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 Coasting in the
Countertransference

Psychoanalysis in a New Key Book Series

Volume 7

RT20608.indb 1 1/10/08 11:06:18 AM

 Psychoanalysis in a New Key Book Series
DONNEL STERN, PH.D., SERIES EDITOR

Volume 1
Clinical Values:
Emotions That Guide Psychoanalytic Treatment
Sandra Buechler

Volume 2
What Do Mothers Want?
Contemporary Perspectives in Psychoanalysis and Related Disciplines
Sheila Brown

Volume 3
The Fallacy of Understanding / The Ambiguity of Change
Edgar A. Levenson

Volume 4
Prelogical Experience:
An Inquiry into Dreams & Other Creative Processes
Edward S. Tauber and Maurice R. Green

Volume 5
Prologue to Violence:
Child Abuse, Dissociation, and Crime
Abby Stein

Volume 6
Wounded by Reality:
Understanding and Treating Adult Onset Trauma
Ghislaine Boulanger

Volume 7
Coasting in the Countertransference:
Conflicts of Self Interest between Analyst and Patient
Irwin Hirsch

RT20608.indb 2 1/10/08 11:06:19 AM

 Coasting in the
Countertransference
Conflicts of Self Interest between
Analyst and Patient

Irwin Hirsch

RT20608.indb 3 1/10/08 11:06:19 AM

 Cover: © David Newman, Countertransference Collage #3, 1998. 14” x 17”, cut paper collage.

The Analytic Press The Analytic Press

Taylor & Francis Group Taylor & Francis Group
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New York, NY 10016 Hove, East Sussex BN3 2FA

© 2008 by Taylor & Francis Group, LLC

Printed in the United States of America on acid-free paper

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used only for identification and explanation without intent to infringe.
Visit the Taylor & Francis Web site at
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and The Analytic Press Web site at

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RT20608.indb 4 1/10/08 11:06:19 AM

 In memory of my parents; for my wife—my love and
my life partner; and to my children and their children,
present and future—my joy and my inspiration.

RT20608.indb 5 1/10/08 11:06:19 AM

RT20608.indb 6 1/10/08 11:06:19 AM
 Contents

Acknowledgments ix

Foreword xiii

1 Coasting in the Countertransference: Analysts’ Pursuit

of Self-Interest 1

2 The Influence of Situational Factors, in Analysts’ Lives and

Analysts’ Preferred Relational States, on Analytic Participation 27

3 Analysts’ Character Structure and the Wish for Emotional

Equilibrium 53

4 Preferred Patients, Preferred Relational Configurations 81

5 Psychoanalytic Theory and Its Unexamined Comforts 109

6 Baldness 133

7 Money and the Therapeutic Frame 155

8 Money and the Ongoing Therapeutic Relationship 177

References 201

Index 217

vii

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RT20608.indb 8 1/10/08 11:06:20 AM
 Acknowledgments

My parents, people of great integrity, uneducated and unworldly,

always made me feel loved and were proud of anything I did (or did
not do). I had lots of latitude and little expectancy or judgment from
them, and from preadolescence onward I always felt the freedom to
do as I wished. From this period forward, I had the good fortune
to develop what became enduring friendships, and these boys/men,
originally in the beloved Brooklyn of my youth, both broadened my
horizons and challenged me to be as smart and accomplished as
they were. With the generous help of the City College of New York’s
tuition-free education policy, I encountered some inspiring teachers
and interesting new friends of both sexes, and I became both more
intellectually alive and more ambitious. I disliked the behaviorally
oriented (Skinnerian) graduate school that accepted me, but I was
lucky to find some excellent psychoanalytically oriented colleagues
and mentors in the Veterans Administration’s psychology trainee
program. I also had a very kind and supportive dissertation supervi-
sor to help lead me through this alien graduate program.
Once back in New York City my route to psychoanalysis began
in earnest, first as a postdoctoral fellow at Albert Einstein College
of Medicine, and then at New York University’s Postdoctoral Pro-
gram in Psychotherapy and Psychoanalysis. My teachers and super-
visors in both these venues were, by and large, outstanding. My
personal analysis was both illuminating and most helpful. As well,
I learned an enormous amount from my peers at these two institu-
tions, and to this day I deeply value these connections. During this
period I was first exposed to analytic thinking and writing that had
strong resonance, that excited me, and that ultimately inspired me
to begin writing myself. Prominent among these influential authors
are Harold Searles, Edgar Levenson, and, somewhat later, Merton
Gill. The psychoanalytic supervisors whose clinical thinking had the

ix

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  Acknowledgments

most significant impact are Erwin Singer and Benjamin Wolstein.

Of course, I continue to become more educated by the writing and
thinking of my peers, and of my juniors as well. There are too many
to specify (though one can get an idea by examining my references
section), and they come from a range of theoretical traditions. I am
fortunate to have teaching and/or supervisory appointments at five
different psychoanalytic training programs (The Manhattan Insti-
tute for Psychoanalysis; William Alanson White Institute; Adelphi
Postgraduate Program in Psychotherapy and Psychoanalysis; New
York University Postdoctoral Program, my alma mater; and National
Training Program of the National Institute for the Psychotherapies),
and this has provided me with multiple homes, and the opportunity
to meet and to get to know a long list of deeply valued students and
peers. Of these affiliations, the Manhattan Institute, the White Insti-
tute, and Adelphi have been very special to me, and the teaching I
have done at these institutions in particular has had great influence
in the development of my thinking and my writing.
I have deep gratitude to my patients, past and current. Though it
troubles me profoundly that I have not always been helpful to them,
I have grown immeasurably as a person from my extended contact
with so many of them. Being a psychoanalyst is a marvelous way for
a relatively reserved person to meet interesting people and to develop
many more mutually affectionate bonds than one otherwise might. I
feel powerful attachments to many people who under normal social
circumstances I might never have had the privilege of encounter-
ing, or even would be inclined to avoid. I have become a much more
tolerant person in the context of meeting individuals toward whom I
feel an initial distaste, getting to know them beyond their character
armor and developing strong feelings of affection. I have grown as a
person from recognizing and accepting some of the personal short-
comings that became apparent in my relatedness to my patients. I
wish I could be friends, outside of our professional context, with
many of the people I now see or have in the past worked with as
patients. On an especially selfish note, my patients obviously have
been instrumental in the formulation of the ideas about which I
write, and albeit with much disguise I use them to help me publish
articles (and this book) so that I can fulfill some of my desires for
recognition and status.
My wife, Willa Cobert, also a psychoanalyst, merits special men-
tion and expressions of gratitude. We met as colleagues at Hillside

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 Acknowledgments xi

Hospital in Queens, New York, and a part of our initial connection

was based on how thoroughly compatible our clinical thinking and
theorizing were. This area of convergence maintains to the present.
She is the best clinician I know, and there is no one from whom I
have learned more with respect to clinical and conceptual matters.
When I first began to write, she thoroughly critiqued everything and
totally corrected my very wanting grammatical constructions. Then
and now she tolerates long hours of isolation and of enforced silence,
as I try to create pristine conditions for this trying and tension-pro-
ducing avocation of writing for publication. Though I did not write
much when my children were little and wanted me around all of
the time, I began to write more as a way of filling the emotional gap
left by their expanding their lives to friendships, to outside interests,
and now to families of their own. My children made me more alive
than I had ever been, and it is this vitality that proved instrumental
in fueling my ambitions, and writing has been significantly among
these ambitions. I have wanted to match their curiosity and their
passion for life with some of my own, and I have wanted to make
them proud of me.
On both a professional and a friendship dimension, Donnel Stern
also merits special recognition. Not satisfied with being the initiator
and force behind my honorary appointments to the White Institute,
he repeatedly pushed and cajoled me to do this book. He listened to
years’ worth of fears and anxieties about undertaking this project,
and time after time he reassured me that he would make it as easy
as possible to publish this thing under his book series label at the
Analytic Press. Indeed, he fulfilled this promise, devoting enormous
time and concern, in the context of a very busy family and profes-
sional life, with very careful editing, feedback, and anxiety-reduc-
ing conversations. This book would not have happened without his
efforts, and I am very grateful to him.
My editors at the Analytic Press have treated me with respect and
courtesy, and have been patient with a range of my foibles. They have
conspired to make this book a better product, and I thank them for
making this first effort less stressful than it might have been. Simi-
larly, I wish to thank my extraordinarily helpful computer instructor
and technical consultant, who also added talented editorial input.
Some of what I have said here may sound more like autobiogra-
phy than “acknowledgment.” Perhaps it is fitting that a book that
focuses on my own and others’ countertransference self-absorption

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 xii Acknowledgments

has this tone. However, I consciously chose to write this section as I

did because I wish to make it clear that many people were pivotal in
contributing to my development both as a person and as a psycho-
analyst. Though there are far too many to mention by name (and
I certainly cannot mention my patients by name) they deserve my
notation and my gratitude. My writing of this book, and its content,
is an end product of both purely personal relationships and deeply
personal professional relationships.

RT20608.indb 12 1/10/08 11:06:20 AM

 Foreword

With a depth and authenticity I have rarely encountered, Irwin

Hirsch feels a thoroughly unsentimental gratitude, appreciation,
and affection toward his patients. You will encounter that attitude
throughout this book, beginning with the Acknowledgments. I
know that he means what he says in this regard; it is one of the things
you feel about Irwin as soon as he starts to talk about the people he
works with. (I hasten to add that feeling this way hardly stops him
from being as open as anyone I know to his irritation, dislike, hatred,
envy, and all the other less warm and fuzzy feelings. That also will be
obvious in these pages.) Along with all of this good and bad feeling, I
believe that Irwin also harbors a certain melancholy about his work.
We all feel our failures; but I think Irwin feels them with a particular
keenness, despite the fact that I suspect he has fewer of them than
most of us do. His failures lie at the heart of his book.
One of the best pieces of clinical advice I ever got was from Irwin.
He described to me his phone calls, long after the fact, to a handful of
his ex-patients with whom things had ended unsatisfactorily. Irwin
had started thinking about the ways in which he had failed these
people. He was distressed about these incidents and these treat-
ments, as we are all distressed by such events and treatments, and
he decided that he wanted to see how it was for these people he had
worked with. He said little to me about what was said in the phone
calls, and I didn’t ask. But he made it clear that he was very glad he
had called them.
What he told me wasn’t advice, actually, because Irwin didn’t
suggest that I do the same thing. But after thinking about it for a
while, I did do the same thing, and as far as I can see it was enor-
mously reparative for all concerned. My former patients, against all
my expectations, were relieved, even delighted to hear from me. We
talked about what had happened between us. I learned a lot that they

xiii

RT20608.indb 13 1/10/08 11:06:20 AM

 xiv Foreword

hadn’t been able to tell me at the time. They were very glad to find out
that it had all really mattered to me, and that it still did. These con-
tacts were reparative for me, as they were for Irwin. I think that this
book is, among other things, a further reparative effort for Irwin.
For Irwin and those few others who have thought about the every-
day problem of the analyst’s self-interest (Sandra Buechler [2002,
2004] and Joyce Slochower [2003, 2006] come to mind, and citations
of their papers on the subject appear in Irwin’s references), the real-
ity is that, much more frequently than we like to think, we all act
on self-interest during our clinical work, self-interest that, even as
we are carrying it out, we know is not in our patients’ best interests.
Irwin is not talking about unconscious countertransference here,
but behavior we actually have some awareness that we are engag-
ing in. He is certainly not claiming that our willingness to satisfy
ourselves this way has nothing to do with the countertransference.
In fact, he claims just the opposite: Our willingness to sacrifice the
patient’s interests for our own comfort and equilibrium has every-
thing to do with the particular clinical relatedness with a particular
patient. It needs to be analyzed. It is precisely because we so often do
not analyze it, while being aware that it is going on, that such behav-
ior represents “coasting” in the countertransference. The fact that we
may not know the unconscious roots of our self-interested behavior,
in other words, has little to do (for instance) with our willingness
to make a shopping list or scan the internet (Slochower, 2003, 2006)
during a phone session.
I think it is fair to say that however clear-eyed we psychoanalysts
may be in many respects, and no matter how devoted we believe we
are to the ideal of looking truth in the face, we do commonly allow
ourselves an idealization of the degree to which we check our self-
interest at the office door. Irwin’s hope is to contribute to the punc-
turing of this idealization. But he doesn’t want to condemn us. It’s
not so simple. He doesn’t want to make us feel badly, or at least not
only badly. In fact, I know he would be unhappy if he thought that
were the primary impact of these chapters. His message, instead, is
about facing all of what we are and what we do with our patients. In
the process, we might have to bear feeling badly about what we con-
clude we need to face about our conduct. But guilt and shame aren’t
the point of what Irwin has to say; our awareness of ourselves is.
Irwin doesn’t tell you what to do, any more than he told me what to
do when he told me about calling those ex-patients. But in the course

RT20608.indb 14 1/10/08 11:06:21 AM

 Foreword xv

of telling us about his disappointments in himself, he awakens our

awareness of our own behavior, and of our similar disappointments
in ourselves. If we allow ourselves to see what he sees, we open our-
selves to the possibility of a fuller and more satisfying experience
— for our patients, yes, but also for ourselves, because managing not
to think about our tolerance of self-interest comes at a cost. In the
end, I hope this book encourages not only closer and more honest
self-observation among psychoanalysts and other psychotherapists
but also, through its revelation of the ordinariness of coasting in the
countertransference, a greater acceptance of our personal shortcom-
ings and frailties, even if we do not excuse them.
We are always in conflict over what is best for our patients and
what is most comfortable for us. For better or worse, in any two-
person psychology the analyst as a particular person, right along
with the patient, is at the heart of the therapeutic process. Indeed,
often an interactive equilibrium, typical of the patient’s life and/or
the analyst’s, is established in lieu of a much less comfortable and
more disruptive progression toward new forms of relatedness. This is
Irwin’s primary theme. But Irwin also shows us in these pages that,
if we really do accept two-person psychology, we must also accept
that our personalities, our flaws, and our own selfish interests must
always and inevitably be taken into account as an intrinsic part of
what makes up therapeutic relatedness.

Donnel Stern

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RT20608.indb 16 1/10/08 11:06:21 AM
 1
Coasting in the Countertransference
Analysts’ Pursuit of Self-Interest

I have had, over the years, many informal conversations with psy-
choanalytic colleagues who are also close friends that focus on some
of the selfish motivations both for our work with patients and in
our broader professional pursuits. These conversations are often in
a humorous vein, sarcastically tweaking both our own self-serving
interactions and the myth that those of us in the helping professions
are possessed by especially altruistic spirits. In the candor of friend-
ship we have teased one another about a variety of familiar themes;
for example, the joys of being the object of sexual desire, especially
in the eyes of patients toward whom we are physically attracted; the
pleasures of being admired in a myriad of ways, in contrast with
being the target of hurtful criticism or scathing anger, even though it
is clear to all in the field that anger in the transference is an essential
part of any depth analysis; the high that comes from the affirma-
tion of receiving new referrals, having most of our available hours
filled, and earning a satisfactory living; and the ever present specter
of boredom, and the frequent temptation to not listen carefully to
patients. I recall one specific moment of shared laughter and recog-
nition when a colleague quipped to a small group of us that, by far,
his favorite form of transference was idealization.
Though conventional wisdom dictates that self-interest is a sig-
nificant, though not exclusive, motivation for much of what all living
creatures do (Slavin & Kriegman, 1992, 1998), psychoanalytic litera-
ture has, for the most part, avoided addressing the degree to which
this impacts analytic therapy in ways that are sometimes helpful
but sometimes harmful to patients. Analysts’ pursuit of money, or,
put more colloquially, the need to earn a living, has received more
attention in the literature than other dimensions of analysts’ selfish

RT20608.indb 1 1/10/08 11:06:21 AM

  Coasting in the Countertransference

pursuits (see, e.g., Aron & Hirsch, 1992; Josephs, 2004; Lasky, 1984;
Liss-Levinson, 1990; Whitson, n.d.), and I intend to address this
important question again in chapters 7 and 8. Recently, Maroda
(2005) has emphasized the importance that analysts recognize that,
inevitably, they seek gratifications from patients, and that this should
be seen as normal and inherently human (Slavin & Kriegman, 1992,
1998). Maroda referred, for example, to desires to be important and
effective as virtually standard features of all interpersonal engage-
ment, though she was aware that pursuit of these “normal” grati-
fications can become overly narcissistic, excessive, and ultimately
harmful to patients. In an earlier generation, iconoclastic analytic
writers like Singer (1965a, 1965b, 1968, 1971, 1977) and Searles (1960,
1965, 1979) both suggested the ubiquity of analysts’ self-interest, and
the need to be aware of it, so that the analytic process is neither a
sham (i.e., analysts’ portrayal of themselves as selfless and as caring
only about what is best for patients) nor a vehicle for unrestrained
pursuit of this self-interest. Singer implied what is essentially a capi-
talist ideal—the pursuit of financial compensation and professional
recognition is best served by being an optimally competent analyst
for patients. Searles suggested that vigorous enjoyment of one’s inter-
action with patients is likely to lead to more authentic and passionate
engagement with them. Needless to say, past a certain, difficult-to-
determine point, an emphasis on self-interest usually involves at
least a measure of disregard for the other.
In this volume I write about the kind of analyst self-interest
that is not an aspect of the analyst’s character alone, nor simply an
expression of a wish to be successful in one’s work. My interest lies
in pursuits of self-interest that emerge as potentially useful data
from the transference–countertransference matrix, though are not
necessarily used to further the analytic work. Instead, the analyst
can be said to coast in the countertransference, choosing comfort
or equilibrium over creating useful destabilization (Mendelsohn,
2002; Slavin & Kriegman, 1992). In this chapter and in what follows,
I plan to address a variety of ways that, with at least some conscious-
ness, analysts commonly pursue their own interests at some cost to
patients. The first issue I address in this chapter reflects momentary
indulgences, the countertransference implications of which the ana-
lyst does not use to deepen the analytic process. Lapses in attention
and daydreaming are quotidian examples. The second theme in this
chapter refers to the way analysts structure their practice, including

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 Coasting in the Countertransference 

the length of the workday, spacing between analytic sessions, and

competing professional activities. In subsequent chapters (chapters
2, 3, and 4), my attention focuses upon analysts’ unique personalities
and the situational factors in analysts’ lives. These enduring and/or
transient states generally lead analysts, usually unwittingly at the
start, to shape the analytic relationship to conform, more or less, to
their most comfortable and preferred relational states. At some point
these interactions inevitably become conscious to the analyst, and
the choice presents itself whether to create a disquieting disequilib-
rium by using these interactional data to productively address the
transference–countertransference theme, or, conversely, whether to
coast with the status quo and maintain what might be a mutually
comfortable equilibrium between patient and analyst. I am suggest-
ing that it is more common than one would suspect from the psy-
choanalytic literature for analysts to consciously choose to maintain
personal and/or mutual states of equilibrium with patients over the
promotion of therapeutically useful mutual destabilization. Perhaps
the most common example of this can be seen in many long analy-
ses, where a dependent patient wishes to remain eternally, and an
analyst, gratified by both a sense of importance and an economic
annuity, chooses not to address the mutually gratifying nature of
the transference–countertransference relationship (Renik, 1995,
2006). Along the same lines, a situational factor of analysts’ loneli-
ness (Buechler, 2004; Fromm-Reichmann, 1959) may readily lead to
efforts, unconscious at first, to facilitate patients’ excessive depen-
dency and to discourage separation and autonomy.
In chapter 5, I address the often powerful role that any analyst’s
cherished psychoanalytic theory may have in both structuring and
understanding the therapeutic dyad. Analysts’ respective theoreti-
cal heritages provide comfortable and familiar homes for them, and
patients are commonly shoehorned into a conceptual space that
is designed to reinforce analysts’ sense of stability. In chapter 6, I
discuss the rarely addressed issue of male analysts’ and/or patients’
baldness, and the enormous anxiety that either state may create
within the analytic dyad. I argue that analysts’ avoidance of dealing
with this issue is more characteristic than otherwise, for it may read-
ily create in both parties what could be experienced as a premature
confrontation with mortality. In my final two chapters (7 and 8), I
emphasize the degree to which analysts’ economic needs may influ-
ence every aspect of the analytic relationship. I underscore that the

RT20608.indb 3 1/10/08 11:06:21 AM

  Coasting in the Countertransference

impact of therapists’ economic concerns reflects the single biggest

dilemma in any of the helping professions.
Slochower (2003, 2006), referring to what she called everyday
“crimes and misdemeanors,” wrote with unusual candor of the inher-
ent conflict that may exist at any moment of analytic work between
attention to patients’ and analysts’ wishes and/or interests. Though
it seems so obvious after it is noted, Slochower highlighted what has
rarely been acknowledged in the literature—the difficulty of suspend-
ing attention to one’s interests and listening carefully to others for
even one analytic session, much less all day long. The joke that ends
in the analyst’s shrug of his shoulders and his question “Who’s listen-
ing?” is a reflection of how well most analysts know privately that
they do not always listen to patients, choosing instead, at any given
moment or for much longer, to attend to themselves in priority. Slo-
chower argued that pursuit of self-interest of any kind is most harm-
ful when analysts fail to acknowledge this phenomenon as a powerful
force in any given analytic experience. Needless to say, analysts who
face themselves and embrace their deficiencies with a good measure
of honesty are less likely to persistently pursue selfish interests to the
severe detriment of patients. For instance, because most lapses in
attention by the analyst have something to do with the patient or with
the analytic interaction, each instance of this becomes an opportunity
for analytic inquiry. Few of us use productively each such instance.
However, though no analyst can operate with this degree of presence
all of the time, some approach this ideal more consistently and, of
course, with some patients more than with others.
Self-awareness, however, is not a guarantee that any given ana-
lyst will change the way he or she is relating to a particular patient,
either at specific moments or over extended time periods. The power
of the quest for personal comfort and equilibrium, with each unique
individual patient, is always potent. In the dyadic work of analysis,
it is quite common that analysts’ self-interest and patients’ comfort
levels dovetail, and persisting in perhaps stagnant but relatively
anxiety-free enactments or mutual configurations is compelling for
both parties (Feldman, 1997). For instance, think of the schizoid
patient who is quite comfortable with the analyst’s withdrawal, the
overdependent patient who relishes the analyst’s infantilization, the
sexually provocative patient who enjoys the analyst’s flirtations, or
the masochistic patient who expects to be ignored. Analysts’ aware-
ness of such engagements or enactments has the potential to lead to

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 Coasting in the Countertransference 

a useful deconstruction of them, but because they can be so mutu-

ally gratifying, this is often not the case. On a conceptual level, most
contemporary analysts agree that the analysis of a mutually con-
structed configuration is the sine qua non of the process and that
such interactions are hard to meaningfully address unless they have
been enacted within the transference–countertransference matrix
(Black, 2003; Bromberg, 1998, 2006; Gabbard, 1995, 1996; Green-
berg, 1991, 2001; Hirsch, 1996, 1998a; Jacobs, 1986; Levenson, 1972,
1981, 1992; McLaughlin, 1991; Mitchell, 1988, 1993; Poland, 1992;
Renik, 1993; Sandler, 1976; Stern, 2003, 2004; Varga, 2005; Wachtel,
1980). The issues addressed here, however, focus on analysts’ con-
scious disinclination to assert the effort to put these interactions
(unwitting enactments) into words, choosing instead to remain in a
comfortable moment, or in a long-standing equilibrium of what may
perhaps be either free of anxiety for the analyst singularly or a famil-
iar and therefore comfortable mutual enactment for both analytic
participants. Implicit in this exegesis are the ideas that analysts often
fail to use countertransference productively and that the thorough-
going embrace of countertransference experience in much of con-
temporary two-person psychology theorizing may not be sufficiently
thought out. A more genuine two-person relational psychology
cannot assume optimistically that each unique analyst will engage
countertransference experience to good end. Analysts’ idiosyncra-
sies dictate that each individual analyst will at times indulge his or
her countertransference, and that patients will be the worse for this.
If the examination of the experience and participation of both par-
ties in the dyad is to be as thorough as interpersonal and relational
writers suggest it should be, there will have to be added a focus on
how often patients’ progress is limited by analysts’ failures to trans-
late what they know about their countertransference experience
into helpful shifts in analytic relatedness. That is, the inclination to
pursue self-interest must be included as a feature in any conception
of a mutually subjective (Aron, 1991, 1996; Benjamin, 1995; Hirsch,
1990; Levenson, 1972, 1981, 1992; Renik, 1993, 1995; Singer, 1977;
Stern, 1997; Wolstein, 1954, 1977, 1997), two-person psychology of
psychoanalysis. Though I do believe that analysts’ unwitting partici-
pation is inevitable and virtually always potentially productive, I also
believe that analysts too often are willing to coast with comfortable
modes of participation after they become witting. What Buechler
(2002, 2004) has called “effort fullness” reflects her recognition of

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  Coasting in the Countertransference

how counterintuitive it is for anyone to choose discomfort and dis-

equilibrium in preference to their opposite states (Slavin & Krieg-
man, 1992, 1998). Theories of therapeutic action are based on ideals
and on analysts behaving ideally, though each individual analyst is,
indeed, a flawed human being who operates selfishly and falls short
of analytic ideals very often.
In what follows throughout this volume, I will address a variety of
ways and contexts that reflect analysts’ at least somewhat conscious
choices to maintain self-interest, or to coast, and to make less than
optimum effort to use immediate experience to help patients prog-
ress to satisfactory termination (Renik, 2006). Though, as noted,
I will try to separate these pursuits of self-interest and personal
equilibrium into discrete categories, inevitably there is much over-
lap between categories, and they are not at all independent of one
another. In the remainder of this chapter I address the particular
theme of analysts’ lapses of involvement and attention, and the often
selfish way analysts structure their workday and integrate their range
of professional commitments. Implicit throughout all chapters is the
concept that analysts need to tolerate disequilibrium and to person-
ally change in relation to patients, if patients themselves are expected
to change (Buechler, 2002; Mendelsohn, 2002; Slavin & Kriegman,
1992, 1998; Wolstein, 1954, 1959).

The Analysts’ Lapses

It is worth restating Slochower’s (2003, 2006) obvious but rarely

addressed acknowledgment of how difficult it is to suspend atten-
tion to one’s own concerns, and intently listen to another person for
45 or 50 minutes, much less do this repeatedly over the course of
an entire workday. Indeed, this seems to me quite impossible, and
I believe every analyst has lapses in attention for some fractions of
time in every session. When these periods of inattentiveness occur,
of course, are crucial data, because analysts’ boredom or affective
withdrawal is usually related to the patients’ participation and to ele-
ments of the analytic interaction. As well, the content of analysts’
ideation during periods of inattentiveness may be highly informa-
tive about patients and about the analytic interaction. Ogden (1994)
and Wilner (2000), from very different analytic perspectives, both
suggested that all of analysts’ fantasies or reveries are related to the

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 Coasting in the Countertransference 

analytic interaction not only in form, but in content as well. In a

sense, they imply that analysts never really withdraw from patients,
because every withdrawal and how it is spent are actually just other
forms of being involved with patients.
Though I agree that this often is the case, this conception seems
to me somewhat idealistic, and a denial of the flawed humanity of
all of us who practice analysis. It suggests that analysts never retreat
into privacy and self-involvement for reasons that are largely narcis-
sistic and selfish, and that are more often than acknowledged inde-
pendent of patients’ participation. I do believe that every act, when
with another person, indeed does have some interpersonal mean-
ing. However, this meaning could be far secondary, for instance, to
an analyst’s communication of the wish for privacy or respite, or a
statement, for example, of analysts’ fatigue, preoccupation, worry,
or looking forward to what lies ahead in the day or evening. Most
analysts will acknowledge privately that boredom is an occupational
hazard, and that this experience is not always primarily related to
a particular interaction with a given patient. I will say more about
this later in this chapter, but boredom is often related to how many
patients are seen in a day, how they are spaced, the time of the day,
and competing activities. I suggest that although analysts are, of
course, more likely to withdraw into boredom and self-involvement
with some patients more than with others (and that this is always
of informational value), the reverie involved in these withdrawals
sometimes reflects exclusively analysts’ narcissistic concerns (Bach,
1995; Blechner, 2005b; Fiscalini & Grey, 1993; Hirsch, 1993), and
may not at all be of informational value in understanding patients.
Although some analysts are better able than others at suspend-
ing attention to their own concerns during sessions, and most ana-
lysts can do this best when not especially busy or fatigued, or when
their personal lives are relatively smooth, I do not believe that any-
one does not use his or her workday, in some degree, to retreat into
privacy. Indeed, the structure of the analytic situation lends itself
to this. Psychoanalysts are expected to be quiet and reflective, and
patients quickly learn not to expect very much verbal interaction.
When patients lie on the couch, they face away from the analyst,
and the analyst probably speaks less often, so that both visual and
auditory cues about the analyst’s experience are less available to
patients than when they sit up. I am not sure, though, that patients
on the couch know as little about the analyst’s ongoing experience

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  Coasting in the Countertransference

as analysts often seem to think. I have always believed that patients

are able to read our sentiments, attitudes, and levels of engage-
ment despite even lengthy silence and/or not seeing us. However,
because analysts’ roles, even in current times, are defined by at least
reserved or infrequent verbal and nonverbal expressiveness, it is
difficult for patients to entirely trust their perceptions about ana-
lysts’ momentary, or sometimes even long-term, disengagements.
Indeed, analysts often do not encourage patients to challenge them
about their withdrawals, preferring instead to remain in such states,
often protected by patients’ unwillingness to be overly critical and
to lose analysts’ affections. Because analysts’ work is defined more
by listening than by speaking (we are supposed to be “good” listen-
ers), we can usually get away with brief or even extended periods of
listening to ourselves more than to our patients. Obviously, this is
more likely with patients who do not expect and/or demand a great
deal from us, or from relationships in general. Independent of par-
ticular transference–countertransference interactions, I believe that
the use of the analytic couch lends itself to analysts’ taking selfish
leave from patients. Designed to minimize analytic influence on
patients and to provide analysts optimal freedom to use creative rev-
erie in the service of helping patients, this freedom, unfortunately,
extends to greater latitude to be absent without detection—to be
self-involved, and “missing in action.” Slochower (2003, 2006), with
some self-effacing humor, cited a variety of ways that she and/or her
colleagues have taken leave from patients, aided by the absence of
visual cues afforded by the couch or, even more extremely, in the
context of telephone sessions. Indeed, this latter phenomenon has
become more common in recent years (Richards, 1999). Slochower’s
examples include making shopping lists and schedules, paying bills,
scanning the Internet, and looking at personal photographs. The
humor involved in noting such unabashedly selfish pursuits is the
humor of recognition—each analyst feeling some personal exposure
to what Slochower called analytic “crimes and misdemeanors.” In
face-to-face analyses, one must learn to be more subtle, to scan the
Internet of our mind, so to speak. Paying attention to oneself and not
to patients will never be eliminated by any of us—it will only at best
be controlled when analysts fully acknowledge this to themselves
and encourage patients to make us uncomfortable by expressing, not
containing, their transference-related perceptions of us (Aron, 1991,
1999; Blechner, 1992; Fiscalini, 1988; Gill, 1982, 1983, 1984, 1994;

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 Coasting in the Countertransference 

Goldstein, n.d.; Greenberg, 1986; Hirsch, 1998a; Hoffman, 1983,

1987; Singer, 1968; Stern, 1987; Wachtel, 1982).
Later in this chapter I refer to circumstances that make analytic
disengagement more likely, independent of particular transference–
countertransference configurations. Nonetheless, as noted earlier,
analysts’ boredom, retreat into privacy, and the like are usually
related to the person of the patient, and to the nature of the interac-
tion at any given moment. I want to emphasize that I do not consider
experiences like boredom, lapses in attentive listening, and affective
retreat and isolation as unmediated expressions of the analyst’s char-
acter or personality, and therefore as countertransference in the one-
person sense described by writers such as Reich (1951). Instead, I view
such states as intrinsic to any interpersonal situation that endures for
even a modest period of time. What is problematic (albeit univer-
sal), and reflects my emphasis throughout, is analysts consciously
choosing to remain in these states because this represents the most
comfortable place to be situated at any given moment for the analyst,
and often for the patient as well. Analysts’ failures to make the effort
to return from lapses in attention and pursuit of personal reverie,
and/or to use these retreats for therapeutic ends in order to expose
mutual enactments, comprise the countertransference theme most
unaddressed in our literature. Here is a brief illustration.
Hillary has been in analysis for some time, and has made only
modest gains in her original presentation of herself as depressed in
a “low-grade” (her words) way and passionless in both her marriage
and career pursuits. She reports “the blahs” and, indeed, relates to me
with a flatness and absence of verve or of urgency, virtually regard-
less of the seeming importance of the issue she brings to me. This was
so when she told me of uncovering her husband’s sexual infidelity,
as it was true of her recent report of the acute mental collapse of her
elderly mother. Our interaction follows a pattern. I usually tell her
that she is speaking in a flat and disinterested tone about something
I know that she has strong feelings about. She takes note, though
continues in the same vein. I begin to become bored and retreat into
my own private world, and then mobilize, and convey to Hillary that
she still sounds like she’s deadening her feelings. Hillary agrees, yet
continues true to form. I resort to interpretive comments, reminding

 In this and other clinical examples used throughout the book, names and other
identifiers have been changed to protect confidentiality.

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 10 Coasting in the Countertransference

her of the origins of her retreat. In capsule, the origins to which I

refer are largely the loss, in her early teens, of her romantic fantasies
with, and strong sense of being special to, both her father and her
brother, a loss brought on by her mother’s success in “stealing back”
her father, and the beginning of her brother’s relationship with a girl
who eventually became his wife. Until her acquiescent father with-
drew profoundly, Hillary describes herself as having felt special to
him and, as well, felt vivacious and excited about life. Subsequent to
this period, she usually chose safety, including a marriage to a man
she knew she was not in love with, but whom she perceived as steady
and potentially a good provider economically. This combination of
safety and dependency has characterized our relationship, and in an
effort to emerge from an incipient boredom and retreat that I know
will soon intensify, I interpret to Hillary that she is playing it safe
with me and, as well, isolating what she might be feeling about her
mother’s deterioration. My patient agrees, genuinely I believe, but
very soon again returns to pattern. In this context, my retreats and
my private reverie become longer. Depending on the day, my reverie
could be about anything from phone calls I must make, to what I
am doing that evening, to worries about one of my adult children, or
even to all of the above and more in the course of one session. What
I wish to emphasize is that, with Hillary (and others), for periods of
time I desist from making the effort to return to the key issue of her
emotional retreat and its impact on me, and I just coast with this
impact. During these periods I am pursuing my own self-interest,
soothing myself and ignoring my patient, as I feel she is ignoring me.
Though I am not these days usually conscious of feeling hurt, angry,
or retaliatory, indeed I have often used this obvious instance of pro-
jective identification, in the form of an interpretation to Hillary, as
an additional way of combating my withdrawal. Earlier in our work
together I had made much of her passive-aggressive withdrawal as
a reflection of her transference and her usual retaliatory anger, and
conceptualized my own affective retreats from her as reflections of
my anger in relation to Hillary’s deprivation of me. These interven-
tions were seemingly accepted and understood, but I found that they
did not advance our situation. Indeed, were I to have been mak-
ing a consistent and persistent effort to be optimally present, there
would have been much process and content to address with Hill-
ary. Unfortunately, she evokes my withdrawal by her flatness and

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 Coasting in the Countertransference 11

absence of excitement about me, and then is content to let me stay

there, leaving herself with the considerable safety of emotional dis-
tance in a context where she feels certain that I will not abandon her
entirely. Part of Hillary wishes to remain this way with me forever,
dissociated from her emotional dependency on me, though part of
her also wishes to risk being more vulnerable and alive. I depend on
my initial comments and transference observations and interpreta-
tions to energize me, and when she rejects them by returning to her
withdrawn pattern, I may disappear, in part hoping that Hillary will
bring me back. We are, however, in a state of mutual equilibrium.
My patient almost never challenges my withdrawals. I know that it
is solely my responsibility to make the requisite continuous effort to
emerge from the safety and comfort I often feel when I coast in my
own self- absorbed and self-enclosed rumination or reverie.
Related to the theme of effort is the question of analysts’ mem-
ories about patients’ life history, significant details of current life,
and dreams. Bion (1967), in his well-known directive, recommended
that analysts do best when free of memory or desire. He suggested
that this position allows patients to be uninfluenced by analysts’
wishes, and enables them to address only what is of most urgency to
themselves at any given moment. In addition, analysts’ knowledge
of history or of previous dreams readily leads to interpretive bias
on analysts’ part. That is, there is risk that immediate experience is
seen less as something fresh, and to be examined with naïve curios-
ity, than as something that fits into a schema that is based on past
knowledge. In Bion’s eyes, analysts’ attention to immediate experi-
ence reflects the heart of the process. Indeed, analysts’ attempts to
not make the effort to recall data about patients, for the reasons Bion
advised, seem to me like one reasonable view of ideal analytic pro-
cess. This corresponds to a traditional classical Freudian perspective,
in which meticulous care is exerted to avoid influencing patients
with analysts’ subjectivity. Though central to the relational turn in

 Though it is not my intention to discuss Bion’s significant contributions beyond

the one segment that is relevant directly to the issue of analysts’ memory, it is
worth noting that Bion has developed an intricate theory of therapy. In contra-
diction to his care to avoid analysts’ influence on patients, looking at analytic
process through his theoretical lens creates a distinctive perceptual set of biases
(Hirsch, 2003a).

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 12 Coasting in the Countertransference

psychoanalysis is the argument that analysts’ subjectivity is irre-

ducible (Renik, 1993) and must be examined in the analytic process,
it is the rare analyst who advocates purposeful attempts to influ-
ence patients, or influence the material that patients present. That
is, analysts’ subjectivity is viewed as unwitting, and not consciously
designed to bias either the analytic data or the patients’ choices. In
fact, analysts’ unwitting influence on patients ideally is to be care-
fully analyzed, in a verbal forum (Aron, 1991, 1996; Blechner, 1992;
Friedman, 1988; Gabbard, 1995; Gill, 1982, 1983, 1984; Greenberg,
1995; Hirsch, 1987, 1996, 1998a; Hoffman, 1983, 1987; Levenson,
1991, 1992; Mitchell, 1988; Sandler, 1976; Stern, 1987, 1996a), in part
as a means of trying to neutralize analytic influence and the power
of the analyst as a person.
Returning to the question of analysts’ memory, I suggest that
although some analysts may try to not remember material in order
to keep the analysis optimally pure, most forgetfulness exists for less
noble reasons. Indeed, depending on how many patients a given ana-
lyst sees, it is often very difficult to recall, in particular, many details
of life history. I believe that the majority of analysts value remem-
bering as much as possible about each patient, though there is much
individual difference in how much effort is expended in remember-
ing. The most vigilant analysts may keep detailed notes of history
and of each session, and review the former periodically and the latter
prior to each session. This, of course, is very time-consuming, and
dramatically so when one sees many patients. Nonetheless, this does
seem like the most responsible approach if an analyst is to maintain
an optimal presence in the effort to know a patient as thoroughly
as possible. It reflects a commitment to patients at the considerable
expense of analysts’ time—a choice of interest in the other in prior-
ity to self-interest. Though I believe this last statement to be true, I
do not routinely review patients’ life historical data, nor do I keep

 For example, Thompson (1950), Sullivan (1953), Wolstein (1959), Schachtel (1959),
Tauber and Green (1959), Fromm (1964), Searles (1965, 1979), Singer (1965a), Lev-
enson (1972), Barnett (1980), Wachtel (1982), Hirsch (1987), Mitchell (1988, 1993,
1997, 2000), Greenberg (1991), Davies (1994), Benjamin (1995), Josephs (1995),
Aron (1996), Slochower (1996), Stern (1997), Rucker and Lombardi (1997), Brom-
berg (1998), Hoffman (1998), Layton (1998), Frankel (1998), Pizer (1998), Cooper
(2000a, 2000b), Grand (2000), Knoblauch (2000), Bass (2001), Berman (2001),
Fonagy (2001), Crastnopol (2002), Beebe and Lachmann (2002), Dimen (2003),
Fosshage (2003), Safran (2003), Seligman (2003), Bonovitz (2005), Harris (2005),
and Skolnick (2006).

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 Coasting in the Countertransference 13

detailed notes of sessions in order to review them prior to any given

appointment. I believe that in this regard I am in the majority, espe-
cially among analysts who have at least a reasonably large practice.
It is difficult to rationalize the many lapses in memory that I think
exist in most analyses. Clearly, some analysts listen more carefully
than others, are more passionately involved, and are likely to keep in
mind a considerable amount of data about their patients. It is equally
apparent that some patients’ lives are more compelling, and/or their
presentation more demanding, making their analysts’ memory for
details about them better than it is with other patients. And, when
patients are seen multiple times per week and/or over a number of
years, analysts tend to remember more historical detail as time goes
by. Though these features are all highly relevant transference–coun-
tertransference data to explore with patients, the fact remains that I
and most of my colleagues, especially those with large practices, do
not always make the maximum effort to know our patients in full by
having life historical details at hand to use in any given session.
Murray has a very spare personal life, and spends much time in
fantasy and in intellectualized ideation. He speaks to me in a man-
ner that is stilted and impersonal, barely above a whisper, and main-
taining attention to him takes much work. This is, of course, is a
key transference–countertransference theme, and Murray has a long
history of being relatively ignored. He has developed a marked pas-
sive-aggressive character in response to this, and has become a mas-
ter of ignoring and thwarting others. Despite how little he gives me
on a manifest level, I am sure Murray is both attached to me and
dependent on me. He has opened up with me more than he has ever
done with anyone, and I am his most intimate contact except for his
dog. I try to stay alert by challenging him about his passive-aggres-
sive retreats, but all too often I withdraw into my own ideation. Mur-
ray never challenges me, and I feel that I could get away with entire
sessions of not listening to him, or literally not even hearing him. He
demands nothing from me. Murray comes from a large family in a
small town, where grandparents, aunts and uncles, pastors, neigh-
bors, storekeepers, and others played important roles in his own
and his siblings’ development. Though Murray’s interest in history
(his own as well as American history) is among the most interesting
things about him, I have an awful time remembering which brother
is which, and which grandparent was warm and caring, and which
was neglectful and harsh. I have a very good sense of the doings in

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 14 Coasting in the Countertransference

his current life, and about the way he relates to me and to others, but
there is much in his life history that he has told me, and that is clearly
significant, that I do not hold on to. I never take a detailed history
when I begin with patients, and I learn about history as the work pro-
ceeds. I do take notes early in the analysis, but as treatment proceeds
my notes become perfunctory, more for legal requirements than for
information. I can consult my notes and study Murray’s history, but
I usually do not. I ignore aspects of him, passive-aggressively, as he
can ignore me. I rationalize that if I help him come alive in the here
and now of our exchange, I will naturally recall his history in more
detail. I tell myself that transference and attention to the immedi-
acy of process are far more central than historical detail per se, and
though I do believe this to be true, my failure to remember is part of a
transference–countertransference enactment, and I do not make the
full effort to pull myself out of it. As I write this, I resolve to examine
my notes and get Murray’s life history straight, prior to each session
if need be. This will take time and effort, and perhaps interfere with
the number of patients I can see in each day, for Murray is not the
only person whose historical data elude me. This would represent a
financial sacrifice. Murray wants to emerge from his state of with-
drawal, and he wants to be loved and attended to. He is, however,
too comfortable and too familiar with both receiving and giving less
than full attention. We both can live with our situation the way it is,
but it is my place to make the effort and the sacrifice, and to create a
situation of greater discomfort and disequilibrium for both of us.
Rory is young, exceptionally handsome, athletic, and success-
ful; he is charismatic and charming and seductive. He has many
close friends, and was always very popular and a leader through-
out school. He feels special and central to both his parents. Though
his divorced parents are both very troubled people, Rory has never
doubted their love and commitment to him. Rory initiates analysis
because he cannot commit. He has so many career opportunities and
is so heavily recruited that he does not know what to pursue. Simi-
larly, he is involved with a young woman who is desperate to marry
him, but other women are constantly falling into his lap. He fears
that he is similar to his father—never able to love anyone but his
son. Though I have seen Rory for a much briefer time than Murray,
I remember everything Rory tells me. I am always on my toes and
never tempted to wander. Though I do not think he would tolerate
my lack of attention or absence of memory, my near perfect recall

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 Coasting in the Countertransference 15

of Rory’s history and our previous sessions is effortless. It is not so

much that he is particularly involved with me—he commands my
total attention without reciprocating. Rory’s narcissism and abso-
lute sense of entitlement comprise our central transference–coun-
tertransference theme, yet I have been reluctant to address it in the
extratransference, much less in the transference. The issue of forget-
ting or remembering details of patients’ lives merges at this juncture
with a theme to be discussed next—analysts’ inclination to avoid
uncomfortable transference themes (Gill, 1982; Goldstein, n.d.). This
latter factor is yet another way that analysts may maintain a mutu-
ally constructed equilibrium and fail to make the effort to promote
potentially productive discomfort.
Whereas I am quick to challenge and confront Murray about
almost anything (when I am not withdrawn from him), I am very
careful with Rory. Not only am I on my best behavior with regard to
an almost photographic memory about his life and life history, but
also I am never inattentive even when he obsesses endlessly about
which job offer to consider. Rory is often late for sessions and in pay-
ing his bills, and on a few occasions he has forgotten to come alto-
gether. He is very well bred and is always apologetic, though he has
little awareness of his degree of self-centeredness. His looks, charm,
and considerable intelligence have always given him much latitude
with others, and I find myself reluctant to address his palpable nar-
cissism in the transference. In contrast with Murray, I feel lucky to
have him as a patient, and I, along with everyone else he knows, offer
him my royal treatment. To the extent that I recognize a highly sig-
nificant transference–countertransference enactment and do not
address it, of course he actually receives very poor treatment from
me. Rory is comfortable with being special, and even though I am
not comfortable with my role in this mutual configuration, I avoid
the greater discomfort of raising his ire and his disapproval. Rory
reports that he has a short fuse, and is quick to walk away from situ-
ations that get what he calls “too sticky.” I know what I must do in
this situation, and I trust that I will be more courageous at some near
point, and risk losing him.
I wish to highlight that it is quite common for analysts to with-
draw in this way. Though this is a very different sort of withdrawal
than retreat into boredom, or forgetfulness, it is also similar. Con-
scious avoidance of a palpable and key transference theme (Aron,
1991, 1996; Friedman, 1988; Gabbard, 1995, 1996; Gill, 1982, 1983;

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 16 Coasting in the Countertransference

Greenberg, 1995; Hirsch, 1996, 1998a; Hoffman, 1983; Jacobs, 1986,

1991; Mitchell, 1988; Renik, 1993) reflects being less than pres-
ent in a social context, and suggests an analyst’s preference for the
maintenance of mutual equilibrium and minimal anxiety. Freud
(1912/2000) long ago observed that transference is both the heart
of analysis and the hardest part of analysis. Gill (1982, 1983, 1984,
1994) supported analysis of transference as the sine qua non of the
process, while noting that examination of transference is commonly
avoided by many or most analysts who adhere to this principle in
theory (see also Goldstein, n.d.; Hirsch, 1987; Hoffman, 1983, 1987;
Stern, 1987, 1997). As reflected in my work with Rory, transference
is often consciously avoided when it creates anxiety in the analyst.
Addressing transference themes in the context of extratransference
content shifts the focus to a you–me, here-and-now engagement, a
level of interaction far more intense than most other analytic data
or content. The intimacy involved in dealing with immediate inter-
personal experience, regardless of the feelings involved, is in and of
itself potentially difficult to endure with some patients more than
others, and/or with multiple patients per day. As well, different
analysts are more or less comfortable with different affective states,
and it is quite common for analysts to consciously avoid some and
encourage others. Among the feeling states commonly avoided in
the transference are disrespect, disappointment, disinterest, anger,
sexual interest or disinterest, and dependency (often reflected and
enacted in overly long analyses). In my work with Rory, I fear his
disrespect, and I fear direct confrontation with his disinterest. For
Rory, being angry usually means walking away—there are plenty of
others who want him. In listening to his extratransference content
and not taking him up on his narcissistic entitlements and his for-
getfulness, I am consciously retreating from him and depriving him
of proper psychoanalysis. I suggest here, with Gill (1982, 1983, 1994),
that analysts generally are comfortable (though often bored) listen-
ing to excessive extratransference reporting, in which patients may
express affect about parents, lovers, colleagues, and so on. When we
are relatively at ease with the affects expressed, we are more likely to
introduce transference implications and/or parallels. As reflected in
my work with Rory, analysts are often quite conscious of transfer-
ential themes they are not addressing, although they often rational-
ize this by claiming that the patient is not ready to hear something
(Coen, 2002; Fromm, 1964; Hirsch, 1987, 1998a; Mitchell, 1988;

RT20608.indb 16 1/10/08 11:06:24 AM

 Coasting in the Countertransference 17

Searles, 1979; Singer, 1965b, 1968, 1977; Thompson, 1950; Wolstein,

1954, 1959). Though I believe that addressing uncomfortable trans-
ference themes often raises anxiety in patients, this often evokes even
greater anxiety in analysts. My most frequent intervention, when I
supervise others, is to point out reluctances to address transferences.
It is relatively easy and anxiety-free, if sometimes tedious, to listen to
patients’ reports of their extratransference interactions, though the
power of the analytic process, and the part of the work that is much
harder for analysts, lies in making use of the ways in which what the
patient says and feels shapes the experience and interaction of ana-
lyst and patient. I always encourage supervisees to allow themselves
to become uncomfortable and to deconstruct mutual equilibrium
(Levenson, 1972, 1983, 1988, 1991), whereas I, in full consciousness,
may choose a path of self-interest and self-preservation with Rory,
and with all too many others with whom I am anxious. Analysis of
transference is usually in direct opposition to coasting in the coun-
tertransference, and forcing oneself to use countertransference expe-
rience to address destabilizing mutual patterning is, I believe, the
best analytic hedge against a comfortable status quo. Excessive focus
on extratransference material reflects a very common lapse, one
that is invariably fueled by avoidance of anxiety related to expected
transference affect.

The Structure of the Analytic Setting

Our psychoanalytic literature, with some exceptions (e.g., Abend,

1982; Basescu, 1977; Blechner, 1993, 2005a, 2005b; Boulanger, 2007;
Buechler, 2004; Cole, 2002; Crastnopol, 1999, 2001; Drescher, 2002;
Frawley-O’Dea & Goldner, 2007; Frommer, 1994, 2006; Gartner,
1999; B. Gerson, 1996; Goldman, 1993; Hoffman, 2004; Hopkins,
1998, 2006; Kantrowitz, 1992, 1993; Lasky, 1993; Leary, 1997; Nach-
mani, n.d.; Newman, 2006; Pizer, 1997; Richman, 2002, 2006; Singer,
1971, 1977; White, 2002), has not attended to the myriad of personal
and professional variables that impact the way analysts work with
patients during any given hour or day, or over extended periods of
time. Prominent among these unaddressed professional variables
is the way analysts structure their working day. The personal and
professional are inseparable. For example, if one is worried about
personal health issues or a breakup of a love relationship, does this

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 18 Coasting in the Countertransference

lead to throwing oneself into work, or being unable to concentrate

on work? In either case, if there are preoccupying factors in an ana-
lyst’s personal life, does this lead to being intensely consumed with
patients as a way of casting worry aside, or to considerable distrac-
tion from patients?
Though most professionals are aware of this and would not deny
it, I believe it is fair to say that self-interest is the first consideration
in choosing the length of sessions, which hours to hold sessions, how
many hours to work each day or week, the spacing between analytic
sessions, and what other professional activities compete with com-
mitment to one’s patients. If patients’ interest was analysts’ primary
concern, we would conduct longer rather than shorter sessions, work
during hours most convenient to patients, work only a modest num-
ber of hours each week in order to maintain optimal involvement
with each patient, space our sessions sufficiently far apart so as to
be able to reflect on each patient hour and prepare for the next, and
orchestrate our workday and schedule in a manner that maximizes
what physicians like to refer to as patient care. Though I do not think
of psychoanalysis or psychotherapy as at all part of a medical model,
and the term care in this context has always struck me as cloying
and insincere, I do think a concept of optimal patient involvement is
relevant for analysts to reflect upon.
I will rather quickly refer to the matter of length of sessions and
the time of day they are scheduled—I think that there is only a little
bit to say about this. Analytic sessions used to be 50 minutes, with a
10-minute break built in, in order to add up to a legitimate “hour.”
Currently for me and most colleagues, the “hour” lasts 45 minutes,
usually without a break scheduled between any given sessions. One
thing that happened to the 50-minute hour was that the break in
between disappeared, and sessions were commonly scheduled in suc-
cession. Given this purely economic-based practicality, 50 minutes
became an odd and arbitrary number, and scheduling times emerged
at awkward and difficult-to-remember times (e.g., 2:50 p.m.). Thus,
with the loss of the between-session break, the more sensible num-
ber of minutes to be with patients was rounded down to 45 minutes,
which is easier to keep track of. It could have been rounded up to 60
minutes, a true “hour,” and even easier to remember. Though I know
a number of analysts who still meet for the traditional 50 minutes,
I know of no one who holds full-hour sessions, and hardly anyone
who tries to schedule a 10- or a 15-minute break between sessions. I

RT20608.indb 18 1/10/08 11:06:24 AM

 Coasting in the Countertransference 19

am not here challenging the importance of maintaining boundaries

and structure with patients—of choosing a set amount of time and
working strictly within this. I do think, however, that it is impossible
to avoid the conclusion that seeing patients back-to-back, and reduc-
ing analytic time by 5 minutes, works strictly for analysts’ benefit in
priority to patient interest. Who would argue that for the same fee,
50 minutes would not be more beneficial to patients, or that round-
ing up to 60 minutes would not have been more of a patient-oriented
choice for our analytic culture to have adopted?
The time of the day analysts choose to work is a complex vari-
able, because it combines analysts’ preference with the question of
when patients are available, as well as how busy any given analyst
may be. There is little to say about this except that it is usually ruled
by the capitalist law of supply and demand. Those analysts who are
in sufficient demand can work whatever hours they choose, and need
not take into account what is convenient for patients. Most patients
with full-time jobs prefer to come either before or after work hours,
though analysts who are in great demand often prefer not to work
during the evening. Analysts who are more “accommodating,” for
example to patients’ wishes for evening hours, usually do so because
their preferred daytime hours are not sufficiently filled up. In order to
earn a reasonable livelihood, most analysts feel they have no choice
but to work at times they would prefer to be at leisure. Indeed, much
analytic work is conducted in the evening, a time of day when one’s
concentration may be less than optimal and one’s wish to be working
at low ebb. I recall many years ago a colleague who was in analytic
training, which required him to be in analysis four times per week
with one of a number of training analysts, all of whom practiced in
Manhattan. My colleague lived in Manhattan but worked in a nearby
suburb, and commuted back and forth from his place of work for each
session, in the middle of the day. I remember thinking he was either
crazy or masochistic, and that this senior analyst must be an absolute
monster to not even see him once each week in the early morning or
in the evening, when my colleague was already in Manhattan. Now,
in my own more senior status, I think I would do my best to move
such a patient into an early morning or late afternoon hour, or 2:00
or 3:00 p.m. if they became available. But maybe I would not, and in
that case I would be as selfish as this sadistic analyst of yore. My col-
league was an accommodating (masochistic?) man, and he was will-
ing to take analytic hours totally convenient to his analyst. Am I sure

RT20608.indb 19 1/10/08 11:06:24 AM

 20 Coasting in the Countertransference

I would give up a harder-to-fill, middle-of-the-day hour and transfer

him to a more precious time, given his willingness to come at my
behest? What if I did this and someone interesting came along who
claimed he could come only early or late in my day, and I now had no
such available time? In such an instance, I would probably have been
the masochist. If this new patient were Rory, would I do everything
possible to accommodate him—perhaps start my day earlier, or end
later? I know that I would more likely do this for Rory than for Mur-
ray. In any of these situations, would I use the scheduling issue to
deepen the analysis? Would I address with my masochistic colleague
(were he my patient), or with Murray, his pathological compliance
and his passivity, thereby placing my comfortable schedule in jeop-
ardy? Would I address in any way with Rory how desirable he was to
me, and how much I accommodate him? In these situations I specu-
late about, I think that many analysts would be likely to continue
engaging in ways that are both practically and emotionally comfort-
able, choosing consciously not to address themes that would be too
disruptive to the respective psyches and/or selfish conveniences of
perhaps either coparticipant, and to the enactments that evolve from
these configurations.
In the realm of the structure of the analytic setting, perhaps the
purest illustration of analysts’ self-interest can be seen in the choice
of how many patients (and/or supervisees) are seen on any given day,
and how these sessions are spaced. Given the choice, for economic
purposes I believe most analysts will see as many people as possible,
short of mental exhaustion. If referrals are plentiful, it is likely that
many of these sessions will be conducted back-to-back, perhaps in
clusters of 3, 4, 5, or more hours in succession. Speaking personally,
when I have the choice my ideal day consists of seeing 11 people,
starting at 7:15 a.m. and ending at 6:30 p.m., recently with a one-
half day on Friday. There are days when I will see 12 individuals,
sometimes even 13, though I prefer not to do this. Again, when I can
choose, I will see individuals in clusters of three to a maximum of
six sessions with no break (I prefer no more than four consecutive
sessions), though I have seen as many as eight people in succession.
I am taking the liberty of assuming that, with regard to scheduling,
most analysts place economic concerns in higher priority to patient

 This is not simply an assumption, for I have both observed and spoken with many
colleagues about these matters.

RT20608.indb 20 1/10/08 11:06:24 AM

 Coasting in the Countertransference 21

concerns. That is, as a group we are quite conscious that seeing fewer
patients, and not seeing them back-to-back, generally allows us to
devote more affective and cognitive energy to each individual. There
is no benefit to our patients to be one of many, or to walk in and
sit or lie down in a warm chair or couch just vacated by a “sibling.”
Of course, this issue is ripe for analytic exploration and should be
used to this advantage, but analysts’ motivation is clearly to maxi-
mize income. Though I have developed the ability over the years of
quickly shifting attention from one person to another, and of keeping
in mind who each of my patients is, can there be any doubt that my
concentration would be more acute if I saw fewer people and took a
break between each one? If I had 10 or 15 minutes between patients,
I could look back to the last session to refresh myself about an impor-
tant dream, or I could look at my notes and try to get straight some
details about siblings or grandparents. A near ideal commitment
and passion to patients cannot exist under the conditions I describe
as my own, and those of virtually every colleague I know who has
the same opportunity or luxury.
The impact of analysts’ busy schedules and selfish use of time will
invariably affect interaction with different patients in different ways.
Rory will get my attention no matter how busy I am and regardless of
when in the day or in a sequence of patients I see him. I will remem-
ber his siblings and his recent dreams without checking notes. When
I am tired or in the midst of a demanding day, Murray’s interests are
not well served by my relative inattentiveness. Murray is comfortable
in his schizoid isolation, and will allow me to relax, to be less intent
on his every word or gesture—actually, even to ignore his nonverbal
and his verbal communications. When I see patients back-to-back,
or if I see Murray at a time of day when I seem most sleepy (early
afternoons, around 1:30–2:30, just before my lunch/gym break of
2 hours), I will often take a respite from listening and escape into
daydreams, reverie, and the like. When a patient who asks for little
follows someone who is demanding, or where the former session has
been particularly affectively intense, the second patient is likely to be
used, at least to some degree, as a vacation—a respite. I now schedule
Murray early in my workday, when I am most alert, and his analysis
has benefited from this timing.
However, I do see Jack three times per week in the early after-
noon, and this is far from ideal for him. Jack is not employed, lives
off of a trust fund, and can come at any time of the day. He is very

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 22 Coasting in the Countertransference

dependent on me, for I am one of the few people who populate his
life. I am his primary human contact, and if I permit this, I will be
able to see him interminably and use him as a financial annuity.
Jack is most ambivalent about restarting his career ever since he lost
his high-tech job during the recession. Similarly, he refuses to risk
loss of any kind in his personal life, and allows no sexual or personal
intimates. His personal contacts are restricted to the bar where he
hangs out each night (reminding me of the television series Cheers),
and the musicians he sometimes jams with. He spends much time
with pornography, and is quite used to taking care of himself and
living a life of solitude. One might think that Jack is psychotic, or
near this, by the way he lives, but I know that he is not. He is very
lucid and clear thinking and articulate, and is by now conscious of
many of his motives. Jack is clear that he wants to play it safe in life,
and he sees the historical antecedents that have brought him there.
He also sees that he rejects anyone who comes too near to him, doing
to them what his caretakers did with him. Jack has let me into his
life and does not want to lose me. He will come to see me whenever
I wish, for as long as I allow him. Where I place him in my daily
schedule takes advantage of his dependence on me, and his compli-
ance toward me. If I am fatigued, or if I had a trying session prior to
his, he will allow me to coast, to listen to him with one-half an ear.
He teases me when I forget things, but his anger does not intimidate
me, and there is no threat of losing him. I do, of course, address his
dependence and his wish to be with me forever. However, at least
one of his sessions should be at a time of the day when my alertness
is optimal, and I have not facilitated this, nor have I addressed this
element of his compliant dependency with him. I reserve my early
morning times for those patients who cannot come during their
workday, and I do not risk Jack demanding that I give this up for his
benefit. It might benefit both patients if I attempted to trade Jack’s
time slot with Rory’s. However, at the point of this writing my self-
interest and my mutual equilibrium with each of these patients stand
in place.
Analysts’ self-interest and the practice of less than optimal ana-
lytic treatment can also be seen in the way patients’ lateness and/or

 I will address this issue in more detail in two ensuing chapters. I will at this point
only note that long analyses are very often driven by analysts’ economic needs
(Aron & Hirsch, 1992; Renik, 2006).

RT20608.indb 22 1/10/08 11:06:25 AM

 Coasting in the Countertransference 23

absence may be handled. It goes without saying that both lateness

and absence invariably reflect transference feelings of some sort, and
always should be examined, with an eye to minimize this form of act-
ing out a particular affective expression. However, in the context of a
busy schedule, especially when seeing patients in succession, I some-
times find myself wishing that my next patient will either be late or
not show up at all. Because analysts are not penalized economically
by lateness or by last-minute cancellations, there, indeed, is some-
thing to be desired about being paid for taking a break and relaxing
in the midst of a demanding workday. It is difficult to avoid wishing
for free time, even though lateness and absence might reflect some
problem in the analysis. Given this selfish desire, it is quite likely that
we sometimes communicate encouragement to our patients who are
anyway inclined toward lateness or absence. The most likely way to
encourage patients in this way is to avoid diligent exploration of each
late minute and absence. When analysts too readily accept excuses
that are, on the surface, quite reasonable, this is likely to convey to
patients that lateness or absence represents a comfortable state for
both parties, albeit perhaps for very different reasons. Although the
patient, for example, may be characterologically conflicted about
engaging with emotional intensity, the analyst may be conflicted
more situationally, based on the analyst’s heavily loaded schedule. Of
course, it is quite possible that either the analyst or the late or absent
patient is conflicted about consistent and intimate relatedness.
Terence drives from the suburbs to see me in Manhattan at 9:30
a.m. The traffic is awful and not entirely predictable. It is clear that
to make this trip is effortful for him, and that it reflects a strong
commitment to analytic work. He is not someone who finds such
emotional commitments easy, and he tends to live more in his head
than in a world of emotional mutuality. I find him quite interesting
to be with, yet I am often relieved if he is 5 to 10 minutes late, for he
is the fourth person I see in succession, and I can use a break by the
time he arrives. Terence always seems troubled and apologetic when
late, and he seems to believe that his tardiness is all traffic related. I,
of course, have challenged this, suggesting that leaving earlier would
provide a hedge against unpredictable traffic, and that his lateness
has personal more than practical meaning. He groans that he knows
this, but already wakes up so early to see me. I let Terence off rela-
tively lightly, and I do not press the issue for meaning nearly as much
as I could. I know that there must be a subtle communication that

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 24 Coasting in the Countertransference

this equilibrium suits both of us, if not on a deep emotional level (for
me), then at least on a practical one.
Dorian is a banker, earns a great deal of money, and works very
long hours. He has always been a very high achiever and a thorough,
if not compulsive, worker. He has great emotional investment in his
career, and in the considerable stature this brings him. Dorian has
never been comfortable within the confines of intimate personal rela-
tionships, and he began analysis at his wife’s behest for this reason. I
have been pleasantly surprised at how well he has taken to analysis,
and the degree to which he has been willing to examine himself. He
appears fond of me and attached to me, though often he is called on
to address some important business deal with very little notice, and
he cancels far more sessions than most other patients. I have worked
with a number of individuals in his field, and I know that many such
absences are unavoidable. Dorian, however, has more than his share
of last-minute cancellations, and I often cannot discern what is nec-
essary and what is avoidable. He is unusually compulsive about his
work, and he is probably unusually prone, even for someone in his
field, to give work priority over other activities. We have discussed
this theme often and in great detail, and Dorian acknowledges how
much easier work is for him than the “personal stuff” we do. Besides,
he argues, the way he goes about his career has worked for him, and
he loves his success and the financial rewards and prestige it brings
to him and to his family. Despite how much we have focused on
this issue, and on the cancelled sessions that are so emblematic of
it, as with Terence I sometimes find myself anticipating with relief
Dorian’s last-minute call to tell me that he cannot get out of a meet-
ing. The reason for my relief is not that I find Dorian difficult to be
with. Actually, I feel quite the contrary. My relief is based on the free
time his cancellation affords me, again somewhere in the midst of a
number of successive sessions. My patient’s cancellations represent
crucial data about who he is as a person, yet my anticipation of these
cancellations must communicate to him conflicting messages. On
the one hand, I convey to him that I wish his intimate presence, yet
on the other, I tell him that I am all too comfortable with his emo-
tional disconnection. The latter state represents what has come to be
a comfortable equilibrium for both of us.

RT20608.indb 24 1/10/08 11:06:25 AM

 Coasting in the Countertransference 25

Summary

I have used examples from my own clinical work to illustrate some

fundamental ways that self-interest influences the quotidian ele-
ments of my engagement with patients. Some of the particular ways
that self-interest enters and impedes my work are unique to me, and
reflect my particular character structure. These factors will be more
dramatically illustrated in subsequent chapters. Other forms of the
pursuit of self-interest, like the way I structure my workday, seem less
idiosyncratic. Were these clinical illustrations simply confessionals,
it would be safe to say that the sole purpose of this volume would be
geared to some expiation of my crimes. Though I believe that I may be
more narcissistically engaged than many of my analytic colleagues,
I do believe that largely unspoken conscious pursuit of self-interest
exists in different ways, and to different degrees, for everyone who
practices this work. All of us analysts coast with our countertrans-
ference experience to some degree or another, and we do this in ways
that reflect who we are as unique individuals, the situational factors
that may be dominating our lives, and how these intersect with each
idiosyncratic patient we see. At this juncture I feel compelled to say,
albeit defensively, that though I am concerned that the interactions I
have delineated in this section (and will in subsequent chapters) may
reflect egregious behavior to some, if one were to secretly videotape a
large sample of practicing analysts, I believe the findings would sug-
gest that situations parallel to those I have described and illustrated
might be closer to the norm than the exception.

RT20608.indb 25 1/10/08 11:06:25 AM

RT20608.indb 26 1/10/08 11:06:25 AM
 2
The Influence of Situational
Factors, in Analysts’ Lives and
Analysts’ Preferred Relational
States, on Analytic Participation

It now seems only obvious that, in this analytic era characterized by

the relational turn, who the analyst is as a person will have a signifi-
cant impact on each unique patient. Though the concept of transfer-
ence still refers to the internal world of the patient that is brought into
each human interaction, it is now widely agreed that the person of the
analyst has an impact on how and when different elements of transfer-
ence are expressed (Crastnopol, 1999, 2001; Dimen, 2001; Gill, 1982,
1983, 1984; Hirsch, 1993, 1994; I. Hoffman, 1983, 1991; M. Hoffman,
2004; Kantrowitz, 1992, 1993; Maroda, 1981; Mitchell, 1988, 2000;
White, 2002). Most contemporary analysts will no longer speak of
transference in isolation from countertransference (Blechner, 1992;
Coen, 2002; Davies & Frawley, 1994; Friedman, 2006; Hirsch, 1995;
Jacobs, 2001; Wachtel, 1982), the analysts’ participation in what is
often called the transference-countertransference matrix (Mitchell,
1988, 1993, 1997). The concept of mutual enactment has taken cen-
ter stage in characterizing the analytic situation, taking into account
how transference experience is played out somewhat differently with
each unique analyst as coparticipant (Fiscalini, 2004; Guarton, 1999;
Wilner, 2000; Wolstein, 1977, 1983). Later in this chapter I will discuss
the potential impact of analysts’ personalities on analytic work, and
how analysts’ maintenance of stable personality features can obscure

 Levenson (1972, 1983), Sandler (1976), Jacobs (1986), Friedman (1988), Greenberg
(1991), McLaughlin (1991), Poland (1992), Renik (1993), Gabbard (1995), Aron
(1996, 2005), Hirsch (1993, 1996, 1998a), Bromberg (1998, 2006), Stern (2003,
2004), Black (2003), and Varga (2005).
27

RT20608.indb 27 1/10/08 11:06:26 AM

 28 Coasting in the Countertransference

the emergence of certain features of patients. In this section I hope

to highlight that analysts’ life circumstances also may have consid-
erable effects on what patients express or fail to express, and also
significantly color the quality of the interaction. Indeed, either situ-
ational or enduring aspects of analysts’ lives could be a prime source
in shaping the heart of the analytic relationship. These factors are
often either not considered or, if they are considered, not addressed
or explored in the context of the transference–countertransference
matrix. Consider, for example, the sexually deprived analyst who is
more than usually stimulated by his physically attractive patient; the
elderly analyst who wishes his young patient were sexually attracted
to him; the gay analyst who, especially in years past, feels that he
must hide his sexual orientation from patients and/or colleagues;
the lonely analyst who cherishes time spent with patients, for this
may represent the most intimate exchange in the analyst’s life; the
analyst who has young babies, and can barely keep his eyes open
during sessions; the analyst who is ill, and preoccupied with this; the
analyst who has a sparse practice and can ill afford to lose patients;
the analyst who is so booked up that a patient’s departure might be
welcomed; and the analyst who is so involved with and/or excited by
a given professional situation (e.g., writing an article or book; devel-
oping a conference presentation; or preparing for a new course, an
institutional appointment, a promotion, or an institutional setback)
that involvement with patients becomes of secondary importance.
As in every other patient–analyst dyad addressed to this point, fac-
tors like those just noted will play out differently with each unique
patient. For instance, the fatigued or the preoccupied analyst will be
more alert with some patients than with others—Rory may still get
near full attentiveness, whereas Hillary and Murray will facilitate
their analyst’s withdrawal into private concerns. Analysts’ self-inter-
est will prevail in either case, because the issue of Rory’s entitlement
and my wish to keep him as a patient may very well be enacted with-
out being analyzed, and Hillary’s and Murray’s schizoid retreats may
be reciprocated instead of being challenged.

 Singer (1971), Basescu (1977), Abend (1982), Prince (1985), Hirsch (1993), From-
mer (1994), Leary (1997), Crastnopol (2001), B. Gerson (1996), Pizer (1997),
Gartner (1999), Grand (2000), Dimen (2001, 2003), Cole (2002), Drescher (2002),
White (2002), Cohen (2003), Blechner (2005a, 2005b), D’Ercole and Drescher
(2004), Frank (2005), Newman (2006), Richman (2006), Boulanger (2007), Fraw-
ley-O’Dea and Goldner (2007), and Szymanski (n.d.).

RT20608.indb 28 1/10/08 11:06:26 AM

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