Hamlet 5.2.220-221

If it be now, 'tis not to come ... 

if it be not now, yet it will come.

The readiness is all ....

One of the best day's work Freud ever did was to observe that we repeat the past in order not to remember it. In 1914 in Remembering, Repeating and Working Through he described a special class of early childhood experiences for which no memory can be recovered. These experiences are reproduced not as memory but as action. A "repetition compulsion" results when a person acts out the past while in the grip of this defensive amnesia. Repetition is a way of remembering.

If the forgotten past is acted out with another person as object, this Freud called "transference." If the other is a psychoanalyst and the acting out is systematic, then this is a "transference neurosis." But in analysis that's not such a bad thing: the lost memory of these defended-against, hidden events lose their power to cause the patient's compulsions when psychoanalysis "... succeed[s] in giving all the symptoms of the illness a new transference meaning and in replacing his ordinary neurosis with a 'transference neurosis' ...." (p 154)

What is "transferred" is the past onto the present, as if with a "stereotype plate" -- sexual and aggressive drives and impulses. Also transferred are defenses which grew up to protect the fragile ego from primitive desires. It is this transfer that gives rise to "transference resistance," which is somewhat redundant since transference typically has defensive functions. Freud saw resistance and at first sought to minimize it -- but he came to recognize that it was not so much a problem in impeding free association as it was a clue to what had happened to the patient. Most important, the explication of the transference is key to unlocking the neurotic shackles of the past. While in everyday life transference is ubiquitous and often gives rise to repetitions, during analysis the repetition comes to center around the analyst. "In place of the patient's true illness there appears the artificially constructed transference illness...." For Freud, this transference neurosis is a specific product of the analytic setting.

[T]he whole of his illness's new production is concentrated on a single point -- his relation to the doctor.... When the transference has risen to this significance, work upon the patient's memories retreats far into the background. Thereafter it is not incorrect to say that we are no longer concerned with the patient's earlier illness but with a newly created and transformed neurosis...[in which all] the patient's symptoms have abandoned their original meaning and have taken on a new sense which lies in a relation to the transference.... (Introductory Lectures, SE 1917 p 444)

 Evolution of the concept: Transference Neurosis

Inconsistent terminology, imprecise labels, translation errors, different patient populations -- all these make the literature a collapsed Tower of Babel where analysts speak different languages and imagine they're understood. There are numerous clinical situations in which a transference neurosis does not develop. There are other clinical situations where the transference neurosis is stunted or unrecognized by the analyst. There may be patients who are too healthy to develop a transference neurosis, and there clearly are patients too ill to develop classical transferences.

Also there are political rivalries, for instance, about the difference between psychoanalysis and psychotherapy. Some attempts to differentiate psychoanalysis from psychotherapy hinge on differences in the way the transference neurosis is permitted to unfold (in analysis by avoiding "premature interpretation" in order to let it 'flower' to its 'full blown' state, as the saying goes).

Some irony can be read between the lines. "The transference has become a sort of projective device, a vessel into which each commentator pours the essence of his or her approach to the clinical situation and to the understanding of ... the analytic situation." (p2) The concept has been distorted by a type of transference itself. There is confusion even on grammar. What is the difference between a transference and the transference -- at least as reflected in actual clinical practice? It may be a useless distinction between two muddy concepts. On the other hand, it may be hasty to discard the concept of the "transference neurosis" altogether because, clearly, there is a place for an analogous concept: the transference psychosis.