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 and 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

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.

It is a measure of the treacherousness of the ground on which discussions of transference are held that Gill can simultaneously believe in a “real situation” and not believe in an “absolute external reality.” But more to the point, perhaps, is the inescapable impression of Gill’s own stern absolutism regarding proper and improper analytic conduct which one receives from a reading of the annotated transcripts of Volume II. Gill has divided the five analysts into two groups—those who have been schooled in his theories and techniques and those who have not—and he begins the book with four sessions conducted by the unindoctrinated analysts. The first session, dramatically, is one in which the analyst never utters a single word. As the patient wanders from subject to subject like a Scheherazade desperately searching for a story that will entertain her dangerously restive interlocutor, Gill and Hoffman, like annotators of a wretchedly played chess game, interject their disapproval of the analyst’s unrelenting silence—which they see as the real subject of the patient’s discourse.

The silent session offers the ad absurdum example of what Gill calls “enactment of the transference,” whereby analysts unwittingly lapse into the very behavior that patients “imagine” of them. When the patient tells the silent analyst a story about how she took a sick cat to the ASPCA, where it died because “they fooled around for a few days” instead of operating immediately, she is (according to the annotators) alluding to her fear that she herself has fallen into the hands of a negligent practitioner who “fools around,” saying nothing instead of decisively intervening with interpretations. And by remaining silent in the face of the patient’s persistent efforts to move him to speech, the analyst at least partially corroborates the patient’s fantasy of mistreatment. For by letting all opportunities go by for a transference interpretation—for allowing the patient to equate silence with malpractice—he is in fact falling down on his job as analyst.

In a session with another benighted practitioner, a patient becomes angry when the analyst brings up, obviously not for the first time, the subject of her penis envy. “You know, I’m getting sick of this,” she says emotionally, adding, “I’m thinking of knocking all the books off the wall again.” The transcript continues:

ANALYST: What about knocking all the books off there?

PATIENT: It’s, I’m getting mad. I’m lying here getting mad and I’m afraid to move because I’m mad. I mean, what it seems like—and I know it’s worked—but what it seems like is that you’re always, no matter what I say, you’re always bringing it back to this, you know—my thing about something being wrong with me. And then we just get to that, and then nothing fucking happens. We just end up saying, “Well, you think there’s something wrong with you.” So big fucking deal. What about it? You know, when are we going to get away from the illness and onto the cure?

ANALYST: I take the idea about knocking all the books off the wall as if you wanted to knock my penis off.

Gill and Hoffman hasten to register their outrage at this “almost unbelievably pat interpretation.” They go on to say, “Instead of finding out what she means by wanting to knock down his books, the analyst uses what she has said to reiterate his fixed conviction, which—however correct it may be—she had just characterized as unhelpful. It is far more likely that her conscious experience is that he is repeating a formula from his books and that that is why she wants to knock them down.” The dialogue goes on:

P: You do?

A: Yes, I do.

P: [laugh]

A: That your reaction to my saying it is to want to do that.

P: Is to want to be [inaudible]—what?

A: Is to want to do that.

P: Well, if that’s what getting mad is.

A: It wasn’t just getting mad. It was also knocking all the books off the wall.

P: But why, but why are books a penis now? [sigh] Huh? Yeah, I think I always thought they were. That’s why I read so much. I’m serious and I’m saying it sarcastically, but think back about trying to be smart.

A: Yeah, I know.

P: [inaudible]—OK. Well, I’m admitting it ruefully, but I’m admitting it pissed-offedly. [inaudible] If I can’t have one, you can’t have one either? And if you won’t give me one, then you can’t have yours. But it’s still the same question. And it’s still the same feeling.

At the end of the session, which has continued in the above vein, the annotators write:

Whatever the truth about the role of penis envy in her neurosis, it cannot be gotten at usefully by eliding the transference. The patient experiences the relationship as one in which a tyrannical male forces his will on her without any genuine understanding of what she is feeling. She is left in part submissive and in part raging and distrustful. The analyst fails to see…how his behavior only reinforces how the patient experiences him, and probably strengthens her convictions about what men in general are like. The neurosis has been enacted, not analyzed.

When Gill and Hoffman turn to the work of the “good” analysts—those who are “consciously attempting to employ our point of view”—they find them, astonishingly enough, screwing up just as badly as, and sometimes even worse than, the “bad” analysts. It is immensely to Gill’s credit (in fact, it authoritatively removes his book from the category of polemic and raises it to the status of a work of true research) that he has permitted the chips to fall where they may, at whatever cost to his thesis. He and Hoffman are just as hard on the new-school analysts when they lapse as they were on the old-school ones. When a new-school analyst says to a patient, “I can understand that you essentially experience me as putting you down, so, presumably, you must feel I have a purpose in doing that,” they sternly point out that the analyst is indeed putting the patient down: “That he says you ‘essentially experience me’ suggests, again, a hyperbole—that there is no basis for the patient’s feeling. This disguise of an attack as empathy makes it all the more difficult for the patient to assert his anger.” In another session, the analyst asks the patient, “What did I do last week that gave you the feeling that I’m not strong enough? My tiredness, perhaps, or other things?” The patient replies, “Maybe your tiredness….” When the analyst interpolates, “That is to say, what you thought was tiredness,” the annotators disgustedly comment, “As has happened repeatedly in the hour, a promising start in exploring the patient’s perceptions of the analyst is followed by an abrupt, defensive, and gratuitous emphasis on the subjectivity of the patient’s impressions.”

As Gill and Hoffman hold up example after example of “enactment of the transference” (which increasingly sounds like their euphemism for bullying), one begins to wonder whether Gill’s active technique isn’t itself at fault—whether it doesn’t invite the very abuses it is designed to protect the patient against. Is not the persistent minute examination of what is going on between patient and analyst that Gill recommends a kind of trap? Isn’t the analyst—once he starts squabbling with the patient about whether it was really two o’clock or two-fifteen—lost? In his paper “On Beginning the Treatment: Further Recommendations on the Technique of Psycho-Analysis (I),” Freud advises analysts not to behave like “the other member of a married couple.” The following exchange, which is typical of the dialogue of the last five “good” sessions, illustrates (among other things) the wisdom of Freud’s advice:

A: I was late three times?

P: Mmm-hmm. According to the clock in the hall. You weren’t today.

A: Which clock—downstairs?

P: No. This one.

A: That one? Oh…

P: That—but I don’t think that’s a big thing. The first two days, as I said, I was relieved because I was late myself, so… [pause]

A: You don’t think it’s a big thing, but it sounds like you noticed it and added them up.

P: I noticed it. Yes.

A: Yes.

P: I guess that’s because it’s become pretty—you know, it’s become an issue for me to get here on time so I do watch the clock pretty, pretty closely.

A: Well, when you said three days in a row…

P: Mmm-hmm.

A: …I thought you meant I was late two minutes.

P: You—that’s right, but I mean, I’m watching the clock so I’m sensitive…

A: How did you know I was, if you were late? I’m not clear.

P: Because I got here and it was two minutes after…

A: Oh, you got here and I still…

P: And you hadn’t opened your door.

A: Oh. [pause] You mentioned. it only one time, is that right?

P: Mmm-hmm.

A: Why did you not tell me the other times?

P: Because I didn’t think it was worth mentioning.

A: Why not?

P: Because…

A: You noticed it.

P: That’s right. But, I mean, I notice a lot of things and…

A: You attributed some important significance to it.

P: I don’t think I did.

A: Oh, you don’t think so. You think, maybe retrospectively, these things started to pile up, is that it?

P: Yes.

A: I see. [pause] And what, then, did they mean—I’m losing interest in you, or what?

P: You didn’t want to see me.

A: I didn’t want to see you because…

P: ‘Cause it’s going to be such a struggle.

One question naturally arises: How representative of the profession at large are the analysts in Gill’s book? If they are merely exceptionally inept, then the transcripts are merely illustrations of poor analysis rather than documentation of common problems and pitfalls of analysts and of the relative merits of the orthodox and new techniques. Much depends on the answer, but unfortunately the answer is not forthcoming, because the majority of analysts refuse to taperecord their work, and so there is no material to which the Gill transcripts can be compared. It would be nice to think that there are wiser and larger-souled people doing analysis than those in Gill’s book, but until they identify themselves and produce examples of their work, Gill’s analysts will have to be accepted as not uncharacteristic and their work as standard. Certainly the self-congratulatory clinical histories in the analytic literature cannot be accepted as evidence of anything beyond the writers’ self-regard.

If Gill’s new technique leaves intact the Gordian knot of the unplayability of the analytic role—as we have seen, it seems simply to allow analysts more scope for petty tyranny than did the old technique—its effect on the associations of patients is momentous. “Associations,” indeed, is hardly the term for the few words the patient manages to get in edgewise before the new-school analyst engages him in interminable discussion of the “here and now” of the analysis. Gill’s dislike of analytic silence—“sustained silence is a very powerful stimulus, the effect of which will, by definition, pass uninterpreted and probably unrecognized as long as the analyst refrains from speaking”—has had the paradoxical but predictable result of muffling almost to inaudibility the voice of the unconscious. In fact, it is only from the early “bad” sessions that one can gain any sense whatever that psychoanalysis is the study of unconscious rather than of conscious mental life. Gill’s idea—that in order to determine what is irrational and past-ridden in the patient’s attitude toward the analyst one must first be clear about the inevitable “real” contribution of the analyst to this attitude—is commendably logical, admirably fair-minded, but utterly unpsychoanalytic. The business of analysis is to acquaint the patient with the parts of himself he is least eager to know and has hidden most cleverly from himself. Gill’s obsessive examination of the actuality of the analysis—of the rights and wrongs of the patient’s beliefs and feelings about the analyst—effectively prevents this business from ever going forward. “The patient does not remember anything of what he has forgotten and repressed, but acts it out,” Freud wrote in his paper “Remembering, Repeating, and Working-Through,” adding:

He reproduces it not as a memory but as an action; he repeats it, without, of course, knowing that he is repeating it. For instance, the patient does not say that he remembers that he used to be defiant and critical towards his parents’ authority; instead, he behaves in that way to the doctor….

In the Gill version of analysis, the memory that is being reproduced as an action is never pursued to its source. The analysis remains frozen in the present. The session ends, and analyst and patient are still squabbling about whether it was three-fifteen or three-twenty last Wednesday. Gill’s valiant attempt to solve the conundrum of the analyst–patient relationship—to cut through what Philip Rieff has called “the profound and true absurdity of psychoanalysis”—has led to the even greater absurdity of analysis whose hidden agenda is to corroborate the patient in his conscious perceptions of the analyst.

The analyst who told the patient, “I take the idea about knocking all the books off the wall as if you wanted to knock my penis off” may be the tyrannical prig the annotators say he is, but he could also be a perfectly workmanlike analyst who—following Freud’s directive to listen with “closely hovering attention” in order to “put himself in a position to make use of everything he is told for the purposes of interpretation and of recognizing the concealed unconscious material”—had “heard” the patient’s unconscious message and reported it accurately. While the literal meaning of the interpretation is outlandish, there is plenty of support, not only in psychoanalytic case material but in mythology, anthropology, art, and literature for the theory that a woman’s unconscious life is beset by a profound sense of powerlessness, a gnawing dissatisfaction—a feeling for which the term “penis envy” is thoroughly inadequate, not to say extremely irritating to women.

In reading the transcript of the session with the angry patient, one cannot but recall the famous last section of Freud’s “Analysis Terminable and Interminable,” in which he holds up what he sees as the two most troublesome complaints of patients (“in the female, an envy for the penis—a positive striving to possess a male genital—and in the male, a struggle against his passive or feminine attitude to another male”) and confesses his pessimism about the power of analysis to cure them:

We often have the impression that with the wish for a penis and the masculine protest we have penetrated through all the psychological strata and have reached bedrock, and that thus our activities are at an end.

In Gill’s optimistic belief that the feeling of defeat and hopelessness on the part of the angry patient derives from the way her analyst is treating her—and that if only he behaved better she would feel better about herself—he is leaving psychoanalytic theory far behind. This is surely not what he intends to do. His critique in Volume I of contemporary clinical theory and practice is offered in a spirit of deference and constructiveness. He is proposing to restore and modernize the sagging and peeling mansion of psychoanalysis, not to demolish it and put up a skyscraper. But the “improvements” of Volume II only show how delicately poised the whole thing is, and how easy it is to bring it crashing down with a few large, ill-considered movements.


Talking to the Analyst: An Exchange February 28, 1985