The Conception of Transference
This last method has unmistakably been due to strong scientific interest, the traces of which are clearly seen in the delineations of cases so far. Thanks to this, Freud was also able to discover wherein lay the therapeutical effect of psychoanalysis. Whilst formerly this was sought in the discharge of the traumatic affect, it was now seen that the phantasies produced were especially associated with the personality of the physician. Freud calls this process transference (“Uebertragung”), owing to the fact that the images of the parents (“imagines”) are henceforth transferred to the physician, along with the infantile attitude of mind adopted towards the parents. The transference does not arise solely in the intellectual sphere, but the libido bound up with the phantasy is transferred, together with the phantasy itself, to the personality of the physician, so that the physician replaces the parents to a certain extent. All the apparently sexual phantasies which have been connected with the parents are now connected with the physician, and the less this is realized by the patient, the more he will be unconsciously bound to his physician. This recognition is in many ways of prime importance.
This process has an important biological value for the patient. The less libido he gives to reality, the more exaggerated will be his phantasies, and the more he will be cut off from the world. Typical of neurotic people is their attitude of disharmony towards reality, that is, their diminished capacity for adaptation. Through the transference to the physician, a bridge is built, across which the patient can get away from his family, into reality. In other words, he can emerge from his infantile environment into the world of grown-up people, for here the physician stands for a part of the extra-familial world. But on the other hand, this transference is a powerful hindrance to the progress of treatment, for the patient assimilates the personality of the physician as if he did stand for father or mother, and not for a part of the extra-familial world. If the patient could acquire the image of the physician as a part of the non-infantile world, he would gain a considerable advantage. But transference has the opposite effect; hence the whole advantage of the new acquisition is neutralized. The more the patient succeeds in regarding his doctor as he does any other individual, the more he is able to consider himself objectively, the greater becomes the advantage of transference. The less he is able to consider his doctor in this way, the more the physician is assimilated with the father, the less is the advantage of the transference and the greater will be its harm. The familial environment of the patient has only become increased by an additional personality assimilated to his parents. The patient himself is, as before, still in his childish surroundings, and therefore maintains his infantile attitude of mind. In this manner, all the advantages of transference can be lost.
There are patients who follow the analysis with the greatest interest without making the slightest improvement, remaining extraordinarily productive in phantasies, although the whole development of their neurosis, even to the smallest details, has been brought to light. A physician under the influence of the historical view might be thus easily thrown into confusion, and would have to ask himself: What is there in this case still to be analyzed? Those are just the cases of which I spoke before, where it is no longer a matter of the analysis of the historical material, but we have now to face a practical problem, the overcoming of the inadequate infantile attitude of mind. Of course, the historical analysis would show repeatedly that the patient had a childish attitude towards his physician, but it would not bring us any solution of the question how that attitude could be changed. To a certain extent, this serious disadvantage of transference is found in every case. Gradually it has been proved that this part of psychoanalysis is, considered from a scientific standpoint, extraordinarily interesting and of great value, but in its practical aspect, of less importance than that which has now to follow, namely, the analysis of the transference.