PubMed · 13283154
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T HORA. 1956. Beyond countertransference.. https://doi.org/10.1176/appi.psychotherapy.1956.10.1.18
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Since Freud's time, psychoanalytically oriented therapists have been wary of accepting gifts from patients, and have also been reluctant to give them to patients. This article first provides a literal definition of the word "gift," and then defines it within the context of the therapeutic relationship. It then reviews the literature on gifts and presents clinical examples describing five categories of offerings from therapist to patient, experienced by the patient as gifts, namely: 1. the gift of a transitional object; 2. the gift of self-disclosure; 3. the gift of time; 4. the gift of physical touch; and 5. the gift of developmental presence. Examples of therapists' considering but not offering gifts to patients are discussed and viewed from the perspective of whether they are requested by the patient, whether they arise from within the therapist, or whether they are offered in a context of reciprocation. Guidelines for how and when the therapist could attempt such interventions most safely are suggested, placing particular emphasis on counter-transferences.
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In this paper, the author explores the phenomenon of not being able to dream (as opposed to not being able to remember one's dreams) from three different vantage points. First, from the point of view of psychoanalytic theory, he discusses Bion's idea that the work of dreaming creates the conscious and unconscious mind (and not the other way around). A person who cannot dream is unable to generate differentiable conscious and unconscious experience and, consequently, lives in a psychic state in which he is unable to differentiate waking from sleeping, dreaming from perceiving. The author then approaches the problem of the inability to dream from the perspective achieved by a literary work. He discusses a Borges fiction that creates, in a singularly artful way, the experience of not being able to dream. Finally, the author utilises the vantage point of a detailed account of a clinical experience to explore what it means not to be able to dream. He describes an initial state characterised by the patient's proliferation of unutilisable 'psychic noise' which, over a period of years, led to the analyst's experiencing 'reverie-deprivation' and brief periods of countertransference psychosis. Two analytic sessions are presented and discussed in which psychological work was done that contributed to an enhanced capacity on the part of both patient and analyst for genuine dreaming - both in sleep and in analytic reverie states.