BENIGN/MALIGNANT REGRESSION

The notion of benign versus malignant regression comes from Michael Balint's book Thrills and Regressions (1959); he distinguished two types of regression that can appear during analysis. The benign form is minor, temporary, and reversible; the other, malignant form is major, serious, lasting, or even irreversible. The former brings with it beneficial, therapeutic effects; the latter is pathogenic and can potentially result in insurmountable problems for the patient and the analysis.

Regression, discovered very early on by Sigmund Freud in its topographical, temporal, and formal aspects as a defense mechanism and therapeutic support, suddenly appeared as a threat to the patient and to treatment. Generations of analysts thus came to dread it. Balint took up this issue at the point at which Freud and then Sándor Ferenczi had left off, and between 1932 and 1960 he created this notion, which aimed to change analysts' attitude toward this phenomenon.

Balint no doubt used the terms benign and malignant with reference to the work of Otto Warburg, his former boss at the Berlin Charity Hospital, on tumors, for which Warburg won the Nobel Prize in 1931. The analogy is found in surgical techniques. This clinical distinction goes beyond the theoretical positions and techniques of Freud and Ferenczi. Freud recommended that regression be overlooked in analytic technique and saw it as a therapeutic support, but he advised analysts to maintain a degree of distance. Ferenczi used it and even provoked it (trance states) for therapeutic ends, and, during the 1930s, carried away by theoretical fervor, he conducted his "great experiment." He devoted himself completely to his patients and responded to their impassioned demands with small gratifications; he also gave the patients extra sessions on demand, day or night, including during vacations.

The experiment elicited Freud's "massive condemnation" (Freud, Letter to Ferenczi, December 13, 1931), which Balint called "unfair and not very productive" (1968). Balint reassessed Ferenczi's approach during his continuation, after 1933, of Ferenczi's unfinished analyses; this enabled him to understand his predecessor's errors. The question arose as to whether he should return to the former techniques with these patients or rather, as he had begun to, derive a new evaluation of their object relations and make a prognosis of the transference (massive or non-massive) in order to adapt the treatment accordingly.

He then elaborated a differential diagnostic between two syndromes he called "Cluster A and Cluster B" (1968) with their respective constant characteristics: mutual trust or its absence, demands that were either moderate or insatiable, the inclusion of addictive states or none, and so on. To avoid "the appearance of a malignant form of regression," he advocated the development of adapted analytic techniques: The "discreet" (not omnipotent or needlessly intrusive) analyst must create the secure, permissive atmosphere that the patient needs, as well as the time needed for regression and what he called a "new beginning." This notion, linked to his theory of the "basic fault," is unquestionably the one that in Balint's corpus has had the greatest influence among analysts.

Michelle Moreau Ricaud

See also: Basic fault.

Bibliography

Balint, Michael. (1959). Thrills and Regressions. New York: International Universities Press.

——. (1968). The basic fault: Therapeutic aspects of regression. London: Tavistock Publications.

Freud, Sigmund, and Ferenczi, Sándor. (1992-2000). The correspondence of Sigmund Freud and Sándor Ferenczi (Eva Brabant, Ed., and Peter T. Hoffer, Trans.). Belknap Press of Harvard University Press.