Cremerius argues that it is inappropriate to apply the rule of abstinence rigidly with all psychoanalytic patients. The problem is difficult: too much abstinence, and the analyst becomes a distant observer; too little, and he becomes a participant in the patient's neurotic process. But the rule is often too strictly applied; an inhuman rigidity can occur in analytic technique, whether the analyst's style shows paternal strictness or maternal empathy. Our literature on the subject is unsatisfactory. Cremerius traces the development of the rule of abstinence, which began with contact with hysterical female patients who tended to fall in love with the psychoanalyst and demand his participation in their love. We see the problem in the treatment of Anna O., and the later discussions of the problem with Jung when he was involved with Sabina Spielrein. In 1911 Freud recommended that discussion of countertransference,
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which clearly had to do with the analyst's feelings toward the patient, should be withheld from publication and circulated only in manuscript form. Cremerius points out come contradictions in Freud's conduct, such as his analysis of his daughter and of colleagues with whom he was engaged in literary collaboration. Freud continued to emphasize over-involvement as a danger with female patients, whereas he gratified in many ways the passive-feminine and masochistic wishes of the Rat Man and the Wolf Man. Cremerius sees in this Freud's unconscious fantasies, shared by many men, concerning women as dangerous creatures of desire. Freud continued to emphasize the unfolding of unconscious wishes and fantasymaterial as a result of the lack of gratification in the sessions; there must be no more than verbal discharge of these. Freud, in a dilemma between his technique and his theory of technique, attempted to distinguish two transferences, a neurotic one and an "unobjectionable" one. Cremerius is skeptical of such a division between the transference and the real personal relationship (which actually has transference meaning). This division enabled Freud to use an engaged activity and a neutral passivity. This, however, is an artistic concept, neither logically nor psychologically grounded. Ferenczi deals with the antinomy between personal relationship and technique; so does Gill.
Adherence to the rule of abstinence injures patients today in its rigidity. The obsessive-compulsive patient is so well defended against his infantile longings and needs that for a long time they do not become evident in the transference love, and the pressure of suffering remains for a long time the only motivation for treatment. The patient's compulsive manner ritualizes the sessions in such a way that the repressed cannot be made to appear, and the patient's affect remains separated from all representations. If the analyst is reserved in this situation, as Freud recommended, no psychoanalytic process ever gets started, because the highly ritualized analytic method and the highly ritualized compulsive structure of the patient immobilize one another. In masochistic transference, analytic abstinence becomes an instinctual gratification for the patient. The analyst must avoid offering this gratification; instinctual renunciation is achieved by an opposite behavior: friendliness, loving dedication, and understanding for the patient's sufferings. In cases involving preoedipal or preverbal conflicts, with structural deficits, the rule also has to be modified. When such cases led Ferenczi to modify his technique, Freud objected that Ferenczi was "mothering" his patients. But in such cases the rule of abstinence is always modified, and the patient is permitted to experience deep and wideranging gratifications. Nacht speaks of a loving presence, Spitz of a diatrophic bearing, Gitelson of a fostering figure, Winnicott of non-interpretation in favor of an experience. Balint based his theory on the thesis that the therapist should let himself be used like the ground on which one walks and the air that one breathes, because the patient is regressed to the level of the mother-child dyad. The resulting stimulation and gratification of the patient's libidinal and aggressive impulses has not been discussed.
Cremerius discusses the question, What is abstinence? Countertransference has dangers far greater than Freud recognized, and the sexual fantasies and needs from which Freud felt the analyst should defend himself seem relatively harmless compared to the dangers recognized today, such as controlling analysts, lonely analysts, paternal or parental analysts who want to make their analysand into the child they
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perhaps lack, etc. It is safe to say that the outcome of an analysis depends more on the countertransference than on the analyst's knowledge and technical skills. And the analyst is never so anonymous as he thinks. His manner, voice, office, dress, even his interpretations enable the patient to build up a model of his personality. When the transference is not primarily a new edition of infantile urges, the old, exaggerated abstinence is not appropriate. Moreover, extreme abstinence and mirroringbehavior may compromise the analyst's ability to hear the patient clearly and to empathize; it has made analysis rather deaf to the developments of Ferenczi and Balint. Cremerius would modify the technique according to the special requirements of each patient.
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Wilson, E., Jr. (1987). Psyche. XXXVIII, 1984. Psychoanal. Q., 56:599-601