Perception or Fantasy? A New Clinical Theory of Transference©
By V. A. Bonac
(Copyright ©1996 by V. A. Bonac; Apr. 1996; Aug. 1998)
Abstract (Apr. 1996; Revised Aug. 1998) The author claims that the clinical phenomenon of transference has never been correctly observed and that this is the reason for the loose and inconsistent definition of the concept of transference throughout psychoanalytic literature. A further problem was identified as a basic issue of technique: While communicative psychoanalysis has developed clinical means for identifying unconscious perceptions (Langs, 1982), there has been a curious neglect of transference. On the other hand, traditional psychoanalysis appears to all but ignore the need for a clear clinical separation and identification of both, transference and unconscious perception, while transference seems to be interpreted without verification. The paper reports findings of the author's three-year empirical study (Bonac, 1998) of the therapeutic process with adult patients in private communicative psychoanalysis using the research method of sequential analysis (Langs, 1984). Author claims that transference proper can only become observable during a particular sequence of states of the analytic frame. The author found that transference proper, as originally conceptualized by Freud, occurs only as a manifestation of such patient's fantastical expectations of a future event which are driven by a past trauma and which contradict all existing patient's own perceptions-driven expectations of this future event. The author claims to have empirically confirmed both of Freudís hypotheses about transference: the seduction and the illusion theories. The paper offers clinical examples and a new definition of transference proper as well as six formal propositions for a new theory of transference.
Perception or Fantasy? A New Clinical Theory of Transference©
By V. A. Bonac
(Copyright ©1996 by V. A. Bonac; Apr. 1996; Aug. 1998)
What is life, after all? The future isnít 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.)
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 Szaszís 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 patientís 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 patientís transference Ė 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 patientís sane and salutary functioning, about the effects of the analystís 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 patientís 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 patientís 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 Ė the classical psychoanalysts and those who interpret reality Ė 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 patientsí responses to changes in the analytic frame (Bonac, 1991; Langs, 1982, 1988).
My understanding of Quinnís (1995) report that his research findings did not confirm the claim of universality of patientís responses to frame changes is the following: The effects of the therapistís self-revelations and confrontations in the sessions, on the variables of the patientsí 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 therapistsí 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 therapistsí 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 60ís and the 70ís, 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). Freudís 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 patientís 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 patientsí 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 patientsí material is taken at face value while the active derivative meaning of free associations is neglected (see Langs, 1984, l985, 1992b).
Starting with Freudís (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 patientís verbal material involved unconscious perceptions of the reality of the therapistís 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. Patientís psychological difficulties in living have three sources: social, interpersonal and intra-psychic. As psychotherapists, we can do nothing to improve the patientís 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 patientís 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 patientís 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 patientís 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 patientís 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 patientís past onto the therapist. And, can all this occur while the reality of the current situation in the patientís 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 patientís 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 patientís 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 Langsís 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. Langsís writing on the gravity of the therapistís 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 patientís 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 therapistís 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 patientís 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 patientís 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 patientís 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 patientís transference. Langs responds by pointing to the patientís derivatives. Look, he says, every time the analytic frame is "broken" (i.e., changed away from the "ideal") the patientís 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 patientsí current state of the frame. The interesting questions are these: Are these views significantly different? Which method of treatment is better? Who is right?
Langsís 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 therapistís breaks in the analytic frame. This is aggravated by further harm done by the therapistís insistence on their version of reality. With this, I wholeheartedly agree: one only has to listen to the unconsciously communicated meaning of the patientís 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 70ís (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 patientís 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 Langsís 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 Langsís method of investigating unconscious mental processes. My theory of transference gives credence to both of Freudís 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 Langsís 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 patientís 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 Freudís 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 patientís 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 patientís 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 Freudís writing on transference (without its Oedipal emphasis) and used it as a guiding light in my study. I think that Greensonís 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:
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:
After much effort to validate my research hypotheses about transference, I concluded that the patientsí 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 patientís 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 patientsí 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 Ė 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 patientís 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, motherís lap, normal pregnancy, breast-feeding, good marriage, etc.
I have observed that patients react realistically when they are anxious following their therapistís 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 patientís 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 therapistís troubles with containing the pathology of their patients have serious consequences for the patientís 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 patientís expectations of the future. This expectation of the future is, in turn, heavily influenced by the real traumatic past events in the patientís 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 patientís 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 patientís derivative material, positive images of the therapistís explicit offer of the frame as well as positive images of the patientís 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 patientís past experiences Ė 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 patientís 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", "therapistís 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 patientís 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 patientís intra-psychic state, i.e., the memory of his or her trauma is driving the patientís anxiety about the future securing of the frame. The following is my proposed definition of transference in communicative terms:
The patientís 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 patientís 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 patientís 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 rememberÖ!"
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 analystís 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 patientsí symptoms and in their lives. Clinically, the interpretation of transference must be offered during the brief period of the patientsí 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 patientsí intensely emotional experience which only aggravates the therapistís 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:
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 patientís derivatives are telling us another story, i.e., that the patientís 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 patientís 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 patientsí 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 patientís 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 patientís 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 patientís 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:
Baranger, M., and Baranger, W. (1966) Insight in the analytic situation. In R. Litman (Ed.), Psychoanalysis in the Americas, pp. 56-72. New York: International Universities Press.
Berns, U. (1994) Die Uebereinstimmungsdeutung - Ein Ergebnis der Evaluationsanalyse. (Ger. The tally interpretation: an outcome of evaluation analysis.)
Forum der Psychoanalyse (Ger. Psychoanalytic Forum) 10: 226-244.
Bird, B. (1972) Notes on transference: universal phenomenon and hardest part of analysis. Journal of the American Psychoanalytic Association 20: 267-301.
Bonac, V. A. (1991) Unconscious Perception of Children in Psychotherapy. (Thesis) Vancouver: University of BC.
Bonac, V. A. (1992) Clinical evidence and the communicative model of the mind. International Journal of Communicative Psychoanalysis and Psychotherapy 7: 47-61.
Bonac, V. A. (1993a) Clinical issues in communicative psychoanalysis: Interactional aspects of requests for premature termination as reflections of secured-frame anxiety in adult and child psychotherapy. International Journal of Communicative Psychoanalysis and Psychotherapy 8: 67-78.
Bonac, V. A. (1993b) Clinical issues in communicative psychoanalysis: Premature securing of patientís breaks in psychotherapy frame as expression of therapistís counter-transference difficulty with containing patientís projective identifications. International Journal of Communicative Psychoanalysis and Psychotherapy 8: 115-121.
Bonac, V. A. (1994) A communicative psychoanalytic theory of human development: Part one - Introduction, methodology and theorems. International Journal of Communicative Psychoanalysis and Psychotherapy. 9: 99-105.
Bonac, V. A. (1996) The color of money in consultation room: a communicative interpretation of transference response. (Presentation paper, Conference on Mental Health Insurance, International Society for Communicative Psychoanalysis and Psychotherapy. 5 October, 1996, New York, USA.)
Bonac, V. A. (1995) The bountiful mother and the fate of transference in managed care. International Journal of Communicative Psychoanalysis and Psychotherapy, 10:59-72.
Bonac, V. A. (1998). Moments of mystery and confusion: Transference interpretation of acting-out. Unconscious Perceptions in Clinical Practice (E. M. Sullivan, Ed.), London: Open University Press.
Brown, R. D. & Krausz R. (1984) The patient's unconscious perceptions of the therapist's disruptions. Listening and Interpreting: The Challenge of the Work of Robert Langs (Ed. J. O. Raney). New York: Aronson.
Freud, S. (1912a) the dynamics of transference. Standard Edition 12: 97-108.
Freud, S. (1912b) Recommendations to Physicians Practicing Psychoanalysis. Standard Edition 12: 111-120.
Freud, S. (1913) On Beginning of the Treatment (Further Recommendation on the Technique of Psychoanalysis I). Standard Edition 12: 121-144.
Freud, S. (1915) Observations on transference-love. (Further Recommendation on the Technique of Psychoanalysis III) Standard Edition 12:157-171.
Freud S. (1920) Beyond the Pleasure Principle. Standard Edition 18: 3-64.
Freud, S. (1925) An autobiographical study. Peter Gay (Ed.), The Freud Reader. New York: W. W. Norton (1989), pp. 3-41.
Frick, E. M. (1985) Latent and manifest effects of audiorecording in psychoanalytic psychotherapy. The Yearbook of Psychoanalysis and Psychotherapy, Vol. I. (Ed. R. Langs). New Jersey, Emerson: Newconcept Press.
Greenson, R. (1978) Explorations in Psychoanalysis. New York: International Universities Press.
Greenson, R. (1990) The "real" relationship between the patient and the psychoanalyst. R. Langs (Ed.), Classics in Psychoanalytic Technique (pp. 87-101). New York: Aronson. (Reprinted from The Unconscious Today, Ed. Mark Kanzer, pp. 213-232. New York: International Universities Press, 1971.)
Hodges, A. G. (1984) The Langsian approach to acting out. Listening and Interpreting: The Challenge of the Work of Robert Langs (Ed. J. O. Raney). New York: Aronson.
Kahl-Popp, J. (1994) Ich bin Dr. Deutschland.: - Rechtsradikale Phantasien als verschluesselte Kommunikation in der analytischen Psychotherapie eines Jugendlichen. (Ger. I am Dr. Germany: Right-wing Extremist Fantasies as Encoded Communications in the Analytic Psychotherapy of an Adolescent.) Praxis der Kinderpsychologie und Kinderpsychiatrie, (Germ. The Practice of Child Psychology and Child Psychiatry) 43: 266-272.
Keene C. (1984) Framework rectification and transient negative effects. Listening and Interpreting: The Challenge of the Work of Robert Langs (Ed. J. O. Raney). New York: Aronson.
Langs, R. (1973) The patientís view of the therapist: reality or fantasy? International Journal of Psychoanalytic Psychotherapy 2: 411-431.
Langs, R. (1975) The therapeutic relationship and deviations in technique. International Journal of Psychoanalytic Psychotherapy 4: 106-141.
Langs, R. (1976) The Bipersonal Field. New York: Aronson.
Langs, R. (1978a) The Listening Process. New York: Aronson.
Langs, R. (1978b) Technique in Transition. New York: Aronson.
Langs, R. (1979a) The Supervisory Experience. New York: Aronson.
Langs, R. (1979b) The Therapeutic Environment. New York: Aronson.
Langs, R. (1980a) Interactions: The Realm of Transference and Countertransference. New York: Aronson.
Langs. R. (1981) Resistances and Interventions, The Nature of Therapeutic Work. New York: Aronson.
Langs, R. (1982) Psychotherapy, A Basic Text. New York: Aronson.
Langs, R. (1984) The Contributions of the Adaptational-Interactional Approach to Classical Psychoanalysis. Analytic Psychotherapy and Psychopathology 1: 21-47.
Langs, R. (1984/85) Making interpretations and securing the frame. International Journal of Psychoanalytic Psychotherapy 10: 3-23.
Langs, R. (1985) Workbooks for Psychotherapists, Vols. 1, 2 & 3. Emerson, N.J.: Newconcept Press.
Langs, R. (1988) A Primer of Psychotherapy. New York: Gardner Press.
Langs, R. & Searles, H. (1980) Intrapsychic and Interpersonal dimensions of Treatment. New York: Aronson.
Langs, R. & Stone L. (1980) The Therapeutic Experience and Its Setting: A clinical Dialogue. New York: Jason Aronson.
Meacci, m.g. (1993) Issues in communicative psychoanalysis. International Journal of Communicative Psychoanalysis and Psychotherapy 8: 79-84.
Quinn, B. P. (1992) Interpreting patientís unconscious needs for seeking modification of the psychotherapy frame. International Journal of Communicative Psychoanalysis and Psychotherapy 7: 35-38.
Quinn, B. P. (1995) Testing communicative Postulates. International Journal of Communicative Psychoanalysis and Psychotherapy 10: 19-28.
Smith, D. L. (1991) Hidden Conversations. London: Tavistock/Rutledge.
Strachey, J. (1934) The fate of the ego in the analytic therapy. International Journal of Psychoanalysis 50: 275-292.
Szasz, T. (1963) The concept of transference. International Journal of Psychoanalysis (44): 4432-443.
Ticho, E. (1972) The effects of the analystís personality on psychoanalytic treatment. Psychoanalytic Forum 4: 137-151.
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