Int J Psychoanal 2003; 84:10171041 EDUCATION SECTION

Analysis of transference:
A North American perspective
H ENRY F. SMITH
17 Hammond Street, Cambridge, MA 02138-1915, USA henryfsmith@cs.com
(Final version accepted 11 February 2003)

Using detailed clinical vignettes, the author illustrates and compares several North American
approaches to the analysis of transference, tracing their origins in Freuds works and in various post-
Freudian conceptualizations, including the writings of Anna Freud and Charles Brenner. Particular
attention is paid to the work of Merton Gill, Evelyne Schwaber, Paul Gray, and the British analyst,
Betty Joseph. Discussed and illustrated are controversies over the broader and narrower views of
transference, the interpretation of action in the analytic setting, earlier and later interpretations of
transference with particular emphasis on the contrast between contemporary Kleinian and ego
psychological perspectives, the role of extra-transference interpretation, and the concept of the
transference neurosis. An argument is made for an integrative approach, drawing upon different
emphases, depending on the clinical circumstances and the point of affective immediacy for the
patient, which may or may not coincide with the point of affective immediacy for the analyst.

Keywords: transference, transference neurosis, enactment, extratransference interpretation

Contemporary approaches to the analysis of transference cannot be examined outside of the

many de nitions of the concept that have evolved over the years. I will begin by highlighting
some conceptualizations that I understand to have been particularly in uential on clinical work in
North America. The positions on which I will focus can all be traced to different strains in Freuds
writings on transference from 1895 to about 1920, after which he had little to add to the subject.

Freudian origins of transference

As with many of Freuds theoretical discoveries, his elaborations of the concept of transference
were attempts to understand the cause of clinical failure and frustration. Following his
preliminary references to transference in a purely neurophysiological sense, his rst mention of
the term as we use it today followed Anna Os dramatic erotic response to Breuer, which sent
Breuer back to neurology and Freud into his initial conceptualization of the false connection
made by the patient between a person who was the object of earlier, usually sexual wishes and
the gure of the physician (1895, p. 302).
Doras ight from treatment led to Freuds (1905) next attempt at de ning the problem of
transference. Viewing it primarily as a resistance to the treatment, he distinguished two types of
transferences: (1) those that differ from that of their model in no respect whatever except for the
substitution, which, using an analogy to the publication of books, he called new impressions or
reprints; and (2) others that take advantage of some real peculiarity in the physicians person or
circumstances, resulting not in new impressions, but revised editions (p. 116). The implications
of this distinction have reverberated through the work of all major transference theorists; that is,
to what extent is transference purely imposed, a distortion of the reality of the analyst, and to
what extent does it draw upon the analysts idiosyncrasies?

2003 Institute of Psychoanalysis

1018 HENRY F. SMITH

Freud elaborated on this latter position in his postscript to the Dora case:
Now, I ought to have said to her, it is from Herr K. that you have made a transference on to me.
Have you noticed anything that leads you to suspect me of evil intentions similar to Herr K.s?
Or have you been struck by anything about me or got to know anything about me which has caught
your fancy, as happened previously with Herr K.? Her attention would then have been turned to
some detail in our relations, or in my person or circumstances, behind which there lay concealed
something analogous but immeasurably more important concerning Herr K. (p. 118).

Freud was clearly groping here for a way to convert his new discoveries into an intervention
that might have made sense to his young patient, and it may sound clumsy to our ears, but his
emphasis on the actual person of the analyst has a peculiarly contemporary ring, at least in North
America, where such issues have become a point around which, as we shall see, many of the
current views of transference divide.
Not long after establishing transference as a resistance, Freud began to see it as a therapeutic
agent of the treatment. In fact, he conceded that what seems ordained to be the greatest obstacle
to psychoanalysis, becomes its most powerful ally (1905, p. 117). Soon he elaborated on this
position: Every con ict has to be fought out in the sphere of transference (1912, p. 104)
because, when all is said and done, it is impossible to destroy anyone in absentia or in ef gy
(p. 108). This emphasis on the central importance of transference analysis anticipated work by
Strachey in the UK and, considerably later, by Bird and Gill in the US, among others.
Freud viewed transference as an ally in yet another sense. He judged that the positive
transference, which he called the benign or unobjectionable positive transference, was essential
to sustain the patient in the dif cult work of analysis. In addition to the unobjectionable positive
transference, Freud also identi ed another form of positive transference, one that he deemed a
source of formidable resistance, namely the erotic transference.
In his paper on transference love, Freud discussed a particular dif culty he encountered in
the analysis of the erotic components of the transference:
It is just as disastrous for the analysis if the patients craving for love is grati ed as if it is
suppressed. The course the analyst must pursue is neither of these; it is one for which there is no
model1 in real life. He must take care not to steer away from the transference-love, or to repulse
it or to make it distasteful to the patient; but he must just as resolutely withhold any response
to it. He must keep rm hold of the transference-love, but treat it as something unreal
(1915, p. 166).

In my view, these guidelines apply to all transference analysis and to a paradoxical balance the
analyst must strike between regarding the transference to be as real as any other experience in
lifeone might say, it is what makes reality feel realand, at the same time, as a displacement
or projection of the patients internal experience and, hence, an imposition on the gure of
the analyst. However ubiquitous the transference may be as a component of all perceptual
experience, its analysis depends upon the capacity to glimpse the illusory quality of our own
inner lives, to sense the distinction between reality and illusion, and to appreciate the manner
in which we shape experience from our own psychic reality. This is a perspective we hope the
patient will develop and sustain, sometimes referred to as an appreciation for the as-if quality
of transference, and it is one that the analyst must always keep in mind in order to acknowledge
his or her own contributions to the patients transference.
In his papers on technique, Freud wrote again about the management of the transference

1
Strictly speaking, I believe Freud was wrong that there is no model in real life. The clinical management he is describing might
be compared to the way a parent handles the loving, erotic entreaties of a young child. Someday I will marry you, Mommy
necessitates a similar balancing act on the parents part, keeping a hold on reality without repulsing the childs experience.
 ANALYSIS OF TRANSFERENCE 1019

and introduced another concept, the very existence of which is much debated in North America
today, that of the transference neurosis:
We admit [the compulsion] into the transference as a playground in which it is allowed to expand
in almost complete freedom 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 thus creates an intermediate
region between illness and real life through which the transition from the one to the other is made
(1915, p. 154).

Later he clari ed his de nition of this entity, when he commented that the patient is
obliged to repeat the repressed material as a contemporary experience instead of, as the physician
would prefer to see, remembering it as something belonging to the past. These reproductions
are invariably acted out in the sphere of the transference, of the patients relation to the physician.
When things have reached this stage it may be said that the earlier neurosis has now been replaced
by a fresh, transference neurosis (1920, p. 18).

Friedman has pointed out that, whereas Freuds initial interest in psychoanalysis was on the
recovery of memory and the resistances to doing so, in his papers on technique he was beginning
to view analysis as a passionately committed experience (Friedman, 1991, p. 564) and, we
might note, an engagement between two people in which transference plays an increasingly
central role. Much of the current debate over the management of the action component of
the work, referred to in the contemporary literature variously as acting out, acting in, and
enactment, owes its origins to this period of Freuds work.
Freud articulated his own recommendations concerning the approach to action in the
transference not only in his paper on transference-love, but also in his discussion of working
through. Thus in 1914, at a time when he was concerned with the way the patients actions would
obscure the recovery of his memories, he wrote,
Only when the resistance is at its height can the analyst, working in common with his patient,
discover the repressed instinctual impulses which are feeding the resistance The doctor has
nothing else to do than to wait and let things take their course, a course which cannot be avoided
nor always hastened (p. 155).

It was Freuds view that, over time, interpretations directed at the repressed impulses
would allow the patient to become more conversant with this resistance to work through it, to
overcome it, by continuing, in de ance of it, the analytic work according to the fundamental rule
of analysis (p. 155). This represented Freuds more optimistic side, that eventually the light of
the intellect would shine through the darkness imposed by the patients con ictual issues. Over
the next several decades, however, Freuds increasing pessimism about the dif culties posed by
the role of repeated action in the transference contributed to his formulations of the repetition
compulsion and the death instinct. While Freuds view that thought, or memory, and action are
inversely related is now widely disputed, much of our more recent focus in North America on
the action components of the work as a valuable source of data derives from Freuds elaboration
of its role as a formidable resistance at this time.

Post-Freudian developments
As with many analytic concepts, in the years since Freud there has been a general broadening of
the concept of transference, resulting in a loss of precision (Sandler et al., 1973). Nevertheless,
all of the post-Freudian elaborations of the concept, both in their broader and narrower forms, can
be seen to derive from different strains in Freuds initial clinical and theoretical deliberations.
1020 HENRY F. SMITH

The narrower view of transference

In 1936, Anna Freud de ned more precisely several varieties of transference phenomena, which
she classi ed as: (1) transference of id impulses; (2) transference of defense; and (3) acting in
the transference.
Her notion of the transference of id impulses was roughly comparable to her fathers
early view of transference. As Anna Freud saw it, the patient transfers undistorted infantile id
impulses, which become subject to a censorship on the part of the adult ego secondarily (p. 19).
Notice that this de nition is based, in part, upon the topographic model with its discrete censors.
Since Freud wrote very little about transference after 1920, we do not know whether her
father agreed with the second and third types of transference his daughter described, but it is
likely that he did (see Brenner, 2000). Anna Freuds delineation of the transference of defense
and its management has had a major in uence on psychoanalytic technique. As she viewed this
form of transference, the patient transfers id impulses in all those forms of distortion which took
shape while he was still in infancy (1936, p.19), thus giving expression to the impulse or affect
in the only way still open to him, namely, in the distorted defensive measure (p. 20). To manage
such transferences, she advocated a shift in the analysts focus of attention from the instinct
to the speci c mechanism of defense, i.e. from the id to the ego (p. 20).
This suggestion, which was highlighted by Kris (1938) in his review of her monograph,
and later by Sterba (1953), has given birth to many current trends in the analysis of the
ego, including, most recently, Grays recommendation that the proper foci for the analysts
attention are the moments of con ictual interference that can be observed in the patients
train of associations, through which both the analyst and the patient can come to know the
unconscious defensive activities of the ego. Gray, in fact, bases much of his technique on the
shift in attention Anna Freud proposed, although it is questionable whether she was advocating
as radical a revolution as Gray implies. Her recommendation applied speci cally to the analysis
of transferences of defense, which, to be sure, she regarded as the more fruitful (1936, p. 21)
focus for interpretation. Even though defense analysis was soon to become the dominant strain
in North American psychoanalysis, the analysis of the drives still held a place in her repertoire.
That Anna Freuds view remained carefully balanced is indicated by her often-quoted
suggestion that the analyst should direct
his attention equally and objectively to the unconscious elements in all three institutions. To put
it in another way, when he sets about the work of enlightenment, he takes his stand at a point
equidistant from the id, the ego, and the superego (1936, p. 28).

Among ego psychologists her precept had, before long, become the benchmark de nition of
analytic neutrality. It is not clear when this occurred, although Gray cites it in his seminal 1973 paper.2
Frequently overlooked is the fact that Anna Freud was not attempting to de ne neutrality at the time,
nor does the term neutrality appear anywhere in her monograph. As I have noted previously,
it would seem that ego psychology, seeking a more precise de nition for a term loosely introduced
in the topographic era, adopted Anna Freuds view of the analysts attention to clarify a concept
for which it was never intended. In other words, a precept without a name was grafted onto a term
without a de nition, and it then became the gold standard (Smith, 1999, p. 470).

Notice that Anna Freud was, in fact, situating the analysts focus of attention among the
various components of con ict, and, as such, her view bears a striking resemblance to Brenners

2
One of the determinants of the analysts perceptual focus will be the particular form of his neutral position. Anna Freuds
(1936, p. 28) observation that the analyst takes his stand at a point equidistant from the id, the ego, and the superego has
been virtually the only explicit guideline for over 35 years (Gray, 1973, p. 478).
 ANALYSIS OF TRANSFERENCE 1021

(1982, 1994, 2002) later writings. Even though Brenner advocates abolishing the terms id, ego
and superego, he no less strongly proposes giving equal and simultaneous attention to all the
components of con ict, which he de nes as wish, defense, self-punishment and unpleasurable
affect. This effort to divide the analysts attention, giving due consideration to all the components
of con ict and compromise formation, has shaped much of current transference analysis among
those branches of contemporary con ict theory in North America in which Brenners views have
been foundational (Smith, 2003a).
Brenners position also represents a subtle shift away from Anna Freuds separate
classi cations of transference, for, when we consider his view that every mental event, including
every instance of transference activity, is a compromise formation between wishes (or, as Anna
Freud would have it, id impulses), defenses, self-punitive measures and painful affect, it
becomes clear that every transference is, in part, a transference of defense, and no transference
can contain undistorted id impulses, in Anna Freuds words, as was implied by the old
topographic model. This has important implications for the clinical approach to the transference,
since, with every manifestation of transference, the analyst must ask what defensive, wishful and
self-punitive purposes this transference is serving, and what childhood misery is being warded
off. In contrast, in the work of Gray and others, we can still hear a tendency to prioritize the
analysis of defense, as if the defensive component could be separated from the analysis of all the
other components of con ict, an approach that, some would say, substitutes a part for the whole
(Smith, 1995, 1999, 2003a).
The third form of transference described by Anna Freud, acting in the transference, was
her way of designating those activities by which the patient, under the throes of a particularly
intense transference, will begin to act out in the behavior of his daily life both the instinctual
impulses and the defensive reactions which are embodied in his transferred affects (1936, p. 23).3
In general, Anna Freud held that transference represented
all those impulses experienced by the patient in his relation with the analyst which are not
newly created by the objective analytic situation but have their source in earlyindeed, the
very earliestobject relations and are now merely revived under the in uence of the repetition
compulsion these impulses are repetitions and not new creations (p. 18).

This position brings her into direct opposition with many of the current relational and
constructivist in uences in North America, wherein transference is viewed predominantly as a
joint creation of the analytic couple and, hence, a new entity. In other words, Anna Freud was a
strong proponent for the narrow view of transference to designate certain speci c constellations,
transferred from the past to the present and imposed upon the objective reality of the analytic
situation. She also rmly de ned transference as a phenomenon that is distinct from the general
category of thoughts and feelings the patient has about the analyst.
Her view derives from her fathers original description of a false connection, and it has
been an important heuristic touchstone over the years. Of those analysts who still maintain a
narrower perspective on transference, however, many have adopted a modi ed position. Arlows

3
The terminology here bears some clari cation. Freud referred to such action in the transference as agieren, which Strachey
translated as acting out (Freud, 1914, pp. 1503). Freud considered the phenomenon a form of repetition, by which the
patient replaces remembering with acting. Such action could take place either outside the analysis or within the analytic
situation itself. These different forms of the phenomenon were later shortened to acting out (acting outside the analysis) and
acting in (acting within the analytic situation). This left Anna Freuds term, acting in the transference, in a confusing state,
since it was her way of designating acting out, not what had come to be known as acting in. In recent years, as the role
of action has become an increasingly important focus of the analysts attention, both acting out and acting in have been
subsumed under the term enactment, thus bringing us full circle to a single term, comparable to Freuds agieren, for this
entire realm of activity.
1022 HENRY F. SMITH

view, for example, that transference is a distortion of the current situation and an attempt on the
part of the patient to foist a role (1985, p. 110) on to the analyst, contains elements of both the
original false connection along with a more contemporary, interactive component that bears
some resemblance to Sandlers (1976) notion of role-responsiveness, which is, in turn, derived
from the Kleinian concept of projective identi cation.

The broader view of transference

Anna Freuds in uence notwithstanding, de nitions of transference have broadened over the years
for several reasons. It has become generally recognized across many psychoanalytic schools of
thought that transference is ubiquitous, in no way limited to the analytic situation (seee.g. Klein,
1952; Brenner, 1982). Brenner put it succinctly: What is unique about transference in analysis
is not its presence. It is that it is analyzed (p. 211). In fact, once one recognizes the ubiquity
of transference, it becomes increasingly dif cult, in my view, to identify any moment that is
completely free of transference. Hence, we have to consider that all of the patients perceptions
of the analyst are shaped by transference activity, as every perception of the present must be
in uenced by past con gurations. Arlows own theory would lead us to this conclusion when he
suggests that every perception is shaped by unconscious fantasy (1969).
In contrast to the classi catory approach taken by Anna Freud and others, Brenner
has argued that many of the ways in which we delineate separate forms of transference are
misleading and should be abandoned. He includes such terms as erotic transference, negative
transference and positive transference. Since, as we noted in the discussion of transference of
defense, every transference includes all the components of con ict, and the wishful component
always contains both erotic and aggressive elements derived from childhood con ict, it follows
that all transferences are ambivalent with both positive and negative manifestations. To retain
such separate designations misleads the clinician into thinking that any one component can exist
without all of the others, and that the analyst does not have to consider all the components of
con ict in every transference manifestation.
Brenner also argues persuasively that concepts such as the benign or unobjectionable
positive transference, and the conceptually related therapeutic alliance (Brenner, 1979), are
also best discarded. Both mislead the analyst into thinking that some aspects of the analytic
situation are con ict-free and, hence, do not need to be analyzed. To leave any transference,
or any alliance, outside the realm of what is to be understood and analyzed is to ignore the
inevitable resistances that will evolve from them (see also Friedman, 1969; Stein, 1981).
In the United States, views of transference have also broadened under the in uence of
what has been called the relational turn, as inspired by the teachings of many interpersonal
and relational analysts, including the work of Gill (1982, 1994) in the last two decades of
his life. From a de nitional point of view, Gill used the terms transference and analytic
relationship interchangeably. Others, including Goldberg (1997), have argued that these are, in
fact, very different concepts. However much the transference may pick up on the idiosyncrasies
of the analyst and be affected by the analysts individual character, as Freud himself noted,
transference, precisely de ned, derives from intrapsychic activity displaced on to the gure of
the analystit is psychical reality that is transferredwhereas the term analytic relationship
has no such precise meaning. In general, the more the patient and the analyst are seen as making
equal contributions to the co-creation of the transference, the more this distinction tends to be
overlooked or considered irrelevant.
As Sandler et al. (1973) note, the broadening of the concept has also been encouraged
by those analysts in uenced by Klein. Several have had a major impact on the culture of
 ANALYSIS OF TRANSFERENCE 1023

transference analysis in North America more generally. Strachey (1934), for example, argued
that the most effective, indeed mutative, interpretations are those that are given at the point of
urgency, particularly the moment of transference immediacy. We can hear how this might derive
from Freuds view of the transference as the place where every con ict has to be fought out.
But Stracheys technical position was more extreme than Freuds and, subsequently, there was a
tendency among some analysts to consider that only transference interpretations were effective
and, hence, to frame all their interventions as such. I hasten to add that Strachey acknowledged
that analysts make many other useful interpretations, including extratransference ones, and that
a careful reading of his 1934 paper suggests that his position was more balanced than the one
often attributed to him.
I believe some of these consequences can be explained by Stracheys use of the term
mutative, which subtly implies that transference interpretations have a special power in
themselves to change the patient and that, perhaps, only such interpretations have this power.
In my view, it can be useful to think of Stracheys position as re ecting an idealization both
of the analytic method in general and of transference interpretations in particular. This sort of
idealization, which may be inevitable to one degree or another in the construction of any theory,
is particularly common in part-for-whole reasoning and harkens back to Freuds original and
somewhat magical expectation, before the discovery of the power of resistance, that with a single
explanation or interpretation the analyst could alter the patients neurosis for ever, rather than
having to rely on the painstaking process of working through over time, as he later discovered.
We can detect a contemporary re ection of this form of idealization in the current emphasis
on moments of self-disclosure that are sometimes presented in the literature as mutative in
themselves by virtue of their special authenticity. In any case, while Stracheys in uence has
been variously felt, there has been a tendency among many North American analysts, particularly
those more ego-psychologically minded, to feel that he overstated his case.
Among contemporary British Kleinians, who tend to focus their interventions in the
transference, the most in uential within North America may be Joseph (1989), who is widely
cited for having usefully expanded on a comment of Kleins to the effect that in unraveling the
details of the transference it is essential to think in terms of total situations transferred from the
past into the present, as well as of emotions, defences and object relations (Klein, 1952, p. 437;
quoted in Joseph, 1985, p. 447). Arguing that framing interventions in terms of a reconstruction
of childhood experience is not advisable until late in an analysis, when the patient can begin to
think more clearly and thus to integrate such reconstructions (Joseph, personal communication),
Joseph has demonstrated how, in every dealing with the analyst, the infantile situation and, in
particular, the childs object relations are recreated:
everything of importance in the patients psychic organization based on his early and habitual
ways of functioning, his fantasies, impulses, defences, and con icts, will be lived out in some way
in the transference. In addition, everything that the analyst is or says is likely to be responded to
according to the patients own psychic make-up (1985, p. 453).

In contrast, many have spoken of the risks of a more or less exclusive focus on the
transference, including Anna Freud. As if foreseeing the direction contemporary analysis would
take, she warned in 1936 of the results of a technique which concentrated too much on the
transference:
There is no doubt that patients, when in the state of intensi ed transference which such a method
would foster, produce abundant material from the deepest strata of the id. But, in so doing, they
overstep the bounds of the analytic situation. The ego no longer remains outside, its energies
diminished, its strength reduced, its attitude that of objective observation, with no active part
1024 HENRY F. SMITH

in what is going on. It is caught up, overwhelmed, swept into action. Even though, under the
domination of the repetition compulsion, it behaves wholly as an infantile ego, this does not alter
the fact that it is acting instead of analyzing. But this means that such a technique, embarked upon
with high hopes of attaining a more profound knowledge of our patients, may end in all those
disappointments from the therapeutic standpoint which on theoretical grounds we should naturally
expect to result from acting in the transference (p. 27).

Anna Freuds caution can be heard as directed not only toward what she regarded as Kleinian
excesses, but to a number of our own contemporary trends.

The contemporary focus on the transference

I would like to discuss in more detail four analysts, Merton Gill, Evelyne Schwaber, Betty
Joseph, and Paul Gray, each highly in uential in North America, all of whom pay systematic
attention to detailed transference communications. I will also try to document their approaches
with brief clinical illustrations from my own work. I include the British analyst, Betty Joseph, not
as a spokesperson for the contemporary Kleinians of London (Schafer, 1997), many of whom
have made their own distinct contributions to contemporary transference analysis, but because,
through her extensive clinical teaching in the United States and her writing, her in uence has
been particularly signi cant in North America in recent years. My interest is not only in the
differences between the perspectives I will illustrate, but also in their potential integrations.
My intention here is not to be comprehensive. Rather, my selection, while necessarily
idiosyncratic, is an attempt to focus on the kind of attention paid in North America to the patients
use of and experience of the analyst, sometimes understood through close examination of the
observable surface (Levy and Inderbitzin, 1990; Smith, 1993) of the patients communications. In
a sense, the approaches of all four analysts can be seen as a reaction against what has sometimes
been characterized as an analytic approach marked by excessively deep interpretations and large
leaps of inference. At the level of clinical detail these analysts document, and with particular
focus on the patients defensive maneuvers against unpleasurable affect (Schafer, 2003), I
believe we may begin to integrate a number of points of view formerly considered disparate.

Merton Gill
In the United States, Merton Gill (1982a, 1982b) argued in the nineteen eighties and subsequently
that analysts do not interpret resistance to awareness of the transference or allusions to the
transference consistently and early enough in the analysis. He saw this as the primary cause of
stalemated and intellectualized analyses. Gill advocated a particular approach to the transference,
focusing on the plausibility of the patients perception of the analyst, which he linked to the
analysts actual behavior, an interest that we can derive from the way Freud rst imagined exploring
Doras transference (e.g. have you been struck by anything about me ? [1905, p. 118]).
Let me try to illustrate an aspect of this approach. Notice that in the following sequence,
which I have presented in more detail in an earlier paper, I attempt to link my patients experience
to what she has observed about me, and, initially, I get it wrong.
A patient in her early forties, sensing that I have become momentarily distracted, says to me from
the couch, What are you doing? And then she adds, compliantly, You are simply adjusting your
chair. I am so good. I dont turn around and look. I say, Looking would be too aggressive. She
says, It would startle you. She pauses and then tells me she has just become aroused. Wanting
to pick up on the precipitant, and thinking her arousal may be a response to her sense of my
distractedness, I say, Notice that you got aroused just after you felt you had lost me. Perhaps,
she says, sounding unconvinced. Suddenly I think again about what has just transpired in the
 ANALYSIS OF TRANSFERENCE 1025

interaction between us and about what I know from her earlier excitements, and I say, Or perhaps
your arousal started when I said that looking at me would be too aggressive. Yes, she says with
conviction, and it subsequently leads us into an exploration of the ways she experiences my words
as invitations into secret and forbidden pleasures (excerpted from Smith, 2001).

It is important to note that my comments here, both the one that seems off the mark and
the one that seems more accurate (judgements that can only be proven in time), are attempts,
following an observable shift in my patients affective state, to link her experience of me to what
I judge might plausibly have precipitated it in my behavior. But both comments also re ect my
attention to my patients wishes, defenses, self-punishments and painful affect, the elements of
compromise formation, as Brenner has outlined them, that together make up each psychic event.
In that respect, I am trying to link her internal shifts to her experience of my behavior in the here
and now.
Gill published the transcript of an hour that exempli es some of the hazards of a too-
zealous rendition of this approach, one that could serve as an illustration of Anna Freuds
cautionary tale. It involves the analysts persistent attempt to link the patients fear of being
perceived as homosexual to his experience of the analysts interpretations. Soon the patient
begins to wonder defensively if it may be the analyst who is homosexual, to which the analyst
responds, My interpretation that you care about me meant to you that I was saying that Im a
faggot (1982b, pp. 1001). As Gill notes, what becomes clear as the hour unfolds is that the
problem that is being interpreted by the analyst is also being enacted by both the analyst and the
patient in the very act of interpretation. The more persistently the analyst pursues the plausibility
of the patients transference experience, the more the patient feels both homosexually threatened
and homosexually grati ed.
While the problem of enacting with the patient the same dynamics that the analyst is trying
to put into words may be particularly striking in this hour, notice that, to a lesser degree, a similar
phenomenon occurs in my vignette above, where my speaking becomes the stimulus for the erotic
experience we are trying to understand. We can say that I am not participating to the same extent
as the analyst in Gills transcriptin other words, that my illustration constitutes an enactment
only as experienced by the patient, who wants to actualize her fantasybut my sense is that this
is not an adequate explanation of the situation. I would suggest that, if examined closely enough,
the analyst is always and inevitably a collusive participant to one degree or another in the
patients efforts at actualization. That degree makes a very great difference in the progress of the
analysis, of course, as does the analysts capacity to think about what is going on despite being
drawn into the enactment, and to use the very experience of being drawn in as data to further
his/her understanding of the patient. Such enactments are, I believe, an inevitable and continuous
accompaniment of the work, especially under conditions of intense transference experience.

Evelyne Schwaber
Many analysts who themselves focus on the transference experience of the patient have taken
exception to aspects of Gills position. Evelyne Schwaber (1983, 1992, 1995, 1998a, 1998b), for
example, teaches a method of paying close attention to the patients perception of the analysts
participation in the transference but does not advocate that the analyst step back to judge its
plausibility, seeing this as an off-shoot of Gills interest in interpersonal techniques. Instead,
Schwaber would suggest that the analyst attempt to maintain a strict focus on elaborating the
patients psychic reality without setting herself up as an external judge of its plausibility. Schwaber
would agree, nevertheless, that the patient constructs his or her transference experience, in part,
from aspects of the analysts behavior, much as Freud indicated in his postscript to the Dora case.
1026 HENRY F. SMITH

Because of the clarity and persistence of her focus on the patients experience of the analyst
in her writing and teaching, Schwabers in uence on North American transference analysis has
been extensive. Her stance is an elaboration of what she describes as a shift in listening that was
introduced by Kohut in the early nineteen seventies. Rather than embracing Kohuts theoretical
and developmental preoccupations, she takes up a particular aspect of his methodology: the
understanding of the resistance had shifted from being viewed as a phenomenon arising from
internal pressure within the patient to that in which the speci city of the analysts contribution
was seen as intrinsic to its very nature (Schwaber, 1983, p. 381).
As an illustration, notice that in the following sequence I attempt to nd my patients use and
experience of me in the transference, using narrower leaps of inference than in my earlier example.
My patient had begun analysis because of a sense that he was drifting in his life. Soon the experience
of drifting appeared in the moments at hand. One day, in a silence, I ask, Did you drift off again?
Yes, he says and then reports something that had been troubling him before he drifted away.
This might have been an opportunity to explore the con ictual interference he encountered that
prompted his drifting. Instead, I try to call attention to the phenomenon at hand and to his use of,
and transference experience of, me: When I asked about your drifting away just now, it seemed to
bring you back. I wonder what thats about, drifting away and then coming back when I comment.
He says, I dont know. Maybe I wonder if you really want to hear it. So I wait until I get the cue.
It feels like a cue. Thus, we begin to explore his searching for cues, which turns out to have been a
lifelong compromise formation, beginning with his earliest years, that has become key component of
his character, now expressed in the transference (excerpted from Smith, 1990, 1993).

It is important to note, again, that this stance does not preclude other modes of exploring
the transference. What sort of cue was my patient seeking? What unconscious fantasy was
he actualizing? What erotic and aggressive wishes lay behind it? And what did he mean that I
might not want to hear it, with its suggested link to another aspect of his transference and also,
perhaps, to my countertransference.
There is an epistemological question at issue here. Gill advocates looking for what is
plausible in the patients transference, which implies that the analyst can judge which of the
patients perceptions are plausible and which are not; in this sense he relies on the analysts
relative objectivity with respect to the patient. We can hear in this a vestige of Freuds false
connection, or of Arlows view that transference, however construed, is a distortion. Schwaber,
on the other hand, would argue that transference is a perception, not a distortion. In my view,
while this distinction, most clearly de ned by the opposing views of Schwaber (1998a) and
Arlow (1995), highlight sharply different modes of analytic listeningwhether one listens
in any given moment for what is distorted in the patients perceptions or for what is valid in
themepistemologically, the debate is a misleading one. If we consider Arlows view that all
perception is an act of creation (Smith, 1992), or Brenners position that all mental events are
compromise formations, then all perception is a distortion in the sense that it must inevitably
be a subjective reading of what is out there. Further, not all distortions are the same. To put
it another way, everything may be a compromise formation but not all compromise formations
address what are sometimes called considerations of reality in the same way or to the same
degree. Ultimately, the question is whether ones epistemology allows for relative degrees of
objectivity (Smith, 1999, 2003a).

Betty Joseph
A third position, which we might compare to the rst two, is that of Betty Joseph. Like Schwaber,
Joseph pays close attention to the details of what is transpiring between the analyst and the
patient, and to the patients experience of the analyst. But, compared to both Schwaber and Gill,
 ANALYSIS OF TRANSFERENCE 1027

Joseph is less interested in the analysts actual behavior or the manifest level of the patients
subjective experience. Rather, she would attend closely to her countertransference experience of
the patient to develop an understanding of what the patient is unconsciously doing to and with the
analyst and, in particular, with the analysts interpretations. Utilizing the concept of projective
identi cation, Joseph describes, for example, certain masochistic patients who try to create
despair in the analyst and then get him to collude with the despair or become actively involved
by being harsh, critical, or in some way or another verbally sadistic to the patient (1982, p. 449).
She might comment, for example, on the cold, cruel way in which a patient deals with her when
she inquires about a dream (p. 451).
In addition to her attention to how the patient deals with the analysts comments, Josephs
approach seems to me one way of attempting to monitor, moment by moment, how genuinely
the patient is engaged with the analyst and with the analytic work. How successfully we can
integrate her teaching into the more usual North American approaches to the work remains an
open question, but it is essential, in my view, to address the phenomena she identi es. Again, I
will try to illustrate an aspect of her approach.
A patient of mine, a writer in her late 20s, frequently pretends that she knows nothing,
idealizing my own abilities, admiring them as if they were a marvelous erotic object, but then
she invariably becomes disappointed, despairing and denigrating, as she nds them to be so
useless to her. As I have come to recognize my own sense of helplessness in response to this
repeated pattern, I try to point out what she seems to be doing. Again, she admires my acuity and
then strikingly nds it, once more, to be of no use. Or she uses it to accuse herself of being so
stupidor so destructive. Sometimes, when I am able to contain my own countertransference
relatively well, she feels me to be loving but, as that soon begins to frighten her, she then nds
reason to attack herself or to experience me as her attacker. We speak about these apparent
defensive shifts, which seem so calculated to avoid pleasure, to replace her own wishes with a
sense of humiliation and defensive self-attack, and to turn the envious attack both upon herself
and upon our work together. And these observations, too, appear genuinely to interest her before
they undergo the same process by which they also become meaningless. Over time, however,
trying to catch what is happening moment by moment, often in an atmosphere that is frequently
uncomfortably disruptive, there are eeting experiences of a more genuine understanding of
what is transpiring between us.
It is important to note that, in examining any clinical stance, one can observe various
triadic con gurations, consisting of the patient, the analyst and the analysts theory or approach
to the work, each component of which is in dynamic balance with both of the others. As the
contemporary Kleinians have pointed out (Britton, 1989; Feldman, 1993), these triads become
the focus for many of the patients transferences, more prominent for some patients than others.
Some of these transferences are related to what we in North America consider to be classical
oedipal dynamics and some appear to be triadic in con guration but suffused with earlier
anxieties (Smith, 2002).
This same patient, for example, seems to ask repeatedly that I respond to her as someone
other than her analyst; that I relinquish, that is, my own analytic stance. (This is, of course, in
some sense a component of every transference.) From time to time she says directly that she feels
envious of my commitment to my work and to psychoanalysis. I sense both in her associations
and in my countertransference that she would like to come between me and my work, as if she
were a small child climbing into bed between her parents, or manipulating one away from the
other for a more exclusive dyadic experience. I can talk with my patient about her wish, but that
talk, which she sees as further evidence of my marriage to my work, only fuels her sense that I am
1028 HENRY F. SMITH

excluding her. It is not so evident what she wants from mea sexual partner, a mother she can
possessbut it does seem clear that, at such moments, she envies and resents my commitment
to my work, to analysis, to analytic theory, and to the good internal object that psychoanalysis
represents (Caper, 1997).
One might argue, in this case, that I am, indeed, holding on to an agenda of my own at
the expense of hearing my patients needs. Clearly there is a risk, well illustrated by Schwaber,
that any approach, including an empathic focus on the patients point of view, can become the
analysts agenda and an obstacle to the elucidation of the patients conscious and unconscious
experience. While I can try to address this potential in my countertransference, and we can
examine as carefully as possible her psychic reality, there is an actuality to the fact that I remain
her analyst (or try to) and that her transference experience of this remains painful.

Paul Gray
The fourth approach to the transference that I will mention is that of Paul Gray (1973, 1982,
1986, 1996). In contrast to Joseph, Gray (1991) maintains that his position necessitates virtually
no attention to the countertransference. Rather, he describes a methodology that pays close
process attention (1996, p. 88) to the surface of the patients associations, listening for the
sequence of drive derivatives in the associative drift. At certain points there will inevitably be
a shift in the patients associations, signaling a defensive maneuver at a moment of con ictual
interference; Gray regards these moments as opportunities to invite the patient to observe the
con ictual functioning of his or her mind. He compares the process to apple-sorting (1991).
Along the conveyer belt of the patients associations passes one drive derivative after another,
until the analyst observes a shift away from the ongoing focus. That shift signals the bad apple
that catches the analysts attention.
Although Gray derived his method from Anna Freuds call for a change in the focus of
attention suitable to the analysis of the transference of defense, we can, paradoxically, hear in
his focus certain Kleinian strains. In practice, for example, Gray pays particular attention to
aggressive drive derivatives, especially within the transference. At a moment when the patient
shifts away from such a focus, the analyst might ask, Did you notice just now that you were
speaking about your dissatisfaction with my comments, how angry they made you, and then your
focus shifted? I wonder if you are aware of some risk you encountered in your criticism of me.
It is important to note that the attention that Gray places on appealing to the conscious
ego, like the emphasis that Gill puts on the actuality of the analyst, or Schwabers focus on the
patients perception of the analysts actual participation in the patients transference experience,
is in sharp contrast to Josephs focus on the patients unconscious manipulations of the analysts
interpretations. These more empirical North American approaches would, I believe, be viewed
by many European analysts, and by some North Americans as well, as distractions from the task
of analyzing unconscious fantasy and unconscious defenses.
Another sharp contrast can be drawn here between the methodologies of Gray and Arlow,
two ego-psychologists who approach the work very differently. Arguing that the analyst is not
the most important person in the patients life, Arlow (1991) focuses, far more than Gray, on
the primary gures in the patients life and the patients experience of his or her childhood,
attempting through attention to context, contiguity and repeated themes in the patients associative
drift, to reconstruct both the infantile situation and the unconscious fantasies that organize the
patients psychic life. Thus, where Gray might intervene at the moment the patient shifts from
an aggressive attack on the analyst to some gure from childhood, Arlow might intervene at
exactly the opposite moment: when a patient who has been talking affectively about an aspect
 ANALYSIS OF TRANSFERENCE 1029

of childhood experience, his fury at his father, for example, suddenly focuses on the analystin
other words, when the transference interrupts the patients associations. Whereas Arlow would
tend to intervene at moments of transference resistance, then, Gray would intervene at moments
of resistance to the transference. In Grays view, Arlow tends toward deeper interpretations that
bypass both the immediacy of the hour and the patients defenses, while Arlow might counter
that Gray tends to avoid the empathic appreciation of the patients experience.
My sense is that these two contrasting styles, seemingly so opposite in their relation to the
transference, can be integrated, in part, if one takes into account the point of affective immediacy
in the hour. If, as in the rst example, the patients shift away from the analyst represents a loss
of affective immediacy or authenticity, the analyst might choose to comment on the defensive
process involved. But if, as in the second example, the patient is no less genuinely intent on
his fury with his father, and his diversion to the analyst is accompanied by a loss of affective
immediacy, that, too, might represent a defensive interference deserving of enquiry, whereas to
embrace the new focus on the analyst would miss the momentary edge of the patients resistance.

Transference and extratransference

While it is clear that analysis as conducted by each of the analysts I have discussed in the
previous section would assume a very different shape, based partly on their particular approaches
to the transference, as analysis evolved over the last century in the United States, a general
model developed in which, for many analysts, both transference and so-called extratransference
interpretations were regarded as useful at different moments. This was re ected in the fact that,
while respect for the importance of transference phenomena in the therapeutic action of analysis
deepened here as elsewhere over time, as I have already mentioned, the exclusive emphasis on
transference interpretation that seemed to originate with Strachey was, in North America, often
seen to be excessive. When Gill advocated such an approach in the mid-nineteen eighties, he was
met with the same concerns that had been directed at Kleinian analysts many years earlier, that
the analyst was forcing the material into a transference con guration, encouraging either a kind
of intellectual appreciation of transference experience or, as Anna Freud implied, an id-based
experience with a runaway transference. Gill subsequently acknowledged that he had overstated
his position at rst.
Much of the debate over transference interpretation in general, then, can be divided
roughly into two camps. To oversimplify, these might be stereotypically characterized as: (1)
a classical approach, with skepticism regarding exclusive and early focus on the transference,
a considerable tolerance for extratransference interpretation, attention to transference as a
resistance, resolvable through genetic interpretation, and a keen regard for the development and
interpretative resolution of the transference neurosis; and (2) a more contemporary approach,
increasingly transference based, utilizing interpretation of the transference early in the analysis,
emphasizing the here and now and the role of action, with considerable skepticism for the
concept of a transference neurosis. I realize that I am schematically lumping together here many
disparate points of view.
It is a curious fact of psychoanalytic history, however, that at different moments in his life
Gill represented the essence of each of these positions. In the last two decades of his life, for
example, he became the principle spokesman within the American Psychoanalytic Association
for the latter approach, which I am labeling more contemporary. But in 1954, he had provided
the very de nition of classical analysis: Psychoanalysis is that technique which, employed
by a neutral analyst, results in the development of a regressive transference neurosis and the
ultimate resolution of this neurosis by techniques of interpretation alone (p. 775). He later said
1030 HENRY F. SMITH

that he disagreed with everything he wrote in that paper. Thus, he argued passionately not only
with others but also with himself. It was his special gift that he could hold a position, question
it, decide he was wrong and change to another equally passionately held position; and each
point of view, both the former and the latter, would become the guiding principles for different
generations of analysts (Smith, 2000a).
My own experience suggests that we do ourselves a disservice when we rely too rigidly
on a particular approach for all instances. Furthermore, the way in which we justify particular
interventions or particular technical devices, based on higher-level theoretical considerations,
seems to me frequently misguided. Theory and practice are not as closely linked as we sometimes
like to think. I do not mean by this to advocate a blind eclecticism, or sharply different approaches
for different patients. In fact, my sense is that every analyst does best with a particular model,
to which he or she returns and that can be applied exibly as the situation demands. I nd I can
locate my work most effectively within the model of con ict and compromise that Brenner has
elaborated. But in the vignette I presented above, the writer who frequently pretends to know
nothing, I borrow from Josephs clinical teaching to try to elucidate what my patient is doing
to and with my interventions, which I regard as part of a defensive process, as well as from
Schwabers attention to the patients experience of the analysts participation, Gills look at the
analysts actual behavior and the patients experience of it, and Grays attention to observable
defensive shifts in the process. If, at times, these appear to be strange bedfellows, I believe they t
within the overall framework of the Brennerian model. We all arrive at idiosyncratic integrations
of different approaches to the work, and can do so only if we do not insist on a linkage between
theory and practice that our theories, at present, cannot bear (Smith, 1997a, 1999, 2003b).
In my experience, analysts feel more fully engaged when the transference is more intense,
the optimal level of intensity varying from analyst to analyst and from analytic dyad to dyad.
Interpretations made under these circumstances, designed to address the patients transference
experience, frequently have a greater experiential immediacy. But there are moments in the
analysis of many patients when their transferences to gures other than the analyst enter the
work in a way that is urgent and affectively immediate. Under such circumstances, interventions
addressed to these transferences, so-called extratransference interpretations, may have a similar
impactin other words, the point of maximum affective immediacy for the patient may not
always be the same as for the analyst. While the analyst must always be mindful of the inevitable
defensive aspects of any such extratransference communication to the analyst, to call attention to
the patients transferential experience of the analyst, under such circumstances, may miss the point.
Ultimately, what we are after is neither the here and now, nor the there and then, but, as Chodorow
(personal communication) puts it felicitously, the here and then and the there and now.
Early in many analyses, transferences tend to be quite labile, with different aspects of the
patients transference emerging sequentially or in various combinations. Although, as Brenner
points out, these complex mixtures characterize, to varying degrees, all transferences, initial
transferences are frequently less cohesive or consolidated than they will become. This can be an
argument for Gills approach to calling the patients attention to allusions to the transference, but
it can also mean that the analyst may pro tably utilize a particularly intense extratransference
experience.
A college professor in his mid-40s had recently begun analysis. As a child, he had been
very close to his mother and her favorite of several children. While he may have been his fathers
favorite as well, my patient was always somewhat fearful of him. In the early months of his work
with me, he would watch me carefully when I greeted him in the waiting room, often asking me,
as if by habit, How are you? What was unusual was that, despite its conventional tone, if, as
 ANALYSIS OF TRANSFERENCE 1031

we walked to the consulting room, I acknowledged the question but did not answer it, he would
repeat it, tenaciously insisting on an answer either before or after lying on the couch. We made
brief forays into understanding the implications of these questions: his anxiety about what might
lie in store for him on his analytic journey and, later, his lifelong need to attend to how the other
was feeling; his fear that his mother might not be there as his anchor; and his worry about his
fathers labile temper. But in the beginning he greeted any early inquiry of this sort with a polite
but clear dismissal; it made little sense to him.
About six months into the analysis we discovered that his mother was dying of a slow,
deteriorating illness. Although she was still alive, it was rapidly becoming clear to him that
he had lost the mother he knew. It was an extremely painful experience for my patient and
signi cantly heightened his apprehension at the beginning of the hours, along with the tenacity
of his questions, especially when he had just returned from visiting his parents. But at this point
the transference immediacy was not as palpable to him as it was to me.
One day he came in and told me of a terrible ght he had had with his wife. She had
been complaining of his distance and his emotional unavailability. He was furious with
her for her failure to provide solace either to him or their children. Prompted partly by my
countertransference-sense of the growing urgency in his already hectic family situation, I said,
It is particularly dif cult when your wife doesnt provide the sort of comfort your mother used
to give you, especially when you feel you need it so much, just as you are losing her. Although
he had never seemed to hear these ingredients in my comments about his transference to me,
this time the affective immediacy of the interaction with his wife convinced him that he was
looking for [his] wife to be a mother, and he came back to it time and again as he worked with
the tension that began to lessen between them. It was also striking that, following my comment,
he was able to see more clearly how he also looked to me for such solace, and how resentful,
alone and apprehensive he became when I did not provide it. Gradually, the work included the
transference to me in all its immediacy, and we could see the same con gurations played out in
three areas: past, present and transference.
Might there have been other ways to deal with this, perhaps exclusively as a displacement
from the transference to the analyst? Of course. No two analytic couples will follow the same
path. In this analysis, we came in time to see how much more threatening it was for my patient
to experience directly both his longings and his hostility toward me than it was to talk about
how he experienced them with his wife, the displacement to which Gray is so attentive. And we
also discovered the ways in which my patients frustrating experience with me fueled that very
longing and frustration that he felt with his wife, the acting in the transference that Anna Freud
described. But I felt we needed to deal with the transference where it was most observable at the
moment and, in this instance, that immediacy was more apparent outside the analytic situation.
Notice that, whereas Joseph might work with the patients use of her interpretations until
the patient could genuinely think about her genetic and reconstructive commentsa position I
embracein this instance I am suggesting the opposite, that with the level of anxiety experienced
by this patient in the transference, some preliminary work outside the transference allowed him
to approach his experience of me more directly. With any given patient, we can never be sure,
in retrospect, about the choices we have made, whether another approach might have led to a
more thorough, less intellectualized engagement and understanding. It is worth emphasizing,
however, that, even though I did not direct my initial comments to the transference in addressing
the interaction with his wife, my patient was able in subsequent material to begin spontaneously
to examine the transference implications of this dynamic issue. This suggests either that he had
heard them in my remark, or was able to hear them and engage them with less anxiety once we
1032 HENRY F. SMITH

had dealt with the issue at the point of urgency in the affective immediacy of his relationship
with his wife.
Sandler et al. (1973) comment that not every communication from the patient should be
regarded as transference. I would suggest that, because the transference is continuous, infusing
every moment of the work, every communication from the patient must have transference
implications. Similarly, as the preceding material demonstrates, even if the analyst chooses
to comment on something manifestly outside the transference, every communication from the
analyst will have transference implications. In other words, there is a transferential component
to every moment of the analysis, one that will be expressed in whatever the patient says and will
be responsive to whatever the analyst says.
Was my patients initial anxiety about what lay in store for him in analysis, expressed in his
insistent questions to me, a transference in the proper sense of the word? Such anxieties can be
a frequent and painful component of the beginning of many analyses, often revealed in dreams,
fantasies, associations and bodily sensations. Some would say these are not transferences proper
but, rather, habitual ways the patient deals with unfamiliar and threatening situations. My sense
is that such experiences, prompted by the entry into the analytic situation, are best thought of as
inchoate transference feelings that may coalesce in time, that derive from early object ties, and
that should be analyzed as one would any other aspect of the patients analytic experience.
There are times when an analyst may deliberately utilize a genetic interpretation or
attempt a reconstruction precisely in order to decrease the affective immediacy of a particular
transference experience.
A patient in her mid-30s, who has been in analysis for several years, sometimes
experiences the work as so painful that no amount of clari cation and exploration seems to
alleviate what appears to be her relentless need to create pain. Flooded, she seems to re-create
and relive with me her fantasied experience of her infantile world in all its totality. Under such
circumstancesand if there is room to do soI may remind her of that world: It is as if you
have become that little girl, alone in your fathers house. The intensity of the moment will lessen
as the patient begins to think about her own less accessible past. Such reconstructions, like some
more exact genetic interpretations, function both as displacements from the transference and as
partial interpretations of it.
There are risks, however, in rushing too quickly to the infantile situation. One of them is
that we may bypass later, especially adolescent, developmental contributions to the transference.
Adolescence is a time in which the patients experience of her own affective life undergoes
critical shaping and structuring. The experiences of adolescence have an affective intensity and
immediacy that, together with the action components of the period, are unique in our memories
of the past. In the clinical situation, the recreated intensity of adolescent experience can be
mistaken for borderline functioning, and its peculiarly adolescent qualities may then be bypassed
in search of its infantile roots. It is my sense that important affective structures related to the
memory of certain affectsin particular, the experience of ones affective self, its potential and
limits, and the representation of affect in general (Green, 1973)are built in important ways in
adolescence. All of this can be missed if the analyst and the patient bypass these aspects of the
transference (see also Hauser and Smith, 1991). In our eld, as well as in our culture generally,
we are seduced by a preference for the primitive, in Gombrichs (2002) telling phrase.
I do not mean by any of these suggestions to undermine the value of a focus on the
transference, which I strongly support. But whether and when one speaks to the transference
or to the extratransference depends wholly on the patient, on the moment in the analysis, and
on what is both observable and engageable by a particular analytic couple. And this would be
 ANALYSIS OF TRANSFERENCE 1033

predicted by Brenners clinical theory, which suggests that every communication from the patient
allows access to wishful, defensive, self-punitive and unpleasurable components. Conversely,
every intervention on the part of the analyst will advance the work in some respects and fuel the
resistance in others (Smith, 1997b, 2000b, 2003a). As an extension of this observation, I believe
it can be demonstrated that all unconscious resistances that develop in analysis are, to some
degree, continuously and jointly created. Thus, the forward movement of an analysis can be seen
to contain within itself defenses on the part of both the analyst and the patient against the roads
not taken. Such resistances are embedded in the very therapeutic action of the work itself.

Early and late interpretations of the transference

To focus on the transference early in the work can, under certain circumstances, allow for a fuller
development of the transference, as Gill suggests, or, under others, for a too-active and intense
acting in the transference, as Anna Freud has warned. For some patients, early and exclusive focus
on the transference intensi es their anxiety; for others it feels arti cial, encouraging a defensive
intellectualization and compliance. To wait until a transference has deepened before interpreting
it allows some patients to observe it at its most immediate; for others, such a transference may
never materialize, analyst and patient forever passing like ships in the night. Each interpretive
strategy, early or late, is an attempt to manage the risks of resistance and stalemate, on the one
hand, and disabling anxiety, on the other.
An instructive example of this dilemma was offered at a recent panel of the American
Psychoanalytic Association, at which Michael Feldman, a contemporary British Kleinian, and
Fred Busch, a North American ego psychologist, each presented material and then discussed the
others work. (Panel, 2001). Feldman, like Joseph, advocated attention to the patients use of the
analysts interpretations and an early focus on the deeper initial anxieties in the transference.
He argued that only by so doing would such anxieties not eventually overwhelm the work.
Busch countered that to do as Feldman was suggesting risked bypassing the patients defenses.
He advocated an approach directed at the surface of the material and at what was immediately
observable by the patient.
The audience was free to speculate on the bene ts and liabilities in each approach. If
Feldmans position was designed to reduce the deeper anxieties, it seemed he also had to navigate
the risk of forcing material prematurely into consciousness, leading either to overwhelming affect
or compliant intellectualization. Busch, on the other hand, while attempting to help the patient
more gradually to observe what lay within, appeared to risk ignoring the sort of unconscious
anxiety Feldman described, which, if left unexamined, might in time either overwhelm the
analysis or lead to stalemate. Thus, each approach, so different in its con guration, tries to
account in different ways for the twin dangers of an analysis that can be either derailed by
anxiety or reduced to a sterile exercise. The panel also provided another illustration that, with
every approach, the triadic con gurations formed by patient, analyst and analysts theory or
commitment to analysis is delicately poised, each position in dynamic balance with the others.
A distinct North American voice on behalf of allowing certain transferences to persist
without early interpretation is that of Kohut (1968), who, as many have pointed out, gave
theoretical legitimacy to what many analysts were struggling to manage intuitively in the work,
particularly with more narcissistic patients. As I have mentioned already, Kohuts work evolved
from a particular listening stance, later elaborated by Schwaber and others. Gradually, he
formulated theories of development, pathogenesis and therapeutic action, based on the analysis
of the selfobject transferences, including idealizing, mirror and twinship transferences.
Kohut described these transferences in the analysis of narcissistic patients, for whom, as
1034 HENRY F. SMITH

he saw it, classical approaches were inadequate, if not frankly harmful. Whereas classical theory
had tended to view idealizing transferences, for example, as defending against more aggressive
content, encouraging analysts, some would say, to ght the narcissistic transferences or
interpret their negative content prematurely, Kohut emphasized their essential developmental
importance and argued that they should be allowed to evolve and not be interpreted until much
later in the analysis. (Some post-Kohutian self-psychologists would add, if at all.) Being the
object of the narcissistic transferences can be a source of considerable discomfort to an analyst.
Hence, Kohuts teaching reminds us that their early interpretation may be driven more by the
analysts needs than the patients.
Kohuts technical approach did not develop in a vacuum. In the nineteen sixties and
nineteen seventies, there were conceptualizations that ran parallel to his in the writings of
analysts such as Stone (1961) and Valenstein (1973), who remained more classically oriented,
and recently Green (2002) has commented that, beginning in the nineteen fties, a number of
French analysts were working the same territory as Kohut without eliminating the role of the
drives, as Kohut did. It is a reminder that, while we speak of integrating our different approaches
today, we might also consider how they were once integrated and then extracted and isolated, as
each grew into separate cottage industries. Kohuts in uence, nevertheless, has been extensive
both inside and outside of the group that call themselves self-psychologists, which at this point
is large and diverse. In legitimizing a way of listening to the patients manifest, subjective
experience, he provided an antidote to what was becoming excessively rigidi ed in what Stone
called the robot-like anonymity of our neo-classical period (1981, p. 106).

Does the transference neurosis exist?

Whether North American analysts advocate early or late interpretations of the transference can
be partly derived from differing views on the concept of the transference neurosis and the time
it takes for such an entity to develop in analysis. Perhaps the most evocative description of the
transference neurosis in the modern literature is Birds:
A transference neurosis is merely a new edition of the patients original neurosis, but with me in
it. This new edition is created, for reasons I wish I knew more about and in ways that are quite
perplexing, by the patients shifting certain elements of his neurosis onto me. In this way he replaces
in his neurosis mental representations of a past person, say his father, with mental representations
of me. Although this maneuver would make it seem that the patient now regards me as his father,
the actual situation is somewhat different. Because the maneuver is basically intrapsychic and
deals with speci c elements of his neurosis, I come to represent not his father, but an aspect of his
neurosis which, although contributed to by early, primarily oedipal experiences with his father, is
now an intrapsychic structure of its own As a result of this process I come to represent the
patient himself. More speci cally, I come to represent some complex of the patients neurosis or
some element of his ego, superego, drives, defenses, etc., which has become part of his neurosis. I
do not, however, represent as such actual persons from the past, except in the form in which they
have been incorporated into the patients neurotic organization (1972, pp. 2812).

In my experience, transferences of this sort tend to be particularly tenaciously maintained

and can be profoundly unsettling for the analyst, accounting, in part, for what makes work in
the transference so narcissistically taxing. The analyst is persistently perceived and may be
encouraged to behave not at all like the person he believes himself to be. Notice again the
conceptual link to the patients use of projective identi cation. To the extent that the patients
transference engages the analyst to act from his own con ictual issues, as must always be the
case to a degree, he may begin to feel or behave exactly like the person he wishes he were not.
 ANALYSIS OF TRANSFERENCE 1035

Here is another illustration from my own work several years into the analysis of an
obsessional man in his mid-30s.
My patient, a profoundly self-critical man, arrives 25 minutes late for his rst hour after my
vacation. He says, As I was coming here I thought I would ease back into this. I thought, I dont
want to be here. Half a session will be ne today. I feel this to be somewhat provocative and am
slightly annoyed. He adds, Its like a herring sandwich. Surprised, I say, Getting back into it feels
like a herring sandwich? He says, Cold and slimy and tastes like sh. In addition to thinking
about the homoerotic overtones, I remember his tears for the death of his grandfather just before
the interruption, and I say, Something unpleasant about it. Those tears were cold and slimy. As
I remember this experience of him, my state changes, and I feel both sad and affectionate toward
him. But he is in another place, When I wasnt here I stopped thinking about those things. Is it
always going to happen like that? Youre like a drill sergeant. You want me here shoes shined spit-
polished. He says a bit more about this and then pauses, adding, It seems like I was just here. I
say, The taste of herring still in your mouth (excerpted from Smith, 2001).

My point here is that, at the moment he calls me a drill sergeant, I am not feeling anything
like such a gure. Note, however, that, in addition to my initial irritation, from his perspective
I may, indeed, be behaving like an analytic drill sergeant, as I continue to explore the very
affective experience he wants to avoid. Thus, the transference that is projected on to the analyst,
and that seems to be a part of the patients neurosis, draws upon aspects both of the analysts
actual behavior and the analysts own con ictual inner life (Smith, 2000b, 2001).
Bird sees the analysts own transference involvement (by which he means the
countertransference) as a necessity if one is to deal with the most dif cult aspects of the
transference neurosis:
Hopefully the struggle will eventually be recognized as a re-enactment in the transference of
various destructive elements of the patients neurosis, a re-enactment in which unconscious
destructive acts of the analyst are likely to be involved.

This dark and ominous time, when both patient and analyst are about ready to call it quits, is,
according to my thesis, perhaps the only kind of transference in which the patients most deeply
destructive impulses may be analyzable. If, as is sometimes possible, the analyst is able to work
his way through this tremendously dif cult, anger-laden impasse, the most effective, enduring
analytical progress may be made (1972, p. 296).

Notice the emphasis Bird places on the shared aggression and mutual destructiveness in this
crucial period of the work. Once again, we hear what is stereotypically considered a Kleinian
echo in the North American ego-psychological literature and, again, it reminds us of points of
convergence and commonality in our various approaches that have been arti cially segregated
for a variety of personal and professional reasons.
Despite Birds eloquence, many contemporary North American analysts have argued that
the term transference neurosis is no longer a useful one. Reed (1990) has provided ample
evidence that among experienced analysts there is very little agreement about what even
constitutes a transference neurosis. Both Reed and Renik (1990) have also suggested that the
concept of the transference neurosis itself was a model based on the analysis of neurotic patients,
and that it is no longer applicable for the broader range of patients we see today in analysis.
Brenner has argued cogently that the term itself is tautologous, misleading and should be retired.
As he notes, both Anna Freud and her father viewed a true transference neurosis as one in
which the dynamics of con ict have changed from con ict over drive derivatives involving
childhood objectsmother, father, siblings etc.to con ict over drive derivatives involving the
analyst (Brenner, 1982, p. 204). He points out,
1036 HENRY F. SMITH

to assert that the mental representation of one of the important objects of childhood drive derivatives
is ever wholly stripped of psychological importanceever wholly decathectedand replaced by any
later object representation is wholly at odds with the available evidence (p. 204).

He goes on to say that analysts today, when speaking of a transference neurosis, generally mean
simply intense transference manifestations which can be satisfactorily analyzed (p. 205). While
I agree with Brenner, I would add that the phenomenon the Freuds describe, if not taken literally,
documents the clinical experience of the analyst who nds him or herself increasingly entangled
in the patients con ictual organization with no one else in sight.
To be sure, however, there are many different manifestations of transference, some more
intense, some less so, varying from patient to patient and from moment to moment. All of them
bear the hallmarks of con ict and compromise. It may be a particularly salutary development
when patients manifestly intense transference experiences can be analyzed. On the other hand,
some transferences are more subtle, more dif cult to detect, but no less analyzable. In my
view, to assert that there is only one form of successful analysis that involves the development
and resolution of a transference neurosis would encourage us to consider many patients
unanalysableor, in retrospect, not to have been analyzedwhen a satisfactory analytic result
may, in fact, have been achieved.
There are also many patients with powerful resistances to entering into an intense
transference relationship or to becoming aware that one has already developed. I am thinking
of patients whose transferences, as Anna Freud pointed out, are primarily defensive, patients
who rely on the sort of narcissistic transferences that Kohut described, and patients who use the
analyst as a kind of secure maternal object, or who, as Green puts it, develop a split transference
to the object as a person and the object as an analyst (2002, p. 643). In these cases, the analyst
needs to be particularly adept at identifying such transference phenomena and in deciding how,
when and whether to interpret them.
I have found that some patients who have great dif culty entering into a full transference
relationship and who are especially wary of the erotic component of the transference may
eventually begin to engage the analyst through a subtle sado-masochistic interaction that the
analyst may detect, at rst, only through his or her countertransference response.
I am thinking of an obsessional woman in her mid-30s, a successful structural engineer,
who, while bright, personable and attractive, felt defeated by her lack of advancement in her
predominantly male profession and her failure in nding a mate. In my of ce, she was frequently
silent or spoke with great caution, carefully choosing her words to tell me about the day-to-day
events of her life. Early in our work, she had asked me to draw her a map so she could nd her
way to my of ce and home again without getting lost, and it soon became clear that she hoped
for a map for her associations as well, so that she might know where she was going before setting
out. I found it dif cult to listen to her and, drifting off, hoped for something more lively to catch
my attention. As I talked with her about the way in which she kept me at a distance by speaking
in cautious abstractions and presenting conclusions without details, she could see what I meant
but complained that I, too, seemed remote, which, of course, I was. And so we struggled to sort
out what part was her response to me and what part mine was to her, and whether she might have
some investment in both her withdrawal and mine. Over time, we learned that she wanted me
to reach out to her, to come and nd her, and to know what she needed without her having to
tell me, all ways in which she felt her mother had failed her. And we learned, too, that, partly to
protect herself from disappointment, she had from an early age developed a highly independent
way of living her life, at the same time as she altruistically buried her own needs in the care of
her fragile parents and siblings.
 ANALYSIS OF TRANSFERENCE 1037

She was not altogether admiring of men and their success but, for a long time, I could
detect no direct re ection of this in the transference. Gradually, however, her mildly denigrating
descriptions of her male co-workers began to irritate me and I tried to call her attention to them.
She took my stance as a sign that I was on their side, not hers and, with considerable anger,
argued that I was wrong, both in my observation and in my approach. She even brought in
books on psychoanalytic technique to prove it. It was many months before we discovered that,
as a teenager, she had provoked her father into slapping her to show him that she could take a
beating, and had subtly challenged her male teachers, simultaneously engaging them with her
brain and disparaging them. In retrospect, I could now begin to see that her subtle dismissal of
my interpretations had been evident for some time.
One day, the patient dreamed that she was lying in a bed in my house, and I was uncovering
her and leering at her. She had another dream that I was tucking her in at night and kissed her and
then frighteningly said, now you give us a kiss, and it was then that we learned of her fathers
repeated mocking of her developing body and her fear that any spontaneous show of feeling,
especially any positive feeling about me, or any feeling at all about her body, would be silently
mocked by me. We also learned that, as far back as she could remember, she had struggled with
her mothers denigration of my patients body and of womens bodies in general.
For my patient, then, an erotically charged provocativeness had initiated a form of
engagement in the transference, free of the more loving and frightening attachments that might
lead to humiliation. But the stalemate did not truly begin to disappear until, several years into
the analysis, I was able to point out her aggressive attempt, however subtle, to denigrate and
humiliate me, which appeared to be a retaliation for all the injustices she had suffered, in addition
to being a source of pleasure.
Such analyses are, in my experience, inevitably long and dif cult ones. They ask that the
analyst remain, sometimes for several years, in a state of uncertainty and apparent stalemate
before the initial glimmers of engagement emerge along the more provocative sado-masochistic
lines I have described. Those glimmers may be rst experienced only in the countertransference
and then engaged through interpretation only after the interaction has developed an edge of what
amounts to an attenuated sado-masochistic enactment that has nally brought the patient, the
analyst and the analysis to life. In other words, it is only when the patients transference awakens
the analysts countertransference, so that both of them come alive in an actual object relationship,
that the analysis truly begins. Such moments come about when the analyst allows himself to
experience what the patient is eliciting, and can momentarily, or in signal form, become the
projected object (Davies, in press). But it is a delicate balance. In my view, without a con ictual
engagement in an object relationship, the analytic work will never come alive (Smith, 2000b)
and, if the analyst is too caught up in the con ict, he cannot analyze it.
This patients experience with me quali es, I believe, as an intense and analyzable
transference reaction of the sort to which Brenner refers, but it took a very different form from
the more classical transference neurosis experienced by the patient who thought me a drill
sergeant, less cohesive, and detectable at rst only in affect and action. Whereas the former
patients transference felt quite foreign to me as he told me how he experienced me (though
less so when I could detect those aspects of my behavior on which it hinged and my own
countertransference engagement), the latter patient spoke rarely of her experience of me, and
I could identify her transference only through my own countertransference response. With her,
transference and countertransference seemed truly to be two aspects of a single phenomenon.
Because of such marked differences as can be seen in these two cases, I nd little basis for
considering the transference neurosis a unitary concept. Intense and analyzable transference
1038 HENRY F. SMITH

reactions take many shapes, depending upon the con ictual organization of the patient and the
analysts counter-response.

A postscript on action
It will not have escaped the readers notice that, throughout this paper, I have been emphasizing
the analysis of action sequences within the work, commonly called enactments, in which both
analyst and patient participate. Because many analysts from different psychoanalytic schools of
thought are converging on the observation and analysis of this facet of the work, a postscript here
may be instructive. While North American analysts commonly regard the action components of
the transference as data for conjecture and interpretation, my impression is that many European
analysts, including many French analysts, have a markedly different approach to this aspect
of the work and customarily refrain from commenting on such action until it is represented in
words. I would like to close with an illustration I have found instructive in this regard.
A French analyst was demonstrating an approach to the work that prioritized the continuing
ow of verbal associations. One day, the patient was twenty- ve minutes late and arrived bruised
and bloodied. The patient related the fact that she had almost reached the of ce when she realized
she had forgotten to bring the check. She turned around and ran back to her apartment but was now
locked out, having forgotten her keys. In trying to climb in through a window, she slipped and fell,
bruising her legs and face. Successful at last, she gathered up the check and ran back to the analysts
of ce, where she now appeared. After telling the analyst this story, the patient then reverted to what
they had been discussing the previous day. While I suspect that most North American analysts would
have called attention to some aspect of this unusual sequence of events, including, perhaps, the
urgency of the patients need to pay the analyst or the self-destructive components in her behavior,
the analyst said nothing about this action sequence. It was not until, in a subsequent hour, there was
a reference to it in a dream that he commented on the material, for it was not until this moment
that the action sequence had entered the discourse and, now represented by the patient, could be
addressed as part of the analytic process. The analysis proceeded to a successful conclusion.

Conclusion
I hope to have clari ed in this paper a number of approaches to the theory and practice of the
analysis of transference from the North American point of view, including different stances on
the concept of the transference neurosis, the role of extratransference interpretations, controversy
around early interpretation of the transference, and the current interest in the role of action in the
clinical moment. I have tried to trace contemporary elaborations of these issues to some of their
historical origins and to illustrate them with clinical material.
If the theories of the analysis of transference are disparate and diffuse, so are its practices,
and I believe we would do well not to try to tie theory and practice prematurely. It is my strong
belief that it is only in the careful examination of the practices of our discipline, attempting
dispassionately to observe our own work as well as that of others, including the ways in which we
use our theories, that we will begin to understand where we might bridge our several approaches
and where they must remain distinct. I offer this description of my own approach to the analysis
of transference from a North American perspective as a contribution toward that goal.

Translations of summary
Analyse der bertragung : Eine nordamerikanische Perspektive. Der Autor illlustriert und vergleicht
mehrere nordamerikanische Anstze zur Analyse der bertragung, indem er ausfhrliche klinische Vignetten
 ANALYSIS OF TRANSFERENCE 1039

benutzt, und er verfolgt ihre Ursprnge in den Arbeiten Freuds und in verschiedenen post-Freudianischen
Konzeptualisierungen, einschliessliche der Schriften von Anna Freud und Charles Brenner. Es wird
besondere Aufmerksamkeit den Arbeiten von Merton Gill, Evelyne Schwaber, Paul Gray und der britischen
Psychoanalytikerin Betty Joseph gewidmet. Es werden die Kontroversen bezglich der engeren und weiteren
Ansichen von bertragung, der Deutung von Handlung im analytischen Setting, zeitlich frhere und sptere
Deutungen der bertragung mit besonderer Betonung auf dem Kontrast zwischen heutigen Kleinianern
und Ich-psychologischen Perspektiven, der Rolle von ausser-bertragungs-Deutung und dem Konzept der
bertragungsneurose diskutiert und illustriert. Es wird fr einen integrativen Ansatz argumentiert, der sich auf
verschiedene Schwerpunktsetzungen beruft, je nach den klinischen Umstnden und dem Punkt der affektiven
Unmittelbarkeit fr den Patienen, der entweder mit der Punkt der affektiven Unmittelbarkeit fr den Analytiker
zusammentreffen kann oder auch nicht.

El anlisis de la transferencia: Una perspectiva norteamericana. Utilizando unas vietas clinicas detalladas,
el autor ilustra y compara diversos enfoques norteamericanos frente al anlisis de la transferencia, mostrando
sus orgenes en las obras de Freud y en diversas conceptualizaciones postfreudianas que incluyen los escritos de
Anna Freud y Chalres Brenner. Se le presta particular atencin a las obras de Merton Gill, Evelyne Schwaber,
Paul Gray y la analista britnica Betty Joseph. Se discuten e ilustran las controversias sobre las visiones ms
amplias y ms restringidas sobre la transferencia; la interpretacin de la actuacin en el marco analitico; las
interpretaciones precoces y tardas de la transferencia, con particular nfasis en el contraste entre las perspectivas
contemporneas kleinianas y las de la psicologa del yo; el rol de la interpretacin extra-transferencial, y el
concepto de la neurosis de transferencia. El autor de ende un enfoque integrador, poniendo el acento en
diferentes aspectos, segn las circunstancias clnicas y la posicin de inmediatez afectiva del paciente, que
puede o no coincidir con el punto de inmediatez afectiva del analista.

Lanalyse du transfert : une perspective nord-amricaine. partir de vignettes cliniques dtailles, lauteur
illustre et compare un certain nombre dapproches nord-amricaines dans lanalyse du transfert, en retraant
leurs origine dans loeuvre de Freud et dans diverses conceptualisations post-freudiennes, dont les crits de Anna
Freud et de Charles Brenner. Lauteur attache une importance particulire aux travaux de Merton Gill, Evelyne
Schwaber, Paul Gray, et lanalyste anglaise Betty Joseph. Lauteur discute et illustre les controverses entre les
conceptions largies et restreintes du transfert, linterprtation de lacte dans le cadre analytique, les interprtations
prcoces et tardives du transfert avec une mention particulire pour le contraste entre perspectives kleiniennes
contemporaines et perspectives de la psychologie du moi, le rle de linterprtation extratransfrentielle , et le
concept de nvrose de transfert. Lauteur argumente en faveur dune approche intgrative, en mettant laccent
sur diffrents points, selon les circonstances cliniques et la position dimmdiatet affective du patient, qui peut
ou non concider avec la position dimmdiatet affective de lanalyste.

Analisi del transfert: una prospettiva nordamericana. Utilizzando vignette cliniche particolareggiate,
lautore dellarticolo illustra e mette a confronto numerosi modi di affrontare lanalisi del transfert nel mondo
nordamericano, facendoli risalire alle opere di Freud e a varie teorizzazioni postfreudiane, tra cui gli scritti di
Anna Freud e di Charles Brenner. Egli dedica particolare attenzione al lavoro di Merton Gill, Evelyne Schwaber,
Paul Gray e a quella della psicoanalista inglese Betty Joseph. Egli inoltre discute e illustra le controversie
sulle teorie pi ampie o pi ristrette del transfert, sullinterpretazione dellazione nel setting analitico, sulle
interpretazioni del transfert precoci e tardive, con particolare attenzione al contrasto tra le prospettive kleiniane
contemporanee e quelle della psicologia dellIo, al ruolo dellinterpretazione extratransferale e al concetto di
nevrosi di transfert. Lautore sostiene un orientamento integrato, enfatizzando diversi elementi, che dipendono
dalle circostanze cliniche e dal punto dimmediatezza affettiva del paziente, che pu o non pu coincidere con il
punto dimmediatezza affettiva dellanalista.

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