Friday, August 30, 2013

Leon Grinberg - Difference Between Countertransference and Projective Counteridentification

"Based on the complementary series of Freud, Racker (1960) described a countertransferential disposition on the one hand, and present and analytic experiences, on the other, which leads to the resulting countertransference. He added that this joining of the present and the past, of reality and fantasy, of the external and internal, etc, makes a concept necessary which envelops the whole of the psychological response of the analyst, and he advised that the term countertransference should be used. Nevertheless, he made it clear that, at times, one may speak of "total countertransference" and differentiate and separate within that term one or other aspect.
Racker emphasised the existance of a "countertransference neurosis" where the "Oedipal and pre-Oedipal conflicts, along with pathological processes (paranoid, depressive, manic, masochistic, etc.), interfere with understanding, interpretation and the behaviour of the analyst".
Racker made a particularly detailed analysis to two types of identification of the analyst with parts of the patient. Based on suggestions of H. Deutsch, he pointed out that the analyst, with his empathic tendency toward understanding everything which happens to the patient, is able to identify "each aspect of his own personality with its corresponding psychological part in his patient; his Id with the patient's Id, his ego with the patient's ego, his superego with the patient's superego, accepting in his conscience these identifications ". (my italics).
These are concordant or homologous identifications based, according to Racker, on introjection and projection, in the interaction of the external with the internal, with the recognition of the remote as his own ("this (you) is me"), and the association of his own with the remote ("that (me) is you"). "Concordant identifications" would be a reproduction of the analyst's own past processes which are being relieved in response to the stimulus of the patient, bringing about a sublimated positive countertransference which determines a greater degree of empathy.
The second type of identification, called "complementary identifications" are the results of the identifications of the analyst with internal objects of the patient; the analyst feels treated like those internal objects and he experiences them as his own.
Racker also described a "concordant countertransference" where there is an approximate identity between parts of the subject and parts of the object (experiences, impulses, defences); and a "complementary countertransference" where "an object relationship" can exist very similar to others, a true transference in which the analyst "repeats" earlier experiences. The patient now represents internal objects of the analyst.
It is here where I would like to outline the difference between Racker's countertransferential terms and my concept regarding "projective counteridentification".
To begin with, confusion only arises with regard to the difference between "projective counteridentification" and "complementary countertransference". "Concordant countertransferences" are related to the empathic link towards the patient, the desire to understand him and deal with identifications which are accepted in the analyst's conscience. It is worth mentioning that they almost depend on an active disposition on the analyst's part.
Let us therefore see what is the essential difference between "complementary countertransference" and "projective counteridentification". "Complementary countertransference" arises when the analyst identifies himself with the internal objects of the patient and experiences them as his own internal objects. Racker emphasizes the fact that the analyst repeats previous experiences in which the patient represents the internal objects of the analyst. The last experiences (which always and continuously exist) could be called "complementary countertransferences".
This countertransference reaction is therefore based on an emotional attitude which is due to neurotic remnants in the analyst, reactivated by the conflicts posed by the patient. It appears in the first situation of process B which I have described above, in which the analyst is the object of the patient's projections, e.g. his internal objects; but he reacts countertransferentially because of his own anxieties and the reactivation of his own conflicts with his internal objects.
On the other hand, "projective counteridentification" corresponds to the second situation of process B. The analyst's reaction stems, for the most part, independently of his own conflicts and corresponds in a predominant or exclusive way to the intensity and quality of the patient's projective identification. In this case, the origin of the process comes from the patient and not the analyst. It is the patient who, in an unconscious and regressive manner, and because of the specific functional psychopathic modality of his projective identification, actively provokes a determined emotional response in the analyst which the analyst will receive and feel in a passive way. (Grinberg, 1963a).
In "complementary countertransference" a reaction always arises which corresponds to the analyst's own conflicts. On the other hand, in "projective counteridentification" the analyst takes onto himself a reaction or a feeling which comes from the patient.
To clarify this point, I will use one of Racker's examples. It is the case of a patient who threatens the analyst with commiting suicide. Racker writes: The anxiety which such a threat aparks off in the analyst can lead to various reactions or defence mechanisms within him, e.g. a dislike of the patient. These feelings, the anxiety and the loathing, would be the contents of the "complementary countertransference". His awareness of dislike or loathing towards the patient can also bring about, at the same time, a guilt feeling in the analyst which can lead to desires of reparation and to the intensification of "concordant identification and concordant countertransference". (Racker, 1960)

Now, if we analyse this extract we find both processes superimposed on each other or co-existing simultaneously. (This usually happens.) The analyst experiences anxiety in the face of the suicidal threat. In this anxiety, two main components are evident: one corresponds to the analyst's own anxiety due to the feeling of responsibility which he has, when confronted with the eventual danger of suicide of his patient which, at the same time, may represent one of the analyst's internal objects. (It can be the patient's internal object which is being experienced as one of the analyst's own internal objects). This form of anxiety corresponds to a "complementary countertransference". On the other hand, the analyst takes onto himself the patient's specific anxiety which, through projective identification, the patient placed in him with the idea of the analyst controlling and eventually resolving it. This response of anxiety now forms part of "projective counteridentification". Later the analyst reacts with dislike (his own mechanism, belonging to "complementary countertransference") and guilt. If we analyze further this kind of guilt, we find that part of it has a persecutory characteristic, i.e., "persecutory guilt" (Grinberg, 1963b). This brings about the dislike for also having embodied (although in a partial way), the impotence and desperation of the patient and his fear of not being able to make a reparation. Another part of this guilt belongs to the "depressive guilt" (Grinberg, 1963b) which the patient is still not able to perceive nor manage, and which, projected into the analyst, makes the analyst feel able to make a reparation. These last considerations with regard to the patient's projection of the two types of guilt and the analyst's response, demonstrate how "projective counteridentification" works. However, it does not include the two qualities of guilt which the analyst may feel, due to his own conflicts which are reactivated by the material presented by the patient ("complementary countertransference).
Naturally, these processes are never pure nor are they isolated; they generally co-exist in different proportions.
When mentioning other examples, Racker maintains that a transferential paranoid-depressive state of the patient corresponds to a "manic-countertransferential state" of the analyst, in the aspects of "complementary countertransference". He is implying the co-existance of the two mechanisms. The analyst may react manically because of his own conflicts which make him feel strong or dominant when confronted by a depressed object; or because he has taken onto himself the manic and triumphant attitude of the patient which, due to the special use of projective identification has "placed" him in that position.
Through "complementary countertransference", each analyst identifying himself with his patient's internal object, will react in a personal way according to the type and nature of his own conflicts. Different analysts will react differently to the same situation, posed by a hypothetical patient. On the other hand, this hypothetical patient using his projective identification in a particularly intense and specific way could bring about the same countertransferential response ("projective counteridentification") in different analysts. I had the opportunity to confirm this through the supervision of material of a patient who had been in analysis succesively with various analysts.
In the way a transferential attitude begs a countertransferential response, a projective identification will also beg a specific projective counteridentification. Although the analyst introjects, albeit passively, this projective identification, what is important to recognize is that the specific reaction of the analyst is due to the way in which the patient projected, lodged or "forced" into the analyst his projective identification.
Furthermore, the "projective counteridentification" will have different modalities related to the respective modalities of the projective identification, coloured by the qualitative shading which gives it a functional specificity. Habitually, in all extra verbal communication, the type of functioning (degree and quality) of projective identification on the part of the patient does not go over the critical threshold of the analyst and the extra verbal message produces countertransferential resonance. It stimulates the response which could be received, controlled and verbalised with relative ease by the analyst. But, on certain occasions in which the degree and quality of the projective identification influence its functional modality in a special way, the result is that the extra verbal communication will pass over the critical threshold, producing "projective counteridentification". This threshold will depend on, in each case, the personality of the analyst, on his previous analysis and the degree of knowledge or awareness he has regarding this phenomenon. (Grinberg, 1976).
I also think that sometimes the analyst, when faced with an excessive projective identification on the part of the patient may respond with a paranoid attitude which will bring about a counterresistance and which will undoubtedly affect his work.
"Projective identification and counteridentification" phenomena are frequent in the analysis of narcissistic and borderline personalities, and give rise to a pathogenic interaction between the analyst and patient which is not easy to resolve. One might say that what was projected, by means of the psychopathic modality of projective identification, operates within the object as a parasitic superego which omnipotently induces the analyst's ego to act or feel what the patient wanted him to act or feel in his unconscious fantasy. I think that, to some degree, this is similar to the hypnotic phenomenon as described by Freud (1921) in which the hypnotist places himself in the position of the ego ideal and a sort of paralysis appears as a result of the influence of an omnipotent individual upon an impotent and helpless being. I believe the same idea applies, sometimes, to the process I am discussing. The analyst, being unaware of what happened, may resort to all kind of rationalizations to justify his attitude or his bewilderment just as the hypnotised person does after executing hypnotic suggestions.
When the analyst is able to overcome this reaction, he may take advantage of this phenomenon so as to clarify some of the patient's unconscious fantasies and emotions making an adequate interpretation possible." (pp. 232- 235)
Leon Grinberg (1979). Countertransference and Projective Counteridentification. Contemporary Psychoanalysis, Vol. 15, pp. 226-247

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