This paper presents a series of training vignettes which suggest that a subtext of defensiveness regarding exposure to our patients, fear of feelings, adherence to an unwritten set of rules, and a profound need to control our way of thinking and working pervades the way psychoanalysis is taught and practiced in many settings. The paper explores the way in which the basic culture of psychoanalysis, and the manner in which psychoanalysts are socialized, may make these kinds of episodes commonplace. The paper suggests that a paradigm shift that has been taking place in psychoanalytic clinical thinking has not yet affected the training process because of the danger that the new paradigm might undermine the safety, clarity, and ways of knowing that our traditional theories and clinical practices have provided.
This paper examines the effect patient transferences have on the analyst and on the analyst's stance in treatment. The paper suggests that certain features of what are commonly considered central to a >classical< psychoanalytic stance may derive from not fully understood dynamics of the transference situation and may be neither necessary nor useful aspects of technique. A comprehensive, developmental conception of transference as a general human endowment is proposed as a way of viewing the impact of transference in the treatment situation. The adaptive function of adolescent regression and adolescent developmental transference is examined as a paradigm for all transferences, both in and outside treatment. In this >adaptive< perspective, transference is understood not simply as a misconstrual of a new relationship on the basis of old struggles. Rather, transference is seen as an effort to bring to bear as much of one's own most vital interests, as they have been shaped developmentally, and to compel the object to provide what one deeply hopes to have gratified. This perspective provides a basis for understanding the powerful influence that the urgent transferences of patients have on therapists, who are not immune to some degree of enactment in response. Analysts may try, through a stereotyped treatment approach, to avoid the impact of the transference and the powerful vortex of feelings generated by it. Maintaining an adaptive view of transference, however, may enable the analyst to use his or her >countertransference< response to further the analytic work.
In classical psychoanalytic models, treatment can be understood as enabling patients to repossess their own agency – to take responsibility for themselves as agents in relation to their own motives and impulses (>Where id was, there shall ego be<). How the question of agency is understood developmentally and as part of the treatment process in relational psychoanalytic perspectives has been less clearly articulated. In this article, we suggest that the attainment of the ability to experience oneself as an agent emerges from complex interpersonal and intrapsychic processes in infancy and early childhood and represents a kind of >glue< that provides the foundation for a feeling of personal coherence. We also suggest that the development of a sense of agency is predicated on the negotiation of recognition and mutual impact with parents early in life. When those negotiations go awry, the child's capacity for agency can be disrupted. We suggest that many of the difficulties patients experience in their lives can be understood in this developmental context.