Solitude. Anthony Storr
of the patient’s life about which they probably knew very little.
Psycho-analysts were often criticized for treating their patients too much as isolated individuals, without reference to their families and friends. The latter, often to their chagrin, were generally discouraged from any participation in the analytic process, and were not usually seen by the psycho-analyst or asked for information about the patient’s behaviour and relationships at home. But, if psycho-analytic theory in its original form is accepted, treating the patient without direct involvement of those currently close to him is reasonable. No one except the patient has access to the phantasies and feelings of his early childhood. Even the most detailed account which parents might give of the patient’s early years will not disclose what the psychoanalyst is seeking: the patient’s subjective reaction to those childhood circumstances rather than the facts themselves.
When Freud first initiated psycho-analytic treatment, he did not anticipate that he would become emotionally important to his patients. He hoped to make psycho-analysis into a ‘science of the mind’ which would ultimately be based upon, and be as objective as, anatomy and physiology. He saw his own role as that of a detached observer, and assumed that his patients would have the same attitude toward him as they would toward a medical specialist in any other field. When he discovered that this was not the case, that his patients began to experience and to express emotions of love and hate toward himself, he did not accept such emotions as genuine expressions of feelings in the here-and-now, but interpreted them as new editions of emotions from the past which had been transferred to the person of the analyst.
Freud originally regarded transference with distaste. As late as 1910, long after he had recognized the importance of transference, he wrote to Pfister:
As for the transference, it is altogether a curse. The intractable and fierce impulses in the illness, on account of which I renounced both indirect and hypnotic suggestion, cannot be altogether abolished even through psycho-analysis; they can only be restrained and what remains expresses itself in the transference. That is often a considerable amount.2
In Lecture 27 of Introductory Lectures on Psycho-Analysis, Freud reiterates his conviction that transference must be treated as unreal.
We overcame the transference by pointing out to the patient that his feelings do not arise from the present situation and do not apply to the person of the doctor, but that they are repeating something that happened to him earlier. In this way we oblige him to transform his repetition into a memory.3
Since Freud’s day, and, more particularly, since the emergence of the object-relations school of psycho-analysis, there has been a shift of emphasis in understanding and interpreting transference. The majority of psycho-analysts, social workers, and other members of the so-called ‘helping professions’ consider that intimate personal relationships are the chief source of human happiness. Conversely, it is widely assumed that those who do not enjoy the satisfactions provided by such relationships are neurotic, immature, or in some other way abnormal. Today, the thrust of most forms of psychotherapy, whether with individuals or groups, is directed toward understanding what has gone wrong with the patient’s relationships with significant persons in his or her past, in order that the patient can be helped toward making more fruitful and fulfilling human relationships in the future.
Since past relationships condition expectations in regard to new relationships, the attitude of the patient toward the analyst as a new and significant person is an important source of information about previous difficulties and also provides a potential opportunity for correcting these difficulties. To give a simple example, a patient who has experienced rejection or ill-treatment is likely to approach the analyst with an expectation of further rejection and ill-treatment, although the patient may be quite unconscious of the fact that this expectation is affecting his attitude. The realization that he is making false assumptions about how others will treat him, together with the actual experience of being treated by the analyst with greater kindness and understanding than he had expected, may revolutionize his expectations and facilitate his making better relationships with others than had hitherto been possible.
As we have seen, Freud discounted any feelings which the analysand expressed toward the analyst as unreal, and interpreted them as belonging to the past. Today, many analysts recognize that such feelings are not merely facsimiles of childhood impulses and phantasies. In some cases they represent an attempt to make up for what has been missing in the analysand’s childhood. The analysand may, for a time, see the analyst as the ideal parent whom he never had. This experience may have a healing effect, and it can be a mistake to dispel this image by premature interpretation or by calling it an illusion.
As we saw earlier, Freud considered that the psycho-analyst’s task was to remove the blocks which were preventing the patient from expressing his instinctual drives in adult fashion. If this task could be accomplished, it was supposed that the patient’s relationships would automatically improve. Modern analysts have reversed this order. They think first in terms of relationships, second in terms of instinctual satisfaction. If the analysand is enabled to make relationships with other human beings which are on equal terms, and free from anxiety, it is assumed that there will be no difficulty in expressing instinctual drives and attaining sexual fulfilment. Object-relations theorists believe that, from the beginning of life, human beings are seeking relationships, not merely instinctual satisfaction. They think of neurosis as representing a failure to make satisfying human relationships rather than as a matter of inhibited or undeveloped sexual drives.
Transference, in the sense of the patient’s total emotional attitude or series of attitudes toward the analyst, is therefore seen as a central feature of analytical treatment, not as a relic from the past, nor as ‘a curse’, nor even, as Freud later regarded it, as ‘a powerful ally’, because of the power which it gave him to modify the patient’s attitudes. Today a psycho-analyst will usually spend a good deal of his time detecting and commenting upon the way in which his patients react to himself, the analyst: whether they are fearful, compliant, aggressive, competitive, withdrawn, or anxious. Such attitudes have their history, which needs to be explored. But the emphasis is different. The analyst stuthes the analysand’s distorted attitude to himself, and by this means perceives the distortions in the analysand’s relationships with others. To do this effectively implies the recognition that there is a real relationship in the here-and-now, and that analysis is not solely concerned with the events of early childhood.
The analytical encounter is, after all, unique. No ordinary social meeting allows detailed study of the way in which one party reacts to the other. In no other situation in life can anyone count on a devoted listener who is prepared to give so much time and skilled attention to the problems of a single individual without asking for any reciprocal return, other than professional remuneration. The patient may never have encountered anyone in his life who has paid him such attention or even been prepared to listen to his problems. It is not surprising that the analyst becomes important to him. Recognizing the reality of such feelings is as necessary as recognizing the irrational and distorted elements of the transference which date from the analysand’s childhood experience.
This concentration upon interpersonal relationships and upon transference is not characteristic of all forms of analytical practice; but it does link together a number of psycho-analysts and psychotherapists who may originally have been trained in different schools, but who share two fundamental convictions. The first is that neurotic problems are something to do with early failures in the relation between the child and its parents: the second, that health and happiness entirely depend upon the maintenance of intimate personal relationships.
No two children are exactly alike, and it must be recognized that genetic differences may contribute powerfully to problems in childhood development. The same parent may be perceived quite differently by different children. Nevertheless, I share the conviction that many neurotic difficulties in later life can be related to the individual’s early emotional experience within the family.
I am less convinced that intimate personal relationships are the only source of health and happiness. In the present climate, there is a danger that love is being idealized