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Introduction to
Psychoanalysis

Contemporary Theory and Practice

Second Edition

Anthony W. Bateman,
Jeremy Holmes, and
Elizabeth Allison
Second edition published 2022
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2022 Anthony W. Bateman, Jeremy Holmes & Elizabeth Allison
The right of Anthony W. Bateman, Jeremy Holmes & Elizabeth Allison to
be identified as authors of this work has been asserted by them in
accordance with sections 77 and 78 of the Copyright, Designs and Patents
Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other
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Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
First edition published by Routledge 1995
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Names: Bateman, Anthony, author.
Title: Introduction to psychoanalysis : contemporary theory and practice /
Anthony W. Bateman, Jeremy Holmes & Elizabeth Allison.
Description: 2nd edition. | Milton Park, Abingdon, Oxon ; New York, NY :
Routledge, 2022. | Includes bibliographical references and index.
Identifiers: LCCN 2021015077 (print) | LCCN 2021015078 (ebook) |
ISBN 9780367375706 (hardback) | ISBN 9780367375713 (paperback) |
ISBN 9780429355110 (ebook)
Subjects: LCSH: Psychoanalysis.
Classification: LCC RC504 .B295 2022 (print) | LCC RC504 (ebook) |
DDC 616.89/17‐‐dc23
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LC ebook record available at https://lccn.loc.gov/2021015078

ISBN: 978-0-367-37570-6 (hbk)

ISBN: 978-0-367-37571-3 (pbk)
ISBN: 978-0-429-35511-0 (ebk)

DOI: 10.4324/9780429355110

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Contents

Preface to the First Edition ix

Preface to the Second Edition xiii
Figure 0.1 xvii

PART 1 Theory 1

1 Introduction: history and controversy 3

2 Models of the mind 34
3 Origins of the internal world 61
4 Mechanisms of defence 92
5 Transference and countertransference 117
6 Dreams, symbols, and the psychoanalytic imagination 140

PART II Practice 161

7 The assessment interview 163

8 The therapeutic relationship 181
9 Clinical dilemmas 212
10 Psychoanalysis and mental health practice 243
viii Contents

11 Research in psychoanalysis 282

12 The future of psychoanalysis: challenges and
opportunities 312

Index 332
Preface to the First Edition

Newcomers to psychoanalysis, especially if they wish to avoid confusion, are

usually best advised to go straight to Freud – to the lectures on technique
(Freud, 1912, 1914), the Introductory Lectures (Freud, 1916–1917), or the
Two Encyclopedia Articles (Freud, 1923). This is not just because Freud is
the fount from which psychoanalysis has flowed, or because of the clarity of
his thought and style, or even because “going back to Freud” remains a
psychoanalytic imperative. It is also because in the early years a single
psychoanalytic “mastertext” (Schafer, 1990) was still possible, in a way that
has not only become increasingly problematic as the psychoanalytic
movement has expanded and diversified, but also been challenged by
controversy and schism.
There are many excellent introductory or semi-introductory contemporary
books about the practice of psychoanalysis. Those that we have found especially
useful are starred in the references. Each tends to present a particular perspective
on the psychoanalytic process – Kleinian, Independent, Contemporary Freudian,
Interpersonal, Kohutian, Lacanian, and Ego Psychological. This is partly an
inevitable result of the unique centrality of personal analysis in analytic training.
Each of the differing psychoanalytic approaches represents not only a theoretical
orientation, but also a tradition, style, affiliation, and set of common values and
assumptions that the analysand acquire in the course of this training. He or she
has to undergo the maturational task of both assimilating all that has been
identified with and at the same time achieving the inner freedom needed to find
his or her own analytic voice.
When we were invited by Edwina Wellham of Routledge, at Jonathan
Pedder’s suggestion, to write a companion volume to his and Dennis Brown’s
(Brown & Pedder, 1993) Introduction to Psychotherapy, we felt that the time
was ripe for an attempt to bring together the varying strands of psychoanalytic
theory and practice, to highlight their “common ground” (Wallerstein, 1992) as
well as their differences. We were encouraged by the idea that despite
theoretical divergence, “clinical theory” (Klein, 1976) can be unified in a
meaningful way. We were determined to anchor our text with many clinical
x Preface to the First Edition

examples, and to try to show how a variety of clinical approaches fit within a
common framework. We are aware of the dangers and pitfalls of both
sectarianism and eclecticism. Analysts need to be able to draw on the range
of different ideas and techniques that are encompassed within the diversity of
their profession. At the same time, to practice effectively, most need to practice
within a particular analytic perspective.
Our book is perhaps in the “critical dictionary” (Hinshelwood, 1989;
Rycroft, 1972) tradition in that it tries to clarify, question, and extract what
is valuable from each psychoanalytic viewpoint. Wherever possible, we have
brought research findings to bear on psychoanalytic concepts and practice,
and, within the limitations of the lag between composition and publication, to
be as up to date as possible with contemporary psychoanalytic thought. We
have subtitled our book “contemporary” psychoanalysis, drawing a useful, but
nonetheless somewhat artificial, contrast between “classical” and “modern” (or
“contemporary”) practice and thought. “Classical” and “modern”, while useful
as a shorthand, should not be thought of as oppositional, but rather the one
resting on the other. Also, since we work simultaneously both within a public
sector psychiatric context and in private practice, we have angled a fair
proportion of what we discuss towards the role of psychoanalytic therapy with
quite disturbed patients.
That raises the issues of who we, the authors, are. One of us (A.B.) is an
analyst with considerable psychiatric experience, the other (J.H.) also a
psychiatrist and psychotherapist with psychoanalytic leanings. We hope that
as a team we have enough in common to provide a unified view, enough
difference to add breadth to our exposition. On the whole our collaboration
has run smoothly. On occasions one of us has felt that we have been too
critical and not “analytic” enough; the other that we were being too reverential
and have failed to locate the analytic approach within a wider intellectual and
cultural context.
And what of you, the reader? Our hope was to produce a book that would
be useful for students of psychoanalysis and psychoanalytic psychotherapy
looking for a single volume that would encompass the main principles and
practice of contemporary psychoanalysis, be clinically relevant, and theore-
tically stimulating. For some, no doubt, much of what we say will be familiar,
for others obscure. We hope we have created sufficient transitional space
between innocence and sophistication to be of value.
We are only too aware of the many faults of omission and commission in the
book. We have tackled the issues of ethnicity, class, and gender in only a very
limited way. Our psychoanalytic approach is almost exclusively “Freudian”, and
we have undoubtedly failed to do justice to the scope of Jungian or Lacanian
psychoanalysis. Another notable omission is any serious consideration of child
psychoanalysis, which is beyond both our competences. Lacking space rather
than enthusiasm, we have failed to follow the important cultural ramifications of
psychoanalysis into the fields of literary theory, psychohistory, and sociology.
 Preface to the First Edition xi

The text is illustrated with many examples. We are deeply aware of the ethical
difficulties in using case material in print. In some instances, we have asked our
patients for permission to publish such material. In others, this has not been
possible, but we have in every case disguised and fictionalised biographical
details.
Books should not necessarily be read from start to finish. Each chapter is
complete in itself, and we have used extensive cross referencing between them,
since some topics – transference, projective identification, mutative inter-
pretations, and transitional space – inevitably crop up over and over again.
There is a dialectic between theory and practice in the learning of any craft or
skill, and psychoanalysis is no exception. We are aware of a marked shift of
tone between the first, theoretical part, and the second, more clinical and
practical part. The first aims to convey an up-to-date account of contem-
porary psychoanalytic theory, and will, we hope be of interest to advanced
practitioners as well as beginners. The second half is inevitably more
introductory. This divergence between the sophistication and diversity of
theory, and a common strand of practice has become an increasing focus for
debate with psychoanalysis (Tuckett, 1994).
A book such as this owes an incalculable debt to the teachers, analysts,
colleagues, students, patients, supervisors, and friends (many of whom fall
into several of these categories) who have influenced and helped the authors.
We would like especially to thank John Adey, Mark Aveline, Rosemarie
Bateman, Patrick Galwey, Fiona Gardner, Isabelle Grey, Stephen Grosz, Ros
Holmes, Matthew Holmes, Jane Milton, Jonathan Pedder, Rosine Perelberg,
Glenn Roberts, Charles Rycroft, and Mark Solms, who have generously and
time-consumingly read part or all of the manuscript, and have made many
helpful suggestions and corrections. Alison Housley, chief librarian at North
Devon District Hospital; Jill Duncan, chief librarian at the Institute of
Psychoanalysis; and Eleanor MacKenzie, chief librarian at St Ann’s Hospital,
Haringey Healthcare, have tolerated our requests for references with amazing
cheerfulness and efficiency. Finally, without the love, support, helpful
criticism, occasional exasperated protest, and balancing diversion provided
by our immediate families, this book could not possibly have come so happily
into being.

References
Brown, D., & Pedder, J. (1993). Introduction to Psychotherapy: An outline of
Psychodynamic Principles and Practice (2nd ed.). London, UK: Routledge.
Freud, S. (1912). The dynamics of transference. In J. Strachey (Ed.), The standard
edition of the complete psychological works of Sigmund Freud (Vol. 12, pp. 97–109).
London, UK: Hogarth Press, 1958.
Freud, S. (1914). On narcissism: An introduction. In J. Strachey (Ed.), The standard
xii Preface to the First Edition

edition of the complete psychological works of Sigmund Freud (Vol. 14, pp. 67–102).
London, UK: Hogarth Press, 1957.
Freud, S. (1916-1917). Analytic therapy. Lecture XXVII in Introductory Lectures on
Psycho-Analysis. In J. Strachey (Ed.), The standard edition of the complete psy­
chological works of Sigmund Freud (Vol. 16, pp. 448–463). London, UK: Hogarth
Press, 1963.
Freud, S. (1923). Two encyclopaedia articles. In J. Strachey (Ed.), The standard
edition of the complete psychological works of Sigmund Freud (Vol. 18,
pp. 233–260). London, UK: Hogarth Press, 1955.
Hinshelwood, R. (1989). A dictionary of Kleinian thought. London, UK: Free
Association Books.
Klein, G. (1976). Psychoanalytic theory: An exploration of essentials. New York, NY:
International Universities Press.
Schafer, R. (1990). The search for common ground. International Journal of
Psychoanalysis, 71, 49–52.
Rycroft, C. (1972). A critical dictionary of psychoanalysis. London, UK: Penguin.
Tuckett, D. (1994). The conceptualisation and communication of clinical facts in
psychoanalysis. International Journal of Psychoanalysis, 75, 865–870.
Wallerstein, R. S. (1992). The Common Ground of Psychoanalysis. New York, NY:
Jason Aronson.
Preface to the Second Edition

It came as something of a shock when our excellent editor at Routledge,

Susannah Frearson, invited us to undertake a new edition of this book. Was it
really a quarter of a century since we compiled our account of psychoanalysis,
and how it has shaped our psychiatric and psychotherapeutic practice? But
plus ça change, plus c’est la même chose, we thought. Given that the wheels of
psychoanalysis move slowly – what is new?
Somewhat to our surprise, the answer turned out to be quite a lot – both for
us parochially, and more widely. A.B. has devised and spearheaded
psychoanalytically informed mentalisation-based treatment (MBT), which is
now a leading worldwide therapy for borderline personality disorder, antisocial
personality disorder, substance abuse, psychosis, and eating disorders. MBT
represents applied psychoanalysis at its best, evidence based from inception, and
meeting the gold standard of randomised trials which psychoanalysis had
hitherto evaded or eschewed. Meanwhile, J.H.’s interest in attachment theory
and more recently relational neuroscience have helped to overcome initial
psychoanalytic resistance, moving both towards the psychoanalytic mainstream.
Psychoanalysis tends to be something of a gerontocracy. We are delighted
therefore to have a new co-author, E.A., who brings youth, freshness, and a
background in English literature, and her experience of running a university-
based psychoanalytic training. The latter reflects another innovation in that
university-based courses are markedly different from the stand-alone and
often cultish trainings that held sway when the first edition was written.
Govrin (2019) makes a useful distinction between what he calls “first-order”
and “second-order” creativities in psychoanalysis. The former are elaborations
of concepts and techniques pioneered by Freud and his contemporaries, which
have been built on and extended by his successors. Among the examples that
we describe in this new edition are how the contemporary concept of projective
identification emerged from Klein, Bion, and Heimann’s reformulations of
Freud’s concept of countertransference, and have been carried further by
Ogden, Birkstead-Breen, and Ferro; how Klein and Winnicott, and later
Steiner and Britton, extrapolated back from Freud’s Oedipal constellation to
xiv Preface to the Second Edition

the primal mother–baby relationship; and how Barratt’s reworking of Freud’s

discovery of free association draws on Bollas and Lacan. Second-order
innovations are advances and discoveries that are external to psychoanalysis
but impact significantly on its theory and practice. These would include
observational studies of mother–baby interactions; the demonstrable long-
term effects of childhood adversity on mental and physical health; advances in
neuroscience; and changing attitudes to gender, ethnicity, and sexual
orientation.
Our aim in this second edition is to incorporate these innovations, advances,
and extensions, while remaining true to our core aim of presenting psy-
choanalytic concepts and techniques in a clear and comprehensible way. While
every chapter has been extensively rewritten, and references updated, we have
stuck with the original structure of the book, except for the addition of a new
final chapter, which, we hope, brings the text up to date with the 21st-century
context, including a discussion of social media and distance therapy and
learning.
After some discussion, we decided to preserve the psychoanalytic “family
tree”, which forms the frontispiece to the book, although we have not updated it,
for fear of inaccuracy, causing offence, or breaking confidentiality. In addition,
our aims are to bring psychoanalysis into the contemporary scientific and
intellectual mainstream and to focus primarily on ideas and techniques rather
than personalities and guru-figures. But there is undoubtedly what Balint (1952)
called an “apostolic succession” in psychoanalysis, in which the “succession” of
analysts, starting with Freud, represents the equivalent of laying on of hands in
the Catholic church. This oral tradition should not be dismissed, in that it
embodies (literally) the analyst–analysand relationship, which forms the core of
the psychoanalytic method. From a psychoanalytic perspective, personality,
developmental history, and espoused ideas are inextricably linked. Practitioners
like to know which tradition – Kleinian, contemporary Freudian, relational, self-
psychological, etc. – a particular analyst belongs to and thus who their analyst(s)
have been. This is not only a matter of gossip – although, admittedly, that plays
a big part in analytic life – but also helps to contextualise a colleague’s ideas and
methods, signposting “where they are coming from”.
We stress that this has been an entirely collaborative project. After the first
edition appeared, one of us (A.B.) was asked by a purist colleague, wanting
perhaps, as some psychoanalysts are wont, to drive a wedge between
psychoanalysis and other “lesser” forms of therapy, which chapters he as a
fully trained psychoanalyst had written. The loyal riposte was that we were
both responsible for every word in the book. We would like to think the same
is true for all three of us here.
Underpinning both this and the first edition is a fundamental question,
which we take up in more detail in the next chapter. Does psychoanalysis still
matter? Is our enthusiasm merely a residue of nostalgia and loyalty to a meta-
narrative that has shaped us, but is no longer relevant to contemporary
 Preface to the Second Edition xv

mental health practice and the wider vicissitudes of 21st-century life? Classical
psychoanalysis has all but disappeared from the psychiatric and clinical
psychology curricula and is almost nowhere to be found in publicly funded
psychological therapies. For the uninitiated, the term “psychotherapy” now
more or less equates to cognitive-behavioural therapy. Various forms of
“wellness” and positive psychology programmes are also very popular.
By contrast, however, there has been a flowering of interest in psychoanalytic
ideas in the wider fields of literature, social anthropology, and gender studies. As
mentioned, applied psychoanalysis has much to offer in mental health contexts,
especially with more disturbed people, and where long-term therapies are needed.
But more generally, we see psychoanalysis as the standard-bearer for what in
Jungian terms is the “shadow” side of human existence: the disruptiveness of
desire, and the inescapability of “deathfulness” (Barratt, 2019), and how these are
variously projected, disowned, suppressed, and avoided. In a contemporary
Western world, where instrumentalism, surface-living, and visibility dominate,
psychoanalysis provides an indispensable language for the contours of an inner
world, the uniqueness of an individual life, and fostering a strengthened sense of
freedom and resilience.
Finally, sadly, some of those mentioned as inspirations in the first edition
are no longer alive. These include two of our mentors, Jonathan Pedder and
Charles Rycroft. But others have also swung into our orbit. We would like to
thank our friends, family, and colleagues who have helped us to hone our
ideas and tolerated the irritations of living with author spouses and parents,
but generally spurred us on. For J.H., they include, in no particular order,
Kristin White, Evrinomy Avdi, Arietta Slade, Alessandro Talia, Joan
Raphael-Leff, Mary Hepworth, Peter Fonagy, Andrew Elder, Tobias Nolte,
Sebastian Kraemer, Nick Sarra, Richard Mizen, Josh Holmes, Jacob Holmes,
and, as ever, Ros Holmes; for A.B., they include Rosemarie Healy/Bateman
who patiently listens to or ignores my growing pains about writing a book
without complaint, Alexandra Bateman who is the sharpest of critics, Peter
Fonagy for his encyclopaedic knowledge, which he so willingly shares, the late
John Gunderson for our long friendship and our close working relationship
on the promotion of psychoanalysis and psychiatry, and colleagues and
friends who have questioned me over the years; for L.A. they include Peter
Fonagy, Mary Hepworth, and David Tuckett, who have supported me to
develop my interest in psychoanalysis for over 20 years, Kerry Sulkowicz,
whose passion for psychoanalysis has renewed my own, and numerous
colleagues in the British Psychoanalytic Society, the Comparative Clinical
Methods group led originally by David Tuckett and more recently by Olivier
Bonard, and the Psychoanalysis Unit at UCL.
Anthony Bateman
Jeremy Holmes
Elizabeth Allison
xvi Preface to the Second Edition

References
Balint, M. (1952). Primary love and psychoanalytic technique. London, UK: Hogarth.
Barratt, B. (2019). Beyond Psychotherapy: On becoming a (radical) psychoanalyst.
London, UK: Routledge.
Govrin, A. (2019). Facts and sensibilities: What is a psychoanalytic innovation?
Frontiers in Psychology, 10, 1781. doi: 10.3389/fpsyg.2019.01781
 SIGMUND
FREUD
(1856–1939)

DOROTHY ANNA ALIX JAMES JOAN SÁNDOR

BURLINGHAM FREUD STRACHEY STRACHEY RIVIERE FERENCZI
(1891–1979) (1885–1982) (1892–1973) (1887–1967) (1883–1962) (1873–1933)

DONALD
WINNICOTT
(1896–1971)

HEDWIG WILLI ERIK

HOFFER HOFFER ERIKSON
(1888–1961) (1897–1967) (1902–1994)

CLIFFORD MICHAEL MELANIE ERNEST

SCOTT BALINT KLEIN JONES
(1903–) (1896–1970) (1882–1960) (1879–1958)

JOAN
RIVIERE
(1883–1962)

HERBERT PAULA WILFRED JOHN

ROSENFELD HEIMANN BION RICKMAN
(1910–1986) (1899–1982) (1897–1974) (1891–1951)

SUSAN JOHN DONALD

ISAACS BOWLBY WINNICOTT
(1885–1948) (1907–1990) (1896–1971)

W. RONALD D.
FAIRBAIRN
(1889–1964)

JOHN D. HARRY M. MASUD R.

SUTHERLAND GUNTRIP KAHN
(1905–1991) (?–1975) (1924–1989)

Figure 0.1 Who analysed whom: the transmission of psychoanalytic culture.

 ABRAHAM KARL JOHN HEINZ
BRILL ABRAHAM RICKMAN HARTMANN
(1874–1948) (1887–1925) (1891–1951) (1894–1970)

JAMES ALIX EDWARD KAREN

GLOVER STRACHEY GLOVER HORNEY
(1882–1926) (1892–1973) (1888–1972) (1885–1953)

MARJORIE MELITTA
BRIERLEY SCHMIDEBERG
(1893–1984) (1904–1983)
HANS
SACHS
(1881–1947)

ADRIAN SYLVIA ELLA BARBARA KAREN FRANZ

STEPHEN PAYNE SHARPE LOWE HORNEY ALEXANDER
(1883–1948) (1880–1976) (1875–1947) (1887–1955) (1885–1953) (1891–1964)

KARIN ADRIAN
STEPHEN STEPHEN
(1889–1953) (1883–1948)
Part I

Theory