BettyJoseph,born March 7 1917, died April 4 2013.
Psychoanalystandformer chair of the Melanie Klein Trust, she explored how patientsdevelopdefence systems to resist change that threatens them with anxiety.
Shewasparticularly skilled in following the projections in the analyticsession,where they have a powerful impact on the analyst, who may find herselfevadingher own difficult and sometimes frightening thoughts and feelings,without alwaysbeing fully aware of what is happening. She believed that theexploration andinterpretation of these processes offered the most effective wayof bringingabout lasting psychic change. Working in this detailed way on whatis immediatein the interaction between the patient and analyst requires adegree of courageand the capacity in the analyst to tolerate anxiety, doubt anduncertainty.
Shebelievedthat only by paying the most rigorous attention to what the patient isnot onlysaying but doing in the analytic session, together with the analyst’sown countertransference, can psychic reality emerge. This task isenormouslydifficult because of the way the patient’s structure and defenses will pull theanalyst back to something which ismore bearable, because psychic change andnew insight always causes disturbanceand creates a strong tendency to returnto the old equilibrium.
Astartingpoint for good technique demands of the analyst absolute personalhonesty, notonly because analysts want to believe that they are doing well andmay betempted to accept their patients’ reassuring agreement with theirinterpretations, but because of the waythey are influenced by powerful andpartly unconscious pressures by the patientto fit in with them in order tomaintain the status quo. This countertransferenceneeds to be rigorouslyscrutinised, however uncomfortable this may be.
(1985). International Journal of Psycho-Analysis, 66:447-454
Transference: The TotalSituation
Betty Joseph
Myintention in this paper is to discuss how we are using the concept of transference in our clinical work today. My stresswill be on the idea of transference asa framework, in which something is alwaysgoing on, where there is alwaysmovement and activity.
Freud'sideas developed from seeing transference as an obstacle, to seeing it as anessentialtool of the analytic process,observing how the patient's relationships to their original objects weretransferred, with all their richness, to the person of the analyst.Strachey (1934), using Melanie Klein'sdiscoveries on the way in which projection and introjection colour and build upthe individual's inner objects, showed that what is being transferred is not primarily the external objects of the child's past, but the internal objects, and that the way that these objects areconstructed help us to understand how the analytic process can producechange.
MelanieKlein, through her continued work on early object relationships and earlymental mechanisms, perhaps particularly projective identification, extended our understanding of the nature of transference and theprocess of transferring. In her (1952) paper 'The origins of transference'she wrote: 'It is my experience that in unravellingthe details of the transference itis essential to think in terms of totalsituations transferred from the past into the present as wellas emotion defences and object relations'. She went on to describe how for manyyears transference had been understood in terms of direct references to theanalyst, and how only later had it been realized that, for example, such thingsas reports about everyday life, etc. gave a clue to the unconscious anxietiesstirred up in the transference situation. It seems to me that the notion of total situations is fundamental to our understandingand our use of the transference today, and it is this I want to explore further. By definition it must includeeverything that the patient brings into the relationship. What he brings in canbest be gauged by our focusing our attention on what is going on within therelationship, how he is using the analyst, alongside and beyond what he issaying. Much of our understanding of the transference comes through ourunderstanding of how our patients acton us to feel things for manyvaried reasons; how they try to drawus into their defensive systems; how they unconsciously act out with us in the transference, trying to get us to act out with them; how they convey aspects of their inner world built up from infancy—elaborated in childhood and adulthood,experiences often beyond the use ofwords, which we can often only capturethrough the feelings aroused in us, throughour countertransference, used in the broad sense of the word.
Countertransference,the feelings aroused in the analyst, like transference itself, was originallyseen as an obstacle to the analytic work, but now, used inthis broader sense, we would see it, too, no longer as an obstacle, but as an essential tool of the analytic process. Further, thenotion of our being used and of something constantly going on, if onlywe can become aware of it, opens up many other aspects of transference, which Ishall want to discuss later. For example, that movement and change is an essentialaspect of transference—so thatno interpretation can be seen as a pure interpretationor explanation but must resonate in the patient in a way which is specific tohim and his way of functioning; that thelevel at which a patient is functioning atany given moment and the natureof his anxieties can best begauged by trying to be aware ofhow the transference is actively being used; that shifts that become visible in thetransference are an essential part of what should eventually lead to real psychic change. Such points emerge more clearly if we arethinking in terms of total situations being transferred.
I want to exemplify this by bringing a short piece ofmaterial in which we can see how thepatient's immediate anxieties and the nature of her relationship with herinternal figuresemerge in the whole situation lived out in the transference,although individual associations and references to many people came up in thematerial as if asking to be interpreted. This material comes from thediscussion of a case at a recent post-graduateseminar of mine. The analyst brought materialfrom a patient who seemed very difficultto help adequately: schizoid, angry, an unhappy childhood with probablyemotionally unavailable parents. The analyst was dissatisfied with the work ofa particular session which she brought, and with its results. The patient hadbrought details of individual people and situations.
Theseminar felt that many of the interpretations about this were sensitive and seemed very adequate. Then the seminarstarted to work very hard tounderstand more. Different points of view about various aspects were putforward, but no one felt quitehappy about their own or other people's ideas. Slowly it dawned on us thatprobably this was the clue, thatour problem in the seminar was reflecting the analyst's problemin the transference, and thatwhat was probably going on in the transference was a projection of the patient's inner world, in which she,the patient, could not understand and, more, could not make sense of what was going on. She wasdemonstrating what it felt like to have amother who could not tune intothe child and, we suspected, couldnot make sense of the child's feelings either,but behaved as if she could, aswe, the seminar, were doing. Sothe patient had developed defences in which she argued or put forward apparentlylogical ideas, which really satisfied no one, but which silenced the experience ofincomprehensibilityand gave her something to hold on to. If the analyst actuallystruggles in such situationsto give detailed interpretations of the meaning of individualassociations, then she isliving out the patient's own defensive system, makingpseudo-sense of the incomprehensible, rather then trying to make contact with the patient's experience of living in an incomprehensible world. The latter can be a very disturbing experience for the analyst, too. It is more comfortable to believe that oneunderstands 'material' than to live out the role of a mother whocannot understand theinfant/patient.
I thinkthat the clue to the transference here (assuming that what I amdescribing is correct) lay in our taking seriously the striking phenomenon in the seminar, ofour struggling to understand and our desperate need to understand instead ofg etting stuck on the individual associations brought up by the patient, whichin themselves would appear to make a lot of possible sense. This we got more through ourcountertransference of needing toguess, feeling pressurized to understand at all costs, which enabled us, wethought, to sense a projectiveidentification of a part of the patient's inner world and the distress, ofwhich we got a taste in the seminar.
I amassuming that this type of projective identification is deeply unconscious and notverbalized. If we work only withthe part that is verbalized, we do not really take into account the objectrelationships being acted out in the transference; here, for example, the relationship between theuncomprehending mother and the infant who feels unable to be understood, and itis this that forms the bedrock ofher personality. If we do not get through to this, we shall, I suspect, achieveareas of understanding, even apparent shifts in the material, but real psychic change, which can lastbeyond the treatment will, I think, not be possible. I suspect that what hashappened in such cases is that somethinghas gone seriously wrong in thepatient's very early relationships, but that on top of this has been built up a character structure ofapparent or pseudo-normality, so that the patient has been able to get intoadulthood without actually breaking down and apparently functioning more orless well in many areas of her life. Interpretationsdealing only with the individual associations would touch only the more adultpart of the personality, while the part that is really needing to be understoodis communicated through the pressures brought on the analyst. We can sense herethe living out in thetransference of something of the nature of the patient's early objectrelationships, her defensiveorganization, and her method ofcommunicating her whole conflict.
I wantnow to continue this point by bringing materialfrom a patient of my own, to show first how the transference was beingexperienced in a partially idealized way conveyed through the atmosphere thathe built up, and linked with his own history. Then how, when this broke down,primitive aspects of his earlyobject relationships and defences emerged and were lived out in thetransference and he attempted to draw the analyst into the acting out. Then howwork on this led to more movement and some temporary change in his internalobjects.
Thispatient, whom I shall call N, hadbeen in analysis many years and had made some very satisfactory progress, which was,however, never adequatelyconsolidated, and one could neverquite see the working through of any particular problem, let alone visualizethe termination of treatment. Inoticed a vaguely comfortablefeeling, as if I quite likedthispatient's sessions and as if I found them rather gratifying, despite the fact I alwayshad to work very hard with him.When I started to rethink my countertransference and his material, I realized that my rather gratified experience must correspond to an inner conviction on the patient's part that
I want tomake a further brief point about this material, concerning the nature of interpretation. If one seestransference and interpretations as basically living, experiencing and shifting—as movement—then our interpretations haveto express this. N's insight into his unconsciousconviction of his special place, of the vague unreality of much of our work, ofmy attachment to him and so on, emerged painfully. It would have been more comfortable tolink this quickly with his history—the youngest child, the favourite of his mother, who had a very unhappyrelationship with his father, a rather cruel man, though the parents remainedtogether throughout their lives. Buthad I done this, it would have played into my patient's conviction again thatinterpretations were 'only interpretations'and that I did not really believewhat I was saying. To my mind theimportant thing was first to get the underlying assumptions into the open, sothat, however painful, they could be experienced in the transference as hispsychic reality, and only laterand slowly to link them up with his history. We shall need to return to theissue of linking with history later.
I shallnow bring further material from N from a period soon after the time I have justdiscussed, to show how when theomnipotent, special place fantasies were no longer dominating the transference,early anxieties and, as I said, the living out of further psychic conflict cameinto the transference, emerged in a dream, and how the stuff of the dream waslived out in the transference. At this period, N, despite insight, was stillliable to get caught up into a kind of passive despairing masochism. On aMonday he brought the following dream. (I am only giving the dream and myunderstanding of it, not the whole session nor his associations.)
The dreamwas:
there wasa kind of war going on. My patient was attending a meeting in a room at theseaside. People were sitting round a table when they heard a helicopter outsideand knew from the sound that there was something wrong with it. My patient anda major left the table where the meeting was going on and went to the window tolook out. The helicopter was in trouble and the pilot had baled out in aparachute. There were two planes, as if watching over the helicopter, but sohigh up that they looked extremely small and unable to do anything to help. Thepilot fell into the water, my patient was wondering whether he would have timeto inflate his suit, was he already dead, and so on.
I am notgiving the material on which I based my interpretations, but broadly I showedhim how we could see the war thatis constantly raging between the patient and myself, which is shown by the wayin which he tends to turn his back, in the dream, on the meeting going on at the table, onthe work going on from session to session here. When he does look out knowingthat something is wrong (as withthe helicopter) he sees that there is an analyst, myself, the two planes, thetwo arms, the breasts, watchingover to try to help him, but he is absorbed watching the other aspect, that isthe part of himself, the pilot, that is in trouble, is falling out, dying—which is the fascinatingworld of his masochism. Here I mean that he shows his preference for getting absorbed intosituations of painful collapse rather than turning to and enjoying help andprogress.
At thetime, he seemed, as the session went on, to get well into touch with theseinterpretations, and to feel the importance of this fascination with hismasochism. On the following day he came, saying that he had felt disturbedafter the session and the work on the dream. He spoke in various ways about thesession and his concern about the fight, how he felt awful, that whatever goeson in the analysis he seemed somehow to get caught up in this rejection andfight; he went on to speak about his awareness of the importance of theexcitement when he gets involved in this way. And then he talked about variousthings that had happened during the day. This sounded like insight, almostconcern. In a way it was insight, but I had the impression from the tone of hisvoice,speaking in a flat, almost boring, way, that all that he was saying wasnow second-hand, almost as if theapparent insight was being used against progress in the session, as if aparticular silent kind of war against me was going on, which I showed him. My patient replied in agloomy voice: 'There seems to be nopart of me that really wants to work, to co-operate' and so on … I heard myself starting to showhim that this could not be quite true, since he actually comes to analysis—and then realized, of course, that I was acting asa positive part of himself, as if the part that was capable of knowingand working had been projected into me andso I was trapped into either living out this positive part, so thathe was not responsible for it, or for the recognition of it, or I had to agree that there was no part of himthat really wanted to co-operate, etc. So either way there was no way out.
My patient saw this,said he could do nothing aboutit, he quite understood, but he felt depressed, he could see what I meant … More and more the sessionbecame locked in the notion ofhis understanding but not being able to do anything about or with it. (Thispicture is, I think, in part what the previous day's dream was describing whenhe becamefascinated watching the pilot about to drown, and I myself, as theplane high up, was unable to help, and hewas now fascinated with his own words like 'I understand, but it cannot help'. The dream is now lived out in thetransference.)
I showed him that hewas actively trapping me, by this kind of remark—which was in itself a demonstration of the war going on between us. After somemore going to and fro about this, my patient remembered for 'no apparent reason', as he putit, a memory about a cigarettebox; how when he was at boardingschool and very miserable, he would take a tin, or a cardboard box, and coverit extremely carefully with canvas. Then he would dig out the pages of a bookand hide his cigarette box inside the cover. He would then go into the countrysidealone, sit, for example, behind an elder bush and smoke; this was the beginningof his smoking. He was lonely, it was very vivid. He subsequently added thatthere seemed to be no real pleasure in the cigarettes.
I showed him that Ithought the difficulty lay in his response to my showing him about how he wastrapping me with the remarks such as 'there seems to be no part of me thatwants to co-operate', etc. He realized that he felt some kind of excitement in thefight and the trapping, but that whatwas really significant was that thisexcitement had very much lessened duringthe last sessions and indeed the last year; he was much less addicted to itnow, but could not give it up, itwould mean giving in to theelders, myself (the reference to sitting behind the elder bush), but he was not really getting muchpleasure from the smoking, which, however, he silently, secretly, had to do.The problem now, therefore, in the transference, was not so much that he gotsuch pleasure from the excitement, theproblem lay in the recognition and the acknowledgement of his improvement,which would also mean his being willing to give up some of the pleasure indefeating me. He was willing to talkabout bad things about himself, sadism or excitement, you will remember, at thebeginning of the session, but nothis improvement, and he was notyet willing to give in on this point and enjoy feeling better (in terms of yesterday's dream to acknowledge and use the helping hands,the planes).
Mypatient tended to agree with this and then said that things had changedin the last bit of the session, he realized his mood had altered, the locked and blocked sense had gone, nowhe felt sadness, perhaps resentment, as if I, the analyst, hadnot given sufficient attention to the actual memory of the cigarette boxincident, which seemed to him vivid and important, as if I had gone away fromit too quickly. I went back to the cigarette box memory, and had a look at hisfeelings that I had missed something of its importance; I also reminded him of the stress he had put on hisexcitement while I felt that a lot of pleasure had really gone out of this now,as in the non-pleasure in the smoking. But I alsoshowed him hisresentment at the fact that his feelings had shifted, he had lost theuncomfortable blocked mood.
N agreed,but said: 'Still I think you have gone toofast'. He could accept that partof the resentment might be connected with the shift that the analysis hadenabled him to make—to undothe blocked feeling—but 'toofast' he explained was as if I, the analyst, had become a kind of Pied Piperand he had allowed himself to bepulled along with me.
I pointed out that itsounded as if he felt that I hadnot really analysed his problem about being stuck, but had pulled and seduced him out of hisposition. It was my initiative that had pulled him out, as he felt seduced by his mother as a child.(You will remember the earlier material in which he was convinced I and his mother had aspecial feeling for him.) He quickly, very quickly, added that there was alsothe other fear at that moment, the fear of getting caught up into excited warm feelings,like the feeling he used to call puppyish.
I now showed my patientthat these two anxieties, that ofmy seducing him out of hisprevious state of mind and hisfear of his own positive,excited, infantile or puppyish feelings, might both need further consideration—both were old anxieties that had come up before as important—but I thought they were being used at that moment so that he could project them into me in order not to have to contain and experience andexpress the actual good feelingsand particularly the warmth and gratitude whichhad been emerging in the latter part of the session (and was linked, I believe,with the awareness in the dream of a helpful quality in the planes overhead).At this point, very near the end of the session, my patient agreed with me andwent off, clearly rather moved.
I ambringing this apparently rather straightforward material to stress a number ofpoints that I find of interest in theuse of the transference. First, the way in which a dream can reveal its meaning in a fairly precise way by being lived out in the session, where we can see the patient's specific and willing involvementwith misery and problems rather than meeting up with his helpful and livelyobjects, the planes, which are minimized, small. The analysis, interpretations,breasts are turned away from, when they are recognized as nourishing andhelpful. The helpfulness isrecognized specifically, but old problems are mobilized against it—called excitement, badness, non-cooperation. Positive aspects of thepersonality are seen, but his owncapacity to move warmly towards an object is quickly distorted and projectedinto me, it is I who pull and seduce. But the whole thing is cleverly hidden,like the cigarette box in the book (probably bookish old interpretations, nowno longer so meaningful). But hereally knows that he doesn't get pleasure from the activity. We have here thespecific meaning of the symbols and we can locate them in the transference. Thepatient gets insight, I believe, into what is almost a choice betweenmoving towards ahelpful object or indulging in despair—his defences are mobilized and he goes the latter way and tries to draw theanalyst into criticizing and reproaching—into his masochisticdefensive organization. Then followed further work and we can see thatthesedefences lessen until he can actually acknowledge relief and warmth. Further, ashe can acknowledge a helpful object, he can relate to it and internalize it,which leads to further internal shifts.
I thinkin addition we can see here howthe transference is full of meaning and history—the story of how the patient turnsaway, and I suspect always has done, fromhis good feeding objects. We can get an indication of one way in which, by projecting his loving into hismother and twisting it, he has helped to consolidate the picture of her as soseductive, an anxiety which still to some extentpersists about women. Of course we can add that she well may have been aseductive woman towards her youngest son, but we can see how this has been usedby him. The question of when and whether to interpret these matters is atechnical one that I can only touch on here. Mystress throughout this contribution has been on the transference as arelationship in which something is all the time going on, but we know that thissomething is essentially based onthe patient's past and the relationship with his internal objects or his belief about them and what theywere like.
I thinkthat we need to make links forour patients from the transference to the past in order to help to build a sense oftheir own continuity andindividuality, to achieve somedetachment, and thus to help to free them from their earlier and more distorted senseof the past. About these issues many problems arise, theoretical and technical.For example, is a patient capable of discovering in the transference an objectwith good qualities if he had never experienced this in his infancy? About thisI am doubtful; I suspect that, if the patient has met up with no object in hisinfancy on whom he can place some, however little, love and trust, he will notcome to us in analysis. He will pursue a psychotic path alone. But what we cando, by tracing the movement andconflict within the transference, is bringalive again feelings within arelationship that have been deeply defendedagainstor only fleetinglyexperienced, and we enable themto get firmer roots in the transference. We are not completely new objects,but, I think, greatly strengthenedobjects, becausestronger and deeper emotions have been worked through in the transference. This typeof movement I have tried to demonstrate in N, whose warmth and valuing have, over time, apparently come alive, but I am convinced thatthey were weakly there before, but much wardedoff. Now, I think, the emotionshave been freed and have been strengthened, and the picture of his objects has shifted accordingly.
There isalso the issue as to when and howit is useful to interpret the relation to the past, to reconstruct. I feel that it is important not to make theselinks if the linking disrupts what is going on in the session and leads to akind of explanatory discussion or exercise, but rather to wait until the heat is no longer on and thepatient has sufficient contact with himself and the situation to want tounderstand and to help to make links. Even this, of course, can be used in a defensive way. These, however,are technical issues which do not really belong to this contribution.
I wantnow to return to a point that I mentioned earlier on, when I spoke ofthetransference as being theplace where we can see not onlythe nature of the defencesbeing used, but the levelof psychic organization withinwhich the patient is operating. To demonstrate this, I shall bring a fragmentof material from a patient whom I shall call C,who is a somewhat obsessionalpersonality, with severe limitations in his life, the extent of which he hadnot realized until he started treatment. I began to gain the impressionthatbeneath the obsessional structure, controlling, superior and rigid, therewas a basicallyphobic organization. I shall try to reduce the piece of materialthat I am bringing to its bare bones.
C hadasked during the week to come a quarter of an hour earlier on the Friday, myfirst session in the day, in order to catch a train, as he had to go to Manchester for work. Then he described in greatand obsessional detail on the Friday his worries about catching the train,getting through the traffic, etc., and how he had safeguarded these problems.He also discussed an anxiety about losing his membership in a club because ofnon-attendance, and spoke about a friend being slightly unfriendly on thephone. Detailed interpretationsabout his feeling unwanted relatedto the weekend, feeling shut out, and a need not to go away but rather to remain here or shut inside, did not seem to make real contact or tohelp him. But in relation to my showing him his need to be inside and safe hestarted to talk, now in a very different and smooth way, about how similar thisproblem was to his difficulty in changing jobs, moving his office, getting newclothes, how he stuck to the old ones, although by now he was short of clothes.Then there was the same problem about changing cars …
At thispoint I think that an interesting thing had occurred. While all that he wassaying seemed accurate and important in itself, the thoughts were no longer being thought, they hadbecome words, concrete analyticobjects into which he could sink, get drawn in, as if they were the mentalconcomitant of a physical body into whichhe was withdrawing in the session. Thequestion of separating off, mentally as physically, could be evaded since ourideas could now be experienced as completely intune and he had withdrawninto them. When I pointed this out to C, he was shocked, saying: 'Whenyou said that,Manchester cameinto my mind, it was like sticking a knife into me'. I thought that the knifethat goes in was not just my pushing reality back into his mind, but a knifethat goes in between himself and me, separatingus off and making him aware ofbeing different and outside, and this aroused immediateanxiety
I bringthis material to show how theinterpretations about hisobsessional control and his reassuring himself and me, then the interpretationsabout his needing to avoid separation, new things, etc. and to be inside, were not experienced as helpfulexplanations, but were used asconcrete objects, as parts of myself that he could get inside defensively, warding off psychotic anxieties of amore agoraphobic type associated with separation. Thus the two levels of operating—obsessional defending against phobic—could be seen to be lived outin the transference, and when thedeeper layer was tackled, when I showed him the smooth defensive use of mywords, my interpretations were felt as knife-like, and the anxieties re-emergedin the transference. In one sense this material is comparable with the case wediscussed in the seminar. In such situations, ifinterpretations and understanding remain on the level of the individualassociations, as contrasted with the total situation and the way that theanalyst and his words are used, we shall find that we are being drawn into apseudo-mature or more neurotic organization and missing the more psychoticanxieties and defences, which manifest themselves once we take into account thetotal situation—which isbeing acted out in the transference.
In thispaper, I am concentrating on whatis being lived in the transference andin this last example, as at the beginning, I tried to show how interpretationsare rarely heard purely as interpretations, except when the patient is near tothe depressive position. Then interpretations and the transference itselfbecomes more realistic and less loaded with fantasy meaning. Patients operating with more primitivedefences of splitting and projective identification tend to 'hear' ourinterpretations or 'use' them differently andhow they 'use' or 'hear' and the difference between these two concepts needs tobe distinguished if we are to clarify the transference situation and the stateof the patient's ego and the correctness or not of his perceptions. Sometimesour patients hear our interpretations in a more paranoid way, for example, as acriticism or as an attack. C, after getting absorbed in my thoughts, heard myinterpretations about Manchester as a knife that cut into him—between us. Sometimes the situation looks similar, the patient seems disturbed by aninterpretation, but has, in fact, heard it, understood it, correctly, butunconsciously used it in an active way, thus involving the analyst.
N, Ibelieve, did not hear my interpretations about his dream of the helicopter ascruel or harsh, but he unconsciously used them to reproach, beat and tormenthimself masochistically, thus in his fantasy using me as the beater. Or, toreturn to C: having heard certain of my interpretations and their meaningcorrectly, he used the words and thoughts not to think with, but unconsciouslyto act with, to get into and try to involve me in this activity, spinning wordsbut not really communicating with them. Such activities not only colour butstructure the transference situation and have important implications fortechnique.
SUMMARY
I havetried in this paper to discuss how I think we are tending to use the concept oftransference today. I have stressed the importance of seeing transference as aliving relationship in which there is constant movement and change. I haveindicated how everything of importance in the patient's psychic organizationbased on his early and habitual ways of functioning, his fantasies, impulses,defences and conflicts, will be lived out in some way in the transference. Inaddition, everything that the analyst is or says is likely to be responded toaccording to the patient's own psychic make-up, rather than the analyst'sintentions and the meaning he gives to his interpretations. I have thus triedto discuss how the way in which our patients communicate their problems to usis frequently beyond their individual associationsand beyond their words, and can often only be gauged by means of thecountertransference. These are some of the points that I think we need toconsider under the rubric of the total situations which are transferred fromthe past.
REFERENCES
KLEIN, M.1952 The origins of transference In The Writings of Melanie Klein, Vol. 3London: Hogarth Press, 1975 pp. 48-56
STRACHEY,J. 1934 The nature of the therapeutic action of psychoanalysis Int.J. Psychoanal. 50:275-292 [→]
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