Ten years later, when he came to publish his account of Dora’s treatment, Freud would sharpen his definition of transference, specifying it more precisely as an attempt to bridge egological gaps in understanding and perception with ‘new editions or facsimiles of the impulses and fantasies which are aroused and made conscious during the progress of the analysis’, which ‘replace some earlier person [i.e., for Freud, a constitutive individual from the patient’s psychosexual history] by the person of the physician’ (S.E 7: 116). And, a decade later still, in his seminal clinical paper ‘Remembering, Repeating, and Working-Through’, Freud would literally place transference at the epicentre of psychoanalysis – the concept occupying discussions at the textual mid section of the paper, forming the point of contiguity with the other notions he is there concerned to explicate. Transference operates, therefore, as the keystone of Freudian psychoanalysis, holding its differentiated theoretical and practical elements together whilst simultaneously resolving and preserving the tensions between these elements: ‘We soon perceive [during clinical work] that the transference is itself only a piece of repetition, and that the repetition is a transference of the forgotten past not only on to the doctor but also on to all the other aspects of the current situation’ (S.E. 12: 151). 

By assuming centrality as the bridge between the clinical and theoretical domains of psychoanalysis transference emerges, in the process, as the organising principle of psychoanalysis, the principle in relation to which all other theoretical and therapeutic developments must, thenceforth, situate and define themselves. We claimed earlier that the notion of transference was what enabled Freud to reconcile, for psychoanalysis, the tension between the universal and the singular. As we have seen, Freud’s ambition was to produce a psychology with universal applicability; a psychology that could take its place alongside the natural sciences, offering a complete account of psychical functioning. This, of course, entails the presupposition of theory as universal. 

The problem with confronting a universal theory of human suffering, however, was that Freud was increasingly bedevilled with the clinical lesson that every patient presents as irrepressibly unique, despite certain key structural similarities underpinning, amongst other things, the nosology and aetiology of pathology. In medicine, each boil confronting the physician is doubtlessly differentiated; nevertheless, there will only be a discreet number of causes for its development, whilst the procedure of excision does not have to be reinvented anew each time, physiology remaining consistent enough to permit a standardised treatment. Psychoanalysis, Freud quickly discovered, could not hope for the convenience of a one-size-fits-all approach; there would be no lancing of psychological carbuncles on the Freudian couch – psychological symptomatology and structure being too labile, too mobile. As he complained in his case study of Dora, often a ‘patient’s condition shows no noticeable alteration even though considerable progress has been made with the analysis’, so that it is insufficient for a patient’s symptoms to be merely deciphered like a ‘text’. What also needs to happen is a reckoning with ‘the relations between patient and physician’, a branch of technique that is ‘by far the hardest part of the task’ and cannot be learned procedurally, as one might the technique of interpreting dreams (S.E. 7: 115–116). In relation to precisely these issues, Ella Sharpe writes concerning analytic treatment that: 

We have to remember that [psychoanalytic] technique, if good, has been orientated to the psychology of an individual. It will represent in all essentials the classical norm of Freudian technique; and yet it is the shades and nuances of application to a particular person [i.e. patient] that mark the work of skilled technician. These special orientations to one individual will not necessarily apply to any other. It is this capacity for these subtler adaptations that makes the difference between applying a dead and rigid set of rules and the mobile handling of a real person (1930: 251).