(1992).

Psychoanalytic Inquiry, 12(2):225-247

Comments on Transference and Countertransference in the
Initial Analytic Meeting
Thomas H. Ogden, M.D.
We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.
T.S. Eliot, “Little Gidding”
Psychoanalytic concepts and techniques, in order to retain their vitality,
must again and again be discovered by the analyst as if for the first time. The
analyst must allow himself to be freshly surprised by the ideas and
phenomena that he takes most for granted. For example, he must be able to
allow himself to be genuinely caught off guard by the pervasiveness of the
influence of the unconscious mind, by the power of the transference, and by
the intrasigence of resistance, and only retrospectively apply the familiar
names to these freshly rediscovered phenomena. If the analyst allows himself
perpetually to be the beginner that he is, it is sometimes possible to learn
about that which he thought he already knew. The present paper is a collection
of thoughts addressed to myself (and other novices) on
—————————————
Dr. Ogden is a member of the faculty of the San Francisco Psychoanalytic
Institute.
This article is an expanded version of a paper originally published in Dr.
Ogden's most recent book, The Primitive Edge of Experience (1989).

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the subject of the opening of the analytic drama with particular reference to
the transference and countertransference. I make no attempt to be exhaustive,
since the topic touches upon almost every aspect of psychoanalytic theory and
technique. My starting point for a discussion of the first analytic meeting is the
idea that there is no difference between the analytic process in the first
meeting and the analytic process in any other analytic meeting: the analyst in
the initial meeting is no more or less an analyst, the analysand is no more or
less an analysand, the analysis is no more or less an analysis than in any other
meeting.
Creating Analytic Significance
Everything the analyst does in the first face-to-face analytic session is
intended as an invitation to the patient to consider the meaning of his
experience. All that has been most obvious to the patient will no longer be
treated as self-evident; rather, the familiar is to be wondered about, to be
puzzled over, to be newly created in the analytic setting. The patient's thoughts
and feelings, his past and present, have new significance, and therefore the
patient himself takes on a form of significance he has never held before. There
is a particular form of significance generated in the analytic context that is
unique to that setting. For the analysand, the consulting room is a profoundly
quiet place as he realizes that he must find a voice with which to tell his story.
This voice is the sound of his thoughts, which he may never have heard
before. (The analysand may find he does not have a voice that feels like his
own. This discovery may then serve as the starting point of the analysis.)
The analyst speaks and refrains from speaking in a way that communicates
the fact that he accepts the patient as he is without judgment, and yet it is at the
same time understood by both patient and analyst that they are meeting
together for the purpose of psychological change. The analyst attempts to
understand why the patient is as he is and cannot change and yet implicitly
asks the

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patient to give up his illness sufficiently to make use of the analysis. For
example, the schizoid patient must enter into a relationship with the analyst in
order to overcome his terror of even the most minimal involvement with other
people; the obsessional patient in order to get help with his endless
ruminations must give up his ruminations sufficiently to enter into an analytic
dialogue; the hysterial patient must interrupt the drama that constitutes (and
substitutes for) his life long enough to become an observer in addition to
being an actor in it.
The analyst is the object of the patient's transference feelings even before
his first meeting. In addition to viewing the analyst as a person trained to
understand and (through some as yet unknown process) help the patient find
relief from psychic pain, the analyst is also experienced as the healing mother,
the childhood transitional object, the wished-for oedipal mother and father,
and so on. With these hopes comes fear of disappointment.
Just as the patient has a (fantasied) analyst before the first session, the
analyst also has a patient (more accurately, he has many patients) in his own
mind prior to the initial meeting. In other words, prior to meeting the patient,
the analyst has drawn upon such particulars as the sound of the patient's voice
on the telephone, the source of the referral, the analyst's relationships with his
current patients, as sources of conscious and unconscious feelings about the
patient that he will bring to the first analytic meeting. In addition, there is
regularly a feeling of suspense connected with the anticipation of the initial
interview. Both patient and analyst are about to enter into an interpersonal
drama for which many scripts are already written (the analyst's and the
patient's internal dramas), and yet if the work is to be productive, a drama
never before imagined by either will have to be created. Along with the sense
of excitement, there is also an edge of anxiety. To a large extent the danger
posed by the first meeting arises from the prospect of a fresh encounter with
one's own inner world and the internal world of another person. It is always
dangerous business to stir up the depths of the unconscious mind. This anxiety
is regularly misrecognized by therapists early in

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practice. It is treated as if it were a fear that the patient will leave treatment;
in fact the therapist is afraid that the patient will stay.
A patient recently described with unusual clarity a fragment of her train of
thought prior to the first meeting: “How much should I say in the beginning
about the things about which I am most afraid and ashamed? How should I
phrase it? I don't want him to think I am so crazy, so deceitful, so selfish, so
seductive that working with me will be experienced as so unpleasant that he
will soon find some excuse for getting rid of me. Is the humiliation of
revealing myself in this way worth it? Did I make a mistake in deciding to see
him? He was disappointing to me when I spoke to him on the phone. I wish he
were older, more like a grandfather. He sounded a little crazy: he didn't seem
to know his own address. His office is in a kind of decrepit neighborhood. I
wonder if he's having trouble in his practice.”
When a patient phones inquiring about working with me in therapy or
analysis, I suggest to the patient that we find a time to meet for a consultation.
I intentionally use the word consultation in order to make it clear that this
meeting will not necessarily be the beginning of ongoing work together
(despite the fact that I intend it to be an analytic experience regardless of what
the outcome of the meeting might be). I do this because I cannot know ahead
of time whether, after talking with the patient, I will feel that I can be of help
to him and will want to work with him. Among the multiplicity of factors that
go into making this determination is the question of whether I feel that I
generally like the patient and feel some concern for and interest in him.
It is important that the analyst attempt in part to organize his thinking
diagnostically. However, with a few exceptions (e.g., drug- or alcohol-
addicted patients, violently acting-out sociopaths, severely organically
damaged patients), I am generally open to working analytically with patients
suffering from a wide range of psychological disturbances (cf. Boyer &
Giovacchini, 1980; Ogden, 1982, 1986). However, it seems to me that one is
claiming too much if one claims to be able to work with any patient who is
interested in analysis. I believe we do a patient a disservice if we

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agree to work with someone when we are aware of not liking him. It is
sometimes said that the analyst ought to be able to analyze his negative
countertransference and therefore should be able to work with any patient
who is otherwise suitable for analytic work. In theory this may be true; in
practice, however, I believe that the analytic task is difficult enough without
attempting to build the analytic edifice upon a foundation of a powerful
negative countertransference (or an intense negative transference). In my
experience, this is so whether or not the analyst (or the patient) recognizes
these transferences to be irrational. This caveat has seemed to me equally
applicable to instances in which there are from the beginning very intense
erotic transferences or countertransferences.
On the other hand, when speaking with a patient, I do not refer to the initial
meetings as an “evaluation period” or “assessment phase” since these
designations seem to me to convey the idea that the patient is to be relatively
passive in this enterprise. Such terms would misrepresent my understanding
that the function of the first meeting centrally involves the initiation of the
analytic process. The nature of the interaction of the first meeting is not
simply that of one person evaluating another or even of two people evaluating
one another. Rather, it is in my mind an interaction in which two people
attempt to generate analytic significance, including an understanding of the
meanings of the decision-making process that is involved in the initial
meetings. It is my intention in the initial meeting to facilitate the creation of an
interaction that will constitute an analytic experience that will be of some
value to the patient in providing him with a sense of what it means to be in
analysis.
Despite the fact that transference anxiety is extremely high in the period
leading to the initial interview, I do not view it as the analyst's job to put the
patient at ease in the first meeting. On the contrary, I believe it is his task to
help the patient not miss an important opportunity to recognize and understand
something about the transference thoughts, feelings, and sensations with which
he has been struggling.

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Sustaining Psychological Strain in the Analytic Setting
As with all other meetings, the initial analytic hour begins in the waiting
room. The patient is addressed as Dr., Mr., or Ms. and the analyst introduces
himself in kind. The paradox inherent in this formal introduction is not lost to
the patient: the analytic relationship is one of the most formal and at the same
time one of the most intimate of human relationships. The foramlity reflects
respect for the analysand and for the analytic process. In addition, it is an
expression of the fact that the analyst is not pretending to be, nor does he
aspire to be, the analysand's friend. (We do not pay our friends to talk to us.)
It is clear from the outset that the intimacy of the analytic relationship will be
an intimacy in the context of formality.
Therapists early in their training often feel the impulse to “put the patient at
ease” or “to act human” as they walk with the patient from the waiting room to
the consulting room. For instance, a therapist attempting to ease the tension of
the walk to the consulting room said, “I hope you didn't have trouble finding a
parking space. Parking is awful around here.” To make such a comment is not
a kind thing to do in terms of the analytic process. In fact, from the
perspective being discussed here, this therapist has been rather unkind in
several ways. First, he has communicated to the patient his unconscious
feeling that the patient is an infant who has trouble making his way in a hostile
world and that the therapist feels guiltily responsible for not making the
patient's life less difficult. Such a comment immediately puts the patient into
the analyst's debt and puts pressure on him to return the “kindness,” i.e., to
help the analyst avoid feelings of discomfort. There is also a hint in the
therapist's comment that he is not confident that the therapy he will offer the
patient is worth the trouble to which the patient is going.
Further, this sort of comment is an act of theft: it robs the patient of the
opportunity to introduce himself to the analyst in a way he consciously and
unconsciously chooses. The patient has available to him an infinite number of
ways of beginning the

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analytic discourse. His choice of the way he will go about doing this will be
repeated by no other analysand. One must not deprive him of his opportunity
to write the opening lines of his own analytic drama by burdening him with
the analyst's unconscious contents before he even sets foot in the consulting
room. (There will be plenty of time for that later, as the analyst inevitably
becomes an unwitting actor in the patient's unconscious fantasies.)
Finally, a comment of the type being discussed misleads the patient about
the nature of the analytic experience. As analysts, we do not intend to relieve
anxiety (our own or the patient's) through tension-reducing activity,
reassurances, gift-giving, or the like. Since maintaining psychological strain is
not only something we demand of ourselves but is also part of what we ask of
the patient, it makes no sense to begin the analytic relationship with an effort
at dissipating psychological strain. Whether the incident is ever spoken of
again, the analysand unconsciously registers the fact that the analyst has
granted himself license to handle his own anxiety by means of
countertransference acting in.
The patient brings to the first interview many questions and worries
(usually unspoken) about what it means to be in analysis, what it means to be
an analyst, and what it means to be an analysand. The analyst's attempts at
answering these questions in the form of explanations of free association, the
use of the couch, frequency of meetings, differences between psychotherapy
and psychoanalysis, differences between “schools of psychoanalysis,” and so
on, are not only futile, they invariably limit the patient's opportunity to present
himself to the analyst in his own terms. As is illustrated by the following
clinical vignette, the analyst's most eloquent explanation of what it means to
be “in analysis” is to conduct himself as an analyst.
Mr. H, a 42-year-old television producer, explained in the initial session
that he had come to see me because he felt intensely anxious and had
“obsessional ideas” about dying, including fears of suffocating in his sleep
and of being trapped and killed during an earthquake. The patient was
preoccupied by the thought that his six-year-old daughter, who was mildly
hearing-impaired,

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would “not be able to make it in the world.” He said that he knew that each of
his fears was overblown, but this knowledge did not diminish the intensity of
his anxiety.
The patient said that he had been fearful from the time that he was a small
child. Mr. H's father, a college professor, was continually dissatisfied with
the patient and insisted on “helping him” with his homework each night. This
inevitably ended with the father's shrieking at the patient for his “incredible
stupidity.”
Mr. H told me that his success at work seemed unreal to him. He felt as if
he had to be continually preparing for the day when he would no longer be
able to function. As a result, he hoarded every penny he earned. He gave
several examples of feeling dangerously depleted when he spent money. I then
said that it seemed that he was suggesting that the idea of paying for analysis
would be frightening because it would mean giving up one of the few sources
of protection he felt he had. Mr. H smiled and said he had thought a great deal
about this and the prospect of paying for analysis felt to him like a blood-
letting in which there would be a race between his “cure” and his bleeding to
death.
When I met Mr. H in the waiting room for our second meeting, he was
perspiring and seemed to have been awaiting me like a man anxiously
awaiting some terribly important piece of news, perhaps a verdict.
Immediately upon entering my consulting room, he walked briskly across the
room and reached for the phone, saying, “I locked my keys in the car and so if
it's all right, I'd like to call my wife to ask her to meet me here with a spare
set of keys after our meeting.” I said I thought it must seem to him as if his life
depended on his making the phone call, but I thought he and I should talk about
what it was that was happening between us before attempting to undo it. He
sat down and said, “Actually, what just happened is kind of typical of me. I
had my lunch in the back seat of the car, and there was a sign in the parking
garage that said, ‘Leave keys in car.’ I felt uneasy about leaving my lunch in
an unlocked car. I had the thought that somebody might tamper with my lunch,
and so I didn't want to leave the car unlocked.”

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I said to Mr. H that without realizing it he seemed to have done both things:
he had locked his lunch in the car so it would not be tampered with and had
left his keys in the car as the sign had directed. He told me he had become
very panicky when he realized his keys were locked in his car and
immediately thought of calling his wife from my office. He said he felt greatly
relieved by this idea. I repeated his realization that he had thought of me as
well as his wife at that moment. He said that was so, but he had thought of me
earlier when he saw the sign, which somehow seemed to have been put there
by me.
Mr. H explained that the request to use my phone was also characteristic of
him. He is almost always afraid that people are angry at him and regularly
reassures himself that people do like him by asking small favors of them. For
example, he frequently borrows change or a pencil from colleagues at work,
or he asks directions to a place when he already knows perfectly well how to
get there.
He told me he was certain I already thought he was a real jerk. (I assumed
there was a wish as well as a fear underlying this feeling, but I did not
interrupt the patient at this point since he was in the midst of introducing me to
the cast of characters constituting his internal object world.) Mr. H went on to
tell me more about his parents. His father had died ten years ago, but had
lived his entire life as if he were at death's door. He had suffered from renal
disease originating in childhood and was preoccupied with the fear of death.
The patient said that he had been frightened that his father would die when he
was yelling at the patient. Mr. H told me that his father could at times be very
kind and that the patient had loved him despite the fact that he had been
frightened of him so much of the time.
I asked if the patient had expected that I would yell at him for locking his
keys in the car and for asking to use my phone. He said he thought he had had
that feeling in a diffuse sort of way, but had not quite known why he was
feeling so frightened while waiting in my waiting room. (It occurred to me
that the patient may have

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been attempting to call his wife in an effort to get her to protect him from
me[as his mother had protected him from his father] and to protect me from
him.)
In the course of the analytic work that followed, many layers of meaning of
this transference enactment (referred to by Mr. H as the “telephone caper”)
came to light, including the patient's wish to be treated as a helpless little boy,
thus defending himself against his feelings of being a powerfully destructive
person who had done great harm to his father and who would do harm to me.
A second aspect of this transference enactment involved the wish to provoke
me into acting in a manner similar to his father, wherein I would yell at him
for his stupidity. In part, he was afraid I would act in that way and was
attempting to reassure himself that I would not. Then too, he found sensual
pleasure in such intense scoldings. In addition, he felt relief in being punished
since this is what he unconsciously felt he deserved for the crime he imagined
he had committed in relation to his father (i.e., provoking him to the point that
he had made him sick and ultimately had killed him). Further, he felt that his
father demonstrated love for him in the father's intense, controlling
involvement. The patient unconsciously hoped to elicit from me this form of
love in the anticipated scolding. Over the course of the analysis, the
“telephone caper” served again and again as a symbol of the analytic process.
Cautionary Tales
In the initial interview I am listening from the outset for the patient's
“cautionary tales,” i.e., the patient's unconscious explanations of why he feels
the analysis is a dangerous undertaking and his reasons for feeling the analysis
is certain to fail.1 To say
—————————————
1 Ella Freeman Sharpe (1943) used the term cautionary tale to refer to
fantasies serving the purpose of instinctual impulse control by means of
unconscious self-warnings of bodily destruction. In this paper, I have used
the term to refer to a more circumscribed and differently conceptualized set
of fantasies: the patient's unconscious set of fantasies concerning the dangers
of entering into the analytic relationship (McKee, personal communication,
1969).

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this is to say nothing more than that I am listening for (and attempting to put
into words for myself and for the patient) the leading edge of transference
anxiety in the hour. Whatever the nature of the analysand's disturbances, his
anxieties will be given form in terms of the danger of entering into a
relationship with the analyst. The patient unconsciously holds a fierce
conviction (which he has no way of articulating) that his infantile and early
childhood experience has taught him about the specific ways in which each of
his object relationships will inevitably become painful, disappointing,
overstimulating, annihilating, unreliable, suffocating, overly sexualized, etc.
There is no reason for him to believe that the relationship into which he is
about to enter will be any different. In this belief the analysand is of course
both correct and incorrect. He is correct in the sense that, transferentially, his
internal object world will inevitably become a living intersubjective drama
on the analytic stage. He is incorrect to the extent that the analytic context will
not be identical to the original psychological-interpersonal context within
which his internal object world was created i.e., the context of infantile and
childhood fantasy and object relations.
Everything the analysand says (and does not say) in the first hours can be
heard in the light of an unconscious warning to the analyst concerning the
reasons why neither the analyst nor the patient should enter into this doomed
and dangerous relationship. It must be emphasized that the patient feels that
the analysis will endanger the analyst as well as himself and that it is in large
part in an effort to protect the analyst that the patient balks at entering the
relationship. The analyst, from this perspective, serves as the container for the
patient's fears about beginning this relationship as well as for the analysand's
hopes that internal change is possible and that pathological attachments to
internal objects can be altered without sacrificing the life of the patient. The
following account of an initial analytic meeting is an illustration of the way in
which the patient often unconsciously attempts to symbolize for himself and
for the analyst the dangers he anticipates.
Mr. J began his first meeting by describing his empty relationship

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with his wife and children, the boredom he felt at work, and the lack of joy he
felt in his life in general. He said he had been referred to me by his internist,
who thought analysis would be of benefit to him. Despite Mr. J's presentation
of his feelings of desolation, I suspected that there were pleasures in his life
that he felt he must keep secret both from himself and from me. I had the
fantasy that Mr. J was having an affair—perhaps with a woman, perhaps with
music, art, or some other “passionate interest,” perhaps with a memory of a
childhood romance. This fantasy was not the product of intuition, but a
response to something about the patient's presentation of himself. In
retrospect, it is easier to see that this had been communicated by his choice of
words, by the rhythm of his speech, by his gait, his facial expressions, etc. He
behaved like a man with a secret. I surmised (but did not say to Mr. J) that he
unconsciously seemed to feel that analysis would contain forms of pleasure
that he would have to keep well hidden, and I anticipated that as a result
analysis would have a rather arid feeling to it (both for him and for me) for
quite a long time.
The patient said he felt convinced that he needed treatment and he knew his
wife and children would benefit if he were to get help. Nonetheless, he felt
extremely guilty about spending money on analysis which could be spent in
buying things his whole family could enjoy. I said, after some time had
elapsed in the first hour, that the patient seemed to feel that to begin analysis
would be equivalent to having an affair. He told me how devoted he was to
his wife and that he had never considered the idea of really having an affair.
However, he said, it was strange that I had said what I had because earlier
that week for the first time he had heard himself making a comment to his
secretary that was sufficiently ambiguous to have been construed as a
proposition. She chose not to directly respond to the ambiguously proposed
affair. He said that he had felt quite disturbed by this episode and had left
work early for the first time in years.
In this instance, I elected to interpret an aspect of what I understood to be
the leading transference anxiety (i.e., the most accessible
unconscious/preconscious set of transference and resistance

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meanings). The internal drama the patient seemed to be bringing to the
analytic relationship was one in which there was an anticipation of passionate
attachment and intense secretiveness. It was within this area of experience
(the “affair”) that I suspected Mr. J was afraid that analysis would become
extremely painful and perhaps become impossible to continue. In the course
of the succeeding several years of analysis the patient was able to make sense
of these feelings in terms of a relationship that he had had with a nanny whom
he had loved deeply, a love he unconsciously felt he had to keep secret from
his mother. His feelings of anger and guilt, as well as fears of becoming
involved in similar impossible entanglements, had led to his developing a
character defense in which he remained rather detached in all sectors of his
life. The idea that he was “only going through the motions” served important
defensive functions in the initial stages of his analysis.
The Timing of Transference Interpretations
As a result of my interest in ideas deriving from the British psychoanalytic
dialogue, I have often been asked if it is true that Kleinians interpret the
transference from the very beginning of the analysis. The question is always a
puzzling one to me. It hardly seems surprising that one would attempt to talk
with the patient about what it is about this new relationship (the analytic
relationship) that is so frightening, exciting, disappointing, futile, etc.
Generally, the initial session does not feel complete to me unless the patient's
anxiety in the transference has in some way been addressed. One does not
have to be a Kleinian to talk with one's patient about one's current (and
always tentative) understanding of what it is that is disturbing to the analysand
about the initial meeting.2
—————————————
2 At the same time, clinical judgment must guide the analyst in every
therapeutic situation. There are many instances in which the analyst senses
that it is critical he not be too “clever” (Winnicott, 1969p. 86) or know too
much, and therefore chooses to refrain from offering even the most tentative
versions of what he thinks he understands (cf. Balint, 1968; Winnicott,
1969, 1971).

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The following is an illustration of a situation in which there was
countertransference resistance to discussing transference anxiety in the initial
meeting.
A 32-year-old man made a phone call to a therapist for the purpose of
setting up a consultation. He told her in the course of asking her for an
appointment that he felt in danger of getting into disputes that would end up in
his punching someone. Mr. N said that he is a large man, that he speaks in a
booming voice, and that people are often frightened by him even when he is
not angry. He said that, despite all this, he hoped the therapist would not be
afraid of him since he was not a dangerous person and had never attacked
anybody.
When Mr. N appeared for his initial meeting, the therapist was surprised to
find him a man of average build who spoke in a pressured but not a loud or
bullying manner. She learned that Mr. N was a successful owner of a retail
business. He was born to a psychotic mother and had been placed in a foster
home just before his first birthday. Mr. N had seen neither his mother nor his
father since that time. After a succession of five foster-home placements in a
five-year period, he was finally adopted by a couple with whom he lived until
he left at 18 to join the Army. In the course of his latency and adolescence, the
patient's adoptive parents became alcoholics.
The therapist (who had only recently completed her training) did not
discuss with the patient his implicit, ambivalent warning that she would be
well advised to have nothing to do with him. There seems to have been an
unconscious sense on the part of the therapist that talking to Mr. N about his
fear of his destructiveness would make him more dangerous to her. There was
also a denial of her own fear of the patient that left her unable to think about
his warning. (Other therapists might have refused even to meet with this
patient, thus engaging in a countertransference enactment of the patient's
experience of himself as a danger to both his internal and external objects.
The patient after all had already, from the perspective of his unconscious
psychic reality, caused his original mother to become psychotic, leading her
to abandon him,

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had been so unlovable and perhaps dangerous as to have caused five sets of
foster parents to refuse to keep him, and had driven his adoptive parents to
alcoholism.)
The patient came to his next four weekly meetings in an increasingly
agitated state. Several days after the fifth meeting, he phoned the therapist
saying that he had felt more and more anxious after each of his meeting with
her and that it had become unbearable. He had therefore decided to
discontinue therapy. The therapist suggested that Mr. N come to his next
meeting in order to talk about these feelings.
It was at this point that the therapist sought consultation on the case. I
suggested that the patient had indicated from the very outset that he was
terrified that his anger (particularly in the maternal transference) would
frighten and damage the therapist. The therapist's unconscious fear of the
patient had led her to suggest once-weekly meetings with Mr. N despite
indirect indications from him that he felt he needed and could afford more
intensive therapy. The therapist's unconscious decision to seek a safe distance
from the patient had confirmed the patient's belief that she would (with good
reason) find him dangerous and would eventually refuse to see him. It seemed
to me that Mr. N had telephoned the therapist in order to see whether she had
been injured in the previous meeting and that he had been temporarily
reassured by her asking him to come to his next meeting. I hypothesized that
Mr. N was in a rage at his (internal object) mother for being crazy and unable
to love him and for having abandoned him as well as terrified that it was his
anger that had driven his mother crazy and had led her to abandon him.
Mr. N began the meeting that followed the telephone call by asking the
therapist, “How are you?” as they walked from the waiting room to the
consulting room. Once in the consulting room, he said that his heart was
pounding. The therapist suggested that Mr. N was worried that he had scared
or perhaps hurt her in the previous meeting and that this had been a concern of
his from the very beginning. The patient calmed down considerably after this
interpretation. The therapist later in the meeting suggested

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that since the patient felt such intense anxiety in response to each meeting, it
might be useful to meet more frequently in order to discuss what it was that
was frightening him. To her surprise, Mr. N seemed receptive to this idea. In
a sense, the beginning of the analytic dialogue had been postponed for six or
seven meetings largely as a result of unanalyzed anxiety in the
countertransference which had led to an inability to think about or interpret
the patient's transference anxiety.
Analytic Space
Entry into the analytic experience (beginning in the initial interview)
involves the enlargement of the psychological space constituting the “matrix
of the mind” (Ogden, 1986) in such a way that this space more or less comes
to approximate the analytic space, i.e., the analytic space becomes the space
in which the patient thinks, feels, and lives. In a subtle way, the events making
up the patient's experience in relation to his internal and external objects, the
events making up his daily life, and his responses to these events come to be
important to him insofar as they contribute to the analytic experience.
Eventually, it is to a large degree the analytic space and not the analysand's
individual psychological space in which the unconscious internal drama is
experienced. The evolution of this process includes, but is by no means
limited to, what is usually referred to as the elaboration of the transference
neurosis and the transference psychosis.3
That which constitutes analytic space is individual to each analytic pair.
Just as each mother learns (often to her surprise) that the process of creating a
play space differs greatly with each
—————————————
3 The termination phase of an analysis is not simply a phase of resolution of
conflicted unconscious transference meanings. Equally important, it is a
period of the “contraction” of the analytic space such that the patient comes
to experience himself as constituting the space within which he lives and
within which the analytic process continues. If this does not occur, the
prospect of the end of the analysis is experienced as tantamount to the loss
of one's mind or the loss of the space in which one feels alive.

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of her children, the analyst must learn that the process of creating analytic
space is different with each analysand (Goldberg, 1989). In the same way
that each infant's unique character draws upon and brings to life specific
aspects of the mother's emotional potential, the analyst must allow himself to
be created/molded by his patient in reality as well as in fantasy. Since the
infant has a role in creating his mother, no two infants ever have the same
mother. Similarly, no two patients ever have the same analyst. The analyst
experiences himself and behaves in a subtly different manner in each analysis.
Moreover, this is not at all a static phenomenon: in the course of each analysis
the analyst undergoes psychological change, which in turn is reflected in the
way he conducts the analysis.
More seriously disturbed patients experience the analytic space as a
vacuum which threatens to suck out of them their mental contents (which are
concretely experienced as bodily parts or contents). One such patient began
the first meeting by barraging me with an uninterrupted series of obscenities.
Taken aback by the onslaught, I decided to allow the patient to have his say
and to observe the impact he was having on me. It was apparent that his
barrage was far more anxious than hostile. After about five minutes, I said to
him that I thought it was not easy for him to be here with me. He quieted down
as I said this. I then told him that I thought he had emptied his garbage into me
because he did not mind giving up a part of himself that he did not value. I
said that I guessed he had more important things inside of him that he felt he
needed to protect. Following this intervention, the patient was able to tell me
more about himself, albeit in a psychotic way. I in turn discussed with him the
little bit of what I thought I understood of what he was telling me. Almost all
of what I said was addressed to the patient's fears about being with me.
Anxious Questioning
Analysands often pose direct questions in the initial meeting. A few of
these I answer directly. For example, I will in a “matter-of-course”

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way (Freud, 1913p. 131) answer the patient's questions about my training or
my fee. Most questions, however, I do not answer, including questions about
whether I have a particular specialty, with which “school of psychoanalysis”
I am associated, whether I see more men than women in my practice, whether
I consider homosexuality to be an illness, etc. These sorts of questions I treat
as fairly undisguised statements of the patient's fantasies about the specific
ways in which I will fail to understand him due to my own psychological
difficulties, e.g., my fear of women or men, my fear of homosexuality or
heterosexuality, my need to dominate or submit to others, and so forth.
When a patient persistently asks questions after question, I often say to him
that it must feel too dangerous to wait to see what happens between us; that,
instead, the patient hopes he will be able to sample the future through the
answers to his questions, thereby short-circuiting the tension connected with
waiting.
Very often the analysand uses questions in an attempt to get the analyst to
fill the analytic space because the patient feels that his own internal contents
are shameful, dangerous, worthless, in need of protection from the analyst,
etc. or that there is nothing at all inside of him with which to occupy the
analytic space. Other patients may quickly fall silent, thus inviting the analyst
to fill the space with his (the analyst's) questions and therefore with the
analyst's psychological organization, chain of associations, curiosity, and the
like. Under such circumstances, I attempt to talk with the patient about the
aspect of the patient's anxiety that I think I understand. In so doing, I make it
clear that my understanding is tentative, and in all likelihood, quite inadequate
in many ways. I thus invite the patient to tell me which parts of what I have
said seem true to him and which parts seem off the mark.
Creating a History
The question often arises of whether one “takes a history” in the initial
meeting. The very form of the question seems to me to have

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significance. I attempt not to “take” a history from a patient (by means of a
series of questions), and instead make every effort to allow the patient to give
me his conscious and unconscious versions of his history in his own way.4
The patient has come to see the analyst for help with psychological pain, the
nature of which the patient is often unable to accurately name. He must be
afforded all the time and room he needs to tell the analyst, in whatever way he
has available to him, what he knows about himself. It is important that the
analyst not interfere with the patient's efforts by introducing an agenda of his
own, such as collecting historical data, making a treatment recommendation,
or laying out the “ground rules” of analysis (cf. Freud, 1913; see also,
Shapiro, 1984).
As the patient tells the analyst, however indirectly, about the nature of his
pain (and the ways he consciously and/or unconsciously expects this pain to
become exacerbated in the course of analysis), his past experience will be
articulated in two ways. First, to the extent that the patient tells the analyst
about his understanding of the origins of his difficulties, he will be giving the
analyst one form of historical data, i.e., what the patient consciously
conceives of as his past. Inevitably, there will be gaps, vaguenesses or
complete omissions of large sectors of the patient's life experience. For
example, a patient may omit any reference to a given family member, make no
mention of his sexual experience, not refer to any event occurring prior to the
current crisis or prior to his adolescence. Under such circumstances, when I
feel that the patient has told me what he wants to and what he is able to, I may
ask him if he has noticed his not mentioning, for example, anything about his
father. (This is essentially a process of addressing
—————————————
4 It is essential to keep in mind that a patient's history is not a static entity
that is gradually unearthed; rather it is an aspect of the patient's conscious
and unconscious conception of himself, which is in a continual state of
evolution and flux. In a sense, the patient's history is continually being
created and re-created in the course of the analysis. Moreover, it is by no
means to be assumed that the patient has a history (i.e., a sense of
historicity) at the beginning of analysis. In other words, we cannot take for
granted the idea that the patient has achieved a sense of continuity of self
over time such that his past feels as if it is connected to his experience of
himself in the present.

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the patient's relationship to his external and internal objects in terms of
resistance, i.e., in terms of the patient's conscious and unconscious object-
related anxiety.)
As with any comment addressing resistance, it is not the information
“behind” the resistance that is of central concern; the focus is on what it is that
the patient is afraid will happen if he tells the analyst about a given aspect of
his internal life and the ways the patient has of protecting himself against this
danger. Hence the act of “taking a history” (by means of direct inquiry) is a
form of overriding resistances and thereby losing a good deal of what is most
important to the analysis, for example, an understanding of who in the patient's
internal object world would be betrayed, injured, killed, lost, made jealous,
and so on, if the patient were to talk about his feelings about “the past”; or
what sort of loss of control over the patient's relationships to his internal
objects would be experienced in his giving up exclusive access to them.
The second form of personal history provided by the patient is data
conveyed in the form of the transference-countertransference experience. This
is the patient's “living past,” i.e., the set of object relations established in
infancy and early childhood which has come to constitute the structure of the
patient's mind, both as content and context of his psychological life. It is
therefore this past that is of central analytic interest.
Of course, the two forms of history under discussion, the consciously
symbolized past and the unconscious living past, are intimately intertwined.
As the patient's internal object world is given intersubjective life in the
transference-countertransference, both patient and analyst have an opportunity
to experience directly the forms of attachment, hostility, jealousy, envy, etc.
constituting the patient's internal object world. In the
transference-countertransference, the past and present converge as “old”
contents are brought to life in a new context, i.e., the context of the analytic
relationship.
It has been my experience that in the period surrounding (and including) the
initial analytic meeting, the patient is in a “deintegrated” (as opposed to “dis-
integrated”) state that involves

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unusual potential for psychological change. It is regularly the case that the
external circumstances of the patient's life are not significantly different from
what they had been six months, a year, or even several years earlier. (Of
course, there are many exceptions to this observation.) What is different at the
time the patient finally seeks analysis is the state of the patient's internal
world. The defensive structure that the individual has been relying on is
temporarily in a state of flux sufficient to allow him to unconsciously
experience himself as having the potential to live differently, i.e., to make
changes in his internal world so that he might come to experience himself and
conduct himself in the world differently.5 It seems to me a shame to squander
the unusual “ripeness” for psychological change associated with the patient's
state of de-integration in the initial analytic meeting by conducting the meeting
as a “history taking” session.
Concluding Comments
The ideas I have discussed in this paper are simply that—ideas. They are
not intended to be used as rules or guidelines, nor are they intended as a
statement of how the initial analytic meeting should be conducted. At the same
time, the thoughts discussed here are thoughts of a specific nature—they are
psychoanalytic thoughts. This represents one of the dialectics constituting
psychoanalytic technique: analytic technique is guided by a set of ideas that
are roughly recognizable as forming a method or group of methods, with a set
of principles that gives coherence to this
—————————————
5 This state of “de-integration” (Fordham, 1977) associated with the initial
analytic meeting might be compared with the experiential state of a married
couple during the last trimester of the woman's pregnancy. Not only is each
of the individuals comprising the couple in a period of de-integration of
his/her personal identity (as a man/woman, an adult/child, a son/daughter,
father/mother, husband/wife), but also the couple is in a state of
de-integration in preparation for the creation of a new set of relationships
(internal and external) that is larger and more complex than that which had
constituted the marriage to that point. In other words, they are consciously
and unconsciously attempting to make room in their internal and external
object worlds to become a family (cf. Brazelton, 1981).

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group of methods. From the first meeting, analytic practice occurs between the
poles of the predictable and the unpredictable, the disciplined and the
spontaneous, the methodical and the intuitive.
The initial face-to-face analytic meeting is viewed as the beginning of the
analytic process and not merely as a preparation for it. In the first meeting all
that was familiar to the patient is no longer treated as self-evident. The
analysand takes on a form of significance for himself that he has never held
before. The analyst attempts to convey to the patient something of what it
means to be in analysis, not by means of explanations of the analytic process,
but by conducting himself as an analyst. To this end, psychological strain is
not dissipated through reassurance, forms of acting in, suggestion, and so on.
All that the patient says (and does not say) in the initial meeting is understood
as an unconscious warning to the analyst (and to the patient) concerning the
reasons why the patient unconsciously feels that each of them would be well
advised not to enter into this doomed and dangerous relationship. The analyst
attempts to understand the patient's warnings in terms of transference anxiety
and resistance.
References
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Brazelton, T. B. (1981). On Becoming a Family: The Growth of Attachment.
New York: Delacorte/Seymour Lawrence. [Related→]
Fordham, M. (1977). Autism and the Self. London: Heinemann.
Freud, S. (1913). On beginning the treatment. S.E., 12. [→]
Goldberg, P. (1989). Actively seeking the holding environment. Contemp.
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approach. Int. R. Psycho-Anal., 11: 11-25. [→]
Sharpe, E. (1943). Cautionary tales. In Collected Papers on Psycho-
Analysis. London: Hogarth Press, 1950, pp. 170-180. [→]

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Winnicott, D. W. (1969). The use of an object and relating through cross
identifications. In Playing and Reality. New York: Basic Books, 1971,
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Winnicott, D. W. (1971). Playing: creative activity and the search for the self.
In Playing and Reality. New York: Basic Books, pp. 53-64. [→]

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Article Citation [Who Cited This?]
Ogden, T.H. (1992). Comments on Transference and Countertransference in
the Initial Analytic Meeting. Psychoanal. Inq., 12(2):225-247

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