A New Multi-Dialectic, Cross-School Understanding of Transference: A Tribute to The 100th Year Anniversary of Freud's Classic Essay, 'The Dynamics of Transference (1912), and The 130th Year Anniversary of The End of Joseph Breuer's Therapeutic Relationship With Anna. O. (1882)

The history of the concept of transference -- arguably Freud's most important concept in his lifelong professional career (although Freud at one point argued that 'repression' was his most important concept and the foundation of psychoanalysis) -- goes back formally to 1895 (Studies on Hysteria, S.E. Vol. 2, p. 302) when Freud first technically introduced the concept, but looking back in hindsight, 'the psycho-dynamics of transference' can be traced back to what is generally considered the first case in psychoanalysis -- The 'Anna O. case', and Joseph Breuer's interaction with this first psychoanalytic patient.

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From Wikipedia....

Anna O. was the pseudonym of a patient of Josef Breuer, who published her case study in his book Studies on Hysteria, written in collaboration with Sigmund Freud. Her real name wasBertha Pappenheim (1859–1936), an Austrian-Jewish feminist and the founder of the Jüdischer Frauenbund (League of Jewish Women).

Anna O. was treated by Breuer for severe cough, paralysis of the extremities on the right side of her body, and disturbances of vision, hearing, and speech, as well as hallucination and loss of consciousness. She was diagnosed with hysteria. Freud implies that her illness was a result of the resentment felt over her father's real and physical illness that later led to his death.^[1]

Her treatment is regarded as marking the beginning of psychoanalysis. Breuer observed that whilst she experienced 'absences' (a change of personality accompanied by confusion), she would mutter words or phrases to herself. In inducing her to a state of hypnosis, Breuer found that these words were "profoundly melancholy fantasies...sometimes characterized by poetic beauty".Free Association came into being after Anna/Bertha decided (with Breuer's input) to end her hypnosis sessions and merely talk to Breuer, saying anything that came into her mind. She called this method of communication "chimney sweeping", and this served as the beginning of free association.

Anna's/Bertha's case also shed light for the first time on the phenomenon called transference, where the patient's feelings toward a significant figure in his/her life are redirected onto the therapist. By transference, Anna imagined she was pregnant with the doctor's baby. She experienced nausea and all the pregnancy symptoms. After this incident, Breuer stopped treating her.

Historical records since showed that when Breuer stopped treating Anna O. she was not becoming better but progressively worse.^[2]She was ultimately institutionalized: "Breuer told Freud that she was deranged; he hoped she would die to end her suffering".^[3]

She later recovered over time and led a productive life. The West German government issued a postage stamp in honour of her contributions to the field of social work.^[4]

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From The Anna O. case, and other cases like it, with similar psycho-dynamics and therapeutic dynamics entering into the 'pyschotherapeutic/psycho-analytic' relationship, Freud drew up the following theoretical conclusions which, in my opinion, make up the essence of the most important conclusions that Freud ever committed to paper relative to the art and paradigm of psychoanalysis ...In short, and in my words, 'transference' enters into the psychotherapeutic relationship from the client's very first interactions with the therapist although 'crystallizing' into a coherent 'style of encounter' and 'style of relationship' that usually carries a greater or lesser degree of 'perceptual-interpretive-evaluative distortion and mis-evaluation' -- a 'false connection' in Freud's own words back in 1895 -- based on 'the historical etiology (cause, influence) of that part of the client's current 'neurosis' that is rooted in the person's usually early childhood past entering into the present, here-and-now immediacy of the therapeutic relationship -- past and present, in effect, 'conflating' into one 'style of the client interacting with the therapist'  ... In Freud's own words, in what I will repeat here as a long quote....

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From 'Studies on Hysteria', 1895, S.E. Vol. 2, p. 301....

I have already (p. 266) indicated the important part played by the figure of the physician in creating motives to defeat the psychical force of resistance. In not a few cases, especially with women and where it is a question of elucidating erotic trains of thought, the patient's co-operation becomes a personal sacrifice, which must be compensated by some substitute for love. The trouble taken by the physician and his friendliness have to suffice for such a substitute. If, now, this relation of the patient to the physician is disturbed, her co-operativeness fails, too; when the physician tries to investigate the next pathological idea, the patient is held up by an intervening consciousness of the complaints against the physician that have been accumulating in her. In my experience this obstacle arises in three principal cases.

(1)  If there is a personal estrangement -- if, for instance, the patient feels she has been neglected, has been  too little appreciated or has been insulted, or if she has heard unfavourable comments on the physician or the method of treatment. This is the least serious case. The obstacle can easily be overcome by discussion and explanation, even though the sensitiveness and suspiciousness of hysterical patients may occasionally attain surprising dimensions.

(2)  If the patient is seized by a dread of becoming too much accustomed to the patient personally, or losing her independence in relation to him, and even of perhaps becoming sexually dependent on him. This is a more important case, because its determinants are less individual. The cause of this obstacle lies in the special solicitude inherent in the treatment. The patient then has a new motive for resistance, which is manifested not only in relation to some particular reminiscence but at every attempt at treatment. It is quite common for the patient to complain of a headache when we start on the pressure procedure; for her new motive for resistance remains as a rule unconscious and is expressed by the production of a new hysterical symptom. The headache indicates her dislike of allowing herself to be influenced. 

(3)  If the patient is frightened at finding that she is transferring onto the figure of the physician the distressing ideas which arise from the contents of the analysis. This is a frequent, and indeed in some analyses a regular, occurrence. Transference (this is Freud's first use of the label and concept of transference in the history of psychoanalysis as noted by the main editor of The Standard Edition of Freud's Complete Works, James Strachey) on to the physician takes place through a false connection. (Strachey notes in this last regard that a long account of 'false connections' and 'the compulsion to associate' -- later to be followed by 'the compulsion to repeat' -- will be found above in a footnote on p. 67 -- Freud had already discussed them in relation to obsessions at the beginning of Section 2 of his first paper on 'The Neuro-Psychoses of Defense', 1894). I must give an example of this. In one of my patients the origin of a particular hysterical symptom lay in a wish (my editorial note: this last line here by Freud has huge historical significance: 1895 can be viewed as the year of the beginning of Freud's greatest psychoanalytic theoretical mistake -- his switchover from his previous 'traumacy-memory' theory to his just emerging (as you can note in this last line above) to 'wish' or 'fantasy' theory -- the mistake was not in his developing his emerging 'wish-fantasy theory' but rather in his 'mutually exclusive, either/or' approach to this apparent conflict between 'traumatic memories' and 'wishful fantasies' which left his 'traumatic memory theory' more or less dead in the water. What Freud didn't see -- but should have -- was the 'dialectical interaction' between 'memories' and 'fantasies' that often created a new brand of 'neurotic' symptoms that might be construed as 'conflations' or 'mixtures' of 'memory and fantasy woven together'. Far from being mutually exclusive, Freud's pre-1895 'traumatic memory theory' and his just emerging here 'wishful fantasy theory' can usually be viewed as two inherent and interacting parts of the same 'neurotic transference complex'.  For one reason or another -- perhaps because of Freud's background training in science and Aristolean 'either/or' thinking -- Freud could get  no sense of the Hegelian idea of 'dialectic interaction between thesis and anti-thesis resulting in 'the synthesis of a dialectically interactive-integrative 'memory-fantasy compulsion' that is the essence of any and all neurotic transference obsessive-compulsions. The 'memory-traumacy' or, worded otherwise, 'the narcissistic injury' associated with the original 'traumacy-transference memory fixation' would be propelled forwards -- or worded otherwise, be 'the traumatic-transference propulsion force' that would dialectically connect our traumatic-narcissistically injured past with our present and future, and with the psycho-dynamic 'wish' of 'reversing the essence and history of our traumacy-transference neurotic complex'  in a more favorable direction with a more narcissistically favourable version of the 'encounter ending' to the original traumacy-transference neurosis.  In the combined words of Alfred Adler, Karen Horney, and Eric Berne -- conflated together -- this 'more narcissisitically favourable punch line or ending' to the original ending of the original traumatic encounter-memory with its 'perceived self-esteem demeaning punch line in the original script' can be viewed as either taking us...1. away from people; 2. towards people (in an approval-seeking or disapproval-avoiding manner); or 3. against people in a confrontational manner (Horney); or from a position of perceived 'inferiority' or 'insecurity' to one of greater 'superiority' or 'security' (Adler); and/or create the existence of what might be called '(transference) scripts and games' that people play. Of course, none of these ideas entered Freud's consciousness in any type of organized and coherent fashion -- at least not with the power to 'stick' in his ongoing theory of psychoanalysis -- and the rest is history -- Freud's incomplete understanding of transference, and the need for present theorists and therapists to elicit the help of Object Relations (Klein, Fairbairn-Winnicott-Guntrip...)-Adlerian Theory (Adler) -Gestalt Theory (Perls, Hefferline, Goodman) -Transactional Analysis (Eric Berne)-Primal Theory and Therapy (Arthur Janov) with the addition of such concepts and theories as 'topdog-underdog' and/or 'superego-underego' and/or 'superiority-inferiority' dialectic interactions' , inferiority and superiority complexes working in dialectic interaction with each other as part of the same neurotic-traumatic-wishful-transference process; also, the addition of the importance of the idea of 'conscious early memories' and their 'metaphorical transference-lifestyle significance' to a better and greater understanding of neurotic traumacy-(lifestyle)-transference conflicts, With Gestalt Theory, we have the addition of the idea of 'the unfinished situation' as an essential part of the neurotic-traumacy-wishful-transfrence process relative to its 'obsessive-compulsive nature' and the perceived wish of the individual person for some sense of better 'ego-satisfaction' and make a 'split ego more whole again'....

In the words of Brian Bird, transference can and should be viewed as a 'universal phenomenon' (1972) -- but more than this as essentially, usually stemming from a 'self-esteem deficiency problem' which can be traced to either a specific historical moment-encounter-memory and/or a more 'serial set of similar moment-encounter-relationship-memories' which in turn result in an 'obsessive-compulsive' wishful drive of the highest proportions that can propel a person to either or both the heights of creativity and greatness and/or to the deepest depths of the abyss of personal despair. In the words of Brian Bird (1972), 

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'Perhaps all great discoveries, or at least all 'creative leaps' are made, via the transference, within the discoverer's own person. Perhaps all monumental breaches of the confines of the known depend not only upon the basic givens of genius but upon a capacity of greatly heightened cathexis of certain ego apparatuses, a development which, in turn, may require the kind of power generated by the ego only in a transference situation. (Brian Bird, 'Notes on Transference: Universal Phenomenon and Hardest Part of Analysis, 1972)

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I (dgb) use the label-concept of 'transference-sublimation' to describe the phenomenon that Bird is describing above.  

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To limit our discussion of transference to just the 'distorted' elements of a 'transferred relationship' consisting of 'drives, impulses, defenses, allusions, and compromise-formations', from a person of past importance (who may or may not be still alive and relevant today) to a different person of importance in the present would be a mistake. 

For one thing, not all elements of the transference should be viewed as 'distorted'. If a woman has had a physically abusive father whose abusive characteristics have been 'transferred' onto the similar characteristics of a 'physically abusive' boyfriend or husband who she is now emotionally involved with -- one can hardly rightly call this transference similarity 'distorted'. No indeed. This is where Freud's 'wishful fantasy' theory enters into the picture and the woman's generally unconscious wish to turn a 'bad father-transference figure' into a 'good boyfriend/husband transference figure' the latter of whom is wished to generally not be abusive (in the essence of one type of 'transference-reversal' wish) but not so 'unabusive'  that the boyfriend/husband loses his 'similarity in transference characteristics' to the original father-bad transference figure'. If the boyfriend/father loses entirely the idea of 'similarity' with the father, then that would/will in effect detract from the 'handicap challenge' of a person with an inferiority complex towards her father having the same or similar amount of 'neurotic twisted respect and the accompanying 'erotic transference desire'. Extrapolating on the words of Ronald Fairbairn, we must not lose track of the idea in these types of transference situations and relationships that what was originally our 'rejecting (transference) object or figure has now, in the immediacy of our present situation, become our 'exciting object' with a neurotically distorted desire and drive on our part to 'undo' the damage or in some way 'reverse the transference' of the original transference relationship with the person we are now relating to in the present who we still (neurotically) wish to be reminiscent of the original, past transference figure.    

Did you get all that? 

All of these ideas need to be greatly expanded but not here at this time. 

One last point to close my thinking about transference at the end of 2012. 

Transference should not only be associated with the similarity between a past and present relationship. 

Rather, transference, in the role of 'universal phenomenon', should be associated with the totality of the entire 'traumatic memory-wishful fantasy neurotic transference conflict-complex. 

This would equate transference with almost the whole entirety of psychoanalytic psychotherapy -- i.e., in terms of 1. 'raising the client's traumacy-fantasy transference awareness', 2. doing the best that both client and therapist can do in tandem with each other in coming to terms with a better, more productive and functional, resolution of the client's traumacy-fantasy transference conflict, and 3. never losing track of, awareness of, and proper respect for, the immediacy of the present, here and now relationship as an encounter and a relationship in its own unique, humanistic-existential right that in the end is different than, and should not be 'analyzed to death' as simply a 'clone' of a relationship from the client's past that does not properly appreciate the current wishes and needs of both the client and the therapist in a newly evolving dynamic, dialectic -- and ideally mutually caring -- relationship ....

Happy New Year to all my readers and their loved ones...

-- dgb, Dec. 31st, 2012, 

-- David Gordon Bain, 

-- Dialectic Gap-Bridging Negotiations and Creations...

-- Are Still in Process...