Excerpts from Must Read Books & Articles on Mental Health Topics
Books, Part XXIX


Freud: A Life for Our Time
Peter Gay
Chapter 6: Therapy & Technique (pp.246-267)

The young woman whom the world now knows as Dora first came to Freud's consulting room in the summer of 1898, when she was sixteen, and entered psychoanalytic treatment two years later, in October 1900. She abandoned it in December, after some eleven weeks, with most of the analytic work still to be done. As early as mid-October, Freud reported to Fliess that he had a "new case," an eighteen-year-old girl, "smoothly opening for the available collection of passkeys"--an erotic metaphor whose overtones he did not choose to explore.
     In January 1901, after Dora's departure, he wrote up her history rapidly, recording its completion on January 25. "It is the subtlest I have written so far," he announced, indulging in a moment of self-congratulation. But he instantly subverted his exhilaration with predictions of general disapproval: he had no doubt that the paper would put people off even more than usual. "Anyhow," he added, with his characteristic mixture of self-assurance and stoical resignation, "one does one's duty and indeed does not write just for the day." In the end, he did not publish Dora's history until 1905. This delay provided him with a minor dividend: he could append the report of an interesting visit that his former patient paid him in April 1902, a visit that elegantly rounded out Freud's failure.
     The reasons for this long gestation are not wholly transparent. Freud had strong incentives to publish Dora's history promptly. Since he saw it as the "fragment" of a case "grouped around two dreams," it was "really a continuation of the dream book"--The Interpretation of Dreams applied on the couch. It also offered a striking illustration of an unresolved Oedipus complex at work in the formation of Dora's character and of her hysterical symptoms. Freud adduced several explanations for the delay, notably medical discretion, but these seem a little lame. He was evidently disheartened by his friend Oscar Rie's critical reception of the manuscript, and no less by the decay of his most impassioned friendship. "I withdrew my last work from the printer," he told Fliess in March 1902, "because just shortly before I had lost my last audience in you." This response seems somewhat excessive: Freud must have known that the case had much to teach anyone interested in psychoanalysis. Moreover, it fitted the pattern of his clinical publications to perfection, Dora was a hysteric, the kind of neurotic who had been the mainstay of analytic attention since the mid-1890s--in fact since Breuer's Anna O. almost two decades earlier. No doubt the case had some peculiar, vaguely uncanny meaning for Freud; when he referred to it in retrospect, he consistently pushed it back from 1900 to 1899, a symptom of some unanalyzed preoccupation. Freud's reserve hints at intimate reasons why it disconcerted him and why he kept the manuscript on his desk.
     One striking piece of evidence that Freud was not wholly at ease is the preface he attached to his report on Dora: it is unusually combative even for a writer not allergic to spirited controversy. He was offering the case, Freud wrote, to instruct a reluctant and uncomprehending public in the uses of dream analysis and its relation to the understanding of neuroses. Certainly its original title, "Dream and Hysteria," aptly sums up the points Freud wished to make with it. But the reception of his Interpretation of Dreams had shown him, he noted in a somewhat injured tone, how unprepared specialists were for his truths: "The new has always aroused bewilderment and resistance." In the late 1890s, he noted, he had been criticized for giving no information about his patients; now he expected to be criticized for giving too much. But the analyst who publishes case histories of hysterics must enter into details of the patients' sexual life. Thus discretion, the physician's supreme duty, clashes with the demands of science, which lives on uninhibited open discussion. But he defied any of his readers to identify Dora.
     For all this heavy weather, Freud was not yet ready to start on the business at hand. He accused "many physicians" in Vienna of taking a prurient interest in the kind of material he was about to present, of reading "such a case history not as a contribution to the psychopathology of neuroses, but as a roman a clef designed for their entertainment." This was probably true, but Freud's somewhat gratuitous vehemence suggests that his involvement with Dora was more unsettling than he suspected.

THE MOST WORLDLY reader might have been astonished, even shocked, by the sexual entanglements among which young Dora lived. Perhaps only Arthur Schnitzler, whose disenchanted stories and plays sketched the intricate choreography of Vienna's erotic life, could have imagined such a scenario. Two families were performing a ballet of covert sensual self-indulgence draped in the most assiduous propriety. The protagonists were Dora's father, a prosperous and intelligent manufacturer who, suffering from the aftermath of tuberculosis and of a syphilitic infection he had contracted before his marriage, had been Freud's patient and had brought his daughter to him; her mother, to judge by all reports foolish and uncultivated, a fanatical, obsessive house cleaner; her older brother, with whom her relations were strained, and who would take his mother's side in domestic disputes, just as she, Dora, could be counted on to back her father. "Thus, " Freud placidly commented, "the ususal sexual attraction had brought father and daughter on one side, mother and son on the other, closer together." The case was rounded out by the members of the K. family, to which Dora and her family had become very much attached: Frau K. had nursed Dora's father during one of his severe illnesses, and Dora had taken care of the young K. children. Despite the discord in Dora's household, the cast looked very much like two respectable, domestic, bourgeois families companionably helping one another out.
     They were anything but that. When Dora was sixteen, growing into an engaging and good-looking young woman, she abruptly declared her detestation of Herr K., hitherto her affectionate older friend. Four years earlier, she had begun to show some signs of hysteria, notably migraines and a nervous cough. Now her afflictions intensified. Once attractive and lively, she acquired a repertory of disagreeable symptoms: beyond her cough a hysterical whisper (aphonia), intervals of depression, irrational hostility, even thoughts of suicide. She provided an explanation for her unhappy state: Herr K., whom she had long liked and trusted, had made a sexual advance to her during a walk; deeply offended, she had slapped him. Confronted with the charge, Herr K. denied it and went on the offensive: Dora cared about nothing but sex and was exciting herself with lubricious literature. Her father was inclined to take Herr K.'s word and dismissed Dora's accusations as a fantasy. But Freud, after he took Dora into analysis, was struck by certain contradictions in her father's story, and decided to reserve judgment. This was the most sympathetic moment in Freud's psychoanalytic relationship with Dora, which would be marred by mutual hostility and a certain insensitivity on the analyst's part. Freud proposed to wait for Dora's revelations.
     They proved worth waiting for. Her father, it came out, had told the truth only about one thing: his wife brought him no sexual satisfaction. But while he was parading his ill health before Freud, he had actually compensated himself for his domestic frustrations by carrying on a passionate love affair with Frau K. The liaison did not remain a secret to Dora. Observant and suspicious, she became convinced that her adored father had refused to believe her anguished denunciation for his own scabrous reason: by selling her to Herr K., he could continue to sleep with Frau K. undisturbed. Yet there were still other erotic crosscurrents; penetrating to the truth of this illicit affair, Dora half consciously made herself its accomplice. Before she broke off her eleven-week analysis with Freud, he had discovered in her passionate feelings for Herr K., for her father, and for Frau K., feelings she partially confirmed. Puppy love, incest, and lesbian desires were competing for preeminence in her anxious adolescent mind. At least this is how Freud read Dora.
     Herr K.'s amorous proposition was, in Freud's judgment, in no way sufficient to account for Dora's florid hysterical symptoms, which had emerged even before she had grown resentful at her father's mean-spirited betrayal. Freud thought that not even an earlier traumatic incident that Dora disclosed to him could have caused her hysteria; rather, he saw her response as proof that the hysteria was already in existence when the incident occurred. When Dora was fourteen, a full two years before Herr K. had made his disputed advance, he had waylaid her in his office, suddenly embraced her, and kissed her passionately on the lips. She had responded to this assault with disgust. Freud interpreted that disgust as a reversal of affect and a displacement of sensations; the whole episode struck him as a perfect hysterical scene. Herr K.'s erotic advance, Freud flatly said, "was surely the situation that would call up in a fourteen-year-old innocent girl a distinct feeling of sexual excitement," caused in part by feeling the man's erect member against her body. But Dora had displaced her sensation upward, to her throat.
     Freud was not insinuating that Dora should have yielded to Herr K.'s importunities at fourteen--or, for that matter, at sixteen. But he thought it only obvious that such an encounter should generate a measure of sexual arousal, and that Dora's response was a symptom of her hysteria. Such a reading follows naturally from Freud's posture as a psychoanalytic detective and a critic of bourgeois morality. Intent on digging beneath polite social surfaces, and committed to the proposition that modern sexuality was screened by an almost impenetrable blend of unconscious denial and conscious mendacity, particularly among the respectable classes, Freud felt virtually obliged to interpret Dora's vehement rejection of Herr K. as a neurotic defense. He had met the man and had found him, after all, an agreeable and handsome person. But Freud's inability to enter Dora's sensibilities speaks to a failure of empathy that marks his handling of the case as a whole. He refused to recognize her need as an adolescent for trustworthy guidance in a cruelly self-serving adult world--for someone to value her shock at the transformation of an intimate friend into an ardent suitor, to appreciate her indignation at this coarse violation of her trust. This refusal testifies also to Freud's general difficulty in visualizing erotic encounters from the woman's perspective. Dora wanted desperately to be believed, not to be thought a liar or a fantast, and Freud was willing to accept her story rather than her father's denials. But that was as far as he was prepared to go in seeing her side of the case.

HERR K.'s SEXUAL aggressions were not the only scenes in Dora's drama whose implications Freud failed to explore sympathetically. Almost on principle unwilling to accept Dora's qualms about his interpretations, he stood ready to read her denials as covert affirmations. In line with his practice at that time, much modified later, he offered immediate and energetic interpretations. Insisting that she was in love with her father, he took her "most emphatic contradiction" as proof that he was right in his conjecture. "The `No' one hears from a patient after one has presented his conscious perception with a repressed thought for the first time only registers the repression and its decisive character and, as it were, measures its strength. If one takes this 'No' not as the expression of an impartial judgment, of which the patient is in fact not capable, disregards it, and continues the work, proofs will soon appear that `No' in such a case signifies the desired `Yes.' " Freud thus opened himself to the charge of insensitivity, and worse, of sheer dogmatic arrogance: though a professional listener, he was not listening now, but forcing his analysand's communications into a predetermined pattern. This largely implicit claim to virtual omniscience invited criticism; it suggested Freud's certainty that all psychoanalytic interpretations are automatically correct, whether the analysand accepts them or disdains them. "Yes" means "Yes," and so does "No. Freud did not confront the perils of such a stance at that time; he would do so explicitly only years later. "If the patient agrees with us," he wrote in one of his last papers in 1937, paraphrasing some unnamed critic, "then [we are] right, but if he contradicts us, then that is only a sign of his resistance, which again puts us in the right. In this way we are always in the right against the helpless poor individual whom we are analyzing, no matter what attitude he may take toward our imputations." And he quoted the saying, in English, "heads I win, tails you lose," as a condensation of what is generally thought to be psychoanalytic procedure. But actually, he demurred, this is not how analysts work. They are as skeptical of their analysands' assents as they are of their denials. (" Konstruktionen in der Analyse" [1937], GW XVI, 41-56/-Constructions in Analysis," SE XXIII, 257-69.)
     Freud's interpretations leave the impression that he viewed Dora less as a patient pleading for help than as a challenge to be mastered. Many of his interventions proved beneficial. Discussing her father's relationship with Frau K., Dora had insisted that it was a love affair, but also that he was impotent, a contradiction she resolved by telling Freud, candidly, that she knew one could secure sexual gratification in more than one way. Associating to her troublesome symptoms--her impaired speech and irritated throat--Freud told Dora that she must be thinking of oral sex, or, as he put it, delicately lapsing into Latin, of "sexual satisfaction per os, " and she tacitly confirmed the validity of this interpretation by shedding her cough. But Freud's almost angry insistence that Dora endorse the psychological truths he was offering calls for an interpretation of its own. After all, by 1900, Freud was aware that resistance to unwelcome revelations are perfectly predictable, as the analyst probes into recesses the patient has kept carefully out of the sunlight for years, even if he did not yet recognize that to put pressure on a patient was a technical lapse. With later patients he would be less exigent, less overbearing, partly because of the lessons Dora taught him.
     The vigorous and voluble interpretations Freud lavished on Dora have a dictatorial air about them. In the first of Dora's two revealing dreams, she had dreamt of a small jewel case which her mother wanted to save from a burning house over the protests of her father, who insisted on saving his children instead. Listening to her recital, Freud fastened on the jewel case that her mother seemed to value so highly. When he asked Dora for her associations, she remembered that Herr K. had given her just such a case, an expensive one. Now, the word Schmuckkdstchen, Freud reminded her, stood for the female genitals. Whereupon Dora: "I knew that you would say that." Freud's response: "That is, you knew it.--The meaning of the dream is now becoming even more distinct. You said to yourself, `The man is pursuing me, he wants to force his way into my room, my `jewel case' is in danger, and if something unfortunate happens it will be Papa's fault.' That is why you took into the dream a situation expressing the opposite, a danger from which your Papa saves you. In this region of the dream in general everything is turned into its opposite; you will soon hear why. The secret, certainly, lies with your Mama. How does Mama come in here? She is, as you know, your former rival for the favor of your Papa." And Freud keeps up the pace for another page, emitting a very torrent of interpretations in which Dora's mother stands for Frau K. and Dora's father for Herr K.; it is Herr K. to whom she will hand her jewel case in return for his extravagant gift. "Thus you are prepared to give Herr K. as a present what his wife refuses him. Here you have the thought which has to be repressed with so much energy, which necessitates the conversion of all elements into their opposite. As I already told you before this dream, the dream confirms once again that you are reawakening your old love for Papa in order to protect yourself from your love for K. But what do all these efforts prove? Not only that you are afraid of Herr K.; you are even more afraid of yourself, of the temptation to yield to him. Thus you confirm how intense your love for him was."
      Freud was not astonished at Dora's reception of this outpouring: "Naturally, Dora did not want to follow me in this piece of interpretation." But the question the interpretation raises is not whether Freud's reading of Dora's dream was correct or merely ingenious. What matters is his insistent tone, his refusal to take Dora's doubts as anything but convenient denials of inconvenient truths. This was Freud's share in the ultimate failure.

FAILURE, OF COURSE, both recognized and unrecognized, is the hallmark of this case, but--paradoxically--precisely this failure constitutes its ultimate significance for psychoanalytic history. Freud, we know, took it as a demonstration of the uses of dream analysis in psychoanalytic treatment and as confirmation of the rules which, he had discovered, govern dream construction. Moreover, it beautifully exhibited the complexities of hysteria. But one crucial reason why Freud finally published "Dora" was his inability to keep his troublesome patient in analysis.
     In late December 1900, Freud worked on Dora's second dream, which satisfactorily confirmed his hypothesis that she had been unconsciously in love with Herr K. all along. But at the start of the next session, Dora blithely announced that this was her last. Freud took the unexpected announcement coolly, proposed that they use their final hour continuing to analyze, and interpreted for her, with new detail, her innermost feelings for the man who had insulted her. "She had listened, without contradicting as usual. She seemed moved, said farewell in the most amiable way with warm wishes for the New Year--and did not come back."
     Freud interpreted her gesture as an act of revenge, animated by the neurotic desire to harm herself. She had left him at a moment when "my expectations of a successful termination of the treatment were at their highest pitch." He wondered out loud whether he might have kept Dora in treatment if he had theatrically exaggerated her importance to him and thus provided her with a substitute for the affection she craved. "I do not know." All he knew was, "I have always avoided playing a role, and contented myself with the unpretentious art of psychology." Then, on April 1, 1902, Dora returned for a visit, professedly to ask for help once again. Freud, observing her, was not convinced. Except for one period, she told him, she had been feeling much better. Having faced down both Frau and Herr K., she had secured confessions from them; her reports about them had been true. But for a couple of weeks she had been suffering from a facial neuralgia. Freud records that at this point he smiled: exactly two weeks before, the newspapers had announced his promotion to his professorship, and so he could read her facial pains as a form of self-punishment for having once slapped Herr K. and then transferring her rage onto him, her analyst. Freud told Dora he forgave her for depriving him of the opportunity to cure her completely. But he could not apparently quite forgive himself.

THE PERPLEXITY IN which Freud found himself as Dora dismissed him resembled his perplexity during the summer of 1897, as his seduction theory of neuroses had proved to be untenable. He had taken that earlier defeat as a foundation for far-reaching theoretical discoveries. Now he confronted this new defeat, explored its causes, and thus moved psychoanalytic technique forward a giant step. He frankly admitted that he had failed to "master the transference in time"; indeed, he had "forgotten to take the precaution of paying attention to the first signs of the transference." The emotional bond between analysand and analyst was only beginning to be understood when Freud worked with Dora. He had ventured some sketchy anticipations in Studies on Hysteria, and his letters to Fliess of the late 1890s show that he had already glimpsed, though far from wholly grasped, the phenomenon. Now, with Dora, for reasons of his own, he failed to build on what he had begun to understand. The case seems to have been the one that largely clarified the issue for him--but only after it was over.
     The transference is the patient's way, sometimes subtle and often blatant, of endowing the analyst with qualities that properly belong to beloved (or hated) persons, past or present, in the "real" world. Freud now recognized that this psychological maneuver, "which seems destined to become the greatest obstacle to psychoanalysis," can also become "its most powerful auxiliary when it can be discovered and translated for the patient." But he had not discovered this while working with Dora, certainly not in time, and in her willful, somewhat unpleasant way, she had proved to him the costs of such neglect. By failing to observe her "infatuation" with him, which was only a substitute for the secret feelings she harbored for others, Freud had allowed her to exact on him the revenge she had wanted to visit on Herr K. "Thus she acted out an essential piece of her memories and fantasies instead of reproducing them in the treatment," and that inevitably led to the disruption of the analytic work.
     This abrupt end hurt Dora, Freud thought; she had been, after all, on the road to recovery. But it also hurt Freud. "He who, like me, awakens the most wicked demons that he may fight them," he exclaimed in the most rhetorical passage of his recitation, "demons who dwell incompletely tamed in the human breast, must be prepared to suffer damage himself in this contest." But while he felt the injury, he could not clearly define it, for it touched him too closely. Freud could see that he had neglected to recognize Dora's transference onto him; but, worse, he had failed to recognize his transference onto Dora: the action of what he came to call countertransference had escaped his analytical self-observation.
     As Freud later defined it, countertransference is an affect arising in the psychoanalyst "through the patient's influence on the analyst's unconscious feelings." Freud's continuing self-analysis had made self-scrutiny almost second nature to him, but the problematic influence of patients on the analyst never loomed large in his mind or in his technical papers. (In recent years, some psychoanalysts have forcefully argued that they often find it profitable to enlist the unconscious feelings their analysands arouse in them to deepen their understanding of these analysands' minds at work. But this position would have found scant sympathy with Freud.) He did not doubt, however, that countertransference is an insidious obstruction to the analyst's benevolent neutrality, a resistance to be diagnosed and defeated. It does to the psychoanalyst what unacknowledged bias does to the historian. The analyst--he sternly laid it down in 1910--"must recognize this countertransference in himself and master it," for "every psychoanalyst only gets as far as his own complexes and inner resistances allow." But as his conduct in the analytic sessions with Dora shows, he was far from invulnerable to her efforts at seduction and to her irritating hostility. That was one lesson of the case: Freud could be assailed by emotions that at times clouded his perceptions as a therapist. (By the mid-1920s, psychoanalytic institutes would expect candidates to uncover, and if possible master, their complexes and resistances by means of the didactic analysis that was by then an indispensable part of their training; seasoned practitioners, for their part, would consult a colleague if they had reason to believe that they were not listening to an analysand with the required clinical
attitude. When Freud wrote "Dora," no such remedies were at hand.)
     Yet this was the very case in which Freud proclaimed the sovereignty of the skilled observer who can glean information from the faintest movement, the slightest flicker. "He who has eyes to see and ears to hear," he wrote in a famous line, "becomes convinced that mortals can keep no secret. If their lips are silent, they gossip with their fingertips; betrayal forces its way through every pore." (Laurence Sterne, that psychological novelist before his time, had already said something very much like it a century and a half earlier: "There are a thousand unnoticed openings, continued my father, which let a penetrating eye at once into a man's soul; and I maintain it, added he, that a man of sense does not lay down his hat in coming into a room,or take it up in going out of it, but something escapes, which discovers him." [Tristram Shandy, book VI, ch. 5.]) As Dora lay before her analyst on the couch, dilating on her misery at home, recounting her adventures with the K. family, and trying to make sense of a dream, she played with her little purse, opening and closing it, pushing her finger into it over and over. Freud promptly interpreted her little gesture as a pantomime of masturbation. But Freud's emotional stake in Dora is harder to read than her gesture with the purse. "Of course," as he once confessed to Ernest Jones, "there is a great difficulty if not impossibility in recognising actual psychical processes" in one's own person.
     It would be naive to insinuate that Freud was in love with this goodlooking and difficult adolescent, however appealing she may have been to him at times. Rather, his principal feelings toward Dora seem to have been rather more negative. In addition to sheer interest in Dora as a fascinating hysteric, he showed a certain impatience, irritation, and in the end, undisguised disappointment. The rage to cure was upon him. It was a passion Freud would later deride as inimical to the psychoanalytic process. But with Dora he was in its grip. He was only too sure that he had access to the truth about Dora's twisted emotional life, but Dora would not accept that truth, even though he had proved to her the curative powers of cogent interpretations. Had he not exorcised her nervous cough by means of interpretation? He was right about her, knew he was right, and felt utterly frustrated that she should be so determined to prove him wrong. What is astonishing about the case history of Dora is not that Freud delayed it for four years, but that he published it at all.

TWO CLASSIC LESSONS
In pleasing contrast to the case of Dora, that of Little Hans was wholly gratifying to Freud. In the four years between the publication of the two case histories, much had happened in Freud's life. In 1905, he had published, in addition to "Dora," the epochal essays concerning the theory of sexuality and his psychoanalytic study of jokes. In 1906, the year he turned fifty, he had transformed the Wednesday Psychological Society by making Rank its secretary, broadened the base of the psychoanalytic movement by taking up contact with interested psychiatrists in Zurich, broken publicly with Fliess, and published his first major collection of papers on the neuroses. In 1907, he played host to Eitingon, Jung, Abraham, and other important adherents at Berggasse 19 for the first time. In 1908, the year Little Hans occupied his attention, he reorganized his Wednesday night group as the Vienna Psychoanalytic Society, presided over the first international congress of psychoanalysts in Salzburg, and visited his beloved England for the second time in his life. In 1909, he went to Clark University for his only American visit, to lecture and receive an honorary degree, and inaugurated the Jahrbueh fur psychoanalytische and psychopathologische Forschungen,
with the history of Little Hans as the lead-off contribution to the first number. He was very pleased with it.

"I AM GLAD you see the importance of `klein Hans,' " he wrote to Ernest Jones in June of that year. He too had seen the importance of this "Analysis of a Phobia in a Five-Year-Old Boy," he noted. "I never got a finer insight into a child's soul." Nor did Freud's affection for his youngest "patient" wane after the treatment was over; he remained "our little hero." The general idea Freud wanted to enforce with this case history was that Little Hans's "childhood neurosis" corroborated the conjectures which Freud's adult neurotic patients had encouraged him to explore: the "pathogenic material" that makes them suffer can be "traced back every time to the very infantile complexes that could be uncovered behind Hans's phobia." As we have seen, the history of Dora, with its exhaustive analysis of two dreams, had demonstrated the relevance of Freud's Interpretation of Dreams to the clinical setting and the sizable share of oedipal feelings in the making of hysteria. The report on Little Hans could serve as a pendant, illustrating the conclusions Freud had outlined in lapidary fashion in his second fundamental treatise, the Three Essays on the Theory of Sexuality. As usual, Freud the clinician and Freud the theorist never let one another out of sight.
     Freud had deliberately said little about technique in "Dora," and he said even less about it in "Little Hans." With good reason: while he had visited the little boy and taken him a present for his third birthday, he now worked almost exclusively through his father, who served as an intermediary. By its nature, then, however broad its theoretical implications, "Little Hans," with its most unorthodox technique, hardly commended itself as an exemplar. It must remain unique. The five-year-old in analysis was the son of the musicologist Max Graf, who had been for some years a member of Freud's Wednesday night group. The boy's "beautiful" mother--it is Freud's word--had been Freud's patient, and together his parents were among the earliest adherents of psychoanalysis anywhere. They had agreed to raise their son according to Freudian principles, with as little coercion as possible; they were patient with him, took an interest in his chatter, recorded his dreams, and found his childish promiscuity in love entertaining. He was enamored of everyone: his mother, the daughters of a family friend, a boy cousin. Freud noted with undisguised admiration that Little Hans had developed into a "paragon of every wickedness!" When he began to show neurotic symptoms, his parents resolved, consistent with their principles, not to bully him.
     At the same time, their psychoanalytic style of rearing their son did not protect the Grafs from falling into the dominant cultural evasions. When Little Hans was three and a half, his mother found him touching his penis and warned him that she would call the doctor to cut off his "wi-wi-maker." Again, when around this time his sister was born--"the great event in Hans's life"--his parents had nothing more original to offer by way of preparing him than the legend of the stork. At this point Hans was more reasonable than his presumably enlightened parents. His investigations into the facts of life, especially into the process of birth, had made early and impressive progress, and in the course of his analysis, he let his father know in his shrewd little-boy way that he viewed the stork story with contempt. Later, when they partially enlightened him, they told him that babies grow inside their mothers and are then painfully pressed out the way a "lumf," as Hans called a turd, is pressed out. The tale only intensified the little boy's interest in "lumfs." But beyond displaying a certain precocity in his observations, his speech, and his erotic interests, Little Hans was growing up a cheerful, lovable bourgeois boy.
     Then in January 1908, something unexplained and unpleasant happened. Little Hans developed a crippling fear that a horse would bite him. He grew afraid, too, that large dray horses pulling wagons might fall down, and he began to avoid the places where he might encounter them. Max Graf, father, hero, villain, and his son's private healer in one, began to interview his son and to interpret the meanings of Little Hans's phobias, reporting to Freud frequently and in detail. He was inclined to attribute the boy's anxieties to sexual overstimulation generated by his wife's excessive tenderness. Another of his suspicions, which Little Hans came to share, was that his masturbating was the source of those anxieties. But Freud, as usual willing to wait before offering a diagnosis, was not convinced. In accord with his early theorizing about anxiety, Freud conjectured that the trouble stemmed rather from Hans's "repressed erotic longing" for his mother, whom in his boyish way he kept trying to seduce. His repressed erotic and aggressive wishes were transformed into anxiety, which then fastened on a particular object to be feared and avoided--this was the horse phobia.
     Freud's way of attending to Little Hans's symptom was characteristic of his analytic style: he took reports about mental states seriously, no matter how absurd or apparently trivial they might appear. "A little boy's foolish anxious idea, one may say. But a neurosis never says anything foolish, any more than a dream. We always scold," Freud commented, frowning at his readers, "when we don't understand. That is to make things easy for oneself." In one of his few observations on technique in this account, Freud ventured to criticize Hans's father for pushing his son too hard: "He asks too much and investigates in accord with his own presuppositions instead of letting the little boy express himself." Freud had made that mistake with Dora, but now he knew rather better, and the emotional stakes were not quite so high--at least not for him. To follow Max Graf's method, he warned, is to make an analysis "impenetrable and insecure." Psychoanalysis, as Freud had been saying since the 1890s, and usually remembered, is the art and science of patient listening.
     Little Hans's phobia became more pervasive. He was reluctant to leave his house, but when he did, he sometimes felt compelled to look at horses. At the zoo, he would avoid the large animals, which he had liked before, but continued to take delight in the smaller ones. The penises on the elephants and giraffes evidently bothered him; Hans's preoccupation with genitalia--his own, his father's, his mother's, his little sister's, those of animals--was threatening to develop into an obsession. But Freud found it necessary to dispute Max Graf's obvious inference that his son was afraid of big penises. The conclusion to one conversation on Little Hans's favorite subject that his father recorded for Freud supplied an invaluable clue: "You were probably frightened"--the father is speaking--"when you saw the horse's big wi-wi-maker, but you need not be frightened of that. Big animals have big wi-wi-makers, little animals, little wi-wi-makers." Hans's reply: "And all people have wi-wi-makers. And my wi-wi-maker is growing with me when I get bigger; after all, it's attached." To Freud this was a clear signal that Little Hans was afraid of losing his own "wi-wi-maker." The technical term for that fear is castration anxiety.

AT THIS STAGE of the analysis the young patient and his father came to consult Freud, who now heard for the first time, and saw, material that greatly advanced the resolution of Little Hans's malaise. The threatening horses stood in part for Hans's father, who was equipped with a big black mustache just as the horses were with their big black muzzles. Hans, it turned out, was mortally afraid that his father was angry with him because he could not contain his overwhelming love for his mother and his obscure death wishes against his father. The biting horse was a stand-in for his angry father; the falling horse, for his dead father. Little Hans's fear of horses, then, was a sophisticated evasion, a way of coping with emotions he did not dare avow freely to himself or to anyone else. The American psychoanalyst Joseph William Slap has offered an intriguing complementary (rather than contradictory) interpretation of Little Hans's fear of horses: In February 1908, in the second month of his neurosis, the little boy had his tonsils out (see "Little Hans," SE X, 29), and at this point his phobia grew worse. Shortly thereafter, he explicitly identified white horses as biting horses. On the basis of this and related evidence in Freud's history, Slap suggests that little Hans probably added his fear of the surgeon (with his mask and his white coat) to his fear of his mustachioed father. (Joseph William Slap, "Little Hans's Tonsillectomy," Psychoanalytic Quarterly, XXX [1961], 259-61.) Little Hans experienced his conflicts all the more painfully because he also loved the father whose rival he fancied himself to be, just as he harbored sadistic wishes against his mother in tandem with his passionate affection for her. The travail of Little Hans underscored for Freud
the ubiquitous working of ambivalence in mental life. Hans would punch his father and then kiss the spot he had hit. This was emblematic of a general human disposition; ambivalence is the rule in the oedipal triangle, not the exception.
     From the moment that Freud kindly interpreted these realities to his five-year-old patient, Hans's phobia began to recede and his anxiety to disappear. He had distorted his unacceptable wishes and fears into symptoms. His way of dealing with bowel movements, the "lumfs" that came out, was characteristic of this defensive distortion: he thought about them inquisitively, but translated the pleasurable and exciting associations with his conjectures about them--babies are like so many "lumfs"--into unconscious shame and then into an overt expression of disgust. In the same way Hans's phobia, that source of troubling uneasiness, was the offspring of such activities as vigorously playing horse, which had once given him keen enjoyment. His case was a splendid illustration of defense mechanisms at work in the oedipal phase.
     As Hans's analysis took hold, as he gained greater inner freedom, he could admit that he harbored death wishes against his little sister. He could also deal with, and talk about, his "lumf" theory and about the thought of being at once a mother and a father to his children, whom he would bear anally. These were tentative confessions, for he took them back as soon as he had made them. He wanted children, he said, and (in the same breath) he did not want children. But to admit to such feelings and such conjectures at all was a leap toward cure. Indeed, throughout his treatment, Little Hans showed extraordinary analytic acumen; he rejected his father's notions about his neurosis if they were offered at the wrong time or with intolerable intensity, and intelligently distinguished between thoughts and actions. He knew at age five that wishing and doing are not the same thing. Hence he could insist on his right to plead innocent in face of his most aggressive wishes. When he told his father that he thought--really, wished--that his little sister might fall into the bath water and die, the elder Graf interpreted the remark: "And then you would be alone with Mummy. And a good boy doesn't wish for that!" Little Hans, unfazed, rejoined, "But he may think it. " When his father objected, "That isn't good," Hans had a ready response: "If he thinks it, it's good just the same, so that one can write it to the Professor." The Professor could not conceal his admiration: "Bravo, Little Hans! I could wish for no better understanding of psychoanalysis from any adult." The resolution of his oedipal conflicts was quite as inspiriting: he imagined his father married to his mother; thus he, Little Hans, could keep the elder Graf alive and at the same time marry his mother and have children with her.
     The trail that Freud followed to expose the villain in Little Hans's psychological drama was far shorter, far less tortuous, than the trail would have been if Freud had been asked, a dozen or so years later, to analyze Big Hans: "The physician who treats an adult psychoanalytically, at last reaches through his work of uncovering psychical formations, layer by layer, certain hypotheses about the infantile sexuality in whose components he believes he has found the motive forces of all the neurotic symptoms of later life." With Little Hans, there was no need for such deep digging. If Freud, with evident satisfaction, claimed for the case "typical and exemplary significance," that was precisely because it condensed so perspicuously what analyses of adults were compelled to unravel in time-consuming labor.
     One theory this unconventional psychoanalysis of a child exemplified was that of the Oedipus complex, which, we know, Freud had been able to complicate considerably since he had first broached the idea a decade or so earlier. Little Hans was no less informative about the work of repression, was in fact a veritable textbook case with his transparent self-protective maneuvers. A five-year-old, though he is well on his way toward erecting psychological defenses like shame, disgust, and prudery, has not yet consolidated them. Certainly, Freud suggested in his best anti-bourgeois manner, they are still far from being the steep and solid fortifications that will protectively hem in the adult, particularly in modern middle-class culture. This look at the history of repression in a growing child allowed Freud to say some sharp words in behalf of candor in the canvassing of sexual matters with the young. Hence the case study of Little Hans is more than a copious anthology of psychoanalytic propositions: it hints at the impact Freud's thinking would come to have outside the consulting room--though not yet in 1909, and not for some years after.
     Freud was satisfied that the analysis of Little Hans had not had the dubious benefit of suggestion; the clinical picture made sense, the patient had assented to interpretations only when they fitted. Besides, Hans had conquered his anxieties and his phobia. In a short postscript added thirteen years later, in 1922, Freud triumphantly reported a visit from a "sturdy young man of nineteen," Little Hans grown up. Herbert Graf, later to become a well-known producer and director of operas, stood before him. Freud could not help gloating that the dire forecast of his critics had not been realized. They had predicted that the analysis would rob the little boy of his innocence and ruin his future. Freud could tell them that they had been proved wrong. Hans's parents had been divorced and had remarried, but their son had survived this ordeal, like that of his puberty, without apparent damage. What Freud found particularly interesting was his visitor's observation that when he looked at the case history, he felt he was reading about a complete stranger. It was rather like Martin Freud being unable to recall what his father had said to make him regain his self-respect after his humiliating confrontation at the skating rink. Hans's comment was a reminder to Freud that the most successful analyses are the ones the analysand forgets after termination.

DORA WAS HYSTERIC, Little Hans phobic, the Rat Man, yet another of Freud's classic patients, was obsessive. He was most suitable, then, for inclusion in Freud's repertory of published case histories. We know that Freud thought the Rat Man's case very instructive, as instructive in its way as Dora's had been. But he liked him much better: it was Freud himself who referred to his famous patient informally, with a measure of affection, as the Rattenmann, or, in English, as the "man of the rats." The treatment started on October 1, 1907, and lasted rather less than a year, setting a pace that analysts of later generations would consider breath-taking rather than deliberate. But Freud claimed that it was enough to relieve the Rat Man's symptoms. Yet he could not defeat history. Looking back at the great slaughter of the First World War, he concluded somberly in a footnote added to the report in 1923, "The patient perished, like so many other valuable and promising young men, in the Great War."
     The case had everything in its favor. Ernst Lanzer, a twenty-nine-year-old lawyer, struck Freud from the first meeting as clearheaded and shrewd. He was also entertaining; he told his analyst amusing stories and presented him with an apposite quotation from Nietzsche about the power of pride over memory which Freud happily quoted more than once. Lanzer's obsessive symptoms were obtrusive and bizarre. Freud had discovered in his practice that obsessive neurotics can be interesting, with their self-contradictions and perverse logic. Rational and superstitious at once, they sport symptoms that conceal and reveal their origins, and are beset by maddening doubts. The Rat Man displayed this symptomatology more flamboyantly than most: as his treatment progressed, oscillating between the patient's communications and his analyst's interpretations, adult illness and infantile appetites, thwarted sexual needs and aggressive wishes, it became a model for the elucidation of obsessional neuroses as Freud then understood them.
     They urgently called for such a model. As Freud noted in the introduction to this case history, obsessional neurotics are far harder to read than hysterics: the resistances they mobilize in the clinical setting are remarkable for their ingenious obstructiveness. For, while "the language of the obsessional neurosis" is often free of puzzling conversion symptoms, it is, so to speak, "only
a dialect of the hysterical language." To compound the obscurities, an obsessional will simulate health as long as possible and seek out the psychoanalyst's help only when very sick indeed. All this, combined with the need for discretion, prevented Freud from making this case report complete. He could offer nothing more than "crumbs of insight" which were, he thought, in themselves perhaps not very satisfactory. "But the work of other investigators may link up with it." The year Freud wrote these words, after all, was 1909; by now there were other investigators on whom he thought he could count.
     Apart from a handful of interesting deviations, the case history Freud published generally followed the process notes he made every night. In the introductory hour the patient presented himself and listed his complaints: fears that something terrible might happen to his father and to a young woman he loved; criminal impulses like the wish to kill people and retributive ones like the urge to cut his own throat with a razor; obsessive preoccupations, some of them centering on almost ludicrously insignificant matters such as repaying negligible debts. He then volunteered some details about his sexual life. When Freud asked why he had lit on this theme, the Rat Man acknowledged that he thought this would suit Freud's theories, of which he in fact knew virtually nothing. But after that, the Rat Man proceeded on his own.
     Following this first hour, Freud acquainted the Rat Man with the "fundamental rule" of psychoanalysis: he would have to report everything, however frivolous or senseless, that came into his mind. Accordingly, the Rat Man started talking about a friend whose counsel he greatly appreciated, particularly when his impulses to commit murder or suicide troubled him most, and then he launched--"quite abruptly," Freud commented--into a recital of his sexual life in childhood. Like all early communications in the course of a psychoanalysis, this choice of initial topics--his male friend and his desire for women--had a significance that the analysis would gradually unravel. The topics the Rat Man chose pointed both to the episodic emergence of strong homosexual impulses in his childhood and adolescence and to even stronger, precociously developed, heterosexual passions.
     In fact, it became quite obvious before long that the Rat Man's sexual activity had begun unusually early. He recalled pretty young governesses whom he had espied in seductive undress or whose genitals he had fondled. His sisters, too, had been of absorbing sexual interest to him; observing them, playing with them, was virtually incest accomplished. But soon the young Rat Man found his sexual curiosity, including the pressing wish to see women naked, undermined by the "uncanny feeling" that he must prevent such thoughts from arising lest, say, his father die. Thus in the opening phase of his treatment, the Rat Man threw a bridge from the past to the present: his father had died some years before, but his fear for him had somehow persisted. This uncanny feeling, first experienced when he was about six, yet still remaining extremely disturbing to him, was, the Rat Man told Freud, "the beginning of my illness."
     But Freud had a different diagnosis: the events of his patient's sixth or seventh year were "not merely the beginning of his illness, but already that illness itself." In order to grasp "the complicated organization of his later illness," Freud thought, it was necessary to recognize that the six-year-old boy, that "little voluptuary," already displayed "a complete obsessional neurosis lacking no essential element, at once the nucleus and the prototype of his later disease."
     This was a rich beginning. But the Rat Man kept up the pace; he recounted to Freud with deep emotion the event that had sent him into psychoanalysis. On military maneuvers he had heard a captain describe a particularly horrifying punishment practiced in the Orient. At this moment, dramatically interrupting himself, the Rat Man stopped, got off the couch, and pleaded with Freud to spare him the rest. Freud instead gave his patient a short lesson in technique. Disclaiming all inclinations to cruelty, he insisted that he could not give what was not at his disposal. "The overcoming of resistances is a law of the treatment." What he could do was to assist the Rat Man in finishing the story sentence by broken sentence: someone convicted of a crime was tied down, a pot with rats in it was turned upside down on his buttocks, and the rats would--here the Rat Man got up again in great agitation--bore their way into . . . "Into his anus," Freud supplied the decisive last word.
     Observing the Rat Man closely during this recital, Freud noticed in his patient's face "a very strange composite expression" which he could unriddle only as "one of horror before a pleasure of his unknown to him." It was a slight intimation, nothing more, which Freud filed away for later use. Whatever the Rat Man's concealed mixed feelings about the rat punishment might be, he told Freud that he visualized the young lady he adored, as well as his father, being subjected to it. Then, when such awful ideas invaded him, he would call elaborate obsessive thoughts and actions to his rescue.
     These salvage operations resisted rational understanding and presented Freud with aesthetic as well as clinical puzzles of the first order. The Rat Man told Freud an involved, barely coherent, and it would seem trifling story about some money he owed a fellow officer, or perhaps a clerk at a post office, for a package containing some eyeglasses he had ordered. Freud glossed his conscientious account of his patient's absurd preoccupations and odd ideas by sympathizing with his audience: "I would not be surprised, if at this point the reader fails to follow me." Even Freud, intent above all on extracting meaning from the Rat Man's thoughts and ceremonies, found some of them "senseless and incomprehensible." But then, the Rat Man experienced his symptoms, whether inexplicable or ludicrous, as virtually unbearable. Freud appreciated this; still, at times they drove him almost to despair. With their extraordinary expenditures of energy on the unimportant, their seeming irrelevance and illegibility, and their repetitiveness, obsessive symptoms may become as boring as they are irrational.
     Freud, the most literary of psychoanalysts, could not rest satisfied with serving up a dry case report or a collection of undigested observations; he wanted to reconstruct a human drama. But the material that the Rat Man scattered with such abandon--material strange, copious, apparently pointless--threatened to elude Freud's control. He complained to Jung as he was completing his case history, "It is very hard for me, almost surpasses my arts of presentation, will probably be inaccessible to anyone except those closest to us. How botched our reproductions are, how miserably we pick apart these great art works of psychic nature!" Jung privately agreed. Writing to Ferenczi, he grumbled that while Freud's paper on the Rat Man was wonderful, it was also "very hard to understand. I will soon have to read it for the third time. Am I especially stupid? Or is it the style? I cautiously opt for the latter." Freud would have blamed the subject matter instead.
     In his bewilderment, Freud resorted to technique to provide a map to the maze. The point was not to set about rationally solving the puzzles that the Rat Man had set, but to let him pursue his own path--and to listen. Freud in fact converted the case history of the Rat Man into a small feast of psychoanalytic technique applied and explained; he repeatedly interrupted his account with brief excursions into clinical procedure. He instructed his patient in the difference between the conscious and the unconscious mind, the transience of the first and the endurance of the second, by pointing to the antiquities standing in his consulting room: "They were really only objects from tombs; their burial had meant preservation for them. Pompeii was only now being destroyed, since it had been uncovered." Again, after recounting how his patient had declared an interpretation plausible but unconvincing, Freud commented for his readers' benefit: "It is never the intention of such discussions to call forth conviction. They are only supposed to introduce the repressed complexes into consciousness, to kindle the conflict about them on the soil of conscious mental activity, and to facilitate the emergence of new material from the unconscious." In showing how he taught the Rat Man about psychoanalysis, Freud taught his readers no less.
     The Rat Man called the "new material" about his father that he explored in response to Freud's interpretations his "train of thought"; it was harmless, he insisted, but connected somehow with a little girl he had loved when he was twelve. Freud was not content with such a vague, euphemistic formulation, so typical of the Rat Man's discourse. Rather, he interpreted this train of thought as a wish, a wish in fact, that his father might die. The Rat Man energetically protested: he was afraid of precisely such a calamity! he loved his father! Freud did not dispute that at all, but insisted that this love was accompanied by hatred and that these two powerful emotions had coexisted in the Rat Man from his earliest youth.

HIS UNDERSTANDING OF the Rat Man's fundamental ambivalence now beyond cavil, Freud could approach the enigma of his patient's obsessions. Patiently, he inched up to the episode in which the sadistic captain had described the oriental punishment and precipitated the Rat Man's current neurosis. Freud's notes on this case disclose that the Rat Man employed rats as symbols for many things: gambling, penises, money, children, his mother. The mind, Freud had always maintained, makes the most acrobatic, most improbable leaps, defying coherence and rationality, and the Rat Man amply confirmed this conviction. What appeared most far-fetched in the case, the ceremonies and prohibitions, turned out to be a compendium of the Rat Man's neurotic ideas, leading in subtle ways to unexplored regions in his mind. They were clues to his repressed and disavowed sadism, which explained his simultaneous horror of, and lascivious interest in, cruelty--the source of that strange mixed expression on the Rat Man's face that Freud had glimpsed at the very beginning of the treatment.
     Exploring these hints, Freud now proposed a solution to the question of what the captain's story meant for the Rat Man. It revolved around his patient's conflicting feelings about his father. Freud found it highly significant that when, several years after his father's death, the Rat Man had first experienced the pleasures of sexual intercourse, a strange thought had forced itself into his mind: "But this is wonderful! For this one could murder one's father!" Freud found it no less significant that a few years before, just after the Rat Man's father had died, he had begun to masturbate, but had since managed to stop by and large, because the practice made him ashamed. By and large, but not completely: at some beautiful, elevating moments, such as reading a moving passage in Goethe's autobiography, he could not resist the urge. Freud interpreted this curious phenomenon as an instance of a "prohibition and the defiance of a command."
     Stimulated by Freud's analytic construction, the Rat Man contributed a poignant, memorable incident dating from the time he was between three and four. His father had given him a thrashing for some sexual misdemeanor connected with masturbation, and in a burst of fury, he had begun to curse his father. But since he did not yet know any swear words, he had called him "all the names of things that occurred to him, and said, `You lamp, you towel, you plate!' " Astonished, the father was moved to predict that his son would become either a great man or a great criminal, and never beat him again. With this memory out in the open, the Rat Man could no longer doubt that concealed behind his love for his father, there lurked an equally strong hatred. This was the ambivalence that governed the Rat Man's life, a tormenting ambivalence characteristic of all obsessional thinking, and was echoed in his relations with the woman he loved. These conflicting feelings, Freud concluded, "were not independent of one another, but soldered together in pairs. His hatred of his beloved was necessarily coupled with his attachment to his father and vice versa."
     Freud pressed on with his solution. The Rat Man had not only fought his father but identified with him. His father had been a military man who greatly enjoyed telling anecdotes about his army career. What is more, he had been a "rat," a "gambling rat"--Spielratte--who had once run up a gambling debt that he could not afford to pay until a friend had opportunely lent him the money. Later, the Rat Man had reason to believe, his father, prosperous in civilian life, had been unable to repay his generous rescuer because he could not find his address. Freud's patient judged this youthful peccadillo of his father's very harshly, much though he loved him. Here was another link to his own peculiar compulsion to repay the minute sum someone had laid out on postage for him, and another link to rats as well. When, on maneuvers, he had heard the sadistic story of the rat punishment, it had awakened these memories, and remnants of his childhood anal eroticism no less. "In his obsessional deliriums," Freud noted, "he had made a veritable rat currency for himself." The story had dragged up from repression all the Rat Man's cruel sexual impulses. Once he had absorbed this cluster of interpretations and accepted it, the Rat Man approached closer and closer to the exit from the labyrinth of his neurosis. The "rat delirium"--the obsessive compulsions and prohibitions--disappeared, and with that the Rat Man had graduated from what Freud beautifully called his "school of suffering."
     Despite the problems he set for his analyst, the Rat Man was something of a favorite with Freud from the beginning. There is a cryptic entry in Freud's notes for December 28 that attests to his feelings for his patient: Hungerig and wind gelabt--"Hungry and is refreshed." Freud had invited
his patient to a meal. This was a heretical gesture for a psychoanalyst: to gratify a patient by permitting him access to his analyst's private life, and to mother him by providing food in a friendly and unprofessional setting, violated all the austere technical precepts that Freud had been developing in recent years and was attempting to inculcate among his followers. But evidently Freud saw nothing wrong in thus setting aside his own rules. Indeed, despite these departures, Freud's account remains exemplary as an exposition of a classic obsessional neurosis. It brilliantly served to buttress Freud's theories, notably those postulating the childhood roots of neurosis, the inner logic of the most flamboyant and most inexplicable symptoms, and the powerful, often hidden, pressures of ambivalent feelings. Freud was not masochist enough to publish only failures.

 

Projective Identification & Psychotherapeutic Technique
Thomas H. Ogden
Chapter 5- The Developmental Impact of Excessive Maternal Projective Identification

The concept of identification has historically served as a vehicle for conceptualizing the interface between object relations and individual psychological organization. This has involved therapists and analysts in the task of coming to terms with their views about the ways in which the psychological attributes of one person are "taken in by" or "made a part of" another person (Fairbairn, 1952; Fraiberg et al., 1975; Freud, 1905, 1915b; Guntrip, 1961; Hartmann, 1939; Kernberg, 1966,1976; Knight, 1940; Loewald, 1962; Schafer, 1968).
     In this tradition the present chapter examines a form of identification demonstrated by a specific group of patients. This form of internalization will be explored to further refine the concept of identification and contribute to our thinking about the interplay of maternal pressures and the psychological processes of the infant.'
     The clinical focus will be on one of this group of patients who demonstrate a form of identification with their mother and in particular with the conflicted aspects of the mother. These patients seem to take the mother's pathology, and especially the mother's view of the patient as colored by her pathology, as a model for identification which is reflected in their self-representations, in their object relations, and in many of the characteristics of their ego organization. The early history of these patients is dominated by a picture of a mother deeply involved in her own problems--problems from which she failed to shield the infant. Among the group of patients studied, examples of such maternal preoccupations include: one mother who was consumed by wishes for the child to be an embodiment of an aspect of herself which was both intensely hated and highly idealized; another mother who was filled with the need for the baby to restore her relationship with her mother, who had died when she was 10 years old; and finally, a mother consumed by wishes and fears concerning the sex of the child because of her own wishes, fears, and disappointments about her own sex.
     Such circumstances become pathogenic when the mother's attempts to deal with her problems interfere with her ability to respond empathically to her child. Such interference may occur under conditions where the mother, in her attempts to deal with consciously unacceptable feelings, develops excessive reliance on such psychological processes and modes of behavior as splitting, denial, projective identification, and impulsive activity.
     A clinical discussion of the process of internalization of the conflicted psychological state of the mother will be used as a vehicle to formulate a developmental hypothesis regarding this identification, and to offer some thoughts about this specific use of early identification as a defensive response to excessive maternal projective identification. In this volume "early history" is not viewed as a static fact that is slowly discovered but rather as a dynamic construction, which patient and therapist work toward and which is based on the patient's changing retrospective view as well as on the unfolding data of the transference and countertransference.

CASE HISTORY
Miss R., a 34-year-old single woman born in Wales, was working as a secretary in a large American city when she decided to seek psychotherapy. Life had become "unbearable" as a result of her desperate longing for a boyfriend who had just broken off their relationship. Unable to live without him, she felt on the verge of suicide. The patient thought constantly about this man who had let her down. Miss R. ruminated about the things she might have done to prevent the breakup and the ways she could possibly get him to take her back.
     This was the fourth time in 12 years that the patient had been involved in a very intense, dependent relationship that had ended this way. She had been treated for a year in psychotherapy after the third of these relationships. That therapy was terminated when the therapist left the area. Eighteen months later, the patient sought therapy for a second time.
     Miss R. appeared considerably older than 34 and gave the appearance of being a rather old-fashioned, slightly untidy woman who had somehow refused to accept the fact that times had changed. She looked drained and tired; her eyes were red, presumably from crying and lack of sleep.
     Since Miss R. was 18 years old she had been filled with the conscious wish to find a man who loved her and could alleviate her intense feelings of longing and incompleteness. The involvements that dominated the patient's adult life were all so similar that a description of one can serve for all four.
     Soon after the end of the previous therapy, the patient became involved with a lawyer who had had a long series of short, unsuccessful relationships with women. The patient knew this about the man but blinded herself to the fact that he did not express any affection for her. Miss R. became
more and more clinging and demanding of his affection, until he told her after 14 months that she was "too much for him" and ended the relationship. The patient appeared at his office begging him to take her back. and telephoned him several times a day. She cried at work, took frequent sick days, and finally was dismissed.
     On the basis of talks with her mother (the circumstances of which are described below), as well as through discussions with her father and maternal grandfather, the patient gradually constructed the following history, which she presented over the course of the beginning stages of therapy. Miss R. was the eldest of three children born to a lower-middle-lass family in urban Wales. The patient's mother, Mrs. R., was a strikingly attractive woman who had had a series of successes in amateur singing competitions in London before she married. She was considered very talented and had fantasies of becoming a famous opera singer. However, at 23 she felt old and thought that she had already lost her chance for a successful operatic career.
     Mrs. R. had been raised by two alcoholic parents who could barely provide the essentials of life for their two children. From the age of 9, Mrs. R. worked to buy relatively expensive clothes for herself and her brother in order to create the impression that she came from a middle-class family. She daydreamed of having immense wealth and of marrying a diplomat or a man of royal lineage.
     While in London the patient's mother met and, after 6 months, married a man who had recently inherited a family business in Wales. Upon returning to Wales, they discovered that the business had faltered and was nearly bankrupt. Two months after the marriage, the patient was conceived. The infant was seen as a quiet, "easy" baby. Breast-feeding was continued for 16 months. In these early months the patient's mother seemed to enjoy the closeness of the breast-feeding situation, during which she would sing to the infant.
     The patient believed that this relationship changed drastically once she was weaned. From then on the mother was described as having been a very powerful, angry woman who could be ruthless in her attacks on the patient. The patient had vivid memories, dating back to a time before she was 4, of being treated with disdain and disgust and of having been told over and over that she was incorrigibly stupid, unlikable, and exceedingly ugly. In the mother's mind the distastefulness of these traits was compounded by their apparent close resemblance to the traits of the patient's father. The mother treated her husband with contempt and ceaselessly criticized him for his ineptitude and lack of manliness. The father remained very much to himself, hardly involving himself with his children.
     The patient developed a quiet somberness and was often stubborn, but never defiant. Miss R. remembered her childhood as a continual barrage of verbal attacks from a mother whose venom seemed to increase instead of subside with each assault.
     Mrs. R. would periodically withdraw into severe depression, sometimes lasting for months at a time. During these periods, she would cease to care for her own appearance (which she highly prized at other times) and would neglect the cleaning of the house and the preparation of meals. Instead, she spent most of her time in bed talking to herself and to the patient about how worthless, old, and unattractive she felt.
     From early school age, Miss R. was interested in music and dance and was recognized at school as having talent. When the patient performed in school programs, Mrs. R. consistently refused to attend. The patient's fantasies of becoming a famous ballerina elicited rage from the mother who would accuse her of living in a dream world.
     The patient's mother repeatedly threatened to send her to live with an aunt in London. At the age of 6, and again at the age of 9, Miss R. was sent to London for a period of a month when the mother could "bear it no longer." Then, when the patient was 11, without warning, the mother moved away with a man 10 years her junior. She returned after 6 months, disappointed and defeated. Shortly thereafter, the patient and her family emigrated to America. The verbal attacks on Miss R. continued until the patient left home at age 18. Having done well in secondary school, the patient was accepted at a university. However, her parents refused to pay the tuition, even though they could have afforded it, and in the end the patient moved to another city, where she began working as a secretary. A few years later, she became involved in the first of the four relationships that dominated the succeeding years of her life.
     Miss R. insisted that she had found her previous therapy extremely helpful and would "do anything" to be treated again. In the twice-weekly therapy to be presented here, the patient very soon established a pattern of filling the hours with detailed descriptions of the latest insults, embarrassments, and humiliations that she had suffered at the hands of her most recent boyfriend. These monologues were intertwined with repetitive accounts of her intense longing for this same man and the feeling that she could not go on without him. The descriptions were delivered in a monotonous, persistent tone that did not reflect any ability to distance herself from the material or understand it. In addition, the patient managed to communicate the fierce tenacity with which she would hold onto this mode of relating.
     As the therapist began to feel he understood some aspect of the transference or some other part of the patient's communication, he would venture a clarification or occasionally an interpretation. Such interventions were consistently met with indifference, and the patient would go on with her descriptions in precisely the same way as she had before the intervention. For example, in the third month of treatment, the patient spent large portions of a number of sessions mechanically and repetitively describing a bout of shingles that she had had a year before beginning therapy. In the course of this narrative, Miss R. talked about how callously several doctors had treated her. She said that she had had this kind of experience with doctors all through her life. "I've always hated their patronizing, their use of their knowledge and position to belittle others and to boost their own egos. I could never relax with any of them and always felt humiliated by them." As this theme was repeated in several sessions, the patient at one point made a slip and substituted the therapist's name for that of one of the earlier doctors. Later in the session the therapist said, "I wonder if you sometimes feel that I can be a patronizing, belittling, humiliating doctor?" The patient, without pause or hesitation, responded that the therapist was a psychiatrist and that she was referring to internists. In the same breath, the patient began a lengthy description of an incident in her adolescence when a dermatologist had paraded her in front of a group of medical students so they could examine her severe case of facial acne.
     Gradually, after several more weeks of this form of interaction, the therapist began to stop the patient when she attempted to ignore what had been said and would ask her to consider the way that she had of not giving any evidence of having "held" or "taken in" what had been said even for a moment. This intervention in turn would be ignored or paid momentary lip service, and the patient would return to another monologue as if nothing had been said. In the same way, the patient responded with bewilderment when her repeated lateness to her sessions was treated as worthy of exploration for possible meaning.
     This form of interaction continued for 6 months, during which the therapist struggled to understand the meaning underlying this transference-countertransference pattern. The therapist would often feel tormented by the patient's relentless, monotonous, lifeless descriptions, frequently feeling trapped in seemingly endless therapy hours. Sometimes, he felt as if he were utterly helpless in the hands of a robot, without any hope of appealing to a responsive human core. At other times, he imagined himself taking the patient by the throat and sadistically jolting her from her lifeless discourses. It was when these sadistic fantasies were at their peak that the therapist felt the greatest impulse to flee from the room. At the same time as the therapist was becoming aware of these countertransference feelings, he also noted a recurrent theme in the patient's monologues. The patient began to talk almost exclusively about her mother's threats to abandon her and the three different occasions when she actually did so.
     The awareness of the transference-countertransference themes described and their link to the theme of abandonment led the therapist to say to the patient: "I get the feeling that the repetitive descriptions you bring to each session are in ways an attack on me, an effort to goad me into attacking you in precisely the way your mother used to do. Maybe there would be some comfort in that for you. After all, at least you knew your mother was there when she was attacking you."
     A subtle shift occurred at this point. The patient seemed not to be moved by this interpretation, any more than she had been by earlier interventions, but for the first time something different happened in the therapy. In the succeeding sessions, Miss R. continued with her monotonous descriptions with one important change: she no longer looked at the therapist. The patient's impact on the therapist was no longer simply one of torment; there was a glimpse of some other element in it. In retrospect, it seemed that this element had been present in the earlier phase of work but had been more thoroughly masked by the intensity of feeling involved in the tormentor-tormented aspect of the interaction. Even though the form of the repetitive descriptions remained the same, there were subtle, almost subliminal shifts in the nature of the interpersonal interaction. The patient no longer nodded at the therapist as she walked to her chair at the beginning of the session; she made no reference to the content of previous meetings; her dreams were very vague and contained only one person, herself. The therapist found himself struggling to maintain the sense of himself as the tormented object in preference to the increasingly chilling and disorienting feeling that was being fostered in him--the feeling of his not being there at all.
     Even though this awareness of the struggle was helping the therapist to clarify for himself the nature of the therapeutic interaction, the therapist did not immediately offer this to the patient in the form of an interpretation. It was felt that the resistance to such an idea was still very powerful, and that the therapeutic alliance was fragmentary.
     The therapist was able, however, to make use of this understanding in his handling of the material that the patient was offering. Over the next several months, as Miss R. talked about the tormented feelings she had had in her relationships with her boyfriends and her mother, the therapist was attuned both to the way the mother was felt to be more securely present in a tormented-tormenting relationship and to the way the patient herself felt more recognized, more present, more real for her mother at those times.
     Very slowly the patient's descriptions of the mother's torment began to reflect a distance on the material. Miss R. for the first time was able to tell the therapist about the infrequent but highly significant periods of calm in the storm of maternal torment: it had been very important to Mrs. R. that the patient and no one else look at her photograph album with her. At these times, the patient's mother took on a softness and youthfulness that she displayed at no other occasion. They would spend hours admiring photographs and newspaper clippings from the era of the mother's amateur singing competitions and the patient's early infancy. Mrs. R. would sing in a way that the patient genuinely admired and felt soothed by. She said she felt "aglow" at these special times. In fact, she took on a gentleness in the therapy hours as she quietly talked about the way she had felt special to her mother at those times, as if there were something about herself that the mother could not do without. But these times with her mother had had abrupt endings leaving the patient feeling as if she (Miss R.) had disappeared afterward.
     It was at this point in the therapy, just when a therapeutic alliance seemed to be developing, that the patient became increasingly anxious, developed migraine headaches and nausea, and began to cancel sessions. It took a long time before Miss R. was able to say that she had become very frightened of talking openly to the therapist because she had "known" from the beginning that there was a secretary in another division of the clinic whom she knew socially, who had access to her records and had been reading them. She knew this because the secretary had made reference to Miss R. being over 30, and there was no other way she could have known that other than from the records. Since in the therapist's view the patient appeared to be well over 30, this suggested that Miss R.'s suspicions may not have been founded in reality. The therapist explored with the patient the basis of her belief that the secretary had seen her records. In the following session, the therapist said that he had found on looking into the record-keeping practices of the clinic that it was highly unlikely that the secretary could have had access to the patient's records, but that it would be naive to say that any records are totally immune to vandalism. The patient sullenly said that she had half-expected to be publicly humiliated when she came to any clinic, and that she guessed she would just have to live with that danger.
     Over the next few weeks of therapy, the patient was able to address the transference level of her anxieties. She noted that although she had had fears about doctors and breaches of confidentiality prior to the beginning of the therapy, not until she began talking about and reexperiencing in the therapy the moments of feeling aglow did she begin to be overwhelmed by her fears of exposure. She said that she felt that the core of her worries was a fear of being found out, of being exposed as different from what she appeared to be. She talked about fantasies and dreams that she had had since childhood of being exposed as utterly and basically fraudulent. It was not so much that there was a horrible crime that she was keeping hidden; rather, it was the act of deception itself that was the crime.
     As this was being discussed, Miss R.'s anxiety and somatization subsided. The patient went on to relate the feeling of being exposed to earlier feelings that she had had with her mother. She could understand the feeling being present at the "special" times with her mother because to be that special was such a fragile and tenuous situation in the midst of all that had happened before and all that was sure to happen afterward. How long could it be before the mother would see the patient for what she was? What was surprising to the patient was the awareness of the same fear of exposure during the mother's torment. The patient began to be aware that there too she felt the danger of exposure. For how long could she really be the living embodiment of worthlessness and ugliness for the mother to rave at?
     At this point the therapist could make use of his experience in the countertransference to say: "You must have struggled desperately to be a child your mother could despise and torment, because you must have been afraid that if you weren't, you would have ceased to exist for her at all."
     Over the next year of the therapy--which lasted two years in all--the patient's fear of becoming nonexistent appeared and reappeared in the transference, in the patient's outside relationships, and in the patient's increasing understanding of her early relationship with her mother. During a series of sessions in the middle of the second year of the therapy the patient reexperienced an eerie feeling that she had not thought much about since she was a child, although the feeling had not been an uncommon one for her. It was only through her description of a group of memory images that she could convey to the therapist any sense of the feeling that she was experiencing.
     In each of these memories, the patient pictured herself in a dimly lit room watching her mother doing something, while her mother was unaware that the patient was in the room. The mother was pictured as being lost in her thoughts as she sat listening to the radio, or cleaning the silverware, or smoking a cigarette. The patient became extremely anxious in the therapy hours as she remembered these scenes. Miss R. said that she hated the eerie feeling associated with these memories, and that she could hear a thin, high-pitched, "empty" sound that went along with the feeling. The patient said that the sound ought to be used in a science fiction movie about outer space. The sound somehow reminded her of a large, clean, empty stainless steel container that did not even have any fingerprints on it." The feelings of outerspace-like aloneness and sterile emptiness that Miss R. had often felt when she was with her mother were powerfully felt in the therapy hours over a period of several months. At times the patient said she felt nauseated by these feelings and was afraid that she would leave the hour and only be able to remember the therapist as a man in a semidarkened room, lost in thought and unaware that she had been sitting with him during the sessions.
     Many of the issues dominating this phase of the work were brought into clearer focus in a session that followed the patient's viewing The Wizard of Oz on television. In that hour Miss R. described how terrified she had been of the movie when she was a child. She said that during the previous evening while watching the film she had been very moved at the end when Dorothy finds that the Wizard is a little, bald-headed man and in a rage of disappointment shouts at him, "You're a very wicked man." The Wizard says, "No, Dorothy, I'm not a very good wizard, but I'm not a bad man." The patient sobbed bitterly and said, "I'm like the Wizard. I wasn't as special as she needed me to be or as ugly as she needed me to be. If I wasn't a wizard, I was nothing to her."
     In the months of therapy that followed, various aspects of this early relationship were expressed in the transference. At one point, the patient began to feel she had some very special importance for the therapist, perhaps as a star patient. In the midst of this the patient became very anxious and in one session asked the therapist to authorize in writing that her lateness to work on a given morning had been due to her therapy session. Upon analyzing this request the patient became aware that her reason for the request was the feeling that she was so unreal to the therapist that he would not be able to remember her name without consulting his records. At other times, there was intense despondency between sessions, stemming from the feeling that she did not exist for the therapist when she was not with him.
     This material was discussed in terms of the patient's feeling that she did not exist for her mother other than as the ugly, stubborn, villainous child the mother needed to torment and despise, or the child who could reflect the glow of the mother's feelings about herself in the photograph album.
     As the profound sadness of these ideas was discussed, the patient grew increasingly free with her anger, an emotion that had been almost totally absent before. Formerly, anger had to be disavowed, as in her attribution of her lateness to events outside her control. The patient had also tended to somatize (migraine headaches and nausea) or feel suicidal at times when one would have expected her to have felt angry. Very gradually, the patient became more and more able to express her resentment toward her mother for having used her "to be her wicked and wonderful wizard." Miss R. could also say that she did not intend to be a special patient for the therapist any more, and that he would have to find someone else to do that for him. This change could be discussed as a reflection of the fact that the patient was no longer afraid to acknowledge the separateness of herself and her mother-therapist. Formerly, feelings different from those appropriate to the "wizard" had been experienced as threatening to expose her as being other than simply a reflection of her mother's or of her therapist's needs and fantasies.
     There was also the feeling of freshly discovering people and things around her. She complimented and criticized the therapist for the selection of pictures in his office and noticed new clothes that he wore. She also seemed to discover herself as a physical being and began to dress and wear her hair much more age-appropriately and stylishly. Again, this was understood in terms of the patient's ability to acknowledge and even enjoy a sense of her own separateness without feeling in danger of becoming nonexistent for the internalized mother or for the therapist as a result of being separate from each.

PROJECTIVE IDENTIFICATION AND IMPINGEMENT
Projective identification constituted an important dimension of the therapeutic interaction between Miss R. and her therapist, and the latter's awareness of this was central to his understanding of his countertransference responses to the patient. For example, Miss R. relied heavily on projective identification in her efforts to master the internalized tormentingtormented relationship with her mother. For a long period of time, the patient projected the internalized, tormented child into the therapist, while she herself adopted a strong identification with her tormenting mother. In so doing, Miss R. felt she had rid herself of an unwanted part of herself and succeeded in turning the therapist into the tormented child.
     This was not simply a fantasy, since the patient's mode of relating elicited a very strong counter-transference response in the therapist, in which he felt powerless to be anything other than the object of torment for the patient. The therapist fantasied that the only alternative to being the tormented object was to become nonexistent for the patient. At other times the therapist felt that fleeing from the room (thus ending the relationship) would be the only way to oppose the immense pressure to be the tormented object for the patient.
     Later the therapist came to understand the patient's projective identification as a defense against reexperiencing in the transference the painful awareness of separateness from the mother-therapist. Only through his awareness of his feelings as responses to the patient's projective identifications was the therapist able to make use of this material to understand the patient and avoid acting on or closing off his feelings. In part, it was the therapist's analysis of these countertransference responses that allowed the patient to reinternalize the projected aspect of herself in a modified form--a form she could accept as a part of herself and analyze and integrate in the second year of therapy.
     The history, recovered memories, and transference-countertransference patterns offered important data regarding the unique qualities of the failure of maternal responsiveness that were internalized by the patient. It must be borne in mind that the "failures of maternal responsiveness" that we learn about through our work with our patients are necessarily reflections of the subjective experience of the patient and do not necessarily bear a one-toone correspondence to an objective assessment of the mother's capacity for empathy. Despite the fact that we are always viewing the patient's past through the lens of the patient's subjectivity, reconstruction remains an important part of analytic work. The history is replete with examples of the mother's difficulty in responding to those aspects of the patient's needs, wishes, and interests that were not simply extensions of what the mother needed the patient to be.
     The patient poignantly portrayed in the transference aspects of her early experience with maternal impingement. The patient had been noticeably relaxed in the sessions for several weeks in the beginning of the second year of therapy and seemed to be getting considerable pleasure and satisfaction from the meetings. In the session that marked the end of this period, the patient came in, sat down, and immediately began to cry. The therapist asked her what was wrong. She explained that she had just been yelled at by her boss at work. She then told the therapist to go on with what he had in mind for that day's session, adding that she did not want to interfere with what he had planned for that meeting.
     The therapist was stunned by this and said, "You're saying that you feel I have a plan for each session that I need to get through at any cost, and that my plans have nothing at all to do with anything you happen to be feeling?" The patient said that was right and was curious why the therapist had called it a feeling of hers, when she felt that it was a fact.
     This theme recurred over and over again in different forms. Since the therapist was reasonably certain that he was not being unresponsive to the patient, the material could be understood as a set of feelings portraying early experiences of maternal impingement. The patient was gradually able to view such interactions with the therapist as a re-creation of her own relationship with her mother, wherein gratification of specific maternal needs was substituted for an empathic responsiveness to the child's internal state.
     The history that Miss R. presents and the therapeutic relationship she established offer ample evidence of the presence of an intense, circumscribed mother-daughter interdependence. This interdependence can be understood as having been based on the projection of maternal pathology in such a way that highly circumscribed aspects of the relationship with the child took on critical importance, leaving the mother virtually oblivious to and unresponsive to qualities and aspects of the child that lay outside the "beam" of the projected maternal pathology (Greenacre, 1959). As described above, Miss R.'s mother oscillated between intense feelings of glowing grandiosity and equally intense feelings of worthlessness and self-hatred. Both of these sets of feelings became the basis for a powerful projective identification, with the patient as recipient. While the patient was acting in congruence with these projective identifications, aspects of the patient were terribly important to her mother, but the scope of these projective identifications was limited. The patient felt that, at those times when she was unable to be the embodiment of the projected aspect of the mother, she ceased to exist for her mother.
     To summarize, Miss R. presented a picture of her mother as a powerful woman who needed her child to be a reflection of a specific aspect of her own pathology--the wicked or the wonderful wizard. More specifically, the mother's pathology seemed to be characterized by a splitting of self- and object-representations into idealized and denigrated parts. This splitting was maintained by means of projective identification and was reflected in her to-and-fro movement from idealization of self and object to feelings of worthlessness and despair. The analysis of the transference and the countertransference suggested that the patient had felt real for the mother only when she was in a tormentedtormenting relationship, and that she had clung to this form of relatedness in preference to the sense of not existing for the mother. A basic anxiety for the patient with her mother, with her boyfriends, and in the therapy was a fear of being exposed as different from what she was in the mother's projective fantasies. If this were to happen, Miss R. feared, she would be outside the realm of what was meaningful to the mother and that outside this "beam" she would be unmothered and dangerously unprotected. Any acknowledgment of separateness from the mother's fantasy of the patient was experienced as a threat to the relative safety of the equilibrium wherein the patient was for her mother what her mother needed her to be.

THE DEVELOPMENT OF A DEFENSIVE IDENTIFICATION
In viewing internalization of maternal pathology from a developmental perspective, the discussion must immediately center around the changing pattern of the ways in which the mother and child perceive one another. At the beginning, the good-enough mother and her infant feel to one another as if they are a single unit (Mahler, 1968; Spitz, 1965; Winnicott, 1956). There is no inside or outside, self or other. The mother's role is to be responsive to the infant's emotional and physiological needs and in so doing create the illusion that the infant and mother are one. The wished-for breast is there when it is wanted and in precisely the way that it is wanted because that is the nature of things.
     Miss R. gives us some indication that her mother was a good-enough mother at this early stage and could take genuine pleasure in caring for her infant and in responsively meeting the infant's needs. In addition, there is evidence for an early period of good-enough mothering in the therapeutic relationship. Miss R. was extremely adept at creating a holding environment for the therapist for a brief time while he was ill: in a tender and humorous way, the patient expressed her concern for the therapist in a card in which she parodied Welsh home medical remedies.
     On the road to developing the capacity to differentiate self and object, the mother helps the infant create transitional objects and phenomena (Winnicott, 1951). The transitional object is at once an object created and magically controlled by the infant and an object separate from him. The question of which it is, is never asked because it is both, in such a way as to make the question never arise. As soon as there is an awareness of the question, the child is on his way to recognizing the object as separate. Mrs. R.'s ability to help the patient create a transitional realm of experience was hampered by the intrusion of her own pathology into her efforts at empathy. The patient gives us evidence that her mother ceased to be a responsively flexible medium (a mirror) and instead reflected the very definite features of her own conflicted and poorly integrated internal state. The subjective object was prematurely given definite shape that denied the infant the illusion that she herself had created it. This resulted in a premature awareness of the separateness of the infant and mother which the infant could not tolerate.
     Miss R.'s internalization of maternal pathology may be understood in terms of a specific mode of defense employed by the infant in her attempt to protect herself against the premature recognition of separateness imposed on her by excessive maternal projective identification. The infant struggled to maintain the illusion that it was she herself, and not an outside object with motives and wishes different from her own, that she was sensing in the maternal impingements. The child attempted to create the illusion that her spontaneous gesture was characterized specifically by those qualities of the mother's pathology that were communicated through the nature of the projective identifications. She struggled to maintain the crumbling illusion that it was she who created the conflicted moods and feelings that she was perceiving, even though this was at variance with the sense that she was coming upon something that had nothing to do with her.
     This defensive illusion is not at all equivalent to the creation of the normal transitional object, which is characterized by the irrelevance of the question, "Is it me or not-me?" In her desperate attempts to deny her perception of separateness, she took the mother's pathology (communicated by means of projective identification) as the basic mark of herself and modeled her self- and object-representations according to it. The anxiety underlying the fiercely stubborn allegiance to the character structures that evolved in this way is the terror of reexperiencing the feeling of being prematurely separate from the mother and subject to feelings of intense helpessness and a sense of being dangerously exposed and unprotected.
     On the basis of this developmental formulation, I feel that we can conceptualize the internalization under study as a distinctive form of identification. As with other forms of identification, it involves a process in which the infant modifies his selfrepresentations and patterns of behavior in an effort to make himself like the perceived object (Schafer, 1968). This particular form of identification is distinguished by the following characteristics: (1) the identification originates as a specific defensive response to maternal projective identification in an effort to deny the separateness of self and object; (2) the qualities of the projective identification that are internalized are taken as the basic mark of the self and used as a model for the development of object relations, self-representations, and other internal structures.
     From this perspective the observations of Ritvo and Solnit (1958), based on a Yale Child Study Center longitudinal study, become particularly relevant. They reported that identifications seem to develop in the service of defense rather than in the service of adaptation when an infant's inborn characteristics collide "forcefully with the deepiest conflicts in the mother" (p. 81). "The child imitated the mother in toto and in this way perfected a controllable, kinesthetic image of the mother to replace the threatening representation of the mother" (p. 82). What was imitated was not simply the mother, but the mother in a state of distress in which her pathology was most graphically expressed. It is significant that their findings relate the observation of conflict-laden maternal handling of the infant to the appearance in the child of a form of identification that was felt to function in the service of defense and that took the form of a total imitation of the mother in a state of conflict.
     The particular defensive identification under discussion can be understood as arising out of a failure of the mother to adequately shield the infant from her pathology, thereby exposing the infant to a premature awareness of the object as separate. The infusion of the internalized representation of the maternal conflict into so many aspects of the developing psychological structures and organizations of the infant reflects both the massive effort to deny the separateness and the very malleable and incomplete nature of the infant's psyche at the stage in question. The aim is not to model the self after an external object in order to emulate it; rather, it is an effort to modify the internal structures in order to deny the perception that the object is different from the self. For this reason the aspects of self and ego modeled in this way are not sources of pride, strength, or wellbeing; instead, they are felt to be fragile and sensitive areas that can tolerate no inspection lest the disguise cease to function, leaving the patient exposed to the knowledge of the separateness of the mother.

SUMMARY
A defensive form of internalization stemming from the impact on the infant of excessive maternal projective identification has been discussed. This internalization took the form of an identification with the conflicted aspect of the mother and influenced the development of the patient's self-representations, qualities of ego and superego functioning, and object relations. A developmental hypothesis was proposed in which the infant was seen as having experienced premature awareness of the mother as a separate person as a result of the mother's excessive reliance on projective identification as a mode of relatedness and form of psychological defense. In the child's attempt to defend herself against such disturbing awareness of separateness, she struggled to maintain the illusion that it was herself and not the mother that she was perceiving in the projected maternal pathology. The result was a strong defensive identification with the projected aspects of the mother. The motivation for this identification was powerfully enhanced by the fact that the child felt real for the mother only when in the "beam" of her pathology, that is, only when behaving in a way that was congruent with the mother's projective identifications. The development of this type of defensive identification is understood as representing one of a variety of possible pathological adaptations to excessive maternal projective identification.