PSYCHOTIC TRANSFERENCE

The term psychotic transference describes the intense and primitive feelings experienced by some patients during analytic sessions; such experiences occur during periods marked by a deep regression, and they are totally real to the patient, which is why a number of authors speak in this connection of delusional or regressive transference.

The concept of psychotic transference is often used to evoke very intense, primitive or undifferentiated experiences and emotions based on part-objects. Some authors use this model in working with patients presenting psychotic crises. Others use it with neurotics, when the relation with the therapist displays primitive and regressive features which are taken to be "psychotic aspects of the personality."

Freud at first argued, apropos of transference in psychosis, that in psychotics the libido had been withdrawn from the outside world, and that consequently no transference was possible (1914c). Later, however, he moderated this view: "Since then analysts have never relaxed their efforts to come to an understanding of the psychoses. Especially since it has been possible to work with the concept of narcissism, they have managed, now in this place and now in that, to get a glimpse beyond the wall. . . . [T]he mere theoretical gain is not to be despised, and we may be content to wait for its practical application. In the long run even the psychiatrists cannot resist the convincing force of their own clinical material." Freud noted in this context, in connection with those aspects of psychosis which allow for transference, that "Transference is often not so completely absent but that it can be used to a certain extent; and analysis has achieved undoubted successes with cyclical depressions, light paranoiac modifications, and partial schizophrenias" (1925d [1924], pp. 61, 60).

In his treatment of psychotic patients, Herbert Rosenfeld (1965) discovered that they did in fact establish a transferential link with the therapist, and he called this phenomenon "transference in psychosis" or "psychotic transference." He was the first to take an interest in this question after the fashion of Hanna Segal and Frieda Fromm-Reichmann. As for Wilfred R. Bion, when he discussed the psychotic personality, he was referring, in effect, to psychotic transference or delusional transference: "Since contact with reality is never entirely lost, the phenomena which we are accustomed to associate with the neuroses are never absent and serve to complicate the analysis, when sufficient progress has been made, by their presence amidst psychotic material" (1957, p. 267). Bion described the relationship to the analyst as premature, precipitate, intense, tenacious—and founded on projective identification (p. 266).

David Rosenfeld

See also: Countertransference; Ego Psychology and Psychosis ; Negative therapeutic reaction; Psychoses, chronic and delusional; Transference.

Bibliography

Bion, Wilfred. R. (1957). Differentiation of the psychotic from the non-psychotic personality. International Journal of Psycho-Analysis, 38, 266-275.

Freud, Sigmund. (1914c). On narcissism: An introduction. SE, 14: 67-102.

——. (1925d [1924]). An autobiographical study. SE, 20: 1-74.

Rosenfeld, David. (1992). The psychotic aspects of the personality. London: Karnac.

Rosenfeld, Herbert. (1965). Psychotic states: A psychoanalytic approach. London: Hogarth.