How does recovery come about in psychoanalysis?
Aspects of Psychoanalysis - The Transfer
This paper is intended to shed light on a central aspect of psychoanalysis, the transference. The explanation of this phenomenon is in the foreground. Since the transference is of considerable importance for the success of a psychoanalytic therapy, it is also shown how the therapist has to deal with the transference and how he can use it most effectively for the benefit of healing. Finally, there is a conclusion on the topic dealt with.
2. Aspects of psychoanalytic therapy
Before we can go into more detail about the transference and its effect on therapy, some basic statements about the therapist's approach must first be made. However, this is by no means intended to be a comprehensive “guide to psychoanalysis”. Rather, a brief overview of the way in which the therapist has to deal with the experience of the patient and the conflict arising from the illness. Only then is it possible to grasp the significance of the transference and its importance for the success of psychoanalytic therapy.
2.1 The therapist's approach
There are various factors that make the path to successful psychoanalytical therapy difficult. The first to be mentioned here are the hereditary dispositions, ie the hereditary conditions of the patient, which the therapist must accept as such and which can limit the treatment. Furthermore, the already existing childhood experiences of the patient, which play a significant role in psychoanalysis, make the treatment more difficult because they lie in the past and cannot be reversed by the therapist. (Cf. Freud 2000: 411) In addition, the human being possibly shaped by various influences, be it his unhappy financial situation, an unsatisfactory marriage, conflicts in the family or social demands that are perceived as unpleasant. All of these are dispositions that must first be accepted as given.
It would be wrong, however, to address one of these factors directly in therapy. Psychoanalysis sees the experience of a sick person as characterized by a "persistent conflict between libidinal impulse and sexual repression, between the sensual and ascetic direction." (Freud 2000: 412). Defense mechanisms of the ego come into play, which then gives rise to the symptoms. An obsessional neurotic, for example, flees from threatening libidinal impulses, e.g. those that could lead to a serious crime by protecting himself from their execution by renouncing and restricting his freedom. Instead of the action that the instinctual impulse would require, it carries out other harmless compulsive actions that represent the symptoms. (Freud 2000: 248) This conflict cannot be resolved by the therapist strengthening one of the two sides and having the upper hand wins, there would always be one aspect of the conflict unsatisfied. What is special about the conflicts neurotics experience is that they take place on different levels. While one movement is taking place in the preconscious and the conscious, the other is held in the unconscious. It is precisely for this reason that the conflict cannot be resolved. Only when both impulses can be perceived in the conscious mind can the conflict be worked on and resolved, and achieving this is the goal of psychoanalytic therapy (cf. Freud 2000: 413).
It is not part of the job of psychoanalysis to influence the patient in serious decisions that he has to make in his life. Rather, it demands that the patient make all important decisions, eg ending a relationship, getting married or choosing a career, only after the therapy has ended, so that the direct influence of the therapist is not the decisive factor in favor of one Decision there. Therapy is also more likely to be unsuccessful if the therapist tries to guess, interpret and communicate the patient's unconscious. The unconscious thereby in no way becomes the conscious; the new information is only absorbed and, alongside the unconscious, canceled without replacing it. The therapeutic path must lead to the experience, the reason, which led to the repression into the unconscious. If this repression can be removed, it is possible for the patient to see his unconscious and thus to transform it into the conscious.
In order to be able to eliminate this repression, it must first be localized, after which it is possible to overcome the resistance that causes this repression. At this point the therapist can then resort to the means of interpretation and communication, but this time more successfully than if he were to encounter the repressed, the unconscious, in the same way. The essential difference between repression and the resistance it maintains is that the former takes place on the level of the unconscious and the latter on the level of the ego is also really conscious, but it is on the level of the conscious and is therefore accessible to the patient. It is therefore the task of the therapist to localize this resistance and communicate it to the patient, assuming that the patient gives up the resistance as soon as he has really recognized it. Once the resistance has been removed, access to the unconscious is also possible, which can then be converted into the conscious and processed. This assumption is based on the fact that both the patient's desire to get well and his intelligence drive the dissolution of the resistance. To this end, the patient must be made aware that his previous decision, that is, the repression, the build-up of resistance, led to his current state and that a change, the way in the other direction, led to an improvement in the state will lead. In this way, the conflict that led to repression in the past is refreshed, but this time with completely different basic conditions. “At that time the ego was weak, infantile and perhaps had reason to outlaw the libido demand as a danger. Today it is strengthened and experienced and moreover has a helper at its side in the doctor. ”(Freud 2000: 418) For this reason, it can be expected that the renewed conflict this time will be decided in favor of health.
This approach is one of the foundations of psychoanalytic therapy. By localizing the repression, interpreting and resolving resistance, and making the repressed visible, the unconscious can be transformed into the conscious. The success that this approach actually has in the treatment of diseases such as hysteria and anxiety and obsessive-compulsive disorder is the proof of these explanations (cf. Freud 2000: 418)
2.2 The transfer
Another fact of psychoanalysis is the so-called transference. This term describes the special relationship in which the patient sees himself with the therapist.
If the therapy lasts for a certain time, it happens again and again that the patient behaves in a special way towards the therapist. This is also remarkable because it is actually the intention of the therapist to rationalize the relationship between him and the patient and to make it clearly understandable. Nonetheless, the patient's relationship often develops in a complex, unexpected way (cf. Freud 2000: 419).
This change in relationship manifests itself in the fact that the patient develops a conspicuous interest in the therapist. Although the patient should be primarily interested in his recovery according to his role, it seems that the therapist person is more interesting for him and will distract him from being ill. This can be expressed in that the patient tries to show himself from his best side, ie is extremely polite and grateful or shows positive traits that the therapist would not have expected. For the therapist, this change is of course very pleasant; under certain circumstances, his or her opinion of the patient may even change in a positive direction. But this changed relationship also has a positive effect on the progress of the therapy. The patient demonstrates a remarkable faculty of understanding when it comes to understanding hints, encounters tasks that are given to him as part of the therapy with pronounced motivation, and he is also not lacking in memories and ideas. At the same time, an improvement in the condition of the disease can also be noticed by outsiders.
However, this positive influence, which the change in the relationship between patient and therapist has on therapy, does not last long-term. After a while, the patient's concentration and interest seem to decrease significantly. It is also typical of this situation that the patient can think of little that could help the therapy. Now what is the cause of this rapid change in the relationship between the therapist and the patient?
The reason for this change lies in the fact that "the patient has transferred intense, tender feelings to the doctor, which neither the doctor's behavior nor the relationship established during the cure entitle him to." (Freud 2000: 420). tient has developed certain feelings for the therapist, which are generally unusual for a relationship between a doctor and his patient. The nature of these feelings and their goal, however, depends heavily on the constellation of these two people. If, for example, the patient is a young woman and the therapist is also a young man, the woman's feelings can be compared to normal falling in love (cf. Freud 2000: 421). if, for example, the patient suffers from an unhappy marriage and longs for her wishes to be fulfilled. This development of feelings is understandable in these cases, as the therapist approaches the patient as a helper, with whom she is often alone and can discuss intimate matters. Finally, in everyday life it also happens that a woman develops feelings for a man with whom she spends a lot of time and who proves to be a good, understanding interlocutor. It is noteworthy, however, that this type of emotional relationship can be found even when there is a considerable age difference between the therapist and the patient. What is even more remarkable is that when patients are asked about this development, they say that they expected, if not hoped, such a development. The patients apparently believed they knew even before the therapy that they could only recover through love and hoped to find this in therapy. This hope was apparently the decisive impetus to start the therapy and to continue it with the appropriate motivation (cf. Freud 2000: 421)
Psychoanalysis has long regarded this phenomenon as an accidental disturbance of therapy and has not taken into account that this event could only be brought about by therapy. However, since this development occurred conspicuously often and also in the most diverse constellations of therapist and patient, it could no longer be assessed as occurring by chance. Rather, it had to be recognized that this noticeable change in the relationship is rooted in the nature of the disease and essentially amounts to transferring the patient's feelings to the therapist.
Psychoanalysis calls this phenomenon just described the transference. This choice of words should point out that the feelings that are brought to the counselor do not arise during the therapy, but were already present in the patient's emotional life. It is not in the interest of the therapy that such feelings develop, nor should the framework conditions in which a therapy takes place strengthen the development of such feelings. The psychoanalytic theory says that “the whole emotional readiness comes from elsewhere, in which the patient was prepared and, on the occasion of the analytical treatment, is transferred to the person of the doctor.” (Freud 2000: 422) From this it can be concluded that the personality of the therapist is of subordinate importance for the development of the feelings described. Rather, the therapist involuntarily, given by the structure of the therapy and the illness, offers himself as an object for these feelings, since they are also part of the concern with which the patient enters the therapy.
These feelings can take a wide variety of forms. Even if one restricts oneself to considering constellations in which the patient is a female and the therapist is a male person, the transference can take different forms. An obvious manifestation is certainly the patient's wish to find a lover in the therapist. Furthermore, a patient's wish to experience fatherly love can also be transferred to the therapist. But regardless of the form in which the transmission is presented, it is always based on the nature of the disease.
However, the transfer is not limited to therapy situations in which only a female patient and a male therapist take part. A transfer can be noted even if both participants are male. Here, too, it can be stated that the patient gains an increased interest in the person of the therapist and tends to overestimate his characteristics. However, sublimated forms of transference are more common here than direct sexual demands, that is to say, the desire for friendship is transferred more often than for a love relationship (cf. Freud 2000: 423). But another form of transference also occurs male patients significantly more frequently in relation to a male therapist than in female patients, namely the hostile or negative transference.
The transference and also the form of the same are, as already explained, rooted in the nature of the disease and begin to influence the relationship between therapist and patient at the beginning of therapy. As long as it positively reinforces the work of the therapist, it cannot be precisely perceived and does not require any further analysis. However, as explained above, it has been shown that sooner or later it creates a resistance in the patient that hinders further work. This resistance can manifest itself in the form that the patient no longer seems to think of anything or seems to devote himself to the therapy with little interest. There are two conditions for this conversion. Suppose the transference takes place in the form of a desire for a love affair or a sexual desire, which the person of the therapist has as an object. As the therapy progresses, this desire, this tendency, can become more and more pronounced until it is clearly perceptible to the patient and provokes an inner reluctance to face them. So the patient has perceived the transmission and refuses to allow it. This creates a resistance that hinders further therapy. Another condition for a change in the patient's feelings is if the transference is hostile or negative. The negative feelings are already present from the beginning of the therapy, but only come to the fore later than the positive ones. Since the negative feelings, like the positive ones, represent an emotional bond, albeit with a different sign, they must be summarized under the term transference analogously to the positive feelings (cf. Freud 2000: 423).
But what does the transference mean for therapy, what difficulties does it cause and what benefits can be drawn from it? Understandably, it is not feasible for the therapist to accept the feelings transferred to him and to engage in the relationship desired by the patient. It is also not conducive to the success of the therapy if the patient's feelings are unfriendly or even outraged. The correct way to overcome the resistance created by the transference is to let the patient understand the origin of these feelings.It must become clear to the patient that his feelings did not arise in the therapy and also do not apply to the person of the therapist, but that they are only part of a repetition of something that has already been experienced. This hint leads the patient to try to remember the origin of these feelings and thus to transform the unconscious into the conscious. As a result, “the transference, which, whether tender or hostile, seemed to represent the greatest threat to the cure in any case, becomes the best tool for it, with the help of which the closed compartments of the soul's life can be opened” (Freud 2000: 424 As already mentioned, the transmission is already based in the nature of the disease and is therefore part of the cause of it. If the patient succeeds in ascertaining the origin of the feelings and in remembering them, information relevant to the illness will change from unconscious to conscious material.
In order to fully appreciate the therapeutic benefit that transference can offer, it must be remembered that the disease is not of a static nature. It is not something that has already been completed, but rather continues to develop during the therapy. The task of the therapist is to influence this development in the interests of the patient. If the patient has been successfully involved in the therapy, this development is concentrated on the therapist or the relationship with him. From this point on, the therapist is no longer confronted with the patient's memories, but with a newly created and modified neurosis that replaces the original one. The advantage of this newly created neurosis is that the therapist has observed it from the beginning of its emergence and, above all, sees himself as the object of it. The neurosis is still present, but has turned away from its original objects and is now directed towards the transference. When the therapist works with the patient on this new, artificial neurosis, he also copes with the symptoms with which the patient came to therapy at the beginning.
The transference enables the therapist to reproduce the neurosis and thus to see it arise in a certain way. This time, however, it is in the center of the reproduced neurosis and can influence its development. Since the “new” neurosis is a reproduction of the original disease, the therapist can achieve a cure for the original by treating this created neurosis.
However, the condition for this approach is that there actually be transmission from the patient. If a patient maintains a normal relationship with the therapist, which means that the relationship remains unaffected by the instinctual impulses that make up the illness to be treated, the therapist cannot exert any influence on the neurosis. The transference has this central meaning in the “hysteria, anxiety hysteria and obsessional neuroses, which are therefore rightly summarized as transference neuroses.” (Freund 2000: 425) All these neurotic phenomena are characterized by the fact that their symptoms are expressions of suppressed libidinal instinctual impulses . (cf. Freud 2000: 425)
So transmission is a central element of therapy. However, it not only gives the therapist access to the neurosis, but can also act as a drive for the patient. During therapy, the patient is in a fight against the resistance that the therapist has shown him or her. In order to win this battle and to prevent the material developed in therapy from slipping back into the unconscious, the patient needs a strong drive. His intellectual abilities are too weak for this fight, the decisive factor here is the relationship with the therapist. As already mentioned, positive transference leads to the patient appreciating the therapist, following his explanations and being extremely focused on his work. It is precisely this that is necessary for the transference to become an effective engine for the patient's struggle. Only if he respects the therapist, values him and regards him as an authority, will he take up the arguments that are brought up to him and deal with them. If, on the other hand, there is a negative transference, the patient will either not listen to the therapist at all or, even if so, he will have little faith in what he has said and will treat them with suspicion. Only if the arguments come from a respected person close to the patient does the willingness to engage with them arise (cf. Freud 2000: 425f).
These aspects lead to the conclusion that a person is only really accessible if he is “capable of libidinal object cathexis” (Freud 2000: 426). This in turn shows that a person's narcissism is a considerable resistance to can represent analytical therapy attempts, since it influences the transferability. Patients with narcissistic neuroses have a serious lack of transferability. While their narcissism does not make them hostile to the therapist, they view them with indifference. They are simply not interested in what he said and are not inclined to grapple with them. As a result, the disease cannot develop again, it cannot be reproduced and the resistance to repression cannot be overcome. In these patients, narcissism prevents the therapist from accessing them, which means that psychoanalysis cannot cure them (cf. Freud 2000: 427).
Transfer is an important element of psychoanalysis. It enables the therapist to access the patient's illness and is an effective driving force in the fight against resistance. However, positive transmission does not automatically lead to successful therapy. Here it is the therapist's task to analyze the transference and to use it for the benefit of the patient. However, there are also cases, such as the narcissistic neuroses, in which there is no transference and which consequently cannot be cured in this way.
It must be mentioned about this work that the presentation mainly adheres to the fundamental considerations of Sigmund Freud. Subsequent revisions or related aspects such as countertransference were not dealt with in this work. Nevertheless, this work should have succeeded in giving a general impression of the transference as an element of psychoanalysis.
Freud, Sigmund: Lectures for Introduction to Psychoanalysis, Frankfurt am Main, 10th edition, 2000.
Amelang, M., Bartussek, D .: Differential Psychology and Personality Research, Stuttgart, 4th ed., 1997.
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