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This paper illustrates the beneficial effect of a positive benevolent transference in the development of an internalized representation of the therapist/analyst in a variety of patients in psychodynamic treatments ranging from consultation to psychoanalysis itself. This is described in patient presentations. In those who have had substantial early nurturant life experience and now find themselves in a dysphoric state due to crisis, the effect lies in the transference reactivation of these positive object relations that relieve their distress. In those who have been deprived of such early experience, the positive transference may emerge during the intensive work of psychoanalysis and may lead to the internalization of a new positive object representation of the analyst generated in the transference that persists after termination of treatment. In both of these situations, the patient discovers a sense of greater harmony with self and the world. The special conditions that permit and facilitate this process are described since this does not occur in all psychodynamic interventions.

Through a case study, the importance of supporting the positive transference is stressed—from both a psychological and neurobiological perspective. The article argues that the neurobiology of expectation underlies transference. This neurobiology has been investigated particularly over the past several decades in work concerning the placebo effect. By understanding the neurobiology of expectation, one gains a better understanding of the neurobiology of the transference. This enables clinical predictions—and decisions—that are informed not just by the teachings of psychology but also by the science of biology.

The paper discusses Frieda Fromm-Reichmann's theoretical contributions on the psychotherapy of psychoses and refers it to other authors' views. Today widely accepted, she stressed transference and countertransference as essential issues in the treatment of severely disturbed patients. She disagreed with authors like Federn who interpreted the concept of regression in a way that to treat schizophrenics means to treat children of different ages. Different from Federn, she advocated interpretations also of the positive transference to show the patient where he stands in life. Later on, Fromm-Reichmann opposed John Rosen and his direct analysis interpreting first the contents of the psychotic's speech. She stressed the form of the interaction and of the everyday behaviour where she saw where the patient stands in the world. The discussion shows that Fromm-Reichmann developed her theories and practice in cooperation and discussion with other psychoanalysts working with psychotic patients.

A psychoanalytically oriented treatment of a middle-aged male schizophrenic patient is described. The therapy lasted for ten years, with a follow-up period of four years. The frequency of sessions was once a week throughout. The patient had been chronically psychotic for five years hearing voices accusing him of masturbation. From the beginning a positive transference with idealization developed. Mutual trust and a sense of communion was an important feature of the therapeutic relationship. Humour played an important part even during the most difficult periods of the patient's psychosis. He came regularly to sessions and was able to finish his studies soon after starting in therapy. The psychosis continued for many years. The pivotal point occurred after six year's of therapy when the patient dared to travel abroad alone and realised that the voices, speaking to him in Finnish, must be hallucinations, as he was surrounded by foreigners who did not know his native language. The economic recession forced th...

The path from narcissism to self pathology is described through five case vignettes. In Analysis Terminable and Interminable Freud presented a case illustration to argue that when a negative transference is not present, it can not be analyzed. After Freud, some analysts seem to have taken this argument a step further. They assumed that a patient's admiration of the analyst invariably conceals devaluation and therefore, beneath the positive transference there always lurks a negative transference. In this same paper Freud also described two “bedrocks”, which psychoanalysis can not penetrate. A man must accept his passive, feminine attitute toward another man. A woman must accept that she lacks a penis. Subsequently, these clinical and theoretical narcissistic issues have been reconceptualized within self pathology. The diagnosis of narcissism was based on an inability to relate to other people due to a fixation to an early stage of development. Additionally, narcissism signified defenses against ra...

This article considers three related questions: (a) Are positive transference and countertransference feelings imitations of true loving feelings or are they real? (b) What is the difference between a loving analytic relationship and an ordinary loving relationship? (c) What is the nature of the tension created in the analyst by the opposing tendencies of the relatively anonymous asymmetry in the analytic relationship and the self-revealing mutuality in an ordinary loving relationship?

In the previous chapter we have looked at the meaning of the client’s experience and behaviour through an investigation of the internal world and object-relations. There is one particular kind of object relationship to which both client and counsellor have immediate access, the relationship between client and counsellor. All forms of psychodynamic therapy are distinguished from other therapeutic approaches by their focus on the nature of this relationship, known as the transference. Turning one’s attention directly onto the nature of the relationship between client and counsellor, focusing on what goes on in the room between the two, is an essential part of the psychodynamic approach, as we can see again in the case of Mrs A.

Yet despit e th e need for esta blishme nt of ra pport an d positive transference th e ph ysician onl y too frequently, eve n in th e best ins t it ut ion s, ope nly di spl ays a cynica l, unreali stic and hostile a tt itude towa rd s th c addic t; he is indifferent to th e latter's ge nuine compla in ts, ass umes in adva nce th at he is a liar and maintains that it is a was te of effort a nd mon ey to a tte mpt a cure. (Ausubel, 1958; quoted in Imh of, 1993, p. 494)

The author describes his contact with Bion over a twenty-year period, from Bion's supervision of his control case in London in 1960 to the period from 1968 to 1978 when they were both working in Los Angeles. He outlines Bion's views on the use of 'instinct' and intuition in patient observation, the depressive position in patient and analyst, and memory and desire as impediments to knowledge of 'ultimate reality'. Some case material is presented, illustrating how Bion's ideas, particularly concerning attacks on linking, informed the course of the treatment. The author then discusses Freud's, Klein's and Bion's approaches to the problem of resistance, Bion's expansion of some of Klein's ideas, his definitions of psychosis and his formulation concerning thoughts that develop before thinking. The author then argues how essential it is for the analyst to differentiate between primitive projections from the patient that are pre-verbal attempts to communicate a state of mind and those that are an expression of hostility or control. He then discusses the importance of understanding idealizing projections and differentiating these from a healthy positive transference. He concludes by characterising Bion's way of working in terms of his humility, his courage and, fundamentally, his use of his intuitive binocular mind.

An invitation to the Balint Society’s annual dinner provided a welcome opportunity to revisit and review the enduring legacy of Michael Balint on British general practice and psychiatry. I was one of the smallish band of “Balint boys” (and girls) who were lucky enough to be in his seminars for medical students at University College Hospital, London, which ran for a couple of years in the mid-1960s. Several of us ended up as psychiatrists. I remember that first electrifying seminar well. He instantly reminded me of my maternal grandfather, a powerful influence in my life: stocky, bull necked, with thin, swept back hair, myopic, intriguingly deformed hands, and a bossy yet an acute listener. In retrospect, the resemblance was probably only superficial, but Balint, like all charismatic people, had the ability to evoke strong transference reactions. One could not help projecting onto him significant aspects or figures from one’s life: the father one wanted to please, the feared critic, the Goliath figure one would have to slay to find one’s manhood, the encyclopaedic polymath that one admired and envied, the attentive and protective lover. As for the last: an acquaintance who had been a patient of his always referred to him as “my darling Balint.” She was still seeing him at the time of his premature death and, like many others, was not given time to resolve her positive transference. His skill with medical students was to persuade us that we—role-less nothings in the medical hierarchy then prevailing in hospital medicine, even in a liberal institution like UCH—were the “experts” on our patients. Only we, not the consultants and other gods, had the time, he insisted, to sit and talk with our patients, to hear their fears and hopes. He taught us …

(1987). The Objectionable Positive Transference. Contemporary Psychoanalysis: Vol. 23, No. 3, pp. 491-502.

In keeping with the flexibility advocated by the senior author in psychoanalytic psychotherapy with the long lived (Cath, 1982), individual treatment of a 57-year-old man was converted to conjoint therapy with his wife and the therapist’s wife. The shift was considered advisable for several reasons. From the patient’s point of view, his therapist “had been through it with him before,” by which he referred to the time when cancer had reappeared in his 56-year-old wife’s second breast. Later, with the onset of her ominous back pains, he found his terrifyingly calm wife adamant about her choice of someone to consult, namely, his therapist. In their discussions, it became clear to him that through his 2 years of therapy, she had developed a “silent positive transference” based upon his sharing much of what he learned about his interactions with his families of origin and of generation. Reinforcing their decision to come together was the gratitude he and his wife felt for the therapist’s clarifications and interpretations of the surgeon’s verbal and nonverbal behavior, for example, turning his back to them as he talked, especially after her destiny had been sealed by the pathologist’s report.

The following statements deal with the establishment of transference in schizophrenics as we observe it in the Research Institute for Psychopathology and Psychotherapy of the Max Planck Society. The data are provided to illustrate the ideas put forward.