Transference is a core tenet of classical psychoanalytic theory and practice. In 1914, Freud went as far as to say that “every investigation which recognizes these two facts [of transference and resistance]… may call itself psychoanalysis, even if it leads to other results than my own” (Freud, 1914, p. 10). Considering Freud’s rather turbulent experiences when other analysts’ research did lead to results other than his own (e.g., Jung, Adler, Rank, Stekel, Ferenczi), his humble conviction regarding the importance of transference and his openness to different research outcomes on the matter becomes rather noteworthy.   

In this paper, I will examine selected elements of the development of the clinical concept of transference, paying particular attention to the genesis of the technique of transference interpretation from the postscript of Freud’s Fragment of an Analysis of a Case of Hysteria (1905). I will trace the progression of transference as an initially misunderstood and feared idea in the early days of the psychoanalytic project, examining its historical background and social context and how it developed into a foundational concept of psychotherapeutic practice today.

Historical and Social Context

Sigmund Freud and Josef Breuer first discovered the existence of transference in their work with women experiencing hysterical symptomology between 1880 and 1895. In their 1895 Studies on Hysteria, they wrote about these cases in which transference was viewed as among the ‘obstacles’ that impeded the patient’s work of remembering repressed material as a part of the cathartic ‘chimney sweeping’ method. The ‘obstacle’ of transference reached its apex with Breuer’s patient ‘Anna O’, who developed what later came to be known as a ‘transference neurosis,’ in which she experienced symptoms as though she was pregnant with Breuer’s child. The concept of transference was then taken to new depths by Freud in his Interpretation of Dreams (1900), in which he claimed, “the earliest reminiscences of childhood […] are replaced by transferences and dreams” (p. 29). In this text, he understood that the “interpretation of dreams is the royal road to a knowledge of the activities of the unconscious mind” (p. 608). But it wasn’t until over a decade later that he discovered that the interpretation of transference within the psychoanalytic dyad was an adjacent royal road.

Around the time that Freud published The Interpretation of Dreams in 1900, he saw an 18-year-old woman, whom he called Dora, in analysis—though this entire paper, Fragment of an Analysis of a Case of Hysteria, wasn’t published until 1905. In the 1905 postscript of this paper, Freud finally began to explain his developing understanding of how to make clinical use of transference through its interpretation.

While transference and resistance analysis were landmark scientific and medical discoveries, an essential critique of the technique of its interpretation in the early psychoanalytic setting lies in its emphasis on the intrapsychic world of the patient, which runs the risk of neglecting the social reality of women at the time. The emergence of the concept of transference must be understood against the backdrop of 19th-century European medical, social, and cultural attitudes. The diagnosis of hysteria in women mirrored a societal need to control and pathologize female behavior that deviated from prescribed norms. In addition, Freud, as a Jewish intellectual, navigated the constraints of anti-Semitism and the skepticism with which his ideas were often met. Despite these limitations, Freud’s introduction of transference was groundbreaking, challenging the notion that mental processes could be understood solely through biological or empirically observable phenomena.

Freud’s Clinical Understanding

In his clinical work with Dora between the years 1900 and 1901, with a technique informed by his initial metapsychology of the topographical theory of mind, Freud attempted to interpret to Dora directly the unconscious contents of her psyche. He tried to work with her symptom-by-symptom, at the time completely missing the therapeutic value of the transference itself. Freud's approach to interpreting Dora’s unconscious content is exemplified in his interpretation of her first dream: “The dream confirms,” Freud explains to Dora, “what I had already told you before you dreamt it—that you are summoning up your old love for your father in order to protect yourself against your love for Herr K. But what do all these efforts show? Not only are you afraid of Herr K., but you are still more afraid of yourself and of the temptation you feel to yield to him. In short, these efforts prove once more how deeply you love him” (p. 70). Freud interpreted Dora's behavior as rooted in her relationship with Herr K. and her father, viewing her affection as displaced. Freud’s formulation here foreshadows his later development of the theory of the Oedipus complex, emphasizing unconscious fantasy, projection, and psychical reality. His original method of interpreting Dora’s dream is an attempt to prove that her denied love for Herr K exists. This way of working is almost combative, which this paper’s later exploration of Freud’s potential countertransference reactions to Dora might explain.

In the article’s postscript, Freud defines transference as “new editions or facsimiles of the impulses and phantasies which are aroused and made conscious during the progress of the analysis; […] they replace some earlier person by the person of the physician” (p. 116). Freud began recognizing how patients would displace their unconscious feelings from significant figures in their past onto the analyst. For example, Freud noted, “’ Now,’ I ought to have said to her, ‘it is from Herr K. that you have made a transference on to me. Have you noticed anything that leads you to suspect me of evil intentions similar (whether openly or in some sublimated form) to Herr K.’s?” In this postscript, written around 1905, Freud recognized how Dora likely perceived him through her experience with Herr K. Yet; he did not fully utilize this recognition in his clinical technique by critically examining the personal feelings that the analysis evoked.

By the time of his paper The Dynamics of Transference in 1912, Freud’s conceptions of transference had been fully formulated. His certainty about this fundamental aspect of psychoanalytic theory and practice was a hard-won result of several metapsychological wrong-turns and clinical failures. A central question Freud asks in this paper is: “How does it come about that transference is so admirably suited to be a means of resistance?” (p. 104). By answering this question, he ponders why a positive transference would not be a therapeutic boon to the treatment, making a patient more receptive to the analyst’s suggestion or construction. Ultimately, he comes to the answer related to ambivalence, in which he discerns positive and negative transferences. He traces both positive and negative transferences back to the repression of their erotic origins in infantile amnesia. He states, “transference to the doctor is […] resistance to the treatment only in so far as it is a negative or a positive transference of repressed erotic impulses” (p. 104). The key for Freud in this paper is that transference becomes a resistance in treatment when it is used as a mechanism of repression via displacement of erotic impulses. Freud’s goal of analysis maintains that these erotic impulses are to be brought to consciousness in a way that has a radical impact on a person’s experience of self and others. The notion of ambivalence that Freud uses rests on the assumption that we feel primordial forms of love and hate towards the essential people in our lives. This free exchange between love and hate towards our objects is what frees a psyche from psychoneurotic libidinal fixation. He is essentially making a case for an integration of these ‘pairs of opposites’ when he states that, “In obsessional neurotics, an early separation of the ‘pairs of opposites’ seems to be characteristic of their instinctual life and to be one of their constitutional preconditions” (p. 107).

Laudably, Freud sought to analyze and interpret transference rather than to use its positive aspect to directly influence the patient to what would amount to hypnotic suggestion. He aimed to understand the transference dynamics and the unconscious meanings behind them rather than exploit them for suggestive purposes. This was because he felt that suggestion tended to mask symptoms rather than help patients understand their underlying psychic conflicts, which, for Freud, was the central aim of analysis.

Contemporary Clinical and Social Relevance

By the time Freud wrote The Dynamics of Transference in 1912, he had already understood the decisive role of transference neurosis in every psychoanalytic treatment. He called this the transference neurosis because it is a type of synthetic neurosis that is constructed within the analysis itself, where the infantile aspects of the neurotic symptoms that manifest in the patient’s outside life can then be examined in vitro in the analytic here-and-now of the relational encounter with another person. While Freud acknowledges the fantasized and real relationships between patient and analyst, he is not yet at the point of extrapolating on how the analytic encounter changes the analyst’s subjective experience of the therapeutic relationship and how this changes the patient. The mid-20th century psychoanalytic movement to study the analyst’s countertransference can be traced to this phenomenon, which Freud neglected. Later analysts, like Paula Heimann (1950) and Heinrich Racker (1953), came to understand that countertransference can be utilized in at least two critical ways that Freud had not overtly considered: (1) that countertransference may contain essential data about the nature of the patient’s relational unconscious; and (2) that it is the analyst’s ‘working through’ of his countertransference reactions that play a massive role in resolving impasses and resistances in analysis.

An inherent contradiction marks Freud’s concept of transference: on the one hand, it represents resistance to accessing repressed material, yet on the other, it serves as the medium for expressing unconscious wishes. In the two-person model of contemporary analysis, transference is understood as a relational phenomenon that arises within the unique interaction between patient and analyst rather than as an isolated construct in the patient’s psyche. The contemporary practice of the psychoanalytic method is one where the analyst’s feelings are considered clinical data. This is because the countertransference feelings that register within the therapist are felt to be, to some degree, reciprocally related to the transferential feelings coming from the patient towards the analyst. This means that if Freud were practicing in a more contemporary psychoanalytic manner, he might consider interrogating his feelings towards Dora. I believe that if this were to be done, we might discover much more aggressive feelings than erotic ones.

Freud’s negative countertransference is evident when Dora returns for treatment after fifteen months, and he notes, “One glance at her face, however, was enough to tell me that she was not in earnest over her request” (pp. 120-121). Why was a man who emphasized self-analysis so uncritical of his emotional reaction to Dora’s return? Perhaps the answer to his countertransferential feelings can be seen at the very end of the postscript when he says, “I do not know what kind of help she wanted from me, but I promised to forgive her for having deprived me of the satisfaction of affording her a far more radical cure for her troubles” (p. 122). We must note that this happened in 1902 when Freud was still trying to make a name for himself in medicine. He was very concerned with how the medical community would receive his new psychological science, and this anxiety manifested in many of the dreams that he interpreted throughout his self-analysis, as elaborated in The Interpretation of Dreams (1900). It is very doubtful that he was feeling confident in the course of his analysis of Dora, and he would surely have benefitted from a deeper interrogation of his countertransference feelings, not to neutralize them but perhaps as an earlier signal of an entry point into working through the negative transferential situation with Dora. While Freud knows he missed the negative transference interpretation in his analysis with Dora, he has no idea of the clinical utility of analyzing his negative countertransference towards his patient. His failure at this level later opened the field to consider transferential and countertransferential dynamics as valuable analysis tools.

An additional critique of the way that Freud handled the Dora case is that he denies the possibility of any real sexual trauma that may have occurred for Dora. When done in the persuasive or combative manner that Freud embodies in his analysis of Dora, transference interpretation can look like victim blaming.  This critique is because, from 1899 onward, Freud emphasized psychoanalytic knowledge solely on psychical reality. Though he sometimes acknowledges factors of social reality and psychological constitution—often in footnotes—the essence of his psychoanalysis project was based on drive theory, which views the mind as a place of unconscious ambivalent forces outside of our self-conceptions. This view increases our internal world's complexity while potentially trivializing a person’s social reality.

Critical Analysis

I subscribe to Freud’s essential notion that what makes a treatment psychoanalytic is its focus on transference and resistance. An emphasis on transference in therapeutic work separates psychoanalytic work from other types of therapy. While transference interpretations can be incredibly valuable to raising present-moment relational awareness (i.e., interpersonal and intrapsychic), I do not believe it is the only therapeutic or analytic action mechanism. Other types of interpretation facilitate therapeutic action and effect change in the psyche. For instance, Donald Meltzer (1973) coined the technique of ‘descriptive interpretation,’ which he claims can be used for more primitive levels of the mind in a manner that contains more preverbal emotional experience. The goal of a descriptive interpretation is not to unbind neurotic fixation through transference interpretation but, following Freud’s ideas laid out in his 1915 paper The Unconscious, to ‘bind’ the free energy of preoedipal-level anxieties by simply giving word-presentations to thing-presentations. 

Another example of contemporary use of the technique of transference interpretation is Ron Britton’s (1998) notion of ‘patient-centered interpretation.’ The classical psychoanalytic technique, and the one most used by Freud in Dora's case, is what Britton calls ‘analyst-centered interpretations.’ This is where the analyst interprets the unconscious dynamics of the patient from the analyst’s point of view. Britton's extension of technique is that of a ‘patient-centered’ interpretation, in which the analyst tries to describe the subjective movements of the patient’s experience of the analytic environment or of their own mind. 

In my clinical practice, transference is a foundational element. However, I do not use classical transference interpretation as the sole method of therapeutic action. As outlined above, many methods of interpretation or intervention, in general, can have a therapeutic effect, most of which aim to develop the ego strength that makes classical transference interpretation more tolerable and useable. There must be enough ego strength before a mind can use a transference interpretation for therapeutic effect. In my clinical practice, I find that much of my work is working with my patients in a way that allows them to become more curious and reflect on their own subjective experiences — both outside relationships and within the analytic setting itself. 

Contemporary psychoanalytic transference interpretation is entirely different from what Freud practiced. Clinically, I am often unaware of ‘making an interpretation’ when engaging in a therapeutic dialogue with a patient. I am trying to be with the patient. One of my critiques of Freud’s Dynamics of Transference (1912) is that he does not expound on the nature of the unconscious as it exists within the therapeutic relationship. This would have required him to acknowledge what Antonino Ferro later would come to call the ‘bi-personal field’ (1999) of the analytic situation. This is an intersubjective and relational approach, which was developed later in the 20th century. The basis of my critiques of Freud’s theory of transference and its interpretation is grounded on two premises: (1) the analytic setting is an intersubjective exploration, which influences (2) the method of interpreting the unconscious in analysis.

Freud’s development of the concept of transference—from its identification as an "obstacle" in treating hysteria to its elevation as a core aspect of psychoanalytic theory—reflects his enduring contribution to understanding the unconscious. Transference interpretation remains a powerful tool in psychoanalytic practice, offering a window into the patient's internal world and providing opportunities for therapeutic change. However, contemporary perspectives remind us that transference interpretation is not the only pathway to transformation. Approaches that emphasize containment, descriptive interpretation, and an understanding of countertransference offer essential additions to our therapeutic repertoire, ultimately expanding our capacity to engage with the complexities of the human mind.

References

Britton, R. (1998). Belief and imagination: Explorations in psychoanalysis. Routledge.    

Freud, S., & Breuer, J. (1895). Studies on hysteria (J. Strachey, Ed. & Trans.). In J. Strachey (Ed.), The Standard Edition of the Complete Psychological Works of Sigmund Freud (Vol. 2). Hogarth Press. (Original work published 1895)

Freud, S. (1900). The Interpretation of Dreams. In J. Strachey (Ed. & Trans.), The Standard Edition of the Complete Psychological Works of Sigmund Freud (Vol. 5, p. 608). London: Hogarth Press

Freud, S. (1905). Fragment of an analysis of a case of hysteria (Dora). SE VII (pp. 7-122).

Freud, S. (1912). The dynamics of transference. In J. Strachey (Ed. & Trans.), The Standard  Edition of the Complete Psychological Works of Sigmund Freud (Vol. 12, pp. 97-108). Hogarth Press.

Freud, S. (1914). On the history of the psycho-analytic movement. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 14, p16). Hogarth Press.

Freud, S. (1915). The unconscious. In J. Strachey (Ed. & Trans.), The Standard Edition of the Complete Psychological Works of Sigmund Freud (Vol. 14, pp. 159-215). Hogarth Press.

Heimann, P. (1950). On counter-transference. International Journal of Psycho-Analysis, 31, 81-84.

Meltzer, D. (1973). The psychoanalytic process. Heinemann.

Racker, H. (1953). The meanings and uses of countertransference. Psychoanalytic Quarterly, 22, 303-357.