The Collected Works of Sigmund Freud. Sigmund Freud
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the new psychological facts which are so hotly contested by the healthy persons in the world outside. An objective improvement in the condition of the patient, universally admitted, goes hand in hand with this harmonious relation of the physician to the patient under analysis.
But we cannot always expect to have fair weather. There comes a day when the storm breaks. Difficulties turn up in the treatment. The patient asserts that he can think of nothing more. We are under the impression that he is no longer interested in the work, that he lightly passes over the injunction that, heedless of any critical impulse, he must say everything that comes to his mind. He behaves as though he were not under treatment, as though he had closed no agreement with the physician; he is clearly obsessed by something he does not wish to divulge. This is a situation which endangers the success of the treatment. We are distinctly confronted with a tremendous resistance. What can have happened?
Provided we are able once more to clarify the situation, we recognize the cause of the disturbance to have been intense affectionate emotions, which the patient has transferred to the physician. This is certainly not justified either by the behavior of the physician or by the relations the treatment has created. The way in which this affection is manifested and the goals it strives for will depend on the personal affiliations of the two parties involved. When we have here a young girl and a man who is still young we receive the impression of normal love. We find it quite natural that a girl should fall in love with a man with whom she is alone a great deal, with whom she discusses intimate matters, who appears to her in the advantageous light of a beneficent adviser. In this we probably overlook the fact that in a neurotic girl we should rather presuppose a derangement in her capacity to love. The more the personal relations of physician and patient diverge from this hypothetical case, the more are we puzzled to find the same emotional relation over and over again. We can understand that a young woman, unhappy in her marriage, develops a serious passion for her physician, who is still free; that she is ready to seek divorce in order to belong to him, or even does not hesitate to enter into a secret love affair, in case the conventional obstacles loom too large. Similar things are known to occur outside of psychoanalysis. Under these circumstances, however, we are surprised to hear women and girls make remarks that reveal a certain attitude toward the problems of the cure. They always knew that love alone could cure them, and from the very beginning of their treatment they anticipated that this relationship would yield them what life had denied. This hope alone has spurred them on to exert themselves during the treatments, to overcome all the difficulties in communicating their disclosures. We add on our own account —“and to understand so easily everything that is generally most difficult to believe.” But we are amazed by such a confession; it upsets our calculations completely. Can it be that we have omitted the most important factor from our hypothesis?
And really, the more experience we gain, the less we can deny this correction, which shames our knowledge. The first few times we could still believe that the analytic cure had met with an accidental interruption, not inherent to its purpose. But when this affectionate relation between physician and patient occurs regularly in every new case, under the most unfavorable conditions and even under grotesque circumstances; when it occurs in the case of the elderly woman, and is directed toward the grey-beard, or to one in whom, according to our judgment, no seductive attractions exist, we must abandon the idea of an accidental interruption, and realize that we are dealing with a phenomenon which is closely interwoven with the nature of the illness.
The new fact which we recognize unwillingly is termed transference. We mean a transference of emotions to the person of the physician, because we do not believe that the situation of the cure justifies the genesis of such feelings. We rather surmise that this readiness toward emotion originated elsewhere, that it was prepared within the patient, and that the opportunity given by analytic treatment caused it to be transferred to the person of the physician. Transference may occur as a stormy demand for love or in a more moderate form; in place of the desire to be his mistress, the young girl may wish to be adopted as the favored daughter of the old man, the libidinous desire may be toned down to a proposal of inseparable but ideal and platonic friendship. Some women understand how to sublimate the transference, how to modify it until it attains a kind of fitness for existence; others manifest it in its original, crude and generally impossible form. But fundamentally it is always the same and can never conceal that its origin is derived from the same source.
Before we ask ourselves how we can accommodate this new fact, we must first complete its description. What happens in the case of male patients? Here we might hope to escape the troublesome infusion of sex difference and sex attraction. But the answer is pretty much the same as with women patients. The same relation to the physician, the same over-estimation of his qualities, the same abandon of interest toward his affairs, the same jealousy toward all those who are close to him. The sublimated forms of transference are more frequent in men, the direct sexual demand is rarer to the extent to which manifest homosexuality retreats before the methods by which these instinct components may be utilized. In his male patients more often than in his women patients, the physician observes a manifestation of transference which at first sight seems to contradict everything previously described: a hostile or negative transference.
In the first place, let us realize that the transference occurs in the patient at the very outset of the treatment and is, for a time, the strongest impetus to work. We do not feel it and need not heed it as long as it acts to the advantage of the analysis we are working out together. When it turns into resistance, however, we must pay attention to it. Then we discover that two contrasting conditions have changed their relation to the treatment. In the first place there is the development of an affectionate inclination, clearly revealing the signs of its origin in sexual desire which becomes so strong as to awaken an inner resistance against it. Secondly, there are the hostile instead of the tender impulses. The hostile feelings generally appear later than the affectionate impulses or succeed them. When they occur simultaneously they exemplify the ambivalence of emotions which exists in most of the intimate relations between all persons. The hostile feelings connote an emotional attachment just as do the affectionate impulses, just as defiance signifies dependence as well as does obedience, although the activities they call out are opposed. We cannot doubt but that the hostile feelings toward the physician deserve the name of transference, since the situation which the treatment creates certainly could not give sufficient cause for their origin. This necessary interpretation of negative transference assures us that we have not mistaken the positive or affectionate emotions that we have similarly named.
The origin of this transference, the difficulties it causes us, the means of overcoming it, the use we finally extract from it — these matters must be dealt with in the technical instruction of psychoanalysis, and can only be touched upon here. It is out of the question to yield to those demands of the patient which take root from the transference, while it would be unkind to reject them brusquely or even indignantly. We overcome transference by proving to the patient that his feelings do not originate in the present situation, and are not intended for the person of the physician, but merely repeat what happened to him at some former time. In this way we force him to transform his repetition into a recollection. And so transference, which whether it be hostile or affectionate, seems in every case to be the greatest menace of the cure, really becomes its most effectual tool, which aids in opening the locked compartments of the psychic life. But I should like to tell you something which will help you to overcome the astonishment you must feel at this unexpected phenomenon. We must not forget that this illness of the patient which we have undertaken to analyze is not consummated or, as it were, congealed; rather it is something that continues its development like a living being. The beginning of the treatment does not end this development. When the cure, however, first has taken possession of the patient, the productivity of the illness in this new phase is concentrated entirely on one aspect: the relation of the patient to the physician. And so transference may be compared to the cambrium layer between the wood and the bark of a tree, from which the formation of new tissues and the growth of the trunk proceed at the same time. When the transference has once attained this significance the work upon the recollections of the patient recedes into the background. At that point it is correct to say that we are no longer concerned with the patient’s former illness, but with a newly created, transformed neurosis, in place of the former. We followed up this new edition of an old condition from the very beginning, we saw it originate and grow;