Internal Object Relations Research Articles

The Management of Affect Storms in the Psychoanalytic Psychotherapy of Borderline Patients

Affect storms are a frequent complication in the psychoanalytic approach to borderline patients. The descriptive, psychodynamic, and structural characteristics of these storms are explored, and the verbal, nonverbal, and countertransference manifestations that permit the formulation of interpretations under such conditions are described, as are the interventions required to maintain the treatment frame as a precondition for an analytic approach. The principal theoretical formulations regarding the affect pathology of borderline patients are reviewed and related to a proposed interpretive approach. An apparently opposite development, the utter absence of emotional developments in the sessions, is examined, and its defensive function of avoiding affect storms is explored. Clinical case material illustrates the proposed approach to these storms, and clinical evidence is given to support the approach, which centers on systematic analysis of the primitive internalized object relations of these patients in the transference, the use of countertransference analysis without countertransference communication to the patient, and the repeated restoration of technical neutrality in the service of protecting the treatment frame.

On Attachment to Internal Objects

This paper considers some clinical implications of attachment theory from the perspective of the theory of internal object relationships and the unconscious phantasies that derive from such relationships. The paper focuses on the contributions of Bowlby and his followers, particularly Mary Main, who has developed a language-based methodology to study representational processes in adults and children, bridging the gap between the systematic study of human behavior and clinical psychoanalysis. The theory of inherent role responsiveness in the internal object world—mental representations of self and other in interaction and externalized in complementary role relationships through exchanges of unconscious and conscious messages—is presented as the psychoanalytic complement of Bowlby's theory of internal working models of attachment. Role responsiveness occurs internally as well as externally, so that one can speak of attachment to phantasy objects as well as external objects. Clinical examples illustrate how the therapist, through maintaining a free-floating responsiveness to the patient's enactments, may reconstruct the internal working models of attachment and their origins in the transference. The paperthus illustrates the way in which the origins of phantasy derive from the wished for and feared states related to early experiences of felt security, or lack of it, in relation to the attachment objects, thereby integrating the psychoanalytic theory of phantasy with attachment theory.

Discriminating among subgroups of borderline personality disorder: an assessment of object representations.

The purpose of this study was to identify subgroups of borderline personality disorder (BPD) by examining internalized object relations. It was predicted: (a) that the internalized object relations of borderline patients as a group can be differentiated from psychiatric patients (comparison group N = 15), and (b) that BPD subgroups significantly differ in their object-relational profiles. Fifty-seven adult borderline subjects (28 male and 29 female) were separated into three groups based on Horney's description of interpersonal styles (moving away, against, and toward). Object relations were assessed using the Bell Object Relations Inventory and from early memories. Four written early memories were scored using the Social Cognition and Object Relations Scale (SCORS). The results suggest that the malevolent inner object world of borderline patients is fundamentally different from nonborderline psychiatric patients; and that the defined BPD subgroups of moving toward, against, and away differed significantly on specific structural and thematic object-relational dimensions. Aspects from Fairbairn's object relations theory and contributions from the self/representational, ego deficit, and Kernberg's models of borderline psychopathology are used to help interpret the findings. Identifying subtypes of BPD may allow for more precise discriminations in separating BPD from other disorders and may provide meaningful therapeutic and prognostic information for the different subgroups of borderline patients.

Addiction as Mind—Body Bridge Commentary on Paper by Lisa Director

Director's paper calls our attention to the lack of attention to addiction in the relational literature. Clinical case studies of patients with chemical dependency may provide a window into the complexities of the mind—body connection in psychoanalysis. The transference—countertransference dimensions of the treatment of addicted individuals offer the therapist a privileged glimpse of the patient's internal object relations and thereby enable the therapist to gain greater understanding of the patient's characteristic problems in relationships with others.

Teachers Get Educated About Biopsychosocial Therapies

Teachers Get Educated About Biopsychosocial Therapies

Minding the Gap not Bridging the Gap: Family Therapy From a Psychoanalytic Perspective

Following recent interest in this journal in building bridges between a psychoanalytic and systemic approach to family therapy (Vol. 19, 1997), the authors take up the debate. A clinical vignette from a recent article is used for discussion and, in order to describe further work from a psychoanalytic perspective, two case vignettes are presented. The comparisons are discussed with particular reference to the concepts of projective identification, transference/countertransference and internal object relations.

Extra-Transference Interpretation

New psychoanalytic techniques stemming from various object relations and Kleinian frameworks have increasingly diverged from many of the principles of classical analysis, such as interpretations of genetic transference, resistances and reconstructions of the past. In contrast to the wide-ranging foci of classical technique, the so-called modern analysis is narrowly focused on the interpretation of transference in the here-and-now analytic relationship. This change in technique is attributed to paradigm shifts from Freud's intrapsychic metapsychology to two-person theories about internal object relationships, infantile phantasies and countertransference. This paper examines important elements of this broad issue through a specific focus on the controversy over the therapeutic value of extra-transference interpretations vs. here-and-now transference interpretations. An extensive review of the literature is followed by excerpts from published analyses to illustrate the different clinical styles of classical vs. modern analysis. Freud's actual analytic work with a patient is presented to show his natural, rule-free clinical style is very different from his early technique papers. Classical technique is also illustrated by a description of relevant aspects of the author's own training analysis with Anna Freud. Finally, a clinical vignette illustrates the author's approach to extra-transference material and its interpretation.

Psychodynamic Psychiatry in Clinical Practice, 3rd ed.

Psychodynamic Psychiatry in Clinical Practice, 3rd ed.

Otto Kernberg's Object Relations Theory

A conceptual and empirical critique of Kernberg's influential object relations theory is presented as a case study of the limitations of structural ontological presuppositions in accounting for psychological processes. A summary overview is provided of Kernberg's systems model, the process of internalization, his developmental stages, and his conception of the borderline personality organization. Then a detailed critique considers: (1) the foundations of Kernberg's model in affective memory and units of internalized object relations; (2) the principles of construction underlying his developmental processes; (3) the resulting product of these processes, his structural model and theory of the borderline personality organization; and (4) the relationship between his metapsychology and his clinical theory. Suggestions are made for how process models of personality and psychopathology can redress the problems with structural accounts.

Collaborating with the unconscious Other

The analysand's capacity for making use of psychoanalytic treatment has been a subject of importance since the beginning of psychoanalysis. The author addresses an aspect of the difficulty encountered by analysands in achieving a psychic state that allows the creative use of free association, dreams, parapraxes and other spontaneous phenomena occurring during the course of treatment. He suggests that a very specific state of mind is essential to both the psychoanalytic process and the creative process. Using theoretical concepts derived from Freud, Klein and Bion, he develops the idea of an internal object relationship, ‘the collaboration with the unconscious other’, which forms the basis for both creative thinking and the psychoanalytic function of the personality. Creative thinking is distinguished from artistic endeavour and discussed as a universal potential, on which growth in psychoanalysis depends. The term ‘unconscious other’ is meant to signify the subjective experience of a foreign presence within oneself from which both spontaneous creative inspiration and involuntary psychic phenomena are felt to emanate. The author presents clinical material to suggest that paranoid‐schizoid and depressive anxieties form obstacles to collaborating with the unconscious other, and must be worked through in order to achieve an analytic process.

Freud and Klein on the concept of phantasy

In summary, I think Freud's idea is that the prime mover of psychic life is the unconscious wish, not phantasy. The 'work' of making phantasies and the 'work' of making dreams are parallel processes in which forbidden unconscious wishes achieve disguised expression and partial fulfilment. For Freud himself, especially in his central usage, and even more for his immediate followers, phantasies are conceived as imagined fulfilments of frustrated wishes. Whether they originate in the system conscious or the system preconscious, they are an activity of the ego and are formed according to the principles of the secondary process. That is not the whole story, however, because phantasies may get repressed into the system unconscious, where they become associated with the instinctual wishes, become subject to the laws of the primary process, and may find their way into dreams and many other derivatives. For Freud and for French psychoanalysts particularly, there are the primal phantasies, 'unconscious all along', of the primal scene, castration and seduction, also capable of being directly incorporated into dreams and expressed through other derivatives. For Klein phantasy is an even more central concept than for Freud and it has continued to be used by her successors with only minor changes. In Klein's thinking unconscious phantasies play the part that Freud assigned to the unconscious wish. They underlie dreams rather than being parallel to them--a much more inclusive definition of phantasy than Freud's. The earliest and most deeply unconscious phantasies are bodily, and only gradually, with maturation and developing experience through introjection and projection do some of them come to take a verbal form. Freud's central usage, the wish-fulfilling definition of phantasy, is a particular type of phantasy within Klein's more inclusive definition. And, as in Freud's formulation, conscious phantasies may be repressed, but in Klein's formulation this is not the only or even the main source of unconscious phantasies. In Klein's usage, unconscious phantasies underlie not only dreams but all thought and activity, both creative and destructive, including the expression of internal object relations in the analytic situation. Finally, it is my tentative suggestion that conceptual and clinical focus on the concept of phantasy, especially unconscious phantasy, as in Britain and France, tends to involve a heightened awareness of the unconscious--hardly surprising, since unconscious phantasy is such a fundamental aspect of the unconscious. I have suggested that, although there are many individual variations, the structural model and the self-psychology, relational and intersubjectivist models tend to discourage focus on the dynamic unconscious.

Freud and Klein on the concept of phantasy.

In summary, I think Freud's idea is that the prime mover of psychic life is the unconscious wish, not phantasy. The 'work' of making phantasies and the 'work' of making dreams are parallel processes in which forbidden unconscious wishes achieve disguised expression and partial fulfilment. For Freud himself, especially in his central usage, and even more for his immediate followers, phantasies are conceived as imagined fulfilments of frustrated wishes. Whether they originate in the system conscious or the system preconscious, they are an activity of the ego and are formed according to the principles of the secondary process. That is not the whole story, however, because phantasies may get repressed into the system unconscious, where they become associated with the instinctual wishes, become subject to the laws of the primary process, and may find their way into dreams and many other derivatives. For Freud and for French psychoanalysts particularly, there are the primal phantasies, 'unconscious all along', of the primal scene, castration and seduction, also capable of being directly incorporated into dreams and expressed through other derivatives. For Klein phantasy is an even more central concept than for Freud and it has continued to be used by her successors with only minor changes. In Klein's thinking unconscious phantasies play the part that Freud assigned to the unconscious wish. They underlie dreams rather than being parallel to them--a much more inclusive definition of phantasy than Freud's. The earliest and most deeply unconscious phantasies are bodily, and only gradually, with maturation and developing experience through introjection and projection do some of them come to take a verbal form. Freud's central usage, the wish-fulfilling definition of phantasy, is a particular type of phantasy within Klein's more inclusive definition. And, as in Freud's formulation, conscious phantasies may be repressed, but in Klein's formulation this is not the only or even the main source of unconscious phantasies. In Klein's usage, unconscious phantasies underlie not only dreams but all thought and activity, both creative and destructive, including the expression of internal object relations in the analytic situation. Finally, it is my tentative suggestion that conceptual and clinical focus on the concept of phantasy, especially unconscious phantasy, as in Britain and France, tends to involve a heightened awareness of the unconscious--hardly surprising, since unconscious phantasy is such a fundamental aspect of the unconscious. I have suggested that, although there are many individual variations, the structural model and the self-psychology, relational and intersubjectivist models tend to discourage focus on the dynamic unconscious.

Relational Therapy for Personality Disorders

Back to table of contents Previous article Next article Book Forum: PsychotherapiesFull AccessRelational Therapy for Personality DisordersGLEN O. GABBARD, M.D., GLEN O. GABBARDSearch for more papers by this author, M.D., Topeka, Kan.Published Online:1 Feb 2001https://doi.org/10.1176/appi.ajp.158.2.334-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The unsuspecting reader may assume that the “relational therapy” referred to in the title of this book is a variant of relational psychoanalysis, the increasingly popular theoretical school deriving from the work of Stephen Mitchell, Lewis Aron, and others. However, Jeffrey Magnavita uses “relational therapy” to refer to integrative relational psychotherapy, a model of conceptual understanding and treatment that leans heavily on familiar theories of family systems. To his credit, Magnavita avoids the frequent problem of reductionism by fully acknowledging the necessity of thinking in biopsychosocial terms. Genetic factors and temperament are taken into account. He also values psychodynamic thinking in understanding how early attachment relationships create patterns of internal object relations that are played out within family systems. He reviews much of the existing literature on personality disorders in a scholarly fashion and comes up with his own classification of dysfunctional personological systems. The subtypes involved in this taxonomy take some getting used to. For example, the paranoid dysfunctional personological system is abbreviated as “Par Dps,” the somatic dysfunctional personological system is abbreviated “Som Dps,” and so forth.The author goes over a number of treatment interventions in a truly pluralistic manner, drawing from many different theoretical schools. Unfortunately, what readers gain in the breadth of the author’s coverage is not matched by the depth of case material. What is sorely lacking in the book is a detailed and extended clinical case that illustrates the author’s method in great detail. The clinical examples provided are quite sketchy and unsatisfying. So the reader is left with headlines but no details. The other major deficiency in the book is lack of any empirical evidence that the approach is useful. Even in the absence of systematic research, the author might have at least outlined a way to study the method that he is proposing.Psychiatrists and other mental health professionals who are interested in family approaches to personality disorders might find this book interesting and useful. However, much more testing of the method is needed before one can endorse broad use of the treatment described.By Jeffrey J. Magnavita. New York, John Wiley & Sons, 1999, 291 pp., $45.00. FiguresReferencesCited byDetailsCited byNone Volume 158Issue 2 February 2001Pages 334-a-335 Metrics History Published online 1 February 2001 Published in print 1 February 2001

Psychoanalytic Clinical Practice

RICHARD D. CHESSICK, MR: Psychoanalytic Clinical Practice. Free Association Books, London, 2000,294 pp., $30.00, ISBN 1-85343-479-5. This book presents an in-depth investigation of classical and contemporary psychoanalytic theories and therapeutic approaches in a concise and clear fashion. It is a pleasure to read and study. In the preface Dr. Chessick reaffirms psychoanaly- sis as primarily a clinical science that combines both hermeneutics and empirical study, emphasizing its role as a medical science in an era of neurobiological advances. He notes that the incorporation of hermeneutics and energetics was Freud's crucial epistemological discovery (p. xv). The first chapter deals with the conceptualization of psychoanalysis as a science that mandates an examination of the continuous mutual influencing of the conscious and unconscious levels of the psychic fields of the therapist and patient. The author views a humanistic education for the psychotherapist as a necessity for the complete understanding of a patient, something that cannot ever be achieved by a purely technical education in dynamic psychiatry. The unfreezing of destructive introjects can only occur in a controlled regression in a secure therapeutic alliance between a healthy therapist and the mature aspects of the observing ego of the patient. The therapist functions as a new object for the corrective reparative experience of the patient, thus allowing for an exchange of destructive introjects for the more benevolent psychic field of the therapist. Chessick also discusses his five-channel approach to psychoanalytic listening, a perspective that is emphasized throughout the book. These channels are conflicting and irreconcilable, yet are used continuously in the same with the analyst changing from one to another as necessary. The first channel includes the Freudian focus on the Oedipus Complex and the need for drive satisfaction in the transference. The second is the perspective of object relations theory, including the work of Klein, Bion, and Kernberg. This involves the study of projective identification of the patient's earliest internalized object relations and how the infant organized these into and object. The third, the phenomenological perspective, focuses on the patient's being-in-the-world, which is a unique situation for each person depending on the culture, a perspective espoused by Husserl, Heidegger, and Boss. The fourth encompasses the psychology of Kohut and focuses on the patient's sense of as it is empathically grasped by the analyst. Contributors have included Fairbairn, Winnicott, R.D. Laing, Chessick, and Gedo. The final channel is termed the interactive, focusing on the countertransference of the therapist and the here-and-now factors in the treatment (p. 11). The analyst's participation is emphasized in terms of how the patient experiences the analyst as a major factor in the curative process. There is an elaboration of the various contributors to this approach. Chessick emphasizes throughout this book that the analyst must be willing to keep discontinuous and conflicting models in one's mind, which offends the natural and very dangerous human tendency for a neat, consistent and holistic theoretical explanation of all material, even if it is wrong (p. 14). This approach requires tolerance, flexibility, and maturity on the part of the therapist. Historically, in the arts and sciences, the ability to entertain conflicting and contradictory ideas has led to remarkable discoveries and creativity. The author's willingness to entertain and work with diverse theoretical constructs is a paradigm of the type of scholarship and intellectual honesty this book represents. Chapter two deals with Postmodern Psychoanalysis, characterized by radical ontological and epistemological doubt, and the claim that the is not a core entity, the 'decentering' of the self (p. 16). Here the author draws on his extensive knowledge of philosophy and again emphasizes the five-channel approach in obtaining something structurally consistent with the patient and validating the material obtained from the treatment. …

Multiple Selves, Multiple Voices; working with Trauma, Violation and Dissociation

Dissociation. A Reconsideration of Freud's Views of Trauma. Back to Janet: Early Studies of Trauma, Repression and Dissociation. The Effects of Trauma and Abuse on the Developing Self. The Effects of Trauma and Abuse upon Internal and External Object Relations, Belief Systems, and Psychobiology. Remembering, Forgetting and Confabulating: Terror in the Consulting Room. Multiple Personality Disorder/Dissociative Identity Disorder. What is Going on in Multiple Personality Disorder/Dissociative Identity Disorder? Therapeutic Considerations with MPD/DID. Illustration of Therapy with MPD/DID: A Composite Fictitious Case - Discussion. Reflections of Evil: The Mystery of Deep Perversion. Epilogue. Appendix. References. Index.

Changes in Object Relations in Long-Term Mentally Ill Patients Treated in a Psychiatric Day-Care Unit

The treatment outcome of a psychiatric day-care unit for long-term mentally ill patients was studied. The aim was to investigate internal representations of object relations among the patients at admission and at a one-year follow up. Another aim was to compare the pattern of, and change in, internal object relations with external events, behaviors, social relationships, and overt change. Twenty individuals, both psychotic and nonpsychotic patients admitted during the first five years of the unit's existence, were included in the study. Instruments used were the Perceptgenetic Object-Relation Test (PORT), the Health-Sickness Rating Scale (HSRS), and qualitative interviews. Patient internal object relations matured during the period of treatment and follow up. The themes in internal object relations were frequently paralleled by similar themes in the individual external life situations. No associations were found between change according to the PORT and the HSRS. This underscores that internal object relations form a specific entity and could be included as a measure of structural change to add to the spectrum of important criteria of treatment outcome in clinical studies. In dieser Studie wird das Behandlungsergebnis einer tagesklinischen psychiatrischen Behandlung für psychiatrisiche Langzeitpatienten untersucht. Ziel der Studie war eine Untersuchung innerer Repräsentanzen von Objecktbeziehungen bei den Patienten im Vergleich der Aufnahme mit einem 1-Jahres-Katamnesezeitpunkt. Ein weiteres Ziel war der Vergleich von Veränderungsmustern der internaliserten Objektbeziehungen mit äußeren Ereignissen, Verhaltensweisen, Sozialbeziehungen und sichtbaren Veränderungen. 20 Personen, sowohl psychotische als auch nichtpsychotische Patienten, die innerhalb der ersten fünf Jahre der Existenz der Einrichtuung aufgenommen wurden, bildeten die Stichprobe der Studie. Die verwendeten Erhebungsinstrumente bestanden aus einem Objektbeziehungstest, der Health-Sickness Rating Scale (HSRS) sowie qualitativen Interviews. Die internalisierten Objektbeziehungen der Patienten reiften während der Behandlung und bis zum Katamnesezeitpunkt. Die Themen der internalisierten Objektbeziehungen wiesen oft Parallelen auf zu ähnlichen Themen im wirklichen Leben der Patienten.Es zegten sich keine Zusammenhänge zwischen Veränderungen in der Objektbeziehungsskala und der HSRS. Dies unterstreicht, daß internalisierte Objektbeziehungen eine spezifische Einheit darstellen. Sie sollten deshalb–als ein Maß für strukturelle Veränderungen–das Spektrum wichtiger Kriterien zur Bewertung des Therapieerfolgs in klinischen Studien erweitern. Le résultat du traitement dans une unité psychiatrique de jour pour des patients mentaux de longue durée a été examiné. Le but était d'étudier les représentations internes des relations d'objet chez des patients à l'admission et après une année. Un autre but était de comparer la configuration et le changement des relations objectales internes en fonction des événements extérieurs, des comportements, des relations sociales et des changements manifestes. 20 sujets psychotiques et non-psychotiques admins au cours des 5 premières annèes de l'existence de cette unité ont été inclus dans l'étude. Comme instruments ont été utilisés le PORT (Percept-genetic Object-Relation Test), la HSRS (Health-Sickness Rating Scale), et des interviews qualitatifs. Les thèmes des relations d'objets internes se retrouvaient fréquemment en parallèle dans la situation de vie externe des sujets. Le changement n'a pas montré d'association au niveau du PORT ou de la HSRS. Ceci souligne que les relations d'objets internes constituent une entité spécifique qui s'ajouterait, en tant que mesure de changement de structure, aux critères importants de l'évaluation des résultats dans les études cliniqes. Se estudió el resultado del tratmiento prolongado de pacientes mentalmente enfermos en un hospital psiquiátrico de día. El objectivo fue investigar las representaciones de las relaciones objetales de los pacientes en el momento de la admisión y un año después. Otro objectivo fue comparar la estructura y el cambio en las relaciones objetales internalizadas en relación con acontecimientos externos, comportamientos, relaciones sociales y cambio ostensible. Se incluyeron en el estudio veinte pacientes, tanto psicóticos como no psicóticos, admitidos en los primeros cinco años de existencia de la unidad. Los instrumentos usados fueron el Test de Perceptos-genéticos de Relaciones objetales (Percept-genetic Object-Relation Test) (PORT), la Escala de Evaluación de Salud-Enfermedad (HSRS) y entevistas cualitativas. Las relaciones objetàles internalizadas de los pacientes maduraron tanto durante el período de tratamiento como al seguimiento. Los temas de las relaciones objetales internalizadas mostraban un paralelo frecuente con los temas de situaciones externas de la vida del individuo. No se encontró asociación entre los cambios del PORT y del HSRS. Ester hecho enfatiza qe las relaciones objetales internalizadas forman una entidad específica y que, incluídas como medida del cambio estructural, podrín agregarse al espectro de los criterios importantes para evaluar resultados en los estudios clícos.

Review of Infant Mental Health papers

The paper of the Change Process Study Group of Boston addresses an unsolved conceptual problem: How does one codify intersubjective states? The transfer of concepts from infant research to the adult therapeutic dyad is more than an analogy in that certain primitive aspects of mind appear in infancy, but persist throughout life. The regulation of consciousness is one salient example. The adult therapeutic dyad and the mother–infant dyad can be viewed as self-regulating dynamic systems that are also self-reparative. The concept of implicit relational knowledge is offered as an alternative way of thinking about internal object relations. © 1998 Michigan Association for Infant Mental Health

Unbearable Ecstasy, Reverence and Awe, and the Perpetuation of an “Aesthetic Conflict”

The author discusses Tustin's concept of the unbearable ecstasy of at-one-ment and her attentiveness to the importance of the containing function of the mother, Bion's distinction between “reverence and awe” and defensive idealization, and Meltzer's notion of the “aesthetic conflict.” Each theme has bearing upon the provocation or mitigation of envy, the process of introjection and the development of both healthy and pathological internal object relations, the nature of the superego, and self-esteem. Clinical material is presented to illustrate the phenomena described, and conclusions which may have an impact upon our attitude and technique in psychoanalysis are put forward.

The psychoanalytic dream. some theoretical aspects

Abstract Dream interpretation was at the center of psychoanalytic interest in the first three decades of this century, constituting the royal road to the unconscious. Even though Freud insisted that the meaning of the dream should be sought in its latent content, he early warned against excessive interpretation of dream symbols and underlined the importance of eliciting the patients' associations and taking the total clinical situation into consideration when analysing dream material. He later stated that “a dream is as a rule merely a thought like any other. Later analysts have expanded and developed both dream theory and psychoanalytic theory in general, which has led to focus on different aspects of both the understanding of dreams and its position in clinical practice. This paper presents some of these aspects concerning the poetic diction in dreams, the integrating and adaptive functions of dreams, implications of the structural theory, the internal world and object relations and the psychoanalytic setting and process. Emphasis is placed on the Kleinian critique of Freud's dream theory which presupposes a well integrated ego, leaving out the impact of what excessive use of primitive defense mechanisms may have on both dreaming and the analytic process in less integrated individuals. The “capacity to dream” and to use “the dream space” has been compared to Winnicotts ideas about a persons capacity to “use an object” and his relationship to “transitional space. Even though different psychoanalytic “schools” differ in what aspects of dreams and dreaming are emphasized, there are convergent lines. Dream interpretation is still a major, if not the royal road to a patients' unconscious. There are, however, other roads, an important one consisting of the transference-countertransference pattern as it evolves in the psychoanalytic situation.

Countertransference as Projective Identification

SUMMARY While all countertransference reactions call upon the therapist to examine his/her internal family and unresolved issues, many instances of countertransference can best be understood as originating from and replicating and clients' internalized object relations. In this way, countertransference can be likened to projective identification. By processing countertransference as a form of projective identification the couples therapist can more effectively comprehend and work with important relationship problems. This article outlines the process of analyzing and responding to these kinds of countertransference reactions.