Some patients enter therapy with an intensity of feeling and need that touches the therapist much more deeply and on a more personal level than do others. This can and should raise questions in the psychotherapist's mind about what this intensity of feeling means. There can be a legitimate concern that the response is part of an unprofessional and ultimately unhelpful emotional over-involvement with the patient. This may be due to some neurotic conflict within the therapist which the patient unwittingly fits into. In the best interests of the patient, the therapist must therefore always be prepared to think long and hard about such emotional responses, privately and in discussion with colleagues.
But when it becomes sufficiently likely that this is not a neurotic response on the psychotherapist's part, he or she is left with a phenomenon that is very clearly related to the patient, which the psychotherapist then comes to live with during the course of the therapy. In such cases there is a great deal to be learnt about transference and counter-transference, because subtleties which are often difficult to decipher in other therapies are here written large. This chapter is about a patient who affected me in this way.
Freud's discovery of the counter-transference (Freud 1910) and the realisation of its great importance for psychoanalytic work led to the establishment of training analysis as essential in all psychoanalytic training. Racker (1957), points out how puzzling it was that so little attention was nevertheless paid to counter-transference in the literature for nearly 40 years. It was as if, having accorded the analyst's feelings such central significance, they were swiftly tidied away into the private area of training analysis, almost as if they were too revealing of the humanity and personality of the
1 Much of this chapter was originally published in 1989 as 'Variations on the theme of transference and counter-transference in the treatment of a ten year old boy', Journal of Child Psychotherapy, 15(2):85-102. In this chapter I have clarified my thinking from the original paper and added some new thoughts in the context of the subject matter of the book.