HATE IN THE GOUNTER-TRANSFERENCE Hate in the Counter-Transference By D. W. Wivnvicott I: this paper I wish to examine one aspect of the whole subject of ambivalency, namely, hate in the countertransference. I believe that the task of the analyst (call him a research analyst) who undertakesthe analysis of a psychotic is seriously weighted by this phenomenon, and that analysis of psychotics becomes impossible unless the analyst's own hate is extremely weil sorted-out and con- scious. This is tantamount to saying that an analyst needs to be himself analyzed, but it also asserts that the analysis of a psychotic is irksome as compared with that of a neurotic, and inherently so. Apart from psychoanalytic treatment, the management of a psychotic is bound to be irksome. From time to time’? I have made acutely critical remarks about the modern urends in psychiatry, with the too easy electric shocks and the too drastic leucotomies. Be- cause of these criticisms that I have expressed I would like to be foremost in recognition of the extreme difficulty inherent in the task of the psychiatrist, and of the mental nurse in particular. Insane patients must always be a heavy emotional burden on those who care for them. One can forgive those who do this work if they do awful things. This does not mean, however, that we have to accept what- ever is done by psychiatrists and neuro- surgeons as sound according to principles of science. Therefore although what follows is about psycho-analysis, it really has value to the psy chiatrist, even to one whose work does not in any way take him into the analytic type of relationship to patients To help the general psychiatrist the psy- cho-analyst must not only study for him the primitive stages of the emotional develop- ment of the ill individual, but also must study the nature of the emotional burden which the psychiatrist bears in doing his work. What we as analysts call the counter-transference needs to be understood by the psychiatrist too. However much he loves his patients he cannot avoid hating them, and fearing them, and the better he knows this the less will hate and fear be the motive determining what he dees to his patients. STATEM NT OF THEME ‘One could classify counter-transference phe- nomena thus: 1, Abnormality in counter-transference feelings, and set relationships and iden- lifications that are under repression in the analyst. The comment on this is that the analyst needs more analysis, and we believe this is less of an issue among psycho-analysts than among psy- cho-therapists in general. 2. The identifications and tendencies be- longing to an analyst's personal experi- ences and personal development which provide the positive setting for his ana- lytic work and make his work different in quality from that of any other analyst. 3. From these two I distinguish the truly aj objective counter-transference, or if this is difficult, the analyst's love and hate in reaction to the actual personal- ity and behaviour of the patient, based on objective observation. I suggest that if an analyst is to analyze psychotics or antisocials he must be able to be so thoroughly aware of the counter-transfer- ‘VOLUME 3+ NUMBER 4+ FALL 1994Winnicorr ence that he can sort outand study his objective reactions to the patient. These will include hate. Countertransference phenomena will at times be the important things in the analysis. Motive ImMpiteo ro ANALYST BY THE Parievt Tas THE I wish to suggest that the patient can only appreciate in the analyst what he himself is, capable of feeling. In the matter of motive; the obsessional will tend to be thinking of the analyst as doing his work in a futile obse sional way. A hypo-manic patient who is inca- pable of being depressed, except in a severe mood swing, and in whose emotional devel- opment the depressive position has not been securely won, who cannot feel guilt in a deep way, or a sense of concern or responsibility, is unable to see the analyst's work as an atempt on the part of the analyst to make reparation in respect of his own (the analyst's) guilt feelings. A neurotic patient tends to see the analystas ambivalent towards the patient, and to expect the analyst to show a splitting of love and hate: this patient, when in fuck. gets the love, because someone else is getting the analyst's hate. Would it not follow that if a psychotic is in a “coincident love-hate” state of feeling he experiences a deep conviction that the analyst is also only capable of the same crude and dangerous stzte of coinci- dent love-hate relationship? Should the ana- lyst show love he will surely at the same moment kill the patient. This coincidence of love and hate is something that characteristically recurs in the analysis of psychotics, giving rise to prob- lems of management which can easily take the analyst beyond his resources. This coinci- dence of love and hate to which I am refer- ring is something which is distinct from the aggressive component complicating the primitive love impulse and implies that in the history of the patient there was an environ- mental failure at the time of the first object- finding instinctual impulses. If the analyst is going to have crude feel- ings imputed to him he is best forewarned and so forearmed, for he must tolerate being placed in that position. Above alll he must not deny hate that really exists in himself. Hate that is justified in the present setting has to be sorted out and kept in storage and available for eventual interpretation. Lf we are to became able to be the analysts of psychotic patients we must have reached down to very primitive things in ourselves, and this is but another example of the fact that the answer to many obscure problems of psycho-anaiytic practice ffes in further analy- sis of the analyst. (Psycho-analytic research is perhaps always to some extent an attempt on the part of an analyst to carry the work of his own analysis further than the point to which his own analyst could get him.) A main task of the analyst of any patient is to maintain objectivity in regacd to all that the patient brings, and a special case of this is the analyst's need to be able to hate the patient objectively. Are there not many situations in our or- dinary analytic work in which the analyst’ hate is justified? A patient of mine, avery had obsessional, was almost loath: we 10 me for some years, I felt bad about this until the analysis turned a corner and the patient be- came lovable, and then I realized that his unlikeableness had been an active symptom, unconsciously determined. It was indeed a wonderful day for me (much later on) when {could actually tell the patient that I and his friends had felt repelled by him, but that he had been too ill for us to let him know. This was also an important day for him, a temen- dous advance in his adjustment to reality. In the ordinary analysis the analyst has no difficulty with the management of his own hate. This hate remains latent. The main thing, of course, is that through his own anal- ysis he has become free from vast reservoirs of unconscious hate belonging to the past and to inner conflicts. There are other rea sons why hate remains unexpressed and even unfelt as such: "JOURNAL OF PSYCHOTHERAPY PRACTICE AND RESEARCH1. Analysis is my chosen job, the way I feel Twill best deal with my own guilt, the way I can express myself in a construc- tive way. 2 get paid, or Lam in training to gain a place in society by psycho-analytic work. Tam discovering things. 4. [get immediate rewards through identi- fication with the patient, who is making progress, and I can see still greater (rt rewards some way ahead, after the end of the treatment. 5. Moreover, as an analyst f have ways of expressing hate. Hate is expressed by the existence of the end of the “hour.” I think this is que even when there is no difficulty whatever, and when the pa- tient is pleased to go. In many analyses these things can be taken for granted, so that they are scarcely mentioned, and the analytic work is done through verbal interpretations of the patient's emerging unconscious transference. ‘The analyst takes over the role of one or other of the helpful figures of the patient's childhood. He cashes in on success of those who did the dirsy work when the patient was an infant. These things are part of the description of ordinary psychoanalytic work, which is mostly concerned with patients whose symp- toms have a neurotic quality. In the analysis of psychotics, however, quite a different type and degree of strain is taken by the analyst, and it is precisely this different strain that I am trying to describe. ILLUSTRATION OF Countrer-TRANSFERENCE ANXIETY Recently for a period of a few days I found I was doing bad work. I made mistakes in re- spect of each one of my patients. The diffi- culty was in myself and it was partly personal but chiefly associated with a climax that had reached in my relation to one particular psy- HATE IN THE COUNTER- TRANSFERENCE chotic (research) patient. The difficulty cleared up when I had what is sometimes called a “healing” dream. (Iacidentally [ would add that during my analysis and in the years since the end of my analysis I have had a long series of these healing dreams which, although in many cases unpleasant, have ‘each one of them marked my arrival ata new stage in emotional development.) On this particular occasion I was aware of the meaning of the dream as I woke or even before I woke. The dream had two phases. In the first | was in the gods in a theatre and looking down on the peoplea long way below. in the stalls, { felt severe anxiety as if { might lose a limb, This was associated with the feel ing I have had at che top of the Eiffel Tower that if | put my hand over the edge it would fall off on to the ground below. This would be ordinary castration anxiety. In the next phase of the dream I was aware that the people in the stalls were waich- ing a play and I was now related to what was going on on the stage through them. A new kind of anxiety now developed. What [ knew was that I had no right side of my body atall. This was not a castration dream, It was sense of not having thai part of the body. As I woke I was aware of having under- stood at a very deep level what was my diffi- culty at that particular time. The first part of the dream represented the ordinary anxie- ties that might develop in respect of uncon- scious fantasies of my neurotic patients. [ would be in danger of losing my hand or my fingers if these patients should become inter- ested in them. With this kind of anxiety I was familiar, and it was comparatively tolerable. ‘The second part of the dream, however, referred to my relation to the psychotic pa- tient. This patient was requiring of me that I should have no reiation to her body at all, not even an imaginative one; there was no body that she recognized as hers and if she existed atall she could only feel herself to be a mind. Any reference to her body produced para- noid anxieties because to claim that she had a body was to persecute her. What she needed VOLUME 3» NUMBER 4+ FALL 1904