributed invaluable empirical knowledge about 1) human unconscious communication, 2) the impact of the analytic frame on the therapeutic process and 3) a clinical methodology for investigating derivative material - all this has been the contribution to psychoanalysis by Robert Langs in the years 1973-85. The most important of his discoveries, essential in research and a key element in intervening, is the phenomenon of derivative validation (see Berns, 1994). Without Langss work, psychoanalysis could not have made the quantum leap from intuitive interpreting and informed theory to a proper clinical science. Once you listen to the derivative meaning of your patients unconscious material and link this unconscious meaning to the current state of the analytic frame, you can never again look at your patients in quite the same way. We call this, "the loss of innocence". Yet, I have always believed there is something compellingly true and fundamentally correct about Freuds conception of transference.
It is difficult to put forward proposals for a new psychoanalytic theory of transference without first having to argue the validity of the basic principles that constitute communicative psychoanalysis. It is more difficult still to define transference in new terms based on the new discoveries, without confusing the reader with new terminology. The serious reader will need to become familiar with the basic principles of communicative psychoanalysis, that is, with clinical listening to unconscious perceptions.
I think that different researchers reach different conclusions and advance different theories because they use different clinical methods which limit their observations to different aspects of the same phenomenon without being aware of the specific observational limitation. Any fundamental differences in philosophical outlook between different psychoanalytic schools of thought are therefore temporary and could be overcome by the application of a comprehensive research method. I believe that the communicative clinical investigation of the therapeutic process is such a method. It yields multiple layers of results because a deeper, truly unconscious experience of the patient is not left out of the observational field and because a temporally sequential analysis of the emerging data is maintained (Bonac, 1992; see also: Meacci, 1993; Smith, 1991).
A New Clinical Study of Transference
In 1994, I started a three-year study of issues related to the pathology belonging exclusively to the patient by a systematic examination of all of my sessions. When I studied the patients reaction to the securing of the analytic frame in a systematic manner, I soon realized, that I was observing something closely related to transference. When I started to interpret the patients anxiety, generated by the securing of the frame, as transference some of my interpretations were regularly validated while some were not. I continued with my observations and I found that transference interpretations were consistently validated only when very specific frame conditions existed. On this basis, I formulated a set of propositions which are now the building blocks of my theory of transference.
The manifestation of "secured-frame anxiety" seemed so challenging that I started to systematically study its occurrence in sessions in my work with patients, in supervision and in "self-processing" (Langs, 1992a). Secured-frame anxiety was so named by Robert Langs (e.g., 1984/85, 1988) who mentioned this phenomenon in many of his works. He named his discovery "secured-frame anxiety" because he had observed that anxiety is created in the patient (and the therapist) as a reaction to the securing of the analytic frame. He mentioned that some people are so inordinately sensitive to the securing of the frame that they cannot tolerate it at all. He considered this to be a paradox of human behavior and added that it appeared that this special sensitivity was in some way related to tragic losses in early life. American author, Cynthia Keene (1984) published an excellent research article discussing her detailed study of secured frame anxiety which she described as "transient negative effects" resulting from the securing of the frame by the therapist.
In his work, Langs (1984/85, 1985b, 1988) implied that secured frame anxiety is in some way pathological, not rooted in reality. To me, this meant that there might be a connection with transference and transference resistance. I took the essence of Freuds writing on transference (without its Oedipal emphasis) and used it as a guiding light in my study. I think that Greensons 1967 definition comes closest to what I was looking for, although I left the conditions for the manifestation of transference material, as well as the content of the transferred material (i.e., what it is that is being repeated, the reaction to the other, or the very action of the other person), open for discovery:
Transference is the experiencing of feelings, drives, attitudes, fantasies, and defenses toward a person in the present which do not befit that person, but are repetition of reactions originating in regard to significant persons of early childhood, unconsciously displaced onto figures in the present. (Greenson, 1971/1990.)
To minimize my explicit assumptions and personal expectations and to widen the observational field of my study, I searched the patients conscious and unconscious material for any evidence of an experience of something that is not real and that is somehow related to either, (1) a pathogenic memory of a past experience, or (2) a naturally and spontaneously occurring illusion, or else 3) related to both.
I took the first version as the most likely hypothesis about transference for an important reason: my studies of healthy infants in interaction with their mothers showed clearly that we, when we are infants, perceive unconsciously in a realistic manner. This finding shaped my theory of human development which I outlined three years ago (Bonac, 1994). My findings from infant research do not support the thesis that we are born with faulty perception and with unconscious fantasies. On the contrary, I have gathered evidence that we are born with the most exquisite faculty for perceiving reality and that any unconscious fantasies are the consequences of the introjection of real harm done to us. My findings led to the following conclusion:
Proposition (1): We perceive harm done to us unconsciously when we are powerless to change the dangerous interpersonal frame and when the communication of our perceptions to the perpetrator would provoke retaliation and thus further harm. When we are children the frame is most fiercely and consistently enforced by our parents as it is driven by their unconscious needs.
I have found that unconscious perception and unconscious communication is thus as much a survival mechanism as it is the most efficient way to influence our parents when they are causing us harm. When we are children, we do not have the clinical skill to offer psychoanalytic interpretations to our parents and thus cure them. More importantly, we do not have the power to change the child/parent frame which is the key to changing the reality of the situation. Instead, we try to influence our parents in a way that is unconscious to both the price paid is the distortion of a part of our mind. Since time began, only those humans survived infancy who were able to keep their parents parenting unconscious perceptions and unconscious communication of perceptions kept bodies alive along enough to physically outgrow total helplessness. "Soul murder" is better than the death of the body as long as there is a chance for healing our mind later.
After much effort to validate my research hypotheses about transference, I concluded that the patients request for a break in the analytic frame, or their acting-out of a break in the frame, may very well be a manifestation of their transference to me, that is, a manifestation of the patients own pathology. This proposition sounded intuitively logical and in agreement with the essence of the classical theory of transference.
I soon found, however, that transference expressions can only be interpreted to the patients, in any convincing and acceptable way, when the patients transference manifestation comes as a clear response to the securing of the frame by the patients, on their own, and not when the securing of the frame is done by the therapist. I described this clinical situation in detail in my article on the communicative interpretation of transference (Bonac, in press) and in more general terms in two other publications (Bonac, 1995, 1996). I call this phenomenon transference response because it is manifested as a clear reaction to the securing of the frame. Secured frame anxiety is thus a response to such change in the frame which is beneficial to the patient.
Although transference response is based on traumatic experiences in the past, and although the damage done to the mind is ever-present, the current functioning of the patient appears to be predicated on the current changes in the frame an early finding by Langs. My next question was: How could something good, like a securing of the frame, generate serious anxiety? My research shows that the consequences for the patient are very different when the frame is secured by the therapist from the situation when the frame is secured by the patient. When the therapist secures the analytic frame, such securing is experienced by the patient as persecutory, manipulative and destructive. Typical images in the patients material are: wrongful imprisonment, forced labor, insane withholding of freedom, sadistic exploitation, pathological symbiosis, etc. These images stand in radical contrast to healthy images reflecting a secure frame: warm home, good school, safe playground, mothers lap, normal pregnancy, breast-feeding, good marriage, etc.
I have observed that patients react realistically when they are anxious following their therapists securing of the frame. I have reached the same conclusion in my study of my own responses using the method of "self-analysis" (see Langs on self-processing, 1992). The securing of the analytic frame by the therapist is most often initiated to satisfy the immediate emotional needs of the therapist when the securing neither followed the patients consciously worked through intent to secure the frame, nor was the patient himself or herself allowed to secure the frame. I described the disturbing effects of such securing in my paper on premature securing by the therapist of the patient's breaks in the analytic frame and found that such unilateral securing by the therapist were expressions of the therapist's own counter-transference difficulty with containing the patient's projective identifications (Bonac, 1993b) during the therapeutic phase of "working-through". The paper concludes that the therapists troubles with containing the pathology of their patients have serious consequences for the patients unconscious experience and for the analytic frame.
In my study, I have never observed a clear transference response in situations when the therapist unilaterally secured the frame or demanded that a certain frame change be implemented, i.e., where the frame was forced upon the patient. Instead, when it was not the patient who not only secured the frame, but unconsciously decided to secure the frame, I found only perceptions: the rare positive themes reflected the benefits of securing, while the negative themes revealed the real damage done to the patient. Some positive themes were clearly models of rectification.
I was able to observe transference only when the patients were allowed to secure the frame on their own. Although I believe (in agreement with Langs) that people do not react to the working of their own inner world, I have repeatedly found that people do respond to all changes in the frame, including their own. The critical fact to remember is that the frame is, by definition of therapy, bi-personal and that it needs the inputs of two people in order to exist: the patient might be reacting to their own securing, but this action of securing came as a response to what their therapists had been doing, i.e. interpreting.
When I studied transference, I saw that patients may respond to their own securing of the frame not only in a positive way, that is with realistic perceptions of the current reality of a safer environment, as manifested by positive images and themes in their verbal material. They also respond to their own securing of the frame with severe anxiety which is based not on the immediate reality of the present, and not because of a hypothetical basic flaw in human nature that produces destructive illusions. This anxiety is based on the patients expectations of the future. This expectation of the future is, in turn, heavily influenced by the real traumatic past events in the patients life. These real traumatic events from the past are related to the same type of frame changes as the ones that patients are facing in their therapy in the present. Derivative representation of the anxiety, which is generated by the patients own securing of the frame, involves typical narratives and images of unreasonable fears and of self-destructive acts. Let me give a few examples:
Patients say, "it really bothers me today that the windows are covered" (the curtains in my consultation room are always drawn, yet there was no anxiety before); "I am in a boat with a friend on a sunny summer day - my friend enjoys looking down into clear waters, I cannot look because of a strange fear - I would like to see the bottom because I know it is beautiful, so I spoil my own holiday by feeling anxious"; "I know someone who married a woman he loved but removed his ring the moment he stepped out of the church, then continued to live away from his family even though there were no problems"; "I used to buy old houses - I would renovate one and make it solid and beautiful then, instead of living in it, I suddenly sold it, usually below its value and then I would move on to the next old house - I could never make a home for myself"; "I go to buy a dress, or shoes and I find the one I know is the best yet, I suddenly become confused and for some reason I take another one which is either too small, or too big, or too ugly, so that in the end I never wear it - what a waste"; "I go for a walk in a beautiful park, there are families with children, dogs, flowers, birds all around me - just as I tell myself that I am happy, that the world is a beautiful place to be, I suddenly become so nervous that I cannot stand it any more, I go back inside and my Sunday is spoiled".
A New Theory of Transference
According to my findings, transference is always about a specific future event and is always experienced unconsciously. Patients perceive the present and the past always correctly, mostly on the unconscious level. So, it is only the expectations of the future which are open to the influence of transference and which might be unrealistic. What I am proposing is that the patient is experiencing the present realistically. We find, in the patients derivative material, positive images of the therapists explicit offer of the frame as well as positive images of the patients own intent to secure an aspect of the frame as offered by the therapist. This new securing of the frame by the patient is about a future event. It has been offered by the therapist and is now accepted by the patient, but, and this is critically important, the actual securing of this new frame has not yet happened, it has not yet been experienced, its occurrence lies in the future. Thus, the securing itself cannot yet be perceived, consciously or unconsciously. This future event of the actual securing of the bi-personal analytic frame is thus prey to the power of expectation and speculation.
There can be no perceptions about something which has not yet happened! There can only be an expectation, conscious and unconscious, about what might happen in the future in this new, future state of the frame. These expectations can only be based on the patients past experiences intra-psychically. There is nothing else. Yes, we can have abstract knowledge about similar events and about other people, we might know what is right and what is wrong, what is harmful and what is beneficial. Yet, what really drives our emotional functioning appears to be the events that actually have happened to us, that we have experienced and "recorded" in the form of a memory, conscious or unconscious.
The following is a general example of a transference response which illustrates the principles of my thinking:
A patient has been harmed in the past by one specific aspect of the interpersonal frame-change with their mother, or father. This trauma is ingrained in the patients memory, perhaps totally out of consciousness, with only a screen memory available to consciousness. The patient enters therapy. In the first session, the therapist offers a secure analytic frame for the whole duration of an open-ended treatment by stating the rules of therapy. Some psychoanalytic rules, for example "no physical contact", "no contact with other people", "therapists anonymity", are not specified directly but are convincingly conveyed by the behavior of the therapist. Sooner or later, for some reason, the patient becomes restless and cannot stand some aspects of the secure frame and shows resistance to following the offered ideal frame. Instead, the patient proposes his or her own version of the frame - in effect, the patient has proposed a break in the frame. The therapist interprets the patients derivatives which show that this proposed break in the frame is harmful to the patient. Gradually, the patient works through his or her inability to accept this aspect of the ideal frame. Finally, after a long struggle of working-through, the patient appears able to accept consciously and unconsciously this specific aspect of the ideal frame, i.e. the patient proposes to secure this very aspect of the frame, which had been left broken all this time by the patient.
It is at this very moment, when the patient expresses the conscious intent to secure the frame, that we observe the manifestation of the surprising phenomenon of transference proper: unexpectedly, the patient cannot live with his or her own intent secure the frame. I have termed this intra-psychic component of the transference response "transference proper" because it is independent of the current input from others. The therapist is doing no harm. The patient is doing no harm. In fact, nothing has happened yet. We can then observe the patients intra-psychic state, i.e., the memory of his or her trauma is driving the patients anxiety about the future securing of the frame. The following is my proposed definition of transference in communicative terms:
Proposition (1): Transference proper is an intra-psychic phenomenon which becomes observable in the bi-personal field of therapy as a response to the patients own intent to secure the analytic frame in the absence of the pathological contributions from interpersonal sources, all this within the context of the therapists constant offer of an ideal analytic frame.
Patients verbal communications which accompany their transference response tell clear patho-genetical story from the patients past: The patient as a child was harmed in a frame, which was meant to be secure, but in fact turned into a horror. The child was betrayed by the explicit or implicit promise of a secure interpersonal frame by an important person in his or her life. We can understand intuitively how patients minds work when they find themselves in the same frame situation as the one in their past. The patient, who has been harmed in the past, will have little ground to expect anything positive from the future when the same frame circumstances are about to happen in therapy. To such a patient, when a child, the same secured frame turned again into pain and dread. The patient seems to be saying: If it happened before, it can happen again.
The patients logical reaction to the possibility that the past might be repeated, that harm might be done again, is to avoid the situation and to resist the change. Therefore, the only way out seems to be to escape from the present circumstances, i.e. from the patients own present decision to secure the analytic frame in actuality. The escape can be accomplished either by immediately changing the current frame or by leaving therapy altogether: the patient breaks the frame either way. This is how resistance becomes transference with serious potential for acting-out.
The sequence of events seems intuitively logical enough, yet I must emphasize that all this is happening totally out of consciousness of the patient, who may be aware of nothing more than a certain restlessness, or distressing boredom or, a mysterious fear. A patient may suddenly become argumentative and speculate about "why nothing much is happening in therapy" at the very moment when important frame securing is about to take effect.
Such a state of almost mystical anxiety and sudden confusion then leads to the patients decision to break the frame. Of course, the patient offers brilliant "reasons" to explain his or her need to break the frame. It is, however, possible to demonstrate that such "explanations" are rationalizations: they are good reasons, but not the actual reason. This decision to break the frame now throws the patient in reality into a broken frame. The patient is now repeating his or her past by doing to the therapist what was done to the patient as a child. We observe that the patient is about to enact his or her traumatic memory. It is at this point in therapy that the patient is "sitting on a fence": unable to step into the secured frame, contemplating to do real harm to the therapist and to himself or herself by acting on his decision. At this point, the therapist wants to exclaim, as Freud did, "if they could only remember !"
Only those adults, unburdened by psychic injury can enter new situations boldly, with trust. In my experience, the therapeutic solution to the irrational fear of the future and to the resulting self-destructive actions in spite of beneficial circumstances - lies in the analysts ability to convince the patient with solid current evidence that the future in therapy will not repeat their childhood past. In my practice, communicative interpretations of transference-proper further the work of working-through and eventually lead to surprising changes in patients symptoms and in their lives. Clinically, the interpretation of transference must be offered during the brief period of the patients sense of mysterious confusion and anxiety. It is then that the patients show paranoid avoidance of a future event and before they act out their unreasonable dread of their own securing of the frame in the same way as they had experienced it as victims in their past. The situation is made extremely fragile by the patients intensely emotional experience which only aggravates the therapists own struggles with introjection and interferes with the understanding and with the interpretation of transference-proper.
Starting with the definition of transference in Proposition (1) above, the following propositions comprise the fundamentals of my new theory of transference-proper:
Proposition (2): The patients primary unconscious motivation for acting-out in therapy is the effort to evoke urgently needed therapeutic response in the therapist in the form of containment and interpretation of the acting-out.)
Breaking of the analytic frame is always an acting-out. I believe that patients derivative material reveals that, when they act out, they are not expressing an inner pathological need, that is, the unconscious motivation, for pathological relating. With this I mean that the patient is not unconsciously trying to do damage to therapy or to the therapist. Such pathological relating might very well be the potential or actual outcome of the patients conscious intent of the specific acting-out behavior. The eventual outcome of the patients acting-out must be investigated in interactional terms, by giving full consideration to the contributions to the acting-out by both the patient and the therapist. It appears that the patients acting-out becomes destructive to the analytic space only when the therapist cannot offer a timely interpretation of the acting-out and when the analytic frame cannot be restored. I believe that, in most instances, it is the therapist who is in the position to determine the outcome in reality of the patients acting-out and thus to exert the critical influence on the therapeutic process.
Proposition (3): Patients pathological motivation for, and pathological gratification derived from, their own acting-out can only be fruitfully interpreted in sessions where the origin of the patients action can be clearly observed, that is, when the therapist has not contributed, in a pathological manner, to the specific acting-out by the patient.
This proposition deals with the opportunity to interpret the patients breaking of the frame. Although it is a true fact, in the most general terms, that patients need and seek therapy because "they have pathology". The therapist requires specific and current clinical evidence to formulate an interpretation of the dynamically active deep unconscious. In a previous paper (Bonac, 1993a, p. 71), I proposed that the patients psycho-pathology is best defined in terms of "such unconscious need to break the frame which is the consequence of the patients own intolerable secured-frame anxiety". I am taking this proposition one step further and exploring the deepest pathological source of breaking a secured aspect of the analytic frame.
Proposition (4): In the language of physics, the magnitude of the traumatic content of a thematic representation of an event in the patients derivatives is a linear function of the magnitude of the actual traumatic content of this event. However, the symptomatic reaction to this actual event is a function of two independent variables which confound the clinical observation of the patients response: (a) the magnitude of the triggering event, and (b) the magnitude of the specific vulnerability in the patient as reflected in the patients diagnostic profile.
This proposition deals with the discrepancy between the magnitude of the patients symptomatic reaction and the magnitude of the triggering event which evoked the reaction (e.g., the change in the frame). My observations show that the unconscious reaction is always proportional to the traumatic magnitude of the triggering event, while the conscious verbal, symptomatic and acting-out reaction may be wildly out of proportion to the event that triggered it. In short, patients correctly perceive the frame change on an unconscious level. Yet, they may react to it in a wildly exaggerated manner symptomatically and in the overt meaning of their verbal material. This is easy to understand as a theoretical principle yet, in the midst of a therapy session, it is easy to be misled and to overlook this distinction between the manifest and the derivative meaning of the verbal material and symptoms. One is propelled to seek an unconscious linear correlation with consciously professed opinions and observable symptoms of the patient. In the turbulence of the session, one can easily forget Freuds two fundamental principles in the formation of derivatives, i.e. of symbolization and displacement.
Thus, it is not too difficult for the patient to convince us that a certain securing of the frame is wrong for the patient because something feels dangerous in their conscious experience (i.e., the manifest meaning). At the same time, the patients derivatives are telling us another story, i.e., that the patients fear is in fact without foundation in reality, that the fear should not be there. My examples earlier of the themes we hear when the patient is experiencing secured frame anxiety show that it is critically important to wait patiently for derivatives to emerge fully so that we get to hear the whole "story". The point I am making is that we cannot evaluate a frame change, securing or breaking, by looking solely at the patients emotional and symptomatic reaction - we can only evaluate a frame change by listening to the derivative meaning of the associations and by being clear about who is the initiator of a frame change.
I believe that the dynamically and patho-genetically important explanation of this discrepancy between the great intensity of the patients response and the small magnitude of the triggering event can only be clearly explained to the patient by a communicative interpretation. The reason is that a communicative interpretation explains the immediate dynamic property of the current therapeutic interaction (See: Bonac, 1993a, 1993b, 1996; Brown & Krauzs, 1984; Frick, 1985; Hodges, 1984; Kahl-Popp, 1994; Langs, 1982, 1984/85, 1988, 1988a; Quinn 1989, 1992b;) because it centers around the immediate, dynamic-in-session triggering event. I also believe that this discrepancy between the gravity of the patients reaction and the high intensity of their emotions on the one hand, and the relatively small magnitude of the triggering event on the other hand, is not in itself an expression of transference because there is no loss of the sense of reality and no distortion of the perception of reality in the derivative meaning of the patients communications.
Even though the observable, many times strikingly obvious, symptomatic and action-discharge response by the patient may be alarming and difficult to cope with by both the therapist and the patient, there is no evidence that the patient has confused a genetically important person of the mother or the father with the person of the therapist. On the contrary, the therapist is compelled to admit that the patients unconsciously communicated appraisal of the particular event is not only in agreement with the reality of that event but that it bears a compelling resemblance to the unconscious appraisals by other patients, from a young age on, when the same frame conditions are in effect.
I propose the following as explanation of the psycho-genesis of a transference response:
Proposition (5): The parents pathological changes in one aspect of the child/parent frame in the past, are responsible for the childs inability to tolerate the same aspect of the secured frame (termed secured-frame anxiety) in later life. This results in the adults pathological breaking of that same aspect of the secured frame in any interpersonal relationship, including psychotherapy or psychoanalysis.
Finally, I propose the following as a general definition of transference-proper in terms of the bi-personal analytic frame:
Proposition (6): Transference-proper is defined as the patients paranoid response to their own intended securing of the analytic frame, as offered by the therapist, when the frame-breaking triggers by the parents in the patients past drive the patients own frame-braking indicators in the present therapeutic relationship.
I hope that the time has come to take seriously all those who have
challenged the classical interpretation of transference. With the available new research
methods and with mastering the communicative technique of listening to the unconsciously
communicated material from their patients, every clinician now has the means to observe on
their own the interplay of phenomena within the context of the ever-changing analytic
(Reprinted in the IJCPP, Vol. 11, Nos. 2-3)
(Copyright ©1996 by V. A. Bonac)
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