ABSTRACT
In the course of analytic treatment, the analyst experiences many strands of counter-transference conflict which are the result of complex transference dynamics. Projective identification often plays a significant role in their intra- psychic and interpersonal interactions. Due to the intensity of some patients’ projective efforts, these counter-transference moments of imbalance include periods of deep immersionwithin the patient’s emotional struggleswith love, hate,andknowledge(Bion1965,1967)inwhichdesire,aggression,andlearning are part of complicated internal battles. In these clinical situations, the analyst is pulled into various enactments and often becomes caught up in a numberofspecificcounter-transferencepatternsthatparallelthepatient’sunconsciousworld.Whenexaminedclosely,thesecounter-transferencestrugglesand associatedactingoutarevaluablesignpoststowhatthepatientisunabletotolerateoremotionallyshare.Instead,theyfeelcompelledtodiscard,disguise,ordischargetheirphantasiesandconflictsintotheanalyst. AsGrinberg(1990)notes,thiscanbetocommunicate,topreserve,torepair, to evacuate, to control, or to destroy. Iwould say this is only a partial list of unconsciousmotives thatunderlieprojective identificationand its foundational roleinshapingthetransference.Understandingourplaceinthepatient’sinternal worldbygraduallymakingsenseandmeaningofourcounter-transferencecan leadtohelpfulinterpretationsandareductionofanxietyandactingoutforboth parties. Asaresultofthesedirectandstrongunconsciousmaneuversofthepatientto either locate themselves in theanalyst’smindor tobring theanalyst into their mind in some capacity, the analyst may have moments or extended periods of being caught up in a paranoid (Klein 1946) or depressive (Klein 1935, 1940) counter-transferenceexperience.Thiswillshapeanddirecttheanalyst’smethod ofinterpretingandofrelatingtothepatient.Whileoftenunavoidable,thismay lead to upheavals in or disruptions of the treatment. If the analyst can become awareoftheseclinicalsoftspots,thereisachancefortheanalysttograspsome understanding and then attempt topass that learningon to thepatient through interpretations. This is an attempt, while immersed in the projective counter- identification(Grinberg1990),atdecodingwhatthepatientistryingtodowith
theanalystandtobegintotranslatethattothepatient.Wetrytofindwherewe arebeinglocatedinthepatient’smindandwhatroleweplayintheircorephantasy,andwebegintotalkaboutthatwiththepatientinsteadofsimplyfulfilling our role in the unconscious historical script. This process may not always decrease the patient’s intense anxiety, continuous acting out, or early termination, difficulties all so commonwithmore borderline or narcissistic patients, but it is a way of possibly conveying the hidden meaning or lost communication to the patient. This can momentarily reduce anxiety and provide a sense of hope or temporary trust which may preventacompletecollapseofthetreatment.Ifwearelucky,itmaybuyusmore timetopossiblyestablishamoresecuretherapeuticfooting. In order to be the best possible analyst and truly hear the hidden and distorted messagesthatourpatientsconveyonaconscious,unconscious,andinteractive level,wemusthaveanextrasensitivitytohowothersrelatetousinterpersonally andpsychologically.Wemusthaveanability tounderstandhow thematchor mismatchoftwopartiestakesplace,includinghowwecontributetoitspositive ornegativeflavor. This extra sensitivity is crucial for the analyst to have but may also be a liability in certain circumstances. Especially with the more difficult patient who presentsapressing, thorny,and intense transference,oursensitivitymaybring us into overwhelming, confusing, or painful states of counter-transference. In somesense,thisisunavoidablewhenworkingfromadeeppsychoanalyticperspective.Therealityoftheclinicalsituationisthatwearealwaysimmersedto some degree in the psychological conflict that unfolds in the transference. Throughprojectiveidentification,wearealwayspulledintothepatient’sinternal experienceofselfandotheratsomelevel(Gabbard2004).Thismaymeanwe experiencewhat thepatient feelsorwemay step into the roleof thepatient’s object(Racker1957).Eitherway,itisrarethatwearenotinsometypeofenactmentbecauseofwhatIcalltheimmersionprocessinherentinthepsychoanalytic process. When the patient’s projective identifications shape and color our counter- transference, we enter into close contact with the patient’s core unconscious phantasylife.Thisphantasylifeisaninternalexperiencethatemergesinterpersonallyattimes,bringingexternalrepresentationtointernal,unconsciousobject relationships between self and other that underlie allmental processes. These phantasies are the expressionof conflicts anddefenses surrounding love,hate, andknowledge.Theseelementsofhumanstruggleanddesirearewhatpsychoanalytic treatment hopes to bring intomore conscious awareness and result in integration. The immersion process is critical to and unavoidable in the psychoanalytic process.Webecomeveryfamiliarandoftenidentifywiththepatient’sinternal objects.MelanieKleinhasoutlinedhowthroughoutlifethesubjectprojectstheir variousfeelingsandthoughtsaboutselfandotherontotheirvaluedordespised object and then internalizes the combination of reality and their distortion back
inside.Thisstartsanothercycleofunconsciouscopingandreactiontothatnew internalobjectwhichisthenprojectedagain.Thus,thereisanever-endingrecyclingofone’svisionofselfandotherthatoneiscontinuouslyorganizing,relating, and reacting to, both externally and internally, both intra-psychically and interpersonally. Intheparanoid-schizoidposition,theseinternalobjectsareoftenfragmented part objects rather than themore integrated whole objects experienced in the depressive position. The paranoid-schizoid position is a more immature, primitive state ofmindwhichMelanieKlein encountered in her patients, a state in whichobjectsandtheselfareexperiencedinone-dimensional,black-and-white tones that involve splitting and more rudimentary psychic functioning. This bluntedstateofmindisdominatedbyprojective identification,splitting, idealization,anddevaluation, leaving the subject feelingpersecutedandabandoned by bad objects or united with and loved by idealized objects (Hinshelwood 1989). The paranoid-schizoid mode is usually found in more borderline, narcissistic, or psychotic patients butwe all existwithin thismode to somedegree or can easily regress to it under tryingcircumstances.Kleinbelieved that thehealthy transition from theparanoid-schizoid experience tomorewhole-objectdepressivefunctioninghadmuchtodowiththeconstitutionalbalanceofthelife-anddeath instincts and the external conditions of optimalmothering. The primary anxietyinthisprimitivepositionhastodowithsurvivaloftheselfratherthan concern for the object. Ontheotherhand,thedepressiveposition,arealmofpsychologicalexperience also discovered by Klein, is characterized more by the realization of dependentandhatefulfeelingstowardsthelovedobject,producingguiltandfear of loss. As opposed to earlier paranoid phantasies of ideal and loved objects versusothermorepersecutoryandhatedobjects,nowthesubjectfacesthedifficult realityofwholeobjects towardswhichonehasavarietyof feelings.This creates ambivalence, anxiety, and the desire to repair, restore, and rescue the injured other. Anxiety is still about the survival of the self if abandoned or punishedbytheoffendedandhurtobject,butnowtheanxietyismuchmoreabout thewell-beingoftheobject.Obsessiveandmanicdefensescomeintoplayand projectiveidentificationphantasiesaremuchmoreabouttherelationshiptothe object as opposed to the stark division of self and other found in the paranoid position. Ourmoredisturbedordifficultpatientsstrugglewithwantinga lovingcontainerandyetdespisingtheideathattheyneedacontainer.Thereasonsforthis volatile tension include the fury and sadness of never having one, the idea of onlynowfinallyfindingoneafteralifelongabsencetriggeringpain,resentment, and sorrow, and finally, the loss and desperate envy that is evoked in seeing someone else able to provide a container because this must mean this other person already has access to their own soothing container. In the counter- transference,theanalystmaystruggletoupholdthevalueofbeingacontaineras
theyrepeatedlyfeelunused,unwanted,oraggressivelypreventedfrombeinga helpfulorhealingcontainer. Instead, it is not uncommon for these more emotionally combative and turbulent patients to use the analyst as a vendingmachine to simply put in a coin, pushabutton,andgettheirexpectationsmetondemand.Ifwedon’tconformto these demands and go alongwith this devaluing process, the patient becomes angry or feels completely misunderstood and abandoned. In these situations, there are often counter-transference feelings that evoke these very images of beingusedasadisposablecontainerwithoutanykindofenduringvalue,much likeaspittoon,ashtray,oratoilet.Afterusingusinthismanner,someofthese patientsliterallywalkaway.Theyhavewhattheywantandwefeelcompletely devalued, destroyed, or defaced. Clinically, it is very important to understand exactlyhowandwhythesepatientsarefindingtheirwayintoourmindsandthe details ofwhy theywant or need to use andmisuse us in these specificways (Joseph1985,1987,1988,1989;Segal1987).
