Countertransference and its Influence on Judgements of Fitness for Analysis

Abstract

In responding to an earlier draft of this paper, some colleagues challenged the premise that persons can be meaningfully differentiated into one or another of such personality organizations, raising larger issues concerning the pitfalls of diagnostic labeling.2 Once we pin a label on a person, or accept a label as given—and this can begin, of course, with the label, 'patient'—we may be led easily to think of the person as some-thing-known. And, this may stimulate in our thoughts, a process which begins with depriving the patient of his personhood and ends by negating his therapeutic need to be understood as fully as possible in his own terms. It is, therefore, necessary always to monitor our diagnostic thinking lest we reify our patients or our psychoanalytic constructs. (Feiner 1970), (Schafer 1979) Still, mindful of such cautions, I find the distinction between these two character constellations meaningful, substantively and heuristically. I have found the following to be true, in my own practice, and in an even larger number of cases reported to me in supervision and in case seminars: (1) that there are some patients whose transference patterns in the therapeutic interaction closely correspond to those Kohut has described in connection with the narcissistic personality organization (Kohut 1971), (1978); and (2) that there are other patients whose transference patterns correspond to those described by Kernberg (Kernberg 1975) in connection with the borderline personality organization; and (3) that the therapist's countertransference experience in response to the transference behavior of one or the other type of patient corresponds as well to that which has been described by these writers.3 It is, in fact, the quality of the transference/countertransference matrix which mainly determines whether I think of a patient as having a borderline or a narcissistic character structure or as being in a borderline or narcissistic ego state. I believe these distinctions to be important only in so far as they guide the therapist in his handling of the treatment process. This brings me to a brief discussion of the essential disagreement between Kernberg and Kohut and of some points of disagreement which I have with each. Kernberg disputes Kohut's conception of the narcissistic personality