DESIRE AND RESPONSIBILITY:

THE ETHICS OF COUNTERTRANSFERENCE EXPERIENCE

--The Psychoanalytic Quarterly, April, 2013

Mitchell Wilson, MDTraining and Supervising AnalystSan Francisco Center for Psychoanalysis

The Devil Made Me Do It

The analyst’s counter-transference is not only part and parcel of the analytic relationship, but it is the patient’s creation, it is part of the patient’s personality.

–Paula Heimann, 1950

Origins of the Countertransference Concept

The word countertransference suggests that the analyst is responding to an outside stimulus—he is “countering” the patient’s transference communication. The implication is that the analyst’s action is a re-action, is an action “again,” following the action of the patient. Already one can sense the shrouding of the question of the analyst’s agency--and the desire that animates this agency--in the root elements of the word countertransference itself. The psychoanalytic origins of the term reinforce this point: Freud coined the term “countertransference” in a letter to Jung (June 7, 1909) regarding the possibly erotic nature of Jung’s relationship with his patient Sabina Spielrein (Freud/Jung, 1974). Freud advised Jung “to dominate” his countertransference. The source of Jung’s problem came from Miss Spielrein.

The deep dissatisfaction we find in every psychology—including the one we have founded thanks to psychoanalysis—derives from the fact that it is nothing more than a mask, and sometimes even an alibi, of the effort to focus on the problem of our own action—something that is the essence and very foundation of all ethical reflection.

--Jacques Lacan, The Ethics of Psychoanalysis (1992)

“…an ethics essentially consists in a judgment of our action…” (Lacan, Ethics)

Goals of Paper• Theoretical: establish that

countertransference experience is dependent, necessarily, upon the particular desiring state of the analyst at that moment of experiencing and arises logically prior to other factors involving the patient.

• Clinical: describe the central

importance of the analyst’s taking his desire as a unit of measure and as the first order of business in unpacking the countertransference experience.

• Ethical: Show how the analyst’s

desire and his countertransference experience that unfolds because of this desire are embedded in an ethical field in which responsibility, judgment, and truth are always in play, and the analyst and patient’s sanity are at stake.

Wider Counter-transference View(Neo-Kleinian)

The analyst’s counter-transference is not only part and parcel of the analytic relationship, but it is the patient’s creation, it is part of the patient’s personality

–Paula Heimann, 1950 Much of our understanding of the transference comes through our understanding of how our patients act on us to feel things for many varied reasons; how they draw us into their defensive systems; how they unconsciously act out with us in the transference, trying to get us to act out with them; how they convey aspects of their inner world built up from infancy…which we can often only capture through the feelings aroused in us, through our countertransference, used in the broadest sense of the word

--Betty Joseph, 1985

Projective IdentificationIf a patient wishes to be rid of parts (feelings, ideas, fantasies) of himself he finds noxious or threatening, then one way to do so is to use the analyst as a place to put these parts. The analyst registers this impact by way of his subjective sense of dis-ease and unpleasure. For example, the patient projects a fantasy of an internal object relationship onto the analyst; consequently the analyst feels pressure to act in one way or another--that is, to conform with the felt pressure or resist it. Generally speaking, if the analyst is feeling dis-ease, it seems reasonable to assume that the patient has engendered this feeling in the analyst. It is incumbent upon the analyst to investigate his countertransference because it is the most reliable and direct access he has to the unconscious of his patient (the contours, that is, of the patient’s internal object relations and transference).

The Basic Clinical QuestionHow does one go about the job of parsing the relative contributions to one’s countertransference? How do I differentiate the patient’s feelings, attributions, and pressures from those that originate in me? This is anything but a straightforward project. When is a narrow countertransference (the source of which is the analyst’s desire and unconscious conflict) lurking in what appears to be a wider countertransference experience (the source of which is the patient, via projective identification)?

Parsing of Countertransference experience is arguably impossible if there is a significant gap in our understanding of its nature. And if the nature of countertransference is obscure, then our clinical handling of it will be wobbly at best and have untoward consequences.

Definition of Countertransference

• Countertransference is defined in relation to the analyst’s experience of pleasure and unpleasure.

• Through the analyst’s experience of pleasure and unpleasure we can clarify that the analyst’s desiring position underwrites these states.

• This desire is often manifested in specific conscious or pre-conscious wishes that, when frustrated, become potentially accessible to the analyst.

• The literature on countertransference under-theorizes the analyst’s position as a desiring subject wanting specific experiences moment-to- moment in the work.

The analytic literature amply explains the patient’s role in becoming a frustrating object. Waiting to be sorted out are the needs of the analyst that are not being met; more exactly, these needs have been insufficiently analyzed in the context of the analyst’s vulnerability to feeling frustrated. (Roy Schafer, Tragic Knots in Psychoanalysis, 2009)

Analysts write about being made to feel pressured, frustrated, worried, or curiously over-satisfied or comfortable in a given clinical moment. Feeling these feelings and noticing them rests on the analyst’s being in a state of desire.

Melanie Klein on CountertransferenceI have never found that the countertransference has helped me to understand my patient better. If I may put it like this, I have found that it helped me to understand myself better. At the moment when one feels that anxiety is disturbing one, one would really come to the conclusion what went on in oneself. Therefore, I cannot really find a genuine account that counter-transference, though unavoidable, is to be a guide towards understanding the patient, because I cannot see the logic of that; because it obviously has to do with the state of mind of the analyst.

Searle on Desire

“[E]very intentional state consists of an intentional content in a psychological mode. Where that content is a whole proposition and where there is a direction of fit, the intentional content determines the conditions of satisfaction. Conditions of satisfaction are those conditions which, as determined by the intentional content, must obtain if the state is to be satisfied.”

[Desires] “cannot be true or false, but can be complied with, fulfilled or carried out, and…they have a ‘world to mind’ direction of fit” (p. 8).

A desire is fulfilled or not depending on what happens in the world relative to the desire regarding those happenings; hence the “world to mind” direction of fit.

John Searle, Intentionality, 1983

Structure of Analyst’s Desire

If we take a typical analytic desire as an example of what Searle is describing, one gets something like the following: • Analyst’s desire: that the patient says whatever comes to mind. This is the specific intentional content of the desire. Notice that the intentional content is a representation of its conditions of satisfaction.

• Conditions of satisfaction of the desire: that the patient in fact is saying whatever comes to mind.

Obviously, if the patient is saying whatever comes to mind then the analyst is satisfied. If the patient is not saying whatever comes to mind, then the analyst is not satisfied. The analyst is in a state of un-pleasure.

Clearly, one can list a number of common analytic desires: to “contain”; to understand; to interpret; to have the patient listen to the interpretation; to help/cure; to be without memory and desire. Each of these desires has its conditions of satisfaction.

Heinrich Racker

Jacques Lacan

Features of the Dual Relation/Talion Law • Bi-directional attributions. That is, what the

analyst believes the patient is doing to the analyst, the analyst is also doing to the patient.

• A paranoid analytic field. • Feelings/affects tend to be reciprocated. Racker,

for example, notes that a positive transference will be met with a positive countertransference and a negative transference with a negative countertransference.

• Ego functions, such as logical thinking, memory, and judgment, are by their very nature self-affirming.

• Finally, when in a state of desire in relation to the other person, there is a strong tendency to “battle it out,” to, as Racker says, “clash.” Thus, a latent aggressiveness lurks within the dual relation in which a contest of wills is enjoined, as well as a wish to retaliate. Each party insists the other recognize his desire.

• An inherent confusion of self and other, and no way to adjudicate “truth.” Instead, the exercise of power (often subtle and unspoken) takes over, with compliance/submission or rebellion/domination its hallmarks.

Feldman’s Case: ConclusionThe patient already understands something about the analyst’s desire, and tells this to the analyst at the beginning of the session. But the patient-as-the-interpreter of the analyst’s experience (Hoffman, 1983) is not recognized by the analyst, in the sense that the analyst does not take account of his own desire and the conditions of satisfaction that he has imposed on the patient to begin with. This misrecognition of desire engenders a series of moves by both patient and analyst. The patient retaliates for having been hurt. But the patient becomes compliant, shies away from challenging the analyst in any sustained manner, and instead produces dreams in which he is hurting his mother/analyst and minimizing the hurt he has caused. In a mirroring/dual relation, the patient has identified with the analyst’s minimizing of his own hurtful actions in relation to the patient. Without the analyst having a place for his desire in his theory, it makes the understanding of countertransference experience and the parsing of countertransference contributions a difficult, if not impossible, challenge.

Ethics of PsychoanalysisLacan’s central focus in the Ethics is responsibility for one’s desire and one’s actions. Desire is a composite term that refers to who on is in relation to one’s history, what one has done, has not done, and wishes to do in the future. His famous aphorism is: “the only thing that one can be found guilty of is giving ground relative to one’s desire.” I take this to mean: the assumption of responsibility of one’s desire in all its complexity. Guilt arises for the analyst if he fails to come to terms with his own actions (and inactions) and his responsibility for them within the treatment situation.

Case of Byron: Conclusion

If I had conceptualized the interaction as Byron having “induced” in me a state of mind (say that I felt tormented or scared by his complaining), I would have taken myself out of the equation as an actor who necessarily desires. In other words, I would have falsely inhabited an imaginary place in which judgment regarding my actions—the very heart of ethical reflection, does not apply to me. The dual relation/talion law would have become more prominent, and vagaries of bi-directional attributions would have clouded the analytic field, leading to an increasing sense of confusion. In the end, the patient is not responsible, from an ethical point of view, for the analyst’s actions or states of mind.