Looking for Ground: Countertransference and the Problem of Value (Book Review)

Author:  Carnochan, Peter
Publisher: Analytic Press, 2001
Reviewed By: Geneva Reynaga, Fall 2003, pp. 29-30

Perhaps one of the most relevant controversies facing psychoanalysis is the issue of countertransference. Although there are many schools of thought regarding its value, utilization, and conceptualization, there are few works that thoroughly examine its history and theoretical development. Looking for Ground: Countertransference and the Problem of Value in Psychoanalysis is an important book, not only because it provides a thorough history of countertransference, but also because it allows the reader to decide for him/herself their position regarding its value. Although the author is clearly advocating the active utilization of countertransference in psychoanalysis, he successfully provides a critical overview that provides ample space for the reader to choose his/her own course of action (or inaction). This review considers Carnochan’s description of Freud’s position on countertransference, followed by shifts in psychoanalytic thought regarding the use of countertransference, and the various ways in which we may effectively and appropriately utilize countertransference in the analytic setting.

Freud admonished the use of countertransference because he believed it interfered with the analyst’s clarity. However, he never gave clear criteria for recognizing and/or mitigating against it. Carnochan begins the book with an overview of the inherent positivism in Freud’s work. This helps us understand the traditional proscriptions against the countertransference because, “By eliminating the countertransference, Freud hoped both to secure the analytic method on a foundation of reason rather than emotion and to assist the analysand in the difficult path away from fantasy toward a clarity of perception that would allow a marriage with the real” (p. 8). However, although positivism hopes to transcend opinion on its way to objectivity, we now know that objectivity can never be achieved.

Carnochan states that analysts always participate in the analytic dyad, as even remaining silent is to be active! Therefore, “objectivism is an unworkable epistemology for psychoanalytic practice” (p. 15). This has become increasingly clear as many theories propose that relationships are the principal motivators in human beings. In this way, countertransference becomes an ally, or an additional medium through which we may know our patients. It must remain clear, however, that to think relationally requires analysts to relinquish claims of absolute knowledge of another.

When we begin to understand that therapeutic action depends on a tangible connection between the analyst and the analysand, countertransference becomes an important source of the analyst’s affective participation. The utilization of the countertransference becomes an important model for the analysand, whose goal is to experience a wide range of emotions with freedom. The author argues that it is impossible for the analyst to treat the patient successfully if they are unwilling to utilize countertransference: “…the countertransference offers a kind of proof to the analysand that the relationship matters to the analyst. For the analytic relationship to become a transformative experience, a place where the unimagined becomes actual, the analyst must be willing to bring emotion forward. Only in this way can the analysand’s limiting beliefs about relationship be challenged” (p. 28). In other words, the analyst must be willing to take the same risks as the analysand in acknowledging their emotions.

It must remain clear that to actively utilize the countertransference does not mean to become undisciplined. One must remain patient with the feelings arising in the countertransference, contain it, and separate it from its underlying emotion before “acting” on it. This will allow the analyst to remain genuinely connected to the patient. Carnochan argues that if we do not acknowledge the countertransference, we run the risk that it will be repressed, which will eventually prevent us from accessing all potentially available information regarding our patients.

Carnochan then examines countertransference throughout the history of psychoanalysis. In the days of Freud, in which strong proscriptions against countertransference existed, Ferenczi began looking at countertransference in radical experiments on the limits of the analytic relationship. He eventually came to believe that in order for “cure” to occur, warmth and responsiveness were necessary. One may infer that this required the acknowledgement and use of countertransference, although Ferenczi undoubtedly engaged in behavior some may now consider breaking the analytic frame. Nevertheless, this information helps us understand that controversy has surrounded the issue of countertransference since the early days of psychoanalysis.

The author provides a sound overview of various theories and their conceptualization of countertransference, including ego psychology, Klein, Winnicott, and the interpersonalists. We have already discussed Freud’s proscriptions against the countertransference. Ego psychology similarly speaks against it, characterizing it as a distorter of the analyst’s behavior and perception. Klein sees countertransference as diagnostic in object relations but argues that it must be contained in order to prevent further damage to the analyst’s ability to perceive reality. Winnicott said that countertransference can serve as a way of knowing the patient and is not particularly threatening because human activity is relational. The interpersonalists are the most active with countertransference and believe it forms a part of our empathic knowing of the patient. Carnochan provides detailed passages that further explain these ideas, which are helpful in providing a well-rounded theoretical understanding of countertransference. It is also advantageous to understand countertransference from traditions that may differ from our primary orientation, as it helps inform us of other ways in which countertransference may be conceptualized. Although the field has not reached a unanimous decision regarding utilization of the countertransference, there is an increasingly popular trend to consider its applicability in treatment.

Carnochan makes it clear that the conceptualization and utilization of countertransference is undoubtedly influenced by the analyst’s theoretical beliefs. We must be clear not only in what to do with countertransference, but also in what type of countertransference we strive for, as there are many potential ways of understanding this aspect of the analytic situation. The author suggests that countertransference can be used as a source of further discovery and that disclosing it does not entail abandoning the analytic method. However, we must be cautious in disclosure of the countertransference, as we can easily move from silence to self-disclosure, but less easily from self-disclosure to silence. As the author makes clear, “…I believe that speaking about the countertransference, at some point in the process, is an essential part of an analysis. To avoid this type of speech is to preserve a division between the analyst and analysand that prevents the analysand from becoming a full epistemological peer. Through a willingness to explore the analysand’s perception of our countertransference and a willingness at times to speak of our affectivity, we offer assistance to the analysand in learning how to make use of his own affectivity as part of his ability to know” (p. 290). We must never fail to consider if our understanding of the countertransference helps us move toward understanding the analysand.

Affect is inherently important in the move toward accepting the role of countertransference in psychoanalysis. Although the field is not unified in its account of affect, there are many who argue it is critical for understanding the patient. Without acknowledging affect, the author warns, we may only superficially understand the analysand. Carnochan declares that psychoanalysis must specify the parameters for affective engagement, making sure to include countertransference. He states that, “for analysis to remain vibrant and coherent we must be willing to risk speaking and acting from the countertransference” (p. 390).

We have seen from this modest review that Carnochan provides a thorough historical account of the countertransference. It is clear that the field is not unified on its position of the value or utilization of countertransference, but it is becoming increasingly commonplace to consider its utility in treatment. Although the author is clearly advocating the thoughtful use and consideration of countertransference in analysis, he does so from a grounded understanding of past and present theoretical positions within the field. The work serves as a solid text by which we may gain perspective on the controversial nature of countertransference, allowing us to understand the multitude of issues involved in order to make a grounded decision regarding its utility.

Reviewer Note

Geneva S. Reynaga is a pre-doctoral intern at the Department of Mental Health located at the Correctional Medical Facility in Vacaville, CA. She is a doctoral candidate at Pepperdine University. Interests include neuropsychological assessment, psychoanalysis, and ethnic minority issues.

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