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The Patient Is Always Right

Analysis of Transference, Vol. I: Theory and Technique

by Merton M. Gill
International Universities Press, 193 pp., $22.50

Analysis of Transference, Vol. II: Studies of Nine Audio-Recorded Psychoanalytic Sessions

by Merton M. Gill, by Irwin Z. Hoffman
International Universities Press, 236 pp., $22.50

Does psychoanalysis remain a dialectical relation in which the non-action of the analyst guides the subject’s discourse towards the realization of his truth, or is it to be reduced to a phantasmatic relation in which ‘two abysses brush against each other’ without touching, while the whole gamut of imaginary regressions is exhausted—like a sort of ‘bundling’ pushed to its extreme limits as a psychological experience?”

Jacques Lacan, “The Function and Field of Speech and Language in
Psychoanalysis

Freud stumbled on the concept of transference while desperately casting about for an antidote to the epidemic of latrogenic lovesickness that had spread through his practice in the 1890s. When, one by one, all of his women patients stopped doing the work of free association that they had at first enthusiastically taken up and began shyly and then importunely to declare their love for him, he shrewdly surmised that it was not “the charms of my person” that were the cause of the disturbance but, rather, that the women were in a state of readiness to fall in love, and he was simply Bottom to their Titania.

Freud’s clearsightedness about the profound impersonality of romantic passion was not an original insight—it is one that poets have long been privy to. Where Freud’s genius came into play was in his extension of the metaphor of unseeing, solipsistic passion to the whole of human interaction. It began to dawn on Freud that it is not only love that is blind—all our feelings toward and ideas about one another are marked by a magnificent obliviousness to reality. Like the chains of the prisoners in Plato’s cave, which prevented them from turning their heads to distinguish shadow from substance, the shackles of transference keep us in a state of perpetual misprision. Freud’s modest program of fending off his importunate patients with some sort of tactful and professional-sounding formula—“We overcome 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 he is repeating something that happened to him earlier,” Freud wrote in the Introductory Lectures of 1917—flowered into a powerful and subtle theory of personal relations, which soon became the center of analytic therapy.

According to the theory, we spend our lives playing out the same internal drama—that of our earliest parental and sibling relationships—indiscriminately casting the people we meet in the leading roles and doing our own rote performance of the part of the child, like an actor in a play with a very long run who years ago outgrew his part but whom nobody has thought to replace. Analysis proposes to show the patient (whose reason for seeking help is inevitably bound up with problems in his personal relations) that he doesn’t have to play this part anymore—that other parts are available to him now that he is an adult.

The success of the demonstration is thought to depend on how well the analyst plays his role, which was specially written for the drama of the analytic encounter and has no model in life outside analysis. It partakes of some of the qualities of oracles, lawyers, and hairdressers—the detachment of the first, the acuity of the second, and the intimacy of the third—but has a character (of one could say characterlessness) all its own. In the analysis, as the patient trots out his stale play and absently casts the analyst in the usual parental and sibling roles, the analyst does not react in the way that people in normal life react—which is to trot out their own stale plays—but in a manner the patient has never before encountered. The analyst does not respond in kind to anything the patient says or does; he does not reveal his feelings; he does not talk about anything the patient hasn’t brought up first; he never interrupts the patient; he never argues with him; he never defends himself; he doesn’t want anything from the patient; he talks very little. He is so utterly unlike anyone the patient has ever met—his behavior is so manifestly bizarre—that the patient is ultimately forced to acknowledge that he has made a mistake in thinking about and acting toward the analyst as he would toward a normal person, with the feelings, desires, and flaws that normal people have. As the patient examines his thoughts about and behavior toward the analyst in the light of the actuality of the analyst’s conduct and sees how far off the mark they are, he is compelled to consider the possibility that his thoughts about and behavior toward people outside the analysis are similarly skewed. The analyst’s performance of his role of nonperson is known as analytic technique.

The performance is extremely hard to sustain. The analyst, being a member of a culture that values sympathy, warmth, compassion, kindliness, spontaneity, and sincerity, can never be comfortable playing a part from which these qualities are conspicuously absent, and he is constantly tempted to temporize, to admit some culturally approved behavior into his performance, to let some evidence of his niceness come through to the patient. At the same time—being a member of a species locked in perpetual internal combat between the lofty ideals of society and the pitiful realities of human nature—he is in constant danger of unwittingly wandering off analytic course in the opposite direction—that of cruelty, meanness, vengefulness, envy, spite, and petty tyranny. (Analysts use the term “counter-transference” to refer to—and help forgive themselves for—lapses of either sort.)

A further difficulty in the way of the analytic performance is the ever lengthening duration of analysis. When Freud wrote his papers on technique (between 1911 and 1915), analysis lasted from a few weeks to a year; today, analysis lasts an average of ten years. Freud’s hard-edged metaphors for the analyst—in the technical papers, he described him as a surgeon, a soldier, and a mirror—are plausible enough for a short course of treatment, but seem strained for a lengthy analysis: an operation, a battle, and a look in the mirror can go on only so long. “Our patients become gradually better analyzed than we are,” Sandor Ferenczi wryly noted in 1933. Like children who hang around the house too much and become morbidly attuned to the moods and quirks of their parents, long-term analytic patients get to know their analyst so well that his protestations that there is nothing there for them to know become increasingly hollow.

Throughout the history of psychoanalysis there have been analysts—starting with Ferenczi—who have openly scoffed at the idea that a man can ever abjure his humanity, and who have repudiated the ideal of analytic neutrality not only as impossible but as full of hubris. The analysts belonging to this humanistic tradition have disavowed Freud’s harsh metaphors and have tinkered with the analyst’s role to make it less Wizard of Oz-like and more avuncular. They have argued that the analysts who erect a wall of silence and unresponsiveness between themselves and their patients are being not neutral but simply unpleasant, and that the patient’s reaction to such behavior is not transference but realistic outrage. This school is marked by a spirit of moral reform and has some of the character of a patients’-lib movement. Its members would like to sweep analysis clean of the hypocrisy that they believe pervades it and free patients from the “cold” and “rigid” analysts of the authoritarian old school, who keep them in a condition of cowed resentment like that of Butler’s Ernest Pontifex. Some brilliant and rigorous writing has been produced by this school (Ferenczi and Leo Stone are two of its literary ornaments), and so has some very poor and lax writing, by authors who are under the impression that the constant use of the word “empathy” absolves them from any obligation to think. A recent contribution to the genre, Merton Gill’s two-volume Analysis of Transference, scarcely suffers from lack of thought, and firmly belongs among its most distinguished productions.

The book, indeed, is so far from being simple-minded—is so alive to the maddening complexity of the subject and pursues such high epistemological goals—that it suffers the fate of all obsessively honest intellectual works: it is riddled with contradiction. It reflects the dilemma of a moralist who is trying to remain a Freudian analyst. Gill’s sympathies are clearly with the patient who is being covertly bullied by an authoritarian analyst, but he is equally concerned with the predicament of a profession that is always perilously on the edge of losing its privileged status as a science (of sorts) and becoming just another feel-good therapy. In Volume I of Analysis of Transference, Gill attempts to build a theoretical framework for doing analysis in a more conversational and fraternal way than orthodoxy would allow; and in Volume II (prepared with the collaboration of Irwin Z. Hoffman, a candidate at the Chicago Institute of Psychoanalysis), he illustrates both the old and the new techniques by transcribing sessions with nine different patients, tape-recorded by five different analysts.

In Volume I, Gill argues that old-school analysts do not, on the one hand, pursue transference vigorously enough and are not alert enough to the subtle references to themselves that the patient constantly makes while appearing to be talking about other matters; and, on the other, do not take sufficient account of the influence of their own behavior on the patient’s perceptions of them. “It is the analyst’s task constantly to tear the patient out of his menacing illusion and show him again and again that what he takes to be new life is a reflection of the past,” Freud wrote in 1938 in The Outline of Psychoanalysis, maintaining to the end his idea of transference interpretation as a report from outside the cave. Gill absolutely denies the traditional concept of transference as a kind of delusion. He repudiates Freud’s Platonism and maintains that there is always some truth to the patient’s perceptions, because the analyst is always doing something on which these perceptions must be based. Even when (or as Gill would argue, especially when) the analyst remains silent, he is acting on the patient in a way that will influence his feelings and ideas about the analyst. There is no way, Gill argues, that the analyst’s behavior can be eliminated from the equation. “The realistic situation cannot be made to disappear,” he writes, and adds, “The analytic situation is real.”

Gill accordingly recommends that analytic technique be emended so as to embrace the “new life” that is the actuality of analysis, and he counsels analysts to let no opportunity go by for discussing the effect that their behavior is having on their patients. In denying that transference is a distortion of reality, he writes,

A more accurate formulation than “distortion” is that the real situation is subject to interpretations other than the one the patient has reached. The analyst suggests that the patient’s conclusions are not unequivocally determined by the real situation. Indeed, seeing the issue in this way rather than as a “distortion” helps prevent the error of assuming some absolute external reality of which the “true” knowledge must be gained.

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