The Patient as Interpreter of the Analyst's Experience
作者: Irwin Z. Hoffman, Ph / 11710次阅读 时间: 2010年10月02日
来源: Contemp. Psychoanal., 19:389-422 标签: Analyst Experience Interpreter Patient The
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(1983) Contemp. Psychoanal., 19:389-422

The Patient as Interpreter of the Analyst's Experience

Irwin Z. Hoffman, Ph.D.


Introduction

THIS PAPER PRESENTS A POINT OF VIEW on the psychoanalytic situation and on psychoanalytic
technique through, in part, a selective review of the literature. An important underlying assumption of the paper is
that existing theoretical models inevitably influence and reflect practice. This is often true even of models that
practitioners claim they do not take seriously or literally. Such models may continue to affect practice adversely as
long as their features are not fully appreciated and as long as alternative models are not recognized or integrated.
An example of such a lingering model is the one in which the therapist is said to function like a blank screen in the
psychoanalytic situation.

The Resilience of the Blank Screen Concept

The psychoanalytic literature is replete with attacks on the blank screen concept, the idea that the analyst is not
accurately perceived by the patient as a real person, but that he serves rather as a screen or mirror to whom various
attitudes, feelings, and motives can be attributed depending upon the patient's particular neurosis and its
transference expression. Critiques of this idea have come from within the ranks of classical Freudian analysts, as
well as from Kleinians and Sullivanians. Even if one looks only at the classical literature, in one way or another, the
blank screen concept seems to have been pronounced dead and laid to rest many times over the years. In 1950, Ida
Macalpine, addressing only the implications for the patient's experience of classical psychoanalytic technique as she
conceived of it (that is, not considering the analyst's personal contributions), said the following:

It can no longer be maintained that the analysand's reactions in analysis occur spontaneously. His behavior is
a
response to the rigid infantile setting to which he is exposed. This poses many problems for further investigation.
One of them is how does it react upon thepatient? He must know it, consciously or unconsciously (p. 526, italics
added)
.


Theresa Benedek said in 1953:

As the history of psychoanalysis shows, the discussion of countertransference usually ended in a retreat to defensive
positions. The argument to this end used to be (italics added) that the classical attitude affords the best guarantee that
the personality of the therapist (author's italics) would not enter the action-field of the therapeutic process. By that
one assumes that as long as the analyst does not reveal himself as a person, does not answer questions regarding his
own personality, he remains unknown as if without individuality, that the transference process may unfold and be
motivated only by the patient's resistances. The patient—although he is a sensitive, neurotic individual—is not
supposed to sense and discern the therapist as a person (p. 202).

In 1956 Lucia Tower wrote:

I have for a very long time speculated that in many—perhaps every—intensive analytic treatment there develops

something in the nature of countertransference structures (perhaps even a "neurosis") which are essential
andinevitable counterparts of the transference neurosis (p. 232)
.


Copyright . 1983 W. A. W. Institute, New York
20 W. 74th Street, New York, NY 10023
All rights of reproduction in any form reserved.
Contemporary Psychoanalysis, Vol. 19, No. 3 (1983)


In the sixties Loewald (1960), Stone (1961), and Greenson (1965) added their voices to the already large
chorus of protest against this remarkably resilient concept. From varying theoretical perspectives, the critiques
continued into the seventies and eighties as represented, for example, in the writings of Gill (1979) ; (1982a) ;
(1982b) ; (1983) ; (Gill and Hoffman, 1982a) ; (1982b) ; Sandler (1976) ; (1981) and Kohut (1977), among many
others. In fact, the blank screen idea is probably not articulated as often or even as well by its proponents as it is by
its opponents, a situation which leads inevitably to the suspicion that the proponents are straw men and that shooting
them down has become a kind of popular psychoanalytic sport.1

I am persuaded, however, that the issue is a very important one and that it deserves repeated examination and
discussion. The blank screen view in psychoanalysis is only one instance of a much broader phenomenon which
might be termed asocial conceptions of the patient's experience in psychotherapy. According to these conceptions,
there is a stream of experience going on in the patient which is divorced to a significant extent from the immediate
impact of the therapist's personal presence. I say "personal presence" because generally certain theoretically
prescribed facilitating aspects of the therapist's conduct are recognized fully as affecting the course of the patient's
experience. But the paradigm is one in which proper or ideal conduct on the part of the therapist allows for a flow
of experience which has an organic-like momentum of its own and which is free to follow a certain "natural" course.
An intriguing example of this asocial paradigm outside of psychoanalysis can be found in client-centered therapy.
Ideally, the classical client-centered therapist is so totally and literally self-effacing that his personality as such is
effectively removed from the patient's purview. Carl Rogers stated in 1951:

It is surprising how frequently the client uses the word "impersonal" in describing the therapeutic relationship after the
conclusion of therapy. This is obviously not intended to mean that the relationship was cold or disinterested. It
appears to be the client's attempt to describe this unique experience in which the person of the counselor—the
counselor as an evaluating, reacting person with needs of his own—is so clearly absent. In this sense it is
"im"-personal … the whole relationship is composed of the self of the client, the counselor being de-personalized for
the purposes of therapy into being "the client's other self" (p. 208).

In psychoanalysis, the blank screen idea persists in more or less qualified and more or less openly
acknowledged forms.2 The counterpart of the notion that the analyst functions like a screen is the definition of
transference as a distortion of current reality. As Szasz (1963) has pointed out, this definition of transference can
serve a very important defensive function for the analyst. This function may partly account for the persistence of
the concept. I believe that another factor that has kept it alive has been the confusion of two issues. One has to do
with the optimal level of spontaneity and personal involvement that the analyst should express in the analytic
situation. The other has to do with the kind of credibility that is attributed to the patient's ideas about the analyst's
experience. A theorist may repudiate the notion that the analyst should behave in an aloof, impersonal manner
without addressing the question of the tenability of the patient's transference based speculations about the analyst's
experience. To anticipate what follows, such speculations may touch upon aspects of theanalyst's response to the
patient which the analyst thinks are well-concealed or of which he himself is unaware. Ingeneral, recommendations
pertaining to the analyst's personal conduct in the analytic situation may very well leaveintact the basic model
according to which the transference is understood and interpreted.

1It is interesting that critics of the blank screen concept have frequently been concerned that others would think they were beating a dead
horse (see, for example, Sterba, 1934, p. 117) ; (Stone, 1961, pp. 18–19) ; (and Kohut, 1977, pp. 253–255).

2Dewald's (1972) depiction of his conduct of an analysis exemplifies, as Lipton (1982) has shown, a relatively pure, if implicit, blank screen
position.

Standard Qualifications of the Blank Screen Concept

The notion that ideally the analyst functions like a screen is always qualified in the sense that it applies to only
a part of the patient's total experience of the therapist, the part which is conventionally regarded as neurotic
transference. This is the aspect of the patient's experience which, allegedly, distorts reality because of the persisting
influence of childhood events, wishes, conflicts, and adaptations. There are two kinds of experience which even the
staunchest proponents of the screen or mirror function of the analyst recognize as likely to be responsive to
something in the analyst's actual behavior rather than as expressions of pure fantasy. One is the patient's perception
of the analyst as essentially trustworthy and competent, a part of the patient's experience which Freud (1912)
subsumed under the rubric of the unobjectionable positive transference but which others, most notably Sterba
(1934), Greenson (1965), and Zetzel (1956) have chosen to exclude from the realm of transference, designating it as
the experience of the working or therapeutic alliance.3 The second is the patient's recognition of and response to
relatively blatant expressions of the therapist's neurotic and antitherapeutic countertransference. Both categories of
experience lie outside the realm of transference proper which is where we find the patient's unfounded ideas, his
neurotic, intrapsychically determined fantasies about the therapist. The point is well represented in the following
statements (quoted here in reverse order) which are part of a classical definition of transference (Moore and Fine,
1968):

1.
Transference should be carefully differentiated from the therapeutic alliance, a conscious aspect of the
relationship between analyst and patient. In this, each implicitly agrees and understands their working
together to help the analysand to mature through insight, progressive understanding, and control.
2.
One of the important reasons for the relative anonymity of the analyst during the treatment process is the fact
that a lack of information about his real attributes in personal life facilitates a transfer of the patient's revived
early images on to his person. It also lessens the distortion of fantasies from the past by present perceptions. It
must be recognized that there are situations or circumstances where the actual behavior or attitudes of the
analyst cause reactions in the patient; these are not considered part of the transference reaction (See
countertransference) (p. 93).
Two Types of Paradigms and Critiques

In my view, critiques of the screen concept can be classified into two major categories: conservative critiques
and radical critiques. Conservative critiques, in effect, always take the following form: they argue that one or both
of the standard qualifications of the blank screen view noted above have been underemphasized or insufficiently
elaborated in terms of their role in the analytic process. I call these critiques conservative because they retain the
notion that a crucial aspect of the patient's experience of the therapist has little or no relation to the therapist's actual
behavior or actual attitudes. The conservative critic reserves the term transference for this aspect of the patient's
experience. At the same time he objects to a failure to recognize sufficiently the importance of another aspect of the
patient's experience which is influenced by the "real" characteristics of the therapist, whether these real
characteristics promote or interfere with an ideal analytic process. The dichotomy between realistic and unrealistic
perception may be considered less sharp, but it is nevertheless retained. Although the realistic aspects of the
patient's experience are now given more careful consideration and weight, in relation to transference proper the
therapist is no less a blank screen than he was before. By not altering the standard paradigm for defining what is or
is not realistic in the analytic situation, conservative critiques of the blank screen fallacy always end up perpetuating
that very fallacy.

3For discussions of the implications of Freud's position on this matter see Lipton (1977a) and Gill (1982, pp. 9–15).

In contrast to conservative critiques, radical critiques reject the dichotomy between transference as distortion
and non-transference as reality based. They argue instead that transference itself always has a significant plausible
basis in the here-and-now. The radical critic of the blank screen model denies that there is any aspect of the patient's
experience that pertains to the therapist's inner motives that can be unequivocally designated as distorting of reality.
Similarly, he denies that there is any aspect of this experience that can be unequivocally designated as faithful to reality.
The radical critic is a relativist. From his point of view the perspective that the patient brings to bear in interpreting the
therapist's inner attitudes is regarded as one among many perspectives that are relevant, each of which highlights
different facets of the analyst's involvement. This amounts to a different paradigm, not simply an elaboration of the
standard paradigm which is what the conservative critics propose.

In rejecting the proposition that transference dominated experience and non-transference dominated experience
can be differentiated on the grounds that the former is represented by fantasy which is divorced from reality
whereas the latter is reality based, the radical critic does not imply that the two types of experience cannot be
distinguished. Indeed, having rejected the criterion of distorted versus realistic perception, he is obliged to offer
other criteria according to which this distinction can be made. For the radical critic the distinguishing features of
the neurotic transference have to do with the fact that the patient is selectively attentive to certain facets of the
therapist's behavior and personality; that he is compelled to choose one set of interpretations rather than others; that
his emotional life and adaptation are unconsciously governed by and governing of the particular viewpoint he has
adopted; and, perhaps most importantly, that he has behaved in such a way as to actually elicit overt and covert
responses that are consistent with his viewpoint and expectations. The transference represents a way not only of
construing but also of constructing or shaping interpersonal relations in general and the relationship with the analyst
in particular. One could retain the term "distortion" only if it is defined in terms of the sense of necessity that the
patient attaches to what he makes happen and to what he sees as happening between himself and the analyst.

The radical critiques are opposed not merely to the blank screen idea but to any model that suggests that the
"objective" or "real" impact of the therapist is equivalent to what he intends or to what he thinks his overt behavior
has conveyed or betrayed. What the radical critic refuses to do is to consign the patient's ideas about the analyst's
hidden motives and attitudes to the realm of unfounded fantasy whenever those ideas depart from the analyst's
judgment of his own intentions. In this respect, whether the analyst's manifest conduct is cold or warm or even
self-disclosing is not the issue. What matters to the radical critic in determining whether a particular model is
based on an asocial or truly social conception of the patient's experience is whether the patient is considered capable
of understanding, if only preconsciously, that there is more to the therapist's experience than what meets the eye,
even more than what meets the mind's eye of the therapist at any given moment. More than challenging the blank
screen fallacy, the radical critic challenges what might be termed the naive patient fallacy, the notion that the
patient, insofar as he is rational, takes the analyst's behavior at face value even while his own is continually
scrutinized for the most subtle indications of unspoken or unconscious meanings.

Although we now have a broad range of literature that embraces some kind of interactive view of the
psychoanalytic situation (Ehrenberg, 1982), emphasis upon interaction per se does not guarantee that any particular
theoretical statement or position qualifies as one which views the transference in relativistic-social terms.
Moreover, emphasis on interaction can obscure the fact that a particular theorist is holding fast, for the most part, to
the traditional view of neurotic transference as a distortion of a given and ascertainable external reality.

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