Transference, Countertransference and Projective Identification

1. Transference, CountertransferenceandProjective Identification Wayne Mason 25 November 2009

2. Unconscious Communication “It is a very remarkable thing that the (system) unconscious of one human being can react upon that of another, without passing through the (system) conscious.” (Freud 1915 The Unconscious P194)

3. Transference • Essentially it is an emotional relationship with the therapist that has its origins in the patient’s past rather than in their relationship in the present. • At times this will be very obvious, and at other times it will be subtle and may take a long period of time to manifest. • The patient is unaware of it.

4. Countertransference • “All the feelings which the analyst experiences towards his patient” • “The analyst’s counter-transference is an instrument of research into the patient’s unconscious” • What goes on in the analyst MAY be caused by what is going on in the patient

5. Projective Identification • ‘Notes on some Schizoid Mechanisms’ Melanie Klein 1946. • ‘The Concept of Projective Identification’ Joseph Sandler 1987 • ‘The “Splitting/Trauma” pairing: Ferenczi and the Concept of Trauma’ Thierry Bokanowski 2009

6. Notes on Some Schizoid Mechanisms 1 • Very early paranoid and schizoid anxieties • By inference from material gained in the analyses of adults and children plus psychiatry • In early infancy anxieties characteristic of psychosis arise (NOT - all infants are psychotic) • These psychotic anxieties, mechanisms and ego defences have a profound influence on development (ego, superego and object relations)

7. Notes on Some Schizoid Mechanisms 2 • Object-relations exist from the beginning of life • Ego and Superego built up in first 6 months • Splitting gives rise to: • Good breast via introjection and love • Bad breast via projection and hate • The destructive impulse (death instinct) is turned against the object • Oral and anal sadistic attacks give rise to persecutory fears of retaliation

8. Notes on Some Schizoid Mechanisms 3 Early ego defences • Splitting of Object and Impulse • Idealization • Denial of inner and outer Reality • Splitting of emotions

9. Notes on Some Schizoid Mechanisms 4 Anxiety Contents • Fear of being devoured • Fear of being poisoned

10. Notes on Some Schizoid Mechanisms 5 • Early Ego “the early ego largely lacks cohesion, and a tendency towards integration alternates with a tendency towards disintegration, a falling into bits. I believe that these fluctuations are characteristic of the first few months of life.”

11. Notes on Some Schizoid Mechanisms6 “Anxiety arises from the operation of the death instinct within the organism, is felt as fear of annihilation (death) and takes the form of fear of persecution.” This “is experienced as the fear of an uncontrollable overpowering object.” These become internal persecutors through introjection and thus reinforce the fear of the destructive impulse within.

12. Notes on Some Schizoid Mechanisms 7 “I believe that the ego is incapable of splitting the object – internal and external – without a corresponding splitting taking place within the ego. Therefore the phantasies and feelings about the state of the internal object vitally influence the structure of the ego.” “It is in phantasy that the infant splits the object and the self, but the effect of this phantasy is a very real one, because it leads to feelings and relations (and later on, thought processes) being in fact cut off from one another.”

13. Notes on Some Schizoid Mechanisms 8 • Projection – helps the ego overcome anxiety by ridding it of badness. • Introjection – the good object is taken in by the ego as a defence against anxiety. • Splitting – gratification leads to loving feelings towards good breast while frustration leads to hatred and persecutory anxiety regarding the bad breast. These “breasts” are kept separate.

14. Notes on Some Schizoid Mechanisms 9 Idealization – based on splitting; good aspects of the breast are exaggerated in order to protect against the persecutory breast. It involves DENIAL of both frustration and persecution. This is infantile hallucinatory gratification. Denial – the bad object is not only kept apart but its very existence is denied.

15. Notes on Some Schizoid Mechanisms 10 Omnipotence/Omnipotent Denial Not only an object and a situation are denied and annihilated, but also an object-relation, which means part of the ego. In early phase splitting, denial and omnipotence equate to repression at a later stage of development.

16. Notes on Some Schizoid Mechanisms 11 • Libidinal ad aggressive desires • Oral – suck dry, bite up, scoop out, rob – contents of mother’s body. • Anal/Urethral – expel dangerous substances into mother’s body. • Split-off parts of ego are projected into mother’s body to injure, control and take possession. • Mother not felt to be separate but part of self.

17. Notes on Some Schizoid Mechanisms 12 “Much of the hatred against parts of the self is now directed towards the mother. This leads to a particular form of identification which establishes the prototype of an aggressive object-relation. I suggest for these processes the term ‘projective identification’. When projection is mainly derived from the infant’s impulse to harm or control the mother, he feels her to be a persecutor.”

18. Notes on Some Schizoid Mechanisms 13 “As far as the ego is concerned the excessive splitting off and expelling into the outer world of parts of itself considerably weaken it. For the aggressive component of feelings and of the personality is intimately bound up in the mind with power, potency, strength, knowledge and many other desired qualities. It is however not only the bad parts of the self which are expelled and projected, but also the good parts of the self.”

19. Notes on Some Schizoid Mechanisms 14 “The processes of splitting off parts of the self and projecting them into objects is thus of vital importance for normal development as well as for abnormal object-relations. The effect of introjection on object-relations is equally important. The introjection of the good object, first of all the mother’s breast, is a precondition for normal development.”

20. Sandler 1 • Notes PI is a confused concept. • Starts from Hanna Segal’s 1973 description. • He notes its role in counter-transference. • He notes Bion’s container-contained theory. • He quotes Ogden who described it as the pathway from the intra-psychic to the interpersonal. • He presents his attempt to digest PI.

21. Sandler 2 First Stage of Projective Identification Processes which only occur in fantasy in the child’s representational world. Projection is a displacement in which aspects of the self-representation are shifted to an object-representation. Identification is a “taking-into” the self-representation aspects of an object-representation.

22. Sandler 3 Second Stage of Projective Identification In this stage the therapist is induced to have particular counter-transference feelings through the impact of the patient’s PI. He makes reference to the writings of Heimann, Racker and Grinberg. This is an extension of Klein’s ideas beyond unconscious phantasy to the interpersonal.

23. Sandler 4 Third Stage of Projective Identification This is Bion’s extension of PI in his theory of container-contained. Projections are metabolised by the object (mother or therapist) i.e. modified by the thought (reverie) of the object, and then returned in a more tolerable and assimilable form.

24. Bokanowski 1 • Deals with clinical observations originally proposed by Ferenczi between 1927 and 1933. • Ferenczi spoke of the “psychic rape” of the child by the denial or invalidation of the child’s affects or thoughts by the adult. • This resulted in a “narcissistic splitting of the self.”

25. Bokanowski 2 • Ferenczi was aware of the capacity of the analyst to traumatize the patient by technical rigidity, failure to understand, or absence. • He saw elements of classical technique as a replay of the original traumatisation. • The resultant “narcissistic splitting” leads to evacuation/ expulsion/ extra-jection of part of the ego.

26. Bokanowski 3 • Ferenczi recognized the need for an adaptation of classical technique • He recognised that patients sensitive to fragmentation had been traumatised – usually by an absence – pre-verbally. • He recognised how this happens between therapist and patient in a session and what is required to correct it – i.e. the therapist’s understanding.

27. Bokanowski 4 Bokanowski and Ferenczi bring to our attention the fact that these fragmentations of the ego or self arise – not through the operation of the death instinct – but through entirely understandable interpersonal events in childhood which get replayed (in my opinion through projective identification) in our consulting rooms on a daily basis. They are unavoidable and they represent opportunities to work on the difficulties in the here and now.

28. Bokanowski 5 I think Bokanowski brings to our attention via the writings of Ferenczi the need for us to listen attentively, to recognize when we have re-traumatized a patient, and to proceed without guilt to deal with this openly with the patient. Only in this way can we implement Sandler’s third stage of projective identification in re-integrating the patient’s fragmented ego.