On practising psychoanalytic psychotherapy in the absense of explicit transference manifestations : A clinical enquiry

The aim of this study involved exploring qualitatively how local therapists practice psychoanalytic psychotherapy in the absence of explicit transference manifestations among the kinds of patients who never make any directly verbal or affectively intense (either positive or negative) references to the figure of the therapist. Close phenomenological analysis of the work of four therapists revealed striking parallels with the work of internationally based psychoanalysts among similar kinds of patients in analysis centering on the role of the countertransference as a key analytic tool in the seeming absence of explicit transference. While the findings of this study also revealed striking divergences from classical analysis and convergences with more contemporary psychoanalytic practice, these all emerged on Winnicottian terrain. The conceptual distinctions between interpreting or working in the transference as transference, interpreting or working in the transference as non-transference and the idea of working with rather than directly in the implicit transference emerged as major findings of this study. HOW transference material is treated and interpreted emerged as playing a key role in understanding how psychoanalytic psychotherapy is practiced among the kinds of patients with whom integrated and intact ego functioning cannot be assumed. The central role of the countertransference when working in the transference as non-transference and interpreting or working with implicit transference material rather than directly in it, emerged as playing a central role not only in doing the kind of work that according to Winnicott involves ‘managing the setting’, but in positioning the therapists to maintain technical neutrality by assuming the very role that involves meeting the patient’s ego needs for symbiosis with interpretations that bring news of sameness. Limitations of this study and implications for further research are discussed