In this post, I wished to talk about the research work I’ve completed during the first year of my master’s degrees.
That work was called « Psychotic transference and countertransference in the dual relationship between a psychologist and his patient ». The point was to understand the psychical movements at work in the patient as well as in the psychologist.
As a reminder, the “transference” stand for the unconscious elements that a patient feels towards the psychologist during the course of treatment (actualization of infantile desires). This concept was introduced by Freud (1911) while he was treating a hysterical patient. Back then, it was thought that psychotic people were unable to transfer because they were the only object of their love. Only a couple of years later – with the President Schreber’s case – did Freud admit the possibility of a transference in psychotic patients, however in a different form.
First the Theory…
Indeed, there is an observable return of the early functioning in the psychotic transference : the subject regress to the first primitive states (first months of living). Primary mechanisms are at stake : Cleavage, denial, projection, introjection. The relationship with the psychologist is ambivalent cause he is both the object of love and the object of hatred. The projective identification (introduce by Klein in 1939) is massively at work herse : the psychotic project cleaved parts of his ego toward the psychologist and introject elements of the psychologist (introjective identification). All of these elements refer to the symbiotic relation between the mother and the baby (as described by Searles) in the early months of life, where they are confused, undifferentiated. This symbioses is a necessary step for the baby to grow and mature, thus, it is also a necessary step for the psychotic regressed ego to mature.
The countertransference, however, is the unconscious response of the psychologist facing the transference of the patient. With the psychotic subject, the psychologist is going to feel aggressivity, desire, dependency, depersonalisation, persecution, confusion… all of which linked to the psychotic affects. The term “psychotic transference” (Searles, 1977) is used to describe the state of madness in which the psychologist is stuck while facing a psychotic patient : a madness for two.
…Then the Clinical and Analysis part
To work on the subject of transference and countertransference, I used the case of a psychotic patient. He was hospitalized in a psychiatric department in a major hospital in Western France. I have met with the patient thirty minutes every week for seven months. Thanks to this case, I studied transferential dynamics at work in a psychotic patient within three axes.
The first one is about the return of archaic process in the transference. Indeed, interacting with the patient, there were clears signs of a symbiotic functioning between the psychotic subject and the healthcare team. We were able to see to what extent a psychotic subject can be dependant; the subject needs the resources of a non-psychotic Ego to develop her immature Ego. The second axis brings to light how a psychologist incarnate a parental figure. The psychologist IS the projected parental figure that the patient decided he was beforehand. By roleplaying the relation he had toward his mother, the patient made me adopt the attitude of his mother. By the way, the subject reiterate his identifications to his parents by identifying to his psychologist. It allows him to mature her Ego. Finally, the third axis questions the countertransference felt by the psychologist in his relationship with a psychotic subject. Rouzel (2013) states that “Contrarily to what some people says to get rid of it, transference in psychoses is massive, demanding and a factor of confusion.” (p.117). Indeed, with the patient, my counter-transferential capacities were, at first, flabbergasted, then my whole way of reasoning became confused. The massive psychotic transfer may alter the psychologist capacity to endure a countertransference, because he is trying to defend himself against it to try not to become insane, or because he doesn’t let himself be manipulated by the patient. Once in the “psychotic transference’, the psychologist feels the psychotic experience undergone by the patient, as it was projected in the psychologist by the “psychotic transference”. He experience archaic feelings. Here, it was hatred mixed with an important confusion (identity, psychological, verbal, special, in time…).
Freud, S. (1911). Cinq psychanalyses. Paris : PUF.
Klein, M. (1939). The origins of transference. International Journal of Psycho-Analysis, 33, 433-438.
Rouzel, J. (2013). La prise en compte des psychoses dans le travail Educatif. Toulouse : Eres.
Searles, H. (1977). L’effort pour rendre l’autre fou. Paris : Gallimard.
