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Int. 1. Psycho-Anal. (1993) 74, 659

CONVERGENCES AND DIVERGENCES IN

CONTEMPORARY PSYCHOANALYTIC TECHNIQUE
OTIO F. KERNBERG, NEW YORK

One of the most interesting consequences of velopments. The recent publicationof major texts
the discussion of 'the common ground' of on technique further reconfirms that impres-
psychoanalysis (see Wallerstein, 1992) has been sion. The English translation of Etchegoyen's
the increasing attention given to the actual comprehensive treatise on psychoanalytic
principles of technique that flow from alter- technique, published in 1991, highlights the
native psychoanalytic theories, in contrast to development of a major trend toward explica-
the 'clinical theories' derived from these various tions of similarities and differences among al-
formulations. In other words, general theory ternative psychoanalyticapproaches. In the last
or metapsychology needs to be differentiated dozen or so years we have had Etchegoyen's
not only from clinical theory or patient-specific Kleinian text, Blum's (1980, 1985) contribu-
dynamic hypotheses in concrete clinical situ- tions from ego-psychological technique, Thoma
ations, but also from the technical strategies & Kachele's (1987, 1991) German textbook,
of case intervention. Although Wallerstein's with an emphasis on the analyst's contribution,
concept of the common ground of clinical Le Guen's (1982, 1989) French mainstream
theory-as against the marked discrepancies viewpoint, Greenberg's (1991) and Mitchell's
in metapsychological or theoretical formula- (1988) contributions from interpersonal psy-
tions-is still being debated in the literature, choanalysis, two volumes on developments in
surprising confirmations as well as disconfir- Kleinian theory and practice edited by Spillius
mations of shared technical approaches may (1988), Mertens's introduction to psychoana-
be discovered in comparing the actual work lytic therapy (1990), combining ego-psychologi-
of clinicians from different backgrounds. cal and interpersonal perspectives, a special
On the basis of a review of recent writings issue of the Psychoanalytic Quarterly (Vol. 59,
on psychoanalytic technique in the European, No.4, 1990) dedicated to the psychoanalytic
Latin American, and North American litera- process, Kohon's (1986) and Rayner's (1991)
ture, I think it is possible to detect certain overviews of the Independents' approach, and,
areas of major convergences of technique af- last but not least, the second edition of Sandler,
fecting Kleinian, ego-psychology, British Inde- Dare & Holder's brief and crisp text (1992).
pendent (what used to be called the 'middle To compare these works is to find remarkable
group'), French mainstream (non-Lacanian), agreements as well as certain disagreements
interpersonal (earlier called 'culturalists') and emerging.
self-psychology literature. Growing divergences What is equally interesting is that, even in
in other areas of technique continue to separate texts that clearly announce their author's own
some of these orientations from others. bias, viewpoints of alternative schools are in-
The opportunity to discuss clinical material cluded, and one finds a generally more flexible
with colleagues from different psychoanalytic attitude toward other viewpoints; an indica-
societies and orientations in various countries, tion, in short, that older antagonisms have
has strengthened my impression of these de- given way to a concern for communicating

Presented at a Conference on Contemporary Controversies in PsychoanalyticTechnique, New York, 13 December 1992,

sponsored by the 5 IPA-related psychoanalytic societies of New York City.
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660 OTIOF. KERNBERG

differences. Etchegoyen's text, for example, writ- cept, probably, the Lacanian). The heightened
ten by an ArgentinianKleinian,carefully includes stress and early focus on the transference is
recent contributions from the ego-psychology, moving the technique of ego psychology, for
British Independent, mainstream French, and example, closer to that of object-relations theo-
Lacanian viewpoints. Similarly, Thoma & ries. There seems to be less overall emphasis
Kachele contrast ego-psychology and British on the uniqueness of dreams, on the recovery
perspectives with their own view, which is of concrete memories, on external reality, and
somewhat closer to the interpersonal approach. more on both early and systematic analysis of
Sandler et al. (1992) incorporate, within a the unconscious meanings of transference de-
predominantly ego-psychology approach, con- velopments.
tributions from a broad spectrum of psycho- Gill and Hoffman's (Gill, 1982; Gill & Hoff-
analytic theories. man, 1982) empirical research on transference
In what follows, I attempt to summarise initially received a mixed reception, but left an
briefly some major areas of both convergences important imprint not only on American ego
and divergences. In attributing certain approaches psychology, but on interpersonal psychoanaly-
to a certain school, I have had to simplify and sis and on Thoma & Kachele's theories. Much
generalise, sometimes not doing justice to fme of the early criticism of Gill and Hoffman was
distinctions between viewpoints within each directed at their strong focus on the analyst's
approach. Fairbairn (1954), for example, an contribution to the transference, on their stress
Independent, favoured a rather classical psy- on the interactional matrix within which trans-
choanalytic technique, probably more than most ference develops, but their pointing to the
of his colleagues. Among the Kleinians, Bion importance of defences against the transference
(1974, 1975, 1980), Meltzer (Meltzer & Wil- (rather than to the defensive functions of the
liams, 1988), and Rosenfeld (1987) significantly transference itself) influenced ego-psychology
departed from what I describe as the contem- thinking, increasing the attention paid toward
porary Kleinian mainstream, as reflected in the subtle, particularly nonverbal, manifesta-
Spillius's Melanie Klein Today (1988) and the tions of the transference from early in the
selected papers of Joseph (1989). Within Ameri- treatment. This general tendency toward
can ego psychology, significant differences are heightened alertness and earlier interpreta-
occurring between those who, following Arlow tion of the transference within ego psychol-
& Brenner (1990), tend to de-emphasise such ogy has narrowed the gap between American
concepts as defence mechanisms and concep- ego psychology and British approaches to
tualise all unconscious conflicts and their con- the transference. Indeed, a complementary
sequences in terms of compromise formations, move among the British, particularly the main-
unlike the developmental psychologists influ- stream Kleinians as represented by Spillius's
enced by Mahler (Akhtar & Parens, 1991), edited volumes, indicates that Kleinian
who have introduced object-relations concepts authors are exercising greater caution in their
into an ego-psychologymodel. Similarly, other interpretation of the transference.
American ego psychologists have attempted to The recent work of Joseph (1989), Segal
integrate their views with those of Winnicott (Levine, 1992), as well as Spillius's (1988) own
and the Independent school (Modell, 1990). observations throughout her books, all point
to a more systematic attention on the part of
Kleinian analysts to the analysis of character
CONVERGENCES resistances and their relation to the transfer-
ence, to a more gradual analysis of the patient's
Transference associative and attitudinal material from sur-
face to depth, to omitting direct references to
There is a general tendency toward earlier genetic material in early stages of transference
interpretation of the transference, and an in- interpretation-moving, in this regard, in the
creased focus on the centrality of transference direction of both the Independents and ego
analysis in all psychoanalytic approaches (ex- psychologists. Significant differences nonethe-
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CONTEMPORARY PSYCHOANALYTIC TECHNIQUE 661

less persist in the interpretive approaches to scious'. In a general reaction against the risk
the transference among the different schools. of premature genetic reconstructions and, par-
ticularly, an intellectualised reconstruction of
Character Analysis the past on the basis of patient's conscious
memories that bypass unconscious fantasies
There is a general tendency to focus on the and meanings in the transference, there is a
analysis of the patient's habitual-and often general trend to explore carefully such uncon-
unobtrusive yet rigid-behaviour patterns in scious meanings in the here-and-now before
the psychoanalytic situation: character defences attempting reconstructions of the past. This
instead of the unconscious meanings of par- trend is linked to the increasing concentration
ticular symptoms, experiences, or memories. on analysing the transference in general. Analy-
This approach, however, does not have the sis of the here-and-now does not imply a
qualities of a confrontational (and at times neglect of the unconscious past. Although cer-
authoritarian) 'overcoming' of character resis- tain tendencies to overemphasise the interac-
tances, as did that of Wilhelm Reich (1933). tional aspects of the psychoanalytic situation
In this respect, it is as if Kleinian technique (sometimes linked to an existential approach)
were moving in the direction of ego psychol- may neglect dealing with the infantile deter-
ogy. This trend was spearheaded by Rosen- minants of the transference, this is not the
feld's (1964) descriptions of the transference implication of the growing tendency to explore
resistances of patients with narcissistic person- carefully unconscious meanings in the here-
ality; his emphasis, in his later contributions and-now before linking these with the uncon-
(1987), on the clarification of the patient's scious past.
experiences as well as nonverbal manifestations The ego-psychology formulations on the
reflecting persistent, repetitive characterological metapsychology of interpretation-in particu-
features; and again, in Joseph's (1989) and lar, the economic, dynamic, and structural cri-
Segal's (Levine, 1992; Spillius, 1988) emphasis teria of interpretation most cogently formulated
on chronic, repetitive, subtle, yet significant as- by Fenichel (1941}-always stressed the impor-
pects of the patient-analyst interaction. tance of proceeding 'from surface to depth'-
Although, from an ego-psychology perspec- from the analysis of defence or resistance to
tive, the rigidity of traditional 'Reichian' char- the analysis of impulse or content. Kleinian
acter analysis has long been abandoned, under technique, in contrast, used to focus on inter-
the impact of treating more seriously ill pa- pretation at the deepest level of anxiety (Segal,
tients, a renewed focus on character analysis 1973), and tended to move quickly into genetic
has been evident in practice if not expressed interpretations (often conveyedwith a language
in systematic formulations in this area. The referring to body parts and fantasies of the
fact that character pathology and severe per- infant assumed to exist in the first year of
sonality disorders are becoming increasingly life), and thus risked fostering intellectualisa-
prevalent indications for psychoanalytic treat- tion in the patient, if not inducing him into a
ment may be contributing to this trend, but so restrictive translation of his experiences.
is the growing awareness that the analysis of In reaction to this trend, contemporarymain-
verbal contents that bypass character structure stream Kleinians avoid early, premature ge-
often leads to intellectualisation and pseudo- netic reconstructions, and attempt to analyse
insight (Kernberg, 1983, 1987, 1992). unconscious meanings 'in the here-and-now'
at a level more consonant with the patient's
The Here-and-Now current way of formulating his experiences,
and, as mentioned before, in the process, in-
The focus on the unconscious meanings creasingly focus on the manifestations of char-
in the 'here-and-now' is increasing. A major acter pathology in the transference. Hanna
agreement is evolving regarding what Sandler Segal (personal communication) now stresses
& Sandler (1984) have described as the 'present interpretation at the most active-not deep-
unconscious' in contrast to the 'past uncon- est-level of anxiety, and with the patient's
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662 OTTO F. KERNBERG

current level of mental functioning. Etchegoyen's dent approaches, typically illustrated by the
(1991) text illustrates a parallel development contributions of Heimann (1950), Little (1951),
among the Argentinian Kleinians. Racker (1957, 1968), Annie Reich (1951), and
Winnicott (1949, 1960). The net effect of these
Increasing Focuson Translation of Unconscious contributions was to broaden the concept of
Conflictsinto Object-Relations Terminology countertransference from its narrow sense (as
the analyst's unconscious reaction to the pa-
It is important to differentiate the technical tient or to the transference) into the broader
approach to the clinical material from the sense of the total emotional reaction of the
on-going controversy regarding the relation- analyst to the patient. These contributions also
ship between object-relations theory and drive signalled a shift from a negative-what one
theory, a controversy that separates neatly might even call a phobic-attitude toward the
those object-relations theoreticians who main- countertransference (as an assumed reflection
tain drive theory (Jacobson, Mahler, Klein, of the analyst's unresolved neurotic conflicts)
Kernberg) from those who consider object- to regarding it as an important instrument for
relations theory incompatible with Freudian investigating the transference and the total
drive theory (Sullivan, Fairbairn, Mitchell, patient-analyst interaction.
Greenberg). Technically, there is a general ten- Interpersonal psychoanalysts, as we know,
dency to express impulse/defence configura- started out with such a global definition and
tions in terms of corresponding unconscious, technical approach to the countertransference
internalised identification with self- and object- (Fromm-Reichmann, 1950; Searles, 1979).
representations that carry the corresponding Racker's (1957) path-breaking clarification of
drive derivative or its affective expression. concordant and complementary identifica-
The British and Interpersonal schools have, tions in the countertransference provided a
of course, always formulated their interpreta- theoretical frame for countertransference analy-
tions in object-relations language, and this also sis that has been utilised widely in all object-
holds true for self psychology (with the sig- relations theory approaches, and has become
nificant difference that self psychology disre- a centrepiece in Etchegoyen's Kleinian treatise
gards the existence of aggressively invested (1991). Jacobs's recent text (1991) illustrates
internalised object relations). But the ego- how these concepts have become part of the
psychology literature on technique also has mainstream of ego-psychology thinking in the
increasingly been formulated in object-relations United States as well, and Epstein & Feiner's
terms as, for example, in the developmental (1979) selection of papers on countertransfer-
approach derived from Mahler (Akhtar & Parens, ence points to parallel developments in a broad
1991), and in the work of Arlow (1991), Gill spectrum of psychoanalytic approaches, in-
(Gill & Hoffman, 1982), and Sandler (Sandler cluding French authors (McDougall, 1979).
et aI., 1992). It may be argued that psycho- Major differences remain, however, on the
analytic theory has implied an object-relations extent to which transference and countertrans-
theory from its very beginning, but the increas- ference analysis are linked: interpersonal
ing linkage of affect dispositions and drive psychoanalysis gives an almost symmetrical
derivatives with self- and object-representations attention to transference and countertransfer-
that are part of ego and superego structures ence, a tendency less prevalent among the
has only become dominant, it seems to me, in Independents, and even less so among ego
the non-object-relations theory approaches, in psychologists and Kleinians. I think it is fair
recent years. to say that all analysts utilise the exploration
of their own affective responses to their pa-
Countertransference tients in a consistent and much freer way than
earlier clinicians did. By the same token,
Parallel and well-known developments re- however, there is also a general tendency to
garding countertransference have taken place utilise countertransference analysis only in the
within ego-psychology, Kleinian, and Indepen- formulation of interpretations, while carefully
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CONTEMPORARY PSYCHOANALYTIC TECHNIQUE 663

avoiding the direct communication of it to the (Bollas, 1987, 1992; Casement, 1991; Ogden,
patient. 1989; Stewart, 1992).
From a theoretical viewpoint, the expansion To interpret where the dominant affective
of the concept of countertransference and investment is, however, does not mean simply
its utilisation in the formulation of transfer- to address the material that produces more
ence interpretations implies a gradual accep- conscious affective display. The on-going ex-
tance-in varying degrees and with varying ploration of the relationship between dominant
limitations-of the concept of projective identi- themes in the transference, affective dominance
fication as an important means of defence and in the total material presented by the patient,
unconscious communication in the transfer- and affective dominance in the countertrans-
ence. The actualisation or enactment of past ference, represent, at an operational level, the
conflicts in the transference, particularly with concrete analysis of transference and counter-
'role reversal' (Kernberg, 1984) of the original transference developments in each session. To
pathogenic object relation, on the part of determine the extent to which external reality,
the patient is met by a 'role responsiveness' developments in the transference, and the emer-
of the analyst (Sandler, 1976). The analyst's gence of repressed infantile material contribute
trial identification with the patient includes to shaping the concrete affective climate of each
the activation of reciprocal roles in the counter- session is perceived as a major task by most
transference. contemporary psychoanalytic approaches.

Increasing Focus on Patient's Affective Stress on Multiplicity of'Royal Roads' to the

Experience Unconscious

Psychoanalysts have always focused on the As mentioned earlier, the emphasis on dream
patient's affective experiences. Fenichel (1941) analysis as the 'royal road' to the unconscious
eloquently summarised the risks of two polari- has diminished as our understanding of the
ties of resistance: an intensity of affect as a multiple channels of communication the un-
defence against cognitive awareness of an un- conscious takes in the analytic situation has
conscious conflict, and a reliance on intellec- increased. Brenner (1976) observed that 'The
tualisation and rationalisation as a defence traditional emphasis on the importance of dreams
against affective awareness of such a conflict. in psychoanalytic therapy has been at the ex-
Here, however, I am referring to the gradual pense of attention to the place in analysis of
transformation of the traditional ego-psycho- such other mental phenomena as daydreams,
logical focus on intensity of instinctual conflicts slips, metaphors, jokes, reactions to works of
per se as determining the 'economic' criterion art and even neurotic symptoms ...' (p. 165).
of interpretation (Fenichel, 1941) (or through- Gray (1986), in the context of interpretive
out the Kleinian school as well as ego psy- interventions, points to the multiplicity of
chology, the focus on libidinal and/or aggressive 'surfaces' of the psychoanalytic material, and
investments) into the detailed study on the thereby illustrating the potential flexibility of
affects that represent or reflect the dual drives an ego-psychological approach that directs the
in the clinical situation. patient's attention to a broad variety of de-
Irrespective of one's position regarding the fensive operations. Other developments within
controversy over whether drive theory should ego psychology include Kris's (1982) renewed
be replaced or complemented by other motiv- focus on the technical utilisation of the pa-
ational theories, in the clinical situation the tient's free association, and Schwaber's (1983)
dominance of affective investment has come emphasis on the analyst's exploration of the
to be almost universally accepted as the most patient's subjective experience of the analyst's
appropriate point for analytic intervention interventions, particularly when there are dis-
(with perhaps the exception of Lacanians). This ruptions in the communicative process. It is
point has been stressed most strongly in recent here, I believe, that a major flexibility of ap-
contributions from the Independent group proach to the patient's material has become
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664 OTTO F. KERNBERG

evident throughout different approaches, a hour. Bion's (1967) caution to interpret 'with-
flexibility I attempted, in earlier work (Kern- out memory or desire' points to a related
berg, 1992), to synthesise as the simultaneous concern about exploring afresh, without re-
attention to 'three channels' of communication, stricting preconceptions, the material in each
namely (1) communication of verbal content session.
through free association, (2) communication I believe one may surmise, from a contem-
by means of nonverbal behaviour and the porary perspective, the dynamic and economic
formal aspect of language, and (3) communic- criteria of interpretation by stating that inter-
ation by the total, constant, implicit object pretation should be guided by the analyst's
relation developed in each analyst-patient pair assessment of dominant affective investment
as contrasted to the moment-to-moment shift at any particular time, predominantly, but not
in dominant transference-countertransference exclusively, through the analysis of the trans-
equilibrium. ference, and proceeding from surface to depth,
With regard to the formal aspects of verbal with the awareness of the existence of multiple
communication, Liberman's (1983) pioneering surfaces, and the possibility that the same
work in Argentina on the relationship between impulse/defence organisation may be approached
psycholinguistic styles and dominant character from alternative surfaces into a common depth.
patterns, crisply highlighted in Etchegoyen's
(1991) text, provided a new frame for under- Increasing Concern with 'Indoctrination' of
standing communication within the psychoana- Patients
lytic process. Rosenfeld (1987), in describing
the relationship between narcissistic character Widespread concern has been expressed over
pathology and its transference manifestations, the risks of involuntarily seducing the ana-
updated the importance of the transformation lysand into the theory, or at least the language,
of narcissistic character defences into transfer- of the analyst, the consequent risk of producing
ence resistances within a Kleinian frame, a 'transference cures' rather than transference
transformational process independently high- resolution, and a false, apparent confirmation
lighted by Grunberger (1971) from the French of the analyst's theories as they are reflected
psychoanalytic mainstream, and by Kohut's in the patient's reorganisation of his subjective
(1971, 1977) self psychology. experience. This preoccupation has taken dif-
Within ego psychology, Levy & Inderbitzin ferent forms within the different approaches:
(1990), in their succinct summary of four dif- ego psychology has criticised the concept of
ferent conceptualisations of 'analytic surface', 'resistance' as potentially fostering an adver-
describe how'... [paul] Gray's focus on op- sary relation between patient and analyst, and
portunities for illustrating defensive ego opera- imposing the analyst's views on the patient
tions, [Merton] Gill's careful attention to here- (Schafer, 1992); Kleinians address the problem
and-now transference manifestations, [Anton] in Bion's 'Notes on memory and desire' (1967);
Kris's search for discontinuities in the patient's Lacanians write of the notion of the analyst as
free associative process, and [Evelyne] Schwa- the 'subject of supposed knowledge' (see Etche-
ber's consistent efforts to clarify deficiencies goyen, 1991, chapter 11). The consistent em-
in the analyst's understanding of the patient's phasis on empathy with the patient's subjective
subjective experiences all take off from various experience in self psychology also contains,
suggestions inherent in Freud's ideas about implicitly, a criticism of authoritarian inter-
technique. They organise the analyst's listening pretations (Schwaber, 1990). Interpersonal psy-
and responding' (p. 386). choanalysis and the Independents, in stressing
Levy & Inderbitzin also criticise, however, the fundamental importance of clarifying dis-
the danger of getting lost in any particular ruptions in the patient-analyst communication,
'microscopic focus', in that the analyst may have, implicitly, always focused on the risk of
lose his awareness of other issues. They stress the analyst imposing his views on the patient.
the importance of flexibility, and the multi- The problem is that the analyst's theoretical
plicity of choices of material in each analytic orientation will inevitably influence his style
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CONTEMPORARY PSYCHOANALYTIC TECHNIQUE 665

of communication, and the patient, given his ever, indicates, I believe, that the intimate
alertness to the analyst's communications, will interrelationship between pre-oedipal and oedi-
necessarily extract a view of the analyst's ap- pal conflicts and structures decreases the im-
proach. It is usually not difficult to recognise portance of the more traditional linear models
the theoretical background from any analyst's of development.
particular interventions. An analyst's cautious For example, the original oedipal structur-
avoidance of any interpretation that might be ing of reality, the archaic Oedipus situation,
challenged by the patient as an 'imposition' proposed both by Lacanian theory and by the
may lead to the acting out of sado-masochistic French mainstream (Benvenuto & Kennedy,
transferences, as much as if the analyst inap- 1986; Chasseguet-Smirgel, 1986; Lacan, 1966;
propriately imposes his formulations on the Le Guen, 1974) point to the original function
patient. It is the awareness of this dialectic of the father as the third party interfering with
that increasingly influences psychoanalytic tech- the symbiotic relationship between mother and
nique, and a general tendency toward avoidance infant, so that the progression from archaic
of formulations that might lend themselves to oedipal conflicts to the advanced oedipal con-
intellectualised reorganisation of the patient's flicts occurs simultaneously with the develop-
experience, bringing about closure rather than ment of oral and anal conflicts. At the same
opening a potential space for the unexpected. time, psychoanalytic literature in general that
deals with severe character pathology and bor-
Increased Questioning ofLinear Concepts of derline conditions points to the intimate con-
Development densation of oedipal and pre-oedipal conflicts
in these patients (Akhtar, 1992; Kemberg, 1984,
There is an increasing tendency to question 1992; Rosenfeld, 1987).
the linear sequence from oral to anal to genital My own viewpoint is that the more severe
and oedipal conflicts, in contrast to the elabo- the patient's psychopathology, the more do we
ration, within the psychoanalytic process, of fmd condensed manifestations of early and
highly individualised sequences of condensed later conflicts, so that only in advanced stages
oedipal and pre-oedipal structures. The current of the treatment do we find transferences
trend is for the analysis of transference para- that conform to the classical models of pre-
digms to operate with an oscillation between dominantly oral or anal unconscious conflict
the analysis of highly condensed, synchronic material. From a theoretical viewpoint, the
structures that incorporate disparate aspects importance of retrospective modification of
of the past, and the analysis of any particular past experience in the light oflater ones (Freud's
dyachronic line of development that temporar- Nachtriiglichkeit) has changed the nature of
ily emerges within those condensed structures. our discussion of the emergence of very early,
This development, perhaps most strongly ac- particularly preverbal, material in the psycho-
centuated among Lacanian but characteristic analytic situation (more about this later).
as well of non-Lacanian French psychoanaly-
sis, also focuses on the structural aspects and
developmental consequences of early oedipal- DIVERGENT TRENDS IN CONTEMPORARY
isation; the archaic Oedipus. PSYCHOANALYTIC TECHNIQUE
This emerging consensus, in my view, is
still being obscured by the older controversy The previous section, describing convergent
regarding the dominance of oedipal and/or trends within the technical approaches of dif-
pre-oedipal issues in psychopathology, which ferent psychoanalytic schools at this time, in-
separates self psychology and some radical cluded my own ideas. In fact, since my work
interpersonal psychoanalysts, on the one side, has focused on efforts to bridge ego-psychol-
from ego psychology, the British schools, French ogy and object-relations theory, the correspon-
mainstream, and Lacanian psychoanalysis, on dence should not be surprising. In the section
the other. Careful exploration of the develop- that follows, which examines divergent trends
mental schemata of all these approaches, how- in contemporary psychoanalytic technique, I
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666 OTTO F. KERNBERG

shall spell out where I stand regarding each of deficits and arrests and facilitate the resump-
the issues to be explored. tion of growth in the patient by means of a
new (we might even say corrective) emotional
The 'Real' Relationship and Transference- experience. This latter position often empha-
Countertransference Issues sises as well the particular personality of the
analyst in contributing to this new experience.
Here, in spite of a variety of technical In all fairness, here it is not a matter of the
approaches rather than a sharp dichotomy, analyst artificially providing the patient with
there are significant differences in the concep- a 'corrective emotional experience', in other
tualisation of the psychoanalytic process; dif- words, manipulating the transference, but of
ferences that cut across the major schools providing a genuine, authentic relationship in
referred to before. At one extreme is the as- which the personality of both participants, and
sumption that everything in the patient-analyst certainly transference and countertransference
relationship is transference, and that even the analysis, participate.
'unobjectab1e' aspects of the transference, re- A third factor which intersects with these
lated to what Zetze1 (1956, 1965) described as two, is represented at one extreme by the
the therapeutic alliance and Greenson (1965) position that the transference is an exclusive
as the working alliance or working relation- creation of the patient, the unconscious repro-
ship, reflect transference dispositions stemming duction in the here-and-now of pathogenic
from a normally achieved, trusting relationship conflicts and object relations from the past,
between the infant and mother. In self psy- with the analyst remaining outside these con-
chology, for example, the assumption that, all flicts except to facilitate their clarification by
along the treatment, the analyst fulfils se1f- the successive analysis of transference para-
object functions that continue as a normal digms. This position is often linked with the
aspect of human life for all individuals, implies traditional concept of the transference neurosis,
such a view. This position, which considers all that is, the sequential deployment in the trans-
aspects of the analyst-patient relationship as ference of the patient's unconscious conflicts,
reflecting transference dispositions, as Thoma with a gradual concentration of these conflicts
& Kachele (1987) point out, makes it difficult in the transference as opposed to other areas
to conceptualise how the transference can be of the patient's life, and with the possibility
analysed and resolved. of their gradual resolution by systematic trans-
Those who, like most ego psychologists, ference interpretation.
assume that a 'real' relationship exists inde- This traditional position, rather strongly
pendently from the transference and that the maintained by both ego psychologists and
therapeutic alliance reflects the working rela- Kleinians, was challenged by Gill (Gill &
tionship between the healthy part of the pa- Hoffman, 1982) within ego psychology, and
tient's ego and the analyst in his professional developed further by Thoma & Kachele (1987),
role, may unwittingly foster a distortion of the all of whom emphasise the analyst's contribu-
psychoanalytic situation into a direction of tions to the transference. This point had also
conventionality, in which unacknowledged, earlier been stressed by both the Independents
culturally and socially determined joint biases and the interpersonalists. Thus, paradoxically,
of patient and analyst contribute to restrict traditional ego psychology contrasts the real
the full investigation of the transference: this relationship to the transference relationship,
is, in effect, a critique that Deserno (1990), in but still de-emphasises the importance of the
Germany, makes of the concept of the thera- analyst's personality. By the same token, the
peutic alliance. interpersonal approach (Greenberg, 1991;
The role of the analyst is related to another Mitchell, 1988), proposes that the analyst's
factor, namely, whether the therapeutic effect personality inevitably influences the transference,
of psychoanalysis derives from interpretation and that, in order for the patient to experience
alone, or as a result of a new experience that the analyst as a 'safe' object, the analyst needs
will permit the compensation of developmental to modify his behaviour to maintain himself
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CONTEMPORARYPSYCHOANALYTICTEC~QUE 667
equidistant from the danger of being 'unsafe' full verbalisation of this experience by the
and from colluding with the transference. This analyst. Interpersonal psychoanalysts, espec-
approach thus stresses at the same time the ially the earlier work of Sullivan (1953) and
unavoidability of mutuality in transference- Fromm-Reichmann (1950), as well as Searles
countertransference activation, and, implicitly, (1979), also consider the possibilities of the
what may be considered a manipulative therapeutic effects of severe regression, as long
adaptation by the analyst to the patient's as the therapist analyses the negative, terror-
transference. ising misinterpretations of the treatment situ-
My own view is that the reality of the ation that interfere with the regressed patient's
analyst's personality becomes important only capacity to resume emotional growth.
in so far as it serves as an anchoring point The Kleinians, in contrast, as represented
for the transference, where it requires on-going particularly in the work of Rosenfeld (1987),
self-scrutiny by the analyst of his own behav- stress the importance of a systematic analysis
iour and countertransference reactions. I also of the positive and negative transference of
view the patient's capacity to use the 'real' severely regressed patients, with the analyst
aspects of the therapeutic relationship, in the remaining in a technically neutral position.
case of very ill patients; that is, to perceive The object-relations approach that has evolved
the analyst realistically in his therapeutic role, within ego psychology (Jacobson, 1971; Kern-
as a consequence of the analysis of regressive berg, 1975, 1984; Kernberg et al., 1989) has
transferences. In contrast, the analyst's re- proposed a technique that provides structuring
gression to his own defensive character pat- of the treatment frame in order to protect the
terns, as a consequenceof severely pathological severely regressed patient and the treatment
transference--countertransference developments situation, and at the same time stresses the
with chronically regressedpatients, requires the importance of an essentially interpretive ap-
protection of the treatment frame, and analytic proach. Etchegoyen (1991) spells out in detail
working through of the transference simulta- recent contributions from a Kleinian perspec-
neously with the analyst's work on and at- tive to the analysis of severe regressions in the
tempts to utilise the understanding derived transference that permit the maintenance of a
from his own countertransference. In short, consistent psychoanalytic frame and the tech-
I agree with Etchegoyen's (1991) critique of nical neutrality of the analyst.
the exaggerated emphasis on the importance My view is that, particularly with those
of the analyst's personality in the interpersonal severely regressed patients where a psychoana-
approach. lytic approach is still warranted, the provision
of sufficient structure to be able to maintain
The Therapeutic Aspects versus the Resistance an analytic setting and to interpret the primi-
Aspects ofRegression tive defensive operations and object relations
of the patient in the transference permits the
The controversy in this area is related to gradual transformation of regressive transfer-
the preceding one, and refers specifically to ences into more advanced ones, strengthens
the transference regression of patients with the patient's ego, and permits him to collabo-
severe psychopathology. The Independents fol- rate in the analytic exploration. Under these
lowing Balint (1968) and, particularly, Winni- circumstances, the analysis of the reasons for
cott (1965) propose the therapeutic value of deviations from technical neutrality (when such
regression in the transference in patients with deviations occurred), permits protecting and
severe personality disorders, particularly se- reinstating the psychoanalytic frame.
verely schizoid, antisocial, and those with Increasing attention in recent times to severe
generally 'false self characteristics. The assump- cases of borderline, narcissistic and perverse
tion is that the analyst's capacity to tolerate this psychopathology has highlighted the impor-
regression and to 'hold' the patient during it tance of some patients' efforts to protect them-
permits 'a new encounter', a resumption of selves from the extremely painful awareness of
normal growth at certain points, even without their primitive hatred by the destruction of the
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668 OTTO F. KERNBERG

communicative process in the analytic situ- time, I recognise the enormous value of psycho-
ation, and the very viability of the analytic analytic psychotherapy, in contrast to the tra-
situation itself. Severe, often life-threatening ditional view of it as a 'second-best' treatment.
forms of acting out, destructive violence in the I have proposed differentiating psychoanalytic
sessions, a constant challenge to the boundaries psychotherapy from standard psychoanalysis
of the psychoanalytic situation, reflect sym- by a modification of three basic tools derived
bolically, one might say, the struggle between from standard psychoanalytic technique.
love and aggression at the deepest levels of Firstly, interpretation in psychoanalytic psycho-
regression: now the psychoanalytic frame stands therapy is restricted to clarification, confronta-
for the survival of the analytic process geared tion and interpretation of the unconscious
to resolving this calamity. I believe that, when meanings in the here-and-now only, while
the interpretation of the patient's consistent genetic reconstructions are reserved for the
attacks on the analytic frame does not manage advanced stages of treatment. Secondly, trans-
to protect the frame, to 'contain' or 'hold' the ference analysis in psychoanalytic psychother-
analytic relationship, limit-setting, or structur- apy is modified, in each session, to incorporate
ing of the analytic situation becomes essential. attention to the long-range treatment goals
Such limit-setting in itself represents a modified and the dominant, current conflicts in the
frame that permits the continuation of the patient's life outside the sessions. Thirdly, tech-
interpretive work, to be followed, eventually, nical neutrality must be modified by the need
by the interpretive resolution of that limiting for structuring or setting limits in the treatment
structuralisation itself. situation, but must eventually be reinstated by
the therapist's clarifying to the patient, by means
Psychoanalysis and Psychoanalytic of interpretation, the reasons for departing
Psychotherapy from the neutral position in the first place
(Kemberg, 1975, 1984; Kemberg et al., 1989).
In this long-standing controversy, two prob-
lems are involved: the boundaries of what may The Role ofEmpathy
be considered standard analysis, in contrast to
its modification or extension for patients who Here the controversy is particularly between
are not able to undergo such treatment, and self psychology and all other psychoanalytic
the question of the 'dilution' of standard tech- orientations. Whereas self psychology stresses
nique when a clear distinction between psy- the primacy of the analyst's empathy with the
choanalysis and psychoanalytic psychotherapy patient's subjective experience, and the need
is not maintained, as opposed to those who to focus on such experiences particularly at
wish to experiment freely with the elements of moments of disruption of the affective relation-
the psychoanalytic technique and apply it to ship between patient and analyst, the other
new fields. approaches consider the capacity for empathy
In general, both ego psychologists and Klein- a general precondition for all psychoanalytic
ians favour a firm distinction between psycho- work, and broaden the concept of empathy to
analysis and other psychotherapies, while the include not only the analyst's empathy with
Independents and the interpersonalists main- the patient's central emotional experience but
tain more flexible boundaries regarding the also with that which the patient cannot tolerate
treatment. Such greater flexibility probably also in himself, projects and/or dissociates.
applies to child psychoanalysis within the French In this regard, the utilisation of the concept
mainstream. of projective identification, originally coined
My own view is that, because it is helpful by Klein (1946), but gradually adapted by
to evaluate the specific effects of the technical the Independents, interpersonalists, the French
approach utilised, it is preferable to differen- mainstream, and significant sectors of object-
tiate rather sharply standard psychoanalysis relations-ego-psychology approaches implies
from psychoanalytic psychotherapy. At the same the need to empathise not only with the pa-
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CONTEMPORARYPSYCHOANALYTICTEC~QUE 669
tient's current self-experience, but also with signals the resolution of the transference. It
what the patient projects, dissociates, or re- may be that this controversy represents a tem-
presses. All psychoanalytic approaches point porary 'turbulence' in psychoanalytic thinking,
to the importance of empathy as a precondition in the sense of pointing to the problematic
for the capacity for countertransference analy- nature of many reconstructions, to the fact
sis and its utilisation in transference interpre- that most 'historical' reconstructions represent,
tation. In contrast to self psychology, the other rather, constructions on the basis of the un-
approaches focus on the importance of the conscious meanings in the 'here-and-now', that
multiplicity of observational data in the psycho- the 'logical fit' of the present into the past is
analytic situation. often problematic, and that the correlation or
A related general conceptual issue that sepa- correspondence between past and present is
rates self psychology from other psychoanalytic open to vastly different views. Klein's proposal
techniques is the extent to which negative trans- (1952) that the transference represents real ex-
ference simply reflects the traumatic disruption periences from the past, fantasied experiences
of a 'self-selfobject relationship' (that is, of a from the past, and defences against both prob-
positive transference), or reflects the activation ably reflects a widely accepted intermediate
of 'negative introjects', of persecutory in con- position in this controversy with which I agree.
trast to idealised self- and object-representations Recent knowledge regarding actual, severe
activated in the transference, as all non-self- physical, mental, or sexual trauma in early
psychology approaches affirm. infancy and childhood of patients with re-
With severely ill patients, where verbal com- gressive psychopathology has not solved this
munication itself may be distorted in the service problem. Between the historically documented,
of defence, at times, in an effort to remain severely traumatising situations in the past and
empathically in touch with the patient, the the current, unconscious mental structures of
analyst may adapt himself to the patient's style, our patients lie significant transformational
thus unwittingly reinforcing the resistance. At processes. The direct interpretation of present
other times, the analyst's complete absorption, transference regression in terms of an assumed
in an effort to understand the patient's con- repetition of such past trauma may bypass the
fusing communication, at the cost of a loss of unconscious meanings of the trauma, and its
the analyst's internal freedom to interpret this developmental structuralisations. A typical ex-
very process, may also paralyse his analytic ample is the neglect, in victims of physical or
function: here, one might say, efforts at em- sexual abuse, of interpretation-together with
pathy may become dangerous. An opposite the effects of their experience as victim-of
danger, under such circumstances, is for the their unconscious identification with the ag-
analyst to fall back defensively on his general gressor, and of the elaboration of that identi-
theoretical formulation thus, in effect, discon- fication activated in the transference.
necting himself from the disorganising process
in the transference that would have required Technical Neutrality and Cultural Bias
his understanding.
Cremerius (1984) raises the question of
'Historical Truth' versus 'Narrative Truth' whether an unconscious collusion exists be-
tween analysts and patients regarding social,
Schafer's (1976, 1992) and Spence's (1982) cultural and political issues, ideologies, and
contributions represent a radical proposal that power struggles. Here, the approach of some
replaces the reconstruction of historical truth feminist and Marxist psychoanalytic groups
and causality by the construction of new, nar- converge. In contrast to this viewpoint, the
rative 'myths', and questions the possibility of question has been raised whether an excessive
reconstruction of the historical past in contrast concern over 'hidden' ideologies may transform
to the traditional assumption that the recon- the analytic encounter into a political project.
struction of the historical past facilitates and At the same time, however, in support of the
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670 OTTO F. KERNBERG

concern over ideological distortions, the av- In short, it may be that this is a controversy
oidance of covert-and overt-political issues, that is being laid to rest.
including psychoanalytic politics, may reflect
an unconscious collusion between patient and
analyst. Efforts to recognise how these hidden SUMMARY
ideologies affect the psychoanalytic process may,
I believe, enrich it. A broad survey of the psychoanalytic field
reveals both convergences and divergences in
The Reconstruction and RecoveryofPreverbal technique. The major convergences include
Experiences earlier interpretation of the transference, in-
creased focus on transference analysis, as well
The traditional criticism by ego psychology as growing attention to countertransference
in regard to Kleinian analysis has centred on analysis and increasing concern with the risks
Kleinian interpretation of the assumed devel- of 'indoctrinating' patients. Greater emphasis
opments in the first year of life, and the related is found on character defences and the uncon-
assumption of a degree of sophistication and scious meanings of the 'here-and-now'. Also noted
complexity of unconscious fantasy at that time are trends toward translating unconscious con-
that does not seem warranted. Paradoxically, flicts into object-relations terminology, as well
recent infant research has demonstrated a much as toward considering a multiplicity of royal
higher level of complexity of mother-infant roads to the unconscious.
interaction in the first year of life than ego Regarding divergences, significant contro-
psychology traditionally assumed. Further, on versies continue about the importance of the
the basis of their own experience over the past 'real' relationship, and the therapeutic versus
30 years, Kleinian analysts have become much the resistance aspect of regression. Divergences
more cautious and reluctant in carrying out also continue regarding reconstruction and
early genetic reconstructions of the preverbal recovery of preverbal experience, drawing the
period. linesbetween psychoanalytic psychotherapy and
Simultaneously, the impact of Mahler's in- psychoanalysis, the role of empathy, and the
vestigation of children with symbiotic psycho- relation of historical to narrative truth.
sis and of the separation-individuation process
has given a new impetus to the exploration of
expression of preverbal material in patients' TRANSLATIONS OF SUMMARY
nonverbal manifestations and relationship to
the analytic setting (Akhtar & Parens, 1991). Une large etude du champ psychanalytique revele tout it
la fois des divergenceset des convergencesquant it la technique.
Child observation, Mahler's developmental ap- Les convergences principales comprennent une interpretation
proach, and the analytic exploration of regres- precoce du transfert, une augmentation de I'attention
sive transferences from many viewpoints all portee sur I'analyse du transfert, ainsi qu'une attention crois-
sante it I'analyse du contre-transfert et un interet croissant
point to the importance of continuing investi- quant aux risques 'd'endoctriner' Ie patient. La plus grande
gation of the preverbal in the analytic setting. attention se porte sur les defenses caracterielles et la signifi-
The increased emphasis on 'retrospective modi- cation inconsciente de 'I'ici et du maintenant'. II faut aussi
noter un courant dans Ie sens d'une traduction des conflits
fication' on the part of the Lacanian school, inconscients en terminologie des relations d' objet, ainsi qu'un
as well as in the French mainstream, has courant considerant une multiplicite de voies royales menant
it l'inconscient.
provided an additional impetus to explore con- Pour ce qui est des divergences, de considerables contro-
densation of the preverbal with material from verses se poursuivent sur I'importance d'une relation 'reelle',
later levels of development, a position not far et la therapeutique contre I'aspect resistance dela regression.
Ces divergences s'etendent aussi it la reconstruction et la
from an ego-psychology viewpoint, according reconquete des experiences pre-verbales, etablissant des
to which all aspects of early development can demarcations entre la psychotherapie psychanalytique et la
only be seen in the context of their develop- psychanalyse, Ie role de I'empathie, et la relation de I'histori-
que it la verite narrative.
mental transformation under the impact of
advanced oedipal relationships (Arlow, 1991). Eine umfassende Ubersicht iiber das psychoanalytische
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CONTEMPORARY PSYCHOANALYTIC TECHNIQUE 671

Feld laBt sowohl Konvergenzen, als auch Divergenzen in der Una amplia mirada al campo psicoanalitico revela tanto
Methode erkennen. Die wesentlichen Konvergenzen beinhal- puntos convergentes como divergentes en materia de tecnica,
ten eine friihere Interpretation der Ubertragung, eine stark- Entre los convergentes se encuentran la mayor prontitud en
ere Betonung der Analyse der Obertragung sowie zunehmende la interpetacion de la transferencia, la creciente importancia
Beachtung der Gegeniibertragungsanalyse und wachsende del analisis de la transferencia, la creciente atencion al analisis
Sorge iiber die Risiken, die mit der 'Indoktrinierung' von de la contratransferencia y la mayor preocupacion por e1
Patienten verbunden sind. Es besteht eine starkere Be- riesgo de 'indoctrinar' a los pacientes. Se subrayan tambien
tonung von Charakterverteidigungen und der unbewullten mas las defensas de caracter y los significados inconscientes
Bedeutungen des 'Hier und Jetzt'. Weiterhin werden Tenden- del 'aqui y ahora'. Se advierten tambien tendencias a traducir
zen zugunsten der Ubersetzung von unbewuBten Konflik- los conflictos inconscientes a terminologia de relaciones de
ten in die BegrifTe der Objektbeziehungsterminologie sowie objeto; y se tiende igua1mente a aceptar una multiplicidad de
zugunsten der Erwligung einer Vielfalt von Zuglingen zurn caminos que conducen al inconsciente.
UnbewuBten verzeichnet. Por 10 que a los puntos divergentes se refiere, sigue exis-
Auf der Seite der Divergenzen bestehen weiterhin wesen- tiendo una considerable controversia respecto a la importan-
tliche Unterschiede in der Einschatzung der Bedeutung der cia de la relacion 'real', y respecto a 10que la regresion tiene
'rea1en' Beziehung und im therapeutischen Aspekt im Gegen- de terapeutico por un lado, y de resistencia por otro. Sigue
satz zurn Widerstandsaspekt der Regression. Divergenzen igualmente habiendo divergencias respecto a la reconstruc-
bestehen nach wie vor im Zusammenhang mit der Rekon- cion y recuperacion de vivencias preverbales, delineacion de
struktion und Wiederentdeckung praverbaler Erfahrung, der los campos de la psicoterapia psicoanalitica y el psicoanalisis,
Abgrenzung von psychoanalytischer Psychotherapie und el papel de la empatia, y la relacion entre la verdad historica
Psychoanalyse, der RoUe der Empathie und der Beziehung y la verdad narrativa.
von historischer und erzlih1ter Wahrheit.

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