How, then, to reconcile the ambition of creating a universal theory of psychical life, with the fact that every patient relates so differently to the analyst and therefore requires an individual treatment, as Ella Sharpe identifies? This is the ‘chiasmus of the clinic’ of which we spoke earlier: theory and praxis intersect one another even as they miss each other. The question is not only one of how Freud could satisfy his own ambitions, but is inseparable from the whole project of the psychological treatment of human distress: if the experience of clinical work confronts us with the fact that every patient relates to the physician so particularly during the work as to require a treatment unique to them, then what kind of theory can possibly furnish an effective cure for psychological pain and account for these variations?
The Freudian answer is, of course, through a theory of human suffering and the modes of its treatment built around the notion of transference. Transference, qua concept, is a universal; it is a universal inasmuch as it is said to relate to manifestations universally found in clinical work.2 ((A word of clarification is warranted here: according to Freud, universally found in clinical work with the so-called ‘transference-neuroses’, for instance obsessional neurosis and hysteria. In Freud’s view, only the psychoneuroses capable of transference production were amenable to psychoanalytic treatment – a view thereby debarring the ‘actual-neuroses’ and the psychoses from the couch. For instance, in the penultimate of his Introductory Lectures on Psycho-Analysis (S.E. 16: 497) from 1917, the lecture on ‘Transference’, Freud affirms the link between the ability to produce transference and to undertake psychoanalytic treatment.)) The solution as to why no two treatments can follow the same formula is, surely, the rather platitudinous one that each patient engenders a singular transference, given that the manner in which each patient stands with regards to their failure to coincide with themselves is unique. In order, then, to confront what Freud perceived as the non-correspondence between the universality of theory and the singularity of each case, Freud was led to introduce the notion of transference. However, if transference is clinically ubiquitous then it will be strictly specific to each clinical situation.
This is why it is no accident that one of Freud’s key meditations on transference, the Dora case, began life as a study intended to illustrate the universality of certain theoretical psychical functions (the dream work) and the clinical techniques for interpreting them, by recourse to the psychical singularity of a single patient, markedly departing from his previously favoured approach, exemplified in the dream and joke books, of mobilising a kaleidoscopic host of examples. As such, the Dora case study was already a putative attempt to reconcile the universalism of theory, with the singularity of the unique clinical picture of each patient. As Freud famously comments, he attributed his failure with Dora to being unable to ‘master’ the specificity of her transference in time: in other words, the treatment with Dora failed as Freud was unable to manage the chiasmus of the clinic, to integrate the universalism of theory and the singularity of clinical practice in a way that was non-egological. One way of thinking of Freud’s mistake with Dora, was that he tried to fashion her as the patient he believed she should be, based on his already formulated theories, rather than the patient she actually presented as.
No two patients in relation to any particular analyst will manifest exactly the same transference, as obviously no patient in relation to two different analysts will manifest the same transference. This is not to suggest that patients are solely responsible for the production of transference; clues given by the analyst, that are mostly unconscious (timbre of voice; gestures; timing and holding of silences; seating posture; consulting room décor) naturally have an effect on the character of the transference. However, as Freud argued apropos Dora, ‘psychoanalytic treatment does not create transferences, it merely brings them to light’ (S.E. 7: 117): i.e. the psychical material furnishing transference precedes beginning analysis. The analyst and their idiosyncrasies is merely a prop for the (re)emergence of already existing transference phenomenon whilst, of course, the inverse is equally true: each patient prompts a unique transference in the analyst, the material for which precedes work with the patient.
Of course, commonalities of transference exist; after all, one of the key formulations of transference for Freud is the (re)finding by the patient of their infantile loves in relation to the figure of the analyst. However, no two patients will have the same infantile sexual history, and so by definition cannot produce identical transference. Furthermore every analyst, not just the iconic analysts with their star patients, who we encountered before, will inevitably bring their unique ‘style’ to bear across the spectrum of patients they work with thereby, undoubtedly, producing similarities of transference phenomenon in their patients. The most obvious realm in which this manifests itself is how patients frequently follow and ape their analyst’s intellectual and theoretical interests, reporting archetype strewn dreams to their Jungian analyst or bringing examples of their destructive envy to their Kleinian analyst.