The Technique and Practice of Psychoanalysis
Ralph R. Greenson (1967)
Chapter 3- Transference, pp: 151- 216

     The development of the technique of psychoanalysis has been determined essentially by the evolution of our knowledge about the nature of transference. The greatest advances in psychoanalytic technique were derived from Freud's (1905c) major discoveries about the twofold power of transference; it is an instrument of irreplaceable value, and it is the source of the greatest dangers. Transference reactions offer the analyst an invaluable opportunity to explore the inaccessible past and the unconscious (Freud, 1912a, p. 108). Transference also stirs up resistances that become the most serious obstacle to our work (p. 101). Every definition of psychoanalytic technique must include as a central element the analysis of the transference. Every deviant school of psychoanalysis can be described by some aberration in the way the transference situation is handled. Transference reactions occur in all patients undergoing psychotherapy. Psychoanalysis is distinguished from all other therapies by the way it promotes the development of the transference reactions and how it attempts systematically to analyze transference phenomena.

3.1 Working Definition

     By transference we refer to a special kind of relationship toward a person; it is a distinctive type of object relationship. The main characteristic is the experience of feelings to a person which do not befit that person and which actually apply to another. Essentially, a person in the present is reacted to as though he were a person in the past. Transference is a repetition, a new edition of an old object relationship (Freud, 1905c, p. 116). It is an anachronism, an error in time. A displacement has taken place; impulses, feelings, and defenses pertaining to a person in the past have been shifted onto a person in the present. It is primarily an unconscious phenomenon, and the person reacting with transference feelings is in the main unaware of the distortion.
     Transference may consist of any of the components of an object relationship, i.e., it may be experienced as feelings, drives, wishes, fears, fantasies, attitudes, and ideas or defenses against them. The people who are the original sources of transference reactions are the meaningful and significant people of early childhood (Freud, 1912a, p. 104; A. Freud, 1936, p. 18). Transference occurs in analysis and outside of analysis, in neurotics, psychotics, and in healthy people. All human relations contain a mixture of realistic and transference reactions (Fenichel, 1941, p. 72).
     Before we proceed to amplify the elements outlined above, it is necessary to clarify the terminology. The heading of this chapter is "Transference" and that is the old and familiar term which Freud introduced and which most analysts continue to use. In recent years there has been a movement to modify this because it was felt that the term "transference" might be misleading. "Transference" is singular and transference phenomena are plural, multiple and diversified; the term "transferences" is grammatically more correct. Unfortunately "transferences" sounds artificial and strange to me, and I have had to resort to a compromise between correctness and familiarity. I prefer to use the term "transference reactions" to refer to the entire class of transference phenomena. When I use the term "transference," I shall use it as a collective noun, shorthand for transference reactions.
     Transference reactions are always inappropriate. They may be so in the quality, quantity, or duration of the reaction. One may overreact or underreact, or one may have a bizarre reaction to the transference object. The transference reaction is unsuitable in its current context; but it was once an appropriate reaction to a past situation. Just as ill-fitting as transference reactions are to a person in the present, they fit snugly to someone in the past.

For example, a young woman patient reacts to my keeping her waiting for two or three minutes by becoming tearful and angry, fantasying that I must be giving extra time to my favorite woman patient. This is an inappropriate reaction in a thirty-five-year-old intelligent and cultured woman, but her associations lead to a past situation where this set of feelings and fantasies fit. She recalls her reactions as a child of five waiting for her father to come to her room to kiss her good night. She always had to wait a few minutes because he made it a rule to kiss her younger sister good night first. Then she reacted by tears, anger, and jealousy fantasies-precisely what she is now experiencing with me. Her reactions are appropriate for a five-year-old girl, but obviously not fitting for a thirty-five-year-old woman. The key to understanding this behavior is recognizing that it is a repetition of the past, i.e., a transference reaction.

     Transference reactions are essentially repetitions of a past object relationship. The repetition has been understood in a variety of ways and apparently serves multiple functions. Instinctual frustration and inhibition cause the neurotic to seek belated opportunities for satisfaction (Freud, 1912a, p. 100; Ferenczi, 1909). But the repetition has also been understood as a means of avoiding memory, a defense against memory, as well as a manifestation of the compulsion to repeat (Freud, 1912a, 1914c; A. Freud, 1936; Fenichel, 1945b).
     It is this fact, that a piece of behavior repeats something in the past, that makes it likely to be inappropriate to the present. The repetition may be an exact duplication of the past, a replica, a reliving, or it may be a new edition, a modified version, a distorted representation of the past. If a modification of the past transpires in the transference behavior, then it is usually in the direction of wish fulfillment. Very often fantasies of childhood are experienced as having actually taken place (Freud, 1914b, pp. 17-18; Jones, 1953, pp. 265-267). Patients will experience feelings toward the analyst that can be construed as a sexual seduction by the father, which are later revealed to be a repetition of a wish that occurred originally as a childhood fantasy. Transference feelings that are acted out usually turn out to be such attempts at wish fulfillment (Freud, 1914c; Fenichel, 1945b; Greenacre, 1950; Bird, 1957). An extension of this idea is to be seen in patients who attempt to complete unfulfilled tasks in their acting out (Lagache, 1953).
     The objects who were the original sources of the transference reaction are the important people of a child's early years. They usually are the parents and other upbringers, the dispensers of love, comfort, and punishment, the siblings and other rivals. However, transference reactions may be derived from later figures and even current figures, but analysis will reveal that these later objects are secondary and were themselves evolved from the primary, early childhood figures. Finally, it should be added that parts of the self may be displaced onto others, that is, projection may take place. These will also appear like transference reactions, but I question whether this type of response correctly belongs in the realm of transference reactions. This will be discussed in greater detail in Section 3.41.
     Transference reactions are more apt to occur in later life toward people who perform a special function which originally was carried out by the parents. Thus, lovers, leaders, authorities, physicians, teachers, performers, and celebrities are particularly prone to activate transference responses. Furthermore, transference reactions can also occur to animals, to inanimate objects, and to institutions, but here, too, analysis will demonstrate that they are derived from the important people of early childhood (Reider, 1953a).
     Any and all elements of an object relationship may be contained in a transference reaction; any emotion, drive, wish, attitude, fantasy, and the defenses against them. For example, a patient's inability to feel anger toward his analyst may stem from his childhood defense against expressing anger. As a boy he learned that the best way to prevent terrible quarrels with his explosive father was to remain unaware of anger in himself. In the analysis he was unaware of the anger that lay behind his persistent blandness.
     Identifications may arise during analysis, which may be transference reactions. One of my patients would take on one or another of my character traits from time to time during the analysis. This was apt to occur when he felt left behind by a more successful competitor. It was as though he had to become like me when he could not possess me as a love object. His history indicated that he employed this mechanism when he competed with his older brothers for the love of his father.
Transference reactions are essentially unconscious, although some aspect of the reaction may be conscious. The person experiencing a transference reaction may be aware that he is reacting
excessively or strangely, but he is unknowing of its true meaning. He may even be intellectually aware of the source of the reaction, but he remains unconscious of some important emotional or instinctual component or purpose.
     All people have transference reactions; the analytic situation only facilitates their development and utilizes them for interpretation and reconstruction (Freud, 1905c, 1912a). Neurotics are particularly prone to transference reactions, as are frustrated and unhappy people in general. The analyst is a prime target for transference reactions, but so are all the important people in the life of an individual.
     To summarize: Transference is the experiencing of feelings, drives, attitudes, fantasies, and defenses toward a person in the present which do not befit that person but are a repetition of reactions originating in regard to significant persons of early childhood, unconsciously displaced onto figures in the present. The two outstanding characteristics of a transference reaction are: it is a repetition and it is inappropriate. (For an amplification of this definition see Section 3.41. )

3.2 Clinical Picture: General Characteristics

     In this section I would like to familiarize the student with some of the most typical manifestations of transference phenomena as they are apt to occur during the course of analysis. I believe this can best be done by focusing on those characteristics of the patient's reactions to the analyst which indicate the likelihood of a transference reaction. It should be borne in mind that the presence of the qualities I am highlighting is not absolute evidence of transference. The quality under scrutiny must also be a repetition and inappropriate.

3.21 Inappropriateness
     A basic question immediately arises as we attempt to illustrate the clinical picture of transference reactions. Could we not classify all reactions to the analyst as transference? According to our definition, the answer is no. Let us take a simple example: A patient becomes angry with his analyst. One cannot determine from this fact alone whether one is dealing with a transference reaction. One first has to ascertain whether the analyst's behavior justifies the anger. If the patient became annoyed because the analyst interrupted the patient's associations by answering the telephone, then I would not consider the patient's annoyance a transference reaction. His response seems realistic, in accordance with the circumstances, and appropriate to a mature level of functioning. This does not imply that the patient's reaction is to be ignored, but we handle such occurrences differently than we do transference phenomena. We might explore the patient's history and fantasies in regard to anger reactions, but, despite our findings, we would remind the patient and ourselves that his overt reaction to the frustration was realistic. If the patient had become furious and not just annoyed, or if he had remained completely indifferent, then the inappropriate intensity of the reaction would indicate that we are probably dealing with a repetition or a reaction from childhood. The same would hold true if his annoyance lasted for hours or if he reacted to the interruption with laughter.

Let me cite a typical example of an inappropriate reaction. My telephone rings repeatedly during an analytic hour and I answer, thinking it is an emergency. To my dismay it turns out to be a wrong number and I indicate my annoyance by inadvertently mumbling "Goddamn it" under my breath. Then I am silent. The patient resumes talking where he left off. After a few minutes I interrupt him and ask him how he felt about the phone call. He replies: "How am I supposed to feel? It was not your fault." Silence. He tries to return to the earlier conversation, but it seems strained and artificial. I then point out how he seems to be trying to cover up certain of his emotional reactions by acting as he imagines he "is supposed to." This leads the patient to recall a momentary flash of anger as he heard me answer the phone. This was followed by a picture of me shouting at him angrily. The patient then recalls a host of memories of how he was forced to submit to his father's ideas about how he was "supposed" to behave. I interpreted to him how he had reacted to me as though I were his father.

     The inappropriateness of a reaction to a current situation is the prime sign that the person who triggers the reaction is not the decisive or true object. It indicates that the reaction probably belongs to and fits an object in the past.

3.22 Intensity
     By and large, intense emotional reactions to the analyst are indicative of transference. This is true for the various forms of love as well as hate and fear. The usual restrained, nonintrusive, consistent behavior and attitudes of the analyst do not realistically call for intense reactions. Here again appropriateness has to be kept in mind. It is important to acknowledge that a patient may be justified in reacting with great intensity if the analysts's behavior and the analytic situation warrant this. For example: An analyst falls asleep while listening to his patient. The patient becomes aware of this and finally manages to awaken the analyst by calling to him. The patient becomes furious when the analyst does not concede his error but instead interprets that the patient unconsciously wanted to put him to sleep by being boring.
     In such a situation, I would not consider the patient's fury a transference reaction, but essentially justifiable and appropriate. In fact, any other reaction would have been a more likely sign of a transfer from the past. This does not mean that the patient's reaction is not to be analyzed, but the ultimate analytic aim is different if we are dealing with a transference reaction rather than with a realistic one. Furthermore, there is always the possibility in all intense reactions, no matter how justifiable they seem, that in addition to the realistic superstructure, there is also a transference core. In the ordinary course of analysis, however, intense reactions to the analyst are a reliable indication of a transference reaction.
     The converse of intense reactions to the analyst, the absence of reactions, is just as surely a sign of transference. The patient may be having reactions but is withholding them because he is embarrassed or afraid. This is an obvious manifestation of transference resistance. The situation is more complicated when the patient is not consciously aware of any but the blandest and most innocuous of feelings. It may be that there are strong feelings within the patient, but they are repressed, isolated or displaced. Sometimes it requires persistent analysis of the fear of reacting emotionally to the analyst before a patient will dare to allow himself some spontaneous reactions. Such resistances to the transference were described in Chapter 2. At this point I want to mention briefly the frequent clinical experience that my patients will react quite reasonably to my idiosyncrasies but tend to become distraught by any sign of peculiarity in another analyst. This is a clear-cut example of a displacement of a transference reaction and has to be recognized as a defense against transference feelings toward the patient's own analyst. A similar resistance is manifested by patients who react blandly in the hour and who have unexplained intense emotional reactions toward strangers after the hour.
     It may happen that a patient will not be particularly concerned with his analyst for a short period of time, because important events are going on in his life apart from the analysis. However, prolonged absence of feelings, thoughts, or fantasies about the analyst is a transference phenomenon, a transference resistance. The analyst is too important a person in the life of the analysand to be absent from his thoughts and feelings for any considerable period of time. If the analyst is really not important, then the patient is not "in analysis." The patient may be going through the motions of analysis to please someone else or coming for some purpose other than for treatment.
     It may also occur that some other person in the patient's life may absorb the patient's intense emotions and that the absence of intense feelings for the analyst may not be due primarily to a transference resistance. For example: a patient during the first part of his analysis is freed from his fear of emotional involvement and in the later course of his analysis falls in love. The love affair will in all likelihood contain important elements from the patient's past, but the contribution from the analytic situation may or may not be of decisive significance. One would have to explore such a situation very carefully and repeatedly before coming to any reliable conclusions. Is the patient falling in love to please you? Is he falling in love to spite you because you do not give him sufficient love? Is he falling in love out of identification with you? Has the patient fallen in love with someone who resembles you? Is the falling in love a sign of maturity? Does there seem to be some realistic hope for a sustained happy relationship?
     These questions are not easy to answer; there are no clear-cut answers and only prolonged exploration and time can offer a reasonably reliable answer. This is the basis for the practical rule suggested by Freud that the analyst should ask the patient to promise not to make any major changes in his life situation during the analysis
(1914c, p. 153). This piece of advice can also be misconstrued by the patient because of the transference distortions and has to be given at the proper time and in the proper context (Fenichel, 1941, p. 29). The fact that the duration of analytic treatment has increased in recent years has prompted a further modification of this rule. Today I believe we would tell the patient that it would be better not to make important changes in his life situation until the change in question has been sufficiently analyzed. This problem will be pursued further in Volume II.

3.23 Ambivalence
     All transference reactions are characterized by ambivalence, the coexistence of opposite feelings. It is customary in psychoanalysis to assume that by ambivalence we mean that one aspect of the feelings is unconscious. There is no love for the analyst without hate hidden somewhere, no sexual longings without some covert repulsion, etc. The ambivalence may be easily detectable when the feelings involved are capricious and change unexpectedly. Or one aspect of the ambivalence may be tenaciously maintained in consciousness for long periods, while its opposite is stubbornly defended. It can also happen that the ambivalence is handled by the patient displacing one component onto some other person, often another analyst. This is frequently seen in the analysis of candidates in training. They will maintain a positive relationship to their personal analyst and displace their unconscious hostility onto a supervisor or seminar leader-or vice versa.
     It should not be forgotten that preambivalent reactions also may take place in the transference. The figure of the analyst is split into a good and a bad object, each of which leads a separate existence in the patient's mind. When patients reacting in this way-and they are always the more regressed patients-become able to feel ambivalence to the same whole object it denotes quite an achievement.

Let me cite a clinical example. For several years a borderline patient of mine would give bizarre responses to my interventions whenever he felt anxious. I was slowly able to piece together the following explanations. When he felt angry and hateful toward me, he became afraid and therefore never listened to my words because he felt those were like poisoned darts, and his defense was to become impervious to them. At such times he concentrated only on my tone of voice, paying meticulous attention to the changes in pitch and rhythm. Low tones and regular rhythm made him feel I was feeding him good food like mother used to make and serve when they ate alone. High tones and irregular rhythm meant mother was serving him bad food because father was there and made her nervous and spoiled the food. It took many years of analysis for him to allow me to become a whole person and to remain so whether he loved, hated, or feared me.

A typical example of the sudden and unexpected changes which can take place in the transference situation is the following sequence of events which occurred during a single week in the analysis of a young hysterical-depressive woman patient in her second month of treatment. She had been working well despite the fear that I would find her unrewarding and ordinary. Her feelings toward me were of awe and admiration with the underlying hope that I would like her.
Suddenly in one hour, after considerable difficulty, she admits a feeling that she is in love with me. She attributes the beginning of this feeling to the end of the last hour when she noticed my trousers were wrinkled and my tie askew. She was convinced this meant I was not a materialist, not a greedy capitalist, but a dreamer, an idealist, even an artist. All day and night she fantasied about me in this way; her feelings grew in intensity and she enjoyed this state of affairs. Even when we begin to analyze this reaction and trace it hack to the past, her feelings persist.
The next day she is overwhelmed with guilt. Her child has developed an earache during the night and the patient feels this was the result of her negligence; she has spent too much time daydreaming about her new love instead of caring for her child. She is convinced I must have contempt for such a frivolous woman. When I attempt to pursue the history of this reaction, she feels I am punishing her, as she well deserves.
On the next, the third day, she feels my greeting is cold, almost a smirk, and my silence is disdain. She now feels that I am not an idealist or a dreamer careless about appearance, I am arrogant and contemptuous of my patients, who are "poor rich neurotics." She defends herself and her group by attacking me as one of those evil-minded psychoanalysts who lives off the rich but who despises them. She finds the odor of my cigar repulsive, even nauseating.
The following hour she finds my attempts to analyze her hostile feelings clumsy but endearing. I am probably well intentioned and warmhearted, only moody. I must have changed my brand of cigar and bought a more expensive one because of her criticism, and she was grateful for my consideration. She hopes I will some day become her guide and mentor because she has heard I am brilliant. When I keep silent she feels I am being "stuffy," conventional, and a killjoy. I probably am a grind and a hack who only loves his work. She leaves the hour feeling that I may be a good analyst, but she pities anyone married to me.

A patient of mine, Mrs. K., maintained a positive sexual and erotic transference reaction to me for almost three years. These feelings survived and were not measurably influenced by my persistent interpretations of their resistive function, my prolonged silences, my occasional errors and lapses. Only after she had improved sufficiently to be able to achieve a partial vaginal orgasm which helped abate her fear of homosexuality, did this chronic positive transference change. Only then did she dare to let herself consciously feel her hatred and revulsion toward me and toward men in general.

3.3 Historical Survey

     I would like briefly to sketch the major contributions Freud and others have made to our understanding of the theoretical and technical problems concerning transference. I shall take them up in chronological order covering the years 1895 to 1960. I shall stress only those points which I consider to be significant advances and shall omit many valuable papers which are essentially summaries or repetitions. The student is advised to read the original papers. My version of the meaningful contents is not only extremely condensed but also a subjective selection. This subject has already been touched upon in Section 1.1.
     Freud's first description and discussion of the role of transference is to be found in Chapter IV on psychotherapy in the Studies on Hysteria (1893-95). At first he considered it a disadvantage that the patient unduly forced his personal relations to the physician into the foreground, although he recognized that the personal influence alone can remove certain resistances (p. 301). Some patients tended to feel neglected, others feared becoming dependent, even sexually dependent. Later he described some patients who tended to transfer onto the figure of the physician distressing ideas which arose from the content of their analysis. These patients, said Freud, had made a "false connection" onto the analyst (pp. 302-303). In some cases this seemed to be a regular occurrence. He then went on to describe the technique of handling this situation. (1) It should be made conscious. (2) One should demonstrate how it is an obstacle. (3) One should attempt to trace its origin in the hour. At first Freud was "greatly annoyed" at this increase in work, but he soon realized its value (p. 304).
     The Dora case is a landmark in psychoanalytic technique (Freud, 1905a). Here, in all humility and with great clarity, Freud described how he learned about the decisive importance of transference by his failure to recognize and handle it in one of his patients. This led to a premature interruption of treatment and a therapeutic failure. In this paper, Freud described how his patient experienced feelings in regard to his person during the analysis that were new editions, facsimiles, reprints, and revised editions of feelings which originally belonged to persons of significance in the past (p. 116). Such feelings seem to be a new creation, but actually are a revival of old emotional reactions. Freud called this phenomenon transference, and declared it to be a necessary part of psychoanalytic therapy. It produces the greatest obstacles, but it is also a most important ally in the treatment. He realized too late that the patient's transference feelings to him had changed and that she was acting out with him a fragment of her past. She broke off with Freud as she had not dared to do with her lover (pp. 118-119). Freud then recognized that the analysis of the hostile transference is necessary for a successful therapeutic result (p. 120).
     A paper by Ferenczi in 1909, "Introjection and Transference," is the next step forward. Here Ferenczi touched on certain new ideas about transference, some of which we are still struggling with today. He pointed out that transference reactions occur in neurotics not only in the analytic situation, but elsewhere. He considered transference reactions a special form of displacement and remarked that physicians are particularly likely to be made objects of transference reactions, not only analysts. However, he believed that this predisposition existed in the patient and that the analyst is only the catalyst. Usually these reactions occur in a positive and negative form. Furthermore, Ferenczi believed that all neurotic patients have a hunger for transference. These frustrated people have a tendency to introjection and a hunger for identifications (pp. 47-49). They tend to take in the person of the analyst into their private world. He contrasted this to the paranoiacs and other psychotics, who do not introject the analyst but tend to create a distance between themselves and the analyst. He thought that this hunger of the patient for the analyst comes from a stimulus hunger (p. 51). Furthermore, he theorized that the origins of transference reactions go back to certain projections of infancy. The analyst is a "cover person," is a screen for the important objects in the infantile past of the patient (p. 62). The transference reaction is an attempt at cure.
     Ferenczi went on further and discussed how in hypnosis and suggestion we are also dealing with transference reactions which have a sexual basis and which originate from both of the parental figures. The patient's readiness to transfer onto the hypnotist is derived either from parental love or from parental fear (pp. 62-63, 67). The patients then become blindly believing and obedient. Similar reactions occur in psychoanalytic therapy without hypnosis. One can discern the difference between father and mother transference in hypnosis, and one can see changes, namely, the patient's vacillations between love reactions which are mother reactions and fear reactions which are reactions to the father.
     Freud's paper, "The Dynamics of the Transference" (1912a), adds some further valuable insight into transference. The patient's readiness for transference reactions comes from his dissatisfactions (p. 100). They are so strong in the neurotic patient because of his neurosis and do not arise from the analytic procedure (p. 101). Transference reactions are indications of a regression in libido. Both
transference and resistances are compromise formations (pp. 102103). Every conflict of the patient has to be fought out in the transference situation (p. 104). It is of crucial importance in the analysis, since it makes it possible for the patient to struggle in the present with his unresolved conflicts concerning important object relations in his past. One cannot slay the enemy in absentia or in effigy (p. 108). It is necessary to work these problems out in the ongoing transference situation occurring during analysis.
     In this paper Freud discussed some of the relationships between transference and resistance, particularly the differences between the positive (i.e., sexual and erotic) transference and the negative transference, and how they influence resistance formations (pp. 105-106). He distinguished between the sexual, erotic transference and the negative transference, on the one hand, and, on the other, "rapport," which is the nonsexual, positive transference reaction. In Freud's opinion all transference reactions are essentially ambivalent (p. 106). It is interesting to note, said Freud, that patients not only have transference reactions to the analyst and to physicians but also to institutions (p. 106).
     The paper "Recommendations to Physicians Practising PsychoAnalysis" (1912b) is noteworthy because in it Freud for the first time described countertransference, and the analyst's need for "psychoanalytic purification." Here Freud states for the first time the famous "mirror" simile. In order to resolve the transference it is necessary for the analyst to maintain his anonymity. "The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him" (p. 118).
     The essay "On Beginning the Treatment" (1913b) contains the recommendation by Freud that the theme of transference should be left untouched as long as there is no appreciable sign of resistance. He also suggested that one make no interpretations to the patient until a rapport has been developed between analyst and patient. Rapport will come about if we show a serious interest in the patient, work on his resistances, and indicate an attitude of sympathetic understanding (pp. 139-140). (I would be tempted to say this is the first description of the working alliance.)
     In the paper "Remembering, Repeating and Working-Through" (1914c), Freud discussed in some detail the patient's tendency to act out in the transference situation. He also introduced a new hypothesis in explaining transference reactions, namely, the concept of a repetition compulsion, but that is not yet tied up with the death instinct. Furthermore, in this paper there is the first mention of the concept of the transference neurosis (p. 154). The transference neurosis is an artifact of the treatment and replaces the patient's ordinary neurosis. It is curable by the analytic work.
     "Observations on Transference-Love" (1915a) is noteworthy for two main reasons. In it for the first time Freud mentioned the "rule of abstinence." It is a fundamental principle, said Freud, that the patient's needs and longings be allowed to persist in order that they may impel him to do the analytic work (p. 165). It is also an outstanding paper because of Freud's sensitive, personal, and literary presentation of the problem of properly dealing with a patient's romantic love for the analyst.
     The chapters on "Transference" and "Analytic Therapy" in the Introductory Lectures (1916-17) are essentially a rather systematic and thorough review of Freud's basic ideas about transference up to that time. Furthermore, there is a discussion of the term transference neuroses as a category of neurosis to be contrasted to the narcissistic neuroses as well as a brief discussion of the transference problems in the psychoses (pp. 445, 423-430).
     A major change in Freud's theoretical ideas about the nature of transference phenomena was put forth in Beyond the Pleasure Principle (1920). Certain childhood reactions are repeated in the transference not because there is the hope of pleasure but because there is a compulsion to repeat which is even more primitive than the pleasure principle and overrides it (pp. 20-23). The repetition compulsion is a manifestation of the death instinct (p. 36). For the first time, transference reactions were regarded as manifestations of both the libidinal and death instincts.
     After these papers there were no major new developments until Glover's series of technical papers published in 1928. They were the first systematic clinical description of some of the typical problems in the development and resolution of the transference neurosis and transference resistances. Glover distinguished different phases of transference development, and the typical problems in handling the various transference reactions.
     Ella Freeman Sharpe's (1930) technical papers illuminated the importance of analyzing the fantasies of the patient in regard to the analyst. In her literate and sensitive presentation she emphasized how the representations of the superego, ego, and id are played out in fantasies regarding the analyst. Transference reactions are not only displacements but may be projections. In keeping with the Kleinian point of view, Ella Sharpe was of the opinion that analyzing the transference is not a separate task but is the task from the beginning to the end of the analysis, that the transference situation has to be constantly sought out. Of particular clinical value is her description of some of the complicated problems in the subtle transference resistances to be found in the compliant, submissive patient.
     Freud's "Analysis Terminable and Interminable" (1937a) is notable because in it Freud continued the discussion of controversial hypotheses about transference and transference resistances. He emphasized the problem of protracted negative transference and acting out, which he attributed to the compulsion to repeat, a manifestation of the death instinct. He drew attention to physiological and biological factors (pp. 224-226). Freud also discussed the poor prognosis and limitations of psychoanalytic therapy and the special problems inherent in patients with a so-called negative therapeutic reaction (pp. 241-243). In this paper he touched upon the question of whether or not it is right for the analyst to stir up latent problems in the patient. Freud was adamant that the analyst should not manipulate the transference; his task is to analyze and not to manipulate (pp. 232-234).
     Richard Sterba's two papers on transference (1929, 1934) make an important contribution to our understanding of the therapeutic process. He described the split in the patient's ego which occurs when he is able to identify partially with the analyst's observing function. In this way the patient is able to become an active participant in the analysis. He not only produces the material, but on the basis of the identification he can work with it analytically. This idea is a central element in what later became known as the "therapeutic" or "working alliance."
     Fenichel's (1941) slim volume on technique is essentially a highly condensed, systematic, and thorough review of the theoretical basis of psychoanalytic technique. It also offers an outline of the technical steps to be considered in approaching the typical problems of technique.
     The most outstanding contribution in Macalpine's paper "The Development of the Transference" (1950) is her careful dissection of how the analytic situation itself converts the patient's transference readiness into transference reactions. She isolated some fifteen different factors which play a role in inducing the necessary regression in the patient undergoing psychoanalysis.
     Phyllis Greenacre's "The Role of Transference" (1954) added some important insights into the origins of transference, the "matrix" of transference reactions. She also carefully explained the importance of safeguarding the transference, the avoidance of "contamination." Her notion of the "tilted" relationship in the analytic situation, the unevenness between patient and analyst, is another helpful idea (p. 674). Greenacre realizes that the transference relationship is an inordinately complex one and suggests we ought to pay more attention to the splitting of the transference relationship (Greenacre, 1959).
     The Discussion of Problems of Transference (held at the 19th International Psycho-Analytical Congress in 1955) is an excellent summary of the current psychoanalytic point of view (see Waelder, et al., 1956). Elizabeth Zetzel's (1956) analysis of the importance of the "therapeutic alliance" is an outstanding contribution. In that paper, she stresses how differently it is regarded by the classical analysts and the followers of Melanie Klein. This distinction is, in my opinion, the basis for some important differences in theory and technique. Spitz's (1956b) paper deepens our understanding of how the analytic setting revives some of the earliest aspects of the mother-child relationship. Winnicott's (1956a) essay stresses the modifications in technique required by patients who did not experience adequate mothering in the early months of life. It is his opinion that only when a patient has been able to develop a transference neurosis can we depend essentially on interpretive work.
     In a very sensitive and penetrating study on the "Therapeutic Action of Psycho-Analysis," Loewald (1960) focuses on certain nonverbal elements in the transference relationship. He describes a type of mutuality that resembles the mother's nonverbal and growth-promoting interactions with the child. This hinges partly on the mother's selective, mediating, and organizing functions which aid the child in forming an ego structure. The mother's picture of the child's potentials becomes part of the child's image of himself. A similar process occurs unnoticed in psychoanalytic therapy.
     Leo Stone's (1961) book on The Psychoanalytic Situation is, in my opinion, an important step forward in clarifying some of the problems of transference phenomena. The concept of necessary gratifications, the therapeutic intent of the analyst, and his emphasis on different, coexisting, relationships between analyst and patient, represent a significant advance in our theory and technique. I believe it was Zetzel's paper on the therapeutic alliance and Stone's book on the psychoanalytic situation which led me to formulate the working alliance (Greenson, 1965a). The separation of the relatively nonneurotic relationship to the analyst from the more neurotic transference reactions has important theoretical and technical implications. A patient must be able to develop both types of relationships in order to be analyzable.
     One cannot conclude a historical survey of such a basic topic without including a brief description of some controversial developments. I have selected what seem to me to be the two most important current deviations among psychoanalysts, the schools of Melanie Klein and Franz Alexander.
     The followers of the Kleinian school consider the interpretation of the unconscious meaning of transference phenomena to be the crux of the therapeutic process. However, they believe that the patient's relationship to his analyst is almost entirely one of unconscious fantasy (Isaacs, 1948, p. 79). Transference phenomena are regarded essentially as projections and introjections of the most infantile good and bad objects. Although these early introjects arise in a preverbal phase, the Kleinians expect their patients to comprehend the meaning of these primitive goings-on from the beginning of the analysis (Klein, 1961; Segal, 1964). They do not analyze resistance as such, but instead make interpretations about the complex, hostile and idealized projections and introjections of the patient in regard to the analyst. It seems as though they expect to influence the internal good and bad objects in the patient's ego by interpreting what they sense is going on. They do not communicate with a cohesive, integrated ego; they do not attempt to establish a working alliance, but seem instead to establish direct contact with the various introjects (Heimann, 1956).
     Kleinians hold the view that only transference interpretations are effective. No other interpretations are considered important. Their approach is equally valid, they claim, for working with children, psychotics, and neurotics (Rosenfeld, 1952, 1958). One cannot do justice to these views with so short a description; it is necessary to be familiar with the entire school of thought. The student should read the three most recent books published by Melanie Klein and her followers (1952, 1955; Segal, 1964). For a lucid and temperate discussion of this subject, the student is referred to the chapter on Melanie Klein's work by Brierley (1951).
     Although one may find much to disagree with in the Kleinian approach, nevertheless the Kleinians use the psychoanalytic approach insofar as they interpret the transference. Alexander and his followers (1946) challenge this basic attitude of analyzing and interpreting the transference. On the contrary, they advocate that the transference should be regulated, controlled, and manipulated. It should not be allowed to flower in accordance with the patient's neurotic needs. One should not permit the patient to get into deep regressions since these regressions will lead to dependent transference reactions which are essentially resistances and not productive. It is best to avoid the patient's distrust and antipathy; a hostile and aggressive transference is a needless complication. Analysts may avoid all mention of the infantile conflicts and avoid thereby the dependent transference reactions. A transference neurosis of moderate intensity is permissible, but intense transference neuroses are to be avoided. One ought to focus much more on the present and less on the past.
     This is but a small sample of the views expressed by Alexander and French in their book Psychoanalytic Therapy. This volume created quite a stir in psychoanalytic circles in America (it seems to have been ignored in Europe), since many of the contributors were psychoanalysts of prominence and the views expressed contradicted many accepted basic principles of psychoanalytic theory and technique. The reverberations of this attempt to alter psychoanalysis led, in my opinion, to the setting up of fixed training standards in the American Psychoanalytic Association. It was believed that candidates trained according to the methods advocated by Alexander and his followers would not have undergone a deep psychoanalytic experience.
     As I stated in the beginning of this chapter, every aberration in psychoanalysis can be demonstrated in the deviant way that transference phenomena are regarded.

3.4 Theoretical Considerations

3.41 The Origin and Nature of Transference Reactions
     Before we explore some of the theoretical issues concerning transference phenomena, it is imperative to be more precise about the meaning of the term. There are many different theories about what constitutes a transference reaction and I have the impression that some of the divergencies stem from a failure to define one's terms in sufficient detail. Let me repeat at this point the definition of transference I employed in Section 3.1. Transference is the experiencing of feeling, drives, attitudes, fantasies, and defenses toward a person in the present which do not befit that person but are a repetition o f reactions originating in regard to significant persons of early childhood, unconsciously displaced onto figures in the present.
     This definition rests on four basic propositions: (1) Transference is a variety of object relationship. (2) Transference phenomena repeat a past relationship to an object. (3) The mechanism of displacement is the essential process in transference reactions. (4) Transference is a regressive phenomenon. For a psychic phenomenon to be considered transference, all four of these elements must be present. Each of the four components has important theoretical and clinical connotations.
     Psychoanalytic treatment does not create transference reactions; it merely brings them to light by facilitating their development. Transference phenomena in neurotics are a specialized class of relationship to another person. They represent a kind of intermediary realm between illness and real life (Freud, 1914c). Other modes of relating to the analyst occur during psychoanalytic treatment. A working alliance and a real relationship also take place and play an important role in the psychoanalytic therapy of neurotic patients. They differ from transference phenomena and will be considered separately.
     More primitive ways of relating to the analyst may occur as well. Reactions of a delusional or psychotic character take place but it is not certain whether they may be rightfully called transference reactions (Freud, 1915b). In order to avoid any ambiguity, if the term transference or transference reaction is employed without further specification in these writings, it shall refer to neurotic transference phenomena. In a variety of severely regressed patients, we may see transient psychotic reactions to the therapist. These manifestations are quite different from neurotic transference reactions. The main distinctions stem from the fact that the psychotic has lost his object representations and as a consequence can no longer differentiate between the self and object world (Freud, 1915b; M. Wexler, 1960; Jacobson, 1964). It should not be forgotten, however, that psychotic patients may have neurotic and healthy components and the converse is equally true (M. Katan, 1954). One does see patients who manifest both neurotic and psychotic transference reactions.
     The multiform ways of relating to the analyst during psychoanalysis have to be distinguished from one another because they imply important clinical, theoretical, and technical differences. Simply lumping them all together as transference phenomena does not do justice to the complexities of human relationships and to the intricacies of the therapeutic processes involved in psychoanalytic treatment.

3.411 Transference and Object Relations
     A transference reaction in neurotics is a relationship involving three whole people--a subject, a past object, and a present object (Searles, 1965). In the analytic situation it usually comprises the patient, some significant person from the past, and the analyst. A patient who becomes afraid of his analyst in the same way he once feared his father is misunderstanding the present in terms of his past as long as he is in the grip of the transference reaction (Fenichel, 1945a). However, the neurotic patient knows the analyst is his analyst and not his father, and he also knows that he, the patient, is not the analyst and also not his father. In other words, the neurotic may react temporarily and partially as if the analyst were identical to his father, but intellectually he can clearly distinguish the analyst from his father and his self. In clinical terms, the neurotic patient is able to split off his experiencing ego from his observing ego. He may do this spontaneously or he may need the help of the analyst's interpretations.
     Neurotic transference phenomena are based on two achievements: (1) the individual's capacity to differentiate between the self and the object world; (2) the ability to displace reactions from a past object representation to an object in the present (Jacobson, 1964; Hartmann, 1950). This means that the neurotic has an organized, differentiated self, an entity separate and distinct from his environment, which has the capacity to remain the same in the midst of change (Jacobson, 1964; Lichtenstein, 1961; Mahler, 1957 [see Rubinfine, 1958]; and Greenacre, 1958).
     Very young children have not yet achieved their separation, their individuation, from the mother. Older children have a hunger for new objects. In the treatment situation they do not merely repeat the past, they try new ways of relating (A. Freud, 1965). Psychotics have lost their internal object representations and strive to fill up the feeling of a terrible void by creating new objects (Freud, 1915b). They are prone to fuse and confuse remnants of their self and object representations. Furthermore, their world is full of part objects which they introject and project in their attempts to build or rebuild their lost object relationships (M. Wexler, 1960; Searles, 1963).

One of my schizophrenic patients was convinced for years that she was made of soap and blamed me for this. These ideas were based in part on her literal and concrete acceptance of the axioms, "Silence is golden" and "Cleanliness is next to Godliness." She felt my attempts to get her to talk resulted in the loss of her "pure" silent state. I had used "dirty words" and this had turned her into soap. (Note the confusion of self and analyst.) The basic problem, however, was her sense of emptiness, her awareness of having lost her world of objects. The feeling of being made of soap was an acknowledgment of this as well as an attempt at restitution.

     This kind of relatedness to the analyst is very different from neurotic transference reactions. The reader is referred to the works of Freud (1915b, 1911a), Searles (1963), Little (1958), and Rosenfeld (1952, 1954) for further clinical and theoretical material on transference phenomena in psychotics.
     The foregoing deliberations merely hint at some of the problems that lie behind the differences in the therapeutic approach to the child, the adult neurotic, and the psychotic (A. Freud, 1965). Freud's (1916-17) separation of the transference neuroses from the narcissistic neuroses seems to be based on similar grounds. People who are essentially narcissistic will not be able to maintain a consistently analyzable transference relationship. Their relationship to the therapist will abound with fusions of self and object images, primitive forerunners of identification (Jacobson, 1964). There are transitions between narcissistic relations and object relations,. as Winnicott (1953) has demonstrated with the concept of transitional objects. The serious student is advised to read Jacobson (1964), Fenichel (1945a), Spitz (1957, 1965), and Mahler (1965) for a more thorough view of the beginnings of self and object representations. I agree with Greenacre's (1954) formulation that the matrix of the transference relationship is the early mother-infant union. Man is not able to endure aloneness very well for any considerable period of time. The analytic situation mobilizes two antithetical sets of reactions. The sensory isolation of the patient on the couch stirs up the feeling of aloneness, frustration, and a hunger for object relations. On the other hand, the high frequency of visits, the long duration of the treatment, and the devotion to the patient's needs stir up memories of the early closeness between mother and child.

3.412 Transference and Ego Functions
     Transference reactions demonstrate the neurotic patient's strengths and weaknesses in terms of his ego functions. As previously stated, neurotic transference phenomena indicate that the patient has a stable self representation which is sharply differentiated from his object representations. This implies his early ego development has been essentially successful, he has had "good-enough" mothering, and he can relate to whole people (Winnicott, 1955, 1956b). When he "misunderstands the present in terms of his past," the misunderstanding is only partial and temporary. The regression in ego functions is a circumscribed one and limited to certain aspects of his relationship to the transference figure. Furthermore, it is reversible.

For example, a patient of mine is in the throes of an intense, hostile transference reaction. He spends most of several hours complaining vociferously that I am incompetent, unscrupulous, and callous. Yet, he comes punctually to his appointments, listens attentively to my interventions, and functions adequately in his outside life. Even though he thinks of quitting the analysis, he does not seriously contemplate such a move.

     A patient in such a state of mind is allowing himself to be carried away by his feelings and fantasies. He is letting himself regress in terms of his object relations and ego functions. He renounces certain of his reality-testing functions partially and temporarily. (This is to be differentiated from role playing or pretending.) In the case cited above, the transference reaction was mobilized when I did not answer one of his questions. This action of mine overrode momentarily all my qualities which were in contradiction to his charge that I was incompetent, unscrupulous, and callous. The patient's ego function of discrimination was impaired during this phase of treatment. I became his harsh and punitive father when I remained silent. The patient was able to work with this reaction, began to understand it, when his observing ego and the working alliance were re-established.
     Other mechanisms indicative of a regression in ego functions occur in transference reactions, but they are a supplement to the mechanism of displacement. Projection and introjection may take place, but they are not the basic process in neurotic transference. They may operate in addition to the displacement. I want to stress this point because it is in conflict with the views of the Kleinian school whose followers interpret all transference phenomena on the basis of projection and introjection (Klein, 1952; Racker, 1954; Segal, 1964). They neglect the displacement from a past object relationship and therefore relatively ignore the historical experiences of the patient. I believe this is due in part to their failure to differentiate projection and introjection from displacement as well as to an inexact usage of the terms projection and introjection.
     At the risk of seeming pedantic I shall define these terms briefly, as they are used in the classical psychoanalytic literature. Displacement refers to the shift of feelings, fantasies, etc., from an object or object representation in the past to an object or object representation in the present. When a person projects, he is ejecting something from within his self representation into or onto another person. Introjection is the incorporation of something from an external object into the self representation. Projection and introjection may occur during analysis, but they occur in addition to the displacement. They are repetitions of projective and introjective mechanisms which once took place in regard to past objects of historical importance (Jacobson, 1964).

Let me give an example of projection as a neurotic transference reaction. Professor X.2 who suffered from stage fright complained frequently during his analysis that he felt I was mocking him, laughing at him behind his back, or deriding him whenever I made an interpretation. There were many determinants for this reaction in the patient's history. His father had been known to be a tease who delighted in sadistically embarrassing the patient, especially before company. The patient had developed a very strict superego and flagellated himself severely for a variety of activities he considered shameful. In the course of the analysis his sense of shame was changed to a feeling that I would shame him if I knew what he had done. The patient had projected parts of his superego onto me. His fantasy of being humiliated by me not only was painful but also contained masochistic and exhibitionistic pleasure. This was a carry-over from his childhood relationship to his father which was replete with sexual and aggressive fantasies. However, one important aspect of his humiliation fantasies was based on projection.
     In one hour he shamefacedly reported that he got drunk over the weekend and had entertained a gathering of his friends by doing an imitation of "Gruesome Greenson, the great psychoanalyst." He was amazed at how long a period of time he was able to keep his audience laughing at his analyst. In the analytic hour he realized he did this occasionally at home by imitating certain expressions or gestures of mine whenever there were people present who knew me. The patient became quite apprehensive when he spoke of this; he felt certain "the roof would fall in." This phrase led him to recall a hitherto forgotten memory of being caught by his father doing a burlesque of his father's manner of speech. His father beat him unmercifully and then tormented him for crying. This episode ended the patient's attempt to imitate his father and led eventually to the stage fright.
     It seemed clear to me that, in part, the patient had projected his impulses to be a humiliator onto me. This was a defense against his hostility, a means of avoiding anxiety, as well as other things. But this projection was a supplement to the basic determinant of his feeling of humiliation-the history of a father who humiliated him and whom he longed to humiliate in retaliation.

3.42 The Transference Neurosis
     Freud used the term transference neurosis in two different ways. On the one hand, he used the term to designate a group of neuroses characterized by the patient's ability to form and maintain a relatively cohesive, multiform, and accessible set of transference reactions (Freud, 1916-17). The hysterics, phobics, and obsessive compulsives were thus differentiated from the narcissistic neuroses, the psychoses. In the latter group, the patients were able to develop only fragmentary and sporadic transference reactions and therefore were not treatable by classical psychoanalysis. Freud also used the term transference neurosis to describe a regular occurrence in the transference reactions of a patient undergoing psychoanalytic treatment (Freud, 1905c, 1914c, 1916-17, Chapt. XXVII).
     During the course of an analysis, it can be observed that the patient's interests become increasingly more focused on the person of the analyst. Freud (1914c, p. 154) pointed out how the neurotic patient's compulsion to repeat is rendered not only harmless but useful by admitting it "into the transference as a playground in which it is allowed to expand in almost complete freedom and in which it is expected to display to us everything in the way of pathogenic instincts that is hidden in the patient's mind." If the transference situation is handled properly, "we regularly succeed in giving all the symptoms of the illness a new transference meaning and in replacing his ordinary neurosis by a 'transference-neurosis' of which he can be cured by the therapeutic work." The transference neurosis takes over all the features of the patient's illness, but it is an artificial illness and is accessible at every point to our interventions. It is a new edition of the old disease.
     In the early phases of psychoanalytic treatment we usually see sporadic transient reactions, designated as "floating" transference reactions by Glover (1955, p. 37). If these early transference reactions are properly handled, the patient will develop more enduring transference reactions. Clinically, the development of the transference neurosis is indicated by an increase in the intensity and duration of the patient's preoccupation with the person of the analyst and the analytic processes and procedures. The analyst and the analysis become the central concern in the patient's life. Not only do the patient's symptoms and instinctual demands revolve around the analyst, but all the old neurotic conflicts are remobilized and focus on the analytic situation. The patient will feel this interest as some variety and mixture of love and hate as well as defenses against these emotions. If the defenses predominate, some form of anxiety or guilt will be in the foreground. These reactions may be intense, explosive, subtle, or chronic. In any event, once the transference neurosis has set in, such constellations of feelings are omnipresent.
     In the transference neurosis the patient repeats with his analyst his past neuroses. By proper handling and interpretation it is our hope to help the patient relive and eventually remember or reconstruct his infantile neurosis. The concept of transference neurosis includes more than the infantile neurosis because the patient will also relive the later editions and variations of his childhood neurosis as well. Let me try to illustrate this with a clinical example.

I shall use the case of Mrs. K. This young woman came for psychoanalytic treatment because she had recently become tormented by obsessive ideas and impulses to become sexually promiscuous with a Negro. This alternated with feelings of being a "zombie" or else she felt empty, bored, worthless, and depressed. She had recently married an outstanding man in the community some twenty years her senior whom she had loved prior to the marriage but toward whom she now felt resentment and fear. The outstanding feature in her past history was the fact of her having been brought up by a warmhearted, erratic, alcoholic mother, who alternately worshipped and adored her, indulged her, and at times abandoned her. The father deserted the family when the patient was one and a half years old and the mother's later three marriages each lasted about one year. There were two brothers, three and two years younger, whom the mother ignored and who were looked after by the patient. They were her companions, her responsibility, and her rivals. There was great poverty, much changing of home locations, and little education. When the girl was fifteen her mother insisted she was able to shift for herself; and although shy, frightened, and untrained, the patient did make a successful career for herself as a fashion model. At twenty Mrs. K. met and fell in love with her future husband who taught her the niceties of life and who married her five years later. She had been married some two years when she came for analysis. I shall now try to sketch the main transference developments of a successful analysis lasting some four and a half years.
     The early transference reactions consisted of her urgency to be accepted as a patient by me, whom she fantasied as the "top" analyst of the community and thus a guarantor of a successful analysis. At the same time she dreaded that I would find her boring, unworthy, unattractive, or untreatable. She was torn, on the one hand, by her desire to be a good patient and reveal all her weaknesses, and, on the other hand, by her wish to be loved by me, to be found sexually and mentally attractive, and therefore to hide her defects. I was to make restitution for her lack of a father by making her my favorite patient and by doing for her what I would not do for any of my other patients. I would be the ideal, incorruptible father of whom she would be proud and also the delinquent father who would satisfy her incestuous wishes. Very early Mrs. K.'s symptom of promiscuity impulses shifted to me, as an oedipal figure. This alternated with an image of me as the stern, disapproving, and puritanical, idealized father.
     While this was going on the analysis was concerned with attempting to understand the patient's great shame about masturbation, which she "discovered" only at age twenty-one, and which seemed to occur without fantasies and with little orgastic relief. The analysis of her shame led us to recognize that I was not only the puritanical father_ but also the fanatically clean mother of her toilet-training days. Mrs. K.'s boredom and her feeling of emptiness were revealed to be defenses against sexual fantasies, and became resistances in the analysis. She was afraid to fantasy, because to fantasy meant to become excited, and to become excited meant to lose control and to wet. This was manifested in the analysis by her reluctance to continue talking when she became emotional or excited. If I were to see her weep, or flushed, I would find her unattractive. She removed the Kleenex tissue from the pillow after each hour because she did not want me to see her "soiled" tissue. How could I love her if I knew she was dirty and performed toilet functions. I was either the idealized, desexualized, de-toiletized father who deserted her dirty mother, or I was the compulsively clean mother who loathed dirty children. She then recalled many memories of seeing her drunken mother naked and being repelled by her ugly genitals. Now she dreaded being like her mother, or having her dirty mother inside her, and was terrified that I would abandon her like father had deserted mother. She would rather be empty than full of dirty mother. But empty meant silence and resistance in the analysis and that was equivalent to being a bad patient. Here the working alliance and her longing to be loved by her father analyst won out and she was able to work on what was hidden behind the emptiness.
     Behind the emptiness came a flood of sexual fantasies concerning a great variety of oral, sucking, scoptophilic actions performed both actively and passively with a forbidden man. That man was the analyst or a Negro or Arab who was both sadistic and masochistic. She and her partner alternated roles. At this time I was not only her accomplice in her sexual adventures, but I also permitted her to hate her mother, which she did with gusto. In this period of analysis she longed for each analytic hour, dreaded weekends and even the end of each hour, for I had become the main content of her fantasies, and absence from me meant emptiness and boredom. She felt "hooked up" to me and charged with feelings in my presence and felt drab and flat away from the hour.
     As Mrs. K. slowly realized that I was determined to analyze her and was neither afraid of her impulses nor revolted by them, she slowly dared to permit more regressive impulses to come up. With me as her father protector, she dared to recall occasional dreams and fantasies of oral sucking and sadistic impulses toward feminine men and finally to women. As she trusted me more she also dared to feel some primitive hatred and rage toward me. Earlier she could feel mild hostility to me as the critical father or the disapproving mother. Later she could hate me as the robber of her capital, her secret, and the valuable lump she felt she had inside her which gave her security. She could also love me as her good investment, her security for the future, her guarantee against emptiness, the man who gave her substance. At this time I was also her defense against penis envy by being the penis-man she possessed.
     At this stage of analysis, Mrs. K. was able for the first time to experience an orgasm during intercourse. This gave her the courage to become aware of strong homosexual feelings toward her baby daughter, which she could recognize as being a repetition with reversal of roles of her childhood impulses toward her mother. The fact that these impulses could be experienced without interfering with her capacity to obtain heterosexual orgasms if she so desired, enabled her finally to go through a violent phase of penis envy. She could hate me furiously as a possessor of a penis, who "only wanted a hole to stick his filthy thing in," who didn't give a damn for women, who impregnated them and deserted them. When the patient was able to express these feelings and find that I was neither destroyed nor antagonized she began to feel that I loved her and accepted her unconditionally and permanently--even when I did not agree with her. I had become a fixture inside her, reliable and permanent-a loving, parental, internal object. Now she could allow herself to become a full-fledged mother and wife and could work out her hate and love for her mother without feeling that this would overwhelm her. The case of Mrs. K. will be described in greater detail in Volume II.

     This brief sketch, as complex as it may seem to read, by no means does justice to all the transference reactions of the patient. It does indicate, I hope, how the patient's symptoms, conflicts, impulses, and defenses become focused on the analyst and on the analytic procedure and to a great extent replaced her original neurosis. The transference neuroses enabled me to observe and work on the patient's conflicts in the living present. Transference experiences are vivid, alive, and real and bring a sense of conviction unparalleled in psychoanalytic work.
     In his description of the transference neurosis, Freud (1914c) indicated that the patient's ordinary neurosis is "replaced" by the transference neurosis. Anna Freud (1928) concurs with this and insists that only a structure of this kind deserves the name of transference neurosis.

In the clinical material cited above, one can observe how during different intervals Mrs. K.'s involvement with me supplanted the original neurosis. For a period of time the patient's promiscuity impulses focused on me and were absent elsewhere. Her conflicts about losing control were intense during the analytic hour and concerned her fear of letting out dirty material, and hiding the "soiled" Kleenex. During this period her anal anxieties outside the analysis did not disappear, but they receded into the background. In my experience, that particular aspect of the patient's neurosis which becomes active and vivid in the transference situation will diminish in the patient's outside life. However, often it merely pales and becomes relatively insignificant compared to the transference neurosis-only to reappear in the patient's outside life when another constellation dominates the transference picture. For example, Mrs. K.'s promiscuity fantasies shifted to me exclusively for a period of time. However, when the analysis became focused on her toilet anxieties and shame, her obsessive-impulsive ideas about dark-skinned men returned.