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대상관계이론의 역사
작성자  simonshin 작성일  2017.12.12 18:28 조회수 437 추천 0
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 신현근 박사 강의안: 전이와 역전이  
 

과목대상관계이론의 역사

주제전이와 역전이

교수신현근 박사

내용강의안

교재Scharff, D. E. (1996). Object relations theory and practice: An introduction. Northvale, New Jersey: Jason, Inc.

_____________________________________________________________________________________________________________

Transference and Countertransference

 

1)      Introduction

a)       The new directions in the use of the therapist’s own reactions as a source of information about the patient’s early experience, even before language, began with Klein’s description of transference as “total situation” and Winnicott’s landmark paper, “Hate in Countertransference”.

b)      Freud first described countertransference as the area of unanalyzed neurosis and pathology, requiring supervision and personal analysis.

c)       With Klein’s changing emphasis, Winnicott’s description of the objective hate in the work with some patients, and Paula Heimann’s paper, a new direction was taken.

d)      Quickly, analysts began to study a wider, enriched view of the therapist’s range of responses to the patient and affective currents between them that re-create early relationships through ubiquitous projective and introjective identification.

e)      The work of these early clinicians is continued in the writing of the later clinicians.

 

2)      Paula Heimann’s “On Countertransference” (1949)

a)       Overview

i)        Heimann’s paper followed early papers written by Winnicott and others in challenging the strict analytic abstinence or “neutrality.”

ii)       Many analysts seemed to have taken Freud’s admonition on the analyst’s need to maintain neutrality – by which he meant primarily a position equidistant among the structures of personality – as an injunction to analysts against having feelings toward patients.

iii)     Freud and Klein had thought that countertransference was interference to analysis because it stemmed from the analyst’s unconscious, unanalyzed responses to patient.

iv)     Heimann’s paper delivered a revolutionary message that analyst’s responses were themselves signals of patient’s unconscious issues and conflicts.

v)       This theoretical movement, together with Bion’s work on projective identification and containment and Joseph’s contribution on transference as a total situation were perhaps the major influences toward making countertransference a central aspect of technique in modern psychoanalysis and psychotherapy. 

b)      Additional Overview (The New Dictionary of Kleinian Thought 2011)

i)        Paula Heimann was born in Danzig in 1899 of Russian parents.

ii)       She trained in medicine and then psychoanalysis in Berlin.

iii)     In London, Heimann retained as a psychoanalyst with Melanie Klein and became her staunchest supporter (with Susan Isaacs) throughout the 1940s.

iv)     Mysteriously, she and Klein began to disagree, although this never became public, and finally in 1955 Heimann left the ‘Klein group.’

v)       She was subsequently an important member of the ‘Independent Group’ of analysts in the British Psychoanalytic Society until her death in 1982.

c)       Contents

i)        I have been struck by the widespread belief among candidates that countertransference is nothing but a source of trouble.

ii)       Many candidates are afraid and feel guilty when they become aware of feelings towards their patients and consequently aim at avoiding any emotional response and becoming completely unfeeling and “detached.”

iii)     For the purpose of this paper I am using the term countertransference to cover all the feelings which the analyst’s experience towards his patient.

iv)     The analyst’s countertransference is an instrument of research into the patient’s unconscious.

v)       The analyst along with this freely working attention needs a freely roused emotional stability so as to follow the patient’s emotional movements and unconscious phantasies.

vi)     In the comparison of feelings roused in himself with his patient’s associations and behavior, the analyst possesses a most valuable means of checking whether he has understood or failed to understand his patient.

vii)   The analyst’s emotional sensitivity needs to be extensive rather than intensive, differentiating, and mobile.

viii)  The emotions roused in the analyst are much nearer to the heart of the matter than his reasoning, or, to put in other words, his unconscious perception on the patient’s unconscious  is more acute and in advance of his conscious perception of the situation.

ix)     The analyst’s immediate emotional response to his patient is a significant pointer to the patient’s unconscious processes and guides him towards full understanding.

x)       It helps the analyst to focus his attention on the most urgent elements in the patient’s associations and serves as a useful criterion for the selection of interpretations from material which, as we know, is always overdetermined.

xi)     The analyst’s countertransference is not only part and parcel of the analytic relationship, but it is the patent’s creation; it is part of the patient’s personality.

xii)   The character of the countertransference corresponds to the nature of patient’s unconscious impulses and defences operative at the actual time.

 

3)      Heinrich Racker’s “The Meaning and Uses of Countertransference” (1957)

a)       Overview

i)        Heinrich Racker was born in Poland and trained in Vienna before fleeing the Nazis by moving to Argentina.

ii)       When this article was published in an American journal, The Psychoanalytic Quarterly in 1957, it was influential in introducing the American analytic audience to the widening scope of transference and countertransference.

iii)     Racker added his voice to those who argued for normalizing the functions of countertransference through examination of the identifications and reactions of the therapist.

iv)     Racker suggested new terms to signify that responses can either be in identification with the patient’s self – concordant identification or in identification with the patient’s objects – complementary identification.  

v)       These concepts have increased therapist’s capacity to specify their countertransference responses, thereby increasing understanding and improving their ability to formulate interpretations.

b)      Contents

i)        Relation between transference and countertransference

(1)    The fact that countertransference conflicts determines the deficiencies in the analysis of transference becomes clear if we recall that transference is the expression of the internal object relations; for understanding of transference will depend on the analyst’s capacity to identify himself both with the analysand’s impulses and defenses, and with his internal objects, and to be conscious of these identifications.

(2)    This ability in the analyst in turn depend upon the degree to which he accepts his countertransference, or his countertransference is likewise based on identification with the patient’s id and ego and his internal objects.

(3)    One might also say that transference is the expression of patient’s relations with the fantasied and real countertransference of the analyst. For just as countertransference is the psychological response to the analysand’s imaginary and real transference, so also is the transference the response to the analyst’s imaginary and real countertransferences.

(4)    Analysis of the patient’s fantasies about countertransference, which in the widest sense constitute the causes and consequences of the transferences, is an essential part of the analysis of the transferences.

(5)    Perception of the patient’s fantasies regarding countertransferences will depend in turn upon the degree to which the analyst himself perceives his countertransference processes – on the continuity and depth of his conscious contact of himself.

ii)       Two kinds of identification

(1)    The concordant identification is based on introjection and projection, or, in other terms, on the resonance of the exterior in the interior, on recognition of what belongs to another as one’s own (“this part of you is I”) and on the equation of what is one’s own with what belongs to another (“this part of me is you”).

(2)    The complementary identifications are produced by the fact that the patient treats the analyst as an internal (projected) object, and in consequence the analyst feels treated as such; that is, he identifies himself with this object.

(3)    The complementary identifications are closely connected with the destiny of the concordant identifications: it seems that to the degree to which the analyst fails in the concordant identifications and rejects them, certain complementary identifications become intensified.

(4)    It is clear that rejection of a part or tendency in the analyst himself – his aggressiveness, for instance – may lead to a rejection of the patient’s aggressiveness (whereby this concordant identification fails) and that such a situation leads to a greater complementary identification with the patient’s rejecting object, toward which this aggressive impulse is directed.

 

4)      Joseph Sandler’s “Countertransference and Role-Responsiveness” (1976)

a)       Overview

i)        Sandler has an analytic background as, and a member of, the Freudian group of the British Psychoanalytic Society (now called the Contemporary Freudian Group), but he has maintained a role throughout his career as a broadly informed integrator of thought from all perspectives.

ii)       In this paper, he expanded the definition of countertransference to include not only the feeling responses of the analyst, but the analyst’s unconsciously motivated enactments as well.

iii)     He suggested that the analyst’s role should include an attitude of free-floating responsiveness to the patient’s unconscious initiatives, which is a counterpart of Freud’s prescription of free-floating attention.

iv)     In this way, Sandler suggested, therapists are open to an actualization of roles, which should no longer considered to be simply a matter of the analyst’s acting out but a vehicle that informs the therapist about the way the patients influence others, now from inside a shared experience.

v)       The experience of actualization can therefore open the way to specific interpretations about object relations in current and past life.

vi)     This paper had broad influence. In its wake, Spillius notes that, “it is most useful to think of projective identification as the patient’s phantasy, and to distinguish that phantasy from the patient’s attempts to ‘actualize’ it by evoking appropriate responses in the analyst, which the analyst’s role-responsiveness allows to occur, and which the analyst can use to understand his own responses and the patient’s phantasy and evocations” (personal communication).

b)      Additional Overview (Projective Identification 2011)

i)        Joseph Sandler was originally from South Africa and came to Britain when quite young where he became a member of the Contemporary Freudian ‘group’ of British analysts.

ii)       He also was interested in Kleinian ideas, especially projective identification.

iii)     Many Kleinians have adopted Sandler’s ideas about ‘actualization’ of unconscious phantasies and beliefs, an important aspect of projective identification.

c)       Contents

i)        By free floating attention I do not mean “clearing of the mind” of thought or memories, but the capacity to allow all sorts of thoughts, daydreams, and associations to enter the analyst’s consciousness while he is at the same time listening to observing the patient.

ii)       I have mentioned the interaction between the patient and the analyst, and this is in large part (though, of course, not wholly) determined by what I shall refer to as the intrapsychic role relationship which each party tries to impose on the other.

iii)     What I want to emphasize is that the role relationship of the patient in analysis at any particular time consists of a role in which he casts himself, and a complementary role in which he casts the analyst at that particular time.

iv)     The patient’s transference would thus represent an attempt by him to impose an interaction, an interrelationship(in the broadest sense of the word) between himself and the analyst.

v)       The patient’s unconscious wishes and mechanisms are expressed intrapsychically in (descriptively) unconscious images or fantasies, in which both self and object in interaction have come to be represented in particular role.

vi)     In a sense the patient, in the transference, attempts to actualize these in a disguised way, within the framework and limits of the analytic situation.

vii)   Parallel to the free-floating attention of the analyst is what is should like to call his free-floating responsiveness.

viii)  My contention is that in the analyst’s overt reactions to the patient as well as his thoughts and feelings what can be called his role-responsiveness shows itself, not only in his feelings but also in his attitudes and behavior, as a crucial element of his “useful” countertransference.

ix)     I am absolutely opposed to the idea that all countertransference responses are due to what the patient has imposed on him.

x)       I have suggested that the analyst has, within certain limits, a flee-floating behavioral responsiveness in addition to his free-floating conscious attention.

 

5)      Betty Joseph’s “Transference: The Total Situation” (1985)

a)       Overview

i)        Betty Joseph was among those students of Klein who exerted an early influence on understanding of pathological organization, but her principal contribution has been to technique.

ii)       No one brings a more astute sensibility than she to the study of transference and countertransference, in her study of here and now of the consulting room situation, the moment-to-moment shifts in atmosphere, intent, and content which flesh out Klein’s meaning of “transference as the total situation.”

iii)     Joseph believes that close attention to these matters is more important in facilitating psychic change than any other single factor.

iv)     Joseph is following an early lead of Klein’s to make the intricacies of the relationship the primary focus of analytic study, outlined in Klein’s 1952 paper “The Origins of Transference.”

v)       In the process of her study, Joseph defines the field of the relationship between patient and therapist as the operational heart of therapy and the chief agent of change.

vi)     Spillius believes that Joseph led the Kleinians to more caution about couching their interpretations in anatomical part-object terms, and spelled out the importance of what patient does in contrast to the content of what he says (personal communication).

vii)   This contrast is the starting point for understanding the way that early in their lives and again in the analytic situation patients attempt to control their unconscious expectations.

viii)  Joseph’s contribution complements Sandler’s role actualization, focusing on the patient’s enactments within sessions (Spillius 194).

ix)     She is operationally close to the more general dictum of Fairbairn and Guntrip that it is the therapeutic relationship itself which is the chief agent of change and growth.   

b)      Additional Overview (The New Dictionary of Kleinian Thought 2011)

i)        It was not until the 1970s that she began to find her own distinctive voice, and began the development of her own ideas on technique and on psychic change that have been so influential.

ii)       Joseph’s work is based on the belief that real psychic change is brought about through interpretive work based on what the patient experiences in the session, in his or her interaction with the analyst, rather than explanatory formulations or historical reconstructions.

iii)     Joseph assumes that one of the important ways, of course, in which the analyst is alerted to what is going on in the transference is through the analyst’s countertransference. She suggests paying close attention to what is actually being experienced by the analyst, the way he or she is being nudged, unconsciously manipulated, provoked, etc. into some kind of enactment that the patient requires and from which he may also derive gratification.

iv)     Joseph’s stress on working with what is going on in the present, in the consulting room, has led her to feel that patient’s history is always present and always part of the work, but, like Bion, she believes the analytic work is most effective when the history is generally somewhere at the back of the analyst’s mind rather than when it is being used to organise the material.

v)       She emphasizes the difference between starting from the present and rediscovering the history, and starting from history and basing one’s understanding on the analyst’s view of the history.  

c)       Contents

i)        Melanie Klein wrote:  “It is my experience that in unraveling the details of the transference it is essential to think in terms of total situations transferred from the past into the present as well as the emotion defences and object relations.” (The Origins of Transference 1952)

ii)       Much of our understanding of the transference comes through our understanding of how our patients act on us feel things for many varied reasons.

iii)     I am concerned on what is being lived in the transference and I tried to show how interpretations are rarely heard purely as interpretations, except when patient is near to the depressive position.

iv)     Then interpretations and the transference itself becomes more realistic and less loaded with fantasy meaning.

v)       Patients  operating with more primitive defences of splitting and projective identification tend to “hear” our interpretations or “use” them differently and how to “use” or “hear” and the difference between these two concepts needs to be distinguished if we are to clarify the transference situation and the state of the patent’s ego and the correctness or not of his perceptions.

vi)     Sometimes our patients hear our interpretations in a more paranoid way, for example, as a criticism or as an attack.

vii)   Sometimes the situation similar, the patient seems disturbed by an interpretation, but has, in fact, heard it, understood it, correctly, but unconsciously used it in an active way, thus involving the analyst.

viii)  Conclusion

(1)    I have stressed the importance of seeing transference as a living relationship in which there is constant movement and change.

(2)    I have indicated how everything of importance in the patient’s psychic organization based on his early and habitual ways of functioning, his fantasies, impulses, defences and conflicts, will be lived out in the transference.

(3)    In addition, everything that the analyst is or says is likely to be responded to according to the patient’s own psychic makeup, rather than the analyst’s intentions and the meaning he gives to his interpretations.

(4)    I have tried to discuss how the way in which our patients communicate their problems with us is frequently beyond our individual associations and beyond their words, and can often only be gauged by means of countertransference.

(5)    These are some of the points that I think we need to consider under the rubric of the total situations which are transferred from the past.


 
 
 
 
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