Journal of the American Psychoanalytic

Association
http://apa.sagepub.com

Countertransference, Self-Examination, and Interpretation

Jean Roiphe
J Am Psychoanal Assoc 1999; 48; 571
DOI: 10.1177/00030651000480021601

The online version of this article can be found at:

http://apa.sagepub.com

Published by:

http://www.sagepublications.com

On behalf of:

American Psychoanalytic Association

Additional services and information for Journal of the American Psychoanalytic Association can be found at:

Email Alerts: http://apa.sagepub.com/cgi/alerts

Subscriptions: http://apa.sagepub.com/subscriptions

Reprints: http://www.sagepub.com/journalsReprints.nav

Permissions: http://www.sagepub.com/journalsPermissions.nav

Citations http://apa.sagepub.com/cgi/content/refs/48/2/571

Downloaded from http://apa.sagepub.com by ana carolina santos on October 26, 2009

jap a
Jean Roiphe 48/2

COUNTERTRANSFERENCE,
SELF-EXAMINATION, AND
INTERPRETATION

F red Pine introduced the panel with an excerpt from the essayist
and memoirist Vivian Gornick, who speaks from the vantage point
of the journalist about many of the issues familiar to us as analysts under
the rubric of countertransference: the attempt to know the other through
one’s own reactions, the danger of losing that knowing through too close
and identificatory a response to the other, and the need to refind the other
through achieving some distance once again.
Pine noted that we have shifted conceptually from viewing
countertransference as an interference to viewing it instead as a valu-
able source of knowledge and understanding about the analysand, a
shift made earlier with regard to our views of transference and resis-
tance. Pine asked the panelists to present clinical examples of their
approach to self-examination of countertransference, and of how this
may aid them in their understanding of the patient. He raised the ques-
tions of how we know when to rely on such aspects of our experience
of the patient, how central this form of knowing is to our analytic tech-
nique, and how we maintain our integrity and stability as analysts while
allowing ourselves to be open to this emotional reactivity within us.
Lawrence Epstein’s contribution to the panel focused on the “bad-
analyst” countertransference feelings that must be tolerated by the analyst
in working with a particular sort of patient whose defenses he charac-
terized as “implosive.” He spoke of a set of patients, “imprisoned in
their empathy for others,” who tend to deny or be selectively inatten-
tive to experiences of the analyst’s negative impact. Such patients feel
a need both to protect the analyst from their negative thoughts and

Panel held at the Fall Meeting of the American Psychoanalytic Association, New
York, December 19, 1997.
Panelists: Fred Pine (chair), Lawrence Epstein, Henry F. Smith, Elizabeth Bott
Spillius. Discussant: Glen O. Gabbard.

Downloaded from http://apa.sagepub.com by ana carolina santos on October 26, 2009

 Pa n e l R e p o r t

feelings, and to protect themselves from the analyst’s retaliation. These

patients present clinically as full of self-criticism and self-hatred, and as
prone to depressive mood swings and suicidal urges. Analytic exploration
of their developmental history tends to reveal early recruitment to serve
as a self-object for one or both parents. They have been the target
of parental projections and bad feelings, and simultaneously have
protected the object tie through imploding their own anger and hate,
never acknowledging or addressing the parent as the object at fault.
This leads to a massive resistance in these patients to experiencing
the analyst as anything but a good or neutral transference object, thus
precluding analytic work with the patient’s persecutory self- and object
representations. To counteract this therapeutic danger of impasse,
Epstein recommended that the patient’s use of the analyst as bad object
be actively facilitated through careful exploration of all regressive and
symptomatic behaviors as possibly resulting from neglect, mistreatment,
or failures of attunement by the analyst. To be able to work with such
patients in this way, Epstein noted that the analyst must be prepared to
tolerate countertransference feelings of being a “bad analyst,” to hear
572
the patient “ruthlessly fault the analyst,” without responding with retali-
atory interpretations or discharging the patient from treatment.
Epstein presented his work with one such patient, a forty-year-
old married woman lawyer whose depression and self-hatred had led
to three serious suicide attempts. A previous analysis had ended three
years earlier without improvement in her symptoms, an outcome the
patient presented as being entirely her own fault. She attributed her
experience of the first analyst’s disengagement from her as due to her
having become insufferably repetitious and boring. Epstein chose to
actively challenge these assumptions, stating that the fault lay with
her earlier analyst, and that if the new analysis were to fail that it would
be his own fault, not the patient’s.
Epstein noted in the analysis that the patient’s states of despair and
self-criticism were precipitated by interpersonal interactions in which
the patient felt she had been invalidated, ill-used, or treated dismis-
sively, yet she seemed unaware of the cause-effect relationship. When
the analyst pointed it out to her, the patient experienced shame and
humiliation, as she felt that there must be something terrible about her
that attracted the mistreatment and abuse. Gradually, the patient’s self-
attacks diminished. Epstein described how he would actively push her
to explore how his own behavior might have had a role in bringing about

Downloaded from http://apa.sagepub.com by ana carolina santos on October 26, 2009

 COUNTERTRANSFERENCE, SELF-EXAMINATION, INTERPRETATION

her negative self-states. In response, the patient began reluctantly to

reveal and explore her idea that Epstein was bored with her and pre-
ferred other patients. Increasingly the patient became better able to ini-
tiate such inquiry on her own. This was always accompanied by
self-deprecation, but also by a steady improvement in her symptoms.
During this three-year phase, Epstein was able to experience himself
as a “good analyst.”
A turning point occurred in the analysis when Epstein inquired of
the patient, who uncharacteristically delayed paying her bill, whether
he would be paid that day. The patient’s stunned and dejected response
left him feeling that he had committed a terrible atrocity. These feelings
led him to a countertransference-driven abandonment of his analytic
stance, in which he found himself trying to explain himself to
the patient rather than exploring her response. The patient, furious,
accused him of being, as her parents were, more interested in his
own needs than in hers.
This ushered in a period of several years in which the patient shifted
from blaming herself to ruthlessly faulting the analyst for his every
573
word, tone of voice, or silence. She found him either critical or with-
holding and indifferent. With this, she recovered many memories of
experiencing her parents in similar ways, though these memories did
not appear to help her differentiate the analyst from the persecutory
objects of her internal and external world. Instead she experienced
the analyst as just like her parents and felt hopeless and despairing at
being stuck with him. Epstein described himself as coming often to feel
trapped and to feel also that he was a truly bad analyst for her. He found
himself turning for sustenance to theory, particularly Winnicott’s
concept of object use (1969). His patient, he thought, needed to use
him as the “object not protected,” who survives without retaliating
or abandoning her. He also found himself reassured by the patient’s
steady progress in her life outside the analysis. The treatment finally
shifted as the patient came to realize that she had been reliving the
devastating impact of her mother’s narcissism in the transference, and
she became less focused on deficiencies in the analyst and in herself. As
further work toward termination was done, the analyst was able to
experience himself again as a “good-enough analyst.”
Epstein concluded by noting his view that it is (1) the analyst’s
ability to encourage such patients to become aware of their experience
of the analyst’s negative impact, and the (2) analyst’s capacity and

Downloaded from http://apa.sagepub.com by ana carolina santos on October 26, 2009

 Pa n e l R e p o r t

willingness to tolerate the “bad analyst” feelings this evokes, that pro-
vide the patient deep and enduring corrective emotional experience.
Henry Smith began his presentation by commenting that he adopts
a broad definition of countertransference. He regards it as a primary
source of data about the patient, one that simultaneously facilitates and
interferes with analytic listening. Following Brenner (1982), he views
countertransference as a manifestation of the analyst’s object relations
as they appear in reaction to the patient. Analyst and patient are
engaged in an intense, mutually responsive relationship in which all of
the analyst’s responses represent some combination of what the patient
uniquely evokes and the analyst’s own conflictual issues. Analytic lis-
tening is inevitably conflictual listening. Smith outlined his conception
of analytic work as serving a defensive function initiated by “signal
conflicts” that emerge from within as the analyst listens and responds
to the patient. A necessary immersion in the analytic process with
the patient means that the analyst’s observations are shaped by mutual
projective capacities.
Smith illustrated this point with the clinical example of his lis-
574
tening to a patient angry at his lover for not “being there.” Smith
described his experience of identifying both with the patient in his
abandonment and with the lover who was the object of the patient’s
anger. He noted, using Racker’s terminology (1972), that these simul-
taneous concordant (with the patient) and complementary (with the
patient’s internal objects) identifications occur in the analyst in a
dynamic balance.
Smith expressed his view that much of the literature on both enact-
ment and projective identification tends in different ways to oversim-
plify the countertransference experience. Illustrating with a clinical
example how patients often perceive correctly, but incompletely,
aspects of the analyst’s countertransferential response, he cautioned
that while the patient’s perceptions may match parts of the analyst’s
experience, they are not coterminous with it. The signal conflicts acti-
vated in the analyst lead to attenuated actualizations that both hinder
and facilitate the analytic work.
Using the term benign negative countertransference, Smith referred
to a certain irritation he often experiences in association with the patient’s
resistance to engagement. This feeling, which draws on aspects of his
own conflicts, also serves as an important signal regarding the state of
the relationship with the patient at that moment. Such a feeling, he

Downloaded from http://apa.sagepub.com by ana carolina santos on October 26, 2009

 COUNTERTRANSFERENCE, SELF-EXAMINATION, INTERPRETATION

suggested, is probably often present in analysts; indeed, he noted, Freud’s

own frustration and irritation with his patients’ resistances fueled the
development of his clinical theory.
Smith then presented in closely rendered detail an analytic hour in
which he viewed his countertransference responses, especially his irri-
tation, as tracing like a barometer the patient’s shifting presence and
absence within the session. Smith illustrated the ways in which he used
his own affects and associations to help him “f ind” the patient and
more fully understand her affective state. He explained that he has
come to regard transference and countertransference, in their complex
interweaving, as inseparable, and to think of the patient’s and the ana-
lyst’s experience together as the transference.
Elizabeth Spillius began her presentation with a wry commentary
on how the current American preoccupation with technique, as epito-
mized in the panel’s topic, appears from a British perspective. She
noted the shift that has occurred within American psychoanalysis from
the sense of certainty once afforded by a regnant ego psychology to
the new psychoanalytic pluralism ushered in by Kohut’s self psy-
575
chology and the waning of medical hegemony. With this shift, counter-
transference has taken on a new respectability; acting out is no longer
viewed as patient’s resistance or analyst’s error, but as “enactment”
and “role-responsiveness”; and the analyst’s “irreducible subjec-
tivity” and role as participant are not only accepted but celebrated.
Accompanying this trend is an increased interest in British views of
object relations, particularly the Kleinian approach. Spillius suggested
that from a British perspective certain American schools of thought
appear to have become more preoccupied with the analyst than with
the patient.
She went on to observe that in her way of working (and that of
most British analysts she knows) the analyst is aware of feeling tone
during the session but is not particularly aware of either theory or self-
understanding; self-examination typically occurs only when the session
is over. She noted further that in her view not all the analyst’s thoughts
during the session are evoked by the patient, and not all of the analyst’s
self-understanding will be clinically relevant. She cautioned that the
analyst’s impulse to act out should be controlled by analytic discipline.
Failures in this regard, while perhaps inevitable at times, are not in the
patient’s interest, even though they can sometimes be analyzed and
recovered from at a later point.

Downloaded from http://apa.sagepub.com by ana carolina santos on October 26, 2009

 Pa n e l R e p o r t

Spillius then presented an hour with a patient in order to examine

her use of theory and self-understanding as it emerged both during
and after the session. While the clinical material cannot be presented
here for reasons of confidentiality, Spillius’s conclusion was that the
resonance of her own experience with that of her patient, her counter-
transference response, was something that in this instance had led
her astray. Various sources of information, she noted, can lead her in
formulating interpretations. One such source is her theory, her Kleinian
and post-Kleinian ideas about technique and her views of projection
and introjection as the basis of interpersonal influence and com-
munication. Some interpretations appear to arise from “nowhere”—that
is, from unconscious insight. Others arise from her perception of simi-
larities between her patient’s experience and her own. With this patient,
she concluded, having reflected further on this session and on material
that emerged later, she felt that her countertransference-generated inter-
pretations, while not strictly incorrect, had distracted her from more
fundamental interpretations of the patient’s material, interpretations
that concerned experiences of a sort she did not have in common with
576
her patient.
Glen Gabbard began his discussion with the observation that
American psychoanalysis has over the past couple of decades witnessed
the decline and fall of the blank-screen analyst. Consequently, counter-
transference is viewed no longer as simply an obstacle to be removed,
but is regarded as a source of important data about the patient’s inner
world. We now conceptualize a semipermeable membrane between
analyst and patient across which affects and internal representations of
self and other flow. Projective identification, Gabbard suggested, might
be viewed as having eclipsed repression as an analytic concept.
Gabbard commented that the panelists had each offered a glimpse
into their approach to countertransference, allowing their similarities
and differences to be examined. He welcomed Spillius’s British per-
spective on the recent tendency within American psychoanalysis to
engage in navel-gazing. We must keep in mind, he said, that the
analyst’s efforts at self-understanding are in the service of understand-
ing the patient. He agreed with Spillius’s assertion that most self-
examination by the analyst takes place after the session, and endorsed
her cautionary view that what we experience as countertransferential
resonance with the patient may in fact turn out to be out of sync with
the patient’s internal experience.

Downloaded from http://apa.sagepub.com by ana carolina santos on October 26, 2009

 COUNTERTRANSFERENCE, SELF-EXAMINATION, INTERPRETATION

Gabbard underlined the difference between Spillius’s view that

“not all the analyst’s thoughts during the session are evoked by the
patient” and Smith’s view that every thought, feeling, or action within
the analyst at work is the product of something stirred both by the
patient and by the analyst’s own conflicts. Gabbard wondered whether
Sandler’s concept of role-responsiveness (1976), whereby analysts take
on roles attributed to them in the transference (or ignore, reject, or
actively defend against this), may in part bridge the differences between
Smith’s and Spillius’s positions.
Gabbard agreed with Smith’s view of transference and counter-
transference as fundamentally inseparable, a position held also by
Loewald and Ogden. He underscored Smith’s observation that much
of the literature on countertransference is reductionistic in its focus
on partial or surface aspects of the analyst’s complex experience of
the patient. As Smith indicated, given this complexity, simple self-
disclosures by the analyst may in fact misrepresent the analyst’s
experience.
Gabbard saw Smith as recognizing that the analyst’s observations
577
are shaped by mutual projective capacities, but as stopping short of
acknowledging countertransference as bidirectional. Viewing counter-
transference as only reactive, said Gabbard, risks polarizing the
analysand’s role as initiator and the analyst’s as reactor. He pointed to
relational thinkers such as Hoffman and Aron, who stress the insu-
perable difficulty of sorting out who initiates an interactional sequence.
According to them, both patient and analyst initiate a sequence, and
each reacts to the other.
Gabbard asked the panelists to give their views on the relationship
between countertransference and the analyst’s subjectivity, and to say
whether they agree that countertransference is simultaneously initi-
ating and reactive. He asked whether they think it possible to separate
the patient’s contribution to the countertransference from their
own. Gabbard himself felt that this is difficult, but possible through
observing patterns within the process over time.
Commenting on Epstein’s presentation, Gabbard noted his contri-
bution to an understanding of how hate and aggression function in the
analytic setting. Gabbard felt that Epstein’s ability to stand his ground
with the patient he presented, and to demonstrate his durability, enabled
her to work through her devastating childhood experiences. The analyst
must be able to bear being the bad object and must not attempt to

Downloaded from http://apa.sagepub.com by ana carolina santos on October 26, 2009

 Pa n e l R e p o r t

escape this role through premature interpretation; the patient must be

allowed to see that such feelings are tolerable and survivable. Gabbard
saw Epstein as taking a view similar to Smith’s contention that trans-
ference and countertransference are inextricably linked.
Finally, Gabbard commented on the emotional vulnerability of
the analyst within the analytic situation, which Epstein’s presentation
poignantly illustrated. Gabbard noted as relevant in this regard Smith’s
observation that the work of analyzing inevitably serves a defensive
function for the analyst. The act of analyzing can be viewed as a series
of unmentalized enactments from which we must continuously learn in
order to place the patient’s needs before our own.
In the informal discussion that followed, Epstein stressed that his
monitoring of his countertransference is in the service of providing a
holding environment that can allow the patient to get better. Epstein
stated that he sees analysis as providing a corrective emotional experi-
ence, despite the disrespect with which that concept is often viewed.
Further, he takes an interpersonalist view, in his focus on what hap-
pens between patient and analyst. He sees himself as learning from the
578
patient about his countertransference.
Smith clarified that he does see countertransference as bidirec-
tional: it both initiates and reacts. He responded to the questions posed
by Gabbard by noting that he views countertransference, as Boesky
does, as a subset of the larger concept of the analyst’s subjectivity.
Smith said that though we can separate out what in our counter-
transference is a reaction to the patient, as against something from our-
selves, we can never do so fully, and certainly not while we are in the
hour or when we confine ourselves afterward to reflection on that ses-
sion alone. He expressed the concern that the panel had not stressed
sufficiently the point that countertransference is but one source of data
within the hour, and that the predominant activity of the analyst is the
more deliberate cognitive examination of the patient’s associations.
Spillius agreed with this emphasis that not everything is counter-
transference, and cautioned that the balance of the analytic process gets
distorted if any one element of it becomes too central. She distin-
guished her way of working from Epstein’s approach. In particular, she
felt that his announcement at the beginning of the analysis—that it
would be his fault were the analysis to fail—takes too much away from
the patient. Epstein responded that he knows this is a criticism that
many would make, but he sees himself as working with a particular

Downloaded from http://apa.sagepub.com by ana carolina santos on October 26, 2009

 COUNTERTRANSFERENCE, SELF-EXAMINATION, INTERPRETATION

population of patients with very embedded resistances, and that he has

discovered through trial and error that this is what works with them.
In questions and comments from the floor, Peter Blos Jr. expressed
regret that no child analyst was on the panel, noting the intensity and
immediacy with which transference-countertransference situations
present themselves in work with children and adolescents. He cited
examples of the six- or seven-year-old who remarks, “If you say one
more word, I’ll throw up,” or the adolescent who threatens to hurl an
ashtray out the window. Jack Ensroth queried Epstein as to how long
one should endure being attacked by a patient, and how one can know
when it may be more productive to confront the patient with this behav-
ior. Epstein replied that for him an important criterion is whether the
patient is progressing in his or her outside life. He noted that to some
extent this is a matter of what the analyst can personally tolerate.
Another comment from the floor touched on this issue of whether one
is doing enough in “containing” the patient’s hostility, or whether one
needn’t at some point confront the patient and interpret the hostile
projections. Spillius noted that in her view Epstein’s patient was pro-
579
jecting helplessness, not aggression. She stressed that projection is not
simply or at bottom a means of attack; rather, it is an attempt to get rid
of an aspect of oneself that is too intolerable to contain. Epstein’s
patient, through her expression of aggression, was trying to get rid of
the helpless child aspect of herself by projecting it into the analyst,
beating him up more or less as she felt her mother had done to her.
Spillius noted that it can be helpful to interpret both the attacking and
the communicative aspect of projection to the patient—that is, the
patient’s attempt to express something to the analyst not just through
words but through making the analyst know what her experience feels
like for her.
Finally, at the urging of several panel members, Jacob Arlow came
to the podium briefly to present his thoughts on the panel’s topic. He
drew a distinction between empathy, which is stimulated as a response
to the patient’s productions, and true countertransference, in which the
analyst uses the patient as an object. He noted that we had all been able
to identify empathically with Epstein’s experience of his assaultive
patient and her severe oral incorporative aggressive wishes toward her
mother. This is not a countertransference response, Arlow insisted, if
it does not involve a conflictual foisting off onto the patient of some-
thing of our own. In the transference, a patient foists upon the analyst

Downloaded from http://apa.sagepub.com by ana carolina santos on October 26, 2009

 Pa n e l R e p o r t

a derivative of an unconscious fantasy, as a result of which the former

misinterprets and misreads his or her experience. A true counter-
transference must involve a similar process: the patient must be the
object for the analyst of a persistent unconscious fantasy wish domi-
nating some part of the analyst’s fantasy life over years. Arlow
stressed that empathy is not countertransference, and noted that we
must use cognitive criteria to decide whether our response to the
patient is correct.

REFERENCES

B RENNER , C. (1982). The Mind in Conflict. New York: International

Universities Press.
R ACKER , H. (1972). The meanings and uses of countertransference.
Psychoanalytic Quarterly 41:487–506.
S ANDLER , J. (1976). Countertransference and role-responsiveness.
International Review of Psychoanalysis 3:43–47.
WINNICOTT, D.W. (1969). The use of an object. International Journal of
Psycho-Analysis 50:711–716.
580

40 East 83rd Street

New York, NY 10028
E-mail: [email protected]

Downloaded from http://apa.sagepub.com by ana carolina santos on October 26, 2009