Int. J. Psycho-Anal. (1989) 70, 287

TOLERATING THE COUNTERTRANSFERENCEA MUTATIVE PROCESS

DENIS V. , LONDON

Much has been written about the counter-transference in the more recent psychoanalyticliterature. In this paper I shall look at the patientwho evokes intense feelings in the analyst. I shalldiscuss the basis of such a phenomenon anddifferent possible ways of dealing with it, and Ishall describe how 'tolerating' the counter-transference can be of therapeutic benefit to thepatient.

I shall begin, however, with a few historicalcomments on the concept of countcrtransfcr-ence.

It is often said that although Freud changedhis views about transference from seeing it as ahindrance to appreciating its central therapeuticvalue, he never realized the therapeutic value ofcountertransfcrence. In fact, what we now referto as countertransference, and regard as helpful,is a different phenomenon from that describedby Freud using the same term.

Freud first used the term in 1910 to refer tothe analyst's unconscious resistance againstfreely helping the patient to deal with areas ofpsychopathology which the analyst himselffound difficult, and he maintained this usagethroughout his later writings. What we callcountertransference nowadays is quite different,the term being most commonly applied to con-scious and preconscious feelings which the ana-lyst has towards his patient.

The move towards this more modern versionwas begun by Paula Heimann in her 1950 paper'On countertransferencc'. She starts by definingthe term as 'all the feelings which the analystexperiences towards his patient'. She includesthe unconscious in this, describing the counter-transference as being the result of an interaction

whereby 'the analyst's unconscious understandsthat of his patient', but she focuses in the paperon conscious and preconscious feelings—whatshe calls the analyst's 'emotional response' tothe patient. It is this focus on conscious andpreconscious feelings towards the patient whichhas come to be generally referred to in morerecent years. Segal (1977), however, has pointedout that, contrary to this common usage, themajor part of the countertransfercnce is un-conscious, and we become aware only of itsconscious derivatives.

Heimann goes on to describe how. if theanalyst allows himself to become aware of his:ountertransfcrencc, the feelings can be used tcpoint him towards the areas that are significantto the patient at that time. The process whereby Ifsuch a situation becomes possible can be under-stood through the concept of projective idcnti-.fication, which was first described by Meianie ;

Klein (1946) as a mental activity occurring:initially in early infancy, but continuing through-out life. It is based upon an unconscious phan-tasy in which split off parts of the self are seen ashaving been put into, and become part of, theother person, originally the breast as a part-object. This original concept has since beenextended by Bion (1959) and Rosenfeld (1971)to include the notion that the recipient of theprojectivc identification is affected by it, suchthat he can experience whatever is projected intohim. It is on the basis of such an idea that thelater views of countertransference are now under-stood, and it is interesting that Heimann says in1950 that 'the analyst's countcrtransference isnot only part and parcel of the analytic re- .lationship, but it is the patient's creation, it is a (part of the patient's personality'.

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Writings on this subject are unclear as toexactly how the analyst 's mind is affected in thisway. In discussion of clinical material , analystssometimes talk as if they believe that this aspectof the countertransfcrencc involves the analystactually feeling the patient's feelings, in a con-crete sense—as if feelings leave the patient 'smind and are inserted into the analyst 's mind.

I th ink that the confusion about this arises inpart from writings on the subject which arcdescribing thoughts or phantasies existing in themind of a patient, or baby, or analyst , or mother,but which fail to spell this out clearly, and so cangive the impression that they arc describingphenomena from the point of view of the writer,or any other objective third party observing theinteraction being described. For example, takemy last quotat ion from Hcimann who says that'countcrtransfcrencc. . . is a part of the patient 'spersonality'. The patient might well beiievc, aspart of his unconscious phantasy, that this isconcretely the case. Likewise, the analyst might,thus conceptualize the si tuation if he has read(or misread) the relevant literature. But, in myopinion, a hypothetical objective observer of theinteraction would see that both were mistaken intheir beliefs, and that the patient somehow hadbeen able to induce in the analyst a state of mindvery similar to one he was more or less suc-cessfully a t tempt ing to el iminate in himself.

Projective identification is a primitive pheno-menon and can therefore involve very powerfulfeelings which are only able to be dealt wi th inthis way because the patient is unable to putthem into words. Particularly with more dis-turbed and borderline patients, the analyst findshimself filled with powerful feelings in the ses-sion, and is laced with the problem of how todeal with them. The first diff icul ty is describedby Heimann (1950) when she points out that' v io l en t emotions of any kind, of love or hate,helpfulness or anger, impel towards action ratherthan towards contemplation and blur a person'scapacity to observe and weigh the evidencecorrectly' The danger is that the analyst w i l l actout his powerful feelings, and his first task insuch a s i tuat ion is to a t tempt to tolerate thesefeelings, without acting them out. I shall returnto an examination of this area later.

With a more subtle countcrtransference, thefirst task is often simply to recognize these

feelings, but this can be diff icult , as is pointedout by Bnnman Pick (1985). She reminds ustha t the analyst is a human be'ing, and is thereforeas likely as the patient is to wish to avoid thepain of the projected experience.

She also talks about the analyst's next task.Having recognized his countcrtransfercnce feel-ings, and having avoided acting them out in a

.destructive manner, the analyst must attempt toundo the inevitable tangle in his mind betweenwhat is more directly patient-produced, andwhat is more a function of his own personalresponse to that production. If he can do thisthe analyst can then try to understand what thepatient is projecting, along with the motivebehind it.

All this is fairly generally agreed, but we nowcome to a difficult problem. How is the analystto utilize what he has learned to best therapeuticadvantage?

There are those who have advocated that theanalyst should reveal his countertransfcrcnccopenly to the patient, in a variation of 'Youmake me feel such-and-such'. In a follow-up toher 1950 paper. Hcimann (I960) states that 'acommunication of this kind represents a con-fession of personal matters pertaining to theanalyst, and would mean a burden to the patientand lead away from the analysis. Therefore itshould not occur' (p. 12). I would add thai sincethe patient projects somethingJisJs..unableJLOtolerate, he is likely to experience such a 'con-fession' as confirmatory evidence thai his pro-jection is intolerable, since the analyst is havingto get rid of it also.

The idea has been formulated, principallythrough the work of Bion (I962a, 1963). thatthrough a process of understanding the paiieni's .projections, the analyst functions as a 'con- •t a incr ' of them, such that they are 'detoxified'.That is to say that the fr ightening and distressingnature of what the patient projects is mitigated,and the analyst then has to find a way ofconveying the projected part of the patient backto him in an acceptable form. This is done byinterpretat ion, which allows the patient to takeback in. rc-introject. the parts of himself he hasprojected, but altered such that they can beintegrated into his personality.

The extent to which this is possible variesgrea t ly . The s i t u a t i o n is addressed by Rosenfeld

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(1971) who describes such interpretations asbeing the essence of the analytical task in in-stances where the patient is using projectiveidentification as a communication. He says thathen: the patient is receptive to the analyst'sunderstanding and can find the interpretation

' meaningful. Where projective identification isbeing used, however, to deny psychic reality,interpretation may be experienced as a forcedre-entry. Rosenfeld says it is important to differ-entiate these situations in order to keep contactw i t h the patient and make analysis possible.

Another way to look at this is to consider theextent to which a patient retains within himselfsome vague awareness of whatever is projected.The more a patient retains an awareness of whathe projects, the more he will be able to recognizeit as his when the analyst interprets it to him. Amore disturbed and borderline patient tends touse projective identification in a more completeform, so that he often divests himself entirely ofhis projection, seeing it as entirely foreign tohimself, and retaining no awareness of it what-soever. I t is here that the therapeutic task isrendered particularly difficult, and it is thiss i tua t ion which I principally address in thispaper.

The first point I wish to make is that in sucha situation it is worse than useless for the analystto try to tell "a patient he feels something hesimply does not feel. The patient is furtherconvinced of the reality of his projection by aconfirmation that what is intolerable or un-acceptable does indeed lie elsewhere. Further-more, the patient feels himself to be confrontedby an analyst who is attempting to push some-thing frightening or crazy into him.

There do seem to be analysts who insist uponusing the countertransfercncc in this way, ap-parently in the belief that although the patient isnot aware of feeling what he is being told hefeels, the interpretation will somehow affect himat a deeper level. 1 think that this carries the riskof a pseudo-acceptance of such an interpretation,motivated by fear of a frightening analyst, whichis hidden behind an idealization of the analyst(and his technique). Certainly Roscnfeld (1971)appears to warn against such a technique. Herecognizes the technical problem, and seems tosuggest that the best approach is to interpret theprojective process as well as the content of the

projection. This presumably involves telling thepatient that he avoids feeling such-and-suchthrough a belief that he has got rid of suchfeelings into the analyst, and this also is atechnique used by many. Once again, however,it involves telling the patient he feels somethingwhich he is unaware of feeling, since the phantasyof projective identification being thus spelledout by the analyst is, by its nature, unconsciousand unavailable to the patient. In my own clinicalwork I have not found this approach useful,although Rosenfeld is describing work withpsychotic patients, who may well be more awareof their phantasies than the less seriously dis-turbed.

We are left with the question of how to dealwith powerful experiences in the counter-transference to best therapeutic effect. I amsuggesting in this paper that if the analyst is ableto tolerate such feelings, then this by itself canhelp the patient, and produce psychic change. Ishall explain what I mean by the word ' tolerate'.I am not referring to an abi l i ty to remainunaffected by the patient's projections, or todistance oneself from the heat of the emotionalinteraction, or to 'hide' one's emotional re-sponse from the patient. An analyst who re-sponds in these ways is likely to be experiencedby the patient as distant, or cut-off, or frightened,or insincere. What I do refer to is the ability toallow oneself to experience the patient's pro-jections in their full force, and yet be able toavoid acting them out in a gross way. To do this,one must be able to avoid being taken overcompletely by the experience, but I believe it is •inevitable that if the projections are fully ex-perienced, then the countcrtransfercnce will beacted out to some partial degree. Brenman Pick(1985) says as much when she describes howprojective identification is intended to producereaction, which may be dealt with so quickly asto be unrecognized. 'The analyst has an impulseto enact, and some of this will be expressed inthe interpretation' (p. 158).

I think that this acting out can take manyforms, including«choice of the area of interpret-ation, *he type of interpretation and«its wording.and «the tone of voice in which it is delivered. Ibelieve that this unavoidable aspect of the situ-ation is, in the end, of positive therapeutic value,and later I shall give an account of how this

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might be the case, but firstly ! give a clinicalexample i l l u s t r a t ing the partial acting out towhich I refer.

The pat ient is a single woman in her mid-30s.seen in once weekly psychoanalytic psycho-therapy. Her complaint is of phobic and obses-sional symptoms. She is unable to use elevators,or travel on the Underground or in an aeroplane,describing a fear of becoming 'stuck' in thesesi tuat ions, a l though no such th ing has everactual ly happened to her. She worries constantlyabout her parents' health, particularly fearingtha t her father will suffer another serious nose-bleed and die. This also extends to her ownhealth and she is a frequent attender at thedoctor's surgery with minor ailments. She isobscssionally neat and tidy, and will constantlyrearrange the clothes in her wardrobe, or itemsat work. Before retiring for the n igh t , she has tocheck repeatedly that the doors and windowsare locked, fearing intruders. Eating out is alsoa problem, due to a fear of eating food whichhas gone 'off'. At home she constantly smellsfood before eating it. and discards any whichhas passed the recommended 'sell by' date onthe package. She is unable to eat in restaurants.

She is the only child of Spanish working-classparents, and remains closely lied to them. Shelived with them at home until her early 30s, andonly left to live in her own flat to escape her feartha t her father might have a nosebleed duringthe night and she would have to attend to him.Despite moving away, she spends evenings andweekends at her parents', really only using herown flat as a place to sleep. Mother is describedas soft and calm, and father as harder, and liableto panic attacks.

She left school without qualifications, workedin a clothes shop, and finally opened her ownsmall shop along with a female partner, sellingladies' clothes.

At her assessment interviews, she was de-scribed as being controlled and businesslike,d i sp lay ing no emotions at all. One s t r i k i n g th ingabout her was that she had no memories of anysort before the age of 16. She was also unable todescribe any dreams or phantasies and gave theimpression of having a very empty inner world.She had a couple of girlfriends but had neverhad a las t ing relationship w i t h a man. Shedescribed her emotional state as being on a

constant 'even keel—neither up nor down'.She did admit that she would sometimes getangry with her parents, and described an incidentwhere she had had an argument wi th her mother.Mother subsequently offered to cook the pa t ien ta meal, which she refused, saying she was nothungry , but she then proceeded to eat a slice ofdry bread in front of her mother. This wasdescribed in a characteristically factual andaffec'.less manner, as if she was ent i re ly unawareof having felt a n y t h i n g at ail at the time.

She began once-weekly treatment with meafter a lengthy wait for a vacancy. In the therapyshe presented in a very practical, businesslikemanner, with an attitude that she was a patient,coming to sec a doctor for a course of treatmentdesigned to help her with her phobic symptoms.She greeted me with a 'Good afternoon. Doc-tor ' , and left with 'Goodbye. Doctor'. Dur ingthe sessions she was co-operative and friendly,showing no other emotion, ta lk ing constantlysuch that I found it diff icul t to speak, andreferring occasionally to her dislike of silence.

I quickly discovered that any at tempt by meto interpret the transference would be met withan innocent, surprised bewilderment. She couldnot understand why I was suggesting that sheshould have any feelings about me when, afterall, I was simply the doctor she was coming tofor help with her symptoms. An example of thisat t i tude was where, after several months oftherapy, she asked for a change of her regulartime because of a work commitment, and when Iwas unable to accommodate her, politely askedme whether I could arrange for her to transfer toanother doctor. Almost every comment which Imade to her was carefully and politely examinedand shown to be invalid, either on sensible,rat ional grounds, or because I had used a wordin describing something which was different fromthe word she had used. I tried to interpret this asinvolving her fear of taking in something bad.like the 'off' food, but to no avail.

My countcrtransfercncc throughout many ofthe sessions was an overwhelming feeling ofimpotent rage that I was being dismissed asuseless and unimportant along with my attemptsto help her. I feel that this derived from aprojective identification of similar feelings inher. and tha t for such an effective evacuation ofthese feelings to take place into me, i t was

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necessary for me to be a suitable container forthem. That is to say tha t I myself must besignificantly susceptible to such feelings on my

j own account for such a successfully massive'transfer ' of them to have taken place.

At various times earlier in the therapy, i triedto talk to her about her feeling useless, orresentful towards me. or her wish to control meand prevent me from helping her. but thesecomments were to ta l ly meaningless to her. Irealized I was not helping her in this way. so !tried to avoid such interpretat ions and simply totolerate this countcrtransfcrence. This does notmean that I stopped interpreting. ! continued toattempt to interpret the nature of the trans-

I ference as I saw it, but I paid particular attention\ to the need to avoid interpretat ions which she

i might be unl ikely to accept. I t h i n k that attentionto this endeavour helped me to avoid acting outmy countertransfercncc in a gross manner: how-ever. I shall now give an account of a sessionwhich took place about a year into the therapyand which I hope will demonstrate the con-t inuing degree of partial acting out on my part.

She began the session breathless, as usual,having climbed up four flights of stairs to reachmy room. She smiled and said, in her chattyway. that she was even more short of breaththan usual today because she usually rests for amoment at the top of the stairs, but a man wasstanding wait ing for the lift and she worried hewould th ink there was something wrong withher so she did not wait. She had arrived in thewaiting room earlier than usual today and hadread in a magazine a story about a woman whowas a heroin addict, having turned to drugsbecause she was depressed. The woman had notrealized at the time that she was depressed, onlynoticing that she was tak ing less care of herself.Reading this story hadn't made the patient feeldepressed, it just got to her a bit, that 's all. Onthe bus coming here she was t h i n k i n g aboutwhat she was going to talk about, and. as usual,couldn't t h i n k of a n y t h i n g important t h a t hadhappened since last week. As I know, she doesn'tdo very much, just goes to work and then homeagain. She thought on the bus about last week'ssession and what had happened in i t , though ithadn' t crossed her mind all week. Thinkingabout it . she felt a bit down—not depressed.Reading about this drug addict made her t h ink

about how. over the past couple of years, shehasn't been tak ing quite so much care overthings. It's not tha t she's allowing herself to goto the dogs or anything. There are just somethings she tends to let go. especially in her flatwhere there are things she used to do every dayor every week, but now it's every couple of daysor weeks. Not t h a t it 's dir ty , or that anyone elsewould notice. She doesn't have visitors anyway.If a friend comes to see her it's usually at herparents' house. She supposes that anyone elsewould th ink her flat looked OK, but she's awarethat some things aren't being attended to prop-erly.

The above is really a condensed account ofthe first ha!f hour of the session, where shetalked constantly such that I was given noopportunity to speak. At this point she pausedslightly, allowing me to say to her tha t it soundedas if she had become aware of feeling a bit downinside, something she felt here last week. I addedthat she seemed to be saying that this wassomething other people wouldn't notice, some-thing I was not noticing, so that it wasn't beingattended to here.

Her response was to say that she doesn't secthe point of attending to things. After all. one ofher problems is that she attends to things toomuch, especially at work where everything hasto be perfect. Her partner goes on about how shespends ages making everything neat and tidy-one of her obsessions. And. of course, none ofthat is any better. She's stil l coming up by thestairs.

I said it seemed that when I try to make anattempt to attend to her distressing feelings here,she goes on to talk about her symptoms.

She said she couldn't see the connexion. Shewas trying to think on the bus about how gettingemotional about her parents dying and beingleft alone (an issue from the previous week)could have any th ing to do with her symptoms,and there's no connexion. At least none that shecan sec. Maybe I have some idea about it. but Ihaven't put it to her yet. although she presumesI'm a qualified psychiatrist, and must knowwhat I'm doing.

I said it sounded as if she was able to ' t h inkabout 1 her distress and feel it wasn't connectedto her symptoms, so there was no point inbothering about it. She was making it all neat

292 DENIS V . C A R R Y

and tidy so that she didn't have to worry aboutit.

She said her parents are going to die eventu-ally, and there's nothing anybody can do aboutthat, so it's best just to put it out of her mind.Really she wants help with her symptoms, andmaybe that just lakes a very long time. She seesother people in the waiting room so she supposespeople do get heip here. Maybe it 's just she thatcan't be helped, so I'd really be better seeingsomeone else.

! pointed out to her that she had been cominghere for some time now and had seen that whatseems to happen is that she talks about hersymptoms and I say things about her feelings,which she now admits do cause her some distress.Yet what she seems to be saying is that she's notinterested in having anything to do with herfeelings and her distress; not interested in whatI have to give her. She only wants help with hersymptoms which are troublesome but don't seemto cause any distress, and she feels she's notgetting any help. I added that it was like thesituation with her mother, where she is hungryand her mother offers her a meal but. in heranger, she says she doesn't want it and deliber-ately eats dry bread in front of her mother.

No. she said, that's different, because she docsthat when she feels angry with her mother. Shedoesn't feel angry with me because there's noreason to. It's like if she goes to the doctor, shehopes the tablets will help, but if they don't shedoesn't feel angry with him. She just feels it'ssomething he can't help her with.

At this point we had run out of time, and Itold her so. She commented that the time hadpassed quickly. I said I thought that was becauseshe had felt so much on top of the situation.She smiled and said she thought I was right.'Goodbye, Doctor.'

I think this session illustrates how the patientgot under my skin, causing me to act out slightlyby making comments which were critical andinvolved my trying to make her feel something>he was unable to feel. What I took to be hertriumph at the end resulted. I believe, from herhaving been able to observe that she had got tome jnd affected me in this way. Although 1 thinkshe had a momentary conscious awareness of(his. it Deemed to have gone when I tried to referto it in the following session.

This brings me towards the main point I amtrying to make. The analyst's partial acting outallows the patient to see. consciously or un-consciously, that she is affecting the analystand inducing strong feelings in him. and it allowsher to observe him attempting to deal with thesefeelings.

This is somewhat at variance with the viewput forward by Winnicott (1949) in his paper'Hate in the counter-transference'. He says that'the analyst must be prepared to bear strainwithout expecting the patient to know anythingabout what he is doing, perhaps over a longperiod of time... Eventually, he ought to be ableto tell his patient what he has been through onthe patient's behalf" (p. 72). He is not advocatingthat the analyst actively 'hides' his counter-transference, rather that the patient is incapableof an awareness of the analyst's hatred,

I do not believe this to be the case. Projectivcidentification would not be a particularly usefulmechanism to the patient if the phantasy wasnot supported by some sort of evidence that thepatient's view of the world was a real andaccurate one. I think that my experience withthis patient is only one example of her lifelong,and perfectly honed, ability to get under people'sskins in this way, and observe their frustrationwith her. while she remains devoid of feelings,and one can imagine such an aspect to theinteraction she describes with her mother overrefusing a meal and provocatively eating drybread.

Brcnman Pick (1985) suggests that the patientwatches, consciously and unconsciously, to see ifthe analyst evades or meets difficult areas withinthe interaction. I would like to say. more speci-fically, that I believe it is the inevitable partialacting out of the countertransference whichallows the patient to sec that the analyst is beingaffected by what is projected, is struggling totolerate it, and. if the analysis is to be effective,is managing sufficiently to maintain his analyticstance without grossly acting out.

I believe it is through this process that thepatient is able gradually to re-introject the pre-viously-intolerable aspects of himself that areinvolved. He also is able to introject the capacityto tolerate them which he has observed in theanalyst.

I am saying, therefore, that in these circum-

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stances it is the gradual process of introjection asa result of this non-verbai interaction whichproduces change in the patient's psychic struc-ture, ra ther t han an interpretat ion whose content

, is meaningless to the pa t ien t . The in terpre ta t ioncan only become meaningful as a consequence ofthe patient 's discovery of aspects of himselfthrough this gradual process. It is only then that.he patient is able to recognize what he hasprojected as his. and so the 'successful' in-terpretat ion, and the sense of mutual under-standing produced by it. serves as a confirmationof something which has already become avai l -able to be more consciously understood.

As in all good ana ly t ic work, the interpretat ionhelps in the formation of a l i n k in the patient 'smind , in this case between preconscious andconscious. Projective ident if icat ion is part of amenta l scenario where l inks are destroyed be-cause they cannot be tolerated. I t h i n k tha t inthe interaction I have been describing, the ana-lyst 's to le ra t ing the coumcrtransfercnce involveshis making l inks in his mind, and it is this whichallows the pa t i en t to do likewise.

It i sd i f f icul t to t h i n k abourtfJch issttcatvnthoutspeculating as to how they might be extrapolatedinto the mother-baby interaction.

Bion (1962b) writes about iv.aternal reverie—areceptive state in which the mother is able to beaware of the bad parts of the infant which areprojected in to her. She acts as a container forthese projections and modifies them throughthought. She is then able to 'respond thera-peutical ly ' . This obviously does not mean thatshe gives the infant an interpretation. Bionexplains that she responds ' in a manner thatmakes the i n f an t feel it is receiving its frightenedpersonality back again, but in a form that it cantolerate' (p. 1 1 5 ) . He docs not say exactly howthis comes about. Nor does Rosenfeld (1971)when he tel ls us t h a t ' the mother is able in-stinctively to respond by containing the infant 'sanx ie ty and a l l ev ia t ing it by her behaviour'(p. 1 1 7 ) .

I am suggesting tha t the normal i n f a n t needsto be able to sense tha t his mother is s trugglingto tolerate his projected distress without majord i s r u p t i o n of her ma te rna l funct ion. She Witt otu n a b f e i o avoid giving the infant slight indi-cations of the way she is affected by h im. and itis these i n d i c a t i o n s which allow the i n f a n t to see

that the projected aspects of himself can indeedbg tolerated. The infant is able then to rc-introject these aspects of himself, along with thecapacity to tolerate them which he hashis mother.

The paradigmatic si tuation referred to byBion. is of the screaming hungry baby who feelshe is dying. The mother becomes gripped by apanic that the infant is dying, and she will beunable to feed him quickly enough. If she is ableto tolerate such a panic she will feed the baby. Inmy opinion, what is 'containing' about t h i s isthat the baby will have an experience of beingfed by a mother in whom he can sense panic, butwho is nevertheless able to give him m i l k . This iswhat makes the panic tolerable.

It follows from this that with a 'normal ' babythe degree of 'acting out ' by the mother iscrucial. If it is more than minimal there wil lcome a point at which the infant will experiencethe 'badness' of the panic to be more powerfulthan the 'goodness' of the milk . Instead of themilk making the panic tolerable, the oppositewill happen, with pathological consequences.

Since the same is likely to be true of theanalytic interaction, in no way do I advocatethat the analyst should deliberately act out hiscountertransference. I feel, however, that pre-vious descriptions of containment in mothersand analysts do not fully recognize tjie sig-mficancc of our inability completely to containwhatever is projected into us. and it is this which <I have been trying to address. I have focused onthe more easily observable version of the pheno-menon I describe, as it is found in the therapeuticinteraction with more seriously disturbedpatients. I believe, however, that a similar formof interaction is an aspect of the therapeutic re-lationship with all patients, and that i t corntributes to the therapeutic action of psycho[ "analysis.

SUMMARY

The paper examines the technical problem ofhow to deal with the patient who evokes power-ful feelings in the analyst. It describes how'tolerating' such countertransfercncc can, byitself , produce psychic change in the pa t ien t .This occurs through inevitable partial acting out

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by the analyst , and the patient 's observation ofthis. Implications of this interaction in the under-standing of the mother-baby re la t ionship arediscussed.

I should l ike to (hank Dr H. Stewart. Mrs E. Spil l ius.Dr J. Sieincr. Mrs M. Schneider, and Mr D. Mi l l a rfor their comments on earlier versions of this paper.

TRANSLATIONS OF SUMMARY

Cei article examine Ic problcme technique reialif a !amamerc d'aborder un patient qui jusci te des s e n t i m e n t spuissants chcz I 'analyste. II momre comment la ' tolerance'd'un tel contre-transfcrt pcut elle-meme amcner un change-mem psychique chez le patient. Celui-ci se fait en partieel inevi tablement par acting-out de la pan de I'analysle. c(('observation que le palienl en fail. L'auteur discute les

i m p l i c a t i o n s de cede interaction pcur la comprehension deU relation merc-bebc.

Dieser Aufsatz untersucht das ^echnische Problem deswie mil cinem Patienten umzugehcn ist. der schr starkeGefuhle im Analytiker crzeugl. Es wird beschrieben wie das'Tolleneren' ciner solchcn Gegenubertragung in sich selbslschon psychische Verinderung im Palienten bewirken kann.Dieses fir.dc! s t a t t auf Crund von unvermeidbarem tcilweisenAusagicren durch den Ana ly t ike r und des Patienten Beo-bachtung dieses Vorganges. Es wird diskuiiert welchc Foigensich aus dieser Wechselbcziehung fflr das Verstandnis derMutter-Klcinkindbeziehung crgcben.

El a r t i c u i o explora el problema tecnico decorr.o manejarsecon cl paciente que evoca poderosos sentimiintos en elana l i s t a . Describe como ' lolerar ' una !ai conlra-lrans-ferencia puede en si mismo producir un cambio psiqutco enel paciente. Esto ocurre por inevitables acting-outs parcialespor pane del analista. y su observacion por pane del paciente.Se discuten las i m p i i c a c i o n c s de esta interaccion en lacomprcnsion de la relacion madrc-bebe.

REFERENCES

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D. V. CarpyThe Tavislock Clinic120 Belsize LaneLondon NW3- 5BA(MS. received Scpicmber 1987)

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