Countertransference and the Therapeutic Relationship
Recent Kleinian Developments in Technique

 R. D. Hinshelwood

The two important concepts in contemporary Kleinian practice are those of 'containment' and the 'K-link'.

Following Klein's interest in the very earliest stages of the mind, Bion hypothesised that the first cognitive working of the mind entails a link between something innate (the organism itself) and something foreign (experience perceived in external reality). The infant with certain preconceptions - innate expectations - already knows, as it were, what to do with a certain perception. The typical example is the new-born baby which already seems to know what to do when the nipple touches its cheek. Its head turns and it begins to suckle. This suckling reflex seems to be innate - but the nipple has to be there in the external world to realise the reflex. Bion thought that this kind of link was the fundamental building block of the mind. When the innate pre-conception meets a realisation (in perception), they link to create a mental object, and with it a mind to hold the mental object.

This conversion, from raw experience to mental object, Bion called 'alpha-function'. Bion noticed that in the example of the nipple and the mouth the linking takes a particular form. One thing actually goes inside another. Bion took this as an extremely important characteristic. Linking is not just a coming together like two magnets sticking together, it is much more intimate, like a hand in a glove. He was pleased with this because that kind of 'one-thing-inside-another' link was reflected too in the Oedipus complex, the penis enters the vagina; and Bion sometimes used the signs for Mars and Venus to emphasise this essential quality of linking - G -- F . This is one of the major additions which psychoanalysis has contributed to associationist psychology - the inside quality of links.

Entering of one object into another has similarities also with projective identification. Thus 'linking' brings together a wide range of psychoanalytic ideas. We give it the name 'containing'. These ideas underlie all the work discussed in this paper.

Containing

Bion stressed that containing is not a passive function. It involves both partners in an active inter-relationship. He described the varieties of inter-relations that can be found but his accounts (1970) are rather complex. I find helpful in practice to consider three categories. Remember the relationship between the container and the contained is dynamic, a mutual influencing.

In the first variety, the container reacts to the intrusions by becoming rigid and refusing to respond to what has arrived in it, with the result that the contents, the contained, lose form or meaning. Bion described this in clinical practice:

The analytic situation built up in my mind a sense of witnessing an extremely early scene. I felt that the patient had witnessed in infancy a mother who dutifully responded to the infant's emotional displays. The dutiful response had in it the element of impatient "I don't know what's the matter with the child." My deduction was that in order to understand what the child wanted the mother should have treated the infant's cry as more than a demand for her presence (Bion 1959, p. 103).

An infant needs other than duty from a mother. It needs a mother who can feel the disturbance, and to a degree become disturbed herself.

From the infant's point of view she should have taken into her, and thus experienced, the fear that the child was dying. It was this fear that the child could not contain for himself… (Bion 1959, p. 103)

This implies a mother who could react more sensitively.

An understanding mother is able to experience the feeling of dread that this baby was striving to deal with by projective identification, and yet retain a balanced outlook. (Bion 1959, p. 103).

This is a flexible relationship, one in which the contained enters the container and has an impact on it, whilst the container and its shape and function also modify the contained. The knack is to feel the dread and still retain a balance of mind. An on-going process of mutual influence and adaptation survives.

The third type is rather the opposite of the first, in which the contained is so powerful that it overwhelms the container which bursts or in some way looses all its own form and functions. A mother's mind can literally go to pieces, and she panics or even breaks down.

The central dimension of these three categories of container-contained relationship is the ‘balance of mind’. Some mothers cannot keep a balance of mind. Perhaps it would be true to say that all mothers will fail at times - some more than others. But they fail in characteristic ways. And I claim that in failing the mother becomes a container that is either too rigid or to fragile - as I have described above. A rigid mother takes in as Bion describes and utters formal responses, without a real understanding of the infant's distress. A fragile mother will, when confronted by her distressed baby, got to pieces and panic. In either case the infant receives back its own projection with the implicit message that after all, as it feared, its state of mind is not tolerable. It suffers, in Bion's terms, a 'nameless dread' - i.e. a state of mind that is not thinkable.

This set of emotional, non-verbal interactions, characteristic of infant and mother, has become a model of the core analytic relationship. Hanna Segal was explicit that mother's relation with her infant is a model for the relationship in analysis. For instance, Segal describes it as follows:

The mother's response is to acknowledge the anxiety and do whatever is necessary to relieve the infant's distress. The infant's perception is that he has projected something intolerable into his object, but the object was capable of containing it and dealing with it. He can then reintroject not only his original anxiety but an anxiety modified by having been contained. He also introjects an object capable of containing and dealing with anxiety (Segal 1975, pages 134-5).

The progress of analysis requires an analyst with a mind that can, in the same way, contain reasonably flexibly, the patient’s distress, and thus think about it.

The ‘new’ countertransference

This draws attention to certain aspects of the way the analyst’s mind functions. It is no longer a blank screen. The distinctive aspects of an analyst’s mind cannot, in any case, be effectively concealed from a patient who has ample time to study it carefully. This approach is linked with the new views on countertransference which sprang to the fore in 1950 (Heimann 1950, Racker 1953, Reich 1951, Little 1951, Winnicott 1947). Heimann later wrote:

The aim of the analyst’s own analysis is not to turn him into a mechanical brain which can produce interpretations on the basis of a purely intellectual procedure, but to enable him to sustain his feelings as opposed to discharging them like the patient (Heimann, 1960, pp. 9—10).

A number of papers by various people, and in various countries showed the helpful use to which countertransference can be put. Paula Heimann was, at the time, part of the Kleinian group in London, but Melanie Klein never accepted this change in the status of countertransference. She believed it merely gave analysts an excuse for making the patient responsible for what the analyst felt. Elizabeth Spillius commented,

Klein thought that such extension would open the door to claims by analysts that their own deficiencies were caused by their patients (Spillius 1992, p. 61).

Nevertheless, other Kleinian psychoanalysts did follow in this direction, but the Kleinian version had its own angle. It was cast in terms of the concepts of projection and projective identification, which the Klein group was activity working on in 1950. The most interesting paper was that of Money-Kyrle, in 1956. It is worth spending a little time on this, because it is a grounding for more contemporary Kleinian practice.

Bion and Segal were working out the model of containment in their work with schizophrenics. At the same time, Money-Kyrle was discussing ordinary countertransference with neurotic patients. He talked of 'normal countertransference', and contrasted it with the things that can go wrong. In this sense he is using the idea of normal and pathological forms of projective identification.

Cycles of projection and introjection

Even everyday conversation consists of putting feelings into the listener and their willingness to have that experience in their mind. We talk colloquially of ‘putting something across’, or ‘giving so-and-so a piece of my mind’, etc. In Rosenfeld’s words,

A prerequisite of psychoanalytic treatment is that it is necessary to make enough contact with the patient’s feelings and thoughts to feel and experience oneself what is going on in the patient (Rosenfeld 1987, p. 12).

The gist of the idea is that the analyst's function of making contact, at an emotional level, with the patient's material can go wrong; and it can go wrong in exactly the same way as the mother's containing of the infant's distress can go wrong. Psychoanalytic containing, too, can be rigid or fragile.

Money-Kyrle described the patient’s attempts in an analysis to convey to the analyst his distress and disturbance in such a way that the analyst is actually in receipt of the disturbance. It is necessary that the analyst feel the disturbance, and can thereby become ‘disturbed’ himself. This may simply be called empathy, but this line of work investigated the mechanisms upon which empathy is based - projection (by the patient) and introjection (by the analyst). A normal process consists of cycles of these mechanisms. Money-Kyrle (1956) described, ‘what seems to be happening when the analysis is going well’ (p. 23).

I believe there is a fairly rapid oscillation between introjection and projection. As the patient speaks, the analyst will, as it were, become introjectively identified with him, and having understood him inside, will reproject him and interpret (Money-Kyrle 1956, p. 23).

Conveying experience like this is not merely in the words. ‘I am angry’, can be said with force and threat, or in a joking fashion, or in blank lack of conviction. The phrase can carry a number of emotional tones. These emotional components are received directly and intuitively and not in the form of verbal statements.

I had been delayed for 2-3 minutes at the beginning of a session, at 8 o’clock in the morning. My patient said, immediately she was on the couch ‘You don’t want to see me today’. This could be taken in a number of ways: she was angry, she was wounded by my neglect, she was expressing a customary loneliness… But I sensed a teasing quality, as if she was chiding a friend. The contact therefore felt good, even a little intimate, despite my neglect. I said she seemed a little jocular about it. She denied this saying she was bitter.

I was left at that point with a verbal statement of her emotional state – bitterness –but on the other hand, I had my sense of a jocular intimacy that was not in the words, but in non-verbal cues. I had a choice: to dismiss my own feelings about the communication as my aberration, or to register it as a potential communication, probably unconscious.

Shortly after in this session she told me a dream, which I won’t relate, but the associations involved a great deal of description of happy families around the breakfast table, as often shown in television advertising. She was a little disbelieving and contemptuous of this portrayal of family life.

I could recognise that she was using her associations to deal with her phantasies that my family had delayed me at our happy breakfast table, from which she was excluded. She was contemptuous and instead, unconsciously substituted her own jocular intimacy in place of my family.

When I put this to her, she said, sourly, ‘Of course you would say something like that.’ This was said with much more wounding intent, than her original comment about my lateness. It seemed, this subsequent interpretation of her Oedipal exclusion, felt like a rejection of her seduction and left her more in touch with feeling cruelly alone, and allowed her (perhaps more honestly) to express her sour rejection of me.

Thus my feelings, the sense of a teasing quality in her first words, led me to reflect on her own account of her emotional state. It was not exactly an empathic response of mine. Or rather, if it was empathic, it led to something that was initially out of reach. In that sense, my affective response added considerably to the listening I was actually doing at that moment. It added a route into a possible unconscious state of affairs which formed organised defences against Oedipal issues.

This is an ordinary example of a communication that came from a direct effect of one person upon another. The analytic situation enables us to understand the process in slow motion as it were, and guided by the analyst’s feelings.

Starting with this ‘normal’ involvement of the analyst’s feelings Money-Kyrle (1956) then moved on to deviations from the normal. The analyst, he says, unfortunately

is not omnipotent. In particular his understanding fails whenever the patient corresponds too closely with some aspect of himself which he has not yet learnt to understand… [W]hen that interplay between introjection and projection, which characterises the analytic process breaks down, the analyst may tend to get stuck in one or other of these two positions (Money-Kyrle 1956, p. 24- 25).

In the first of these stuck positions, ill-understood aspects of the patient remain inside the analyst and burden him.

Then, the risk is that these aspects of the patient’s experience, together with uncomprehended aspects of the analyst will be projected into the patient. Then he becomes stuck in the second, the projective position. He will experience a sense of depletion, ‘often experienced as the loss of intellectual potency’ (p. 26) and he may become confused and feel stupid.

Money-Kyrle described a process in a session which started with the patient feeling useless and despising himself for that. The analyst felt somewhat at sea during the session and the patient showed increasing rejection and contempt for his interpretations. By the end of the session the patient no longer felt useless, but angry, "It was I who felt useless and bemused" the analyst reported (Money-Kyrle 1956, p. 27). The analyst was sufficiently disturbed by the patient’s abuse of him that it was only after the session when "I eventually recognized that my state at the end [was] so similar to that he had described as his at the beginning" (p. 27). The projection by the patient and the introjection by the analyst is clear. But the result on the analyst’s mind is that he could not recognise what was happening until he was out of the presence of the projecting patient. His own mind was too disturbed to continue functioning properly for that moment.

Recognising countertransference

Money-Kyle could not take in the patient's state of mind and recognise it emotionally. He was describing failures of containment - though without using the word.  The point however is that the analyst may fail, but his method of failing is interesting and informative. The way in which his mind was put out of action points to the state of mind that the patient is presenting, and which he needs help with.

Money-Kyrle says that this state of affairs requires the analyst to perform a 'small piece of self-analysis'. But that is difficult; and precisely because the experience is not tolerable, and is therefore largely unconscious. How can the analyst be aware of what he is not aware? For this reason the analyst is dependent on the patient giving indications, unconscious indications, that something is going wrong.

In the following example, the patient is very explicit about something going wrong with the analyst’s mind. A patient reported by Rosenfeld in his book Impasse and Interpretation (the case is of another analyst who Rosenfeld supervised), had interestingly suddenly found it difficult to manage the door entry system. The patient talked of her husband going away. Although this was a Wednesday, the analyst interpreted anxiety about the weekend. However the patient, Sylvia, then said,

"It is important for people I am with, whereas at one time I used to make comparisons about how people coped. Now it is the way things feel and how I feel. " [The analyst]interpreted that this meant that Sylvia was very much influenced by her feelings of what she believes other people to be feeling. Sylvia reported, "Yes, I must be very careful if somebody gets flustered. Then I have to be calm."

Dr M. reported that she was unclear what Sylvia meant and so she asked Sylvia, how did she feel now? Sylvia gave a little laugh and said, ‘Well, actually I am feeling rather flustered.’ She gave another little laugh and said, ‘I do not want to annihilate you.’

In this little interchange, we can see how the patient has reacted to an interpretation about the weekend. She feels that the analyst does not understand her; and that is explicitly communicated in the failure with the door-bell. The patient is conveying that she feels she cannot draw the analyst’s attention to her. Then there is a kind of enactment in which the analyst does fail to attend properly to the patient’s material and interprets the weekend when the problem is much closer. The patient then had a particular construction of this. The analyst mind is not working properly, the patient believed; and to the patient’s mind, the analyst must have a flustered mind. Having a flustered analyst, in her mind, she becomes also flustered inside.

The patient wanted to convey something about now, the ‘now’ of the session. She gave explicit indications in the session; she gets upset when others are upset, and when pushed she says that is how things are now – i.e. with the analyst. She was clear she felt the analyst is flustered, and she was flustered by that.

The analyst can then register the patient’s observations and the analyst could accept the need to attend to her (the analyst’s) upset..

Another brief example was reported by Britton and Steiner (1994). Early in a session, after some material about the patient’s girlfriend being angry at his impulsive action, the analyst had made an interpretation of a rather theoretical kind about the patient having to wait – and then avoiding that experience of waiting.

The patient responded by describing an incident a few days previously, when he had waited for his girlfriend upstairs at the theatre. He was sure she was late and doubted if she would come at all after her anger with him… but it turned out that she was actually waiting for him downstairs in the bar.

… Then [the analyst] said. ‘I think you are commenting on my interpretation. You seem to feel that we are in different places. My interpretation did not reach where you were…’ (Britton and Steiner 1994, p. 1074-75).

Here again the analyst’s imprecision has been conveyed in the material The analyst might, if he can, take stock of his own state of mind.

This kind of observation of the countertransference has been one important development of Kleinian technique. It has changed the rather distancing form of interpretation which dealt with concrete part-objects – a style which has adhered to Kleinians since the 1950s. This kind of countertransference has led to a considerable amount of theorising by other psychoanalytic schools (see Hinshelwood 1999).

Organised self-destruction

There is a further development in technique. This is perhaps more specifically Kleinian and concerns the problems with aggression - self-destructive aggression, particularly in schizoid and schizophrenic patients. By the 1970s the interest in analysing schizophrenic patients seemed to have run its course. However, the understanding of the way aggression operates inside the personality has remained of lasting interest.

Klein had for most of her career been interested in the death instinct. She had shown, in contrast to Freud, evidence which demonstrated it was apparent clinically. But, with her description of 'splitting', it was now possible to understand certain phenomena in psychotic patients in which they damaged themselves (their minds) psychically. Rosenfeld, together with others, began to show how the operation of aggression within the personality can be organised in ways that are not psychotic, but which result in strange personalities. Since the 1970s the most important research area in adult psychoanalysis has been the personality disorders. Kleinians have described personality disorders as the structured combination of defences against aggression towards the self which comes from inside the person (Meltzer 1968, Rosenfeld 1971, O'Shaughnessy 1981, Steiner 1982). This fixed structure of defences comes, directly or indirectly, from the Schreber case and Freud's description of the construction of an organised delusional system in place of a fragmented and annihilated reality.

Herbert Rosenfeld described a non-psychotic solution to the problem of the 'bad' parts of the self, that sought self-destruction of the mind. He found patients who achieved some mental stability by idealising these 'bad' parts of the self. The person was then in thrall to the 'bad' self, and operated as if they believed that bad was good, and that dishonesty was truth. Such patients are very stuck in their lives and also in their analyses. The truth that might be discovered is habitually regarded as insignificant compared to some particularly cherished false belief.

Rosenfeld was particularly struck by a patient who because of business trips would miss his analytic sessions and spend time with women he met. He was very resistant to any understanding that some aspects of his self missed his sessions, and felt vulnerable. The patient regularly reported murderous activities in his dreams after such trips, and he began to complain that his sleep was frequently disturbed, and violent palpitations kept him awake,

During these anxiety attacks he felt that his hands did not belong to him; they seemed violently destructive as if they wanted to destroy something by tearing it up, and were too powerful for him to control so that he had to give in to them.

He then dreamt of a very powerful arrogant man who was nine feet tall and who insisted that he had to be absolutely obeyed. His associations made it clear that this man stood for part of himself and related to the destructive overpowering feelings in his hands which he could not resist. I interpreted that he regarded the omnipotent destructive part of himself as a superman who was nine feet tall and much too powerful for him to disobey. ... He had disowned this omnipotent self, which explained the estrangement of his hands during the nightly attacks. I further explained this split-off self as an infantile omnipotent part which claimed that it was not an infant but stronger and more powerful than all the adults, particularly his mother and father and now the analyst. His adult self was so completely taken in and therefore weakened by this omnipotent assertion that he felt powerless to fight the destructive impulses at night. The patient reacted to the interpretation with surprise and relief and reported after some days that he felt more able to control his hands at night (Rosenfeld 1971, p. 252).

Another of Rosenfeld's descriptions was that patients also felt dominated by a kind of intimidation as if a Mafia gang existed inside them. This is a vivid image of the internal situation - an internal Mafia gang which controls the personality and devalues truth, love and vulnerability.

In this classic paper of Rosenfeld's, he terms this phenomenon, 'negative narcissism'. If ordinary narcissism is a pre-occupation with the self and its survival, then he pointed out that these patients are pre-occupied with self-destruction.

Attacks on the K-link

Rosenfeld (1987) conveyed that the analyst's response to this unconscious fear of the indwelling destructiveness, should be to support the 'good' parts of the self. In contrast to that is Betty Joseph's work, which takes up this inward aggression but links it with problems of insight (the K-link).

Bion considered the linking between people, as well as the intra-psychic links. Interpersonal linking, to a degree, develops his early basic assumptions ideas in group psychology. However in this psychology of a couple, the persons can link together in three different ways. Briefly we can link with another person with love. This is the L-link, as Bion termed it. Each person loves and is loved. The second link is the H-link in which each person hates and is hated by the other. And third is the K- link; that means that each person knows and is known by the other. The third of these, the K-link, is an important one, knowing based of course on emotional and relational foundations. It is typically the psychoanalytic link – and is the medium in which insight is created.

Joseph (1989b) was particularly astute in her observations of the fate of insight. In the response to interpretations she picks up many subtle ways that a patient can take the core meaning out of an interpretation. Often this is in an attempt to engage in a masochistic relationship with an analyst who then proceeds with more forceful interpretations to try to compel the patient to grasp the insight; or the analyst starts to complain about the patient's bad ways. Either way the ensuing relationship will be adversarial and probably self-justifying on both sides so that the joint effort to work together for new knowledge has been lost. She sees this as not necessarily ordinary resistance - i.e. the avoidance of knowledge about himself that will be too painful; instead it can also have elements of a wish to devalue truth and to destroy an honest relationship.

By paying attention to minute movements in the affective atmosphere of the analysis she could reveal small moments of this inward aggression. One illustration of these subtle processes was a man who was anxious because the psycho-analysis was ending -

The session was a Friday. My patient, N., arrived saying that he felt bad and anxious, as if too much was going on. He and his wife were currently selling their house and there were important changes going on in his work.

I clarified that it seemed that the anxiety was more focused round the issue of stopping the analysis. This he agreed but went on to describe in detail his feelings of discomfort as if he was angry and resentful. I thought at that point, and suggested, that it was partly that he had not really been able to believe that I could let him go, but that now he was having to face this aspect of stopping.

... My patient responded, however, to my remark by going back to discussing his difficulties, his resentments, his coldness, and so on. I thought, and showed him, that he was sinking into a kind of anger and misery - shown by his settling into and stressing all the difficulties and getting caught up into it, in order to avoid the specific feelings about actually leaving and what it really meant to him at that moment. In other words I thought that he was sinking into a kind of bog of misery as a defence, so that the anger was part of the bog and was not anger in its own right (Joseph 1989a, p. 199-200).

The patient invites the analyst to take notice of his depression, or alternatively of his anger. Both are invitations to miss the fact that the patient has created his miserable state of mind for himself - and does so in order to diminish the side of himself that can acknowledge the loss, and become aware of his own need for support and so on.

N. became silent - a pause - and then he said he had the thought, `clever old bag'. He explained he thought I was right and that he was aware when he made the remark that he resented my being right, so he went quiet. Now we could both agree to the misery being used actively as a kind of masochistic defence, and he himself had clear insight into his resentment about my being right.

... They had been invited to the Xes where the wife is a very poor cook, so his wife had a brilliant idea. She would offer to make a summer pudding, which the patient just adores, and they would take it with them to the supper. He would help his wife by topping and tailing the fruit. This was said in a very positive and warm manner.

The patient is clearly able to find the resources now to retrieve himself from his bog of misery and to face his true situation - his dependence on his wife, and analyst. The implication here is that he did not move away from insight as ordinary resistance. He was in fact able to face the painfulness of his loss. So, it is more likely therefore that he destroys his insight and invites the analyst to follow him as a deliberate method of satisfying a destructive and self-destructive side of himself.

In other patients, Joseph detected a truly perverse quality - that is to say, a successful attack on truth creates a perverse excitement, an erotised destructiveness, with the patient playing the triumphant sadistic role. She stressed how the patient retreats into something which makes him remote and difficult to reach. And this position is reinforced by the erotic satisfaction of destroying an honest relationship.

Contemporary Kleinian psychoanalysis now stresses the fine texture in the on-going process between the analyst and the patient. On the one hand there is an alertness to the way the patient might be communicating something of the analyst's countertransference, and on the other hand there are the very subtle moments that reveal the self-directed aggression of the patient against his own insight, and the analysis which can support it.

This is a major change in technical handling of the transference and countertransference. It is a big step away from the rather blunt part-object interpretations of breasts and penises which more brutally confront the patient with his own aggression - usually towards the analyst.

The analyst's mind as transference object

Finally, there is one further formulation of this current form of practice. This is the distinction drawn by John Steiner between 'patient-centred interpretations' and 'analyst-centred interpretations'. This recognises the fully interactive nature of the transference-countertransference relationship. Many patients who suffer from some severe personality disorder are extremely aware of the object to whom they are relating. They are thus rather different from the psychotic who tends to obliterate any awareness of the reality of those around them. As a result, patients may be extremely sensitive to the state of mind of the analyst; and their own state of mind may be extremely sensitively linked into the state of the analyst's mind, as in the example of Rosenfeld's patient Sylvia. Then the immediate anxiety is about how his analyst's mind is working at that moment. When the analyst then gives an interpretation, the patient may in fact receive it in a very different way. The analyst will intend it as a gift to the patient of the analyst's efforts at understanding and which the patient might be expected to recognise as the beginnings of insight. But the patient may take the 'interpretation' as an opportunity to try to gauge the analyst's mind at the moment of interpretation, rather than to gauge the truth of the interpretation. The risk is that the partners are each going in quite different directions and will 'miss' each other. At these moments the analyst needs to be aware that he is what the patient is worrying about, and his interpretation needs then to focus on the patient’s phantasies about the analyst's mind.

Steiner (1993) remarked on this occurrence:

At these times the patient’s most immediate concern is his experience of the analyst… I think of these interpretations as analyst-centred and differentiate them from patient-centred interpretations… In general, patient-centred interpretations are more concerned with conveying understanding, whereas analyst-centred interpretations are more likely to give the patient a sense of being understood (Steiner 1993, p. 133).

For one of Steiner’s patients,

when patient-centred interpretations implied that she was responsible for what happened between us [then] she became most persecuted and tended to withdraw. It was particularly over the question of responsibility that she felt sometimes I adopted a righteous tone which made her feel that I was refusing to examine my own contribution to the problem and unwilling to accept responsibility myself (Steiner 1993, p. 144).

It is a very important point that interpretations can seem very persecutory and guilt-inducing to the patient - even when the analyst did not intend it so. Then it is important for the analyst to make efforts not to sound critical - but more important than that, he must understand why the patient tends to feel criticised, and what the patient thinks is the analysts' reasons for criticising.

Conclusion

Like Freud's recognition 100 years ago, in the Interpretation of Dreams, the task is one of learning and understanding what is cryptic and unknown. A long journey started then, in 1899, with Freud's rather cognitive detective work on dream symbols. It concludes, today, with the intuitive learning from the moment-to-moment experience of two partners interacting, and struggling to know about that interaction. The knowledge we seek is now the immediacy of the analytic moment, the configuration of projections and introjections that make up both the communication and also the defensiveness in the analytic setting.

References

Bion, W.R. 1959 Attacks on linking. International Journal of Psycho-Analysis 40: 308-315.

Bion, W.R. 1970 Attention and Interpretation. London: Tavistock

Britton, Ronald and Steiner, John1994

Casement, Patrick 1985 On Learning from the Patient. London: Tavistock.

Heimann, Paula 1950 On counter-transference. Internatuional Journal of Psycho-Analysis 31: 81-84.

Heimann, Paula 1960 Counter-transference. British Journal of Medical Psychology 33: 9-15.

Hinshelwood, R.D. 1999 Countertransference. International Journal of Psychoanalysis 80: 797-818.

Joseph, Betty 1985 Transference: the total situation. In Psychic Equilibrium and Psychic Change. London: Routledge.

Joseph, Betty 1989 Psychic change and the psychoanalytic process. In Psychic Equilibrium and Psychic Change. London: Routledge.

Joseph, Betty 1989b Psychic Equilibrium and Psychic Change. London: Routledge.

Little, Margaret 1951 Counter-transference and the patient's response to it. International Journal of Psycho-Analysis 32: 32-40.

Meltzer, Donald 1968 Terror, persecution, dread. International Journal of Psycho-Analysis 49: 396-400.

O'Shaughnessy, Edna 1981 A clinical study of a defensive organisation. International Journal of Psycho-Analysis 62: 359-369.

Racker, Heinrich 1953 [1957] The meanings and uses of countertransference. Psychoanalytic Quarterly 26: 303-356.

Reich, Annie 1951 On counter-transference. International Journal of Psycho-Analysis 32: 25-31.

Rosenfeld, Herbert 1971 A clinical approach to the theory of the life and death instincts: an investigation into the aggressive aspects of narcissism. In Spillius, Elizabeth (ed.) 1988 Melanie Klein Today, Volume 1. London: Routledge.

Rosenfeld, Herbert 1987 Impasse and Interpretation. London: Routledge.

Segal, Hanna 1975 A psychoanalytic approach to the treatment of schizophrenia. In Malcolm Lader (ed) Studies of Schizophrenia. Ashford: Headley.

Spillius, Elizabeth 1992 Clinical experiences of projective identification. In Robin Anderson (ed.) Clinical Lectures on Klein and Bion. London: Routledge.

Steiner, John 1982 Perverse relationships between parts of the self. International Journal of Psycho-Analysis 63: 241-152.

Steiner, John 1993 Psychic Retreats. London: Routledge.

Winnicott, Donald 1947 Hate in the counter-transference. In Winnicott, Donald 1958 Collected Papers: Through Paediatrics to Psycho-Analysis. London: Hogarth.

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